A note on benzodiazepine withdrawal and the Ashton Manual

The Ashton Manual lists some model schedules for withdrawal from benzodiazepines. Dr. Ashton insists, however, that timing of withdrawal should be governed primarily by the patients perceptions of the effects of the process, and not strictly dictated by a physician. The schedules are merely models.

Dr. Ashton has her patients replace benzodiazepines like Xanax and lorazepam with diazepam (Valium) as the withdrawal starts, and she has a formula for this replacement integrated into the withdrawal schedules. The reason for this is that Xanax and lorazepam have a half life of about 12 hours, and especially toward the end of the process, where a single pill will be taken less than the typical three times a day, there will be large fluctuations in the blood level of the drug.

The only two people with whom I have ever discussed the Ashton Manual both said that the concern was needless, since the accumulated blood level would prevent the extreme fluctuations. This prompted my short investigation on blood levels, with a resulting formula.

As shown by the formula, taking a single Xanax or lorazepam pill (with a half life of about 12 hours) only once a day will result in a 400% fluctuation of blood level. So Dr. Ashton’s concern is valid. Taking a single diazepam pill (with a half life of about two days) once a day will produce a fluctuation of only about 33%. (See the examples with the formula).

If you are a patient withdrawing from a benzodiazepine, and your physician does not want you to replace your benzo with diazepam, you can maintain the frequency of your doses merely by crushing the pill(s) into powder (when the pills get too few in number), and dividing the powder into the desired number of piles for a day – typically three, right to the end – the last pill, into three piles.