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I think a need a rotation of hypnotics to fully withdraw from clonazepam


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Originally I posted this question in the insomnia forum. A fellow member suggested that I may have more luck with my question in this section.

 

For the original post, see 'I think a need a rotation of hypnotics to fully withdraw from clonazepam' in the insomnia section. Some additional information in my introduction.

 

Currently I take about 1 mg clonazepam a day. (highest dose 4 mg) Getting lower seems impossible. My main problem while tapering is insomnia. If I could overcome that, I think I could withdraw from this drug. I had pre-existing ideopathic insomnia before I ever started taking this drug, so perhaps you can see the problem ... I never had problems with hypnotic benzos, but while in withdrawal from clonazepam they just don't work.

 

Sometimes I used to drink some alcohol for sleep while tapering, but that was a bad idea ... especially at lower doses. There is always an interaction, even if you don't notice it.

 

For me, clonazepam has both sedating and stimulating properties. I could never take it as a hypnotic.

 

For withdrawal from this drug, or a different benzodiazepine: does anyone have experience with a rotation of hypnotics ?

Taking the same hypnotic every day would not work.

Most modern hypnotics are benzodiazepines, variations on benzodiazepines (z-drugs) and sedating antihistamines or drugs that act like sedating antihistamines.

My tolerance to sedating antihistamines is high, that class of drug would certainly not work for every night.

What little experience I have with antidepressants or antipsychotics for sleep is not good.

 

My insomnia is not anxiety-based, so a pure anxiolytic would probably not work. Inducing sleep is the main issue.

 

Btw, diazepam is even worse for insomnia than clonazepam ...

 

Any suggestions ? I have only a GP, and he isn't very knowledgable. Where I live there is no commercial healthcare system, so I can't just 'buy' medical care.

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For withdrawal from this drug, or a different benzodiazepine: does anyone have experience with a rotation of hypnotics ?

Taking the same hypnotic every day would not work.

Most modern hypnotics are benzodiazepines, variations on benzodiazepines (z-drugs) and sedating antihistamines or drugs that act like sedating antihistamines.

My tolerance to sedating antihistamines is high, that class of drug would certainly not work for every night.

What little experience I have with antidepressants or antipsychotics for sleep is not good.

 

My insomnia is not anxiety-based, so a pure anxiolytic would probably not work. Inducing sleep is the main issue.

 

Btw, diazepam is even worse for insomnia than clonazepam ...

 

I don't really know what to tell you, but when you take a Benzo.. let's say for Anxiety, coming off it .. will create Insomnia.

If you take a Benzo for Insomnia can create Anxiety.

 

I wouldn't even bother with a rotation of meds as it can mess up the taper and so on.

 

Given your Info from above, to me it sounds like you may just want to come of the Clonazepam without any Hypnotic.

 

As far as supplements and so on.. I don't even bother, personally they don't work for me.

 

After taking a Benzo, all these other things like tea IMO would be like almost taking nothing, would be like comparing water to tea.

 

Sounds like you may just have to taper off it and let the healing begin because I find there really is no way around Insomnia nor any of the symptoms.

 

Coping techniques help, you can try exercise and so on for sleep.

 

Good Luck to you.

 

For me, here is what I do, I exercise some and just wait until I am exhausted to sleep.

 

There really is no easy way around this. :(

 

 

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I didn't take this drug for anxiety but for minor neuropathic pain and as a muscle relaxant.

 

'Given your Info from above, to me it sounds like you may just want to come of the Clonazepam without any Hypnotic.'

No. Before I  started taking clonazepam I had severe ideopathic insomnia. Thinking that I could withdraw from clonazepam was borderline delusional.

Clonazepam doesn't help with sleep, it never did. I can't take it as a hypnotic. But tapering makes things even worse !

At this point, it's just poison.

 

Small cuts 'you don't notice' don't work. I will feel every cut.

 

If I want to fully taper the clonazepam I need something for sleep.

 

A rotation of hypnotics makes sense.

 

-http://www.benzo.org.uk/ashunfi.htm-

'For insomnia a rotation of hypnotics was used, a different hypnotic being given each night. The hypnotics included: promethazine (75-100mg), dichloralphenazone (1.3-1.95g), chlormethiazole (two capsules, 384mg base) and butobarbitone (100-200mg).'

Most of those drugs are not even on the market anymore !

 

Supplements ? Most do indeed not work.

 

My higest dose was 4 mg, now I'm at about 1 mg.

I don't see how I can get any lower without taking something for sleep.

Severe insomnia is torture !

 

Exercise in the late afternoon used to work, but not anymore.

 

'For me, here is what I do, I exercise some and just wait until I am exhausted to sleep.'

I can be exhausted, but that doesn't mean I will be able to sleep !

 

'There really is no easy way around this.'

I'm very much aware of that ! The whole withdrawal process has been HELL.

 

If I could overcome the insomnia I could stop taking clonazepam.

 

Options ?

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[67...]

Liberty,

 

I understand what you are saying.

 

I really don't know what to tell you.

 

Hopefully someone has a idea of it.

 

These meds, well Benzos are hard to walk around.

 

I haven't found too many options but get it over with with a good taper and heal.

 

;)

 

Modified

 

You stated you couldn't exchange the klonopin with valium ?

 

valium has a sedating property.

 

-http://www.benzo.org.uk/ashunfi.htm-

'For insomnia a rotation of hypnotics was used, a different hypnotic being given each night. The hypnotics included: promethazine (75-100mg), dichloralphenazone (1.3-1.95g), chlormethiazole (two capsules, 384mg base) and butobarbitone (100-200mg).'

Most of those drugs are not even on the market anymore !

 

I do not know what these medications are.

Promethazine I do.

 

If I could overcome the insomnia I could stop taking clonazepam.

 

I understand.

 

I am having some insomnia myself and I used to sleep alot more than now.

I am up until exhausted on this computer, multitasking, watching Netflix, and just different things.

 

 

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'valium has a sedating property.'

 

True. Sometimes too much.

 

But for whatever reason, I can't seem to fall asleep on it.

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I am tapering off clonazepam, and stopped hypnotics (triazolam and zolipidem CR) cold turkey.  I am taking trazodone and/or amitryptaline (great if you have pain). 

 

If I were you, I would avoid getting on any hypnotics.

 

Other things worth considering are the stronger antihistamines, like hydroxine and cyproheptadine. Contrary to what some may suggest, in higher doses these meds are quite strong.

 

Other things worth considering:  mirtazipine and nefazodone and seroquel. 

 

Several of these meds have a high risk of weight gain.

 

Please let me know if I can be of more help. Good luck.

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Soporiphia,

 

When I mentioned 'hypnotics' I was not referring to benzodiazepines or the z-drugs.

 

Technically, a 'hypnotic' is a drug that help you fall asleep. That's the general idea, anyway.

 

My limited experience with antidepressants and antipsychotics for sleep is not good.

 

I haven't tried hydroxyzine, but I have a high tolerance to promethazine. What would you consider a high dose ?

I don't think it's that safe to take more than 100 mg daily.

 

Cyproheptadine is not commonly prescribed here. From what I gather, it is both a strong antihistamine and a serotonin antagonist.

 

Thanks for the suggestions.

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Hi.

 

I only refer to hypnotics as short-acting benzos and z-drugs.  It's all semantics.  I got you.

 

I've had better luck with Atarax over Phenergan, but you clearly already have some tolerance, and the anticholinergic effects could be too great at a higher dose.

 

Cyproheptadine would be a good option.  It's OTC outside the US.  You can legally have it shipped to the US.  PM me for more info.  It does antagonize serotonin for a short period of time (used for SSRI sexual dysfunction), and it has positive effects on sleep architecture.

 

Trazodone and Elavil come with side effects, particularly in the beginning, but they do usually remit.  Elavil can cause weight gain, but I haven't had a problem at a 25 mg dose. Seroquel, mirtazipine and Lyrica all work as well, but they all can cause massive weight gain.  I am thin and fit, and they all put 10 lbs+ on me within a few months, and not just from eating.  Lyrica is quite good for sleep architecture, but it hits the Gaba receptors, which could interfere with your taper.  I think Neurontin is worthless except at massive doses, and it also hits the Gaba receptors.

 

A reasonable dose of Valerian may be worth trying.  I think it hits the Gaba receptors, but it's very gentle.  I sometimes take it in the early morning, to get a little more sleep.

 

Sorry, this is sort of stream of consciousness.  And I feel for you, as I am going through the same as you, and I am terribly fatigued.  But it's been 11 days for me, and I am not looking back at Ambien, Lunesta or Halcion.

 

Best to you.

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I appreciate the suggestions :)

 

I'm in Europe. Where I live, cyproheptadine's official indication is for allergies. Prescribing it for insomnia is uncommon. It's also a serotonin antagonist, I'm not so sure that's beneficial.

The use of medications is registered and monitored in databases.

I'm not so sure I could just get a prescription from a doc ... I'd have to explain why, and all that. He doesn't know I'm tapering.

(we don't have a commercial healthcare system, it's heavily subsidized and regulated). Definitely not OTC here.

But I suppose there are ways around that, I'm just not sure if it's worth the trouble.

 

Trazodone ... so popular in the USA. According to studies, it's not effective for more than two weeks (like benzo hypnotics) unless the patient is depressed or is already taking an antidepressant. Anyway, in this country they DO NOT prescribe this drug to patients who are not depressed.

 

Elavil/amitriptyline is the local equivalent of trazodone. I did try it once, years ago. I did help me fall asleep, but woke up way too early, hyper-alert, crashed/totally exhausted a few hours later. I'm not eager to try this in withdrawal.

Supposedly, this drug can be very effective long term BUT ONLY AT HIGHER DOSES.

 

Seroquel is a glorified antihistamine, inferior to promethazine. I did try it a few times.

 

Mirtazepine. To a large extent its effectiveness depends on its action as an antihistamine. Being an antidepressant, it also acts on serotonin.

 

Lyrica is not a bad idea. But I think it's more of an option to cross over from clonazepam to Lyrica.

Lyrica would probably potentiate the clonazepam. It's been a while since I studied this drug, but I think the levels/effect of this drug builds up gradually. A real hypnotic should be short acting.

 

Once, before I started this taper I tried Valerian and had a bad reaction to this drug/herb. I'd need a very high dose for it to be effective, anyway.

 

I've had nothing but bad experiences with antidepressants and antipsychotics for sleep.

Clonazepam acts on serotonin, and for that reason alone I'm reluctant to try drugs that act in any major way on serotonin.

 

I'm sorry if I seem negative, I really do appreciate your suggestions.  :)

 

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Has anyone experience with chloral hydrate, short acting barbiturates, other 'old school' sedatives, low doses of anaesthetics, meprobamate, baclofen or other muscle relaxants ?

 

This may seem weird. But it's not a perfect world.

 

My main problem is falling asleep. I've actually had that all my life, but it has become much harder now that I'm older.

Clonazepam is a very long acting drug, so a short acting drug that induces sleep can make sense.

 

About 'natural healing': there is nothing natural about clonazepam.

For me, clonazepam has both sedating and stimulating properties so you can see that it's a messy drug.

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No worries.  It was a reasoned response.  I don't disagree with you.

 

There are a couple other drugs available in Europe that are similar to Lyrica, that may be candidates.  Gabitril, Gabrene and I believe there is one other I ran across recently, but I can find it via a quick Google search -- something like Gabaloxol, or something like this.

 

Another thing to consider, similar to Elavil is Flexeril, which comes in a long acting formula that should last you through the night.  It's side effect profile is better than Elavil, though I find it's not as effective in making me sleepy.

 

Some people find Soma effective, though the half life is short.  And it may cause problems with tapering off of the clonazepam.

 

Baclofen is another.  It only hits Gaba-B.  It doesn't make me tired.

 

There's a discussion of most of the above, as well as OTC remedies on this page.  It's below you in terms of being scientific.

 

http://www.talkaboutsleep.com/sleep-disorders/2005/04/fibromyalgia-eight-hours.htm

 

Regarding Trazadone And Elavil, I actually find that their soporific effect continues.  I had to up my dose a little, but they still work.  They are among the few meds that improves sleep architecture. But that doesn't mean it will put you to sleep.  Sigh.

 

On a final note, I don't know if you can get GHB or GBL legally where you live, but if so, I'd be all over that.  The half life is a bummer, but they can help sleep and more (eg, growth hormone, beyond what is normally produced by good sleep).

 

This is scattershot, and I really haven't given you much new info.  That's about all I can think of.  Fwiw, I am not content with my sleep meds, but they seem to be as good as it gets for now.

 

Wishing you the best, including some restorative sleep.

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Liberty, I responded before reading this.  Coincidentally, I mentioned baclofen and Soma (metabolite of old skool barbs).

 

Baclofen did nothing for me, though it is used to counter withdrawal, so it may help in some respects.  GABA-B does assist sleep for some.

 

I like Soma, as a relaxant and as a mild sedative.  I would try that before pure barbituates, which I understand can be even more addictive then benzos.

 

Another option may be taking a Z-drug, and dropping the clonazepam at the same time, on an equivalency basis.  Though I am sure you've thought of that and already ruled it out.

 

Another option would be opioids, if you have pain, as most do when they dont get regular Delta sleep.  I find hydrocodone very sedating.  Indeed, I would use it for sleep but for the severe constipation it causes me.  (I have a connective tissue disorder that causes major slowing of the GI tract, in addition to chronic pain and sleep issues.)  Oxycontin is a long-acting oxycodone, which also works for some.  For me, the hydro makes me more tired.

 

Sorry I can't be more help.

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Liberty, I responded before reading this.  Coincidentally, I mentioned baclofen and Soma (metabolite of old skool barbs).

 

Baclofen did nothing for me, though it is used to counter withdrawal, so it may help in some respects.  GABA-B does assist sleep for some.

 

I like Soma, as a relaxant and as a mild sedative.  I would try that before pure barbituates, which I understand can be even more addictive then benzos.

 

Another option may be taking a Z-drug, and dropping the clonazepam at the same time, on an equivalency basis.  Though I am sure you've thought of that and already ruled it out.

 

Another option would be opioids, if you have pain, as most do when they dont get regular Delta sleep.  I find hydrocodone very sedating.  Indeed, I would use it for sleep but for the severe constipation it causes me.  (I have a connective tissue disorder that causes major slowing of the GI tract, in addition to chronic pain and sleep issues.)  Oxycontin is a long-acting oxycodone, which also works for some.  For me, the hydro makes me more tired.

 

Sorry I can't be more help.

 

Hi soporiphia,

 

We try to stay away from offering this kind of advice, your post is prescriptive in nature about drugs not related to benzodiazapines. Please review the forum policy about being prescriptive -

 

http://www.benzobuddies.org/forum/index.php?topic=25837.msg389615#msg389615

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With all due respect, it's not perspective when viewed in conjunction with the thread/post it replies to -- which post asked about hypnotic candidates, including most of the drugs I mentioned.  Liberty is having a hard time, and wants some outside-the-box ideas.  I believe that's all I provided, ideas, and did not prescribe a certain course.  Any ranking is largely based on my experience, as connoted.

 

This forum is to discuss "other medications" and this would seem to be a proper use of such a forum, if, indeed, the mission is to help one another.

 

And note, out of the gate, I actually noted that I would be cautious about trying any other med that hit Gaba-A receptors.

 

Notwithstanding, I will be more circumspect in the future.  I do hope you will read the thread and reassess, and if a retraction is due ...

 

Regards.

Sopoterrific

 

 

 

 

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Starbird, I didn't consider Soporiphia's posts prescriptive.

 

I was asking for suggestions, and all she did was trying to come up with some things that might help.

Which is very welcome.

 

I strongly doubt opiates would be helpful for sleep on a consistant base. Here in Europe, when opiates are prescribed it's codeine, morphine for more extreme situations. Super potent synthetics are rarely used, except when really needed.

Here there is no oxycodone, vicodin, hydrocone etc. It's not prescribed, it's not available.

Not to mention the fact that I couldn't get my GP to prescribe something like that.

Pain is not an issue anyway.

 

The z-drugs are not an option, as I believe I mentioned that somewehere.

Not even as an add-on to clonazepam.

 

Perhaps short acting barbiturates could make sense, but they are virtually impossible to get. Perhaps when in a hospital something like that could be arranged, but according to information on the internet they are not even on the market.

 

I'd never take a drug just based on someone's suggestion.

 

'standard treatment' doesn't work for me.

 

It was probably borderline delusional to think that I could withdraw from clonazepam while suffering from serious pre-existing idiopathic insomnia !

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You may wish to look into SOMA, as noted above.

 

If you're borderline delusional, I am borderline and delusional.  I am taking .25 mg of clonazepam, BID, and trazadone and amitryptaline, and no alcohol whatsoever (as should be the case during a taper, as I see it).  I take a acetylcholinesterase, which reduces the anticholinergic sides.  It's been a challenge -- every day -- but it's been nearly 2 weeks, and the worst is over.

 

 

 

 

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With all due respect, it's not perspective when viewed in conjunction with the thread/post it replies to -- which post asked about hypnotic candidates, including most of the drugs I mentioned.  Liberty is having a hard time, and wants some outside-the-box ideas.  I believe that's all I provided, ideas, and did not prescribe a certain course.  Any ranking is largely based on my experience, as connoted.

 

soporiphia,

 

The rules and guidelines clearly state that you cannot write in a prescriptive style. Though I realize you are just trying to be helpful, liberty's soliciting of medical advice does not justify you providing it.

 

eljay

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There was no prescriptive style or advice.  Ideas, just ideas being kicked around.  If you wish to delete the posts, do so.  But there is no need to pile on.  I have nothing further to say about the false allegation.
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