Klonipin withdrawal help needed

[kittycats]

Well were to start. I have been taking Klonipin 1-2mg per day as needed for 9 years now. I am addicted. If I go more than 16-20 hours I begin to itch uncontrollably on my face; particularly around my nose. I am recently married and my husband and I are wanting children. I DO NOT want to be taking these meds, but feel helpless with out them. I have severe panic attacks, for no reason and the klonopin has been prescribed. I do not have any idea how to get off of them. If I even can? If anyone knows any solutions or any alternatives. My doctor has always said that Klonopin is not addictive. I was not until I tried to stop taking it that I realized just how bad it was. Can anyone help me?

[ZZzzZZss]

The only way to stop Klonopin is to gradually taper off it. The slower you do it the easier it will be. You need to consistently reduce your dosage over a number of months. The smaller the dosage change the easier it will be. Klonopin comes in .5mg tablets so can be cut in quarters or .125mg pieces. An example of how it might be done would be if you are taking 2mg then reduce that amount by .125mg every week or so. When you get below .5 mg, you should slow down to every 2 weeks or so depending on anxiety and withdrawal symptoms. Do this until done. Some symptoms will continue for many months so don't let that get you back on the Klonopin as that is the trap.

Another more complex approach is given here. The only problem with Valium or Librium for the taper is they make you groggy all the time. The advantage is they wear off more slowly ( longer half time = more even taper) and they come in small dosages so the taper can be more gradual (smaller changes). If it works to taper directly off Klonopin with .125mg reductions slowing down below .5mg, it is more straightforward for the doctor than the Ashton approach here. You should discuss doing this with your doctor. Don't let your doctor tell you that you don't need to taper. If you don't taper, you can have a seizure and/or will have unbearable anxiety.


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

[mosspa]

Klonopin is not a good choice for panic attacks. First, it is too slow. Second, it only masks the attack. A much better choice for a real panic attack is clonidine (about 150-200 micrograms). Clonidine stops the attack where it starts and snowballs out of controll, the brain's sympathetic output control system. Clonidine is not addictive, but you can use it to turn off an attack so you don't to be on it continuously. It generally has effect in about a half hour. For long term control of panic from a prophylactic standpoint, an SSRI like Paxil is a much better choice than Klonopin.

Moss

[frodoggg]

you need to taper slowly over he course of a year. Then maybe switching to the more short-acting benzodiazepines. This will take a long time, so don't get discouraged

[mosspa]

A succesful taper from your current Klonopin dose oe 2 mg/day should be easily accomplished in about 2 months. The most consistent regimen for the taper is to decrease the Klonopin by .125 mg every 3 days, so it will take 24 days to get to 1 mg and 48 days to get to 0. This is, more or less, the standard Klonopin taper. Since you have been on it for 9 years, however, you might want to add a day or two at each stage. There isn't a lot known about withdrawal from 9 years of Klonopin abuse. ZZzzZZss is correct about the anxiety produced by the withdrawal. Panic is really just a case of the anxiety system out of control. So if you were initially put on Klonopin for panic disorder, and you have been on it for 9 years (amazing), I can't help but believe that you will rebound into panic with some severity just from the withdrawal of the Klonopin. You might want to talk this over with your physician (who sounds like an idiot to me so you might want to get a second opinion by somebody who actually was awake during pharmacology in med school), but you are going to have to control possibility of rebound panic somehow while you withdraw from ther Klonopin. Whatever you do DON'T LET ANYBODY PRESCRIBE A SHORT DURATION BENZODIAZEPINE FOR THIS PURPOSE. ZZzzZZss is again right about Valium or Librium being alternatives from the benzodiazepine class. However, it is my opinion that you should get off the benzos as soon as possible. There is no point substituting addiction to Valium for Klonopin. In my post above, I offer some suggestions. Personally, I would think that Paxil or Zoloft can be safely phased in while the Klonopin is phased out, eventually leaving you with a SSRI regimen that keeps the panic under control. I would also seriously consider carrying some clonidine around just in case an attack starts. At least that way you can be assured that you can get it under control in under an hr. Actually, your best bet would be to find a relatively young psychiatrist with experience in both benzo withdrawal and panic disorder.

[kittycats]

Well OK, here is the deal. I am also on Zoloft 50 mg. every night for the past nine years on and off again to experiment with new drugs. Like paxil which makes me suicidal. Paroxatine (which is also paxil) stupid doctors. Ummm... Effexor, Prozac, welbutrin.. to name a few, but always with the Klonipin. I am helpless with these meds, and no one seems to know how to get me off of them effectively. My "doctor" thinks I need them, and I think they make me go in self defeating circles. I just don't know what to do anymore. If I taper off slowly, what happens when i have a bad panic attack and want to take 2 mg. of Klonipin to stop it. I have terrifying attacks and am not sure I could get through without the K. So it is beginning to seem like a lose lose situation. I want off of all these meds. COMPLETELY. I have a panic attack everyday to every other day. I don't know what to do anymore.

[mosspa]

Ask your prescriber for a prescription for clonidine. Do the taperoff Klonopin and take 100-200 micrograms of clonidine at the first signs of the onset of a panic attack. If you are having them while on the Klonopin, the Klonopin obviously isn't doing much. Clonidine won't interact with your SSRIs. If your physician doesn't see the usefulness of this strategy, find another physician. Also, re-read my posts above. You can print them out, including this one, and bring them to your physician.

Moss Parker, Ph.D.
Neuropsychopharmacology

[kittycats]

Ok, I began seeing a new psychologist today. Since you seem to be knowledgable about meds I thought I would ask you what I should expect to go through once I start to taper off the klonipin. I do not really like to do too much research on it as some times thigns can scare and upset me and cause me to have a panic attack. I understand that my body is addicted to the K. I can take three mg. and still drive, go to the store, and be completly functional. I will be honest I am scared about what will happen to me.I am going to take the replies to my new psychologist on Tuesday next week, and she is going to work with my doctor to help me get off the medicine. I just want my life back, and I am scared of what that means. Also what is clonidine, and how addictive is it. What is it used for? etc..... Thank you so much for your help thus far. Everyones help for that matter. It has given me a bit of courage and hope.

[ZZzzZZss]

If you take it real slowly with tapering the Klonopin ( a few months or more) and do it in small changes (.125mg) , you should only notice minor symptoms of anxiety and feeling out of sorts. These symptoms will come and go. You must avoid the temptation to use more Klonopin to relieve these symptoms. For anxiety the Clonidine is the best choice. Clonidine is not addictive. Its main use is to reduce blood pressure and its used in rehab for opiate detox. If you take it sporadically, it will only reduce your blood pressure and lower anxiety. It turns down your sympathetic nervous system that makes your heart race and your body feel shaky and anxious. Don't take too much Clonidine ( .1-.2mg is good) at once or your blood pressure could go way down. Thats not typically dangerous but you could feel faint when standing up quickly. Don't taper the Klonopin too quickly or the symptoms may be difficult. It takes a few months for the Benzo system to adapt at a minimum so you don't want to taper off any more quickly.

If you get symptoms, slow down. Its really important that you are consistent and stick to the taper plan. Its also important that you don't take any short acting benzos like Xanax as an alternative as that will just cause worse withdrawal symptoms. You should take your Klonopin in half a days dose twice a day so you don't get symptoms as it wears off each day as it can have as short as 18 hours half life but it can be as long as 50 hours. You should stick with your SSRI as that will help the anxiety. Lexapro worked well for me. I tapered off Klonopin but never took more than 1mg so your's will take a bit longer but I did ok. You will do fine if you take your time and take your Clonidine and SSRI.

z

[mosspa]

Well there you have it. I'm a neuroscientist and Z is speaking from personal experience. I think that when you merge the two perspectives you are getting the whole picture. BTW, I've done quite a bit of animal research with clonidine and it is a very safe drug. For humans it is very safe when you take less than 250 micrograms (and even then the only real problem is excessive lowering of blood pressure, which won't happen to you if you are having a panic attack, since during the attack your blood pressure is probably off the scale). Also, I have this bizarre condition which is like panic without the anxiety or increased heart rate where my blood pressure goes way out of control (I've measured as high as 246/152). Like panic the attacks are sudden onset and can occur anytime. I have learned to keep a 150 microgram clonidine tab on my person at all times. Once I detect the shift (and because I don't have the "paniky" panic symptoms, I'm generally farther into it than somebody with real panic would be), the clonidine brings my BP under control in about 1/2 hr. Your mileage may vary, but since you probably recognize your panic a lot quicker then I recognise my blood pressure elevating, you should get it under control even quicker.

[bostonian]

Would the same tapering schedule apply to Lorazepam as well? I know it's a benzo too but don't know the difference between the two.

[mosspa]

Lorazepam (Ativan) is a moderately short duration benzodiazepine. Its serum half life is about 12-15 hrs, and it has an active metabolite that has a half life of about 18 hrs. It statistically takes between 4 and 5 half lifes to fully clear a drug. So, in most people there will be some bioaccumulation over time. As for a tapering schedule, a lot of it is determined by what the maximum peak dose is and how long you have adapted to it. If you do the math, you will find that the steady state serum level (assuming constant scheduled dosing) will peak much lower than for Klonopin (referenced to the initial dose). That means that, proportionately, a long term Ativan user has less serum accumulation than does a Klonopin user. Also, withdrawal from Ativan generally accepted as being a lot less harsh than for Klonipin, mainly becase of the bioaccumulation issue. I could be more specific if I knew how much lorazepam you were taking ant what the frequency of dosing is.

Moss

[bostonian]

I've been taking 1mg of Lorazepam every day for 3 months and stopped without tapering because I was told it's a mild benzo and I shouldn't worry about withdrawals. However I am beginning to think that was a stupid thing to do. My anxiety mostly happens at night andit has become quite violent since stopping L. I also have great sensitivity to sound now and a burning sensation in the back of my head. I am a mess, what can I say. So I wonder if all of this is due to my sudden stop of L. Would you recommend going back to L and taking 1/2 mg and alternating that w/ambien since I can't sleep w/out it at the moment. Thank you moss! Your posts are very informative

[mosspa]

Anxiety is a common side effect od withdrawal from a benzodiazepine. Also, there is no such thing as a "mild" benzodiazepine. Except for pharmacokinetics of absorbtion and metabolism, they all pretty much do the same thing. There are differences as to how anti- anxiolytic they are, but all benzos will induce sleep at some dose. Yes, you could try to go back to 0.5 mg/day and see if that helps the anxiety. If not go back to 0.75 and try there. There is no standardized tapering schedule for Ativan, but my guess would be that you should be able to drop your dose by about .25 mg/week and not be in too bad shape. Also, you are going to have to accept the fact that this isn't going to be a painless process. Read Z's discussion of the phenomenology of tapering, above. However, you weren't on a really high dose. All the scripts we fill here are in the range of 1 mg 3x/day. Also, 90 days isn't a whole lot of time to be on a benzo and develop high levels of tolerance. Finally, I have never heard of a burning head sensation as part of any benzo withdrawal. Also, I'm not too sure what sensitivity to sound means, either. You can put yourself on a taper, but I thik that a visit to your physcian may be in order. One more thing, don't get to reliant on te Ambien for sleep, it could send you down another regretful road.

Moss

[ZZzzZZss]

Given Lorazepam is 3X weaker mg per mg than Klonopin and has about 1/3 the half life and you only took it 3 months, this shouldn't be too bad. Ambien will interfere some with the taper of the hypnotic effects but I understand why you may need to take it. Try not to take it every night. Just figure out how much small a piece you can cut from a pill and spread your reductions over a month and you should be ok. Slow down if you get weird withdrawal symptoms. It might be helpful to read this:

Its overly complex but it gives a sense for how an experienced practioner gets people off benzos.

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

A strength/half life equivalence table for benzos so you can see where Lorazepam falls:

http://www.benzo.org.uk/bzequiv.htm

This too is a bit over the top but it does give a list of every reported withdrawal symptom ever reported. I had many.


http://www.benzo.org.uk/sympt3.htm