Benzo Withdrawal: The Case for Hyperbolic Taper

Mark Horowitz presents the theoretical argument for this popular taper

STUDY: Horowitz M et al, Psychological Medicine 2026

STUDY TYPE: Narrative review

FUNDING: North East London NHS Foundation Trust clinical research fellowship

Background

The hyperbolic taper lowers benzos faster at the beginning and slower near the end. Controlled trials have not tested this strategy, but it is popular in practice and has a theoretical basis. Mark Horowitz developed the hyperbolic taper for SSRI withdrawal, and explains with colleagues in this review why he favors it for benzodiazepines.

Results

The relationship between the dose of a benzo and its activity at GABA-A receptors is hyperbolic, meaning effects are large at low doses and flatten at higher doses.

Linear tapers, like reducing diazepam by a fixed 12.5 mg each step, produce increasingly large jumps in receptor occupancy as the dose falls. Dropping from 12.5 mg to zero, for example, changes receptor occupancy by 33.6 percentage points, more than twice the change from 50 mg to 37.5 mg (6.6 percentage points).

Hyperbolic tapering, reducing by a fixed percentage of the most recent dose rather than the original dose, keeps each step roughly equal in pharmacological terms.

Dr. Horowitz and colleagues recommend reductions of 5–10% of the most recent dose per step, with 2–4 weeks between reductions, going as slow as months or years for long-term users. Final doses before stopping should be very small, as low as 0.2 mg of diazepam, to avoid a disproportionately large last step. Liquid formulations or compounded preparations make those tiny final doses achievable.

Limitations

The dose-occupancy model draws on non-human primate data, not humans. No randomized trial has directly compared tapering methods.

Practice Implications

• While we await clinical trials to sort out the best approach, there is no harm and a potential benefit in the hyperbolic taper.
• You can create the microdoses needed for a hyperbolic taper with liquid formulations, compounding pharmacies, or this dispersion method.
• Learn more in these new patient-informed guidelines on benzo tapers, which also covers hospital tapers.