Extended Klonopin use at 2x per week - Taper

[[Ro...]]

So, I've been taking 2mg of K about every three to four days but no more than twice per week for several years. Back in September I lost my dog, and then my wife passed away unexpectedly in November. Depression kicked in like crazy not too long after my wife passed and I started taking a low dose of Nefazodone several weeks ago. However, over the past couple of weeks I stopped taking the K, but I'm concerned that I'm going through withdrawals from it (insomnia, sporadic break through anxiety). I've never had much success with ADs either and getting on them has always been a challenge. It really stinks not knowing the root cause of the symptoms. 

 

If it is K withdrawal, my questions is how would someone go about tapering off in my situation?  I've seen the equivalency charts and think 30mg to 40mg of V is roughly 2mg of K, but how do I factor in the bi-weekly use? Instigating a 30mg dose of V each day and tapering seems like a lot of extra meds to taper down from. 

 

I've got an appointment with my pDoc this week and want to discuss getting off the K, but also want to make sure I'm informed and have a reasonable plan. 

 

Any insight is appreciated.

 

[[Br...]]

Hello @[Ro...] - welcome to BenzoBuddies!  We're glad you found us!

I am so sorry for the loss of your wife and dear pet. Those are very hard losses.  

I'm sure we can help you with good information and support.  I have a few questions for you that will help give a fuller picture of what's going on:  Have you ever started and stopped a benzo prior to taking Klonopin over the past few years.  Had you started and stopped any antidepressants in the past couple of years prior to nefazodone?  Please tell us why you decided to quit Klonopin? Just to clarify, are you still taking nefazodone?

I understand from what you've written that you're thinking of starting Valium rather than reinstating Klonopin.  As you probably know, both Klonopin and Valium have a long half-life.  I'm personally not sure it would be preferable to make the switch to Valium.  Valium has its own set of issues and people who switch to it often complain of sedation and depression.  I would seriously consider this in light of your issues with depression.

You ask about how to factor in the bi-weekly use.  Your current symptoms sound very much like benzo withdrawal symptoms.  If you started nefazodone around the same time you quit Klonopin it makes it hard to pinpoint what's leading to your symptoms.  But I think the bottom line is you have very likely developed a dependency on Klonopin over several years of bi-weekly use.  It sounds like you did a very fast taper or cold turkey off Klonopin and both scenarios are almost guaranteed to lead to difficult withdrawal symptoms.

Bearing in mind I'm not an expert but my inclination would be to reinstate Klonopin at a consistent daily dose that you're able to stabilize on.  Once you've stabilized, you may then want to begin a careful taper.  The basic guideline we suggest is to make reductions of 5-10% of your most recent dose every 2 weeks or longer depending on your symptoms.  The best taper we know of for helping you remain as functional as possible during the course of the taper is one that is flexible - meaning, you pay close attention to your symptoms and make adjustments. slowing down and/or making smaller cuts if your symptoms become too intense.

We're glad you're here - please let us know what questions you have and be sure to reach out for support.  

[[Ro...]]

Thanks for much for the reply. I broke down last night and took the 2mg. I did sleep 6-7 hours, maybe a little more.  

To answer your question, I took 1 mg of K every other night for three years about 20 years ago and just stopped with no problems that I remember. I could have done a minimal taper, but just don’t remember since it’s been so long. Certainly don’t remember withdrawal.  Also, I took Lexapro for about a year, and stopped back in 2014.  I tried to reinstate Lexapro in 2018 and had an awful time getting up to 10 mg and just pitched it. I’m not a normally depressed person, but I realized I might need to be on Nefazodone for life. I know it’s a seldom used AD, and that’s a shame, since it gets such good reviews for depression and anxiety. Additionally, im  in my mid 50s, but have reinstated 30 minutes of fairly rigorous cardio each day and eat healthy. I just had a complete blood panel done and should get results back soon. My PCP wanted to check thyroid and the T levels along with the other standard tests.  

The nefazodone was prescribed to me a couple of month ago and I finally started in about a month back  300mg is considered therapeutic, but I’m only at 175 right now. It does seems to work for anxiety pretty well and feel with all that’s happened in the past 6-8 months, I need to be on it.

So, from your reply, it’s seems that I need to change to a daily dose and taper from there? Would that be 2mg per day or something less?

I’ve got a great pDoc and I’m sure he will work with me.

i greatly appreciate the insight. 

Edited April 8 by [Ro...]

[[je...]]

19 hours ago, [[R...] said:

However, over the past couple of weeks I stopped taking the K, but I'm concerned that I'm going through withdrawals from it (insomnia, sporadic break through anxiety).

If you have already stopped the Clonazepam and your symptoms are manageable then you might want to consider riding it out. Insomnia and anxiety are very common withdrawal symptoms and you’ll likely experience these types of symptoms even if you do a gradual taper. I am now 16 months off and still struggling big time with insomnia. 

However if you’re really struggling with your symptoms and you feel you cannot manage then reinstating like @[Br...] has suggested might be better.

I just don’t want you to have unrealistic expectations about reinstating as your symptoms tapering off might be the same intensity as it is now. We just don’t know how severe your symptoms are right now. You are the only person to know whether it’s manageable or not. 

[[Ro...]]

Yes, I think I’m going to have to reinstate. I’ve got to get stabilized on the AD first and then slowly work down the K, or V, when I’m ready. This has been going on for 5 years and didn’t even realize it until I tried to cold turkey. Nefazadone is a great AD for depression and anxiety. Hopefully it will be a crutch as I start tapering.

 

What a mess, but at least I feel like I’ve got root cause. Last week was awful and I want to minimize the withdrawal symptoms. In my case I think going to 20mg of V and tapering from there might be the best route, but others may disagree.

 

i appreciate all of the input. 
 

 

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

If you have already stopped the Clonazepam and your symptoms are manageable then you might want to consider riding it out. Insomnia and anxiety are very common withdrawal symptoms and you’ll likely experience these types of symptoms even if you do a gradual taper. I am now 16 months off and still struggling big time with insomnia. 

However if you’re really struggling with your symptoms and you feel you cannot manage then reinstating like @[Br...] has suggested might be better.

I just don’t want you to have unrealistic expectations about reinstating as your symptoms tapering off might be the same intensity as it is now. We just don’t know how severe your symptoms are right now. You are the only person to know whether it’s manageable or not. 

 

[[je...]]

I’m glad you’re making an informed decision. From what I’ve read from other literature it seems that the suggestion is to start introducing at lower doses and work your way up rather than picking a random number to reinstate. This way you can determine if a lower dose might work better for reinstatement and you have less to taper. If you want to reinstate Valium, from memory you’ll start introducing 1mg a day and then work your way up. I don’t know if this is something you’d like to consider? Either way, I’d definitely not go higher than 20mg before giving it considerable time to work. 

[[Ro...]]

Hi Jelly,

That is exactly what I'm thinking; going at 20mg a day and see how things playout. That would be half the dose of 2mg of K based on the tables, but there won't be this "saw tooth" type of decline over the days in between and more steady state.  

I know I can get through this, but no reason to make it more difficult than it has to be.

[[je...]]

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

Hi Jelly,

That is exactly what I'm thinking; going at 20mg a day and see how things playout. That would be half the dose of 2mg of K based on the tables, but there won't be this "saw tooth" type of decline over the days in between and more steady state.  

I know I can get through this, but no reason to make it more difficult than it has to be.

I think we might be misunderstanding each other. I wasn’t suggesting 20mg per day. I was suggesting starting at 1mg  and then increasing by another 1mg every following day up to 20mg max. This means for example you could reach 10mg and feel fairly stable and then decide not to increase any more which will leave you with a lot less to taper. I hope I’ve expressed myself clearly. 

[[Br...]]

Hi @[Ro...] - How are you doing?

[[Ro...]]

On 10/04/2024 at 17:03, [[B...] said:

Hi @[Ro...] - How are you doing?

Thanks for checking in with me. I did see my pDoc today and told him I thought I was physically dependent on the K. He was said that I could be a slow metabolizer and it was possible that I’m having withdrawals from going CT.

He suggested that I try to get stabilized using the least amount of V as possible. Although he wrote a script for 20 mg of V, he said to start out taking 5mg bid and see if that would get me into a better place. However, he said if you need 20mg total per day to take it. He also put me on 15mg of mirtazapine but said try 7.5mg to begin with. He said “let’s get you stable and sleeping better then we will put together a taper plan”.

Since 2018 I’ve lost my mom, both in-laws, and my wife. I try to keep it in perspective and know things could be worse. 

I don’t want to be on any of these meds but I’ve come to terms that I’ve got a physical dependency. No pun, but that’s a bitter pill to swallow. Praying for a slow taper with minimal side effects. 
 

 

[[Br...]]

@[Ro...] - I'm so glad you met with your Pdoc and it sounds like his suggestions were reasonable. I like that there is flexibility in his approach.  Do you feel comfortable with the plan?  Do you have any questions we can help you with?

I'm so sorry you've suffered such profound losses.  Wishing you much healing.

 

[[Ro...]]

Thank you for the reply. I do feel comfortable with his plan and pray that I’m able to slowly come off with minimal side effects. I took 5mg once I got home and have felt better than anytime is the past 2-1/2 weeks. I didn’t think about having developed a dependency and never considered the ramifications of going CT.

I appreciate the replies and concern. Thank you!

Edited April 12 by [Ro...]

[[Ro...]]

Hi Jelly, Brighter Day,

One thing I was unaware of, until I started reading here, was how some went directly from K to V with no problems and others crossed over from K to V slower via substituting. Even my pDoc mention that it takes a while for V to reach the same level due absorption in the fat molecules. That went right over my head and I didn’t consider it. I know the Ashton manual has a cross over schedule from 3 mg of K to V with multiple dosing throughout the day, but I’m not sure how that would work in my situation. Right now I’m taking 15mg of V once in the evening, but wondered if it might be better to substitute 5mg of V with .25mg of K until I get another week out and then move completely to V? 
 

I’m not as bad as I was a week ago but still don’t feel stable. My sleep is fair but certainly better than when I unwittingly CT off the K. 

Thanks in advance!

 

[[je...]]

Hi @[Ro...]

From your initial post, my understanding is that you completely stopped using K for a couple of weeks. If you have stopped it and then you reinstate after a couple of weeks, the Ashton gradual crossover does not apply. The reason being that the majority of the K has already left your system after a couple of weeks.  Ashton did gradual crossovers to prevent acute withdrawal by rapidly reducing one benzo. But you have already experienced the acute withdrawal from K by going cold turkey. Doing a gradual crossover at this late stage is unlikely to mitigate the withdrawal symptoms and make you feel any better. The best course of action IMO is to wait it out. The fact that you're already feeling better is a very positive sign. And I would like to caution you against increasing your dose because you feel you are not making enough progress fast enough. It can take quite some time for Valium to build up in your system. I would hate for you to end up on a higher dose than necessary because you craved relief when the only thing you actually need is time for the drug to work. It can take weeks up to months to feel the full effect of the reinstatement. 

Right now all the signs are positive and I'm hopeful in the coming weeks you'll see some more improvement.  

 

[[Ro...]]

Thanks for the prompt reply. Yeah, I was off of it probably about 7-10 days but understand where you’re coming from. Yes, I’m better but not great, then again who is “great” going thought this! Ha. I’ll stick with your advice and keep moving forward!

Again, thank you for your reply.