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]