Help with clorazepate taper

[[Buddie]]

Hi.  I am new here and need help with tapering Clorazepate. 

This is my story

I have been prescribed clorazepate 3.75 mg twice daily as needed for years.  Only took it a couple of times a year due to panic attacks.  In the time I have been prescribed the med I have filled three prescriptions-that’s how little I took it. 

Then covid happened.  I have health anxiety and my anxiety hit the roof.  So I took one every couple of days or for a few weeks even daily.  And so when my anxiety got better I was taking back every few days.  Now I am concerned about withdrawal , and that I should be tapering.  Looking for advice on this.  Please help!  I have been having pins and needles increased anxiety and panic attacks. 

[[Buddie]]

Can you tell us what your dose has been in the last two weeks and how often you’ve taken it?  Are your  tablets 3.75?

[[Buddie]]

Thanks so much for your reply!  In the last two weeks I have taken 3.75 mg of clorazepate about every other day and I received two doses of Valium in the ED. 

[[Buddie]]

Oh and this week I have taken 3.75 Tuesday and 3.75 Wednesday because I thought I needed to take more often to stop some of these symptoms I am having.  Went to md on Wednesday and he started me on buspar 5 Tid.  Told me to stop the clorazepate and only take prn.  So I am beside myself knowing the right thing to do. 

Thanks so much for your help! Today is Friday here in the USA if you need that information. 

[[Buddie]]

Even though you’ve taken it erratically in the past, it looks like your increased use has left you dependent, are you ready to start tapering?

We typically suggest you take the drug every day, this helps keep blood serum levels stable hopefully helping withdrawal symptoms.  Would you be comfortable finding a dose that would allow you to take it every day, maybe 2 mg?  Do you feel stable taking 3.75 every other day?  I’m not too worried about the Valium in the ED.

What are your thoughts, are you interested in pill cutting or shaving, weighing your doses on a jewelers scale or does liquid titration appeal to you?  You should be able to dry cut for quite awhile, thats the easiest.

Just saw your latest post, is there a reason he prescribed Buspar, it can be tricky adding new medications since our central nervous system is so sensitive.  I’m not crazy about taking the Clorazepate prn, that can still lead to dependence and possibly kindling and its a lousy way to taper.

[[Buddie]]

Hi and thank you for your reply.  I’m definitely ready to taper.  I want off this medication.  He added buspar because my anxiety is so bad and I am having panic attacks.  The physical symptoms of the anxiety are horrible such as dizziness so bad I cannot even do anything work, drive, etc.  the clorazepate at the 3.75 dosage has stopped working so it doesn’t even help with the panic except for after about 3 hours which is wild because it used to work within the hour.  Which is how I ended up in the ED.   

I spoke with the doc extensively about withdrawal and tapering and he kind of dismissed the idea of me having withdrawal symptoms.  He said it was “plausible but not likely”. 

I read the references about the types of tapering and I am willing to do whatever is best.  The 3.75 pill is fine to halve however but it is such a small dosage I’m not sure of the best way. 

[[Buddie]]

In other words, no I don’t guess I am feeling stable on the 3.75 every day since it isn’t controlling the symptoms of anxiety/panic.  And yes I would be willing to take 2 mg or whatever I need to do.  My fuzzy brain is not comprehending the tapering references and how exactly to do it. 

I’m just so out of sorts.  My anxiety has never been this bad, I had occasional panic attacks and that’s it.  Trialed many ssri’s they never worked, so I was just left with the prn clorazepate. 

[[Buddie]]

I believe rather than adding another medication that it might be more advantageous to go back to your original dose of 7.5 mgs daily or whatever dose you think might pull you out of this..  Getting used to another mediation and dealing with new side effects might not be the best choice, a better option would be to taper slowly off of the drug you know.

If you decide to go this route, I’d suggest staying at that dose for at least a week to try to stabilize which you aren’t right now.  We can help you figure out how to cut your tablets.  What do you think, wil your doctor prescribe enough for you to do a slow taper?

[[Buddie]]

Thank you for your reply.  My doctor will not prescribe me another bottle of these.  I have 30 pills of the 3.75 mg.  He definitely would not go up in dosage, I would rather not do that either. It seems like defeating the purpose of getting off them.    I tend to agree with you about the new med though but I needed some relief now. 
He called himself conceding today and said I could take a half pill every other day.  Ugh!

How long would a slow taper last with this med at the 3.75 dosage? 

[[Buddie]]

Are you saying you’ll only have 30 pills to complete a taper, if this is the case I’ll need to get someone to help you figure out a rapid taper plan.