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Help with clorazepate taper


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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. 

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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?
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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. 
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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. 

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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.

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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. 

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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. 

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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?

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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? 

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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. 

 

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That’s what I have for now.  I made an appointment with a psychiatrist but he couldn’t see me until the end of the month. 
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Do you have any confidence you’ll be able to procure a prescription from the new doctor?  I’m not sure if you want to rapid taper or try to maintain until your visit.
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I have some confidence yes.  Not 100%.  I’m terrified to rapid taper.  I want to slow taper off.  I don’t know any other people who have taken this medication at the low dosage and what their experience has been.  Doc seems to think it is no big deal. 
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Hello, Jeepers01.

 

I agree with Pamster that it sounds like you have become physically dependent on the clorazepate.  I also agree with you that a rapid taper would not be in your best interest, despite the fact that you are indeed taking a very low dose (according to the FDA drug label for clorazepate linked below, the usual daily dose is 30mg for the symptomatic relief of anxiety).

 

As a first step, it seems you need to find out sooner rather than later whether the psychiatrist with whom you have an appointment would be willing to prescribe for and support a symptom-based, gradual taper from clorazepate.

 

Would you feel comfortable calling the psychiatrist’s office tomorrow (Monday) to ask?

 

If the psychiatrist is unwilling to prescribe for and support a gradual taper, then the next step would be to find another prescriber.  The prescriber does not have to be a psychiatrist or even an MD or DO.  For example, some members have discovered that Nurse Practitioners are open to the idea of helping their patients with a gradual taper.

 

 

Link:

DailyMed - CLORAZEPATE DIPOTASSIUM tablet

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fb5c9e98-02b2-4c36-b436-25b58fe3c7d5

 

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You are most welcome.  Let us know what you find out. If needed, we can give you suggestions on how to find another prescriber.

 

You might want to write down and rehearse what you want to say before you call the psychiatrist’s office.  You don’t want to come across as a desperate/demanding ‘drug-seeker’ but rather as a rational/reasonable individual who (1) has recently learned about benzodiazepine dependence, (2) is experiencing symptoms that suggest dependency, (3) has learned that a gradual, symptom-based taper is the preferred approach to discontinuing benzodiazepines, and (4) is looking for a healthcare professional who will be willing to help you.

 

 

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