How to Stop/Taper Clonazepam (Klonopin)?

I've been on Klonopin off and on for the past 6 years. Always able to taper and get off in past but never on as long as I've been this time. Developed insomnia about a year ago and have been on anywhere from .25 mg to .5 mg each night for sleep.

My sleep has gotten better and I fear being on Klonopin for a long time. I've had a Psychiatrist tell me that if I need the Klonopin (my ears are better now than early on) then why stop taking? Also that if I stop my tinnitus will get worse and may not get better if I ever started back again.

I could sure use some support and advice on what to do here. I started the Ashton method yesterday by taking .25 mg Klonopin and 5 mg Valium (idea is to move from Klonopin to Valium then titrate down 1 mg every two weeks) but my ear is the worst it has ever been today. Scares the crap out of me.

Anyone here successful with getting off Klonopin and not making tinnitus worse long term?

 

I was taking Lorazepam .5 mg at night for sleep and weened off it by first taking half then a quarter. It did not affect my sleep which was a priority as bad sleep for me equals bad tinnitus the next day. That said, I still have my good & bad days as usual, just not taking meds.

 

Hey Michael. thanks for your reply. How long were you on Lorazepam and what was the time table for cutting in half?

 

Suffice it to say I was taking it longer than most people. It served its purpose in helping me sleep. As far as weening off it, I didn't consulted with a physician (not recommended) and did as I saw fit. Since I was only taking it at night I didn't see a problem with that. The whole process took a few weeks. The hardest part was going from a quarter pill to no pill. Old habits!

 

Old thread, but checking on how you're doing with tapering?

For the record, I wouldn't switch from Clonazepam to Valium. Clonazepam already has a long half-life, you'd be better off titrating down Clonazepam without using Valium.

There are quite easy ways to do it (syringe if you're taking drops, etc.)

While switching to Valium, you're basically integrating a second benzo into your system, which is not what you want to do. I know about the Ashton method though, I've read the whole thing, but the Klonopin-Valium thing is debatable

 

I'm terrified by this. I'm in agony already and it would not be the time for a taper but I suspect the drug is harming me as I worsen on a stable dose. There is an experienced member in BenzoBuddies who dealt with this, she had to reinstate and go through a super-slow taper. She said some US audiologists keep patients on a 2mg Valium maintenance dose for life to avoid tinnitus worsening.

Usually with a very gradual taper tinnitus worsens for a while after quitting but then improves back to baseline, although there are unlucky exceptions who get stuck.
At my current dose I'd need a 6 months taper of 10% weekly to jump off, but that's fast. 10% every 4 weeks looks more realistic but would take 2 years and is still fast. Don't know what to do. One should taper when symptoms are under control but if one is in agony at the start of the taper how can one manage? Updose until one feels better and then start a micro taper of 4 years? Problem is tolerance, updosing might not help.

Switching to Valium could help with the longer half life, sedation and smoother taper, but the switch is often destabilizing initially and could worsen the tinnitus.

A bloody minefield.

 

@Chinmoku, I know one's experience cannot compare to another's, but if you're already in tolerance, I wouldn't updose, as your body already knows how to adapt to the molecule and you will have to taper from a higher dose. I have read this can be a recommended approach, but it hasn't done any good to me.

I had been using 0.4mg Clonazepam until it didn't have any effect, I updosed to 0.7mg, the relieving effect lasted 2 weeks and I was back with more tinnitus and a higher dose when I started my taper.

I'm now at 0.4mg, I'm not following the extra slow taper that I had begun with at the first place, because basically, you may be making it last longer than needed.
I went from 0.7mg to 0.6mg, stayed at 0.6mg for 1 week, went to 0.5mg, stayed at 0.5mg for one week. Yesterday I took 0.4mg.

So far, not THAT MUCH worse (tinnitus is slightly less tolerable, but to be honest it has kept increasing for 2 years so I feel I'd better be off with less benzo in my body).

For me the trouble begins at around 0.25mg or something. I'll slow down when I reach 0.3mg. Maybe I'll do 2.75mg, then 2.50mg, then 2mg. We'll see.

2 years seems like an extremely slow taper. Remember that BenzoBuddies testimonies don't represent how the general population deals with benzo withdrawal. Don't overpanic over it

 

Thanks! I don't know if I'm in tolerance, and sometimes there is a good dosage where the medication starts working stably but it does not work below that dosage. For example, @linearb was almost abandoning the Clonazepam attempt but at some point he went up to 2 mg and it started working stably at that dosage (plus Gabapentin).

What bothers me is that Clonazepam helped me tolerate tinnitus better and made it maskable the first two weeks at 0.5 mg but didn't really lower the volume, it just made it less intrusive. However, at 0.5 mg it lost effectiveness almost immediately. I have been uncertain a long time whether to try a high dose or to wean off. Problem is I'm in agony, literally. My days are horrible, I can't go on much longer. I'm down to 0.33 mg, should go down to 0.3 mg tomorrow, if I keep cutting 10% a week I will be to 0.25 mg in two more weeks but I don't feel like I can really make it if I don't find anything to give me a little relief or peace from this 24/7 horror.

 

I would hang on to the thought that your brain will bring you relief once it actually is allowed to. Tapering is not the norm for your brain, it has to adapt to a new norm everytime you titrate down.

Even if we stick to the horror stories, people find relief at some point, only when they are off the meds. Good thing is, all of these people have the same testimonies: they have never felt better then before once they are "clean".

We are in the same boat. Sometimes I'm like: I should take 20 drops and I would feel better. Well yeah, maybe, but where would that lead me to in a couple of weeks?

Tinnitus is a brain thing after it starts with being an ear thing. I believe we won't help ourselves until our brain finds its main natural function again: adaptation.

Remember even people with extremely loud tinnitus are able to let the sound fade into the unconscious part of their brain.

That is a fact.

Loudness plays a role in how debilitating the sound is, but it won't actually be that much of a problem for your brain to deal with any stimulus that it considers, not as a threat, but part of its environment. Benzos prevent your brain from doing that.

 

Indeed... there is a sense of pain and urgency and agony associated with the sound, the frequency is so high and intrusive, it seems impossible to ignore or habituate to, but it's true what you say, people habituated to monster tinnitus, probably worse than mine. It's the agony I don't understand, it's so loud I can't think, sitting down in front of a computer like now is extremely difficult, I'm restless, I'm trying to meditate but sitting down half a hour with this agonizing urgency and restlessness is becoming impossible. I am suffering too much to reason objectively and I'm scared I could end up doing something stupid as the pain is unbearable.

How do we go on six months - 2 years like this? I'm at a level where "it gets worse before it gets better" cannot work, because worse than this I'm gone.

I'm suffering so much that sometimes I think a cold turkey would make more sense but I already know I wouldn't be able to stand it.

 

Most people have no problems tapering off such a low dose of Klonopin. Everything you hear on here is just horror stories and you don't hear the good stories!

 

Right, that's why it's hard to be sure it's the drug causing the worsening. Most people taper without too many problems. If not for the tinnitus I would be able to taper fast, the other symptoms are tolerable. So I'm not sure it's the drug tolerance that is responsible for the worsening but it's the only hypothesis I have.

 

I think if you are coming off of an anti anxiety drug it's normal to have increases anxiety which makes the tinnitus seem louder.

 

It's not just the anxiety, there is a change in the quality of the signal, it becomes much more intrusive and electric, the pitch gets higher, it gets louder. This might be a consequence of anxiety or not, but benzo tolerance or withdrawal can induce anxiety even on people who went on benzos for completely different reasons and never had anxiety before in their life.

Anyway you are right that people can taper from our dosages relatively quick. I found this paper:

Tapering clonazepam in patients with panic disorder after at least 3 years of treatment

Spoiler: Abstract

High-potency benzodiazepines, such as clonazepam, are frequently used in the treatment of panic disorder (PD) because of their rapid onset of action and good tolerability. However, there is concern about their potential to cause withdrawal symptoms. We aimed to develop a protocol for safely tapering off clonazepam in patients with PD who had been receiving treatment for at least 3 years. A specific scale for judging withdrawal was also developed, the Composite Benzodiazepine Discontinuation Symptom Scale. We selected 73 patients with PD who had been asymptomatic for at least 1 year and who wished to discontinue the medication. The trial consisted of a 4-month period of tapering and an 8-month follow-up period. The dosage of clonazepam was decreased by 0.5 mg per 2-week period until 1 mg per day was reached, followed by a decrease of 0.25 mg per week. The mean dosage at the start of tapering was 2.7 +/- 1.2 mg/d. In total, 51 (68.9%) of the patients were free of the medication after the 4 months of tapering according to the protocol, and 19 (26.0%) of the patients needed another 3 months to be free of medication. Clonazepam discontinuation symptoms were mostly mild and included mainly: anxiety, shaking/trembling/tremor, nausea/vomiting, insomnia/nightmares, excessive sweating, tachycardia/palpitations, headache, weakness, and muscle aches. The improvement in PD and general well-being was maintained during both the taper and follow-up phases. Clonazepam can be successfully discontinued without any major withdrawal symptoms if the dose is reduced gradually. We recommend reducing the dosage of clonazepam after intermediate-term use by 0.25 mg/wk."]

At high dosages they tapered 0.5 mg every two weeks and at low dosages (under 1 mg) they tapered 0.25 mg per week (!) and the patients had mild symptoms. This was for panic disorder. It looks like I should be able to get to zero in two weeks but the tinnitus seems to be much less forgiving. What a mess. This means that either I'm extremely sensitive to the medication (given also my past two years of Pregabalin) or the real reason for my tinnitus worsening is not the Clonazepam. Given the paper even a taper of 20% a week looks conservative, but I don't feel like risking it.

 

Some really good and comforting advice on this thread. thank you. I'm down to half of .125 mg most of the time now. Been very slow since I do have insomnia anxiety issues also. I look forward to being off soon. Probably more of a crutch than anything at this point. I'm figuring out that my tinnitus is worse with allergies (especially ragweed and mountain cedar) but over the past 6 months I've had a good deal of good days where the sound is very minimal or when louder it doesn't cripple me.

 

I am trying to taper off Klonopin as well as I quickly felt the need to updose. I have not been on it very long... I started in late August and I was on 0.5 mg per night for the first month and then 0.25 mg 3x day from September to middle of October.

I started by cutting my dosage 1/2 per week.

One month later I still am having withdrawal symptoms from the Klonopin. Higher anxiety, slight shaking sometimes, pins/needles in hands and feet. The only other prescribed med I take is a BP med and prescription sleep aids; I have been through Ambien, Lunesta, Ambien CR).

Right now I am taking 0.125 mg of Klonopin a day which some days I can feel the effect of needing to take more but trying to push through. Thinking about trying 0.125 mg for a week and then cutting in half the following week to see how it goes.

I have right ear only tinnitus (from TMJ, ear infection... not sure, but I definitely have TMJ) since January.

 

Would taking precursors of GABA be helpful whilst you taper?

 

BenzoBuddies says no, Peter Smith says yes, I had posted the link to his video on the subject earlier but if you google "Peter Smith" "benzo withdrawal" you will find it.
Basically BB says that benzos downregulate your GABA receptors and that in order to go back to normality one has to avoid all GABAergic supplementation in order for the brain to re-build its ability to generate GABA and the receptors.

Peter Smith claims it's not a problem of GABA but a problem of receptors. He claims the mechanism of action of supplements is different from that of benzos, they do not attach to the same receptors and supplements may in fact help by taking the edge off. He has worked with many patients apparently and he says they usually benefit from targeted gaba supplementation.

I looked into this a long time ago when tapering pregabalin. What people usually suggest is using precursors or modulators:

- Taurine (this is the least controversial)
- L-Theanine (this is more dubious, if one's mechanism of conversion Glutamate-GABA is not working properly L-Theanine can make things worse)
- NAC (transforms Glutamate into Glutathione but may have some counterindications)
- Magnesium

Some people use Pharma-GABA or Picamilon directly, but this is more dubious as the action is very direct. If you look at the chemical composition of Pregabalin it looks almost like GABA, so I would be nervous in directly pushing GABA to the brain, I would feel much more at ease with precursors or modulators.

In any case the action of supplements is much gentler and less selective, and Peter Smith says he has never seen a single case of dependence on supplements in many years of practice.

 

I wanted to add to this thread as this might be of interest to @Pitseleh and others. I'm still trying to taper very slowly but I'm worse and worse, even holding makes me worse, I feel I can't survive a six months-1y taper and going any faster would destroy me quickly. Not that going slow is helping, I still find it impossible to go on. Not sure what to do here.

In desperation I came across this status update from @birdy (she probably left the forum):

In another post, she says this:

She also said:

I don't think we all have "benzodiazepine-receptor-deficiency" but some of us might have a natural lack of GABA receptors, or GABA receptors that are underactive. I'm taking the above very seriously as I'm simply too ill and in danger (don't want to trigger anyone by saying more). There is also the case of @linearb, who had to go up to 2 mg before seeing any effect, lower doses would not work and he would still feel incapacitated. His story is quite special, though, so it's hard to deduce anything from these few anecdotal cases.

However, the terror is that if one tries to updose to monster dosages like 2-6 mg (these dosages are used for epilepsy) and yet does not stabilize one is basically fried or dead. The taper from such heights would be eternal and having to do it while in tolerance is impossible. Also, one would have to find a doctor willing to prescribe Clonazepam dosages that are usually only taken for epilepsy.

Thinking of the above, I also recall the success story of Don we talked about in the past. He was on 6 mg and yet could not stabilize and was going through louder and louder tinnitus and had to cold turkey and go through hell for 14 months. Then he healed, including his tinnitus. This says that, in his case, it wasn't really a benzo-receptor-deficiency, although it took him 10 years to start hitting tolerance after a lot of updosing. I need ten years to put my children to safety, if the drug could buy me 10 years and I could find a doctor willing to prescribe those dosages I would try it, but there is no way to know. I am left with the impossible taper. What do you do when even holding brings about a continued worsening? Impossible situation.

 

Hi @Chinmoku -- Your post and dilemma is heart breaking. I can relate, because I took benzos for years, including valium and clonazepam. I went through a year+ withdrawal many years ago, and thought I was done with it for good. And then tinnitus came along. As much as I didn't want to go back to it, I did start occasionally using valium in low dosages to get me through some rough times.

In other words, I ended up doing what I felt I had to do. I think I let go of my "purity" mind set, thinking I'd never touch it again. But then reality sort of hit. I'm more relaxed about it now, and take very small doses 3-4x a month or so. -- I don't know whether my experience is relevant to yours, but it seems your situation is fairly desperate, and that you should perhaps think in terms of doing what you have to do "right now", to get you to the place in the future, where you can possibly re-evaluate.

I've mentioned before on this forum, that I wish I would have been able to do daily HBOT back when I was withdrawing from clonazepam, as I feel it would have made it so much easier. There's something about it that takes an edge off of things for me. Which isn't surprising, because HBOT is well known to be able to heal the brain after head injuries, strokes, aneurisms, etc. Why wouldn't it be able to improve the function of the GABA receptors in the brain?

Other therapies I've tried over the years are also very helpful for me, such as self-acupuncture, self-massage, etc., Just mentioning these in case you haven't tried things like this to help calm down the brain and nervous system. -- Anyway, just a few thoughts for your consideration. I empathize greatly with your situation. I sincerely hope you can find something that can improve things for yourself. -- All the Best!

 

Thank you for your thoughts, Lane. I will ponder your message in my choice of my next steps. I did try acupuncture with a tinnitus experienced acupuncturist, five sessions but it hasn't stopped the progression. I also tried osteopathy with a tinnitus specialist. Nothing. I need to look into HBOT as it's one of the few things I haven't tried.

 

Does anyone know if benzos not only DOWNregulate GABA sites, but also UPregulate Glutamate/Aspartate sites?

How long DO benzos work for you? Do you notice within... 6 hours, 12 hours, a day, three days... that they stop working?

I had to take a ton of benzos yesterday. I was losing my fucking mind and needed to escape the madness.

I took 0.5 mg Klonopin, 0.25 mg Xanax, 2 Kava pills at 9 pm yesterday, and am trying to determine if today's improvements come from the benzos, or the dose of Lasix I took at noon today.

From research, it seems that benzos last about 12 hours but the halflife can be up to 3 days (I'm not sure if the metabolites are GABA active, similar to some SSRIs like Amitriptyline --> Nortriptyline).

 

Please be careful, your mixture of medications is extremely dangerous. The use of one single Benzo can be fraught with danger let alone the use of two.

I understand you want to escape the madness of tinnitus, but the class of medications you are taking are well known to cause tinnitus. They could actually end up making your situation much worse.

I am unsure why you are on the Lasix but loop diuretics are well known for causing tinnitus and hearing problems. Maybe you could discuss this with your doctor and they might be able to prescribe you an alternative medication.

I know the feeling of wanting to escape the noise in your head, unfortunately benzo use for some of us only makes this worse. I was one of those people so please take care

Ototoxic effects and mechanisms of loop diuretics