Tapering from 0.50mg (now at 0.25mg)

[[ti...]]

Hi All,

I started on 0.5mg Klonopin Dec 19 prescribed for panic attacks and sleep. I stayed at this dose for ~3 weeks (except attempted to go down to 0.25mg for a few days after 2 weeks but that was too soon, because could not sleep at all from trying that) then down to 0.375mg for 1 week, then down to 0.25mg and been holding since (so been at 0.25mg since Friday, January 19, so 1 month). So in total taken the drug on a nightly basis for 2 months. I really want to get off as quickly and as safely as possible. A few key points:

(1) I would like to try to keep this Klonopin (as opposed to switching to Valium)

(2) What cut should I start with to be safe, but also get off of this drug ASAP. Is 10% really necessary (so , because at that rate it's .25 to .225 to .20... etc. then if that's per week it would take many months to get down to 0)? I suspect 0.125mg is too drastic a cut at this point though.

(3) To do cuts at this point requires splitting 0.5mg (scored across the middle to break into 0.25mg pieces) pills into smaller pieces. What is best practice here? I would rather weigh things out than dilute to solution, which I am guessing should not really be done anyway.

Thanks! 

[[je...]]

Hi @[ti...]

Welcome to BenzoBuddies!

It's very difficult to guess how you will react to cuts. Two months on the drug is not long but it's not very short either. Some people can stop benzo's without any symptoms whatsoever and some people develop dependency very quickly. The only way to know where you are on the spectrum is to try a cut unfortunately. 

If Klonopin was prescribed for sleep, it will not cure the insomnia. It is only a bandaid and the insomnia will return. If that was your only symptom after cutting 2 weeks in, that is a very promising sign.  However, we still don't know if greater dependency developed since you've been holding your dose. I do think though it might be worth it to attempt a 0.125mg cut and see how it goes. If you present with difficult symptoms, then you can always go back up in dose and taper slower. Ideally, you don't want to stay on these pills longer than necessary.

Let's keep talking and see what you feel comfortable with.

[[ti...]]

Was not the only symptom - though a bit difficult to distinguish because also had been on an SSRI (Zoloft and gotten discontinuation syndrome / relapse from that). Switched to Lexapro which has been helped now on 12mg/day, though may cut it slightly down to 10mg. 

Other likely symptoms included burning sensation in muscles, a bit of tinnitus, headache when I did that. Also noticed those and some sleep disruption in the 0.5 to 0.375 to .25 cuts, but nothing scary. 

Given the sensitivity of my CNS, the fact my sleep is still not great, I have been at 0.25mg for a month, and I have heard cuts at lower amounts can be the toughest, maybe I try starting with half of that - down to 0.18mg? Then wait 1 week and monitor for any changes before deciding to cut again? I don't know how well doing something like a 0.25mg to 0.2 to 0.15 to 0.1 to 0.05 for K compares to 5mg to 4 to 3 to 2 to 1 for V. 

I think this scale should work? But also what is a good tool to cut/shave pills?

[[ti...]]

A few other points too. Given what I have learned from Surviving Antidepressants and my experience in general, I want to avoid adding any psychotropic drugs or those that interact with these kinds of drugs at all costs. This included medications like Gabapentin, Proprononol, other sleeping meds (e.g., Trazodone), which can help alleviate withdrawal symptoms. I have found these to make my experience worse (e.g., I was ill-advised but took Lunesta a few times with the Klonopin and they combined to make me uncoordinated the next day, caused GI irritation, headache, etc.).  So a more gradual, supporting drug minimal taper, would be preferable.

[[je...]]

23 minutes ago, [[t...] said:

Switched to Lexapro which has been helped now on 12mg/day, though may cut it slightly down to 10mg

Generally we don't recommend tapering two drugs simultaneously as it becomes difficult to determine which one is causing withdrawal symptoms.

23 minutes ago, [[t...] said:

I don't know how well doing something like a 0.25mg to 0.2 to 0.15 to 0.1 to 0.05 for K compares to 5mg to 4 to 3 to 2 to 1 for V. 

I tapered from K and I didn't do V comparisons. The Ashton method towards the end is linear and becomes problematic for many people due the linear nature not compensating for percentages. 

What I suggest you do is take it one cut at a time. We advocate for a symptoms based taper and allowing your symptoms to determine how fast or slow you go. At this stage we don't know how you're reacting to cuts, so we first need to see how that first cut pans out before we can determine anything else. 

23 minutes ago, [[t...] said:

I think this scale should work? But also what is a good tool to cut/shave pills?

I'm not sure which scale you're refering to, but most people use a jewelers scalers from Amazon and a nail file to shave their pills. If you want to start off with 0.18mg that is fine.

[[ti...]]

Yea understood makes sense on not tapering multiple drugs at once. Makes sense on tapering approach. Great will try .18 or maybe .2mg. 

[[...]]

Do you believe the panic attacks won't return? Do practice any techniques to reduce having panic? Have you learned coping skills if they return?

[[ti...]]

I’ve developed some skills and definitely more self awareness about them and why I have them. I don’t know if they will come back, I’m sure by the time I’m done with this process I’ll have to deal with them and re-confront them. But in the long term CBT and Lexapro will be preventative and help me cope. Do you have any coping recommendations?

[[...]]

@[ti...] were in a similar boat. I was trying to go up on Zoloft and post partum when I experienced the insomnia/nocturnal panic attacks. Klonipin helped me through that. Zoloft wasn’t a good fit and I came off and went on lexapro (direct switch) I have now been on lexapro 10 weeks at 10mg, and start a tapering klonipin 2 weeks ago (as of two weeks ago I had been on klonipin a total of 12 weeks). I was at .5 nightly, went down to .375 for 10 days with manageable side effects. On Friday I went down to .25, have been here now for 4 days. Hydroxine did help me last night but I had some mild sleep jerks but was able to go to sleep. Once I was woken early morning I couldn’t fall back asleep bc I had them a bit. But I didn’t feel anxious and I’ve been fine today. So I’m going to give it another few days (maybe do 10 again) and see how I fare. If you are level on lexapro and your insomnia was caused by anxiety like mine was, it should and will help. Hydroxine is a good tool to help through it too. You’ve been on a shorter length of time than me. I did experience a little rebound insomnia but not the anxiety with it if that makes sense?

[[...]]

@[ti...] how many days did you go down to .25 before you experienced sleeplessness? Tonight will be night 5 for me so just wondering if I’m passed where you were ?

[[ti...]]

Hey SDE - thanks for sharing. So when I tried going from .5 to .25 early on, it was the second day I took .25 when sleeplessness started, that lasted 3 or 4 days (can't remember which) until reinstated .50mg dose. I realized I was also increasing Lexapro at the time (in retrospect now I've done more research on this not a good idea, which also may have contributed because when I increase dosages it causes insomnia). When I went from .375 to .25 later, I did not actually experience sleeplessness, but definitely some impact / lower number of hours of sleep. It is also confusing because I may still be in withdrawal from Zoloft discontinuation, but Lexapro has helped stabilize me.

Edited February 20 by [ti...]

[[...]]

@[ti...] How long were you on Zoloft before switching and how long are you on lexapro now? I’m sure upping your lexapro had something to do with your issues. Again, the hydroxine has for sure helped me with both some anxiety and getting sleep. I hope it continues. Last night wasn’t a bad night but it was less than ideal. I just hope it doesn’t get worse. Depending how the next week goes I may do .1875 and then .125. Keep me posted on your progress!

[[ti...]]

@[...] I was on it for over 9 years. Then tapered too quickly, and got delayed withdrawal symptoms a few months later. Tried reinstating at too high a dose (supposed starting 'therapeutic' dose of 25mg), got bad side effects, so had to try some new SSRI/antidepressants. Landed on Lexapro, started late in December, so been on the Lexapro for almost 2 months now.

Yea sleep has been a major battle for me too. I tried Hydroxyzine, it was actually highly effective at first, but started getting side effects / being less effective so I stopped. Sounds like a plan!

[[ti...]]

So day 3 at .225mg (10% cut). First two nights sleep around my standard 5 hours (been getting that consistently for a week, been bad overall since Zoloft withdrawal got bad). This past night probably 2 hours, woke up at like 1:45am started feeling pretty wired couldn’t go back to sleep just did not feel tired (like a magic wand was raised and less relaxed feeling came over me), much different than previous nights where felt relaxed in bed for most of the night. Definitely not a good sign. I wonder if switching to Valium for the remainder could help or just give the 10% cut a few more days chance before re-evaluating? I started taking Klonopin to address the panic attacks and insomnia that happened due to Zoloft withdrawal; can Valium tapers be more insomniac friendly?

Cortisol surges in the morning also starting to become brutal.

Also did not follow guidance and per someone else’s advice tried switching Lexapro down from 12 to 11, which did not feel good so was back at 12 today which could have interfered. I will be holding at 12mg Lex for a long time now. Further reason to continue potentially trying 10% cut.

Edited February 23 by [ti...]

[[je...]]

Could you please elaborate on your symptoms? Are you functional? By functional we mean are you able to do what is expected of you on a daily basis i.e. work, chores, taking care of yourself and your family. 

[[ti...]]

I could be functional on the first two nights sleeps of 5 hours, not repeatedly on 2 hours. Will see how tonight goes. Do symptoms generally settle after several days into the taper period at a given dose? I think in general a bit of an elevated feeling of anxiety through day as well, bit of elevated HR sometimes too. Maybe it is extra bad because I held at .25mg for a full month, then brain was getting used to that stability. Hopefully it can adapt to this new dosage after a few more days... I also noticed a meaningful change in how I felt when I shifted the Lexapro the one day to 11mg (also only ~10% change). I am debating adding a sleeping med back into the mix but have refrained from taking anything other than Lexapro in the morning, Klonopin, magnesium, melatonin, and vitamin D3 at night.

In general I am really not a fan of Klonopin (like everyone on this site lol) - I am pretty certain I developed some annoying side effects as well (mild depression, burning in muscles, minor headaches), some of which I hope will go down as I decrease dosage (though I recognize new ones could come up during taper...). It's going to be a bit of a double whammy as well because it still does help me sleep, but I want out ASAP so my brain can heal.

[[je...]]

Symptoms generally peak at day 3-5 and settle around day 10. It could be exacerbated or caused by the Lexapro cut, which is why we usually don't recommend it. We just don't know which one is causing the symptoms.

For the first two years of my taper I got between 1-3 hrs of broken sleep. I hate to be the bearer of bad news but insomnia and not sleeping at all, is very common during withdrawal. It is only at the end of my third year since I started this whole ordeal that I'm now seeing around 5hrs of sleep. I felt horrible on 1-3 hours of sleep but our bodies can function on that. There's just no way around it if we want off these pills. If sleeping is your ultimate priority you might want to consider getting an adjunct med for sleep but these often have their own problems. 

I honestly wish I could give you better news, but I can only tell you the reality of the situation otherwise I'm not doing right by you. If there are few other symptoms and these symptoms are manageable then you should be able to continue tapering. 

You might find this post from @[Th...] helpful

You can also start a thread on this forum above to seek more input on insomnia.

[[ti...]]

30 minutes ago, [[j...] said:

3-5 and settle around day 10. It could be exacerbated or caused by the Lexapro cut, which is why we usually don't recommend it.

For sure, thanks for the insights. So in principle if my symptoms settled (i.e., got pretty much back to where they were before the cut) day 5-6 (would be optimistic I know), I could do another 10% cut on day 7-8? I know you recommend 10-14 but maybe a slightly faster rate is possible given I've only been on it for a bit over 2 months in total now. 

[[je...]]

I would advocate for a faster taper given your short-term use. My opinion is rather test the waters, see if you can get off fairly unscathed instead of staying on longer and risk a taper with deeper dependency, more symptoms and intensity of symptoms. 

The longer you're on, the higher the chances of developing dependency. However it is very likely you will suffer when it comes to insomnia. For me, when it comes to withdrawal I wish I could only have one major symptom to deal with. But I'm dealing with insomnia plus a host of other symptoms due to my long-term use. If you can avoid the other symptoms on top of insomnia you've already managed a great victory in my opinion. 

[[Wa...]]

47 minutes ago, [[t...] said:

For sure, thanks for the insights. So in principle if my symptoms settled (i.e., got pretty much back to where they were before the cut) day 5-6 (would be optimistic I know), I could do another 10% cut on day 7-8? I know you recommend 10-14 but maybe a slightly faster rate is possible given I've only been on it for a bit over 2 months in total now. 

Hey tip, my usage duration was similar to yours when I hit .25mg. You can view it in my history for exact details but I’ve been reducing .025 every 8-12 days. Hit a bit of a bump at .125 but it wasn’t too bad before that. Also have some patience, adding an extra day or two here or there isn’t the end of the world. My symptoms usually hit around day 3, around day 6-7 I would start feeling better, then I would start the party all over again. GL

[[ti...]]

@[je...] and @[Wa...] thanks so much for the support and input. Last night I slept better, maybe like 5-5.5 hours, aside from some mild tachycardia / cortisol rush during morning time, some elevated anxiety in the gut (but better than previous day), doing pretty well. Going to do one more night at .225 for safe measure then if tomorrow isn’t any worse push down to .20 after 5 days at .225.

Edited February 24 by [ti...]

[[ti...]]

@[je...] I ended up taking .19mg tn if it goes well enough will hold there for 5 days or so. Very interesting thing happened. For context, I have also been experiencing some chest pain (I have gotten multiple analyses of my heart over the past couple months on this and they haven’t found anything wrong I think it’s this drug) - not sure whether to qualify it as a side effect or wd symptom, occasional hot/chill sensations, mild headaches, occasional heart palpitations, all of which occurred today (in a random intermittent manner) - tolerable enough but annoying. Well 20min after taking my dose, usually when I first sense K hitting my system, I felt all of these symptoms in quick succession. I don’t know if you can conclude whether they are side effects or withdrawal from this experience but you would think if I got them right after taking it they were not withdrawal? Maybe I’m being too optimistic though with this sentiment. It was also the first night of the lower dose so maybe body’s reaction to getting a bit less. 

Edited February 26 by [ti...]

[[je...]]

In your case I think it's difficult to tell what is benzo withdrawal related and what symptoms are related to Zoloft cessation. I do however doubt it's withdrawal from the first cut on a lower dose. I haven't heard of withdrawal setting in within 20min after cutting. Generally it's 3-5 days. 

I think you're doing really well. Going from 0.5mg to 0.19mg in this short time frame and you still seem to be functioning pretty well is very good news. I would hate for you to be stuck on this drug after such short term use. 

[[ti...]]

Hey all - as an update still at 0.19mg. I had a setback on Wednesday night when this root vegetable dish I ate some of turned out to have been cooked with white wine - even though alc supposed to be burned off, I think I am sensitive to even tiny amounts of active alcohol ingredients. I got a sensation about 10 minutes after eating the veggies sort of like I would get when I used to drink (quit months back before I started taking SSRI/benzo) but a bit different, and weirdly immediately felt more relaxed, and the sense of being overwhelmed by the loud vibe of the restaurant (a form of hypersensitivity I noticed on day 2 of cut to 0.19mg - honestly not that bad on its own, just a bit annoying) was cut away and felt more like normal. On my way out of the restaurant, I felt a bit anxious/irritated at the situation, but the weird stuff started at night. I took my .19mg dose of Klonopin, and felt sleepier than usual (not surprising given combined effect of alc and benzo...). I fell asleep very easily, but then woke up, felt a bit of a brain shock feeling, then anxiety and could not fall asleep for the rest of the night. The next day I started having visual disturbances (vision dim/dark for split second (well under 1 second), light flashes - not horrifying but certainly annoying and making me question what is going on. Also started feeling slight jerking feeling in head (can't tell if it is muscular or more of a brain sensation). My head also sometimes feels just weird at times, in a way I have not felt prior to this incident. These have all continued through today, and have not lessened. I have also felt more tired, out of it, and (weirdly) more relaxed overall, and felt less of some of the other symptoms (less chest pain, sweats, palpitations) for whatever reason. Sleep has strangely gotten a bit better, especially last night got like 7 hours - best sleep I've gotten in weeks. I find it highly disconcerting though I am still feeling different and in some ways better (other ways worse, e.g., head sensations), since it has now been 3 days since the incident, and alcohol is supposed to leave system within 24 hours - it also must have been a very small amount given the situation. 

Practically speaking, my biggest concern by far is having a seizure as I read these can occur if alcohol and benzos are combined (of course this was completely unintentional on my part...). My second concern is I have some massive rebound in a lot of the symptoms that seem to have miraculously gone away or occurred for shorter durations during the day (granted new ones have popped up, other new ones include worse headaches, muscle burning I have not felt for a while , some others).

Any thoughts here on next steps? I plan to hold for at least several days, especially because of the visual/head sensation stuff, am concerned about a rebound in some symptoms, and have cut 24% of my dosage (.25 to .19) over an 11 day period (I know given my shorter term use this is likely an acceptable approach, but I am concerned now because of the alcohol incident).

[[je...]]

7 hours ago, [[t...] said:

Practically speaking, my biggest concern by far is having a seizure as I read these can occur if alcohol and benzos are combined (of course this was completely unintentional on my part...)

It is extremely unlikely that you'll have a seizure from such a small amount of alcohol. I would not be concerned about it. 

Sometimes we react to something, especially when we have a sensitive central nervous system, which seems to be the case with you since you stopped your SSRI. Hopefully this wave will be short lived and you will see some improvement soon. 

I think it's fine to hold for a couple more days to see how you're doing. A taper should always be adjustable and flexible. It would be good if you can try and not worry too much about the alcohol incident. Anxiety can increase our symptoms.