Key Takeaways
- The Ashton Manual never uses the word micro-tapering, but its schedules rest on the same idea of small, gradual reductions that get smaller as the dose falls.
- Professor C. Heather Ashton wrote that her schedules are only general guides and that the rate of tapering should be controlled by the patient, not the doctor.
- Micro-tapering, as the benzodiazepine community uses the term, means very small and frequent reductions, often daily, usually with a liquid.
- Small steps come from tablets split no finer than quarters, then from a manufactured or compounded liquid measured with an oral syringe, never a dropper.
- The Manual says to stop diazepam at 0.5 mg a day, though in this site’s view the 1 mg/mL oral solution lets many people continue in small steps to about 0.1 mg.
- Neither a daily micro-taper nor a step every two weeks suits everyone, so your symptoms and your prescriber decide the next step.
No, the Ashton Manual does not describe micro-tapering by name. Its schedules in Chapter II cut the dose by small amounts, on the order of a tenth of the dose, every week or two, with smaller steps as the dose falls and the pace set by symptoms. Micro-tapering grew from that principle and makes the steps smaller and more frequent.
What the Ashton Manual actually says about step size and pace
Professor Ashton built the schedules in Chapter II of the Manual, published at benzo.org.uk, around diazepam, because it is long-acting and comes in small tablets. The 2 mg tablet she taught from is scored and halves into 1 mg doses, so her schedules end in steps of a milligram, with half-milligram steps from 5 mg down as an option she said some people prefer. Higher up, the steps are larger.
The pace was never meant to be fixed. In her January 2007 message at the front of the Manual, she wrote that the schedules “are only intended as general guides” and that “the rate of tapering should never be rigid but should be flexible and controlled by the patient, not the doctor.”
Chapter II tells the reader to “design the schedule around your own symptoms” and adds, “It is important for you to be in control of your own schedule. Do not let your doctor impose a deadline.” So, the size of each step and the time between steps were always meant to bend to the person taking them.
She also wrote about liquids. “Liquid preparations of some benzodiazepines are available,” the Manual says, “and if desired slow reduction from these can be accomplished by decreasing the volume of each dose, using a graduated syringe.” That one sentence is the seed of what the community now calls micro-tapering.
What people mean by micro-tapering
Micro-tapering means making very small, frequent dose reductions, often daily or every few days, instead of a larger cut every week or two. In fact, the same amount may come off over a month, in many tiny pieces rather than one noticeable step.
Why would anyone bother? Some people tolerate the smaller increments better, because the nervous system is asked to adjust to less change at a time, and an oral syringe can measure amounts that no tablet cutter can.
The method also borrows from hyperbolic tapering, which the Maudsley Deprescribing Guidelines describe. Chapter 3 of the Guidelines explains that “the size of dose reductions should become smaller and smaller as the total dose reduces,” because the relationship between dose and receptor occupancy is not a straight line. This site’s article on why benzo dose cuts must get smaller covers that curve.
The Manual’s subject is dependence on a prescribed dose, and physical dependence is not addiction. Someone who took a benzodiazepine as prescribed and cannot stop without symptoms needs a gradual taper, not an addiction program.
Where the two agree, and where micro-tapering goes further
While this is not a perfect analogy, a flight of stairs and a ramp both get you to the ground floor. The Manual’s schedule is the stairs: a step, a landing, a pause, then the next step. A micro-taper is the ramp, the same descent with no landings.
Both are gradual. Stopping a benzodiazepine abruptly is the equivalent of jumping out the window, and it is never the safe option.
Where micro-tapering goes further is in the size of the cut. A micro-taper may change the dose every day by an amount no tablet can be cut to, which is only possible with a liquid and a syringe.
It also goes further at the very bottom. The Manual says to “take the plunge when you reach 0.5mg daily,” adding that “full recovery cannot begin until you have got off your tablets completely.” That advice reflected the 2 mg tablets she had to work with, where half a milligram was the smallest piece.
In this site’s view, the 1 mg/mL diazepam oral solution changes that arithmetic. With it, many people can keep reducing below 0.5 mg in steps sized to what is left and stop at about 0.1 mg, roughly the smallest amount easily measured on an oral syringe. Still, her 0.5 mg stop remains a reasonable choice for someone who is doing well and prefers it, because diazepam’s long half-life softens that last step.
How small steps are made safely
The first tool is the tablet cutter, and it has a limit. A tablet is split no finer than quarters, and when a quarter tablet is too big a step, the answer is a liquid, not a finer cut.
Unfortunately, quarters run out sooner than people expect. Chapter 3 of the Maudsley Deprescribing Guidelines points out that “reducing from the smallest tablet to zero would cause a large reduction in effect, engendering severe withdrawal symptoms for some patients.”
Measured by its effect, a quarter of the smallest clonazepam or lorazepam tablet is a much bigger step than a quarter of the smallest diazepam tablet. For lorazepam it is more than twice as large, and for clonazepam about five times.
The second tool is the liquid. For diazepam there is a manufactured oral solution at 1 mg/mL, which can be ordered through Walgreens, CVS, and other major retail pharmacies. Alprazolam and lorazepam also come as oral solutions in the United States. Clonazepam does not, so a clonazepam taper that needs small steps uses a compounded liquid or a crossover to diazepam.
Every liquid dose is measured with an oral syringe, never a dropper. It is what makes each step a measured amount rather than a guess. This site’s article on liquid tapers covers the formulations.
Does micro-tapering suit everyone?
No. Some people do better with a clear step, a landing, and a week or two of stillness before the next one. The Maudsley tables space reductions by how long symptoms take to settle, from one to four weeks.
Of course, a hold is part of the method, and it does not mean the taper has failed. Professor Ashton wrote that “you can stand still at a certain stage in your schedule and have a vacation from further withdrawal for a few weeks.” While she asked the reader to avoid going backwards, holding at a step is not going backwards.
Other people feel every step as a jolt and find that small daily amounts pass almost unnoticed. Unfortunately, there is no way to know in advance which kind of person you are. The Guidelines put it plainly in Chapter 3: “The most important information to determine the rate of reduction is how the patient experiences the process. Imposed regimens tend to backfire.”
Professor Ashton also warned against letting the end drag. “Do not be tempted to spin out the withdrawal to a ridiculously slow rate towards the end (such as 0.25mg each month),” she wrote in Chapter II. A micro-taper that becomes a way of never finishing has lost the point, so agree the stopping dose with your prescriber in advance.
Fortunately, neither path has to be chosen once and for all. A person can take ordinary steps through the upper part of a taper and move to a liquid lower down, where each milligram matters more. The Dose Reduction Calculator on this site turns any two doses into the percentage cut between them, so you can see how big a step really is before you take it.
Frequently asked questions
Did Professor Ashton recommend micro-tapering?
Not by that name, and not daily reductions. She recommended small, flexible steps at intervals of a week or two, a schedule the patient controls, and a liquid with a graduated syringe where finer reductions were wanted. The Manual cannot be quoted as endorsing a daily schedule, because it never mentions one.
Is a daily micro-taper better than steps every two weeks?
No source this site relies on says that one is better for everyone. The Manual uses steps with pauses, the Guidelines space reductions by how long symptoms take to settle, and some people tolerate small daily amounts better than a noticeable step. Your response decides.
Can you micro-taper with tablets alone?
Only down to the limit of a quarter tablet, and not with daily changes. For the potent benzodiazepines a quarter of the smallest tablet is still a large step in effect, and beyond that point small steps need a manufactured or compounded liquid measured with an oral syringe.
How low can a diazepam taper go on the liquid?
The Manual says to stop at 0.5 mg daily. In this site’s view, with the 1 mg/mL oral solution a diazepam taper can continue in small steps to about 0.1 mg and stop from there. This applies to diazepam only. Other benzodiazepines end as the Maudsley Deprescribing Guidelines describe, with no fixed drop-off dose, and the slowest clonazepam schedule there finishes on a liquid at a tiny fraction of a milligram.
Does micro-tapering make a taper longer?
Not by itself. Professor Ashton wrote in Chapter II that “whether it takes 6 months, 12 months or 18 months is of little significance if you have taken benzodiazepines for a matter of years.” A year to 18 months or longer is realistic for most people who took a benzodiazepine for years, whichever way the steps are cut.
Whichever shape your taper takes, the steps belong to you and your prescriber. This site’s article on patient-directed tapering explains why that control matters more than any calendar.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
