To Gina

[RCA7591]

Gina,

Good to see you posting again.

1 1/2 months is a good stabilization period. You can begin a taper regimen under the supervision of a medical doctor.

To perform the taper properly, you will need access to the 0.5 mg tablets (the 1 mg tablets are no good). If you don't have these yet, obtain them from your doctor.

I would start the taper on the 1st of September, and would follow this regimen:

-September 1, 2007 - Cut 0.125 mg (1/4 of a 0.5 mg pill) from the *evening* (or center) dose. The morning and night dosages will remain the same. The only dose you are altering is the *evening* dose.

-September 29, 2007 - Cut 0.125 mg (1/4 of a 0.5 mg pill) from the *morning* dose. You will now be taking 0.375 mg in the morning, and in the evening. The night dose will remain at 0.5 mg.

-October 28, 2007 - Cut 0.125 mg (1/4 of a 0.5 mg pill) from the *night* dose. You will now be taking a dosage of 0.375 mg three times daily. The drug will reach a new steady-state and accumulation, allowing you to stabilize very gradually.

-November 25, 2007 - You will now take 0.25 mg in the evening (1/2 of a 0.5 mg pill). The morning and night doses will remain at 0.375 mg (3/4 of a 0.5 mg pill)

-December 21, 2007 - You will now take 0.25 mg in the morning (1/2 of a 0.5 mg pill), as well as in the evening. The night dose shall remain 0.375 mg (3/4 of a 0.5 mg pill)

-January 23, 2008 - You will now take 0.25 mg three times daily (1/2 of a 0.5 mg pill). The drug will reach a new steady-state and accumulation, allowing you to stabilize very gradually.

-February 20, 2008 - You will now take 0.125 mg in the evening (1/4 of a 0.5 mg pill). The morning and night doses will remain at 0.25 mg (1/2 of a 0.5 mg pill)

-March 19, 2008 - You will now take 0.125 mg in the morning (1/4 of a 0.5 mg pill), as well as in the evening. The night dose will remain at 0.25 mg (1/2 of a 0.5 mg pill)

-April 18, 2008 - You will now take 0.125 mg (1/4 of a 0.5 mg pill) three times daily. The drug will reach a new stead-state and accumulation, allowing you to atabilize very gradually.

-May 16, 2008 - The evening dose of 0.125 mg is eliminated. You will now take 0.125 mg twice daily (monring and night)

-June 13 2008 - The morning dose is now eliminated. You will continue to take 0.125 mg of Klonopin only at night.

-July 11, 2008 - The Klonopin is completely withdrawn.

-October 22, 2008 - Your body is now 100% free of Benzodiazepines, and it is safe to try and conceive.

Please print this out! (and good luck).

Ryan

[heartfluttersflyawayplz]

wow ryan your to awesome top take the time and do this it just blows my mind that a 25 year old cares for others like you do. thanks for being around and caring

[Ginasouthcarolina]

thank you so much i will print this out and i will begin to post my weening to help others..thanks again i dont know what i would do without you:)...Gina

[Gingin515]

Hi Ryan.  Can you explain what 'steady state' means.  I guess I am confused since klonopin has such a long half-life what the difference is in taking it once a day, twice a day, or three times a day.  Also, is taking more than once a day better?

Thanks!

[RCA7591]

Gina,

Good luck to you (and let me know if you have any issues).

Gingin,

Steady-state means "without change". Klonopin carries a 50-hour half-life (which is moderate). When dosed twice daily at 0.5 mg, Klonopin reaches a steady-state blood plasma level of 15 ng/mL on average. In one month, the plasma level accumulates to 1.5 times that of the steady-state figure (which is why Klonopin should not be tapered more rapidly than every four weeks). Steady-state is maintained, provided the drug is taken every 12 hours. Since the plasma level does not change, Klonopin is the ideal treatment for panic disorder and panic attacks, as it largely prevents them before they can recur.

Dosed three times daily, the following variables change: (1) The plasma level is increased to 18-20 ng/mL, and (2) The drug accumulates to 3 times that of the steady-state figure in one month.

When Klonopin is dosed once daily, it does not reach steady-state or accumulate. The therapeutic effects of the drug only last for about 12 hours. The plasma level peaks at 2 hours (7.5 ng/mL), and the plasma level troughs sharply. Since there is no steady-state or accumulation, the therapeutic effects are short lived. While Klonopin may carry a 50-hour half-life, the therapeutic effects are only beneficial for 12 hours, which is why the drug is dosed twice daily or three times daily for the maintanence of anxiety disorders.

Taking it more than once daily is better if you suffer from a long-term disorder, such as GAD or Panic Disorder. The effects are maintained through the principals of steady-state and accumulation.

Ryan

[Ginasouthcarolina]

hi its me again one more ? i still have breakthrough anxiety and i take it three times a day. should i have waited to ween off till i didnt have this..im not sure it will stop even if i went up in dosage..and i dont want to do that...if im still having breakthrough anxiety and im on the med im afraid ill never be ok off of them ....can you give me any advise or insite...thanks...Gina

[RCA7591]

Gina,

You always will have some residual "breakthrough" anxiety, regardless of the dosage. Nothing offers a 100% "cure all".

In short, you are well stabilized on the Klonopin, should you decide to taper off of it. The taper regimen will keep you stable until the drug is withdrawn completely.

If you still wish to try and conceive, you ideally would want to be free of Klonopin and any other psychotropic drugs. If you still have anxiety issues after the pregnancy, you could always reinstate the Klonopin at that time. Obviously, this is one trade off that would be well worth it in the end. Benzodiazepines such as Klonopin carry a high risk of birth defects (Pregnancy Category D), and the risks outweigh the benefits in my opinion.

Ryan

[Ginasouthcarolina]

hi thanks i figured that it was normal for me to still be having anxiety..and i did get the ..5 mg from my doctor so i will start my taper on the 1st...wish me luck..lol.....and ps i agree with you i dont think you should take any benzo's while pregnant thats just my opinion..but thanks for the advise i will follow your instuctions....my doctor  (as with all doctors) wants me to ween off much!!! faster than you so i think i will ween slower like you had sudgested..thanks i will keep u posted...Gina