Halfway through my Clonazepam Taper

[[AZ...]]

Hello,

 

I had a series of life events in late 2019 that started causing panic attacks. My general health doctor put me on Metoprolol Succinate ER 25mg once a day for the heart palpitations I was experiencing and Clonazepam 0.5mg twice a day. Once in the morning roughly 8PM and then at 5PM.

 

Te life events have passed, I've been doing talk therapy to identify the causes of my anxiety, and I was diagnosed wit sleep apnea and put on a CPAP machine half-way through already being on my met/clon treatment. I know I want off and asked my doctor if I could start tapering and he said okay.

 

I am halfway through my taper and down to half-tablets 0.25 mg morning / 0.25 mg 5PM.

 

I need help from the benzo community in recommendations on best way to finish my taper.

 

When I asked my doctor for a refill on my Clonazepam he said that they don't do the delayed release tablets at .25 mg and so he prescribed me the fast acting dissolvable tablets (which I've read make withdraw twice as hard).

 

So I still have about 2 -3 weeks of half tablets left. I'm caught in a predicament:

 

1) Do I follow a tele-medicine psychiatrist I talked to online who says I could start my remaining taper at cutting the half-tablets in half putting me at 0.125mg morning / 0.125mg 5PM and run on that for 2 weeks before discontinuing the morning dose for two more weeks and then finally discontinuing the other 2 weeks after that?

 

PROS: My current tablet supply could make that without need to use the new instant dissolve ones

 

CONS: Combining my two doses puts me at a combined 0.5 mg currently, next taper would put me at 0.25mg combined (but inexact because I'm chopping half tablets in half) so it is +/- exact mg each day but pretty close.

 

2) Do I do a baby-step taper and cut my morning dose half 0.25 down to 0.125 and keep the evening dose at 0.25?

 

PROS: Is very gradual

 

CONS: I will run out of the old long delivery tablets and need to switch to the instant ones

 

Not sure. I am leaning toward option 1 but would love opinions and feedback if that is too dramatic? I'm now having panic attacks 2 - 3 times a day but manageable ones, so I attribute to the withdraw. I wake up fine and only 30 - 40 minutes after taking my morning meds do I experience an attack (thinking the benzo is causing it).

 

General legal issue: In my State, they have the doctors make you sign a waiver that you know Benzo is a controlled substance and they believe everyone is out to scam more Benzos with crazy stories or finding multiple doctors, etc... My new prescription is in a box unopened, so I can surrender it to my doctor or pharmacist but they have in the computer that I was prescribed the meds and if doc sends in new prescription for higher dose tabs it will raise a flag (if he is even willing to do it). So, I have some anxiety about switching up to fast release Clonazepam towards the very end of my taper.

 

I'm proud I've made it this far on my own, I've enrolled in a treatment program with my local mental health clinic for extra support, but I don't get to talk to their Psychiatrist until 3 weeks from now for the initial eval, and so I'm thinking I can finish this with the meds I have.

 

Thank you for your comments, suggestions, and this great community. Glad I'm not alone in getting off this crazy drug.

[[...]]

Hi AZSlim2020,

 

Welcome to BenzoBuddies! We are glad you are here!

 

This is a great place to get help with your taper. I'm going to share some links that you may find helpful. The first is the Withdrawal Support board. This would be a good place to post your question about how to go forward with your taper. I would definitely think there would be a difference between the fast acting and slow release benzos.

 

Withdrawal Support (during your taper)

 

I will also give you the link for the Taper board which can help you come up with a taper plan for getting off the rest of the medication.

 

Planning Your Withdrawal (Taper Plans)

 

It sounds like your doctor wants to you to taper fairly quickly. Have you read the Ashton Manual? I will post the link. It's very helpful and Dr. Ashton recommends a slow and steady taper. Not reducing faster than 5 to 10 percent at a time and not more than 7 to 10 days per cut. I hope that is helpful.

 

The Ashton Manual

 

Also feel free to browse any of the boards that seem helpful to you. We are glad you are here with us!

[[Li...]]

Welcome to BenzoBuddies, AZSlim2020. I’m puzzled by your comments about “delayed release” and “fast acting dissolvable” clonazepam tablets. I’m not sure the information you received is correct so you might want to double-check before making decisions based on it.

 

According to the US FDA Orange Book, two forms of clonazepam tablets are available in the U.S. — regular tablets and orally disintegrating (not dissolving) tablets.  Both of these forms are “immediate” (not modified) release and the active drug substance in both enters the body the same way (i.e. via the digestive tract).

 

Re: your comment that “fast acting dissolvable tablets”  “make withdraw[al] twice as hard.”  Do you recall where you read this?  Was it a credible source?  I ask because members who have used/are using the clonazepam orally disintegrating tablets (ODTs) to taper have not reported this.  The only observation some members have shared is the ODTs may act a bit faster than regular tablets (perhaps due to buccal or sublingual absorption of some of the active drug substance before the majority of it is swallowed and enters the digestive tract).

 

I hope the above information is helpful to you.

 

 

[[AZ...]]

Hi Libertas,

 

Thank you for your reply.

 

I apologize for my description. By "disolving tablets" I was referring to the orally disintegrating (ODT). My terminology was based on the description given to me by the pharmacist and also doctor who informed me that you put the tablet in your mouth and it dissolves based on your saliva. So okay, orally disintegrating tablet (ODT) is the proper useage going forward. 

 

The person who informed me that going onto the orally disintegrating tablet would be harder on tapering/withdraw was the tele-medicine doc I talked to recently about my tapering plan. She said it was more advisable to stick to the regular tablets. Sounds like you are experienced in helping other members and following different Benzo user withdraw experiences and perhaps I was given bad advice? Could be. There is a lot of contradictary information out there as I dive deeper into the research. She wanted to put me on Zoloft and I don't feel I'm there yet and feel strongly against taking any more meds especially an SSRI.

 

I discovered this forum because I was looking for a health supplement to help with the withdraw symptoms I have been experiencing and that rabbit hole led me to w-bad.org who laid out some compelling info that the health supplements I was seeking may actually hinder, set-back, or cause issues with my successful taper plan. Then through their links I came across a website that has the Ashton manual which I've read through and another site with this community.

 

As far as my characterization of the ODT being "fast acting" vs the tablet being slow acting, I guess I should have clarified that I received this understanding based on my general health care doc's description of the effect. Mainly, and I'm paraphrasing here, '...the tablets you've been on usually take 30 to 45 minutes before you feel the benefit verses the new tablets I'm putting you on which dissolve in your mouth and your feel the effects right away.'

 

Then the pharmacist did a consult with me as a new med when dispensing the ODT informing me that the effects are almost immediate when taking the ODT and I should give it about thirty minutes to acclimate before driving etc... because I could experience dizziness, etc... <- This is when I was like Oh My God, this sounds way more powerful than what I referred to as the slower release tablets (slower release meaning in the initial delivery of effect), probably wrong terminology again, but that's what I was trying to describe. Then on the call with the tele-medicine doc she was like, ODTs are harder to withdraw from.

 

So sounds like ODTs are not "harder" to withdraw from.

 

That being said, I still have halfed tablets left. Which is a better way to taper? 1/4 tablet (.125 mg) morning and .25mg Half tablet in the evening for two weeks, then 1/4 tablet (.125 mg) morning and evening (and then if I run out I can use the ODT and cut the wafers to match my .125 doses and continue the taper)? Or is the step down to .125 and .125 from current .25 mg and .25 mg halfs still relatively safe within a taper?

 

Thank you for any additional insight.

[[Li...]]

Hello again, AZSlim2020.

 

You are most welcome.

 

No apology needed.  Based on my personal experience, one cannot assume that all prescribers or pharmacists are fully up to speed on the orally disintegrating tablets. 

 

This is why it’s important for members to read the current, complete drug label for whatever benzodiazepine they are tapering.  For members in the U.S., The Withdrawal Project explains how to get copies of drug labels, summarizes what is typically included in a drug label, and highlights the sections of a drug label that are relevant when developing a taper plan.  See URLs below.

 

Would you feel comfortable answering the following questions? 

 

(1) Is this the first time you have taken and tapered a benzodiazepine?  If not, please describe any prior use or tapering experience.

 

(2) Are you currently taking or have you ever taken or tapered any other psychoactive drugs(s)? 

 

(3) After you were prescribed clonazepam, did you take it every day or as needed?

 

(4) What is your tapering history?  When did you reduce your doses?  In what amounts?  Did you experience withdrawal symptoms?  Were they tolerable?  Here’s the timeline you’ve shared thus far:

 

Late 2019: prescribed 0.5mg clonazepam twice a day for panic attacks

.

.

.

October 2021: 0.25mg clonazepam twice a day

 

(5) How did you reduce your doses - via pill splitting or some other method?

 

Now it’s my turn to apologize — for all the questions.   Answering them is worth the effort (as is documenting your history via your Signature). The more you can tell us about your drug history, the higher the quality of input you will receive.

 

Edit:  I see you have answered most of my questions on your other thread.  Well done!

 

 

URLs:

 

TWP’s Guide to the FDA-approved Drug Label | The Withdrawal Project

https://withdrawal.theinnercompass.org/taper/twps-guide-fda-approved-drug-label

 

TWP’s Key to Withdrawal-related Information in the FDA-approved Drug Label | The Withdrawal Project

https://withdrawal.theinnercompass.org/taper/twps-key-withdrawal-related-information-fda-approved-drug-label