Benzodiazepine Tapering & Deprescribing
in Naples, FL

Can a prescription that is decades old be tapered from Naples without leaving home?

Yes. Dr. Leeds, an osteopathic physician who specializes in deprescribing, practices from Fort Lauderdale on the far side of Alligator Alley and sees patients across Florida by secure video, Naples, Marco Island, Bonita Springs, Fort Myers, and Cape Coral included. This page is for the patient who has taken a benzodiazepine for many years, often on a prescription first written somewhere else, and who is now older, on more medications, and wondering whether coming off is still realistic. It is.

In short:

• Dr. Leeds tapers benzodiazepines for Naples area patients by video. He prescribes for patients in Florida, with in-person visits available at his Fort Lauderdale office for anyone who wants them.
• Age does not rule out a taper. The Ashton Manual states that older people can withdraw from benzodiazepines as successfully as younger people, even after many years of use.
• For an older patient the pace is slower and the holds longer, with reductions measured on a liquid, because the body clears these drugs more slowly with age and a misstep costs more.
• A patient who took a sleeping pill exactly as prescribed for twenty years needs a careful medical taper, not a program, because physical dependence is not addiction.

Why does age change the arithmetic of a taper?

Three things change. The first is sensitivity. Older people respond more strongly to the sedative effects of benzodiazepines, and the Ashton Manual lists the consequences: confusion, night wandering, memory loss, unsteadiness, hangover effects, and a slowing of thinking that can be mistaken for dementia. Oversedation lasts longer in an older body and contributes to falls and fractures. The same Ativan (lorazepam) tablet, taken for years, can produce a morning fog at seventy-five that was absent at fifty; the drug did not change, the body did.

The second is clearance. Diazepam (Valium) and its active breakdown products stay in the body for days, longer still in an older person, so a dose once cleared by morning now accumulates across the week. The U.S. Food and Drug Administration (FDA) label for diazepam advises keeping older patients on the smallest effective amount for this reason, naming unsteadiness and oversedation as the hazards.

The third is company. By seventy, most patients have a medication list, and much of it interacts with a benzodiazepine. Opioid pain medications carry an FDA boxed warning against the combination, because together they depress breathing. Blood pressure medications add dizziness on standing to the benzodiazepine’s own unsteadiness, and some heart rhythm and blood pressure drugs slow the liver’s clearance of certain benzodiazepines, so the same tablet lasts longer and hits harder than it once did. None of this means the benzodiazepine should be stopped suddenly, which is dangerous at any age; it means the taper is planned with the whole list in view.

Is a taper still worth it after twenty or thirty years?

Many older people on this coast first took a benzodiazepine in the 1980s or 1990s, and the prescription simply never stopped. The long history is a reason to taper carefully, not a reason to give up. The Ashton Manual, by the late Professor C. Heather Ashton, states that older people can withdraw as successfully as younger people, that a slow regimen was tolerated in her experience even by people in their eighties who had taken the drugs for twenty years or more, and that the reasons to withdraw, falls, fractures, confusion, and memory loss, grow stronger with every year. Her method for older people is similar to that for younger adults, a slow stepwise reduction with liquid preparations where available; the practice’s explanation of it is on the Ashton Manual explained page.

Physical dependence is not addiction. A patient who has taken Klonopin (clonazepam) as prescribed every night for twenty-five years has a brain that adapted to the drug and now depends on it to feel normal, a predictable consequence of the medication, not misuse. The FDA’s 2020 update to the boxed warning on the benzodiazepine class says as much: physical dependence and withdrawal reactions, some lasting many months, occur at prescribed doses, and the way off is a gradual reduction.

What happens when the prescription was written somewhere else?

Many people in Naples, Bonita Springs, or Marco Island who want to taper did not start their benzodiazepine in Florida. The prescription came from a family doctor in Ohio, or a cardiologist in Michigan who added temazepam (Restoril) for sleep after a bypass. Then the patient moved south or began spending the season here, and the original prescriber retired or stopped writing for patients they no longer see.

The patient often arrives with a pharmacy printout, a medication list from the last annual physical, a pill organizer, and a daily dose that may differ from the one on the bottle. Dr. Leeds reviews all of it: records, pharmacy history, what is actually swallowed each day, and the other medications alongside it.

A new Florida prescriber can do three things with that history. Refill it indefinitely, which keeps the patient stable but leaves the falls, the fog, and the interactions untouched. Refuse it, which sounds principled and can put an older patient into abrupt withdrawal, with the risk of seizures, delirium, and a hospital stay. Or take the prescription over and taper it at a pace the patient can tolerate, which is what Dr. Leeds does. He prescribes for patients in Florida; a seasonal resident who spends part of the year elsewhere should bring that calendar to the consultation.

How slow is slow, and why are the holds longer?

Slow enough that the patient’s own symptoms, not a calendar, decide when the next step comes. The Maudsley Deprescribing Guidelines describe the relationship between dose and effect as hyperbolic: a cut of a given size removes a small share of the drug’s effect at a high dose and a large share at a low dose, so the reductions must get smaller as the dose falls. For an older patient, two more allowances are built in: smaller reductions, because the margin for unsteadiness and confusion is thinner, and longer holds, because an older body takes longer to reach a steady level after a change and longer to settle once there. A hold is not a failure; for a patient in her eighties a hold of several weeks is ordinary. A taper that began on a long-held prescription commonly runs a year to 18 months or longer.

One rule holds at every age: a benzodiazepine is never stopped suddenly, and a taper is never allowed to collapse into an abrupt stop. An abrupt stop after long use can bring on seizures, and the result can be fatal. If a seizure, chest pain, severe confusion, or thoughts of self-harm occur, call 911 or go to the nearest emergency room; for suicidal thoughts, the 988 Suicide and Crisis Lifeline answers at any hour.

How are very small steps measured, and where does the liquid come from?

Near the end of a taper the steps become fractions of a milligram, and no tablet splits that finely. The manufactured diazepam oral solution, 1 milligram per milliliter (1 mg/mL), with its own FDA label, solves the problem for most patients: measured with an oral syringe, it allows reductions of a tenth of a milliliter at a time. Dr. Leeds’ usual practice is to continue below 0.5 mg on this solution down to about 0.1 mg before the final dose, and a small step back up after a cut that proved too much is legitimate. For a patient tapering on a different benzodiazepine, or who cannot take diazepam, a Florida compounding pharmacy prepares a liquid of that medication at the strength the taper needs. Where a crossover to diazepam is part of an older patient’s plan, the Ashton Manual’s own advice applies: judiciously, step by step, and only where it helps.

Pharmacies in Naples, Bonita Springs, Fort Myers, and Cape Coral can order the manufactured solution; it is often not on the shelf, so the first fill may take a day or two, and the prescription goes electronically to the pharmacy the patient already uses. Compounded liquids come from a Florida compounding pharmacy, and its turnaround is built into the plan so that a patient never reaches a cut with no liquid in hand. A written card with the current dose and next step matters in Southwest Florida for a reason beyond memory: hurricane season runs June through November, and an evacuation can separate a patient from the pharmacy that fills the liquid, so the plan is settled by text before leaving, and the usual answer is to hold the dose rather than cut it. The benzodiazepine tapering page has more.

What is benzodiazepine-induced neurological dysfunction (BIND), and what if symptoms outlast the taper?

BIND is the name for the cluster of symptoms, surges of anxiety unrelated to any worry, burning skin, ringing ears, insomnia, gut pain, and a restlessness that will not let a person sit, that the drug itself can cause while it is being taken, during a taper, and after the last dose. In an older patient these are easily misread as a new illness, a heart problem, or the start of dementia, and sorting out what belongs to the drug and what belongs to age is part of each visit. Symptoms still present months after the final dose are called protracted withdrawal; most people improve over time, and nobody can honestly promise how much. The pages on benzodiazepine withdrawal and life after benzos cover this ground.

Which other medications does Dr. Leeds taper for older patients?

The same medication list often holds other drugs never meant to be permanent. The z-drugs, Ambien (zolpidem) and Lunesta (eszopiclone), work at the same receptors as the benzodiazepines and come off by the same slow method. Dr. Leeds also tapers the selective serotonin reuptake inhibitors (SSRIs) such as Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine), the serotonin-norepinephrine reuptake inhibitors (SNRIs), the gabapentinoids gabapentin (Neurontin) and Lyrica (pregabalin), and the antipsychotic Seroquel (quetiapine) prescribed off label for sleep. The Maudsley Deprescribing Guidelines give hyperbolic reduction schedules for the antidepressants and gabapentinoids, the antipsychotics follow the same logic, and a compounded liquid handles the steps a tablet cannot. One medication is tapered at a time, and his role with these drugs is to bring patients off them, not to begin them. Details are on the psychiatric medication deprescribing page.

What else does Dr. Leeds treat for patients on this coast?

Opioid dependence, including dependence that began with a pain prescription, is treated with buprenorphine, the active medication in Suboxone, ZubSolv, and their generic films and tablets. Florida patients start it by telemedicine, the first doses taken at home with phone support; a low-dose start is used when it is needed, which can be the case when fentanyl is involved. Visits are monthly, and weekly when needed. The buprenorphine treatment page explains the rest.

Alcohol often sits alongside a benzodiazepine in retirement, and nightly wine with a sleeping pill belongs in the first conversation. For a patient who wants to drink less without an abstinence pledge on day one, the Sinclair Method uses naltrexone taken before drinking so that the reward fades over time. For a patient who needs to stop drinking completely, the practice can supervise withdrawal from alcohol at the patient’s home with a nurse present 24 hours a day; stopping alcohol and a benzodiazepine together without medical supervision is dangerous.

Other addictions are a conversation for the consultation. No medication exists for stimulant addiction, so whether Dr. Leeds can help a particular person is decided there.

How does concierge telemedicine work from Naples and the Lee County coast?

The practice is a concierge practice, outside the insurance system. Every visit is with Dr. Leeds, never a nurse practitioner, a coach, or a covering doctor. Tapering patients are seen weekly by secure video, often up to an hour, with text access around the clock for urgent questions between visits. Office hours are Monday to Friday, 10 AM to 2 PM. A spouse, an adult child, or another advocate is welcome at any visit and never required.

Geography is why telemedicine suits this coast. Fort Lauderdale is about 100 to 110 miles east of Naples on Interstate 75, with Alligator Alley’s roughly 80 miles of Everglades in between and about two hours of driving each way, longer from Marco Island or Cape Coral. The Fort Lauderdale office at 3290 NE 33rd Street is open to anyone who prefers to be seen in person, but a weekly drive across the Alley is not part of the plan. Visits happen at home, from Marco Island to Cape Coral, and prescriptions go electronically to the patient’s own pharmacy.

The first step is a consultation; it is not a medical visit and creates no physician-patient relationship. Dr. Leeds is an osteopathic physician, sits on the medical advisory board of the Benzodiazepine Information Coalition, and hosts The Rehab Podcast.

Frequently asked questions

I am 78 and have taken Ativan since my husband died in 1999. Is a taper still worth it?

Yes, provided it is slow. The Ashton Manual’s position is that older people withdraw as successfully as younger ones, and the reasons to withdraw, falls, confusion, and memory loss among them, grow with age. The taper would use smaller steps and longer holds, and nothing would be done abruptly.

My Klonopin comes from my doctor in Michigan. Can Dr. Leeds take it over while I am in Naples?

Dr. Leeds prescribes for patients in Florida and can review a prescription written elsewhere, pharmacy history and records included, and take it over as a taper rather than a refill. Seasonal residents should bring their travel calendar to the consultation; for someone outside Florida, a consultation may still be possible.

I take blood pressure pills, a blood thinner, and a statin. Does that change the taper?

It changes the pace and the watchfulness, not the principle. The full list is reviewed before the first reduction, because blood pressure medications add to the dizziness a benzodiazepine causes on standing and some heart drugs slow the clearance of certain benzodiazepines.

Where in Collier or Lee County do I get liquid diazepam or a compounded taper liquid?

Ordinary pharmacies in Naples, Marco Island, Bonita Springs, Fort Myers, and Cape Coral can order the manufactured 1 mg/mL diazepam solution; it is rarely on the shelf, so the first fill is planned a few days ahead. A compounded liquid comes from a Florida compounding pharmacy, and its turnaround is built into the taper.

What happens to my taper if we have to evacuate for a hurricane?

The usual answer is a hold, not a cut. A written note of the current dose and the next planned step goes with the medication, and a text to Dr. Leeds before leaving lets the plan be adjusted. The one thing to avoid is running out. Dr. Leeds also advises keeping a reserve of medication on hand so that a natural disaster such as a hurricane never leaves a patient without it.

Anyone in Naples, Marco Island, Bonita Springs, Fort Myers, or Cape Coral who has carried a benzodiazepine, a sleeping pill, or a psychiatric medication for years and wants a physician who will taper it rather than refill it or refuse it can ask Dr. Leeds for a consultation through the contact form. Consultations are by video for patients anywhere in Florida.

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.