I (med researcher) am charting my taper

[[Th...]]

I wanted to share what I’m doing in case it’s useful. I’m a medical researcher so collecting data is my life. I decided to chart my withdrawal symptoms and severity daily to create an accurate record. Over time, hopefully this will allow me to see patterns and predict likely timing/course. 

I wasn’t expecting significant withdrawal; I’d been on only 0.25 mg of clonazepam daily for roughly 100 days. Due to the very low dose, I didn’t anticipate discontinuation issues, but decided to start a 25% total reduction (0.25 to 0.18), not cold-turkeying, just to be cautious. In light of clonazepam’s long half-life, I did my usual dosage (0.25 mg, half of a 0.5 mg pill) one day and then a quarter-pill (0.125 mg) the next day, in an alternating schedule.

I took my first 0.125 mg pill on a Monday and on Thursday withdrawal kicked in big. I was so not expecting it, it took two days to realize it was withdrawal; until then I suspected some unusual form of Covid, despite negative tests. Once I realized it was withdrawal, I switched to ~0.18 mg daily to stop the blood level swoops of my previous method. (I say “approximately 0.18” because cutting an accurate quarter-plus-an-eighth of a dry pill is difficult.)

I also started charting then. It was easy to retroactively know the symptoms/severity I’d experienced the previous few days because I’d texted friends about it on those days and so had a record. Since Day 6 I’ve charted nightly, so the day is accurately recorded without risk of forgetting things by the next day. 

On the chart, a green box means the  symptom was strong enough to interfere with my functioning for up to 4 hours total that day (the symptoms come and go in waves, and are often worst in the morning and in the evening). Yellow indicates 4-8 hours daily. Red is anything beyond 8 hours daily. 

As of my second reduction (Day 15 onward) I discovered the CIWA-B scale for tracking BZD withdrawal symptoms, so the second two-week chart will have a CIWA-B number for each day as well. It’s regrettable that I don’t have that data from the beginning.

It interests me that the chart clearly shows the three days of early withdrawal (panic, heat chills, tremors, GI distress, nausea) and then the symptoms have a gradual shift to mostly different symptoms during the acute phase (GI distress and nausea stayed, panic became lesser anxiety instead, and restlessness, muscle pain, dysautonomia, and mild depression began). The tapering-off of symptoms is clear by Day 14, with only GI distress, anxiety, and muscle pain remaining (along with some panic attacks that I’m 100% certain were due to preemptive fear of the Day 15 reduction). With the break in anxiety on Days 11 and 12, I suspect the anxiety on Days 13 and 14 may also be related to the impending reduction, rather than simply a biochemical withdrawal reaction as on Days 4-10.

Note that on the first day of symptoms (Day 4), the boxes are green, but that’s only because withdrawal started in the evening. Had it started in the morning, I strongly suspect the boxes would have been yellow. 

I judge severity by how long daily symptoms are present at an intensity high enough to bother me, but I have had decades of chronic illness, so I am very skilled with tuning out pain, nausea, etc. What would likely be yellow or red for an able-bodied person is green or yellow for me. My tolerance to suffering means I just don’t notice it as much.

I’m surprised by the intensity of this withdrawal considering my low dose, but I’ll get through it eventually. Pending the symptoms staying tolerable, I’m planning on 20-30% relative reductions every two weeks. (A “relative reduction” relates not to the dose you started with originally, but is calculated from your current dosage. If I started at 0.25 originally and have decreased to 0.125 mg, 0.125 -> 0.09 is a 28% relative reduction. But 0.125 -> 0.09 is only a 14% “total reduction” as calculated from the original 0.25 dose. So it’s important to know whether one is using relative or total calculations for reductions.)

The current plan is 0.125 (what I’m currently on, for another week and a half), then 0.09, 0.07, 0.05, 0.03, assuming my body continues to tolerate each drop. Then I’ll decide (pending symptoms) whether to discontinue or do a final two weeks at 0.015. This image shows the current plan along with the total percentage of remaining drug in my system (as calculated from 0.25) and relative reductions (as calculated from the previous dose) for each downward taper, and the expected time in days to when I’ll be finished with that and preceding dosages (calculated from when the first taper started).

I’ll post a new chart every couple weeks as I finish each two-week series. 

[[Pa...]]

Thank you for documenting your taper, I see you’ve only been on the Clonazepam for a few months, I’m hopeful your recovery once off the medication will be mild and not exceed the time you were on it. 

[[Th...]]

I hope so too! The withdrawal is definitely going to last longer than using it; even if I don’t need the last 0.015 dose, I’ll be hitting 0 blood level at 98 days (assuming a 40-hour half life, and assuming I don’t need any stays longer than 2 weeks), so I’ll still have - at best - a few weeks of withdrawal symptoms past that time, getting me well past the 95-105 days I was originally on it.

I’m resigned to the length of time needed to finish (and it may end up being longer than my plans listed above); all I’m really hoping is that I don’t end up with PAWS. There isn’t really any good research on the incidence of PAWS for benzodiazepine users, and even if there was, “BZD users” is a huge umbrella and we can’t necessarily assume that how things go long-term for, say, lorazepam users is how things will go long-term for clonazepam users or diazepam users or... And good luck finding good research on low-dose usage outcomes. :/

I know all our experiences are incredibly unique so my chart won’t apply directly to anyone else, but there may still be some commonalities that might be useful. Especially if it turns out over time that symptom and timing clusters tend to be similar on each reduction cycle, that might be a pattern that is shared with others, and maybe others early in their withdrawal journey might start tracking too and we can see how things compare.