Feedback on 3mg Klonopin Taper

[[Buddie]]

I was prescribed 1mg Klonopin the beginning in June 2021 after experiencing tremendous anxiety due the pandemic and a health issue my husband had that landed him in the ICU. After a few months, I was prescribed 3mg per day.

By February 2022, I no longer wanted to take it anymore as I was scared of becoming addicted - and I didn't feel it wasn't working. The concept of dependency was never explained to me (as so many of us weren't) and I certainly was never warned about a HORRIFIC withdrawal process.

The psychiatric nurse that was prescribing me, tapered me off of 3mg of Klonopin in TWO WEEKS. The following weeks were a hell that could not be put into words.

I landed in the hospital with EXTREME chest pains and heart palpitations. The ER didn't know the cause and told me to see a cardiologist. I had no idea why I was so so so sick - every symptom possible. My PCP said she believed it was due to Klonopin withdrawal...and it was.

I started seeing a new psychiatrist at that point and he told me 3mg of Klonopin was a completely inappropriate and dangerous dose and he would put me on a plan to taper which up to this point was as follows (total 7.5 months).

May 11-July 21, 2022 (10 weeks) - dropped from 3mg to .5mg (it was WAY too fast)
August 2022 - held on .5mg
September 2022- moved up to .75mg (I could not tolerate the symptoms)
October 2022 to present (3 months) - held on .5mg (still having symptoms, but not nearly as severe as the initial few months)

I am going to resume the taper process from the .5mg in the new year. I am terrified. My psychiatrist is proposing the following, but I think it's too aggressive. I mentioned liquid tapers to him, but he said liquid klonopin was banned in the US.

Can anyone give me suggestions of how they would taper from .5mg (given my prior taper history)? Any advice would be tremendously appreciated. I am scared to death.

Proposed Plan:
Jan 2022 - drop down to .375mg and hold for one month
February 1-14th - drop down to .25mg for two weeks
Feb 14th- Feb 30th - drop down to .125mg and hold for two weeks
March 1st - JUMP

[[Buddie]]

I don't like your psychiatrist's proposed taper.  The hold periods are fine, but the reductions are way too big.  The consensus here is to taper at a rate of 5 - 10% of the current daily dosage every 10 -14 days, allowing symptoms to dictate your pace.

The jumping of dose of .125 mg, I'm afraid, is too high.  Most will jump somewhere around .025 mg while others will jump at 0 mg.

I'm not telling you to use my tapering schedule, but only take a look at it in my signature as an example.

[[Buddie]]

My psychiatrist is proposing the following, but I think it's too aggressive. I mentioned liquid tapers to him, but he said liquid klonopin was banned in the US.

I agree with you and [...] — your psychiatrist’s proposed taper plan is too aggressive given your case history. (I do, however, agree with your psychiatrist that 3mg was an inappropriate starting dose — my understanding is that clonazepam receptor occupancy plauteaus at around 1mg.)

It sounds like your psychiatrist would benefit from learning more about how to safely deprescribe benzodiazepines.  I’ve included a link below to a 2022 deprescribing guidance document developed by the Colorado Consortium for Prescription Drug Abuse Prevention in cooperation with the University of Colorado Anschutz Medical Center.  It’s evidence-based, clear, concise, and current.

It also sounds like your psychiatrist might benefit from learning more about clonazepam dosage forms available in the US.  S/he is correct that an FDA-approved oral clonazepam solution is not available. However, the claim that it has been ‘banned’ strikes me as an over-statement given that it is available in many other countries.  For example, it’s possible that Roche (the patent-holder and brand manufacturer) elected not to submit an application to the FDA for the oral solution in the US because it decided to develop and market a more stable, alternative dosage form here instead (i.e. 0.125mg, 0.25mg, 0.5mg orally disintegrating tablets).

Another dosage form to consider is a professionally developed and compounded oral clonazepam liquid.  For example, a stability-tested formulation for a compounded oral suspension of clonazepam is available (see link below).  Many of our members have used it to taper.  We also have members who have worked with compounding pharmacists to develop formulations designed to meet their specific needs (e.g. to avoid known allergens).
 
Links:
Benzodiazepine Deprescribing Guidance Document (target audience is prescribers)
https://corxconsortium.org/wp-content/uploads/Benzo-Deprescribing.pdf

0.1mg/mL Clonazepam Oral Suspension from Nationwide Children’s Hospital
https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

[[Buddie]]

I'm so sorry this happened to you. It must’ve been brutal. It took me a year to get down from 0.3 to zero at a 5%/14 weeks taper. Granted, there was some weeks of holding in-between due to illness. However I was fully functional.

You have reason to be concerned about the taper plan. I hope you can find another solution.