CHAPTER II
JADWAL PENARIKAN LAMBAT
Berbagai jadwal penarikan dari
beberapa benzodiazepin diilustrasikan di bawah ini. Jadwal seperti ini telah
bekerja pada orang-orang nyata , tetapi Anda mungkin perlu menyesuaikan untuk
kebutuhan Anda sendiri . Referensi Tabel 1 , Bab I , yang menunjukkan kesetaraan
kekuatan dengan benzodiazepin yang berbeda , harus memungkinkan Anda untuk
bekerja di luar program Anda sendiri dan untuk menyusun jadwal yang tepat untuk
benzodiazepin seperti prazepam ( Centrax ) dan quazepam ( Doral ) dan lain-lain
yang tidak bergambar.
Menurut pengalaman saya ,
satu-satunya pengecualian untuk aturan umum pengurangan lambat triazolam (
Halcion ) . benzodiazepine ini dihilangkan begitu cepat ( paruh 2 jam ) yang
Anda praktis ditarik setiap hari , setelah dosis malam sebelumnya . Untuk
alasan ini , triazolam dapat berhenti tiba-tiba tanpa substitusi dari
benzodiazepin long-acting . Jika gejala penarikan terjadi , Anda bisa mengambil
diazepam mulai dari sekitar 10mg untuk beberapa waktu , penurunan dosis seperti
yang ditunjukkan pada Jadwal 2. Pendekatan yang sama berlaku untuk zolpidem non
- benzodiazepin dan zaleplon yang keduanya memiliki paruh dari 2 jam .
Schedule 1. Withdrawal from high dose (6mg) alprazolam
(Xanax
daily with diazepam (Valium) substitution. (6mg alprazolam
is approximately equivalent to 120mg diazepam)
daily with diazepam (Valium) substitution. (6mg alprazolam
is approximately equivalent to 120mg diazepam)
|
Morning
|
Midday/Afternoon
|
Evening/Night
|
Daily
Diazepam
Equivalent |
Starting dosage
|
alprazolam 2mg
|
alprazolam 2mg
|
alprazolam 2mg
|
120mg
|
Stage 1
(one week) |
alprazolam 2mg
|
alprazolam 2mg
|
alprazolam 1.5mg
diazepam 10mg |
120mg
|
Stage 2
(one week) |
alprazolam 2mg
|
alprazolam 2mg
|
alprazolam 1mg
diazepam 20mg |
120mg
|
Stage 3
(one week) |
alprazolam 1.5mg
diazepam 10mg |
alprazolam 2mg
|
alprazolam 1mg
diazepam 20mg |
120mg
|
Stage 4
(one week) |
alprazolam 1mg
diazepam 20mg |
alprazolam 2mg
|
alprazolam 1mg
diazepam 20mg |
120mg
|
Stage 5
(1-2 weeks) |
alprazolam 1mg
diazepam 20mg |
alprazolam 1mg
diazepam 10mg |
alprazolam 1mg
diazepam 20mg |
110mg
|
Stage 6
(1-2 weeks) |
alprazolam 1mg
diazepam 20mg |
alprazolam 1mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 20mg |
100mg
|
Stage 7
(1-2 weeks) |
alprazolam 1mg
diazepam 20mg |
alprazolam 1mg
diazepam 10mg |
Stop alprazolam
diazepam 20mg |
90mg
|
Stage 8
(1-2 weeks) |
alprazolam 0.5mg
diazepam 20mg |
alprazolam 1mg
diazepam 10mg |
diazepam 20mg
|
80mg
|
Stage 9
(1-2 weeks) |
alprazolam 0.5mg
diazepam 20mg |
alprazolam 0.5mg
diazepam 10mg |
diazepam 20mg
|
80mg
|
Stage 10
(1-2 weeks) |
alprazolam 0.5mg
diazepam 20mg |
Stop alprazolam
diazepam 10mg |
diazepam 20mg
|
60mg
|
Stage 11
(1-2 weeks) |
Stop alprazolam
diazepam 20mg |
diazepam 10mg
|
diazepam 20mg
|
50mg
|
Stage 12
(1-2 weeks) |
diazepam 25mg
|
Stop midday dose;
divert 5mg each to morning and night doses |
diazepam 25mg
|
50mg
|
Stage 13
(1-2 weeks) |
diazepam 20mg
|
--
|
diazepam 25mg
|
45mg
|
Stage 14
(1-2 weeks) |
diazepam 20mg
|
--
|
diazepam 20mg
|
40mg
|
Dilanjutkan seperti pada Schedule
2. Mengurangi dari diazepam 40 mg
Catatan Schedule 1:
1. Tidak
ada jumlah penarikan yang pasti (hanya substitusi diazepam) pada Stages 1 – 4,
jadi bisa dilakukan dalam interval mingguan (tapi lebih baik setiap Stage hanya
2 minggu).
2. Dosis
malam diazepam dapat diminum pada saat sebelum tidur, daripada dengan
alprazolam yang harus diminum lebih awal (Jangan meminum obat tidur yang lain
lagi)
3. Beberapa
pengurangan dosis terjadi pada tahap selanjutnya dari peralihan diazepam ( Stage
5-11 ) , sehingga tahap ini bisa dilakukan di interval dua minggu . Bahkan
mengurangi dosis , diazepam harus mencakup penarikan dari alprazolam , karena
saat ini telah memiliki waktu untuk bekerja melalui tubuh dan akan bertindak
dengan lancar baik siang dan malam . Tujuannya adalah untuk mendapatkan dosis
diazepam yang menghindari gejala penarikan tapi tidak begitu besar untuk
membuat Anda mengantuk .
4. Pada
Stage 12 itu akan masuk akal untuk pindah ke dua kali dosis harian . Diazepam
adalah long-acting dan tidak perlu untuk mengambil lebih dari dua kali sehari .
Tidak ada pengurangan dosis saat Anda membuat perubahan ini ( Tahapan 11 dan 12
) .
Schedule 2. Simple withdrawal from diazepam (Valium)
40mg daily
(follow this schedule to complete Schedule 1)
(follow this schedule to complete Schedule 1)
|
Morning
|
Night
|
Total
Daily Dosage |
Starting dosage
|
diazepam 20mg
|
diazepam 20mg
|
40mg
|
Stage 1 (1-2 weeks)
|
diazepam 18mg
|
diazepam 20mg
|
38mg
|
Stage 2 (1-2 weeks)
|
diazepam 18mg
|
diazepam 18mg
|
36mg
|
Stage 3 (1-2 weeks)
|
diazepam 16mg
|
diazepam 18mg
|
34mg
|
Stage 4 (1-2 weeks)
|
diazepam 16mg
|
diazepam 16mg
|
32mg
|
Stage 5 (1-2 weeks)
|
diazepam 14mg
|
diazepam 16mg
|
30mg
|
Stage 6 (1-2 weeks)
|
diazepam 14mg
|
diazepam 14mg
|
28mg
|
Stage 7 (1-2 weeks)
|
diazepam 12mg
|
diazepam 14mg
|
26mg
|
Stage 8 (1-2 weeks)
|
diazepam 12mg
|
diazepam 12mg
|
24mg
|
Stage 9 (1-2 weeks)
|
diazepam 10mg
|
diazepam 12mg
|
22mg
|
Stage 10 (1-2 weeks)
|
diazepam 10mg
|
diazepam 10mg
|
20mg
|
Stage 11 (1-2 weeks)
|
diazepam 8mg
|
diazepam 10mg
|
18mg
|
Stage 12 (1-2 weeks)
|
diazepam 8mg
|
diazepam 8mg
|
16mg
|
Stage 13 (1-2 weeks)
|
diazepam 6mg
|
diazepam 8mg
|
14mg
|
Stage 14 (1-2 weeks)
|
diazepam 5mg
|
diazepam 8mg
|
13mg
|
Stage 15 (1-2 weeks)
|
diazepam 4mg
|
diazepam 8mg
|
12mg
|
Stage 16 (1-2 weeks)
|
diazepam 3mg
|
diazepam 8mg
|
11mg
|
Stage 17 (1-2 weeks)
|
diazepam 2mg
|
diazepam 8mg
|
10mg
|
Stage 18 (1-2 weeks)
|
diazepam 1mg
|
diazepam 8mg
|
9mg
|
Stage 19 (1-2 weeks)
|
--
|
diazepam 8mg
|
8mg
|
Stage 20 (1-2 weeks)
|
--
|
diazepam 7mg
|
7mg
|
Stage 21 (1-2 weeks)
|
--
|
diazepam 6mg
|
6mg
|
Stage 22 (1-2 weeks)
|
--
|
diazepam 5mg
|
5mg
|
Stage 23 (1-2 weeks)
|
--
|
diazepam 4mg
|
4mg
|
Stage 24 (1-2 weeks)
|
--
|
diazepam 3mg
|
3mg
|
Stage 25 (1-2 weeks)
|
--
|
diazepam 2mg
|
2mg
|
Stage 26 (1-2 weeks)
|
--
|
diazepam 1mg
|
1mg
|
Catatan Schedule 2:
1. Anda
bisa mengatur Stage 1 – 5 (bahkan 1 – 10) dalam interval satu minggu (tapi
boleh interval dua minggu jika anda mau)
2. Stage
berikutnya lebih baik dilakukan setelah dua minggu dari stage sebelumnya.
3. Ketika
anda turun ke dosis 5 mg per hari, anda bisa memulai dengan mengurangi 0,5 mg
dosisnya. Tapi rata-rata orang mengatur dengan pengurangan dosis 1 mg.
4. Anda
akan perlu menggunakan campuran 10mg , 5 mg , dan tablet 2 mg diazepam untuk
mendapatkan dosis yang diperlukan . Membagi dua ( mencetak ) tablet 2mg untuk
mendapatkan dosis 1 mg .
5. Jika
dosis awal Anda 20mg diazepam per hari, Anda bisa mulai di Tahap 10 , tetapi
dalam kasus ini Anda bisa mengurangi dengan 1 mg setiap 2 minggu .
6. Jika
mulai dari Jadwal 1 ( alprazolam 6mg harian ) terus pengurangan Anda
menggunakan jadwal ini .
Schedule 3. Withdrawal from lorazepam (Ativan) 6mg
daily
with diazepam (Valium) substitution. (6mg lorazepam is
approximately equivalent to 60mg diazepam)
with diazepam (Valium) substitution. (6mg lorazepam is
approximately equivalent to 60mg diazepam)
|
Morning
|
Midday/Afternoon
|
Evening/Night
|
Daily
Diazepam
Equivalent |
Starting dosage
|
lorazepam 2mg
|
lorazepam 2mg
|
lorazepam 2mg
|
60mg
|
Stage 1
(one week) |
lorazepam 2mg
|
lorazepam 2mg
|
lorazepam 1mg
diazepam 10mg |
60mg
|
Stage 2
(one week) |
lorazepam 1.5mg
diazepam 5mg |
lorazepam 2mg
|
lorazepam 1mg
diazepam 10mg |
60mg
|
Stage 3
(one week) |
lorazepam 1.5mg
diazepam 5mg |
lorazepam 2mg
|
lorazepam 0.5mg
diazepam 15mg |
60mg
|
Stage 4
(one week) |
lorazepam 1.5mg
diazepam 5mg |
lorazepam 1.5mg
diazepam 5mg |
lorazepam 0.5mg
diazepam 15mg |
60mg
|
Stage 5
(1-2 weeks) |
lorazepam 1.5mg
diazepam 5mg |
lorazepam 1.5mg
diazepam 5mg |
Stop lorazepam
diazepam 20mg |
60mg
|
Stage 6
(1-2 weeks) |
lorazepam 1mg
diazepam 5mg |
lorazepam 1.5mg
diazepam 5mg |
diazepam 20mg
|
55mg
|
Stage 7
(1-2 weeks) |
lorazepam 1mg
diazepam 5mg |
lorazepam 1mg
diazepam 5mg |
diazepam 20mg
|
50mg
|
Stage 8
(1-2 weeks) |
lorazepam 0.5mg
diazepam 5mg |
lorazepam 1mg
diazepam 5mg |
diazepam 20mg
|
45mg
|
Stage 9
(1-2 weeks) |
lorazepam 0.5mg
diazepam 5mg |
lorazepam 0.5mg
diazepam 5mg |
diazepam 20mg
|
40mg
|
Stage 10
(1-2 weeks) |
Stop lorazepam
diazepam 5mg |
lorazepam 0.5mg
diazepam 5mg |
diazepam 20mg
|
35mg
|
Stage 11
(1-2 weeks) |
diazepam 5mg
|
Stop lorazepam
diazepam 5mg |
diazepam 20mg
|
30mg
|
Stage 12
(1-2 weeks) |
diazepam 5mg
|
diazepam 5mg
|
diazepam 18mg
|
28mg
|
Stage 13
(1-2 weeks) |
diazepam 5mg
|
diazepam 5mg
|
diazepam 16mg
|
26mg
|
Stage 14
(1-2 weeks) |
diazepam 5mg
|
diazepam 5mg
|
diazepam 14mg
|
24mg
|
Stage 15
(1-2 weeks) |
diazepam 5mg
|
diazepam 5mg
|
diazepam 12mg
|
22mg
|
Stage 16
(1-2 weeks) |
diazepam 5mg
|
diazepam 5mg
|
diazepam 10mg
|
20mg
|
Stage 17
(1-2 weeks) |
diazepam 5mg
|
diazepam 4mg
|
diazepam 10mg
|
19mg
|
Stage 18
(1-2 weeks) |
diazepam 4mg
|
diazepam 4mg
|
diazepam 10mg
|
18mg
|
Stage 19
(1-2 weeks) |
diazepam 4mg
|
diazepam 3mg
|
diazepam 10mg
|
17mg
|
Stage 20
(1-2 weeks) |
diazepam 3mg
|
diazepam 3mg
|
diazepam 10mg
|
16mg
|
Stage 21
(1-2 weeks) |
diazepam 3mg
|
diazepam 2mg
|
diazepam 10mg
|
15mg
|
Stage 22
(1-2 weeks) |
diazepam 2mg
|
diazepam 2mg
|
diazepam 10mg
|
14mg
|
Stage 23
(1-2 weeks) |
diazepam 2mg
|
diazepam 1mg
|
diazepam 10mg
|
13mg
|
Stage 24
(1-2 weeks) |
diazepam 1mg
|
diazepam 1mg
|
diazepam 10mg
|
12mg
|
Stage 25
(1-2 weeks) |
diazepam 1mg
|
Stop diazepam
|
diazepam 10mg
|
11mg
|
Stage 26
(1-2 weeks) |
Stop diazepam
|
--
|
diazepam 10mg
|
10mg
|
Stage 27
(1-2 weeks) |
--
|
--
|
diazepam 9mg
|
9mg
|
Stage 28
(1-2 weeks) |
--
|
--
|
diazepam 8mg
|
8mg
|
Stage 29
(1-2 weeks) |
--
|
--
|
diazepam 7mg
|
7mg
|
Stage 30
(1-2 weeks) |
--
|
--
|
diazepam 6mg
|
6mg
|
Stage 31
(1-2 weeks) |
--
|
--
|
diazepam 5mg
|
5mg
|
Stage 32
(1-2 weeks) |
--
|
--
|
diazepam 4mg
|
4mg
|
Stage 33
(1-2 weeks) |
--
|
--
|
diazepam 3mg
|
3mg
|
Stage 34
(1-2 weeks) |
--
|
--
|
diazepam 2mg
|
2mg
|
Stage 35
(1-2 weeks) |
--
|
--
|
diazepam 1mg
|
1mg
|
Stage 36
|
--
|
--
|
Stop diazepam
|
--
|
Catatan Schedule 3:
1. Tidak
ada penarikan yang pasti (hanya substitusi diazepam) pada Stage 1 – 5, jadi
bisa dilakukan dalam interval mingguan (tapi anda boleh mengambil interval dua mingguan).
2. Dosis
malam bisa diambil sebelum tidur, daripada lorazepam yang harus diminum lebih
awal (jangan meminum obat tidur yang lain).
3. Beberapa
pengurangan dosis terjadi selama tahap akhir dari peralihan diazepam ( Stage
6-11 ) , sehingga tahap ini bisa dilakukan di interval dua minggu . Bahkan
mengurangi dosis , diazepam harus mencakup penarikan dari lorazepam , karena
saat ini telah memiliki waktu untuk bekerja melalui tubuh dan akan bertindak
dengan lancar baik siang dan malam . Tujuannya adalah untuk mendapatkan dosis
diazepam yang menghindari gejala penarikan tapi tidak begitu besar untuk
membuat Anda mengantuk .
4. Dosis
siang diazepam secara bertahap menurun ( Stage 17-25 ) ; dalam mensukseskan
tahap Anda hanya perlu untuk menurunkan dosis malam - waktu dengan 1 mg setiap minggu
atau dua .
Schedule 4. Withdrawal from nitrazepam (Mogadon) 10mg
at
night with diazepam (Valium) substitution. (Nitrazepam
is approximately the same strength as diazepam)
night with diazepam (Valium) substitution. (Nitrazepam
is approximately the same strength as diazepam)
|
Bed-time dose
|
Starting dosage
|
nitrazepam 10mg
|
Stage 1 (1 week)
|
nitrazepam 5mg
diazepam 5mg |
Stage 2 (1 week)
|
Stop nitrazepam
diazepam 10mg |
Stage 3 (1-2 weeks)
|
diazepam 9mg
|
Stage 4 (1-2 weeks)
|
diazepam 8mg
|
Stage 5 (1-2 weeks)
|
diazepam 7mg
|
Stage 6 (1-2 weeks)
|
diazepam 6mg
|
Stage 7 (1-2 weeks)
|
diazepam 5mg
|
Stage 8 (1-2 weeks)
|
diazepam 4mg
|
Stage 9 (1-2 weeks)
|
diazepam 3mg
|
Stage 10 (1-2 weeks)
|
diazepam 2mg
|
Stage 11 (1-2 weeks)
|
diazepam 1mg
|
Stage 12
|
Stop diazepam
|
Catatan Schedule 4:
Jika anda meminum lebih dari 10
mg nitrazepam, gantikan tiap 5 mg dengan diazepam, sekali saja, dengan 5 mg
diazepam, lalu kurangi diazepam sebanyak 1 atau 2 mg setiap stage.
Schedule 5. Withdrawal from clonazepam (Klonopin)
1.5mg daily with
substitution of diazepam (Valium). (0.5mg clonazepam
is approximately equivalent to 10mg diazepam)
substitution of diazepam (Valium). (0.5mg clonazepam
is approximately equivalent to 10mg diazepam)
|
Morning
|
Midday/Afternoon
|
Evening/Night
|
Daily
Diazepam
Equivalent |
Starting dosage
|
clonazepam 0.5mg
|
clonazepam 0.5mg
|
clonazepam 0.5mg
|
30mg
|
Stage 1
(1 week) |
clonazepam 0.5mg
|
clonazepam 0.5mg
|
clonazepam 0.25mg
diazepam 5mg |
30mg
|
Stage 2
(1 week) |
clonazepam 0.5mg
|
clonazepam 0.5mg
|
Stop clonazepam
diazepam 10mg |
30mg
|
Stage 3
(1 week) |
clonazepam 0.25mg
diazepam 5mg |
clonazepam 0.5mg
|
diazepam 10mg
|
30mg
|
Stage 4
(1 week) |
clonazepam 0.25mg
diazepam 5mg |
clonazepam 0.25mg
diazepam 5mg |
diazepam 10mg
|
30mg
|
Stage 5
(1 week) |
Stop clonazepam
diazepam 10mg |
clonazepam 0.25mg
diazepam 5mg |
diazepam 10mg
|
30mg
|
Stage 6
(1-2 weeks) |
diazepam 10mg
|
Stop clonazepam
diazepam 8mg |
diazepam 10mg
|
28mg
|
Stage 7
(1-2 weeks) |
diazepam 10mg
|
diazepam 6mg
|
diazepam 10mg
|
26mg
|
Stage 8
(1-2 weeks) |
diazepam 10mg
|
diazepam 4mg
|
diazepam 10mg
|
24mg
|
Stage 9
(1-2 weeks) |
diazepam 10mg
|
diazepam 2mg
|
diazepam 10mg
|
22mg
|
Stage 10
(1-2 weeks) |
diazepam 10mg
|
Stop diazepam
|
diazepam 10mg
|
20mg
|
Stage 11
(1-2 weeks) |
diazepam 8mg
|
--
|
diazepam 10mg
|
18mg
|
Stage 12
(1-2 weeks) |
diazepam 6mg
|
--
|
diazepam 10mg
|
16mg
|
Stage 13
(1-2 weeks) |
diazepam 4mg
|
--
|
diazepam 10mg
|
14mg
|
Stage 14
(1-2 weeks) |
diazepam 2mg
|
--
|
diazepam 10mg
|
12mg
|
Stage 15
(1-2 weeks) |
Stop diazepam
|
--
|
diazepam 10mg
|
10mg
|
Schedule 6. Withdrawal from clonazepam (Klonopin) 3mg
daily with substitution of diazepam (Valium).
(1 mg clonazepam is equivalent to 20mg diazepam)
daily with substitution of diazepam (Valium).
(1 mg clonazepam is equivalent to 20mg diazepam)
|
Morning
|
Midday/Afternoon
|
Evening/Night
|
Daily
Diazepam
Equivalent |
Starting dosage
|
clonazepam 1mg
|
clonazepam 1mg
|
clonazepam 1mg
|
60mg
|
Stage 1
(1-2 weeks) |
clonazepam 1mg
|
clonazepam 1mg
|
clonazepam 0.5mg
diazepam 10mg |
60mg
|
Stage 2
(1-2 weeks) |
clonazepam 0.5mg
diazepam 10mg |
clonazepam 1mg
|
clonazepam 0.5mg
diazepam 10mg |
60mg
|
Stage 3
(1-2 weeks) |
clonazepam 0.5mg
diazepam 10mg |
clonazepam 0.5mg
diazepam 5mg |
clonazepam 0.5mg
diazepam 10mg |
55mg
|
Stage 4
(1-2 weeks) |
clonazepam 0.5mg
diazepam 10mg |
clonazepam 0.5mg
diazepam 5mg |
Stop clonazepam
diazepam 15mg |
50mg
|
Stage 5
(1-2 weeks) |
clonazepam 0.25mg
diazepam 10mg |
clonazepam 0.5mg
diazepam 5mg |
diazepam 15mg
|
45mg
|
Stage 6
(1-2 weeks) |
clonazepam 0.25mg
diazepam 10mg |
clonazepam 0.25mg
diazepam 5mg |
diazepam 15mg
|
40mg
|
Stage 7
(1-2 weeks) |
Stop clonazepam
diazepam 10mg |
clonazepam 0.25mg
diazepam 5mg |
diazepam 15mg
|
35mg
|
Stage 8
(1-2 weeks) |
diazepam 10mg
|
Stop clonazepam
diazepam 5mg |
diazepam 15mg
|
30mg
|
Stage 9
(1-2 weeks) |
diazepam 10mg
|
diazepam 2.5mg
|
diazepam 15mg
|
27.5mg
|
Stage 10
(1-2 weeks) |
diazepam 12mg
|
Stop diazepam
|
diazepam 15mg
|
27mg
|
Stage 11
(1-2 weeks) |
diazepam 10mg
|
--
|
diazepam 15mg
|
25mg
|
Stage 12
(1-2 weeks) |
diazepam 10mg
|
--
|
diazepam 14mg
|
24mg
|
Stage 13
(1-2 weeks) |
diazepam 10mg
|
--
|
diazepam 12mg
|
22mg
|
Stage 14
(1-2 weeks) |
diazepam 10mg
|
--
|
diazepam 10mg
|
20mg
|
Catatan Schedule 6:
Pengurangan kecil ( dari 27,5 mg
ke 27 mg) antara Stage 9 dan Stage 10 membolehkan anda untuk menyesuaikan ke
dosis dua kali sehari.
Schedule 7. Withdrawal from alprazolam (Xanax) 4mg
daily with
diazepam (Valium) substitution (4mg alprazolam is
approximately equivalent to 80mg diazepam)
diazepam (Valium) substitution (4mg alprazolam is
approximately equivalent to 80mg diazepam)
|
Morning
|
Midday
|
Afternoon
|
Evening
|
Daily
Diazepam
Equivalent |
Starting dosage
|
alprazolam 1mg
|
alprazolam 1mg
|
alprazolam 1mg
|
alprazolam 1mg
|
80mg
|
Stage 1
(1 week) |
alprazolam 1mg
|
alprazolam 1mg
|
alprazolam 1mg
|
alprazolam 0.5mg
diazepam 10mg |
80mg
|
Stage 2
(1 week) |
alprazolam 1mg
|
alprazolam 0.5mg
diazepam 10mg |
alprazolam 1mg
|
alprazolam 0.5mg
diazepam 10mg |
80mg
|
Stage 3
(1 week) |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 1mg
|
alprazolam 0.5mg
diazepam 10mg |
80mg
|
Stage 4
(1 week) |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
80mg
|
Stage 5
(1 week) |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
80mg
|
Stage 6
(1-2 weeks) |
alprazolam 0.5mg
diazepam 10mg |
alprazolam 0.25mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
diazepam 20mg
|
75mg
|
Stage 7
(1-2 weeks) |
alprazolam 0.25mg
diazepam 10mg |
alprazolam 0.25mg
diazepam 10mg |
alprazolam 0.5mg
diazepam 10mg |
diazepam 20mg
|
70mg
|
Stage 8
(1-2 weeks) |
alprazolam 0.25mg
diazepam 10mg |
alprazolam 0.25mg
diazepam 10mg |
alprazolam 0.25mg
diazepam 10mg |
diazepam 20mg
|
65mg
|
Stage 9
(1-2 weeks) |
alprazolam 0.25mg
diazepam 10mg |
Stop alprazolam
diazepam 10mg |
alprazolam 0.25mg
diazepam 10mg |
diazepam 20mg
|
60mg
|
Stage 10
(1-2 weeks) |
Stop alprazolam
diazepam 10mg |
diazepam 10mg
|
alprazolam 0.25mg
diazepam 10mg |
diazepam 20mg
|
55mg
|
Stage 11
(1-2 weeks) |
diazepam 10mg |
diazepam 10mg
|
Stop alprazolam
diazepam 10mg |
diazepam 20mg
|
50mg
|
Stage 12
(1-2 weeks) |
diazepam 10mg |
diazepam 5mg
|
diazepam 10mg
|
diazepam 20mg
|
45mg
|
Stage 13
(1-2 weeks) |
diazepam 5mg |
diazepam 5mg
|
diazepam 10mg
|
diazepam 20mg
|
40mg
|
Stage 14
(1-2 weeks) |
diazepam 5mg |
diazepam 5mg
|
diazepam 5mg
|
diazepam 20mg
|
35mg
|
Stage 15
(1-2 weeks) |
diazepam 5mg |
diazepam 5mg
|
diazepam 5mg
|
diazepam 15mg
|
30mg
|
Stage 16
(1-2 weeks) |
diazepam 5mg |
diazepam 5mg
|
diazepam 5mg
|
diazepam 12.5mg
|
27.5mg
|
Stage 17
(1-2 weeks) |
diazepam 5mg |
diazepam 5mg
|
diazepam 5mg
|
diazepam 10mg
|
25mg
|
Stage 18
(1-2 weeks) |
diazepam 5mg |
diazepam 2.5mg
|
diazepam 5mg
|
diazepam 10mg
|
22.5mg
|
Stage 19
(1-2 weeks) |
diazepam 5mg |
Stop diazepam
|
diazepam 5mg
|
diazepam 10mg
|
20mg
|
Stage 20
(1-2 weeks) |
diazepam 4mg |
--
|
diazepam 5mg
|
diazepam 10mg
|
19mg
|
Stage 21
(1-2 weeks) |
diazepam 4mg |
--
|
diazepam 4mg
|
diazepam 10mg
|
18mg
|
Stage 22
(1-2 weeks) |
diazepam 4mg |
--
|
diazepam 3mg
|
diazepam 10mg
|
17mg
|
Stage 23
(1-2 weeks) |
diazepam 3mg |
--
|
diazepam 3mg
|
diazepam 10mg
|
16mg
|
Stage 24
(1-2 weeks) |
diazepam 3mg |
--
|
diazepam 2mg
|
diazepam 10mg
|
15mg
|
Stage 25
(1-2 weeks) |
diazepam 2mg |
--
|
diazepam 2mg
|
diazepam 10mg
|
14mg
|
Stage 26
(1-2 weeks) |
diazepam 2mg |
--
|
Stop diazepam
|
diazepam 10mg
|
12mg
|
Stage 27
(1-2 weeks) |
Stop diazepam
|
--
|
--
|
diazepam 10mg
|
10mg
|
Catatan Schedule 7:
Dosis malam diazepam boleh
diminum sebelum tidur, daripada alprazolam yang harus diminum lebih awal.
Schedule 8. Withdrawal from lorazepam (Ativan) 3mg
daily with
diazepam (Valium) substitution. (3mg lorazepam
is approximately equivalent to 30mg diazepam)
diazepam (Valium) substitution. (3mg lorazepam
is approximately equivalent to 30mg diazepam)
|
Morning
|
Midday/Afternoon
|
Evening/Night
|
Daily
Diazepam
Equivalent |
Starting dosage
|
lorazepam 1 mg
|
lorazepam 1 mg
|
lorazepam 1 mg
|
30mg
|
Stage 1
(1 week) |
lorazepam 1 mg
|
lorazepam 1 mg
|
lorazepam 0.5mg
diazepam 5mg |
30mg
|
Stage 2
(1 week) |
lorazepam 0.5mg
diazepam 5mg |
lorazepam 1 mg
|
lorazepam 0.5mg
diazepam 5mg |
30mg
|
Stage 3
(1 week) |
lorazepam 0.5mg
diazepam 5mg |
lorazepam 0.5mg
diazepam 5mg |
lorazepam 0.5mg
diazepam 5mg |
30mg
|
Stage 4
(1 week) |
lorazepam 0.5mg
diazepam 5mg |
lorazepam 0.5mg
diazepam 5mg |
Stop lorazepam
diazepam 10mg |
30mg
|
Stage 5
(1 week) |
Stop lorazepam
diazepam 10mg |
lorazepam 0.5mg
diazepam 5mg |
diazepam 10mg
|
30mg
|
Stage 6
(1 week) |
diazepam 10mg
|
Stop lorazepam
diazepam 10mg |
diazepam 10mg
|
30mg
|
Stage 7
(1-2 weeks) |
diazepam 10mg
|
diazepam 8mg
|
diazepam 10mg
|
28mg
|
Stage 8
(1-2 weeks) |
diazepam 8mg
|
diazepam 8mg
|
diazepam 10mg
|
26mg
|
Stage 9
(1-2 weeks) |
diazepam 8mg
|
diazepam 6mg
|
diazepam 10mg
|
24mg
|
Stage 10
(1-2 weeks) |
diazepam 6mg
|
diazepam 6mg
|
diazepam 10mg
|
22mg
|
Stage 11
(1-2 weeks) |
diazepam 6mg
|
diazepam 4mg
|
diazepam 10mg
|
20mg
|
Stage 12
(1-2 weeks) |
diazepam 6mg
|
diazepam 2mg
|
diazepam 10mg
|
18mg
|
Stage 13
(1-2 weeks) |
diazepam 6mg
|
Stop diazepam
|
diazepam 10mg
|
16mg
|
Stage 14
(1-2 weeks) |
diazepam 5mg
|
--
|
diazepam 10mg
|
15mg
|
Stage 15
(1-2 weeks) |
diazepam 4mg
|
--
|
diazepam 10mg
|
14mg
|
Stage 16
(1-2 weeks) |
diazepam 3mg
|
--
|
diazepam 10mg
|
13mg
|
Stage 17
(1-2 weeks) |
diazepam 2mg
|
--
|
diazepam 10mg
|
12mg
|
Stage 18
(1-2 weeks) |
diazepam 1mg
|
--
|
diazepam 10mg
|
11mg
|
Stage 19
(1-2 weeks) |
Stop diazepam
|
--
|
diazepam 10mg
|
10mg
|
Schedule 9. Withdrawal from temazepam (Restoril) 30mg
nightly with diazepam substitution. (30mg temazepam is
approximately equivalent to 15mg diazepam)
nightly with diazepam substitution. (30mg temazepam is
approximately equivalent to 15mg diazepam)
|
Night time
|
Equivalent
diazepam dosage
|
Starting dosage
|
temazepam 30mg
|
15mg
|
Stage 1 (1-2 weeks)
|
temazepam 15mg
diazepam 7.5mg |
15mg
|
Stage 2 (1-2 weeks)
|
temazepam 7.5mg
diazepam 12mg |
15.75mg
|
Stage 3 (1-2 weeks)
|
Stop temazepam
diazepam 15mg |
15mg
|
Stage 4 (1-2 weeks)
|
diazepam 14mg
|
14mg
|
Stage 5 (1-2 weeks)
|
diazepam 13mg
|
13mg
|
Stage 6 (1-2 weeks)
|
diazepam 12mg
|
12mg
|
Stage 7 (1-2 weeks)
|
diazepam 11mg
|
11mg
|
Stage 8 (1-2 weeks)
|
diazepam 10mg
|
10mg
|
Stage 9 (1-2 weeks)
|
diazepam 9mg
|
9mg
|
Stage 10 (1-2 weeks)
|
diazepam 8mg
|
8mg
|
Stage 11 (1-2 weeks)
|
diazepam 7mg
|
7mg
|
Stage 12 (1-2 weeks)
|
diazepam 6mg
|
6mg
|
Stage 13 (1-2 weeks)
|
diazepam 5mg
|
5mg
|
Stage 14 (1-2 weeks)
|
diazepam 4mg
|
4mg
|
Stage 15 (1-2 weeks)
|
diazepam 3mg
|
3mg
|
Stage 16 (1-2 weeks)
|
diazepam 2mg
|
2mg
|
Stage 17 (1-2 weeks)
|
diazepam 1mg
|
1mg
|
Stage 18
|
Stop diazepam
|
--
|
Schedule 10. Withdrawal from oxazepam (Serax) 20mg
three times
daily (60mg) with diazepam (Valium) substitution (20mg
oxazepam is approximately equivalent to 10mg diazepam)
daily (60mg) with diazepam (Valium) substitution (20mg
oxazepam is approximately equivalent to 10mg diazepam)
|
Morning
|
Midday
|
Evening/Night
|
Daily
Diazepam
Equivalent |
Starting dosage
|
oxazepam 20mg
|
oxazepam 20mg
|
oxazepam 20mg
|
30mg
|
Stage 1
(1 week) |
oxazepam 20mg
|
oxazepam 20mg
|
oxazepam 10mg
diazepam 5mg |
30mg
|
Stage 2
(1 week) |
oxazepam 10mg
diazepam 5mg |
oxazepam 20mg
|
oxazepam 10mg
diazepam 5mg |
30mg
|
Stage 3
(1 week) |
oxazepam 10mg
diazepam 5mg |
oxazepam 10mg
diazepam 5mg |
oxazepam 10mg
diazepam 5mg |
30mg
|
Stage 4
(1-2 weeks) |
oxazepam 10mg
diazepam 5mg |
oxazepam 10mg
diazepam 5mg |
Stop oxazepam
diazepam 8mg |
28mg
|
Stage 5
(1-2 weeks) |
Stop oxazepam
diazepam 8mg |
oxazepam 10mg
diazepam 5mg |
diazepam 8mg
|
26mg
|
Stage 6
(1-2 weeks) |
diazepam 8mg
|
Stop oxazepam
diazepam 8mg |
diazepam 8mg
|
24mg
|
Stage 7
(1-2 weeks) |
diazepam 10mg
|
diazepam 2mg
|
diazepam 10mg
|
22mg
|
Stage 8
(1-2 weeks) |
diazepam 10mg
|
Stop diazepam
|
diazepam 10mg
|
20mg
|
Stage 9
(1-2 weeks) |
diazepam 8mg
|
--
|
diazepam 10mg
|
18mg
|
Catatan Schedule 10:
1. Oxazeam
adalah short-acting (half-life 4 – 15 jam) jadi substitusi ke diazepam sangat
dianjurkan karena long-acting.
2. Diazepam
hanya diminum dua kali sehari.
3. Merubah
dosis diazepam dari 5 mg ke 2 mg lebih baik mulai dilakukan pada Stage 4 dan
seterusnya.
Schedule 11. Withdrawal from chlordiazepoxide (Librium)
25mg
three times daily (75mg). (25mg chlordiazepoxide
is approximately equivalent to 10mg diazepam)
three times daily (75mg). (25mg chlordiazepoxide
is approximately equivalent to 10mg diazepam)
|
Morning
|
Midday
|
Evening/Night
|
Starting dosage
|
chlordiazepoxide 25mg
|
chlordiazepoxide 25mg
|
chlordiazepoxide 25mg
|
Stage 1
(1-2 weeks) |
chlordiazepoxide 25mg
|
chlordiazepoxide 20mg
|
chlordiazepoxide 25mg
|
Stage 2
(1-2 weeks) |
chlordiazepoxide 20mg
|
chlordiazepoxide 20mg
|
chlordiazepoxide 25mg
|
Stage 3
(1-2 weeks) |
chlordiazepoxide 20mg
|
chlordiazepoxide 20mg
|
chlordiazepoxide 20mg
|
Stage 4
(1-2 weeks) |
chlordiazepoxide 25mg
|
chlordiazepoxide 5mg
|
chlordiazepoxide 25mg
|
Stage 5
(1-2 weeks) |
chlordiazepoxide 25mg
|
Stop chlordiazepoxide
|
chlordiazepoxide 25mg
|
Stage 6
(1-2 weeks) |
chlordiazepoxide 20mg
|
--
|
chlordiazepoxide 25mg
|
Stage 7
(1-2 weeks) |
chlordiazepoxide 20mg
|
--
|
chlordiazepoxide 20mg
|
Stage 8
(1-2 weeks) |
chlordiazepoxide 15mg
|
--
|
chlordiazepoxide 20mg
|
Stage 9
(1-2 weeks) |
chlordiazepoxide 15mg
|
--
|
chlordiazepoxide 15mg
|
Stage 10
(1-2 weeks) |
chlordiazepoxide 10mg
|
--
|
chlordiazepoxide 15mg
|
Stage 11
(1-2 weeks) |
chlordiazepoxide 10mg
|
--
|
chlordiazepoxide 10mg
|
Stage 12
(1-2 weeks) |
chlordiazepoxide 5mg
|
--
|
chlordiazepoxide 10mg
|
Stage 13
(1-2 weeks) |
chlordiazepoxide 5mg
|
--
|
chlordiazepoxide 5mg
|
Stage 14
(1-2 weeks) |
chlordiazepoxide
2.5mg (½ tablet) |
--
|
chlordiazepoxide 5mg
|
Stage 15
(1-2 weeks) |
chlordiazepoxide
2.5mg (½ tablet) |
--
|
chlordiazepoxide
2.5mg (½ tablet) |
Stage 16
(1-2 weeks) |
Stop chlordiazepoxide
|
--
|
chlordiazepoxide
2.5mg (½ tablet) |
Stage 17
|
--
|
--
|
Stop chlordiazepoxide
|
Catatan Schedule 11:
1. Chlordiazepoxide
adalah long-acting sehingga tidak perlu untuk mengambil lebih sering dari dua
kali sehari ( maka Stage 4 dan 5 ) .
2. Karena
chlordiazepoxide adalah long-acting , tidak ada kebutuhan untuk substitusi
diazepam
3. Jika
Anda mengambil kapsul chlordiazepoxide , berubah menjadi tablet yang dapat
dibagi dua untuk Stage 14 dan seterusnya .
Schedule 12. Withdrawal from zopiclone (Zimovane) 15mg
with diazepam (Valium) substitution. (15mg zopiclone
is approximately equivalent to 10mg diazepam)
with diazepam (Valium) substitution. (15mg zopiclone
is approximately equivalent to 10mg diazepam)
|
Night time
|
Daily
Diazepam
Equivalent |
Starting dosage
|
zopiclone 15mg
|
10mg
|
Stage 1
(1 week) |
zopiclone 7.5mg
diazepam 5mg |
10mg
|
Stage 2
(1 week) |
Stop zopiclone
diazepam 10mg |
10mg
|
Stage 3 (1-2 weeks)
|
diazepam 9mg
|
9mg
|
Stage 4 (1-2 weeks)
|
diazepam 8mg
|
8mg
|
Catatan Schedule 12:
1. Hal
ini dimungkinkan untuk menarik langsung dari zopiclone menggunakan tablet
terkecil ( 3.75mg ) , tetapi dosis ini zopiclone setara dengan 2,5 mg diazepam
untuk pengurangan dosis agak tiba-tiba .
2. Metode
ini juga dapat digunakan untuk menarik diri dari loprazolam dan lormetazepam .
1mg dari masing-masing kurang lebih setara dengan 10 mg diazepam ; mereka paruh
yang 6-12 dan 10-12 jam masing-masing.
Schedule 13. Antidepressant Withdrawal Table
Drugs
|
Dosage
strengths and formulations*
|
Tricyclics
|
|
amitriptyline (Tryptizol, Elavil)
|
tabs 10, 25, 50mg; liquid 25mg/5ml
|
amoxapine (Asendis)
|
tabs 25, 50, 100mg
|
clomipramine (Anafranil)
|
caps 10, 25, 50mg; syrup 25mg/5ml
|
dothiepin (Prothiaden)
|
tabs 25, 75mg
|
doxepin (Sinequan)
|
caps 10, 25, 50, 75mg
|
imipramine (Tofranil)
|
tabs 10, 25mg syrup 25mg/5ml
|
lofepramine (Gamanil)
|
tabs 70mg; liquid 70mg/5ml
|
nortriptyline (Allegron, Pamelor)
|
tabs 10, 25mg
|
protriptyline (Concordin, Vivactil)
|
tabs 5, 10mg
|
trimipramine (Surmontil)
|
tabs 10, 25mg
|
Related antidepressants
|
|
maprotiline (Ludiomil)
|
tabs 10, 25, 50, 75mg
|
mianserin (Bolvidon, Norval)
|
tabs 10, 30mg
|
trazodone (Molipaxin, Desyrel)
|
caps 50, 100mg; tabs 150mg; liquid 50mg/5ml
|
viloxazine (Vivalan)
|
tabs 50mg
|
MAOIs (monoamine oxidase inhibitors)
|
|
phenelzine (Nardil)
|
tabs 15mg
|
moclobemide (Mannerix)
|
tabs 150mg
|
tranylcypromine (Parnate)
|
tabs 10mg
|
SSRIs (selective serotonin reuptake inhibitors)
|
|
citalopram (Cipramil, Celexa)
|
tabs 10, 20, 40mg; liquid 40mg/ml (drops)
|
fluoxetine (Prozac)
|
caps 20, 60mg; liquid 20mg/5ml
|
fluvoxamine (Faverin, Luvox)
|
tabs(s) 50, 100mg
|
paroxetine (Seroxat, Paxil)
|
tabs(s) 20, 30mg; liquid 20mg/5ml
|
sertraline (Lustral, Zoloft)
|
tabs 50, 100mg
|
escitalopram (Cipralex, Lexapro)
|
tabs 5, 10(s), 20mg(s)
|
Others
|
|
mirtazapine (Zispin, Remeron)
|
tabs(s) 30mg
|
nefazodone (Dutonin, Serzone)
|
tabs(s) 100, 200mg
|
reboxetine (Edronax, Vestra)
|
tabs(s) 4mg
|
venlafaxine (Efexor, Effexor)
|
tabs 37.5, 75mg
|
* tabs:
tablets, (s) scored; caps: capsules; 5ml = 1 teaspoon
|
Catatan Schedule 13:
Pedoman bagi pengguna
benzodiazepine yang juga mengambil antidepresan dan ingin menarik diri dari
kedua obat
1. Menyelesaikan
penarikan benzodiazepine sebelum mulai tappering antidepresan.
2. Memungkinkan
setidaknya 4 minggu setelah berhenti benzodiazepin sebelum memulai penarikan
antidepresan.
3. Konsultasikan
dengan dokter Anda sebelum memulai untuk menarik antidepresan dan menyepakati
jadwal tappering.
4. penarikan
antidepresan harus bertahap untuk menghindari efek penarikan.
a.
Membuat setiap pengurangan dosis sekecil
mungkin, misalnya oleh mengurangi separuh tablet atau menggunakan sediaan cair.
b.
Jika dosis yang lebih kecil tidak tersedia,
mengurangi dengan mengambil tablet setiap hari, maka setiap hari ketiga, dll
c.
Memungkinkan 1-2 minggu antara setiap pengurangan
dosis.
d.
Jika gejala penarikan yang parah (Bab 3, Tabel
2) meningkatkan dosis yang sedikit (misalnya untuk dosis pada pengurangan
terakhir Anda). Ketika gejala menetap, melanjutkan penarikan pada tingkat lebih
lambat.
5. Dengan
slow tappering, seperti diuraikan di atas, gejala penarikan dari antidepresan
biasanya tidak ada, atau jika mereka terjadi, ringan dan singkat.
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