Klonopin Taper Question for Ryan

Ryan,

I am trying to reduce Klonopin by 0.125mgs per month(1/4 of a 0.5mgs tab).  I have come from 2.0mgs on February 14th 2008 to 1.50 mgs as of June 1st, 2008.  I take the Klonopin t.i.d. as you recommended to others.  My goal is to steadily reduce to zero and then use Xanax PRN no more than once or twice a week for Panic Disorder.

I am now taking about 15mgs or Timolol per day for heart palps and transient hypertension.  I also have recently in the last two weeks reduced my Ambien CR 12.5mgs to no more than 3 nights a week.  If I have a rough day I may take a 0.5mg Xanax PRN but never more than 0nce or twice a week. I also take 15mgs of Remeron.

I have suffered PAD/GAD for over 12 years since a divorce and have been on and off benzos since then with periodic breaks   I have been on benzos daily for almost two years due to a stressful life event but now but don't want to take them daily. In 2004-2006  I had a good 18 month  period when I only took Xanax 0.5mgs PRN occasionally no more than once or twice a week or less and this was when I felt the best.  I'm trying to get there again.  Tapering seems so very hard at times.  I have brief "windows" of normalcy.  

I figure it will take me about a year to taper the Klonopin to zero reducing 0.125mgs per month.

Question: with reducing each month do you think I am allowing my body enough time to stabilize or should I go slower. Even at this rate of reduction I have a good deal of symptoms. I have recurring symptoms of "muscle ticklishness" that come and go as well as periods of dizziness or derealization as well as heart palpitations and periodic insomnia not to mention muscle cramping and queasiness.  Also, I get LarygoPharyngeal reflux causing neck pressure and occasional shakiness or mucsle weakness.  

Is this just normal with reducing or could I be one of those who are better off staying on a constant dose of Klonopin "long term" as a preventative?  I am 52 years old and have a rather stressful job but have reduced my work week to 3 days now.  I hate taking medicine except in desperation.

Toothartist

[Toothartist]

Ryan,

Once again I am amazed and humbled by your deep knowledge of pharmacokinetics and drug to drug interactions.  You have an incredible knowledge! You truly have more knowledge than almost all doctors I have consulted...and I have met many.  I have read nearly all of your posts in the archives and am impressed. You taught me things I never knew all these years even though I am a health professional.  You should go to medical school.  

Therefore, I am extremely appreciative of your opinions!  Of course I will not do anything without discussing it with my psychiatrist.  However, your knowledge is very helpful in talking with him.

Thank you!  

To answer your questions about why I was prescribed the various agents:

1.  REMERON:  I have been on Remeron for at least 8-9 years for anxiety and periodic depression related to anxiety.  Tried all the SSRI's but they were much too excitatory like putting lighter fluid on a fire and severely aggravated my anxiety disorder.  At first Remeron was used for sleep but this effect quickly waned.  I was afraid to go off of Remeron as it seemed to help me be more emotionally stable according to my wife.  I usually only took 7.5 mgs the entire time until about 6 months ago when I raised it to 15mgs when I had a couple bouts of momentary (hours) depression related to anxiety.  Actually my psychiatrist wanted me to keep it at 7.5mgs because at higher levels it increased norepinephrine and could aggravate my panic disorder.   What if I tapered it back to 7.5 mgs ....would this be enough to cause reduce or eliminate the problems with hypotension?

2.  KLONOPIN:  In Fall 2006 I started Valium at about 15 mgs about 2 years ago when I was having a recurrence of almost daily panic attacks precipitated by a stressful life event but I immediately tried to taper off unsuccessfully (Probably too fast).  I had bad panic attacks and episodes of shakiness which is not good for the type of work I do.  This scared me even more and compounded the panic. After about a year and a half I was up to 18mgs of Valium and feeling terrible.  Either Valium did not help panic disorder or I was constantly in withdrawal because I was always trying to reduce it.  I decided to change over to Klonopin since it was a high potency benzo and took 1mg daily immediately substituting the Valium.  Within 3-4 days had bad panic attacks and upped it to 2.0 mgs to see if I could feel better. It did feel somewhat better in a few days.  Now I know from your posts I did not give it enough time to reach a stable blood level nor did I dose it t.i.d.  So now in February 2008 I began slowly reducing Klonopin with the goal of getting off it.  I wanted to be off entirely and only use Xanax  PRN as I did before.  This worked well for me in the past and I was afraid that I might develop tolerance to Klonopin long term.  Perhaps this is false fear.

On days when the withdrawal seemed bad I have been using 0.5mgs Xanax but no more than 2 times a week.  Is this OK during withdrawal?

3.  AMBIEN:  The insomnia of withdrawal made going to work hard so he gave me Ambien IR or Ambien CR whichever I wanted.  I have reduced this over the last couple of weeks.  Actually, I have not taken it more than 3 times a week over the last two weeks with some of the rebound insomnia beginning to wane.

4.  Blocadren came in the last 6-8 months to reduce periodic bouts of shakiness that I have had during withdrawal and for heart palpitations. It has also given me normal blood pressure.  Was in the upper130s/90 range before.  With 15 mgs of Blocadren it is about 128/80.  Was prescribed 5-10mgs b.i.d. but I took less.  My Psychiatrist likes it better than Tenormin or Inderal because he says they make people feel too down or flat....prefers Blacadren.

  I have been afraid to take too much Blocadren because I heard beta-blockers could cause sexual dysfunction so I was leary of taking too much.  Do you think that Blocadren would cause sexual side effects?  Does Klonopin?

Thank you again for your thoughts!

Toothartist