JP’s Benzo Taper V1.2
[textarea name="variable_1" default="Today we discuss the safety and efficacy of chronic benzodiazepine use. Risk stratification completed. "] [select name="variable_1" value="Based upon assessment, we will begin our benzodiazpine taper at this time. |Based upon assessement, it is determined that we will not begin our benzodiazepine taper at this time. We will revisit at future visits and the below plan will be our tentative approach. | Based upon assessment, it is determined that we will not begin a benzodiazepine taper at this time due to risk of decompensation. Medications are providing over 30% improvment of symptoms. We have discussed alternative pharmacological and non-pharmacological therapies. There are no suspected aberrant drug-taking behaviors. Patient denies medication side effects. Medications are not interfering with ADLS and the patient denies negative consquences as a result of using controlled substances."] Target Date to Begin Taper: [date name="variable_1" default="04-11-2024"] 6 Month Benzodiazepine Taper Plan: Step 1 - 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 2 - Use a long-acting benzodiazepine for the taper Select a long acting benzodiazepine to use for the taper --> [select name="Q2" value="diazepam=10|clonazepam=1"] Equivalent dose is [calc memo="dose" value="score=((N1)/(Q1))*(Q2)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] Step 3 - Suggested taper schedule (Note: doses should be checked for safety and may need to be adjusted to accommodate formulary supplies and availability) Month 1: [calc memo="dose" value="score1=((score)*.75).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] qd - (25% decrease from the original dose) Month 2: [calc memo="dose" value="score4=((score)*.5).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] qd - (50% decrease from the original dose) Month 3: [calc memo="dose" value="score6=((score)*.25).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] qd - (75% decrease from the original dose) Month 4: continue current dose Month 5: [calc memo="dose" value="score7=((score)*.125).toFixed(1)"] milligrams of [var name="Q2" memo="tapering benzodiazepine"] qd - (87.5% decrease from the original dose) Week 14: Clinical decision to decrease quantity or continue current dosage. 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]
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