Probable Klonopin Tolerance Withdrawal and Need Help

[[Wi...]]

During the past month I started having severe pain in my lower right back and hip that extends down the back of my right leg.  This pain has grown in intensity over the past few weeks and has become quite debilitating.  I have seen my doctor and have gone to physical therapy, but the pain is not improving.  My anxiety, depression, and sleep problems are also getting worse.   

 

At my last visit with my psychiatrist she told me that I may be experiencing Klonopin tolerance withdrawal and she told me to stop taking the 0.125 mg dose of Klonopin that I take daily at bed time.  That was two weeks ago.  I have not stopped taking it yet because I am afraid of triggering full withdrawal and even worse symptoms and pain.  I have read many of the devastating experiences that others have reported in their struggles to break free of and recover from Klonopin and other benzodiazepines.

 

I have read that due to the high potency of Klonopin that suddenly stopping even a small dose can cause very serious withdrawal symptoms.  Considering that I have been taking the 0.125 mg daily dose for 4 years now, and that I am likely in tolerance withdrawal, should I abruptly stop taking it?  If not, then I need to formulate a specific alternative plan to present to my psychiatrist.  I would greatly appreciate any help from other members of this forum.  Thanks.

 

Relevant Background/History:

 

    Between 1998 and 2006 I used Klonopin sporadically (as needed) for anxiety.

    In November of 2006 I began regular daily use of Klonopin for anxiety and sleep.

 

    (Nov 2006 - Apr 2007)  1 mg at bed time

    (May 2007 - Aug 2007)  2 mg at bed time

    (Sep 2007 - Dec 2007)  1 mg at bed time

 

    In December of 2007 I began tapering off of Klonopin 

 

    Temporarily changed to two doses per day

    (12/15/2007 - 12/18/2007)  0.5 mg in AM, 0.5 mg in PM

    (12/19/2007 - 12/21/2007)  0.25 mg in AM, 0.5 mg in PM

    (12/22/2007)                      0.25 mg in AM, 0.75 mg in PM

    (12/23/2007)                      0.125 mg in AM, 0.75 mg in PM

 

    Then changed back to one dose per day and tapered

    (12/24/2007 - 12/29/2007)  0.75 mg per day at bed time

    (12/30/2007 - 1/8/2008)      0.625 mg per day at bed time

    (1/9/2008 - 1/19/2008)        0.5 mg per day at bed time

    (1/20/2008 - 1/29/2008)      0.375 mg per day at bed time

    (1/30/2008 - 2/10/2008)      0.25 mg at bed time

    (2/11/2008 - present)          0.125 mg at bed time

 

When I reached 0.125 mg per day I couldn't accurately cut my 0.5 mg tablets into smaller pieces so I just stayed at 0.125 mg per day.  I have been taking 0.125 mg per day for the past 4 years.

 

I have Parkinson's disease and take 1000 mg of carbidopa/levodopa and 1400 mg of COMTAN per day.  I also take 22.5 mg of Remeron per day for depression.

 

During the past two years I have noticed an increase in muscle pain, stiffness and cramping, especially painful dystonia attacks in my left foot/leg that occur in the early morning.  My Parkinson’s disease symptoms (tremor, akinesia, rigidity) have also worsened.  Other symptoms:

 

  anxiety, agitation, and fear

  sleep problems

  frequent urination at night

  blurred/double vision

  fatigue

  weakness in arms

  numbness in feet

  cognitive impairment (difficulty thinking, memory problems)

 

 

[[su...]]

Hello WishToBeFree,

 

I see you are at .25mg of Klonopin. I am currently tapering from Klonopin too. Here is how I am able to get the lower dose reductions.

 

 

You get the % by taking the dose reduction and dividing it by the dose you are currently at. For example; a 0.03125mg dose reduction from 0.5mg is a 6.25% dose reduction.  0.03125 divided by 0.5 = 6.25% reduction.

 

I have been dry-cutting. I have learned some important things about this process for me:

 

 

1) I have found that I need to hold for no shorter than 2 weeks. . That is because Klonopin has a half-life of 30 to 40 hours and the generic clonazepam has a half-life of 18 to 50 hours. It takes five half-lives to get a dose reduction out of our system.

2) I listen to my body and hold until it feels like it has adjusted to the new lower dose. I usually get a few lower symptom days before I do another dose reduction.

3) My average holds have been 2 to 4 weeks

4) In order to keep the symptoms at a tolerable level, I keep my cuts around 10% or lower.

5) I have been able to keep my cuts below 10% by going to .03125mg when I hit .5mg of Klonopin.

 

 

 

In case you are interested in how I am able to dry cut the lower doses:

 

Cutting 0.25mg:

Here is how I am able to get the .25mg pieces. I break the .5mg tablet in half.  The brand Klonopin is scored and breaks in half easily.

 

 

Cutting 0.125mg

 

Take the .25mg and cut that in half. That is a .125mg piece. . I use an angle razor like a box cutter. And cut on hard surface like glass or a mirror.

 

Cutting 0.0625mg

 

I have the 0.5mg Klonopin.

 

I break the 0.5mg tablet in half then, I cut 1/4th off of that. I use an angle razor like a box cutter. I have found that the razor is thinner and sharper than the pill splitters I have worked with. Yet, I have read that some have no problem using pill splitters.

 

I cut the 1/4 off of the tablet on a glass surface. I have found the glass surface to be hard enough to get a clean cut. I press down firm and fairly fast. The 1/4 breaks away (from the .25mg). Now I have 0.0625mg.

 

NOTE: If you are unable to get a chip that is .0625 mg then you could crush it into powder. That would work as well. You would take a .25 mg piece and separate it into 4 piles.

 

Cutting 0.03125mg (Powder)

The way I get the .03125mg is I crush a .25mg piece and separate the powder into 8 piles. I happen to have a window scraper so that is what I use or you could use a razor. I crush the .25mg on a dinner plate with the top part of a pill crusher. Then use the window scraper or razor to separate the pile into 8. Each pile is .03125mg.

 

Note: (What I do is crush the portion of the tablet. Then I put it in one pile. I do my best with the razor to separate the pile into two. Then I take the two piles and separate them into two. That makes four piles. Then I take those and separate them into two more piles. That makes eight.)

 

Cutting 0.0156mg (Powder)

The way I would get a .0156mg cut is by crushing .125mg piece (to get the .125mg, cut the .25mg in half). Then crush the .125mg on a dinner plate, into powder with the top of a pill crusher. I happen to have a window scraper so that is what I use or you could use a razor. Then separate the piles into 8. Each pile is .0156mg.

 

Cutting 0.0078mg (Powder)

 

Crush a 0.625mg into powder and separate into 8 piles.

 

NOTE: With the powder, here is how I take it. I lick my finger, press it on the powder, then I put the powder in my mouth. Then I drink some water after.

 

 

Here is an example of reducing the dose from .125mg by .0078mg:

0.0625mg (Chip or Powder)                 

0.03125mg (Powder)

0.015625 (Powder)

0.0078mg (1/2 of the 0.015625 powder)

--------------------------

0.1172mg Total

That is a 6.2% dose reduction

 

 

 

I hope this is helpful,

Summer

 

[[su...]]

Hello WishToBeFree,

 

 

Why not to Detox or Cold Turkey a Benzodiazepine

 

 

 

I am the type of person who seeks to know what is happening and why, it brings comfort to me. I hope it does the same for you.

 

 

Why Benzos users should taper instead of cold turkey or go to a detox facility or do a rapid taper?

 

“The Benzo Book, Getting Safely off Tranquilizers” by Jack Hobson- Dupont, 2006

 

 

“Those who suffered the worst fates, it seemed, were the people who quit cold turkey. This is a dangerous undertaking. A sudden absence of benzodiazepine in the system may precipitate seizures, severe enough to cause death. Those who had survived were plagued with months- even years- of debilitating effects. This appeared to be the case as well with people who had tapered off benzodiazepine but had done so rapidly, over the course of days or weeks as opposed to months or years, either on their own or at a detox facility.”

 

 

Why Benzos are difficult to get off of compared to other drugs?

 

“The Benzo Book, Getting Safely off Tranquilizers” by Jack Hobson- Dupont, 2006

 

 

“It is the down-regulation of the neural receptors that differentiates benzodiazepine dependency from that of all other substances. That is the explanation of why getting off these drugs can be so horrendously difficult for some people, and why withdrawal symptoms for some can last days, weeks, months, even years after the last dose of benzodiazepine is taken. It is ignorance of this aspect of benzodiazepine discontinuation that leads medical professionals-- even addiction specialists who should know better-- to misunderstand the plight of benzodiazepine users. All of their exceptional difficulties and often bizarre discontinuation phenomena are a result of the single problem of down- regulation of the neural receptors after exposure to benzodiazepine.”

 

 

What is the deal about the GABA receptors that makes it so hard for me to heal faster?

 

“The Benzo Book, Getting Safely off Tranquilizers” by Jack Hobson- Dupont, 2006

 

 

“Those who are in the throes of benzodiazepine dependency would do well to absorb that idea: the sole problem you are having is that benzodiazepine has interfered with one of your body’s most elemental functions, that of attracting GABA to its neural receptors. The results of this condition may well present as a staggering array of withdrawal phenomena, everything from insomnia and anxiety, which would seem understandable, to dental distress, difficulty breathing, sinus problems, twitching muscles…..the list is seemingly interminable and contains phenomena that would appear to have nothing to do with the nervous system. Subjectively, these phenomena feel like illness. What is happening to someone whose many trillion nerve cells are down- regulated because of benzodiazepine is neither disease nor tissue damage, but more like a mechanical malfunction. Therefore, recovery is more akin to ‘repair’ than ‘healing’. Being aware of the actual nature of what is wrong helps demystify the rather bewildering process of getting on with recovery.”

 

 

 

How does GABA affect the body?

 

“The Benzo Book, Getting Safely off Tranquilizers” by Jack Hobson- Dupont, 2006

 

 

“What GABA does is to bind to parts of the neural receptor. It is this action that calms the nerves. Benzodiazepine binds to a different place on the neural receptor than where GABA binds, but its presence there strengthens the bond that the GABA makes, which increases the power of GABA to inhibit stimulation.”

 

 

What is down- regulation of GABA?

 

“The Benzo Book, Getting Safely off Tranquilizers” by Jack Hobson- Dupont, 2006

 

 

“Professor C. Heather Ashton found in her extensive research was that, in some people, after exposure to benzodiazepines, the ability of the neural receptors to attract GABA is reduced. So, even after there is no longer any benzodiazepine in the body to influence the receptors directly, they still aren’t able to bind enough GABA to themselves to inhibit electrical excitation sufficiently. This phenomenon is called “down regulation” of the GABA receptor sites.”

 

 

Why down- regulation of GABA causes a vast array of withdrawal symptoms?

 

“The Benzo Book, Getting Safely off Tranquilizers” by Jack Hobson- Dupont, 2006

 

 

“Dr. Lance P. Longo and Dr. Brian Johnson of the American Academy of Family Physicians, wrote in “Benzodiazepines- Side Effects, Abuse Risk and Alternatives”, that:

 

“With long-term high-dose use of benzodiazepine there is an apparent decrease in the efficacy of GABA receptors, presumably a mechanism of tolerance. When high-dose benzodiazepines are abruptly discontinued, this ‘down-regulated’ state of inhibitory transmission is unmasked, leading to characteristic withdrawal symptoms such as anxiety, insomnia, autonomic hyperactivity and, possibly seizures.”

 

“What Professor Ashton determined was that even when benzodiazepine isn’t ‘abruptly terminated’ as described above, it still has the potential of down-regulating the action of the neural receptors to inhibit excitatory states. While this is a simple, uncomplicated difficulty, the function of GABA throughout the body is so widespread, so fundamental to the operation of a wide variety of bodily systems, that to have it impaired produces an opportunity for a vast array of possible problems to appear.”

 

 

Why do benzos have to be out of the system to feel better?

 

“The Ashton Manual” by Heather Ashton, 2002

Mechanisms of withdrawal reactions. “Nearly all the excitatory mechanisms in the nervous system go into overdrive and, until new adaptations to the drug – free state develop, the brain and peripheral nervous system are in a hyper-excitable state, and extremely vulnerable to stress.”

 

 

 

I hope this is helpful,

Summer

 

[[su...]]

Hello WishToBeFree,

 

 

Remeron

 

I put together some information that may be helpful.  I am the type of person who seeks to know what is happening and why, it brings comfort to me. I hope it does the same for you.

 

"Your Drug May Be Your Problem, How and Why to Stop Taking Psychiatric Medications." Fully revised and updated edition, by Peter Breggin, 2007.

 

Page 90

 

Chapter 4

 

Adverse Effects of Specific Psychiatric Drugs

 

Adverse Effects Caused by Specific Psychiatric Drugs

 

Atypical Antidepressants

 

This category comprises Asendin (amoxapine), Desyrel (trazadone), Effexor (venlafaxine), Ludiomin (maprotiline), Remeron, Remeron Sol Tab, Remeron RD, Cymbalta (duloxetine), and Wellbutrin, Wellbutrin SR, Wellbutrin XL or Zyban (buproprion). See appendix A for a complete list. Following an unexpectedly high number of reports of severe liver injuries, Serzone was withdrawn from Canadian market in November 2003 and from the United States in May 2004.

 

Of extreme importance is the fact that antidepressant Asendin is converted into a neuroleptic (antipsychotic) within the body, producing the same problems associated with other neuroleptics (antipsychotics), including tardive dyskinesia and neuroleptic malignant syndrome (see below). For this drug, the FDA requires class warnings regarding TD and NMS.

 

Ludiomil and Remeron are classified along with Asendin as tetracyclic compounds. Seizures and involuntary abnormal movements (extrapyramidal symptoms) have been reported in association with Ludiomil. Remeron is relatively new: hence its profile of adverse effects is less understood. Many of the adverse effects of other antidepressants, including the tricyclics, should be considered in regard to these three drugs. Remeron, in particular, tends to induce sedation as well as dizziness, weight gain, and low blood pressure. Cardiovascular problems have been reported in connection with both drugs. Like all antidepressants, they can cause toxic psychosis, including mania and delirium.

 

Definitions

Tardive dyskinesia dizzy disfiguring and potentially disabling, unusual permanent neurological disorder characterized by tics, spasms, and abnormal movements. These drugs also cause neuroleptic malignant syndrome (NMS), a potentially fatal disease of the brain with effects similar to those associated with severe viral encephalitis.

 

 

 

Here is some info on Remeron and other medications. The link to this reference is at the bottom of this post.

Medication / Drug Usage During Benzodiazepine Withdrawal and Recovery

 

People who are in the midst of or have completely withdrawn from benzodiazepine drugs often ask the question of what medications they need to avoid in order to ensure they don't risk the danger of making their existing withdrawal symptoms worse. The following lists some, but not all medications, which are commonly prescribed during withdrawal and highlights both the dangers and benefits which can be derived from such medication thereby enabling the reader to make an informed judgment when in discussion with his/her doctor.

 

The information given on these medications is primarily related to benzodiazepine withdrawal but, for the most part can probably be equally applied to other GABA addictive drugs e.g. barbiturates and alcohol.

 

Antidepressants

 

This class of medication is sometimes prescribed in recovery. Some people say they obtain benefit from these drugs however most people find that antidepressants don't help benzodiazepine withdrawal and they are left with yet another drug to taper off of. The mode of action of antidepressants is completely different from that of benzodiazepines and thus they are typically ineffective at alleviating benzodiazepine withdrawal effects. Sometimes they can actually worsen depression or anxiety in what is known as a paradoxical adverse effect. A benzodiazepine slow taper and benzodiazepine recovery time is the most effect treatment for alleviating benzodiazepine withdrawal effects.

 

As with almost all psychotropic drugs you can get withdrawal symptoms or what is sometimes called a discontinuation syndrome. Antidepressants should be gradually tapered instead of stopped suddenly to reduce the severity of any withdrawal symptoms. Generally speaking antidepressants usually do not cause as bad withdrawal symptoms as benzodiazepines.

 

From a personal point of view the only antidepressent that I would advise against is Mirtazapine (BRAND NAMES:- Zispin, Remeron, Avanza, Norset, Remergil, Mirtabene). I have noticed many people having horrendous symptoms, which seem to last an extremely long time after discontinuation of this drug. Whether this bad experience is because of people's past experience with benzo's or whether these bad reactions occur with everyone I am not sure as my points of contact have been mainly with people who were either addicted to or had a past history of being addicted to benzodiazepines.

 

Visit our recommended links page for links to websites which have more information on depression and also websites for those wishing to withdraw from antidepressants.

 

Here is the reference (this reference also includes other medications to avoid)

 

http://www.bcnc.org.uk/drugs.html

 

 

I hope this is helpful,

Summer

[[su...]]

Hello WishToBeFree,

 

 

REMOVE DRUGS ONE AT A TIME

 

"Your Drug May Be Your Problem, How and Why to Stop Taking Psychiatric Medications." Fully revised and updated edition, by Peter Breggin, 2007.

 

Page 162

 

Chapter 8: How to Stop Taking Psychiatric Drugs

 

Remove Drugs One at a Time

 

“Many people, perhaps yourself among them, take several psychiatric drugs simultaneously. Today, polypharmacy – – the practice of prescribing more than one or two drugs to the same patient at the same time – – is quite common and encouraged, especially by physicians presenting in drug company – sponsored symposia. Frequently patients received an antidepressant and a tranquilizer, a stimulant and a tranquilizer, or an anti-psychotic and an anticonvulsant. It is no longer unusual to find children and adults simultaneously prescribed at least one drug from every single major drug class discussed in this book. Such cocktails, if combined with a physician’s failure to recognize withdrawal reactions and to monitor patients carefully, these patients vulnerable to experiencing severe distress. Such cocktails vastly increase the toxicity of each drug and produce dangerous, unpredictable adverse reactions and complicated withdrawal reactions. Patients taking multiple drugs often endure a chronic state of mental confusion, dulled and unstable emotions, and cognitive problems, including memory deficits.”

 

"You can withdrawal from several drugs simultaneously, but this is a risky strategy. It should be reserved for cases of acute, serious toxicity. In addition, since drugs taken together (such as neuroleptics and anti-Parkinson's) often have some similar effects, withdrawing them together can make withdrawal reactions worse. Also, because some drugs suppress or increase blood levels of other drugs, your healthcare professional should be well informed before making recommendations concerning simultaneous decrements for more than one drug. If you intend to withdraw simultaneously from two or more drugs, you should do so under the active supervision of an experienced physician or pharmacist."

 

"When you take two drugs, your brain tries to compensate not only for the effects of each one separately but also for the effects of their interaction. The physical picture gets even more complicated with each additional drug. The increasing complexity goes far beyond our actual understanding, creating unknown and unpredictable risks during both drug use and withdrawal. In cases of multidrug use, withdrawal is like trying to unravel a thick knot composed of many different strings – – without cutting or damaging any of the strings. In this analogous situation, you would have to proceed quite carefully indeed, gradually disentangling one string and continually adjusting the others in response to the ongoing process."

 

"It is usually best to reduce one drug while continuing to take the others. The process begins a new once you've eliminated the first drug completely and have gotten used to doing without it."

 

 

 

I hope this is helpful,

Summer

[[Ha...]]

Your symptoms sound a lot like sciatica.  Has your doctor explored that possibility?  I have the same problem, lower back and leg pain with numbness, but it is definitely caused by a herniated lumbar disc (verified by MRI).  I think the klonopin withdrawals make it much worse, but the cause is definitely an aggravated sciatic nerve.  I would definitely look into sciatica because it matches your symptoms almost exactly.

[[su...]]

Hello WishToBeFree,

 

 

I have researched this information prior to stating my taper. I found the information in Ashton and Peter Breggin M.D. (a Psychiatrist) to be very supportive of a slow taper.

 

Below: I will share some of the research that led me to the path I am on, regarding a slow taper. I shared this with my doctor and was able to get his support on doing a slow taper.

 

 

I am the type of person who seeks to know what is happening and why, it brings comfort to me. I hope it does the same for you.

 

 

"Your Drug May Be Your Problem, How and Why to Stop Taking Psychiatric Medications" 2007 fully revised and updated edition, by Peter Breggin, M.D. (a Psychiatrist)

 

Peter Breggin, MD. “Again, keep in mind that these withdrawal methods are only guidelines and not absolute rules. Applying them depends on how fast you feel comfortable to proceed and on how much discomfort you experience and can bear between dose reductions.”

 

Peter Breggin, MD." The most important rule is to respect your own feelings and to avoid tapering faster than you find bearable. Stay within you own comfort zone when pacing your withdrawal. Keep in mind that the longer you were taking the drug, and the higher the dose, the more gradual your taper should be."

 

Peter Breggin, MD. "Clinical experience with benzodiazepines also suggests that extension of the withdrawal period is not harmful, especially after the initial dose has been decreased by 50 percent. In ordinary circumstances, however, patients should be allowed to share in controlling the process, especially in regard to slowing it down."

 

 

 

“The Ashton Manual” by Heather Ashton, 2002

 

Professor Ashton." It is sometimes claimed that very slow withdrawal from benzodiazepines "merely prolongs the agony" and it is better to get it over with as quickly as possible. However, the experience of most patients is that slow withdrawal is greatly preferable, especially when the subject dictates the pace. Those who have been on high doses of potent benzodiazepines such as Xanax and Klonopin are likely to need more time."

 

Professor Ashton.  "It cannot be too strongly stressed that withdrawal symptoms can be minimized and largely avoided by slow tapering."

 

Professor Ashton. “There is no need to hurry withdrawal. Your body (and brain) may need time to readjust after years of being on benzodiazepines. Many people have taken a year or more to complete the withdrawal."

 

Professor Ashton. "Slow withdrawal in your own environment allows time for physical and psychological adjustments, permits you to continue with your normal life, to tailor your withdrawal to your own lifestyle, and to build up alternative strategies for living without benzodiazepines."

 

Professor Ashton. "Actually, the rate of withdrawal, as long as it is slow enough, is not critical. Whether it takes 6 months, 12 months or 18 months is of little significance if you have taken benzodiazepines for a matter of years."

 

 

 

Here is a copy of the Ashton Manual. You can print it out for free. Just print one section and chapter at a time. There are about 3 or 4 chapters.

 

The Ashton Manual

 

http://www.benzo.org.uk/manual/

 

 

Summer

 

 

[[su...]]

Hello WishToBeFree,

 

 

I was re-reading Peter Breggins” book and found something that might be helpful.

 

 

I am the type of person who seeks to know what is happening and why, it brings comfort to me. I hope it does the same for you.

 

 

"Your Drug May Be Your Problem, How and Why to Stop Taking Psychiatric Medications" 2007 fully revised and updated edition, by Peter Breggin, M.D. (a Psychiatrist)

 

"Stay in Charge of the Withdrawal. This is not to say you should let your doctor control the withdrawal. Even if you have been given every possible reason to believe that he or she understands the withdrawal process, it has to feel like a collaboration. And since physicians often withdraw patients too abruptly from psychiatric drugs, above all else you must feel free to slow the process down. “

 

“Sometimes, as we discussed in Chapter 9, doctors cut the dose by half from one day to the next, while still calling this a “gradual” withdrawal. Such an abrupt reduction is an imprudent strategy in most cases. Because of ignorance, lack of experience in patient-centered withdrawal, or even an unacknowledged wish to sabotage your effort, your doctor may rush ahead and create unnecessary complications. The unfortunate outcome will then be used to prove to you that withdrawal was a bad decision to begin with.”

 

“Some of the steps discussed in later chapters of this book, such as seeking replacement solutions and mastering techniques to cope with various manifestations of your problem, will help you to show your doctor that you are motivated, responsible, and capable of withdrawing successfully.”

 

“If attempts to enlist your doctor’s cooperation or assistance fail, you should be neither surprised nor discouraged. Remember that you, and no one else, will do the actual “work” of coming off drugs. You will feel the pain, you will experience the rewards. You will have to deal with the objections and fears of those around you who resist the idea that at least some of your current problems are actually drug-induced. You must therefore try to be in charge of the entire process from the very beginning, from the very first moment you decide for yourself that coming off drugs is your goal.”

 

 

 

I am thinking of you and wishing you well,

Summer

 

[[Fl...]]

Wish to be Free, I was taking 3 /.125 pills of Klonopin adding up to .375 all at nightime for a few years.  I was most definitely in tolerance withdrawal but did not realize it until this past December when finding BB and reading.  The first thing I did was to spread out my dose slowly until it was evenly spread out through out the day so as to not shock the night time routine that I had been in and make it so I could not sleep.  I then started putting the pill in liquid ( currently using coconut milk) and dosing 4x a day.  As soon as I spread my dose out evenly through out the day I felt better.  In my opinion even though it is such a low dose if you just stop taking it as your Dr said you will feel it worse.  Your body will still think it is a cold turkey.  Have you considered a slow liquid taper?  You got allot of great info from Summer.  I hope this helps some..........

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