Clonazepam taper for my wife

My wife is a member on here, "wanttobecalm"  We were micro tapering ,water titration from 2/2020 until 11/2021,  off and on. She was down 25% down to 1.125 from 1.5 mg a day.  It was then she started taking the pills cut  ⅜ of  a pill,  3 times a day. In February of this year she updosed back to .5mg a day 3 times a day in hopes it would help her pain and mental symptoms. 

She wants to start tapering again.  Should she go back to the water titration or  do a dry taper, I had purchased a Gemini scale awhile ago but we never used it.  Whichever she would choose will somebody please send me a schedule of a known successful taper.

Thank you..

Did the updose help your wife? How did she respond to the water taper? Can you be more specific and explain how you did the micro tapering (ratios)?

To answer your question. She can choose any method that works for her. There really is no recommended "successful taper" because no single person reacts the same to a taper. The best would be for her to start a taper and keep a daily journal of her symptoms. Then based on her symptoms you keep adjusting the taper to make sure the symptoms are under control.

I have used 3 different tapering methods, tried cut and hold as well as titration, adjusted my taper rate (schedule) continuously based on my symptoms and circumstances, and I honestly cannot recommend one as "better" than the other. All the methods and schedules served a purpose at the time and assisted me in getting to know my body better. I am happy to experiment if something does not work for me and happy to continue with something if it does. The only thing that worked exceptionally well was keeping a journal and looking for patterns and triggers. I am lucky that I have been functional throughout my taper.

Tip of the hat for supporting your wife. To help us help you, we need to know her medication history.  She’s provided some of this to us before but you have given us new information.  Would you please review the following and let us know if it is correct?  In particular, is she still taking the oxycodone and a muscle relaxant along with the other medications?

WantToFeelCalm’s History:

1994 - started taking 1.5mg clonazepam a day

Spring 2019 - unsuccessful two-week taper; reinstated after 11 days at 1.5mg. Increased pain over next 7 months; started muscle relaxant and opioid.

Feb 2020 to Nov 2021- tapered to 1.125mg (water titration); switched to pill-cutting (3/8 of a pill)

Feb 2022 - updosed to 1.5 mg (0.5mg, 3 times a day)

March 2022 - quit 2mg Prozac cold turkey

Other meds: trazodone, Protonix, dicyclomine, oxycodone, muscle relaxant

The fact that your wife has taken clonazepam for many years and has had two unsuccessful taper attempts strongly suggest she will need to taper very slowly and carefully.  The Benzodiazepine Deprescribing Guidance document below was written for prescribers but it will also help you understand what’s involved.  As you’ll note, an initial trial reduction of no more than 5% is recommended. 

The guidance document also identifies options for making ‘small enough’ reductions in dose. Options to consider include clonazepam orally disintegrating tablets (0DTs) which come in dosages of 0.125mg and 0.25mg and/or a compounded clonazepam suspension (see link to a 0.1mg/mL formulation below).

Links:

Benzodiazepine Deprescribing Guidance Document

https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf

0.1mg/mL Clonazepam Oral Suspension

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

Did the updose help your wife? How did she respond to the water taper? Can you be more specific and explain how you did the micro tapering (ratios)?

 

To answer your question. She can choose any method that works for her. There really is no recommended "successful taper" because no single person reacts the same to a taper. The best would be for her to start a taper and keep a daily journal of her symptoms. Then based on her symptoms you keep adjusting the taper to make sure the symptoms are under control.

 

I have used 3 different tapering methods, tried cut and hold as well as titration, adjusted my taper rate (schedule) continuously based on my symptoms and circumstances, and I honestly cannot recommend one as "better" than the other. All the methods and schedules served a purpose at the time and assisted me in getting to know my body better. I am happy to experiment if something does not work for me and happy to continue with something if it does. The only thing that worked exceptionally well was keeping a journal and looking for patterns and triggers. I am lucky that I have been functional throughout my taper.

First of all thank you for your response.

At first the updose seemed to help her,  who knows .  For the water titration we dissolved 3 tablets in 300 ML of water, withdrew .3 ml a per day and distributed the 300ml equally into 3 jars. By November of 2021 she was down 25% total

Thank you

Tip of the hat for supporting your wife. To help us help you, we need to know her medication history.  She’s provided some of this to us before but you have given us new information.  Would you please review the following and let us know if it is correct?  In particular, is she still taking the oxycodone and a muscle relaxant along with the other medications?

 

WantToFeelCalm’s History:

 

1994 - started taking 1.5mg clonazepam a day

Spring 2019 - unsuccessful two-week taper; reinstated after 11 days at 1.5mg. Increased pain over next 7 months; started muscle relaxant and opioid.

Feb 2020 to Nov 2021- tapered to 1.125mg (water titration); switched to pill-cutting (3/8 of a pill)

Feb 2022 - updosed to 1.5 mg (0.5mg, 3 times a day)

March 2022 - quit 2mg Prozac cold turkey

Other meds: trazodone, Protonix, dicyclomine, oxycodone, muscle relaxant

 

 

 

The fact that your wife has taken clonazepam for many years and has had two unsuccessful taper attempts strongly suggest she will need to taper very slowly and carefully.  The Benzodiazepine Deprescribing Guidance document below was written for prescribers but it will also help you understand what’s involved.  As you’ll note, an initial trial reduction of no more than 5% is recommended. 

 

The guidance document also identifies options for making ‘small enough’ reductions in dose. Options to consider include clonazepam orally disintegrating tablets (0DTs) which come in dosages of 0.125mg and 0.25mg and/or a compounded clonazepam suspension (see link to a 0.1mg/mL formulation below).

 

 

Links:

Benzodiazepine Deprescribing Guidance Document

https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf

 

0.1mg/mL Clonazepam Oral Suspension

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

Thank you for your response. We will check out the link you sent.

  In early June of 2019 she went to a facility and she along with one of her daughters  thought it would be a  good idea to come off of the clonazapam that she had been on since 1994, 1.5mg daily .5mg 3 times per day. She was consistent with the dose for all that time, never decreased or increased her dosage. The Psychiatrist said they could do that there. After a few days she was having bad symptoms and told the Dr she wanted to stop, she told her "NO, we can't do that" she was off within 2 weeks. When she got out of that facility one of the Drs. at her PCP treated her like she was a drug seeker and told her she would never prescibe the clonazepam to her. She then ended up in another facility, the Dr there told her what was done to her at the other facility was very dangerous, she was reinstated on 1.5 clonazepam daily, 11 days after she was taken off. The other medications are pretty much the same. She was also trying morphine that her PCP prescribed, that seemed to help with some of the pain she has but she get's bad mental symptoms with it.

You are most welcome, Eaglesfan219. Your wife has certainly had a difficult time of it.

Please let us know if you or your wife have questions after reading the Benzodiazepine Deprescribing Guidance document.  Many of our members (as well as their prescribers) have found it helpful.  fyi … the group that developed this document is now working on a nosology paper for ‘Benzodiazepine Induced Neurological Dysfunction’ (BIND).  We are hopeful that having an officially recognized and approved medical definition for this condition will result in more accurate diagnosis and treatment for individuals who suffer from it.

Thank you for the additional information regarding your wife’s medication history.  I’ve included a revised version below.  If it looks ok to you, would you please add it to your signature?  Here are the instructions:Add your history/signature 

Or, if you prefer, one of our administrators can add the signature for you.  Just let us know.

WantToFeelCalm’s History (my spouse)

1994 - started taking 1.5mg clonazepam a day

June 2019 - unsuccessful two-week taper in facility; reinstated after 11 days at 1.5mg. Experienced increased pain over next 7 months; started opioid and muscle relaxant circa Jan 2020.

Feb 2020 to Nov 2021- tapered to 1.125mg via water titration; switched to pill-cutting (3/8 of a pill)

Feb 2022 - updosed to 1.5 mg (0.5mg, 3 times a day)

March 2022 - quit 2mg Prozac cold turkey

Other meds: trazodone (50mg), opioids (morphine, oxycodone), muscle relaxant, dicyclomine, Protonix