Benzodiazepine Taper

Psychiatry
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14 Week Benzodiazepine Taper
Step 1 - Risk assessment checklist
[checklist name="Q0" value="Taking benzodiazepines daily for longer than one month=1|Older than 65 years (because of the risk of injury from falls and other cognitive adverse effects)=1|Taking multiple benzodiazepines=1|Taking benzodiazepines combined with prescribed opioids or amphetamines=1|Taking supratherapeutic dosages=1|Cognitive disorder=1|History of traumatic brain injury=1|current or history of substance use disorder, especially sedative-hypnotic or alcohol use disorder=1"]
Assessment --> [calc memo="count" value="score0=(Q0)"] identified risk factors

Step 2 - Current benzodiazepine use
[select name="Q1" value="lorazepam=2|alprazolam=1|temazepam=30|chlordiazepoxide=25|diazepam=10|clonazepam=1"] <-- Current benzodiazepine
[text name="N1"] <-- Total daily dose of [var name="Q1" memo="current benzodiazepine"]

Step 3 - Use a long-acting benzodiazepine for the taper
Select a long acting benzodiazepine to use for the taper --> [select name="Q2" value="chlordiazepoxide=25|diazepam=10|clonazepam=1"]
Equivalent dose is [calc memo="dose" value="score=((N1)/(Q1))*(Q2)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"]

Step 4 - Suggested taper schedule (Note: doses should be checked for safety and may need to be adjusted to accommodate formulary supplies and availability)

Week 1: [calc memo="dose" value="score1=((score)*.875).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] taken once daily - (12.5% decrease from the original dose)
Week 2: [calc memo="dose" value="score2=((score)*.75).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] taken once daily - (25% decrease from the original dose)
Week 3: [calc memo="dose" value="score3=((score)*.625).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] taken once daily - (37.5% decrease from the original dose)
Week 4: [calc memo="dose" value="score4=((score)*.5).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] taken once daily - (50% decrease from the original dose)
Week 5-8: continue current dose
Week 9: [calc memo="dose" value="score5=((score)*.375).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] taken once daily - (62.5% decrease from the original dose)
Week 10: continue current dose
Week 11: [calc memo="dose" value="score6=((score)*.25).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] taken once daily - (75% decrease from the original dose)
Week 12: continue current dose
Week 13: [calc memo="dose" value="score7=((score)*.125).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] taken once daily - (87.5% decrease from the original dose)
Week 14: continue current dose
Week 15: discontinue

[checkbox memo="hide/display references and links" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"]
references and links:
[link url="https://www.ncbi.nlm.nih.gov/pubmed/19062773" memo="#1"] Lader M, Tylee A, Donoghue J. Withdrawing benzodiazepines in primary care. CNS Drugs. 2009;23(1):19-34.
[link url="https://www.va.gov/painmanagement/docs/OSI_6_Toolkit_Taper_Benzodiazepines_Clinicians.pdf" memo="#2"] Effective Treatments for PTSD: Helping Patients Taper from Benzodiazepines. United States Veteran's Administration website Centers for Disease Control and Prevention website https://www.va.gov/painmanagement/docs/OSI_6_Toolkit_Taper_Benzodiazepines_Clinicians.pdf Updated 2013. Accessed December 24, 2017
[link url="https://www.aafp.org/afp/2017/1101/p606.html" memo="#3"] Ogbonna C, Lembke A. Curbside Consultation: Tapering Patients Off of Benzodiazepines Am Fam Physician. 2017 Nov 1;96(9):606-608.[/conditional]
14 Week Benzodiazepine Taper
Step 1 - Risk assessment checklist

Assessment --> countscore0=(Q0) identified risk factors

Step 2 - Current benzodiazepine use
<-- Current benzodiazepine
<-- Total daily dose of current benzodiazepine

Step 3 - Use a long-acting benzodiazepine for the taper
Select a long acting benzodiazepine to use for the taper -->
Equivalent dose is dosescore=((N1)/(Q1))*(Q2) milligrams of tapering benzodiazepine

Step 4 - Suggested taper schedule (Note: doses should be checked for safety and may need to be adjusted to accommodate formulary supplies and availability)

Week 1: dosescore1=((score)*.875).toFixed(1) milligrams of tapering benzodiazepine taken once daily - (12.5% decrease from the original dose)
Week 2: dosescore2=((score)*.75).toFixed(1) milligrams of tapering benzodiazepine taken once daily - (25% decrease from the original dose)
Week 3: dosescore3=((score)*.625).toFixed(1) milligrams of tapering benzodiazepine taken once daily - (37.5% decrease from the original dose)
Week 4: dosescore4=((score)*.5).toFixed(1) milligrams of tapering benzodiazepine taken once daily - (50% decrease from the original dose)
Week 5-8: continue current dose
Week 9: dosescore5=((score)*.375).toFixed(1) milligrams of tapering benzodiazepine taken once daily - (62.5% decrease from the original dose)
Week 10: continue current dose
Week 11: dosescore6=((score)*.25).toFixed(1) milligrams of tapering benzodiazepine taken once daily - (75% decrease from the original dose)
Week 12: continue current dose
Week 13: dosescore7=((score)*.125).toFixed(1) milligrams of tapering benzodiazepine taken once daily - (87.5% decrease from the original dose)
Week 14: continue current dose
Week 15: discontinue

hide/display references and links
Result - Copy and paste this output:

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