KEY POINTS FOR PRACTICE
| • Patient engagement and shared decision-making are key because the risks of tapering must be balanced against the risks of continuing benzodiazepine therapy, which increase with dose, duration, age, and comorbidities. |
| • A slow initial taper rate, such as a reduction of 5% to 10% over 2 to 4 weeks, is recommended. Completing a taper may require months to years. |
| • Tapering should be considered in adults 65 years and older because they have higher risk of adverse events from benzodiazepine use. |
| • Psychiatric conditions, including substance use disorders, should be addressed before starting benzodiazepine tapering. |
| From the AFP Editors |
Benzodiazepines are prescribed to nearly 24 million patients in the United States to treat conditions such as anxiety, panic disorders, social phobia, insomnia, and seizures. They are effective in certain short-term scenarios, but chronic use increases risk of falls, motor vehicle collisions, cognitive impairment, oversedation, delirium, benzodiazepine use disorder, and overdose, particularly when combined with opioids or other central nervous system depressants. When continued use poses more risk than benefit, clinical strategies are necessary for safe and effective tapering. Tapering also introduces risks because precipitous dose decreases can lead to potentially life-threatening withdrawal symptoms.
The American Society of Addiction Medicine coordinated the joint development of guidelines for tapering benzodiazepines in adults outside of palliative and end-of-life settings. The guidelines were developed with representatives of 10 professional societies, including the American Academy of Family Physicians. Most of the recommendations were based on expert consensus due to limited evidence.
RISKS AND BENEFITS OF BENZODIAZEPINES
Benzodiazepine tapering can be challenging for patients and clinicians, and the decision to taper chronic benzodiazepine therapy should be patient-centered and collaborative. At least every 3 months, the risks and benefits of ongoing benzodiazepine therapy should be assessed (Table 1), and prescription drug monitoring programs should be reviewed. Concurrent substance use, older age, and medical multimorbidity increase the risk of potential harms and may necessitate more frequent assessment.
TABLE 1. Potential Benefits and Risks of Continued Benzodiazepine Use and Tapering
| Potential benefits of continued benzodiazepine use | |
| Effective management of mental and physical health conditions | |
| Related functional improvements | |
| Quality-of-life improvements | |
| Potential risks of continued benzodiazepine use Oversedation, including consideration of use with other sedating medications, alcohol, or other drugs Falls and related injuries Memory and cognitive impacts Motor vehicle collisions Medical safety concerns (eg, medication interactions) Impacts on co-occurring mental and physical health conditions Disrupted sleep patterns Impacts on work and family responsibilities Diversion Substance use disorder Overdose Fetal harm Suicidality |
Potential risks of tapering benzodiazepine Withdrawal symptoms, including severe or complicated withdrawal (eg, seizures, delirium) Recurrence of the condition for which benzodiazepines were prescribed Impacts on co-occurring mental and physical health conditions Protracted withdrawal Return to illicit benzodiazepine use Transition to illicit benzodiazepine use, including risks from contaminants |
Adapted from American Society of Addiction Medicine. Joint clinical practice guideline on benzodiazepine tapering: consideration when benzodiazepine risks outweigh benefits. Accessed January 26, 2026. https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering. Edited for style and licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/).
WITHDRAWAL RISK
Tapering also carries risks, including acute benzodiazepine withdrawal, protracted withdrawal, return of underlying anxiety, and potential transition to nonprescribed benzodiazepine use. Sudden discontinuation or rapid dose reductions carry a risk of severe and potentially life-threatening withdrawal, especially when taking short-duration benzodiazepines.
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