I think I have a Benzo dependency.

[[Er...]]

I would definitely go slower than 66% if you have extra. Is it possible to talk to another doctor who understands about the need for a slow taper?

[[Sc...]]

Just like you nobody told me these drugs can cause damage. The prescribers knew but withheld this important information. My general advice after a grueling withdrawal, go slow to minimize neurological damage. These drugs taken long term are very dangerous and also coming off.

[[Li...]]

How are you doing @[Be...]?  Have you had any luck getting your psychiatrist to reconsider her approach? How about getting assigned to a new psychiatrist who will support an individualized, gradual, symptom-guided taper?  

As I mentioned on your other thread, Angie Peacock is a vet who may be able to help you navigate the Veterans Healthcare Administration if needed.

[[Be...]]

@[Li...] Not doing so well. I have tremors in my hands, anxiety, cognitive difficulty, and balance issues. My psychiatrist says I would be tapering on an Individual case depending on my symptoms. She started me on .5mg per day taper. If I need to go up she would raise my taper based on symptoms. I guess I have to wait and see how it goes.  I appreciate everyone’s help. I consider this place to as group therapy. My doctor is going to refer me to some kind of one on one therapy. 
 

[[Li...]]

1 hour ago, [[B...] said:

Not doing so well. I have tremors in my hands, anxiety, cognitive difficulty, and balance issues. My psychiatrist says I would be tapering on an Individual case depending on my symptoms. She started me on .5mg per day taper. If I need to go up she would raise my taper based on symptoms. I guess I have to wait and see how it goes.

Thank you for checking back in @[Be...].  You’ve been on my mind.

Am I understanding correctly that your psychiatrist reduced your total daily dose from 1.5mg to 1mg?  That’s a 33% reduction in dose.  Our general guideline is to keep reductions in the range of 5-10%. 

Have you already started to take the reduced dose?  If so, the withdrawal symptoms you’re experiencing are a signal the 33% reduction was too large for you.  

If you have not already done so, I suggest you report them to your psychiatrist ASAP.  If she meant what she said about implementing an individualized, symptom-based taper, one would hope that she would reinstate your original 1.5mg dose and come up with a different taper strategy. 

For example, you could use a combination of regular tablets and a 0.1mg/mL compounded oral clonazepam suspension (see link below) to implement the following Phase 1 taper:

0.25mg tablet + 2.5mL liquid, taper liquid to 0 as tolerated
0.25mg tablet + 2.5mL liquid, taper liquid to 0 as tolerated
0.25mg tablet + 2.5mL liquid, taper liquid to 0 as tolerated

Link:
0.1mg/mL Clonazepam Oral Suspension
https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

 

 

[[Be...]]

@[Li...] My doctor reduced my clonazapam dosage from 1.5mg daily to .5mg daily 😞 She did say she could raise my dosage if needed but wanted me to start at 0.5mg

Edited April 3 by [Be...]

[[Be...]]

@[Sc...] my doctor went ham on my dosage. She is very stubborn. 

[[Li...]]

Ah ha. When you indicated she started you on a 0.5mg a day taper, I thought you meant a 0.5mg a day reduction. 

Have you told her you are experiencing withdrawal symptoms?  In your shoes, I’d be inclined to describe them as “intolerable.”

If she won’t increase your dose back to a more reasonable level, I suggest you find another prescriber pronto.  

In the interim, have you considered reinstating yourself using the extra supply you have?

Also, I keep forgetting to ask …

You’ve indicated you are taking four psychotropic meds (identified by italics below): 

Fluoxetine, Aripiprazole, Prazosin, Benztropine Mesylate, Clonazepam, Enalapril, Trazadone, Rosuvastatin, Metformin, Pantoprazole, Naproxen, Famotidine  

Is your doctor making any changes in these or keeping them as is?

If you have not already done so, I encourage you to use one of the free online interactions checkers to look for interactions among and between these four meds.   I also suggest you review the adverse reactions for each of these meds to see if they match any of your symptoms. You can find the current FDA drug labels, including adverse reactions, at:

DailyMed
https://dailymed.nlm.nih.gov/dailymed/index.cfm

 

 

[[Be...]]

@[Li...] I have 45 clonazapam pills of 1mg each. How can I use this in conjunction with my 0.5mg daily taper?

[[Li...]]

@[Be...] I personally would use the extra pills to reinstate to my original dose of 1.5mg per day while looking for a new prescriber.  Or, if I wanted to try to buy myself some extra time to find a new prescriber, I might consider increasing my dose from the current 0.5mg a day to 1mg a day in hopes that I could stabilize at 1mg (if I wasn’t showing signs of stabilization after 7-12 days, I would likely updose back to the original 1.5mg).

Is finding a new prescriber something you are willing/able to undertake?

[[Be...]]

@[Li...] I am going through withdrawal symptoms right now. I will give it a few more days to see how bad this gets. If it becomes unbearable I will contact the doctor to see if she can start me on 1mg a day. If she doesn’t then I will be looking around for a new prescriber. 

[[Li...]]

Thank you for sharing your plans with us @[Be...].  I hope you will continue to do so. 

How many days has it been since you reduced your dose from 1.5mg a day to 0.5mg a day?

Although everyone is different, a common withdrawal pattern for clonazepam reported here on the forum is 3/10.  That is, it takes about 3 days for withdrawal symptoms to fully emerge and about 10 days for them to level out (stop changing in number and nature). 

[[Be...]]

It’s been two days on the .5mg a day. My cognition and concentration are shot. I’m having difficulties communicating with the contractor about work details on my house. 

Edited April 5 by [Be...]

[[Be...]]

I messaged my doctor to see if she would raise my daily dose to 1mg. 

[[Li...]]

Wise decision @[Be...].  If your psychiatrist refuses to do this, I wonder if the following sections from the FDA drug label for clonazepam might persuade her to change her mind?

“Abrupt discontinuation or rapid dosage reduction of clonazepam tablets after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue clonazepam tablets or reduce the dosage.”

“In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months.”

[[Be...]]

@[Li...] I contacted my psychiatrist today and requested to increase my dosage to 1mg a day. She is going too fast. She granted my request. I’ve been beside myself today. My blood pressure was through the roof. 

[[Li...]]

Way to go, @[Be...]!  This is wonderful news.  

Yes, your psychiatrist was going way too fast. Now we need to discover if she’s still going too fast.  A reduction from 1.5mg to 1mg is still a 33% reduction in dose.  Some individuals can handle large reductions like this at the beginning of their tapers but others cannot.

If you have not already done so, I encourage you to start keeping a daily log of your dosing schedule (times and amounts) as well as global ratings of your  symptoms and functionality.  Look for trends in the data - if your symptoms and functionality trend upward toward baseline (i.e. how they were before the 66% reduction) over the next 5 days or so this will be an encouraging sign.

Please keep us posted.

[[Re...]]

You may find the book 'Maudsley Deprescribing Guidelines' by Dr. Mark Horowitz helpful. You can get it on Amazon and give it to your doctor. Dr. Horowitz is a renowned expert in deprescribing based in the UK. Many doctors do not taper medications correctly and this can harm patients. Dr. Horowitz and Dr. Josef Witt-Doerring are experts in benzodiazepine tapering and you can find helpful content from Dr. Witt-Doerring on YouTube. Benzodiazepines and other psychotropic drugs can have delayed withdrawal symptoms in some patients, so tapering too quickly can be harmful. The withdrawal effects can mimic symptoms of other illnesses such as MS or ALS, and patients can end up in a complex medical situation due to being misdiagnosed. Patients are often misdiagnosed with psychiatric illnesses they do not have as well. There are also coaches like Angie Peacock who can provide advice that doctors may not be able to give. Angie knows more than the doctors -- she travels around the country speaking at medical conferences about these drugs. In general, doctors are not trained in medical school to recognize withdrawal symptoms of these drugs nor are they trained in prescribing or deprescribing them. Until there is a change in medical education, we can only trust each other and the experts who advocate for psychotropic medication safety.

Edited April 6 by [Re...]

[[Li...]]

How are you are doing, @[Be...]?  Did you increase your dose back to 1mg yesterday?  How would you rate your symptoms and functionality on a scale of 0 to 10 (0 = no symptoms, no issues with functionality), 10 = intolerable symptoms, unable to function)?

What is your new daily dosing schedule (i.e. how many milligrams of clonazepam do you take at what times)?  I ask because a change in dosing schedule from 3 times a day to 2 times a day has the potential to affect your response to the dose increase. 

[[Be...]]

@[Li...] I started my 1.0mg today. I am feeling better. Yesterday I was in a very bad way. Anxiety was bad as well as poor concentration. I couldn’t function well. I was going through withdrawal symptoms. Last night my blood pressure was dangerously high. 190/100. As for right now I think I’m at a 6. Blood pressure is back to normal. I took .5mg this morning, and expect to take .5mg this evening. I will follow up according to how well I feel later. 

[[Co...]]

23 hours ago, [[B...] said:

@[Li...] I contacted my psychiatrist today and requested to increase my dosage to 1mg a day. She is going too fast. She granted my request. I’ve been beside myself today. My blood pressure was through the roof. 

Good news, @[Be...]!

[[Co...]]

59 minutes ago, [[B...] said:

@[Li...] I started my 1.0mg today. I am feeling better. Yesterday I was in a very bad way. Anxiety was bad as well as poor concentration. I couldn’t function well. I was going through withdrawal symptoms. Last night my blood pressure was dangerously high. 190/100. As for right now I think I’m at a 6. Blood pressure is back to normal. I took .5mg this morning, and expect to take .5mg this evening. I will follow up according to how well I feel later. 

It will probably take a few days for your blood levels to fully reflect your new dose. So you might find that you feel even more relief over the day or two.

[[Li...]]

1 hour ago, [[B...] said:

@[Li...] I started my 1.0mg today. I am feeling better. Yesterday I was in a very bad way. Anxiety was bad as well as poor concentration. I couldn’t function well. I was going through withdrawal symptoms. Last night my blood pressure was dangerously high. 190/100. As for right now I think I’m at a 6. Blood pressure is back to normal. I took .5mg this morning, and expect to take .5mg this evening. I will follow up according to how well I feel later. 

This is very good news @[Be...], especially the part about your blood pressure returning to normal.  Clonazepam has a relatively long half-life so twice a day dosing should work.  As @[Co...] has noted, it may take several days for the level of drug in your blood serum to fully reflect the new dose and dosing schedule. 

[[Be...]]

I want to thank you all for your support! I appreciate being able to communicate with people who really now what I’m going through. I find this very therapeutical and educational. 

Edited April 8 by [Be...]

[[Li...]]

You’re welcome, @[Be...].  How are you doing today?  Are your symptoms and functionality trending in the right direction?  Any signs of stabilization?  In this community, stabilization means symptoms are ‘leveling out’ (i.e. not changing in nature or number).