8
Recommendations
Partnering With Patients
4. Clinicians should develop the BZD tapering strategy in coordination
with patients and their care partners in a shared decision-making
process whenever possible (CC-S).
Level of Care Considerations
5. BZD tapering can typically be managed in outpatient settings.
However, clinicians should consider inpatient care for BZD tapering
when:
a. Patient presentation indicates an imminent risk for significant harm related to
continued use of the BZD medication (e.g., medication interaction, overdose,
accidents, falls, suicidality or other self-harm) that is unlikely to be rapidly
mitigated by the initial dose reduction of the BZD taper (CC-S);
b. Patient symptoms and/or co-occurring physical or mental health conditions are
anticipated to complicate BZD tapering in a way that cannot be safely managed
in an outpatient setting (CC-S);
c. The patient is experiencing or imminently anticipated to experience severe or
complicated BZD withdrawal (See Table 3) (CC-S).
Tapering Process
6. Clinicians should generally consider dose reductions of 5% to 10%
when determining the initial pace of the BZD taper. The pace of the
taper should typically not exceed 25% every 2 weeks (CC-S).
7. Clinicians can consider transitioning patients without
contraindications to a comparable dose of a longer-acting BZD
medication for the taper (CC-C).
8. Clinicians should tailor tapering strategies to each individual patient
and adjust the taper based on a patient's response (CC-S).
9. Clinicians should evaluate patients undergoing tapering for signs
and symptoms related to the BZD taper with each dose reduction
(CC-S).
Adjunctive Interventions
10. Clinicians should offer patients undergoing BZD tapering behavioral
interventions tailored to their underlying conditions (e.g., CBT, CBT-I)
or provide them with referrals to access these interventions (L-S).
11. Clinicians should first consider pausing or slowing the pace of the
BZD taper when patients experience symptoms that significantly
interfere with the taper (e.g., sleep difficulty, anxiety). However,
clinicians can also consider use of adjunctive medications (See
Tables 10 and 11) (CC-C).
