Stopping Klonopin after almost 10 years, switch to what ?

[Breen]

It's a very complicated and long story.

 

So here is the short version.

 

The original reason why Klonopin was prescribed is no longer relevant. (muscle relaxant!)

 

But health complications, failed tapers on my own, failed tapers by doctors have turned me into a wreck. First physically, then mentally.

 

I don't have a psychiatrist, I tried to get one (private) but was dismissed because the issue was apperently too trivial ! Currently I'm dealing with a GP. I'm not too keen on the public psychiatric system.

 

The GP means well but he doesn't really have the skills or knowledge. As far as I'm concerned, a competent psychiatrist (who knows more about Klonopin than the last one!), a neurologist or anyone who could be useful. Perhaps some kind of detox (!)

 

Physical dependence, tolerance to 2 mg a day, paradoxical/problematic effects. And the 'sick body'.

 

At this point diazepam isn't an option. Not on its own (monotherapy), anyway. Klonopin is the least 'benzo-like' benzo I have experienced.

 

Doctors are hard to come by. I live in an obscure European country.

Even 'detox' is usually done with diazepam. But I didn't abuse the drug, and 10 years is a long time.

 

What sort of drugs could be used as an alternative to Klonopin ?

 As in detox, psychiatry ?  Aside from other things, I have to deal with the physical dependence. 

 

I've read about carbamazepine, antidepressants. What else does exist ? Again, in my experience Klonopin is the least 'benzo-like benzo'. Cold turkey would be very harsh, considering the state I'm in. There is some depression, after everything that has happened.

Edited August 24, 2014 by Breen

[jt07]

I have a couple of questions: Is your current dose 2 mg a day? Also, are you looking for an alternative med to treat anxiety?

[Breen]

My current dose is indeed 2 mg a day.

 

Anxiety ? Well ...

 

I have never been diagnosed with an anxiety disorder. But what is anxiety ?

Physical anxiety ? There is some of that. There is physical and mental stress.

 

Historically, I have (some?) difficulty falling asleep. The only drugs that worked wonders for that were the hypnotic benzos and zopiclone (infrequently). So I realize this particular issue may be a contraindition for stopping Klonopin, but waiting will not make things better.

 

I'm looking for options besides 'cold turkey'.

[Bueler]

Why have your previous tapers failed?

[jt07]

I'm sorry, but I'm still having a hard time understanding. Why do you want to switch to another med then if your problem is not anxiety?

 

If you are looking for another med to make the taper easier, I'm not sure there is one other than possibly another benzo.

Edited August 24, 2014 by jt07

[Zazz]

Breen, I agree that 10 years is a very long time to be on Klonopin.   I can't help but think it was an oversight on the part of your doctor, to keep you on it this long.

 

He got you into this mess, and tell him he has to get you out, or recommend to you another doctor who can help.  You are going to need some help getting off it.  Methinks.

 

My best to you.

[melissaw72]

Klonopin was a bitch for me to wean down to a lower dose. I am currently on 0.5 mg 2x/day.  But have been on 5-6 mg/day in the past. 

 

Weaning down for me was a slow process ... 0.25 mg every week/every 2 weeks, until I was down to the 1 mg total.  You're right, it really sucks.  But for me it was a VERY slow process to get down to where I am now. 

 

What did help though, was going on to the ODT kind (the disintegrating kind).  That made things A LOT better/"easier" weaning down.  Still took awhile, but it worked.

[Breen]

I'm sorry, but I'm still having a hard time understanding. Why do you want to switch to another med then if your problem is not anxiety?

 

If you are looking for another med to make the taper easier, I'm not sure there is one other than possibly another benzo.

Because I'm phsyically en mentally in bad shape, and because of the way the drug affects me.

Paradoxical/mixed effects. Can you imagine taking a drug that is both a stimulant and a sedative in the evening ?

 

It wasn't always as bad as this. And I used to take the drug during the day, but that doesn't work anymore.

 

But there have been some health problems, doctors messing around (very long story)

 

Cold turkey is harsh, tapering is ... messy and chaotic, to say the least. Partly it's the drug, partly the 'underlying condition', whatever that might be. I was advised to take 5 months to taper ! it's not as if everything is fine now. And exercise being healthy ? At lower doses (below 1.75 mg) I have to stop doing REAL exercise. Not so much for what happens while exercising, but for what happens afterwards (but that's a matter of semantics)

It's an extremely brutal drug.

 

As for tapering by switching to a different benzo ... it seems it HAS to be diazepam ? Diazepam is a very different drug, and after a brief trial I gave up. Aside from other things, it's even worse for sleep than clonazepam. Diazepam would be the wrong choice.

 

A different drug ? Years ago I read about 'alternative' options, but I don't remember. Antidepressants, anticonvulsants, ?

 

And again, this drug doesn't feel very 'benzo like'.

Edited August 25, 2014 by Breen

[Breen]

Breen, I agree that 10 years is a very long time to be on Klonopin.   I can't help but think it was an oversight on the part of your doctor, to keep you on it this long.

 

He got you into this mess, and tell him he has to get you out, or recommend to you another doctor who can help.  You are going to need some help getting off it.  Methinks.

 

My best to you.

Right. I went back to the doctor who originally prescibed the drug.

 

I had to wait, wait, wait for an appointment. After 45 mins, he kicked me out of the office ! He told me that 'benzo withdrawal' was for GPs and psychologists, or the local addiction center. And he didn't have the time !

I tried making an appointment for the latter, but let's say there were complications. (referral needed, bureaucracy, etc) Besides, they use counseling for people dependent on benzodiazepines. Not the medical approach.

 

It's different than in the USA.

 

There is a shortage of doctors, and there are waiting lists. 

Edited August 25, 2014 by Breen

[Breen]

Btw, has anyone noticed an interaction between this drug and antimuscarinic drugs ? Or technically, the drugs and the brain.

 

I have taken two, and mebeverine seemed to suppress some withdrawal symptoms. When I stopped taking it because of concern about tolerance, dependence (habit) and some unexpected effects there was some rebound that came with a vengeance. A bit on and off, fluctuating. Some kind of depression, euphoria, dysphoria, anhedonia, more. 

[Equivilency]

The benzos depending on the person can take along time to withdraw from. You have to go down very slowly over long periods of time (sometimes months).  2MG is a small dose. I couldn't imagine a detox center being needed for that, but that is always an option. After your successfully off klonopin, start over again and have any remaining psych symptoms treated from there. 

Edited September 11, 2014 by dnautics

[Breen]

2 mg isn't really a low dose, if you consider the potency. It's 'equivalent' to about 40 mg diazepam. It's nasty stuff.

 

About tapering Klonopin with something else, as in tapering the Klonopin with another drug or switching to another drug:

I've read a few anecdotal and very sketchy reports of using Xanax to taper Klonopin ! Any opinions ?

 

Suggestions for anything else than diazepam ? 

[melissaw72]

Using xanax when tapering off klonopin helped me.  When I tried going off of Klonopin, the xanax took the immediate withdrawal side effects (when I had them) away.  It worked really well for me.

[Breen]

Thanks for the response.

 

I have two addtional, very difficult questions ...

 

Since I'm not in good health, and I already had a prior 'disorder' regarding falling asleep, are there any options for taking something for sleep that is NOT an antipsychotic or antidepressant ? I haven't tried all, but they tend not to work. Antihistamines may be sedating, but not good for sleep on their own. 

That clonazepam is so powerful once you have developed tolerance ... Tapering would be much easier if I could have normal sleep.

 

What if you experience paradoxical/serious side effects ? One could switch to a different benzo, but since I find this one so unique, I would suspect that switching to a different benzo is difficult at best. I find diazepam hard to tolerate, and I don't have much experience with the anxiolytics in general.

The pdoc dismissed my 'case' and the GP doesn't know.

Edited October 1, 2014 by Breen

[melissaw72]

 

Since I'm not in good health, and I already had a prior 'disorder' regarding falling asleep, are there any options for taking something for sleep that is NOT an antipsychotic or antidepressant ? I haven't tried all, but they tend not to work. Antihistamines may be sedating, but not good for sleep on their own. 

That clonazepam is so powerful once you have developed tolerance ... Tapering would be much easier if I could have normal sleep.

 

 

Something for sleep I've tried that is OTC (other than Benadryl) is melatonin.  Also for some people Ambien works.  These don't work for me but others swear by them.

 

 

I'm sorry, Idk an answer to your 2nd question.  Side effects of what med/s?

[Breen]

Paradoxical/serious side effects of Klonopin/clonazepam.

 

Sort of, stimulating and sedating, plus lots of other issues especially when trying to taper.

 

I should have been tapered off quickly years ago.

[Velvet Elvis]

2 mgs is what I take to get to sleep at night and have for a few years now.

 

I've had to come off it cold turkey before when I lost my bottle right after getting it filled.  I felt really sick for a couple weeks and was largely incapacitated, but it wasn't the end of the world.  I'd rather not do it again but I've had worse addictions and DTs.

 

I'd just go into a detox facility where they can keep an eye on you to make sure you don't have any complications while you go cold turkey.  2mgs isn't that high a dose.  I have a long history of addiction and substance abuse problems and I wouldn't take it if there was a serious dependency risk.  That's also why it's the only benzo my psychiatrist will give me.  If you think getting off klonopin is bad, any other benzo will be worse.

 

I'd just take a couple weeks off work, maybe check in somewhere, and ride it out.

 

ETA:  If you're addicted to something, your mind will come up with all kinds of reasons why you can't or shouldn't quit.  I know this isn't the addiction forum but I've run the addiction gauntlet enough times to know this is how it almost always works.  The idea of quitting is always much much worse than the reality of it.   

[Breen]

In my experience, it's the worst benzo ... Quite unique, too.

 

I react very badly to even small dose cuts, lots of physical and cognitive symptoms. Also, I don't consider myself 'addicted' but I am physically dependent.

[Equivilency]

I think your going to have to wait the side effects out. There's no easy way to do that other then very small increments. I know the side effects suck bad. Rebound anxiety, rebound insomnia, and muddled thinking for weeks..

[Breen]

I have been offered a 'detox' for a max of four weeks. Switching straight to oxazepam (properties, experience), treating any underlying issues as they emerge.

 

The person in question, although very experienced and competent in general, has never taken anyone off Klonopin/clonazepam. Which is not as odd as you may think since this is an uncommon drug in this country.

 

Isn't that a crazy idea ? Clonazepam is a fairly unique drug based on my experience.

 

Opinions ? There isn't that much else (locally) except the GP. Again, diazepam is not an option and I do have numerous health issues.

[crtclms]

What about Librium?

[Breen]

Librium still is a very different benzodiazepine from what I'm taking. In my experience, this one (clonazepam) is unique.

 

Anyway, in the clinic (inpatient) oxazepam would be used. Any 'issues' that would come up during the taper would be treated with drugs if necessary.

 

The fact that Librium accumulates is fatty tissue like diazepam would most likely be a major downside for a swift (4 week) taper. 

I suppose oxazepam gives greater control over the detox/taper process.

 

But tapering clonazepam with oxazepam ... it just seems weird and risky. Is it just me ?

[crtclms]

To be honest, I have no idea. It was just a med that occurred to me.

[Breen]

The inpatient detox in question seems to be rather harsh.

 

Diazepam is often used for tapering. Librium less often, and I believe that it is shorter acting than diazepam. Both the half life and duration of action of clonazepam/Klonopin is long.

 

But that drug is destabilizing. Especially when I try to taper.

 

Are there any other options ? Perhaps a long acting drug that doesn't accumulate in fat cells would be good.

[crtclms]

Breen, I agree that 10 years is a very long time to be on Klonopin.   I can't help but think it was an oversight on the part of your doctor, to keep you on it this long.

 

He got you into this mess, and tell him he has to get you out, or recommend to you another doctor who can help.  You are going to need some help getting off it.  Methinks.

 

My best to you.

10 years is a long, but not unheard of time for the use of Klonopin. As Breen pointed out, it is not like most other benzos. Not all benzos are for short term use, contrary to popular belief.

 

And good luck getting help after telling your doctor "You got me into this." Treatment is not "getting" someone "into this." The fact that he needs help titrating is normal, and has nothing to do with his doctor "getting" him to a therapeutic level.

 

Breen, Neurontin? Which is an anti-convulsant, but many people here use it for anxiety. Also, did you ask about SSRIs? I think that is what you mean by anti-depressants. If you are using a GP, SSRIs are more likely than Neurontin.

 

I have never heard of carbamenzapine used as an anti-anxiety med, but everyone is different.

 

Unfortunately, if you can't cross titrate, you are just going to have to go down slowly. You said your gdoc doesn't know how to titrate you off the klonopin, or am I confused?

[Breen]

In a way the GP doesn't know, but at this point I no longer see how a simple direct taper from Klonopin could be possible.

Btw, my current GP didn't get me on this drug.

 

In the past he made a few serious errors. He lacks knowledge/experience, but that is not uncommon. A common approach is to use 'supportive conversation' without adding any drugs, but that doesn't always work !

 

The gastrointestinal symptoms are very problematic to say the least (and it could be that way with other benzos, especially fat-soluble ones like diazepam). I recently tried some mebeverine but even that is getting harder to tolerate ! (unusual side effects like mental side effects, anhedonia etc.)

 

Neurontin, Lyrica could not be a replacement for Klonopin, or could it ?

 

'10 years is a long, but not unheard of time for the use of Klonopin. As Breen pointed out, it is not like most other benzos. Not all benzos are for short term use, contrary to popular belief.'

I appreciate the fact that you recognize that Klonopin is not like other benzos (not many docs know!), but in what way do you see it as different ? Klonopin is prescribed frequently in the USA, but not so much in this country. Ignorance abounds.

[Breen]

Please, I'm serious. I cannot get a doctor who is knowledgable about this kind of stuff. I have plenty of odd reactions that I never had before taking this stuff. I could probably get my GP to accept any reasonable withdrawal method.

 

Any options besides diazepam and Librium ? Unfortunately, I've been unable to find a good schedule for Librium (from Klonopin).

The half life, duration of action seems to be variable. And unclear.

[Breen]

An experienced adddiction specialist has advised me to switch to either Librium or oxazepam. Without crossing over gradually, so that would eb a direct switch. Not that I completely disagree, because I had such a hard time tapering this drug.

 

But in my experience, this drug is so unique. It seems nuts. I´m already having a really hard time.

 

Can I get some feedback ? 

[Wooster]

What kind of feedback are you looking for?

 

Did you see this pinned thread at the top of the benzos page?

 

http://www.crazyboards.org/forums/index.php/topic/15305-benzo-comparisons-speed-of-action-equivalents-dosages/

[Breen]

Yes, thank you.

 

Well, feedback about two issues in particular: switching to a completely different benzodiazepine (the simple version is that each benzo binds to various subunits with different affinity, but it's more complicated) and switching without gradually crossing over.

 

In my experience this is such a unique drug ! It's not just a 'vanilla' benzo.

 

In this country this benzodiazepine is not frequently prescribed, unlike in the USA. Too much 'a benzo is a benzo'.

[Wooster]

It's incredibly hard to predict how you will respond in advance because everbody's body has different experiences.

I just got re-prescribed klon to help with sleep, and it's making a HUGE difference for me at night.

 

 

 

 

In my experience this is such a unique drug ! It's not just a 'vanilla' benzo.

Which med are you referring to? Klonopin?

[crtclms]

Oh, and JT07, don't you mean five half-lives, not five days?

[Breen]

JT07 ?? I am familiar with the rule that it takes five times the half life to get a drug out of the body.

 

My assumption is that the half life is two days, but that's just an assumption.

[Breen]

It's incredibly hard to predict how you will respond in advance because everbody's body has different experiences.

I just got re-prescribed klon to help with sleep, and it's making a HUGE difference for me at night.

 

 

 

 

In my experience this is such a unique drug ! It's not just a 'vanilla' benzo.

Which med are you referring to? Klonopin?

 

Yes, Klonopin/clonazepam. 

 

It was suggested that I take the oxazepam two or three times a day.

After doing some research, I found that the half life is highly variable on some charts (sometimes listed as short, sometimes intermediate) and it also differs from source to source. What's up with that ?

 

Also, 'duration of action' and 'half life' are two different things. If I were to go by half life I could taper with lormetazepam or flunitrazepam.

[Breen]

It seems like I'll be going to try a direct switch to oxazepam, followed by a taper. Two or three times a day.

 

The pharmacokinetics and the fact that these drugs are very different concern me very much.

Any comments, pointers ?

 

Melissa, you stated that you used alprazolam/Xanax for a taper ? Your issue was anxiety ?

Unfortunately that is not my issue, so for that purpose it wouldn't work.

[melissaw72]

Melissa, you stated that you used alprazolam/Xanax for a taper ? Your issue was anxiety ?

Unfortunately that is not my issue, so for that purpose it wouldn't work.

 

Yes, it was for anxiety.  But it worked for me to lower the dose.  I was more tired than usually at the time, so we weaned down, and the xanax helped a lot with that.

 

I would think that when I tapered off though, it wouldn't matter the reason why I needed to wean down.  The part that mattered was that the xanax helped to do that, regardless of the reason why.