Klonopin Taper

[benzo2205]

Hi. I have been on 2mg of Brand name Klonopin (0.5mg 4x day) for about 28 Years. I have done much research on tapering off the medication and most of the benzo support groups online have the most horrible withdrawl stories.
I do not discount their stories in the least and have empathy for their pain. But I was wondering on how to taper in a method with bearble withdrawl symptoms if that is even possible.

I saw some posts by Ryan (Rca?) that mentioned a formula, to use your own tablets, with a motor & Pestle and a really sensitive digital scale to have a smooth slow taper. I was going to use the water titration method until I found out that Klonopin is not soluble in H20 or Milk. I am also familiar with the Ashton Valium crossover method.

  In my mind a micro digital scale/motor & pestle/ Empty Capsules and Ryan's formula 0.5/(weight of tablet)=0.0625/x seems like the way for a nice slow taper.
I am most concerned about Gaba down regulation/ and my neurotransmiters "rebalancing" so I don't get a dopamine overload with the presence of too little Gaba. Any suggestions on a Taper schedule based on the length of time/dosage that would allow me to successfully taper without the "benzo hell" that some people have unfortunately suffered through. I have all the time in the world to taper so the slower the better unless anyone has evidence that too slow of a taper is not beneficial in some way.  Thanks.

P.S.  Are there some cases where it is more beneficial for people to stay on medication for life? Is Tolerance Withdrawl a real concern? I was never told Klonopin was addicting I have always taken it as perscribed (I was convinced at the age of 13 that I should take it even though I was against taking any medication), I truly feel foolish for being on this medication for this long now that the prescribing information says it should not be used for more that 4-6 weeks-  at this point that only reason I take it is to avoid the lengthly list of withdrawl symptoms that sound like some type of psychotic episode that can last for months even years in the case of protracted withdrawl syndrome. I called the Roche Scientific phone number and they have a withdrawl schedule that seems rather fast.

Sorry for so many questions. I have been thinking about this decision for awhile.

[Ryan7591]

Hello,

I think, perhaps, the first question that needs to be answered is...how are you currently feeling? Is your anxiety or panic currently under good control? The answer to this question is important, for if it is "no", attempting to taper off of Klonopin at this time will only result in a reemergence of your original symptomatology. Ideally, one should be asymptomatic or largely asymptomatic before making the decision to discontinue Klonopin.

If your anxiety or panic is transient (or virtually eliminated) and has remained so for an extended period, the further use of Klonopin should be questioned. The literature states that no long-term studies have been conducted beyond a period of nine weeks in the treatment of panic disorder. The literature also states that the usefulness should be reevaluated every four months. That is not to say that Klonopin loses its efficacy over the long-term, however (it rarely does, particularly given your low dose). As with any pharmacological treatment, the benefit must be obvious and outweigh the potential risks. The risks of long-term Klonopin use are cognitive dysfunction, depression, motor impairment, hepatic dysfunction, and blood dyscrasias. The latter two are extremely rare.

Should you no longer feel that Klonopin is of benefit, the first step would be to consult with the prescribing doctor, and make your intentions known that you desire to discontinue the drug at your own pace. The average physician or psychiatrist will follow the Roche discontinuation rate of 0.125 mgs, b.i.d./three days. While this rate of discontinuation is "safe" (safe as in convulsions are unlikely to be produced), the rate is typically far too fast to prevent withdrawal symptoms in a user of twenty-eight years.

The efficacy of Klonopin, as it pertains to anxiety disorders, is appreciated within the first one milligram. Dosing beyond this point is less likely or unlikely to produce any additional benefit. Therefore, discontinuing the first milligram will be easier. This may be withdrawn at a rate of 1/8 mg (0.125 mg) every four weeks (starting with dose #3) until the dosage has been reduced to 0.5 mg, t.i.d. At this point, the Klonopin should be dosed every eight hours. There will be no withdrawal at this stage.

Throughout the remainder of the taper, I would suggest that you remain on a t.i.d. schedule, as the accumulation produced from t.i.d. dosing will result in an even plasma level decline of the drug. This will minimize symptoms.

-Weeks 1-4: Take 0.5 mg of Klonopin in the morning, 0.375 mg of Klonopin in the afternoon, and 0.5 mg of Klonopin nightly. Total dose = 1.375 mg

-Weeks 4-8: Take 0.375 mg of Klonopin in the morning and afternoon. Take 0.5 mg of Klonopin nightly. Total dose = 1.25 mg

-Weeks 8-12 Take 0.375 mg of Klonopin three times daily, spaced eight hours apart. Total dose = 1.125 mg

To this point, each reduction has been in 1/8th milligram increments. The remainder of the taper will be in 1/16th milligram (0.0625 mg) increments, which requires the use of an accurate scale, empty gelatin capsules and a mortar and pestle.

The tablet is to be weighed, and its weight recorded. With two known variables (the weight of the tablet, and the content of the active ingredient), it is possible to determine the precise amount of tablet to use.

The idea is to reduce the 0.375 mg dose by 1/16th, to 0.3125 mg.

Example - The tablet weighs 500 mg (0.5 grams)

0.5 mg / 500 mg = 0.3125 mg / X

X = 312.50 milligrams of the tablet contains 0.3125 mg of Clonazepam. This is the amount of the tablet that would be placed into the gelatin capsule and consumed. One tablet will be required daily/four weeks, which means you would prepare a supply of 28 tablets containing 0.3125 mg. Keep these in a pharmaceutical container to preserve the potency.

-Weeks 12-16: Take 0.375 mg of Klonopin in the morning, a prepared capsule in the afternoon, and 0.375 mg of Klonopin nightly.

*Manufacture 56 prepared capsules at this point.

-Weeks 16-20: Take a prepared capsule in the morning and afternoon, take 0.375 mg of Klonopin nightly.

*Manufacture 84 prepared capsules at this point.

-Weeks 20-24: Take three prepared capsules every eight hours.

At the end of week twenty-four, you will be required to prepare an additional 56 capsules containing the same amount of Clonazepam (the dosage of the capsules is not yet alterted).

-Weeks 24-28: Take one capsule in the morning, 0.25 mg (1/2 of a Klonopin tablet) in the afternoon, and one capsule nightly.

-Weeks 28-32: Take 0.25 mg of Klonopin in the morning and afternoon, and one capsule nightly.

-Weeks 32-36: Take 0.25 mg of Klonopin three times daily (every eight hours).

At the end of week thirty-six, a new capsule strength is made (0.1875 mg). Use the same formula as outlined above.

I believe you get the concept - reduce 0.0625 mg from the total daily dosage every four weeks until the drug is discontinued. In total, there will be three capsule strengths. The dosage reductions are rotated  from afternoon, morning and night- just as outlined in the above example.

You will always read horror stories, and in each case there was a causative factor for those stories. Folks abused the drug, combined it with alcohol or other drugs, abruptly discontinued the drug or abruptly ceased taking the drug. Klonopin is predictable, and when tapered properly, there is no cause for concern.

As far as homeostasis (the return to baseline) is concerned, any drug that alters brain chemistry will produce some degree of imbalance upon discontinuation. This is to be expected. To minimize the imbalance, a gradual discontinuation is required.

Klonopin inhibits the CNS and blocks reticular formation. It also acts on the limbic system. Since the drug inhibits the CNS, improper discontinuation will lead to a state of temporary CNS hyperactivity - the result being Catecholamine surge. The three main Catecholamines are Dopamine, Epinephrine and Norepinephrine. Secretion of Dopmaine is associated with psychosis, while secretion of E and NE are associated with autonomic dysregulation (elevated blood pressure and pulse, hyperventilation, and typical anxiety-like symptoms). And since GABA(a) receptors are found in the smooth muscles, it would not be atypical to experience abdominal distress, shortness of breath, muscle spasms, weakness and other muscle involvement. Should any of the aforementioned symptoms present, the rate of taper should be reduced.

I hope that I have answered your questions adequately. Keep in mind that as with any drug discontinuation schedule, it is to be peformed under the knowledge and supervision of a medical doctor.

The rate at which you taper should be individualized for your needs, and your needs only.

Best of luck to you,

Ryan

[greenlydia]

So glad you apparently made it to the place you had to go without hauling around any dead weight.
Funny, but I don't have a single question to ask.
Greenlydia

[abby10]

Hi,
Just a note, I've tappered with klonopin and then switched to valium. Valium was much smoother, I really noticed a difference. It took about 14 or 15 days to feel the full effect. There would need to be a proper "cross over" from the klonopin to valium. Klonopin is also a good choice, I've just experienced valium to be even gentler.

I'm Sorry you were put on those drugs when you were only 13!

abby

[benzo2205]

Ryan,

Thanks for the detailed response. You are a very insightful, rational person who seems to know a lot about this subject matter.

To answer your question I still do have anxiety in my life, not any more panic attacks after being on the Klonopin, but my anxiety level tends to vary from a 1 to a 7 on a scale of (1-10) depending on life events. So i would say the Klonopin has a beneficial effect that maybe I have forgotten about since I have taken it for so long, and when I experience higher levels of anxiety I believe it is the Klonopin not working, tolerance withdrawal. I need to accept my original diagnosis and be glad to live with the tolerable level of anxiety I have most of the time.

I wanted a slow taper schedule for 2 reasons. The new doctor I just switched to has an aversion to perscribing benzodiazapines for anxiety (maybe because she is a DO), she prefers SSRIs which I have tried in the past, and they make me feel 10x worse, it seems to speed up my CNS when I need it slowed down.

I think I need to switch to a doctor that is a little more progressive and realizes "if it aint broke don't fix it".  I can see me tapering off the Klonopin and having my original GAD symtomology come back, and where do I go from there?

The SECOND reason I thought about tapering is Tolerance withdrawal. I need to know if you have any evidence that this even exists. I guess it is when you are still on the medication and experience withdrawal symptoms as if you had stopped taking it. I asked a doctor once and they said they did not think that was even possible.
But i figured if it is real I should taper now before that happens.

In any case thanks for the taper schedule, if I decide or need to taper I think that it makes the most sense in so many ways.

Thanks again,

John

[benzo2205]

Hi Abby,

Thanks for sharing the Valium crossover experience. It may come in handy.
Did you use the Ashton method, or Dr. Peart?

I know 13 right? You would think they would need a parents signature or for me to be of legal age to put me on that type of medication. Oh well, thats the past and I think living in the moment might help me more :-)

John

[abby10]

I never herd of Dr. Peart. But I am curious and will look into it.

I used my own withdrawal schedule, called the cold turkey-seizure method. Then the only take a xanax till you can't stand it any more method. After a year of this I finally found out (not by the medical proffession) that you need to tapper very slowly. By then the damage was done. I finally stopped the xanax and started the klonopin "abruptly" it HURT a lot. Then abruptly stopped the klonopin and started valium, it HURT a lot. But then I leveled off.  As you may know, you need to tapper-in the valium and tapper-out the klonopin, not just stop one and this start the other.  

My original prescribing doctor told me I would have to stay on xanax for life.  Sometimes I wonder who needs the help... the patient or the doctor.

Good luck with everything. I'm glad you have become well informed.

abby

[abby10]

Sorry... to answer your original question, I used ths Ashton method. I wish I had read it a year before I did.

abby

[Anonymous0001]

Not to scare you but the benzos are the hardest drugs in all of medicine to detox from. I was on klonopin for over 9 years when the drug just quit working for me. I spent 30 days in a psychiatric hospital and even attempted suicide once b/c the pain was just so unbearable. I can not even begin to describe what you feel. Anxiety and panic are intensified 100 fold and I am not joking and the withdrawals never seem to stop. I was still suffering after being discharged from the hospital. If the klonopin you are taking still works and you are not experiencing any interdose w/d, I would just stay on the medicine. If you decide to get off, use the Ashton protocol using valium. Even with a slow -  ultra slow taper, you will still go thru hell and for a very long time I might add. They say expect w/d to last about a month for every year you have been on the drug once you are off and I believe this before you start seeing windows of relief. Benzos are wonderful meds IMO and work great for PD but should be reserved for short periods of brief durations to avoid becoming physically dependent on the medication. Many ppl can not stop taking the benzos after many years of use. Many take them just to stave off w/d's even tho the drug has lost most of its effectiveness. Good luck to you whatever you decide.

[benzo2205]

I believe you. I searched the internet for the hardest drugs people have ever had to come off of and Benzos won by a mile. The reason is they are synthetic and so concentrated.
Most people would say Heroin is the hardest but its an orgranic substance, so its actually easier to quit cold turkey than Benzos.

How many milligrams of Klonopin were you on and how long did you taper?
Are you still experiencing withdrawl symptoms now?

[Anonymous0001]

I never had a chance to taper. The drug started working less and less and then finally quit altogether. I was essentially forced into a C/T detox. I was given gabitril to prevent seizures and inderal to help slow my heart down. I only took .5 mgs  of the drug for most of the 9 years I was on it until near the end when the drug started not to work. When this occurred, I started eating .5 mgs tablets every hour just to try and stop the suffocating fear, panic, anxiety, and withdrawals. Obviously, I could not keep doing this and finally ended in a psychiatric hospital where I stayed for almost a month. Thank god I had insurance or IDK what would have happened to me. I was so bad when I got out of the hospital, I ran to my PCP and begged him to put me on valium and there I stayed for nearly 2 years until the valium quit on me. The w/d from valium were horrible but nothing compared to klonopin. I took xanax for 8 years prior to klonopin and xanax w/d's were very close to klonopin in intensity but I consider K far, far worse. Try never to let your body become dependent on benzos. Some ppl can never get off of them...sick on the med and even sicker trying to get off. I have been off all benzos for 6 months and still feel horrible and have a myriad of symptoms....a lot from my original PD and GAD comeback.
I am still taking the AD lexapro but I think most SSRI's are useless for anxiety. I personally have never had in success w/them but YMMV.