Failed attempt…trying to stabilize.

So about a month ago, my Clonazepam seemed to quite suddenly lose most of its affect. I’ve been prescribed between 3.5 and 4.5mg a day for about six 1/2 years with no major or sudden tolerance changes, so I freaked out and told my physiatrist that I wanted to switch to Diazepam to stabilize and then taper from there.

Unfortunately, he decided to do a straight switch to 60mg with no taper, and after about 10 days I started feeling really bad again. To get myself through the night (I work graveyards) I tried taking less Diazepam and reintroduced the Clonazepam. After 2-3 days I feel a lot better.

Right now I really just want to stabilize again on the Clonazepam and eventually switch to Diazepam on a taper.

Any suggestions/help/support would be great!

Hi Airamis0007,

I'm sorry; that sounds really rough. A sudden cross from ~4mg a day of clonazepam to less than the Ashton-equivalent dosage of diazepam isn't something I'd ever want to try. If your average dose of clonazepam is 4mg/day, the Ashton equivalent is 80mg diazepam.

 

The timeframes you describe match what I know about clonazepam; it sounds like you got hit with withdrawal symptoms soon after the clonazepam was entirely eliminated from your body, and you started to recover once you reinstated and it had a few days to build up some of it's half-life overlap potential. I suspect the diazepam already in your system may have aided your clonazepam reinstatement.

 

Are you off the diazepam entirely as of now?

What dose of clonazepam are you now taking daily?

 

It sounds like you're interested in a slow step-wise crossover to diazepam in the future.

Will your doctor prescribe both drugs concurrently so that you can do this?

 

Would you consider tapering your clonazepam directly, at least initially? It has a decent half-life and many buddies, myself included, are tapering it directly while high-functioning. It's definitely not as easy as diazepam to dose nor as long-acting, but IME at doses above 1.5mg clonazepam can be tapered slowly with just 0.5mg tablets and a decent pill splitter.

 

Let us know how we can help. 

I was still taking 30-40mg of Valium for the last couple of days, but now that I’m back on the Clonazepam I’m going to try to take as little as possible. I only have 16 10mg diazepam pills left. Should I just stop taking it, or try to taper down with the few I have? I really don’t want to get sick again…

Hi Airamis0007

When you switched from clonazepam to diazepam you made a short-to-long benzo crossover, which as you discovered is problematic in that the short-acting benzo leaves the body before the long-acting is at full strength. However when you stopped taking the diazepam and returned to taking clonazepam, you made a long-to-short benzo crossover. This type of crossover is problematic because the longer acting benzo is still in the blood and while slowly being eliminated it adds it's effects to that of the shorter acting benzo.

 

A long-to-short benzo crossover can cause a spike in blood serum levels while the long acting benzo is still circulating in the blood (especially if you dosed more than usual as a result of taking both drugs at the same time). This spike will eventually pass as the diazepam is eliminated, and this relative dip in blood serum levels could be temporarily uncomfortable, perhaps making it seem like your previous dosage of clonazepam is now even less effective than it was before.

 

Since you mentioned being tolerant to clonazepam, I want to clarify that diazepam is not a solution to the problem of tolerance. Tolerance to benzo-class medications is a tolerance to a certain type of GABA agonist activity (GABA a-type receptors, aka GABAa). Switching to diazepam is only switching to a different GABAa agonist, and to my understanding this will not resolve the issue of tolerance.

 

The only solution that I am aware of for benzo tolerance is either taking more GABAa agonists (updosing, crossing and updosing, or dosing an additional GABAa agonistic substance like alcohol) in which case tolerance develops again later and the problems return, or tapering ALL GABAa agonists, ideally slowly and patient-led at a rate that the taperer can consistently recover from and remain functional.

 

So, as much as a cross to diazepam has helped many buddies to progress in their taper, IME it's not a solution for tolerance, nor will it prevent many of the challenges associated with benzo tapering. You may get sick again depending on how you manage your taper and how appropriately you respond to your body when it's impaired by either tolerance or reductions.

 

I suggest staying on your current dose of clonazepam if it's similar to where you were before you got on diazepam, and holding for 1-2 weeks to regain some stability; I don't expect you will feel 100%, but I don't see much benefit in updosing unless you're really impaired.

 

I suggest using this time while stabilizing to take care of your nervous system as best you can, start a daily tapering journal, self-educate and self-advocate about slow, step-wise crossovers and patient-led benzo tapering. The only lasting solution I know of for tolerance is tapering off benzos entirely and avoiding GABAa agonists.

 

I suggest revisiting a crossover to diazepam when you have your doctors support with going slowly and step-wise (check the Ashton Manual for sample slow diazepam crossover schedules), or you have a sufficient stockpile of clonazepam to do a step-wise crossover in conjunction with an ongoing diazepam prescription for the daily Ashton-equivalent of your dependent clonazepam dosage.

 

But like I mentioned earlier, at 3.5-4.5mg/day of clonazepam I think you can start slow tapering very easily with a decent pill splitter, even if you only have 1mg tablets cut into 1/4s. 0.5mg clonazepam tablets are available in the US and other countries, and these can allow for even smaller, gentler reductions.

 

I think the crossover was rushed, both in that it was a sudden cross and also because it is not a cure for tolerance nor likely necessary to take safe, well-tolerated reductions at your current dosage of clonazepam.

 

Let us know how we can help. 

I was still taking 30-40mg of Valium for the last couple of days, but now that I’m back on the Clonazepam I’m going to try to take as little as possible. I only have 16 10mg diazepam pills left. Should I just stop taking it, or try to taper down with the few I have? I really don’t want to get sick again…

 

If I were in your situation, I would taper the diazepam rather than stopping it abruptly.  Would you like assistance with a taper plan?  If so, please let us know your current daily dosing schedule (times and amounts) for both the diazepam and the clonazepam.

 

Would your psychiatrist be willing to increase your dose of clonazepam if needed?  It sounds like you may have reached tolerance about a month ago when your clonazepam “seemed to quite suddenly lose most of its effect.”

So about a month ago, my Clonazepam seemed to quite suddenly lose most of its affect. I’ve been prescribed between 3.5 and 4.5mg a day for about six 1/2 years with no major or sudden tolerance changes, so I freaked out and told my physiatrist that I wanted to switch to Diazepam to stabilize and then taper from there.

Unfortunately, he decided to do a straight switch to 60mg with no taper, and after about 10 days I started feeling really bad again. To get myself through the night (I work graveyards) I tried taking less Diazepam and reintroduced the Clonazepam. After 2-3 days I feel a lot better.

Right now I really just want to stabilize again on the Clonazepam and eventually switch to Diazepam on a taper.

Any suggestions/help/support would be great!

 

What effects do you believe were lost?

 

I find this article interesting in regard to tolerance and especially this statement: "Despite decades of basic and clinical research, our understanding of how benzodiazepines tend to lose their efficacy over time (tolerance) is at least incomplete. In appears that tolerance develops relatively quickly for the sedative and anticonvulsant actions of benzodiazepines, whereas tolerance to anxiolytic and amnesic effects probably does not develop at all."

 

https://www.hindawi.com/journals/aps/2012/416864/