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Avatar universal

Having to withdraw from Klonopin, direct taper-diazepam or ??

This is not a real case of substance abuse since I took the drug as prescribed, but I cannot find a better place so I am posting this question here.

I have been on the drug for about 10 years, for over 5 years at 2 mg a day, taken in the evening.
Prescribed as a muscle relaxant and for neuropathic pain but that is no longer an issue. Dependency is.

This drug always had some unusual properties and paradoxical or troublesome side effects, but I could tolerate them easily. No longer.
The past few years my health (physical, and as a consequence ´mental´ too) has declined seriously and it´d incredibly hard to either tolerate or taper the drug. I simply took it too long.

Typically, this drug is either tapered directly or one switches to diazepam. I did try diazepam, and for me it is a completely different drug. Short acting too. (´ half life´ vs ´duration of action´)
Diazepam was hard to tolerate, and I know it will take forever to get it out of the body if I would start a taper.

Doctors have been no help, on the contrary. In my experience they generally don´t have a clue. This drug is not commonly prescribed here.

What are my options, really ?
One the one hand there is the ´taper the drug directly´ school and on the other hand there is the ´Ashton cult´, to put it not so subtly.
I have read the Ashton manual, the promotional material. But the fact is that the ´duration of action´ of diazepam is shorter than clonazepam/Klonopin. The half life of both drugs is long.
The ´clonazepam vs. diazepam´ section of the Ashton manual is mostly nonsense. She did not taper people off clonazepam in her clinic. For me, all benzodiazepines are NOT the same.

Typically, people either taper the drug directly or they switch to diazepam. But what if both are problematic ?
I believe that my problems are partly due to some of clonazepam´s unusual properties (e.g. binding to receptors, serotonin). It´s also the case that I cannot split the dose in an afternoon dose and an evening dose.

I have no theoretical framework beyond the ´Ashton method´. Which is at least partly incorect.

Suggestions, advice ? At one point I considered a ´C-T´ with carbamazepine, but at this point that might just make things worse.
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Avatar universal
There's one drug: Chlordiazepoxide ( Librium ). It has a medium to long half life but it's metabolite has a very long half life. This one might help.
Helpful - 2
2 Comments
Chlordiazepoxide has a slower onset, and is weaker by MG. (Which could be a good thing.)
Except both Chlordiazepoxide and Diazepam are dosed 3-4 times daily.
Diazepam has a faster onset, the same metabolites and both turn into Dimethyl-Diazepam giving them both "Active metabolite half-lives of 50-200 hours.
With Chlordiazepoxide and Diazepam after 6 hours the effects are from Dimethyl-Diazepam and other metabolites.

For tapering Diazepam is probably better in most places, because it comes in 2mg tablets. Easily split into four 0.5mg quarters.
Where as Chlordiazepoxide only comes in 5mg capsules. (Sometimes capsules are easier to taper. If they have beads, not powder.)
Considering Diazepam has a faster onset and almost identical duration. Tablets instead of capsules. Chlordiazepoxide is probably not the best choice. It's still Diazepam. It's the longest lasting, most functional benzodiazepine. (There is no other Benzodiazepine on the market with a longer half-life. No benzodiazepine has been studied more.)
Desmethyl-Diazepam***
Avatar universal
Thanks, but it is similar to diazepam. Also, short to medium acting, metabolites with long half lives.
Helpful - 1
Avatar universal
Hey dead post, but here's my Clonazepam switch to Diazepam, personal story.

I took 4mg of Clonazepam for many years. It only lasted about 6-8 hours.
I would wake up at night, I needed to keep a timer and take a dose every 8 hours, to avoid withdrawal.

My Dr. was dubious about changing Benzos. 4mg Clonazepam=~80mg Diazepam.
I showed him the Ashton method. But was refused 80mg. As it is beyond the recommended dose. (80mg Diazepam)
Taking 1.5mg-1.0mg-1.5mg Clonazepam. I tapered the morning 0.5 and evening 0.5 away.

I had to spend 2 months breaking the 0.5mg tablets into quarters. Taking 0.125mg of Clonazepam less each week. It was too fast and uncomfortable.

Then I was prescribed 30mg Diazepam daily. Plus the Dr. knew I was reducing Clonazepam. Knew I had 200, 0.5mg tablets, to spread over the month
(4mgx30÷0.5=240 tablets a month!)

I took 1.5mg Clonazepam + 30mg Diazepam TID. Spoke to my doctor and was switched to 60mg Diazepam TID. After 1 month, Clonazepam was removed and I was prescribed 60mg Diazepam. (20mg-10mg-30mg Diazepam, 180 tablets a month!)

It was still hard to transfer over. The hypnotic effects of Diazepam actually helped.

Clonazepam took about 2 hours to reach full effects, but left within 6-7 hours.
Diazepam takes me 40-60 minutes to reach full effects, but major effects leave within 4-6 hours.
My doctor does not want me to take Diazepam 4 times a day, because I am trying to reduce.

The Clonazepam effects dropped off fast. Where as Diazepam's metabolites help me wait for my next dose. Less W/D symptoms... After 1 month of steady dosing, there were no more ups and downs. (Clonazepam was a rollercoaster.)

I sleep better, not great. Sometimes forget my dose for an hour or 2. (which is not a big deal. Less intense W/D, faster onset for relief.)

6+ Years on Clonazepam, 2 Years on Diazepam.
I wouldn't add more medications. Slow and steady reduction and transfer to Diazepam is for the best. If you can.

No more depression for me!!! Only Benzodiazepine dependence.
I'm only 30. I metabolize benzo's quickly, and have low body fat.
Diazepam is easier to taper down. It still takes me a month or more to comfortably do a 5mg reduction.

High potency benzo's are hard to transfer from.
Especially Alprazolam or Lorazepam. Because of their short half-life and no metabolites. Clonazepam has no metabolites either, so it is better for the elderly.

But still 20X as potent. In some places it comes in a smaller form or buccal strip.
But most places the smallest is 0.25 tiny round Clonazepam... Someone would want the larger pills, 0.5's to more easily divide into 0.125mg for reduction.

A Dr. should be very aware of what dose you are taking. But you also need to listen to your body. When you start your taper. Make sure you have a full script of Clonazepam, and an appointment within a month, so you can inform your doctor of progress/problems.

That's what I did, am doing.
Helpful - 0
Avatar universal
Nothing new ?

Diazepam is so different and short acting - it may have a long half life, but it is shorter acting than clonazepam.

No other benzos to taper the drug ?
Helpful - 0
Avatar universal
Hi.
I too have been taking Klonopin for many years 1 1/2-2  mgs. I am still recovering from Tramadol discontinuation, over 3 months now and have significant anxiety so am really needing the Klonopin right now. (Paws). I will be tapering from Klonopin when I am completely recovered, whenever that will be. I bought a Gemini brand gram scale and plan to taper extremely slow by shaving and weighing. We are indeed on a very dangerous drug. I'm scared of a disaster happening and not having the Klonopin. I can't go through hell again because that is what Tramadol is and now I want off Klonopin so bad. My problem is I do have anxiety. I had no idea what I signed up for when my Dr prescribed Klonopin though. I also had taken 1 dose at bedtime and was forced to split it do to the severe anxiety from Tramadol. It's working out ok but I don't sleep as good of course. Can you buy a gram scale and shave and weigh?
Helpful - 0
1530493 tn?1410056636
Hi...just want to throw something out there to you.  I have a daughter with a seizure disorder she too dependant on Klonopin  with a backup of diazepam. Trying to wean her off was a nightmare, we could only go so low, before seizures,  mental issues would increase...so had to bump the dose back up.  I've been following the use of cbd oil for over a year ( because of the seizures) finally tried it.  We still did a slow wean, but she was able to come off  both drugs with very few issues.
it's use is still not well received by most docs, also will not find alot of guidence, it's a trail and error for the user,  but might be something to concider.
Good luck
Helpful - 0
Avatar universal
I wish I had done a C/T some years ago. Now I'm just a mess !
I don't see how I can do a real taper.

Aside from other issues, this drug has some mjor action on serotonin. Tapering it with diazepam is somewhat like tapering an SSRI with a benzo !

Does anyone see a point in tapering with lorazepam or another non-diazepam like drug ?
Helpful - 0
4522800 tn?1470325834
How is it going??
All mind-altering drugs whack out the Neuro-Chemisty in our Brain..In return it also can send some false singles to the body. This is why Addiction is so hard on us..Genes play a big role too. I also believe that the Benzo hit, yet another area of the brain too.

You are so right about the Klons. I too went c/t almost 3 yrs ago off of that one and 2 more. The klons are why it took so much longer. They prescribe this drug for anxiety, but it was made for Seizures and Epilepsy.
I talk with the Drs all the time and now they say that any Benzo should only be prescribed for a Short period. If taken to long they will flip on you and cause more Anxiety. I see this in a few friends that still take this med.

I do know from experience that I should of done a nice slow taper. However, I am alive today!! You can cut it back a bit and take it only at night. You have done some great Homework about this med. Being on it for so long is going to be a bit uncomfortable.  I always wondered about going down from the klons to ativan, or diazepam, or others that are short lived. Not on anything, but maybe I will do some more homework for my Friends. I wish you all the best and I sure hope you can figure out a good Plan.
Bless
Helpful - 0
Avatar universal
Whatever you do, DONT GO COLD TURKEY. I did this after 8 years of taking klonopin, taking 6-15 mg a day. Experienced seizures, psychosis, etc.... Take it slow whether reducing the klonopin intake or trying diazepam. Nothing's as dangerous as quitting c/t
Helpful - 0
Avatar universal
I sympathize with your situation although I don't understand it. In a way, I think you're giving Klonopin more power and control than it deserves...

You know time can't be frozen even though you have that feeling. Some of what you've described are symptoms of withdrawal. I still don't understand why you can't taper the drug in small amounts and you have essentially dismissed offering an explanation or can't offer one.

I think my suggestion of tapering by TENTHS is a sound one. A pharmacist can help you cut back those tiny amounts; they have ways to create a lower dose pill or powder.  If you cut back SLOWLY you WILL be able to tolerate the change in dose; especially if you cut back 1/10 at a time every month. I can't believe THAT won't work.

Beyond those suggestionsk I've got nothing else to offer. Give it a try and stick around here for support!   All the best-
Helpful - 0
Avatar universal
As far as addiction docs go, I talked to one and had contact by email with another one. Neiter had any experience with clonazepam. I can't expect to find an addiction doc in this country who has any experience with this drug.
One suggested tapering in 4 weeks with oxazepam (but that one lasts only 6-7 hours!, I tried) inpatient, another suggested tapering with diazepam in 6 weeks, inpatient or not.
They don't have a clue. Those who tolerate diazepam well would have to deal with the withdrawal outside the clinic ('loading of diazepam').
Helpful - 0
Avatar universal
The manufacturer is Roche , or gene.com

I think there is a telephone number on the website, but I can't expect them to give a patient more information/advice. And international calls are so expensive.

I have workked my way through a lot of PI sheets and other material. I understand some of clonazepam's unusual properties (mechanism), but I get only half way.

I haven't been able to find a long acting (that is something different from 'half life') benzo to switch to.
Helpful - 0
Avatar universal
I have absolutely no idea how I could consult a doc in the USA. believe me, I have tried to find a way. A long time ago, telemedicine was supposed to take off ... not so much.

If you know a way, please let me know.

Generally, face-to-face contact is required.

Why I can't taper Klonopin in small amounts ? Too complicated to explain, it would take too long, I don't really know ...
I'll give an example from the past. I used to exercise intensely and I used to be muscular. (I have been on a higher dose of clonazepam for some time in the past, but that is another story). When I went below either 2 mg or 1.75 mg (I don't remember), exercise started to cause major problems. A dramatically slowed subjective perception of time after I had exercised ('time freezing'), a dramatically increased threshold for falling asleep (that is, no sleep), skin issues. At later attempts, rapid muscle loss (and I have very little left). This seems to be dose-dependent. No ' let the body adapt to  lower doses if I taper slowly and continue to live normally'.
This is a very physical drug. The way I function these days and the way my body is built is terrible.Exhaustion and lack of energy is not unknown to me.  I know I would not have these issues with tapering if I was still healthy. I would be able to 'break through it'.
Now, I have a GP who believes it is 'mental' at this point in time ... so no help there, even a referral to a psychiatrist that I accepted led nowhere 'back to the GP, it's just stopping benzos'.
This drug seems to disrupt normal neurological and hormonal functioning, at least at this point in time. (at one point I asked for a referral to an endocrinologist, it was refused)

So I'm looking for a way to deal with some of the unusual properties of the drug to taper, or a different drug to taper.  Something like that.
Helpful - 0
Avatar universal
Yes, that is what I'm suggesting. I'm not saying come to the US but try to find a way to consult with a doctor here who is more familiar with Klonopin. I don't know how you would go about it but anything is possible with the internet.

You could also contact the manufacturer who may be able to guide you.

Tell me why you can't taper Klonopin in small amounts.
Helpful - 0
Avatar universal
You're not suggesting that I try to find a doc on the other side of the Atlantic, or are you ?
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Avatar universal
I don't live in the USA but in a small country in Europe, there is a shortage of doctors and the quality is mediocre in general at best.

I don't have a doc who 'has the answers'. Being unable to get help with problems caused by medications is not uncommon.
Helpful - 0
3197167 tn?1348968606
♥♥♥  Thanks for the clarification~
Helpful - 0
Avatar universal
Are you unable to drop by 0.1mg at a time?

Connie- My "cutting the dose in half" comment was not directed at you. The OP made a statement about half the dose not having half the effect...

Maybe there's someone hiding around here that has some other ideas but, really, your situation is unusual and complicated and most likely requires a medical expert. As I suggested: try speaking with a pharmacist about compounding the Klonopin for you and find a doctor in the US who has more familiarity with this drug.
Helpful - 0
Avatar universal
Well, at this point I don't believe a regular, direct taper would work.
I have plenty of experience at this point. Too much.

I don't really know how to explain my issues with this drug well. I haven't been 'fine' for a long time. Very poor physical shape. Body functioning poorly. And this is a very physical drug. If I were in excellent health I wouldn't be having these issues.
A very messy drug. Neurologically, endocrinologically (if that's a word)

I think I require either a taper with a different drug, or some add-on (I have considered antidepressants and antipsychotics to deal with clonazepam's sertonergic properties, but I can't think of a way that would not introduce other issues) This is a very not-benzo type benzo ...

If I were to take a different benzo for a taper, it would definitely help if it had a long duration of action. Not long half life, but duration of action.
Diazepam has a short to medium duration of action, a very long half life and it accumulates in tissues dramatically.
Are there any non-diazepam like drugs (not Librium, prazepam etc) that could be used ?

Any suggestions ?
I have that 'Ashton resource', which amounts to pretty much nothing since it's just not correct regarding Klonopin vs. Valium for the most part.
I'm taking a single dose of clonazepam a day, not multiple doses a day so her crossover schedules do not apply.
Her experiences 'a benzo is a benzo' are not mine.
I can't taper just by 'symptoms', since I've been having 'symptoms' for quite some time. If I were to try diazepam again, I don't really have a framework/point of reference.

So, back to my 'other benzo to taper', 'add on drug(s)', something else ?
Helpful - 0
3197167 tn?1348968606
If I have my math head on straight....there are 4 (0.5 mg) doses in what she's currently dosing (2 mg).  Definitely, cutting by half would be crazy!  But I'm not sure there is only one way to taper benzos either.

I didn't realize you could take anything lower without shaving a 0.5 tab or using a water dosing reduction.  As Gnarly said, no method will be w/o discomfort and w/drawals....but hopefully she'll find a way that works for her~  
Helpful - 0
Avatar universal
I would never suggest cutting a dose in half and calling it a taper. With benzos, tapering by TENTHS is the only way it should be done.  Perhaps consulting a compounding pharmacy would help.

Are you searching for another way to accomplish this? Other than tapering or switching to Valium?  With your sensitivity, I'm not sure there's another way other than tapering with the Klonopin, very slowly.  You might try consulting a doctor in the US also.
Helpful - 0
3197167 tn?1348968606
Is it not possible to get your script in the 0.5 mg strength as Vicki suggested and continue taking your dose only at night as you always do but tapering the 2 mg by 0.5 mg?

If another benzo doesn't work for you, and you truly want to get off this one....weaning SLOWLY by 0.5 mg seems like the only way to go, imo.

Helpful - 0
Avatar universal
Hi  well I tapered off clonipin a few years back  and it is not a ez detox you MUST GO SLOW  I agee with Vicki see if you can get the .05s and take a little less each month it took me around 5mo to get offf 4mg  im bipolar and my doctor did not want me to go into a manic eppasode just know there is no compleatly comfortable way to do this you wile feel each drop and get anxiety insomnia and just a crummy feeling of withdrawal  I to was on it for years and to day im greatful to be off of it and it is so so worth all the agony to get off it  we do have a member here mymayberry that will see this and post  she is a wealth of information  my adivis is keep posting for support  and we will be here  you can do this but it takes resolve and perseverance .....Gnarly
Helpful - 0
Avatar universal
Well, a classic example would be: taking it twice a day would make the daytime dose sedating, the evening dose more stimulating.
At best, there would be issues with sleep.

This drug has a very complicated effect. I can't just take half the dose and get 'half the effect'. I think someone described it as 'it doesn't scale well'.

It's not a neutral drug. Perhaps a correct phrase (someone else's suggestion) is that it is 'physically destabilizing', perhaps to a lesser extent mentally as well. Especially when tapering
Helpful - 0
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