From Valium to Klonopin to Tranxene, I'm lost!

Hello all,

I was on 15mg Valium when my p-doc switched me to 1.5mg of Klonopin because Valium interfered with my AD Luvox and gave me depression.

I started at 1.0mg of Klonopin but developed high anxiety so I had to updose to 1.5mg. After 3-4 weeks on Klonopin I developed panic attacks I never had before, started shaking all over, and lots of other symptoms.

So it was clear Klonopin would not do it for me. I was switched again, now to Tranxene (1mg Tranxene = 0.75mg Valium appr.). I did try to go on as low a dose as possible to undo the Klonopin updose because I was on it for about 6 weeks.

I'm on 20mg Tranxene now, about equalling my previous Valium amount of 15mg. But way below 1.5mg of Klonopin. My p-doc says I can take up to 30mg of Tranxene, equalling about 22mg of Valium, which is still below the 1.5mg Klonopin.

I'm suffering from major withdrawal symptoms from Klonopin now, but do not want to raise my Tranxene dose too much. But maybe I have no choice. My brain feels numb, my skin is burning, I'm confused and cannot think straight and have high anxiety for hours every day now.

Should I give up my efforts to keep my Tranxene dose at 20mg (15mg V)? It seems the updose of Klonopin cannot be undone by maintaining this. Its unbearable.

The aim of switching is to get me stable to start a new taper.

Thanks and strength to all on this board, Pecoro.

Hello Pecoro,

I'm sorry to hear how much your struggling. The WD symptoms you're going through may be Klonopin withdrawal, or they may be Valium withdrawal; in my opinion it really doesn't matter what caused what. I hear you're in WD, and to me that means your nervous system is trying to adapt to less tranquilizer or other related shocks, and is overloaded with repairs.

As with before, you have the option to titrate up or to hold to relieve symptoms; ultimately your nerves need time to repair. This repair rate is relative to your neurological, psychological, and other physiological conditions, like chronic inflammation or nutritional deficiencies. Ultimately, with enough time you will heal!

A concern that I have is that Tranxene is the brand name of clorazepate. Acording to Wikipedia, clorazepate is an exceptionally long lasting benzo, in large part because it metabolizes into desmethyldiazepam. As you probably know, desmethyldiazepam is one of two primary metabolites of diazepam (Valium) and it is the one responsible for the long half life accredited to diazepam.

My concern is that last I heard you're still on Luvox, which I've learned inhibits the liver enzymes that eliminate diazepam (or more specifically it's metabolites), and which is why I believe you switched to Klonopin in the first place. Is your pdoc aware he's giving your body at least half (the longer acting half) of the same drug he tried to switch you off in the first place?

Hi Slownsteady,

Thanks for your reply! You are right about the desmethyldiazepam, and my p-doc now knows about it. That's why we crossed over to a lower amount of Tranxene than the 1.5mg of Klonopin is worth, to compensate for the extra accumulation caused by Luvox.

Strangely enough drugs.com gives a 'moderate interaction' for Tranxene and Luvox, as opposed to a 'major interaction' for Valium and Luvox. I don't know why. Maybe its because Tranxene has less metabolites than Valium and breaks down more easily.

It is not as sedating as Valium is (missing the Temazepam-metabolite) which is better for me.

Anyway I am really wrestling with the underdose, trying to hang on. I don't know if I should updose to make this more easy on my system. Switching is hard enough as it is, especially like this.

I had no choice but to go off Klonopin, my system could not cope with it. Diaz-e-bam was right about that.

Thanks and greetings, Pecoro. 

I'm glad to hear you're in the know about what you're taking Pecoro!

Thinking back about your journey, I'm wondering why you weren't able to just taper Valium from the start when it felt too depressing? The issue I understand with Luvox is that it makes the Valium more potent (slower elimination), so if you'd started tapering at whatever dose you'd been at, then you'd have been able to gradually get down to a more appropriate dose for the combination. Instead your journey has had so much suffering.

It seems like you're trying that again, basically; finding an appropriate level of a diazepam metabolite that will suit your Luvox dose and your anxiety needs. I can see why this might be a better option, with one less metabolite; I just wonder how long this desmethyldiazepam takes to become effective; I thought that it sequesters in body tissue first and then slowly releases, creating the long half-life. This process might take a couple weeks to get going, hence Ashton's slow diazepam crossover.

I hope you can stabilize on this new medicine! You deserve a rest!

I'll be praying for you Pecoro. 

Hi Slownsteady,

Thanks again for your reply. I don't know why I wasn't able to finish my taper of Valium. I went from 15mg to about 11mg, reducing 1mg/week. This was way to fast as I noticed once reaching 11mg. I had no withdrawal effects until then and suddenly they hit me with enourmous force and did not leave me for the rest of my taper. I updosed to 12mg then.

I kept cutting at a slower rate and took a long hold at 9mg. At that time the sx were unbearable. A little updosing to 10 and later 12mg had no effect. I held for 3 months. I became so ill and depressed that I had to abandon my taper and reinstated to 15mg. I was never able to stabilize, and still am not.

It seemed the lower I got, the more ill and depressed I became. I just had no baseline to return to. My Valium taper lasted 9 months.

My p-doc and I are since then trying to stabilize me on another benzo, until now to no avail. I feel awful from all the switching and things are getting worse instead of better.

I have panic attacks which I got while being on Klonopin, and they haven't left me since. My major sx now is high anxiety hour after hour, only leaving me a few hours before bedtime where I can feel somewhat better.

I think I have to raise my Tranxene dose because this is not working. Something I would rather avoid but this switch to a  not equivalent dose is not bearable.

I don't know when the desmethyldiazepam reaches its peak. It will be different for everyone I believe. I'm now one week off of Klonopin, maybe the wd is at its worst now. Anyway the Tranxene dose is to small to cope with it.

Thanks again for your support, greetings Pecoro. 

Have you considered psychotherapy?

Some people say this is "chemically-induced" anxiety, but I find the same coping skills and self-awareness are effective no matter the cause. In my experience, anxiety is a learned trait, by a very intelligent part of ourselves trying to keep us safe (usually from a situation in childhood). Growing up we can forget about these parts of ourselves, or try to avoid the same kinds of triggering circumstance; but a frightening situation like benzo withdrawal can bring this defensive, reactive, and generally immature part ourselves to the fore.

This is how I view anxiety: a part of ourselves is trying to protect us, but immature, out of touch with our new capabilities, and/or unaware of our present situation.

So the suggestion that comes to my mind is for you to befriend this current anxiety. I know that's a far reach from what you're comfortable with, but new things often don't feel comfortable. As Thich Naht Hanh might ask, how can we suffer better?

I propose a befriending attitude towards your anxiety. Maybe there's a small moment, a little window in your day, when you could give this anxious energy your full attention and offer a peace. It helps me to remember my chronic anxiety is trying to protect me, and needs to be included and respected as an intelligent and hard working part of myself. Like a small desperate child. Visualizations of caring for this small child helps me soothe.

A therapist could teach you this or other skills, via telehealth even, if you have the interest.

Hang in there buddy! You'll get there, and I believe you'll be stronger for it. 

Thank you Slownsteady,

I did a lot of work on the mental side of dealing with withdrawal. I followed Cognitive Behaviour Therapy for 4 months. You look carefully at your way of thinking, and if it is negative you try to replace it with positive thinking. You can write out positive and negative arguments and weigh them against eachother, ofcourse with the aim of thinking more positive but in a realistic way.

If you suffer, it will not take away the suffering but it can give you a way of dealing better with it.

Anyway, now on my 10th day off of Klonopin. Yesterday was a better day for me, going out in nature, but today its bad again.

As I'm trying to undo the updose from 15mg Valium to 1.5mg Klonopin with this switch, going to 20mg Tranxene (about 15mg Valium again) where I should go to 30mg Valium according to Asthon I suffer a lot. I don't know if I should keep this downdose up. Its extremely tough (my brain feels numb, like I have concrete in my head, also my anxiety is very high).

I also don't know if its a wise thing to do (downdosing during a switch) but I don't want to end up on higher doses of benzo's if I can pull it off.

Thanks again and greetings, Pecoro. 

I'm glad to hear you've used CBT. I'd keep up any kind of therapy that's available in your area; the mental struggle of all this must be immense, and while it may all seem like "benzo damage", I think there's a great potential to learn more about yourself and how to live well in this journey. I'm certainly finding this potential in my own taper, and trying to make the best of the bad days with this intention.

I'm really happy to hear you got out in nature again! 

Regarding updosing, you probably know already I'm a proponent in cases of rapid or failed crossovers, and rapid or C/T reductions. There really isn't a benefit, in my mind, of staying at a low dose with debilitating symptoms, especially while trying to earn a shorter taper. In my own taper, and around the forum, I see the same experience being repeated: rushing hurts.

If you can't function on your current dose, and it's been a period of time that you feel is sufficient to test the dose, relative to how much you're struggling, then I would strongly consider an updose. It sounds like your doctor is offering you a higher dose if you need it. If I was you, stability would be my #1 goal after all you've been through; stability first, then, and ONLY then, tapering gradually. This is brain surgery after all!

I know you'll get through this Pecoro! 

Hi Slownsteady,

Thanks again for your advice! I think you are right and as much as I don't want to raise my dose, I have to stabilize first. I have tried 20mg for 11 days now and I feel awful. The Desmethyldiazepam level should have raised enough by now to work.

Was at a party yesterday and felt so ill I wanted to leave. I noticed the difference between myself and the other folks. It made me very sad what I've become. I had difficulty speaking and listening. Felt like I wasn't there. My brain felt numb, like a robot. It was awful.

Klonopin really did damage to my brain, and it seems the withdrawal from it is very difficult. Very different from Valium.

Raised my dose this morning to 30mg as per the Internet benzo-convertor (about 22mg V). I feel have no choice. As you say stability has to be my #1 goal now.

Thanks again and greetings from The Netherlands, Pecoro.