why do american doctors taper using klonopin instead of diazapem???

[Wolfie]

I've lived international, second time tapering off Lorazapem, as I needed to deal with PTSD situation, we used valium it was a nice smooth lovely taper, I convinced my GP here in the US to give me valium after my idiot pdoc insists on Klonopin for some odd reason...  I told him the half life sucks compared to valium and to get educated, he couldn't tell me any rational reason other than "that's how we do it here". Then I found this on the ashton manual: http://www.benzo.org.uk/ashvtaper.htm

Further Note on Klonopin vs Valium: April 15, 2002. It is well known that Klonopin is a good anticonvulsant. In fact its only indication for use in the UK is for epilepsy. The fact that it has a higher affinity for GABA-A receptor sites than diazepam simply means that it is more potent, but potency is mainly a matter of equivalent dosages. Binding of clonazepam to receptors that do not bind to other benzodiazepines and action on sodium channel conductors are relevant to anticonvulsant effects, not tranquillising effects. The fact that clonazepam has sedative and anxiolytic actions and typical adverse effects of benzodiazepines including ataxia, irritability, depression and tolerance shows that there is little overall difference.

Since clonazepam has a relatively short half life, from 18 to 50 hours, I don't think it would be any easier to come off it using 1/64th mg capsules. I think you still need a long-acting benzodiazepine such as diazepam. I would also reiterate that I have known people make the clonazepam to diazepam substitution and final withdrawal without difficulty.

I'm an economist by trade, I assume somebody in the USA is making money off klonopin? I never heard of it anywhere else or anybody taking it anywhere else in the world..

[aquarian]

My pdoc used valium to taper me off of xanax. (ETA: And I live in the US and see an American pdoc.)

Edited January 26, 2017 by aquarian

[notloki]

I don't  think you can generalize by nation. All the americain docs I know use valium. It just makes sense, there are more pills of different doses available for valium.

[Wooster]

As a mental health consumer, I've only ever been offered lorazepam and clonazepam for anxiety. Diazepam was never offered as an option. It might be a regional variation based on which part of the country you live in?

[CrazyRedhead]

My pdoc doesn't like to give Valium, and she doesn't like Xanax, either....The only thing I was offered was Klonopin or Ativan (lorazepam).....

I tried the Ativan first, and it didn't seem to work very well for me, but fortunately the Klonopin did, so that's what I take.

My personal opinion--really just depends on the pdoc, I guess.

I'm glad you were able to get the V from your GP, though.

Edited January 26, 2017 by CrazyRedhead

[DopamineSick]

Valium has a reputation for causing more euphoria (and thus having a higher potential for addiction) than other benzos. I've taken it and didn't experience any euphoria myself, but that's just me. It does have a much longer half life than klonopin, so it does seem to be a logically better choice. Librium also has a very long half life, although the effects are very subtle. I once used Librium to get off of ativan, and it did work. 

[JustNuts]

Valium causing more euphoria than the other benzos? That's the first time I've heard of that. I've always heard that alprazolam (Xanax) was way more addictive and euphoric than any other benzo, and that any differences in addictiveness/euphoria/etc between the other benzodiazepines is due to individual variation in how you respond to them, not due to a generalizable factor.

In terms of half-life, you can't really directly compare those because what actually matters for benzos is the duration of action (signified by β in the one really good paper on comparative equivalences of benzodiazepines that I read at one point but can't find because fulltext PDF indexing is apparently voodoo science that is impossible to do correctly/consistently). Anyways, the duration of action is quite definitely shorter for diazepam than it is for clonazepam (even though the half-life is so ridiculously long because of all those long-lived metabolites).

Edited January 26, 2017 by JustNuts

[dtac]

I think it's all dependent on the pdoc. I had one that didn't use benzos at all (which was bullshit), two that loved Valium, one that loved Klonopin, and my current pdoc will prescribe whatever fits me best.

I've seen the suggested taper routine before, and I think it all comes down to the individual. Personally I get almost zero therapeutic benefit from Tranxene, Klonopin, or Valium at max commonly prescribed doses, and I've had no problems discontinuing them suddenly. However, 0.25mg of Xanax is enough to kill my anxiety probably 80% of the time, and 0.5mg works the remaining 19/20%. 1mg makes me deliriously tired for several hours and is like a mental sledgehammer (except in insomnia, where it extends my eventual sleep to 10-12h.) I can't imagine taking more than 1mg and having any sense of functionality.

Also, from what I've read, Valium tends to be a bit more predictable in how it's metabolized. This is why it's the baseline, and tapering is usually normalized to it. Prozac is often used the same way for SNRI discontinuation (see Cymbalta tapering.) But not everyone needs to be tapered.

[Wolfie]

I'm glad It must be a NY thing... lol, anyway I'm down to 5mg, and i'll be benzo free by march with no suffering, I just don't understand why its such a battle, i guess two big egos conflicting lol anyway good luck to everyone tapering off!