Taper planner
Pick a medication, enter the current dose, and pick a taper cadence. The tool prints a week-by-week schedule using the published framework for that drug: Ashton for benzodiazepines, Horowitz and Taylor for SSRIs and SNRIs, ISBD for lithium. Every schedule is a reference framework, not a prescription. The actual taper belongs with the licensed clinician who knows the patient.
Taper schedule
Enter a drug, dose, cadence, and start date to generate the schedule.
Reference data current as of June 8, 2026. Sources: Ashton Manual (Prof. C. Heather Ashton, Newcastle University); Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry 2019 and BMJ 2019; International Society for Bipolar Disorders consensus on lithium.
How to read this
Every dose in the schedule is rounded to the nearest achievable step for that drug (usually the lowest tablet strength). The linear step size gets smaller each cycle because the reduction is proportional. That approximates hyperbolic tapering, which respects the fact that receptor occupancy at low doses drops faster than milligrams suggest. The Horowitz and Taylor papers describe why this matters.
For benzodiazepines, the Ashton Manual recommends switching short-acting drugs to a diazepam equivalent before tapering. Use the benzodiazepine equivalents calculator to convert first, then run the taper on diazepam or clonazepam. Slow is almost always better than fast. Rapid tapers of long-term high-dose benzodiazepines carry a real seizure risk.
Every taper is a conversation with the prescriber. If discontinuation symptoms show up at any step, standard practice is to pause, wait for them to settle, and consider reinstatement of the last tolerated dose rather than pushing through.
About this tool
Tapering psychiatric medications is one of the most under-taught skills in clinical psychiatry. The FDA labels rarely include taper guidance beyond "gradually reduce," and older training materials often assume every drug can be stopped over 1 to 2 weeks. The published literature and clinical experience are clearer: certain drugs (paroxetine, venlafaxine, benzodiazepines, lithium) cause substantial discontinuation problems if tapered too fast, and the frameworks for tapering them have been worked out in detail.
This tool generates a week-by-week reduction schedule using three reference frameworks: Horowitz and Taylor (Lancet Psychiatry 2019 and BMJ 2019) for SSRI and SNRI hyperbolic tapering, Prof. C. Heather Ashton (Newcastle University, updated 2002 and after) for benzodiazepine tapering, and the International Society for Bipolar Disorders (ISBD) consensus for lithium. The tool selects the appropriate framework based on the drug entered and rounds each dose to the nearest achievable step (usually the lowest available tablet strength).
The calculator covers SSRIs and SNRIs (sertraline, fluoxetine, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, duloxetine), benzodiazepines (diazepam, clonazepam, lorazepam, alprazolam), and lithium. Each drug uses the taper framework most supported by the literature: SSRI and SNRI drugs default to standard 10 percent every 2 weeks with a slow option; benzodiazepines use the Ashton method; lithium uses the ISBD cadence.
Three practical points are worth being explicit about. First, tapers frequently need to be paused when discontinuation symptoms show up. That is not a failure of the plan; it is the plan. Second, short-acting benzodiazepines are typically converted to diazepam or clonazepam first before tapering, because interdose withdrawal on the short-acting drug makes the taper harder than it needs to be. Use the benzodiazepine equivalents calculator to plan the conversion. Third, fluoxetine self-tapers because of its long-half-life metabolite; a shorter or no formal taper is often reasonable for that drug specifically. The full clinical context for each of these decisions is in the discontinuation syndromes guide.
Common questions
- What is the Horowitz-Taylor hyperbolic tapering approach?
Horowitz and Taylor (Lancet Psychiatry 2019 and BMJ 2019) proposed that antidepressant tapers should be hyperbolic rather than linear because receptor occupancy at low doses drops faster than milligrams suggest. A linear taper from 20 mg to 10 mg produces less receptor change than a linear taper from 5 mg to zero. Hyperbolic tapering makes proportional reductions (usually 10 percent per step) so the receptor-level change is roughly constant across the taper. This tool approximates hyperbolic tapering by applying proportional dose reductions in a scheduled cadence.
- What is the Ashton Manual method for benzodiazepine tapering?
Prof. C. Heather Ashton (Newcastle University) developed the reference protocol for benzodiazepine tapering. The method converts short-acting benzodiazepines (alprazolam, lorazepam, oxazepam) to equivalent doses of diazepam or clonazepam first, then reduces the long-acting drug by 10 percent every 2 to 4 weeks. The conversion smooths interdose withdrawal, and the slow proportional reductions minimize withdrawal symptoms. Ashton is the reference standard for benzodiazepine tapers.
- How slow should an SSRI taper be?
Depends on the drug and the patient. Standard cadence: 10 percent reduction every 2 weeks. Slow cadence: 10 percent reduction every 4 weeks, indicated when a patient has a history of discontinuation symptoms or is on a short-half-life drug (paroxetine, venlafaxine, duloxetine). Faster: 25 percent every 2 weeks, appropriate only for shorter courses and less discontinuation-prone drugs. Fluoxetine can often be stopped without a taper because it self-tapers via its long-half-life metabolite.
- How is lithium tapered?
Per the International Society for Bipolar Disorders (ISBD) consensus, lithium should be tapered slowly over at least 4 weeks and preferably 3 months, with roughly 150 mg reductions per step. Abrupt discontinuation of lithium substantially increases the risk of recurrent mania and suicide relative to slow tapering. The ISBD recommendation is one of the strongest in psychiatric pharmacology.
- What if discontinuation symptoms occur during the taper?
Standard practice is to pause the taper, wait for symptoms to settle, and consider returning to the last well-tolerated dose. For severe or persistent symptoms, reinstatement to the last tolerated dose is often the right choice rather than pushing through. Tapers are not competitions; the goal is to get off the drug while keeping the patient functional. See the discontinuation syndromes guide for full detail on presentation and management.
- Is this schedule a personalized medical recommendation?
No. It generates a mathematical taper from published cadences. It does not account for patient history, prior tapers, current stress or life events, concurrent medications, or symptom trajectory. Every taper decision belongs with the licensed prescriber who knows the patient. This tool is a scheduling aid for a conversation with that prescriber, not a substitute for one.