As Needed Clonazepam and Magnesium Glycinate W/D?

[[Wa...]]

Hi everyone

I was prescribed Clonazepam only once before this (about 10 months ago).  I used it for 6 days, stopped and felt fine after.

The original prescription was by an UrgiCare Doctor (20 pills 0.5mg twice daily as needed).  Fast-forward to about a month ago and I had a stressful life events that led me to have some panic attacks.  The day I went into the Doctor's office my PCP was unavailable so I saw the PA.  She refilled my original Clonazepam prescription (20 pills total) and also recommend taking supplements such as Magnesium, Vitamin D, and Fish Oil.  I was already on Vitamin D and fish oil.  I read magnesium could have calming effects, so I started taking 240mg Magnesium Glycinate for the first time daily.

The first 5 days I took a Clonazepam in the morning and one at night, along with a Magnesium pill at night.  I skipped the 6th day entirely of Clonazepam, but felt pretty bad at the end.  The next 5 days I would take 1 Clonazepam in the AM and a Magnesium at night as it had some pretty sedative affects on me (the mag).  The following week I only took 1 Clonazepam, but continued taking the Magnesium Daily.  I felt like I was slowly but surely getting better.  That Sunday was my first time out in weeks and I kind of overdid it socially, and ended up having to take a Clonazepam.  The next week I would take Clonazepam off and on in the morning and still Mag at night.  I started getting really drowsy in the AM from the Mag (I think) so I stopped taking it altogether.

My plan was to just stop taking both CT.  A few days later I had a massive headache arise and took a C.  My PCP said I should not have w/d from the C as I had only taking it intermittently for a few weeks.  He recommended cutting my last pills in half if I wanted to ween off of it (I was down to 4).  The following 2 nights I took half a C with no Mag.  Then the following did half a C with Mag and felt great the next day.  The best I have felt.  Last night I took no C, but a Mag and feel like crap today.  I woke up in the middle of the night with a headache and a hot flash.  Sometimes my TMJ acts up, so that might have caused the headache

I am unsure of what to do next.  Mag affects GABA as well, I really shouldn't have started taking this when I did.  Can I go through C w/d after 30 days of inconsistent usage?  I was on C about 20 of those 30 days.  Or did the Mag supplement mess with all of this?  I ended up mixing quite a bit and it is tough to tell.  The anxiety I had when I started has been healing, but slowly.  I think I still have a few weeks to go in that regard.  I have a meeting with my PCP in about a week.  He recommended trying Vistaril in place of C if I needed another anxiety med (as mentioned he did not prescribe the C).

Thank you for reading and any advice is greatly appreciated.  There is a good chance I am overthinking this as that is something I do.  I also know how dangerous these drugs can be so I just want to be safe.

 

 

   

  

 

 

Edited November 10, 2023 by [Wa...]

[[Br...]]

Hello @[Wa...] and welcome to BenzoBuddies!  I'm sorry you're having trouble with getting off clonazepam.  It's difficult to separate out what the effect of magnesium is in what you're going through.  My first thought is that if I were in your shoes would be to stop the magnesium and begin to taper off the clonazepam.  I believe you can do this more quickly than if you were on it for a long time.  The fact that you were on clonazepam briefly and stopped previously means there may be the possibility of kindling (previous withdrawals leading to greater sensitivity to subsequent withdrawals)- in other words you may be more likely to experience withdrawal symptoms.  You may want to taper off over the course of a month.  Again, it is likely you'll experience withdrawal symptoms but I wouldn't want to risk developing tolerance by extending the taper for too long. This would set you up for even more problems. Does this make sense to you?

[[Wa...]]

Thanks so much for your response @[Br...]

About an hour after I wrote my post this AM I come down with pretty bad lightheadedness, dizziness, and nausea.  I think I was having a withdrawal from the C, so it seems like kindling could be in play.  I agree on stop taking the Magnesium as we don't really know what affect it could be having.

Should I ask my PCP for more pills?  He wasn't the original prescriber so I don't know if he would be willing to give me another dosage.  I'm currently down to 1.5 pills of 0.5mg.  I took a half earlier when I was having withdrawal.

What does a good taper schedule look like to you?  I have only been taking it around once per day, so something like this lets say before bed:

0.5mg 1st week

0.375 2nd week

0.25 3rd week

0.12 4th week

Jump

Thanks again for your insight.  I have never been through something like this, so I am sure my nerves aren't helping me psychologically.  I just feel kind of lost at the moment.

 

 

 

 

[Guest [...]]

Hi @[Wa...]

Welcome to BenzoBuddies!

@[Br...] asked if I’d help here. 

I’m busy for the next few hours, but, I’ll get back to you as soon as I’m free. 

[Guest [...]]

Hi, @[Wa...]

In regard to your usage, I think it’s worth noting that even though you were taking the clonazepam ‘somewhat’ intermittently, the benzo will still remain in your system for quite some time, so it’s kind of like only topping up when you take another dose. It’s not so uncommon for an individual to develop a dependancy within two weeks of continual daily use, so it does sound like you’ve developed a dependancy over the course of the month. 

I think it would be wise for you to seek another prescription and taper off more slowly than your doctor has suggested. His idea to cut your last few tablets in half to ween off is really no different than a C/t. Your system takes 10 -14 days to adjust to each reduction in dose, so I’m not sure how he can possibly think halving your last few tablets could be considered a ‘ween’. 

If I were in your position, I would probably see how I adjust to 0.25mg (half a tablet) daily over the next week to 10 days, and then maybe reduce to 0.125mg (quarter tablet), hold that dose for another 10 days…etc. 

It’s just that I wonder if it’s really necessary for you to take a full 0.5mg tab, when 0.25mg may be enough to make you comfortable as long as you take it daily at exactly the same time. Most importantly, stop taking it intermittently to avoid kindling. Now that you have developed a dependancy, you need to dose daily, and that 0.25mg daily may actually be enough to level you over the next 10 - 14 days before reducing again.

I would definitely seek a new script from your provider to taper off over a 4 to 6 week period. 

Do you feel that the half tablet you took earlier did enough to ease your withdrawal symptoms? 

 

 

 

 

[[Wa...]]

Hi @[Wi...]

Thanks for the reply, I really appreciate it.  Also thanks again to Brighter Day for pointing you in my direction.

Yesterday I only took the 0.25mg and did pretty well.  I had a little extra anxiety during the night, and some diarrhea but nothing too bad.  I actually got a really good nights sleep as well.  Unfortunately things this morning were quite bad.  My anxiety was elevated, had difficulty concentrating, was super sensitive to sounds and screens, and was getting strange warm sensations in my body a couple of times.  I took the initial 0.25mg tablet, but my symptoms did not really clear up, so I ended up taking the 2nd half about 2 hours later.

I am not sure what to do next.  I also have given up the magnesium supplement 2 days ago.  It wasn't super powerful but did give me a sedative effect.  I wonder if there is a brief withdrawal from that going on as well as it is suppose to have an effect on GABA too.

I do think taking it intermittently was a mistake.  Basically I would only take it when symptoms reappeared.  I originally thought this was just the original anxiety reappearing, but I could have been going through mini withdrawals, if that makes sense.  The timing of my dose today was similar to yesterday.  I will start daily dosing.  I am unsure of how much I will take tomorrow.  Maybe I can settle in at 0.375mg or give 0.25mg another shot.

The PCP gave me an additional 5 pills.  If I cut these in half that would be enough until my appointment with him on Nov 6th.  I have also found an advisory member on the board of the BIC in my town who is a tapering specialist.  I am going to call her first thing Monday AM and get her thoughts.  My PCP is a good doc, but he said it himself that he usually doesn't prescribe these types of drugs, so I am not sure I want to do a taper with him.

 

 

 

[Guest [...]]

Hi @[Wa...]

You're welcome.

I think the main issue here is to make sure you have enough of the medication to get you through until the 6th Nov, when you see your PCP. Here’s a link to the Colorado Consortium Benzodiazepine Deprescribing Guideline Document (2022) that you could print out and take to your PCP. It may help you secure a prescription for the purpose of tapering. 
 

https://corxconsortium.org/wp-content/uploads/Benzo-Deprescribing.pdf

 

Do you have enough tablets to get you through until the 6th at a dose of 0.375 or 0.5? 

Do you want to see how you go on a dose of 0.375 daily? 

[[Wa...]]

I have just under enough to do 0.375 daily @[Wi...].  I will be short 0.25 the last day.  I will do .375 the next few days and see how it goes.  That being said I don't think 0.25 is too much of a push, I just don't want to overdo it.  My 10 and 14 day averages are both exactly at 0.25mg daily, with the intermittent use of 0.5mg

What would you recommend for a taper schedule?  I did some googling and most taper schedules I find are for longer term/higher mg users.  I can't really find anything for someone who has used only one month.  Maybe I should post something in the taper sub forum?  Thanks

 

[Guest [...]]

You should be able to do a reasonably quick taper, @[Wa...].

when I say a reasonably quick taper, just go back to my reply a few posts above and it will give you a good idea of what I mean. 

Are your tablets scored to break into quarters, or only halves? 

[[Wa...]]

Yeah, I guess I was just asking more about the jump off level.  Ideally .125?  That would be a quarter

The are only scored into halves, it gets a little tricky trying to cut that quarter.  Any recommendations @[Wi...]?

Edited October 29, 2023 by [Wa...]

[Guest [...]]

@[Wa...]

I think you would have to jump once you held at 0.125 for 10 - 14 days. 

Just try to be as precise as possible when breaking into quarters. 

If you did happen to get to 0.125 and felt that the previous reduction from 0.25 had been very difficult, then you could look at purchasing a jewellers scale and reducing in smaller amounts by calculating tablet weight. If you found you needed to do it this way, we would provide you with a link to a common inexpensive jewellers scale and explain how to make your calculations. It’s very simple. 

But just see how you go with breaking the tablets and reducing that way for now. 

[[Wa...]]

Okay I will see how it goes @[Wi...] and let you know.

I have had some very tough times concentrating the past few days.  Especially when it comes to using computer/watching tv/being on phone.  Like I couldn't watch TV for more than a couple of minutes at a time yesterday.  Is this a normal symptom?  It comes and it goes, feels like it gets worse when I am more stressed/when the pill wears off late in the day.  I haven't had any other symptoms really other than heightened anxiety late in the day and wonder if they may be connected.

[Guest [...]]

Hi @[Wa...]

It’s important to keep in mind that it takes time to adjust to a new dose, no different than tapering. It takes around 10 to 14 days to recover from a cut in dose, so you may have to tough it out for that period until symptoms ease. You may not return to symptom free, as that’s rarely the case, but you should gain considerable relief from current symptoms and be much more functional. 

The symptoms you are experiencing are absolutely normal, and all symptoms do intensify under stress, but your symptoms should ease as you adjust to dosing consistently (same dose, same time) daily.

It’s important you to get through (without running out of medication) until you visit your PCP for another prescription. It may also be worthwhile seeking out a more benzo wise doctor in your area who could prescribe for your taper, just in case your PCP won’t get on board with your taper plan. 

[[Wa...]]

Thanks for the quick reply @[Wi...] and putting my mind a little more at ease.

I already called a benzo specialist in my area this morning as a backup plan.  I left a voicemail so we will see what they say.

 

[Guest [...]]

You’re welcome, @[Wa...]

Good to hear you’re on the front foot….

[[Wa...]]

@[Wi...] It's highs and lows unfortunately.  Was not feeling great the past hour.  Broke down and started to cry.  I was able to call my PCP and he had an opening for tomorrow, so I am going in then.  Any recommendations on how to approach him if he gives resistance to my plan?

[Guest [...]]

@[Wa...]

Be openly honest and forthright about the intensity of symptoms you are experiencing. 

You could print out that document I provided and circle the 5 - 10% recommended patient guided taper. 

It would show that you’ve done your research and that you’re serious about tapering off sensibly. 

[[Wa...]]

Quick update @[Wi...]

The trip to the PCP didn't go great.  He gave me a few more pills and said take .25mg for a few more days and stop.  I didn't really try to convince him otherwise.  He did give me some hydroxyzine which helps with the late afternoon anxiety and sleep.

I did get an appointment with the specialist for Nov 9th.  I have enough pills to last me until then.

Last few days have been okay and I don't really have symptoms as of now aside from a few random weird things throughout the day.  I'm currently at .375mg, at what point do you think I should take a shot at .25mg again? 

My last 10 daily doses have been: .5mg, .25mg, .25mg, 0, .25mg, .5mg, .5mg, .5mg, .375mg, .375mg.  I plan on taking .375mg today as well

 

[Guest [...]]

Hi @[Wa...]

You’re in a tricky situation. 

Im sorry it didn’t go well with the PCP. Most simply have very little understanding of benzodiazepines and the necessity to taper slowly. In addition, the majority are unwilling to open their mind to the possibility that they may not only be wrong, but, they may also be causing a great amount of harm to their patients. 

Even if you’ve been on the medication only a short time and can make large reductions, you still need to give your brain 10-14 days between cuts to recover from each reduction, or the reductions pile up and intensify symptoms. 

My hope is that this specialist you see on the 9th is benzo wise and will supply you with ongoing scripts for the duration of your taper.

 

[[Wa...]]

Yeah @[Wi...] I might give the PCP one more try.  We have a messaging app so I will try to explain it more in detail and give him some links to look at.  My only worry is that the Doc I see on the 9th is also my last day of pills.  So if that doesn't work I am in really bad shape, which is why I am going to try and get the PCP onboard again.

I've been holding steady at .375mg.  I do get weird bouts of anxiety mid afternoon, borderline panic attacks (presumably when it wears off) and also in the morning right before I take it.  Panic attacks were the reason I originally got on the med, they went away for most of my use, but now have returned.

My worry about waiting too long to cut is developing a dependence.  Is that something I should be concerned about?  I am at 5 weeks usage now, although as stated before a lot of that was as needed not daily usage

 

[Guest [...]]

Hi @[Wa...]

I think it’s very sensible to do whatever you need to cover your bases and give yourself the best chance of securing ongoing prescriptions for the taper. 

The bases we are working from is that you have already developed a dependence, or you would be able to just stop the medication and remain functional without any significant symptom uptick. If that were the case, you would simply stop taking them because that would definitely be your best option, but, if not, then at least a relatively quick taper is necessary. 

You are already on a lower dose now, so it’s kind of like beginning your taper from a less than completely therapeutic dose. The idea is for your brain to adjust to that 0.375mg dose and gauge your baseline symptoms. A baseline of symptoms from which you will make each next reduction. 
 

[[Wa...]]

Yeah @[Wi...] it is a tough spot.  I have been doing okay the past few days. Just some anxiety which I think is being caused by my low amount of pills remaining.  Not sure what I'll do if my appt on the 9th doesn't go well.  Do you have any suggestions for that?  Maybe I could go to the original UrgiCare Doc that prescribed them to me the very first time and explain the situation.  I am US based.

 

[[Wa...]]

I was able to get a few extra pills from the PCP to hold me over until today. The meeting with the psychiatrist today went well. Seems to follow the Ashton method and is willing to let me go at my own pace. Knowing I have solid support and a supply of pills is a nice relief. @[Wi...] do you have a link for the jewelers scale? I will be dry cutting to start with. Thanks again to you and @[Br...] for the advice so far. The taper pace she suggested was pretty conservative, I’m going to start a thread in the taper sub forum either today or tmrw to gauge some opinions on that front.

[[Br...]]

Hi @[Wa...] - It's so good to see you had a positive meeting with the psychiatrist and a clear path forward!

This is a popular jeweler's scale which I've used very successfully myself.  There's a learning curve but you'll get the hang of it.https://www.amazon.com/gp/product/B0012TDNAM/ref=ppx_yo_dt_b_asin_title_o00_s01?ie=UTF8&psc=1

[[Wa...]]

Perfect, thanks