crossing over to clonazapam from lorazapam

My Dr. wants to switch me from lorazapam to clonazapam to finish my taper. I have not been doing well at all tapering the lorazapam. Is it a good idea to switch since clonazapam has a longer half life? Also I am taking lorazapam twice per day, if I switch to clonazapam will I be able to take it just once per day?  Right now I am taking .125 of lorazapam twice per day. Will I be able to take .125 of clonazapam just once per day?

Thank you.

Hi gray cloud,

I prefer tapering clonazepam to lorazepam. I've been on lorazepam twice and quit both times CT; I wouldn't want to taper it but obviously many buddies manage. Conversely, I've been largely high-functioning on my clonazepam taper and my taper is going very smoothly at 5%/14 days; I'm currently at 0.625mg, down from 2mg in about 10 months, and I dose twice a day without any interdose WD symptoms.

 

Everyone is different, but I think there are significant tapering benefits to clonazepam compared to lorazepam. I think the positives of lorazepam are that you already know it, there is a liquid solution commercially available in some countries, and... well, that's all that I can think of.

 

You could try dosing clonazepam just once a day at 0.125mg. I am expecting I can also drop to one dose a day somewhere in that daily dosage range, so it might also work for you. 0.125mg is also 1/4 of the smallest standard clonazepam tablets (0.5mg); at your dosages, you might want to look into the orally dissolving tablets (ODTs) for clonazepam which apparently go as small as 0.125mg/tablet.

 

Switching from lorazepam to clonazepam is a short-to-long benzo cross. IMO all crossovers benefit from steps, and generally the more steps the better. However, the limits are usually how small the medicine can be measured and how much time the taperer has to make the cross.

 

How are you currently measuring your lorazepam doses?

Do you have access to ODT clonazepam tablets (ideally the 0.125mg)?

Hi Steady!!  Thank you so much for responding. I have been using a scale. it seems pretty accurate so far. I figured out what the amt of clonazpam would be equal to the .125 mg of lorazapam.  I would take .0625 of clonazapam.  This lorazapam is horrible. I have had withdrawal symptoms the entire time I have been tapering, but I also think that it is actually causing me some symptoms that I think are withdrawal symptoms but might actually be side effects of lorazapam because I feel awful when I first take it.  I am so glad you responded.. I have been so afraid to switch to the clonazapam, I feel much better to do it now!!!!

Steady, Do I have to continue to use the lorazapam or can I just switch over to the Clonazapam?  Do I have to slowly cross over to Clonazapam?

 

I guess if I take it just once a day I should probably take the .125 of Clonazapam not .0625..I think?  not sure...

Hello, gray cloud.  I’m sorry you are having a rough time of it.

 

Just checking ...

 

You’ve told us you have been dosing lorazepam twice a day.  Might some of the discomfort you are experiencing be due to interdose withdrawal?  If so, have you tried increasing the number of times a day you dose? Members who taper directly from lorazepam often find it helpful to dose 4-6 times a day. (Btw interdose withdrawal can also occur with longer half-life benzodiazepines such as clonazepam; it depends on the individual.)

 

A point of clarification ...

 

... you might want to look into the orally dissolving tablets (ODTs) for clonazepam which apparently go as small as 0.125mg/tablet.

The 0.125mg clonazepam tablets available in the US are called Orally Disintegrating Tablets (ODTs). As the name implies, ODTs are designed to disintegrate (fall apart) quickly in saliva and then be quickly swallowed. The drug molecules in the tablet do not dissolve (as in, go into solution).  Instead, they enter the body via the gastrointestinal tract (the same way as the drug molecules in regular tablets).

Hi Libertas, Thank you for responding. I thought at first that it might be interdose withdrawal, but I seem to be in withadrawals even after I take a dose. Not sure if it is withdrawals or side effects from the lorazapam or both.  I feel horrible all the time. The only time I feel a little better is in the evening sometimes.  I just don't know what to do anymore..  My whole goal was to get off of this drug, so I was afraid to add more doses. I was only on it for 1 1/2 months but I became so extremely dependent in such a short period of time. I feel like I have been trying to taper forever. It is just really wearing me down. it seems no matter what I do, nothing helps.    Thank you for taking the time to respond!!

Libertas, Do I need to slowly cross over to clonazapam or can I just switch right over from lorazapam to clonazapam? Not sure how this works.

Thank you!

Ashton recommended gradual crossovers to give the longer-acting benzodiazepine (in her method, diazepam) time to reach full effect while the shorter-acting benzodiazepine was eliminated. So, presumably one would follow the same principle when substituting clonazepam for lorazepam.  Regrettably, I am not aware of any members who have experience making such a substitution.

 

Have you considered asking your doctor if s/he would be willing to prescribe diazepam instead of clonazepam?  Much more is known about that substitution plus we have members who have experience with it.  Other advantages of diazepam over clonazepam include longer-half life, lower potency, and the availability of an FDA-approved, professionally formulated and manufactured 1mg/mL oral diazepam solution (many members have used/are using it to taper).

 

Edit: Diazepam question added

I already asked her and she refused to switch claiming that it is so addictive. Which is bull, I believe that lorazapam is much more addictive.

I have read about Clorazepate dipotassium which I think is similar to Diazapam, so I was thinking of asking her if she would be willing to switch me maybe to that one. 

I’m impressed you already asked your prescriber about diazepam! It sounds like she would benefit from additional education regarding benzodiazepines.  I am unaware of any evidence to support her claim that diazepam is more addictive than other benzodiazepines.

 

Would the following help persuade her to reconsider her stance on diazepam?

 

Reasons for a diazepam (Valium) taper, Professor C Heather Ashton, April, 2001

https://benzo.org.uk/ashvtaper.htm

 

I can provide other, more recent documents you could share as well as identify arguments you could present if it would be helpful.

 

Re: other alternatives ...

 

Tranxene (clorazepate dipotassium) does have a longer half-life, but if I’m remembering right, it is unstable in solution, so that might be a challenge.  Another possibility is Librium (chlordiazepoxide hydrochloride) but I’m a tad concerned about supply issues (it has been listed in the FDA drug shortages database for several months now) and we have at least one member who had to switch to diazepam recently because her pharmacy could not reliably fill her Librium Rx.

 

Thanks Libertas!  As soon as I realized that I was having withdrawal symptoms from the lorazapam, I started reading everything I could on the subject and that is how I learned about the Diazapam. It is so hard to find a Dr. that understands how bad the withdrawals can be. I was in her office last week and she basically told me she has not had this problem with any of her other patients coming off of Benzos.  So of course I felt like there was something wrong with me.  So she wanted me to take Lexapro, which I already knew was going to be a bad mistake. SO I tried one pill and it totally destroyed me for a week. My symptoms were so bad.  She does not like to be questioned or challenged. It is very hard to deal with her but right now I have no other options. In your honest opinion do you think it would be okay to use the clonazapam to continue my taper? Or can it possibly cause more problems for me and actually make things harder. I read somewhere that the clonazpam binds very tightly to the GABA receptors(not sure what that means) and if it could make things worse. I just don't feel confident listening to anything that my Dr. tries to put me on. She seems to have everything backwards. I read that SSRI's are too stimulating when going through benzo withdrawal and she refused to listen to me and caused me great pain for a week.  Thank you for talking to me Libertas!! Just very unsure of myself and what to do...

Rest assured there is nothing wrong with you.  On the contrary, you are facing a difficult challenge and handling it well.  So, tip of the hat to you!

 

You asked for my honest opinion so I’ll give it ... I have concerns about substituting clonazepam for lorazepam.  Clonazepam is one nasty benzodiazepine to taper because of its not-quite-long-enough half-life, very high potency, and limited dosage formats (at least here in the US).  Making compounded or homebrew liquids is challenging due to clonazepam’s solubility profile.  And, last but not least, clonazepam has potentially problematic pharmacodynamic properties such as the one you identified. 

 

If I were in your shoes, I would (1) review my tapering history to make sure I’d done everything possible to maximize the likelihood of a successful taper directly from lorazepam, (2) design and launch a campaign to educate my doctor about why diazepam would be a better choice than clonazepam for tapering, and (3) try one more time to find another prescriber who would be willing to collaborate with me on patient-led taper (word here on the forum is that nurse practitioners are often more understanding and helpful than doctors when it comes to discontinuing benzodiazepines). 

 

If none of the above panned out, I would (1) research options for making “small enough” reductions in dose with clonazepam, choose one to try, and then take the steps needed to implement it; (2) develop and implement a crossover plan, (3) develop and implement an initial taper plan, and then (4) hope for the best.

 

 

Thank you very much Libertas for your help. I do not think she will bend an inch on the valium, so I don't think that will work. I have asked her a couple of times. All these Drs. have been brainwashed into thinking that valium is such a terrible drug, when in fact I believe lorazapam is so much worse. I do not think I can continue on the lorazapam. I have been stuck at .125 twice per day for a month and I have continued to feel terrible the whole time. I believe I am not only having withdrawals but I am also having side effects from it, if that is possible.  I have tried to get another Dr. but the wait time to see anyone is like 2 months.  I'm really worried at this point. Thank you Libertas!

You are welcome, gray cloud.  It sounds like you would benefit greatly from finding another prescriber.  Based on her past behavior, I fear your current doctor will limit the amount of drug she will prescribe and/or pressure you into a too rapid taper.

 

I read through your past posts and have assembled a first draft of your drug history below.  Moving forward, to help others help you, please consider revising it as needed and then adding this information to your signature.  Here are the instructions: Add your history/signature.

 

gray cloud’s history, v. 0.0

 

Current total daily dose: 0.25mg lorazepam (0.125mg 2x a day)

Duration of use: started October ?? 2021

Previous benzodiazepine use/withdrawal: none (?)

 

Took Passion flower for 1 1/2 months for anxiety, stopped abruptly, experienced withdrawal

Oct ??: - Rx’d 0.5mg lorazepam for 3 weeks. Took 1/2 pill twice a day; then took whole pill twice a day. Limited supply so shaved small amounts off pills to make them last.

Nov ??: took mirtazapine for 3 nights, stopped

Nov 18: started taking 1/4 pill (approx 0.125mg) at 9:30 am and 1/4 pill at 8pm

Dec 2: took 5mg Lexapro 1 time, stopped

 

Notes:

Duration of lorazepam effect is about 4 hours, experiencing interdose withdrawal, symptoms seem to increase after dosing. Using nicotine lozenges. Tried many supplements; currently taking magnesium, ginger root, vitamins B1, B2, B6 and a children's B complex.

 

Hmm, I also have very much trouble tapering off Lorazepam and was considering Valium, but maybe Clonazepam is a better option?