What's the best way to switch gradually from Xanax to Klonopin?

[Duffo]

I have long taken 3.5 mg Xanax and 4 mg Klonopin together in a single dose at bedtime. My psychiatrist who treated me for many years retired. I had a visit with a new psychiatrist who predictably was appalled that I was taking two different benzos at the same time. He wants me immediately to stop taking all Xanax and substitute additional Klonopin. (Stop 3.5 mg Xanax and add no more than 2 mg Klonopin.)  He offers no clear or definite plan for how to make that switch, basically saying I can experiment. I'm worried about how any abrupt change will affect me. I intend to proceed with the switch but believe that it should be done gradually in steps. I've researched things like equivalency charts and half-lives. In the absence of other guidance, I plan to devise a stepped transition of some kind and see what happens. Suggestions for such a plan would be appreciated.  

I add the following so that members here are aware of my viewpoint. I know about and understand opinions underlying alarm over the dangers and effects of benzos. These drugs have worked well for me, however. Two experienced, well-qualified, and independent psychiatrists treating me for many years had the opinion that prescribing these medications is appropriate for me in light of my circumstances. Taking them alleviates severe symptoms and allows me to live a normal life, which was imposible before. Lengthy use of these drugs at these doses hasn't caused adverse effects, as confirmed by my psychiatrists and others. I previously discontinued them completely and took none for a few years, and the results were catastrophic. After careful consideration and consultation with professionals in the field, and with knowledge of potential or theoretical risks I've not yet experienced, I intend to continue taking them.

[Paxiled]

I'd be appalled as well, but when you say you've been doing this for years under a doctor's care and it worked for you and you've had no adverse consequences, I'm wondering why change now?  If this appalling combination was going to affect you adversely it would have done so already.  I can't imagine anyone doing this, as you've probably totally burned out your brain's ability to adapt to stress and your GABA system is probably toast, or else you just have an iron constitution and can do just about anything.  There are people like this, like people who can eat the hottest peppers and love them.  To me, any damage has already been done if there has been any, so again, why change now if it's working?  I'd consult a different psychiatrist and get a second opinion.  If you do stop one of the benzos, I'd do it very very very slowly -- you're on very high dosages and the current psychiatrist is putting you on a very high dose of clonazepam, which seems to me to be as dangerous as what you're already doing.  But you don't want to go through the withdrawal that's likely to happen if you just stop, although given your ability to handle what you're taking now, maybe you're just immune to the side effects of benzos.  I'd play it safe if it were me.  I have to tell you, I had a quack put me on Xanax while I was on clonazepam, and it gave me a nice new set of phobias to go with the ones I already had.  Very stupid experience for me, at least.

[Duffo]

Thanks for your feedback. I'm sorry you had a bad experience with this combo. I agree that because I've been taking this combination for so long, I don't see good reasons for stopping it. At least two other psychiatrists I've consulted also said the drugs cannot be combined, but they each had different solutions. I think you may be right that it takes a lot to affect me. One of my psychiatrists once said that it's like I'm always plugged into an electrical outlet. In any event, everyone's different--something a lot of doctors seem not to get. My brain may be fried as you say, but I'm still going and at this point I don't have much choice. I also agree I should pursue a gradual reduction/transition. I'm just not sure how best to do it.

[Paxiled]

Is there any way you can find a doc who will let you just keep doing what you're doing?  I mean, it's been working.  I wish I cold find something that worked!  Every so often someone comes on this site and is on, like, 6 or 7 drugs that would sedate a hippo to eternal rest and they're doing just fine, going to work every day.  They come here concerned, and should be, and it would be better if you could get off one of the benzos, but if the cost is going to be increasing the other benzo to very high levels, again, have you improved your health situation any?  This is what I'd want to have a good long sit down with my psychiatrist about -- what's the real health difference between doing what you've been doing without apparent harm and quitting one to take a whole lot of the other?  If you are a normal person in any way, eventually that clonazepam is going to reach tolerance, and quitting it will be very hard.  Wish I knew more about the true consequences, but nobody actually does know -- we're pretty much guinea pigs for these drugs.  Good luck whatever you do and just be safe and slow about it, don't let them rush you.  Take it at your pace, whatever that turns out to be.  

[Duffo]

Thanks.  I agree with everything you're saying.  Unfortunately, after consulting with three psychiatrists, they all have opinions that combining the drugs is unacceptable for various reasons.  Although it's unclear to me, the consensus seems to be that the effects of the drugs increase geometrically when combined and/or that Xanax is worse and more "addictive" than Klonopin.  Obviously I'm tolerant to both of them and will simply transition to tolerance of a larger dose of the other, assuming I can accomplish it.  One psychiatrist insisted I stop taking both drugs in a very short period of time, another wanted me gradually to stop taking all the Xanax, and the third had the plan described above.  If I keep looking for someone who agrees not to change anything, undoubtedly someone will accuse me of doctor shopping and I'll end up on some blacklist.  I agree it would be nice if I could stop one or both of them while still resembling a functional person, but that's a lot easier said than done.  My prior experience doing exactly that did not go well and ended far worse, even after years of abstinence.  I am one of those hippos you mention and am generally unfazed by most things.  The other medications I take don't concern anybody even if they should be.  They're all just obsessed with benzos and disregard the fact I've been stable on the same dose of them forever.  I didn't ask to be prescribed them, and I can't go back and refuse.  I'm not sure I would in light of my history.