how to taper correctly from clonazapam

[liza220]

   hello everybody. im new to this forum and my name is liza. ive read alot about anxiety and how to withdraw on your forum. im an older woman in her 60s and have been taking 0.5 milligrams of clonazapam for a year now.i take .25 in the morning and .25 in the evening. i would like to know if anyone can help me with a good taper plan. i would like to get off this benzo but with proper advise and of course safe advise. talking with my md doesnt help so if anyone has any advise i would appreciate it.ive read some of ryans suggestions but would like some help.i thank you very much liza

[Ryan7591]

To be performed ONLY under the direct supervision of a medical doctor...

Weeks 1-4: Take 0.125 mg (1/4 of an 0.5 mg tablet) of Clonazepam in the morning, and 0.25 mg nightly.

Weeks 4-8: Take 0.125 mg of Clonazepam in the morning and nightly.

Weeks 8-10: Take 0.125 mg of Clonazepam every other morning. Continue to take the nighly dose of 0.125 mg.

Weeks 10-14: The morning dosage is discontinued. Take 0.125 mg of Clonazepam nightly.

Weeks 10-12: Take 0.125 mg of Clonazepam every other night.

Weeks 12-14: Take 0.125 mg of Clonazepam every third morning.

Week 14: The Clonazepam is discontinued.


-Ryan

[Ryan7591]

I may also point out that 0.125 mg (1/8 mg) wafers (both brand name Klonopin and generic Clonazepam) are available for this purpose. There is no reason to cut 0.5 mg tablets into quarters, although you certainly could if need be.

Accuracy is key, and I would strongly recommend the wafers over the tablets for discontinuance purposes.

-Ryan

[liza220]

i thank you very much for your reply. you seem to have more knowledge than most doctors.have you ben through this experience with clonazapam? i also take 50 milligrams of zoloft for depression.would there be a difference if i cut in quarters compared to the wafers? also would i have bad withdrawel symptoms with your schedule?  i ty very much ryan

[Ryan7591]

I have indeed experienced the pleasure of discontinuing Clonazepam, albeit from a far higher dosage. I  used it for roughly two years, at a daily dosage ranging from 1.5 - 4 milligrams. When I began to taper off of it, I was taking 0.5 mg, three times daily. I experienced no symptoms what-so-ever until I began to reduce the dosage below 0.5 milligrams. A month after reducing my final cut of 0.25 mg (I made larger 1/4 mg reductions), all hell broke loose. From August of '08 until late December of '08, every one of my original symptoms returned ten-fold, and on top of those, new symptoms. This vanished slowly over four months.

Will you have bad withdrawal symptoms if you follow my schedule? I can't answer that question, nor could anyone else. Everyone is individualized. You may experience nothing more than insomnia, or you may experience far more. The dosage is low, however, and that is one thing in your favor. But the schedule has been designed with the pharmacological properties of Klonopin borne in mind. Most physicans would tell you to reduce the dosage by 0.25 mg every three days, which is no good. This drug accumulates to 1.5 times that of the steady-state plasma level (the level of drug in your blood that remains constant). It does this after one month of use, so long as it is dosed twice daily. Logic suggests that discontinuing the drug should follow the same path - hence the one month reduction rates. Two weeks following a reduction, the accumulation factor is eliminated, after which point the remaining amount of the drug decreases to its steady-state level. If withdrawal symptoms occur, they will occur after a span of two weeks following a dosage reduction, as the steady-state level begins to decline, and there is no accumulation factor to maintain it. After a span of two weeks, the drug is reduced to a new steady-state level, which is again subtracted from. To minimize withdrawal during this phase of the discontinuation, my recommendation above is to take the drug every other day over a two-week interval, This allows for a more gradual decline in the plasma value. Lastly, during the final two weeks, the drug is taken every third morning, as this approximates its terminal half-life. Again, the rationale is to allow for a gradual reduction before the drug is completely discontinued.

Given the low dosage and the plan devised above, you should have little in the way of withdrawal symptoms. Rebound would be more common (a rebound of your original "condition"). However, there is a possibility that you will experience something in the way of withdrawal. There are no absolutes with these drugs, and what looks good on paper doesn't necessarily eliminate the symptoms, although it will most certainly minimize them.

There is no difference between cutting the tablets into quarters or using the wafers, so long as the tablets are cut with some degree of accuracy. Using the wafers would be less "sloppy", as you'd be guaranteed the correct dosage each time. I wouldn't expect the Zoloft to be an issue (it's not a large dose), but it may need to be reduced once the Clonazepam is discontinued. Again, it would depend on the person.

Good luck,

Ryan