Which Supplements Help With Benzodiazepine Withdrawal and Tapering?

Key Takeaways

• No supplement treats benzodiazepine withdrawal. The treatment is a slow, medically supervised taper, adapted to the person and continued over months, sometimes longer.
• Evidence for any supplement in withdrawal is limited. The Ashton Manual says there is no general need for dietary supplements or extra vitamins or minerals, all of which can be harmful in excess.
• Magnesium is often helpful during a taper but not always, because in some people it makes withdrawal symptoms worse. The decision is made patient by patient with the prescriber.
• B vitamins, vitamin D, omega-3 fats, and coenzyme Q10 help only where a person is actually low in them, because withdrawal is not known to deplete any of them.
• Food comes before capsules. A varied diet with enough protein, regular meals, and plenty of water supplies most of what those products offer, with no risk of taking too much.
• Calming herbs such as valerian, passionflower, chamomile, kava, and the sleep blends built from them act on the same calming system in the brain as the benzodiazepine. They make it hard to tell what each dose reduction is doing, and valerian in particular has been reported to cause withdrawal symptoms of its own when stopped after regular use.
• St. John’s Wort lowers blood levels of alprazolam (Xanax) and some other benzodiazepines, which in the middle of a taper feels like an unplanned dose cut. Kava carries reports of severe liver injury.
• Put every supplement, herb, tea, and over-the-counter product on the medication list, and make one change at a time so that a flare of symptoms can be traced to its cause.

Can a supplement carry a person through benzodiazepine withdrawal?

No supplement treats benzodiazepine withdrawal. The treatment is a slow, medically supervised taper, adapted to the person and continued over months, sometimes longer, and everything below sits underneath that fact.

Patients who ask about supplements usually have a good reason: they were prescribed a benzodiazepine, or a z-drug such as zolpidem that acts on the same receptors, took it as directed, and their nervous system adapted to it. That is physical dependence, and physical dependence is not addiction. It is a medical condition caused by the medication, and its treatment is a gradual taper, not a bottle of capsules.

Evidence for any supplement in benzodiazepine withdrawal is limited. The Ashton Manual, written by Professor C. Heather Ashton, says in Chapter III that there is no general need for dietary supplements or extra vitamins or minerals, and that all of these can be harmful in excess. What follows is clinical experience, which varies from patient to patient.

The taper matters more than anything in the supplement aisle.

Benzodiazepines act on the gamma-aminobutyric acid (GABA) system, the brain’s main calming system. With long-term use the brain adjusts to the drug, and when the dose falls faster than the brain can readjust, withdrawal symptoms appear: anxiety, insomnia, muscle tension, irritability, and after an abrupt stop, seizures in some people.

The 2020 United States Food and Drug Administration (FDA) boxed-warning update says the same thing: stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening. A seizure is a medical emergency, so call emergency services for a seizure or any other medical emergency.

Stopping cold turkey is never the answer. A slow taper gives the brain time to readjust at each step, and the Ashton Manual, in Chapter II, describes reductions of up to one tenth of the dose at a time, with the patient as the best judge of the pace.

Dr. Leeds, an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, builds each taper around that shape and around the person. That means a crossover taper to diazepam (Valium) per the Ashton Manual where it helps, and hyperbolic dose reductions per the Maudsley Deprescribing Guidelines, which make each step smaller as the dose gets lower.

A supplement can, at most, make a person a little more comfortable while that work happens. It cannot do the work.

Which supplements are reasonable to discuss with the prescriber?

Magnesium is one of the supplements patients ask about most. Some patients find that it eases muscle tension or helps them settle at night.

It is often helpful during a taper, but not always: in some people it makes BIND (benzodiazepine-induced neurological dysfunction) symptoms worse, which is why the decision is made patient by patient. Loose stools are the usual limit on how much a person can take, it does not restore GABA receptors, and there is no evidence that a taper drains the body’s magnesium.

Melatonin is the other. It is a hormone the body already makes to time sleep, and whether a small evening dose has a place for a patient whose sleep has fallen apart during a taper is decided patient by patient with the prescriber. It adds a mild sedating effect of its own, which is a reason to disclose it.

A B-complex vitamin, vitamin D, and omega-3 fats come up often, and the honest answer is that they help only where a person is actually low in them. There is no evidence that benzodiazepine withdrawal depletes B vitamins, calcium, or omega-3 stores, so there is nothing known to be lost that a capsule would replace.

Coenzyme Q10 belongs in the same column. There is no evidence that benzodiazepines deplete it or that it eases withdrawal, some patients take it anyway, and it is generally well tolerated. L-theanine, the amino acid from green tea, has a mild calming reputation and little evidence behind it in this setting.

None of these comes with a milligram figure here, on purpose. The right amount, if any, depends on the patient’s diet, kidney function, other medications, and bloodwork, which is what a prescriber’s conversation is for.

Food comes before capsules.

Most of what a B-complex tablet, a magnesium capsule, or a fish oil softgel offers is already in ordinary food. Leafy greens, nuts, seeds, and whole grains supply magnesium. Meat, eggs, dairy, legumes, and greens supply B vitamins, and fatty fish, flaxseed, chia seeds, and walnuts supply omega-3 fats.

A varied diet with enough protein, regular meals, and plenty of water does more for a tapering patient than any supplement, and it cannot be overdosed. The Ashton Manual makes the same point in Chapter III, advising a normal healthy diet without food fads, coffee or tea in moderation, and room for small pleasures. It also notes that overly restrictive diets can have adverse effects.

Calming herbs act on the same GABA system as the benzodiazepine.

Valerian, passionflower, chamomile, lemon balm, lavender, kava, and the “calming” and “sleep” blends built from them act on or near the GABA system, the same system the taper is slowly recalibrating. A taper works by turning one dial down slowly, and a sedating herb is a second hand on the same dial. Unfortunately, the dose reductions then stop meaning what they should, and neither patient nor doctor can tell what is withdrawal and what is the herb.

These herbs are not substitutes for a taper, and they are not free of dependence and withdrawal of their own. Valerian in particular can cause withdrawal symptoms when stopped after regular use, and all of them add to sedation, interact with sedative medications and sometimes with blood thinners, and are not established as safe in pregnancy.

Ashwagandha, oral GABA, and the amino-acid “anxiety” products get the same answer. Oral GABA crosses into the brain poorly, and none of them has evidence for benzodiazepine withdrawal.

Kava deserves its own sentence. In 2002 the FDA warned consumers that kava-containing supplements had been linked to severe liver injury, including liver failure, and kava also acts on the GABA system. So, kava is one to raise with the prescriber before taking it during a taper, and given the liver risk most patients are better off without it.

What else can quietly undo a taper?

St. John’s Wort speeds up the liver enzyme that clears alprazolam (Xanax), triazolam, and midazolam, so blood levels of those benzodiazepines fall. In the middle of a taper that feels like an unplanned dose cut, with the withdrawal symptoms to match. It also interacts with a long list of other prescription medications, which is reason enough to talk it through with the prescriber before taking it during a taper.

Alcohol acts on the same GABA system as the benzodiazepine, and the Ashton Manual, in Chapter II, warns against compensating for a dose reduction by drinking more. Products that raise serotonin, such as tryptophan and 5-hydroxytryptophan (5-HTP), interact with a number of prescription medications and belong on the list a prescriber reviews. Any other prescription medication a patient takes shapes supplement decisions too.

Do supplements fix the swings between Xanax doses?

No. Alprazolam and other short-acting benzodiazepines are cleared quickly, so blood levels rise and fall between doses, and the Ashton Manual, in Chapter II, describes the mini-withdrawal many people feel before the next dose is due. A supplement cannot smooth those swings, because they come from the drug’s short half-life, not from a missing nutrient.

Fortunately, the fix is in the design of the taper. For many patients that means a crossover taper to diazepam, the slowly eliminated benzodiazepine the Manual uses to turn peaks and troughs into a smooth, gradual fall in blood level. Dr. Leeds discusses that option, and its trade-offs, with patients whose main problem is the swing between doses.

How should supplement questions be handled during a taper?

Every supplement, herb, tea, and over-the-counter product belongs on the medication list the prescriber reviews, next to the benzodiazepine. Supplement decisions during a taper are made patient by patient, with a physician who understands the pharmacology and can judge how that person tolerates it.

A sensible rule follows: one change at a time, so that cause and effect stay clear. If three things changed in the same week, nobody can tell which one caused a flare. A supplement is added or stopped on its own, and a dose reduction is made on its own.

Informed consent runs through all of this. Risks come first, including the risk that a product will interfere with the taper, and the taper itself is the exit plan that should have been discussed when the prescription was first written. Alternatives, including taking nothing at all, stay on the table, and the patient keeps the right to decline any suggestion, from a supplement to the next dose reduction.

Dr. Leeds’ practice focuses on medically supervised benzodiazepine and z-drug tapering for patients throughout Florida, paced by the patient and adjusted to the person. Supplements are part of that care only in the sense that everything a patient takes is part of it. Anyone who wants a slow, supervised taper and an honest answer about what else might help can Contact the office today.

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.