How to taper (or discontinue) a paradoxical benzodiazepine ? (clonazepam)

[Braz]

Specifically, clonazepam.

Paradoxical, in the sense that taking a dose increases alertness and is stimulating.

I know the clichès, but I have not been able to answer to find an answer to that question.

The drug was prescribed as a muscle relaxant and there may well be some kind of central sensitization that makes tapering so much harder. I've been on the drug for many years. Once a day, in the evening.

Where would I be able to find an answer to that question ? I did try, but not force, Tranxene and diazepam.

 

[geraldt52]

There is a ton of information available. Type "klonopin taper" into the search box of the main forum page. You should also visit benzo.uk.org. The bottom line is that Klonopin can be very, very difficult to come off of.

 

[Mary]

@Braz - check out benzobuddies.org, an excellent website for benzo tapers. They do talk about valium as a crossover drug, there's something called the Ashton Manual which seems to be a very good resource which talks about this.

I've been tapering off of 1 mg. of lorazepam for about 3 months, I first went to 0.75 mg for several weeks, and then down to 0.5 mg a little over 2 months ago, after which severe insomnia hit. I'd been taking it once daily in the middle of the night for sleep for about 10 years (!)

Anyways, I've been playing with various supplements trying to get my sleep under control. I took trazodone (low dose) for several weeks but I hated it because it left me tired and drugged, even at small doses. Last night I finally managed to get 8 hours without any trazodone!

So what I'm taking are all things which primarily help produce GABA or stimulate GABA receptors (and a few other things): Niacin, niacinamide, choline/inositol, inositol by itself, glycine, l-theanine, Theanine Serene by Source Naturals, and melatonin. I'd already been taking most of this for sleep prior to the taper, but added in extra inositol and niacinamide.

I had considered whether I might need to use valium as a crossover drug when my sleep was so bad, but preferred not to, and now don't think I'll need to try it. So I have 0.5 lorazepam left to taper off but will go more slowly this time and now that my sleep is manageable I think I'll be able to do it. One interesting fact I learned is that 1 mg. lorazepam is equivalent to 10 mg. valium - it was much more potent than I had realized.

Good luck!

 

[caledonia]

I've tapered off Xanax twice and clonazepam once. I'm currently in the middle of what's become a 9 year taper off Zoloft.

The Surviving Antidepressants forum may also be helpful.

ps. if it's stimulating, maybe move it to the morning so it's helpful to wake you up and doesn't mess with sleep?

 

[Braz]

@geraldt52, @Mary, @caledonia ,

Thanks for replying.
I'm familiar with benzo.org.uk, benzobuddies, survinvingantidepressants.

I'm familiar with diazepam, and know it's a very different drug, also shorter acting. At best, it would introduce new problems and come with its own difficulties ... I know I do not react well to it ...
I'm also a bit sick of the 'slow, s-l-o-w-e-r' approach, implying that the current situation is fine.

The literature (e.g. benzo.org.uk) suggests that in case of paradoxical reactions the drug should be discontinued. Generally immediately, but that is about short term use !

As a question 'what to do in case of paradoxical reactions' (after long term use, when the drug has to be stopped) I have not been able to find any answer. Even under the best of circumstances it would be very rough and hard. These are not the best of circumstances ...
This drug does some non-benzo things ...

Moving the drug to daytime would cause sleep problems (understatement) and other problems, hard to put into words.
In a way, it may act for 24 hours but that is not 24 hours at full strength !

If anyone knows a good place to drop that question ? No luck thus far at benzobuddies, survivingantidepressants. I even emailed prof Malcolm Lader, his response 'I cannot give clinical advice, I retired years ago' and a reference to benzo.org.uk ...

This stuff is getting dangerous to my health.

 

[geraldt52]

I don't think that it is unusual to have to quit benzos due to paradoxical reactions. Benzos are known to cause the same problem that they are used to treat...which is a paradoxical reaction.

It was out of pure lack of knowledge, but I quit Klonopin cold turkey, and it was hell. When I realized what was going on, months later, I began the quest to find something else to restore my sleep, something that I could taper off of. I never found anything that I could taper off of...as soon as I would reduce the dosage by any meaningful amount, the drugs would quit working and I may as well have been taking nothing. Other people seem to have luck with tapering, but I found it to be useless.

I finally quit Ativan, another benzo, cold turkey once again. It was bad, but not as bad as Klonopin. I believe the benzos destroyed my sleep, probably for life. I don't have any good advice for you, but that was my experience. That doctors give these drugs out, long term, with so little consideration for the potential for harm, is really unbelievable.

 

[caledonia]

@geraldt52, @Mary, @caledonia ,

Thanks for replying.
I'm familiar with benzo.org.uk, benzobuddies, survinvingantidepressants.

I'm familiar with diazepam, and know it's a very different drug, also shorter acting. At best, it would introduce new problems and come with its own difficulties ... I know I do not react well to it ...
I'm also a bit sick of the 'slow, s-l-o-w-e-r' approach, implying that the current situation is fine.

The literature (e.g. benzo.org.uk) suggests that in case of paradoxical reactions the drug should be discontinued. Generally immediately, but that is about short term use !

As a question 'what to do in case of paradoxical reactions' (after long term use, when the drug has to be stopped) I have not been able to find any answer. Even under the best of circumstances it would be very rough and hard. These are not the best of circumstances ...
This drug does some non-benzo things ...

Moving the drug to daytime would cause sleep problems (understatement) and other problems, hard to put into words.
In a way, it may act for 24 hours but that is not 24 hours at full strength !

If anyone knows a good place to drop that question ? No luck thus far at benzobuddies, survivingantidepressants. I even emailed prof Malcolm Lader, his response 'I cannot give clinical advice, I retired years ago' and a reference to benzo.org.uk ...

This stuff is getting dangerous to my health.

There is another person on here @Nielk who was having a paradoxical reaction to (I believe) Klonopin. She was losing energy rapidly. She ended up going to a rehab/detox center for a month to be medically supervised and taken off the drug. I'm not sure how long she was on it to begin with.

 

[Braz]

@geraldt52,

Thing is, I have been on it for so many years ... Not just 6 months or 1 or 2 years. And after having been on lorazepam for a while everything went to hell.

I wish I had CT/d clonazepam in 2012 or 2013, the worst I would have expected was not sleeping for a few months ... Now it's completely different, several orders of magnitude worse. My health was mostly fine in 2013, now it's horrible.
One of the 'symptoms' is rapid muscle tissue breakdown. Possibly due to lorazepam W/D or interdose W/D ?

@caledonia,

I talked to Nielk. Her situation was different. And she is/was in a different country. Here, in a detox they put you on diazepam and do a 6 week taper, usually no adjunctive drugs. It appears there is no 'benzo wise' doc here in this country (somehere in Europe). I'm not sure if she'll have anything to add.

It's awful. As I'm writing, I feel my nerves/muscles (?) burning. (Perhaps still lorazepam W/D/interdose W/D)

Sometimes they say the only thing that heals is time off the drug. But CT ? Even what Nielk went though was not a 'dry' CT at home.

And I'm a bit worried about forcing myself on diazepam, becoming dependent on it etc.

 

[geraldt52]

I was on Klonopin for probably 4 years before things went to hell and I quit cold turkey, @Braz. The anxiety and insomnia were nearly unbearable for close to a year, at which time I began using other things to try to taper. It was probably ten years that I was totally messed up, several of those after quitting Ativan cold turkey and swearing off any more sleep medications of any kind. I still struggle with insomnia now 15 years since quitting Klonopin, and I have no doubt that the Klonopin is the reason. I realize how tough it is to make a decision...just trying to give you something to go on.

 

[Braz]

@geraldt52,

Thanks for the encouragement. Its an awful drug indeed. Ever since I was on the lorazepam a small cut in the clonazepam gave me 'chaotic effects'. Only months ago that became a bit less. I would describe the effect of a cut as 'very severe'. I could not imagine tapering like that, not with all the paradoxical effects, smaller doses lasting shorter, how I'd fall apart due to insomnia, insomnia causing more exhaustion, being barely aware of what I would be doing etc ... Extreme.

Did you try tapering before you CT'd ?
How much were you on ?

I have never been give the diagnosis of ME/CFS but I know the drug is rpescribed for 'central sensitization'. I'm probably pretty sensitized at this point !

 

[Mary]

One of the 'symptoms' is rapid muscle tissue breakdown.

This makes me think that perhaps your adrenals are out of whack (technical term! ), no seriously, years ago when my adrenals were wiped out my chiropractor told me that I was in a catabolic state - my body was using muscle tissue for fuel, like you. It was sort of scary. I have since learned a lot about adrenals and high cortisol - high cortisol is catabolic. So your burning nerves and muscle tissue breakdown could be due to high cortisol, which could of course result from stopping Klonopin, lorazepam, any of the benzos.

It would be good if you could get your cortisol levels checked. The best test is an adrenal stress index test - it's a saliva test which measures cortisol levels 4 times during the day/evening to show how levels rise and fall. And in the absence of such a test, you might just try some herbs and other supplements to lower cortisol. When my cortisol was high, I was given Seriphos, which used to be comprised of phosphorylated serine; however, unfortunately, they have changed the formulation and it's no longer effective like it once was. However, there are several supplements which can help normalize cortisol levels - Relora is one (you can read about it), this looks good too: http://www.iherb.com/Now-Foods-Super-Cortisol-Support-90-Veggie-Caps/5022

Also, I would try the GABA supplements I listed in my post above. They are helping me sleep during a lorazepam taper. They're very effective. It's taken me 2 months to work this out, I was taking trazodone for sleep and hated it, it made me tired and drugged during the day and finally was able to stop it, because of all the GABA supplements I'm taking.

eta: one more thing - when my adrenals were wiped out I was given an adrenal glandular, Drenatrophin PMG by Standard Process, and it was a lifesaver - I had to take about 3 or 4 times the recommended dose because my adrenals were so weak.

 

[geraldt52]

@geraldt52

Did you try tapering before you CT'd ?
How much were you on ?

No, I stopped the Klonopin cold turkey before I ever realized it could be a problem...this was more than 15 years ago so the knowledge was not so easy to come by. When I quit, I was on 2 mg/day, and couldn't take any more, couldn't take any less, and couldn't stand the side effects from what I was taking. I was prescribed the Klonopin based on Cheney's nonsense theory that it was "neuro-protective" in CFS, and people with CFS didn't become dependent on it. He must have never actually followed up on any of his patients if he believes that.

Once I realized what I had done, and what was going on, I tried tapering off Klonopin, and a slew of other drugs in it's place, but I never had any success and ended up stopping the last of them, Ativan, cold turkey as well. Maybe it was because I screwed myself up by not tapering in the first place...I don't know.

 

[caledonia]

@geraldt52,

Thing is, I have been on it for so many years ... Not just 6 months or 1 or 2 years. And after having been on lorazepam for a while everything went to hell.

I wish I had CT/d clonazepam in 2012 or 2013, the worst I would have expected was not sleeping for a few months ... Now it's completely different, several orders of magnitude worse. My health was mostly fine in 2013, now it's horrible.
One of the 'symptoms' is rapid muscle tissue breakdown. Possibly due to lorazepam W/D or interdose W/D ?

@caledonia,

I talked to Nielk. Her situation was different. And she is/was in a different country. Here, in a detox they put you on diazepam and do a 6 week taper, usually no adjunctive drugs. It appears there is no 'benzo wise' doc here in this country (somehere in Europe). I'm not sure if she'll have anything to add.

It's awful. As I'm writing, I feel my nerves/muscles (?) burning. (Perhaps still lorazepam W/D/interdose W/D)

Sometimes they say the only thing that heals is time off the drug. But CT ? Even what Nielk went though was not a 'dry' CT at home.

And I'm a bit worried about forcing myself on diazepam, becoming dependent on it etc.

Any option to come to the US or another country with a benzo wise doc? Or consult with a benzo wise doc long distance via phone, or Skype?

I second what @Mary is saying if adrenals are an issue. My cortisol went off the charts high during Zoloft withdrawal. I didn't realize that was a feature of benzos too. Relora worked for me.

 

[Braz]

@Mary,

'This makes me think that perhaps your adrenals are out of whack (technical term! ), no seriously, years ago when my adrenals were wiped out my chiropractor told me that I was in a catabolic state - my body was using muscle tissue for fuel, like you. It was sort of scary. I have since learned a lot about adrenals and high cortisol - high cortisol is catabolic. So your burning nerves and muscle tissue breakdown could be due to high cortisol, which could of course result from stopping Klonopin, lorazepam, any of the benzos'

You don't know how right you are !
Completely messed up. Sometimes (but not always) I can feel an acute rise in the level of glucorticoids (not sure if it's cortisol) after taking a dose. Sometimes during the day. Also, I don't know if it's true that cortisol is the only glucocorticoid that is active. Let's just say that that I have a lot of 'experience'. However, where i live (somewhere in Europe...) it's not that common to have hormones tested. GPs usually don't test for cortisol, and for an endo a referral is required. They may limit themselves to 'diseases'.
I'll look a bit more at Seriphos, and I see there are basically two forms. If I 'd order it, I might order it from amazon.co.uk. It's not cheap ...
Also, I'm not sure if that's the right way to deal with this ...
Norepinephrine may also be catabolic, not quite sure. A hot/warm burning glow ... I can't be quite sure if it is norepinephrine. (I used to be an exercise buff)

It's probably an adrenal issue on its own (everything started due to an issue that caused chronic insomnia, followed by exhaustion)
Clonazepam itself definitely causes hormonal issues. It's probably fair to say that it messes with the HPA axis and more. The worse my health, the worse it gets, the less I'm able to cope.

I'm not sure if that stuff that acts on GABA is so great (GABA supposedly doesn't cross the BB barrier), I remember from years ago l-theanine potentiated clonazepam. I guess I can consider it.

 

[Braz]

@geraldt52,

Well, you didn't taper. Except trying to, after you already quit. I'm rather sensitized, from tapering clonazepam repeatedly, the lorazepam thingie, trying diazepam, two antimuscarinic drugs, some life stuff, insomnia etc. I'd be inclined to think that a true CT would 'blow the fuses', so to speak.
I wish I had CT'd the drug years ago. It's not good to come off this drug while being rather sensitized.
Clonazepam may be neuroprotective, on the short run ...

Frankly, I have been pusing myself beyond my limits for almost three years now ...

 

[Braz]

@caledonia,

Coming to the USA would be an issue. Not necessarily impossible, but my insurance wouldn't pay. I can't spend 50,000 USD or 500,000 USD ...

I did try a consult on healthtap.com , I got an American neurologist with affinity for 'addiction medicine'. He had an idea since he worked for a clinic that did an NAD+ detox for people on benzodiazepine, but he failed to realize that people had to do most of the tapering prior to entry ... So he had some misconceptions.
Benzo wise is often equated with following the Ashton method ... I know that one. It can be really, really hard to find a competent doctor. That clinic in Florida Nielk went to got her off, but at a price ... and she wasn't sensitized the way I am (I don't mean to say it wasn't hard). Flying back across the Atlantic after a detox ...

So I did consult with a doc through healthtap, messages/chatting. One thing that complicates things is that healthcare systems are completely different, almost polar opposites. And yes, I had some health issues for which I didn't get treatment, and I had to wait, wait. wait ...
If anyone knows an American doc ...

I didn't follow up on the neurologist's recommendation to a referral with an addiction doc he had selected. Several reasons. He's no longer available now, so ... even if I'd want to do an American thing like phenobarbital, it would be almost impossible to get that done locally.

I suspect other hormones are effected too, like thyroid (t3, reverse t3, TSH itself doesn't matter), possibly testosterone, possibly others. My GP didn't take me seriously, and frankly the quality of the local healthcare system is rather poor in many respects.

Does anyone feel like commenting on diazepam/Ashton ? Different drug, shorter acting, massive accumulation, many metabolites.

I'll ponder over these things. I hope I didn't come across as negative, but I shouldn't jump into things.

 

[Mary]

@Mary,

'This makes me think that perhaps your adrenals are out of whack (technical term! ), no seriously, years ago when my adrenals were wiped out my chiropractor told me that I was in a catabolic state - my body was using muscle tissue for fuel, like you. It was sort of scary. I have since learned a lot about adrenals and high cortisol - high cortisol is catabolic. So your burning nerves and muscle tissue breakdown could be due to high cortisol, which could of course result from stopping Klonopin, lorazepam, any of the benzos'

You don't know how right you are !
Completely messed up. Sometimes (but not always) I can feel an acute rise in the level of glucorticoids (not sure if it's cortisol) after taking a dose. Sometimes during the day. Also, I don't know if it's true that cortisol is the only glucocorticoid that is active. Let's just say that that I have a lot of 'experience'. However, where i live (somewhere in Europe...) it's not that common to have hormones tested. GPs usually don't test for cortisol, and for an endo a referral is required. They may limit themselves to 'diseases'.
I'll look a bit more at Seriphos, and I see there are basically two forms. If I 'd order it, I might order it from amazon.co.uk. It's not cheap ...
Also, I'm not sure if that's the right way to deal with this ...
Norepinephrine may also be catabolic, not quite sure. A hot/warm burning glow ... I can't be quite sure if it is norepinephrine. (I used to be an exercise buff)

It's probably an adrenal issue on its own (everything started due to an issue that caused chronic insomnia, followed by exhaustion)
Clonazepam itself definitely causes hormonal issues. It's probably fair to say that it messes with the HPA axis and more. The worse my health, the worse it gets, the less I'm able to cope.

I'm not sure if that stuff that acts on GABA is so great (GABA supposedly doesn't cross the BB barrier), I remember from years ago l-theanine potentiated clonazepam. I guess I can consider it.

Hi @Braz - again, re Seriphos, they've reformulated it to phosphatidyl choline, not nearly as effective as phosphorylated serine for normalizing cortisol levels. So unless you can find the phosphorylated serine, I wouldn't bother with it. I don't know how much it is in the UK, it used to be around $23 for a bottle. But as @caledonia and I both said, Relora can be helpful to help normalize high cortisol. I think rhodiola rosea is probably good also, and there are other herbs. Some people have good results with ashwaganda. Whether it's high cortisol or norepinephrine, I don't know, but it does definitely sound like your adrenals are involved and need support.

I used to have severe middle of the night insomnia from high cortisol, and that's where the Seriphos worked like magic. But there are alternatives as I said above.

Yes, GABA doesn't cross the BB brain barrier; however, l-theanine does, and l-theanine helps the brain produce GABA. And there are GABA receptors in other parts of the body (e.g., the gut) so taking plain GABA is not useless. And re glycine and inositol and niacin and niacinamide - they are all helping me with sleep. The niacinamide especially stimulates GABA receptors, and inositol too (though niacin is also helpful). And glycine is calming. So I would not write them off. I was in bad shape 2 months ago due to lack of sleep from a lorazepam taper and I'm now getting 7- 8 hours a night with all of these.

I would think that l-theanine would potentiate clonazepam in that it increases GABA and so would increase whatever effect clonazepam has on GABA, and that's how l-theanine and other supplements that increase GABA or its effectiveness can help with a taper.

You said something above about stopping lorazepam as well as dealing with clonazepam so it's probably hard to tell what is doing what to you right now --- I guess if I were you I would assume my cortisol (or other glucocorticoid) was high and do what I could to lower it, to stop the catabolism and hopefully calm you down, and add in GABA supps as well, as tolerated.

 

[caledonia]

@caledonia,
I'll ponder over these things. I hope I didn't come across as negative, but I shouldn't jump into things.

Just sort of tossing out ideas, hoping something sticks. You definitely want to consider things carefully and do your homework.

I wonder if the herb Kratom could be helpful?

 

[Oci]

@Braz - check out benzobuddies.org, an excellent website for benzo tapers. They do talk about valium as a crossover drug, there's something called the Ashton Manual which seems to be a very good resource which talks about this.

I've been tapering off of 1 mg. of lorazepam for about 3 months, I first went to 0.75 mg for several weeks, and then down to 0.5 mg a little over 2 months ago, after which severe insomnia hit. I'd been taking it once daily in the middle of the night for sleep for about 10 years (!)

Anyways, I've been playing with various supplements trying to get my sleep under control. I took trazodone (low dose) for several weeks but I hated it because it left me tired and drugged, even at small doses. Last night I finally managed to get 8 hours without any trazodone!

So what I'm taking are all things which primarily help produce GABA or stimulate GABA receptors (and a few other things): Niacin, niacinamide, choline/inositol, inositol by itself, glycine, l-theanine, Theanine Serene by Source Naturals, and melatonin. I'd already been taking most of this for sleep prior to the taper, but added in extra inositol and niacinamide.

I had considered whether I might need to use valium as a crossover drug when my sleep was so bad, but preferred not to, and now don't think I'll need to try it. So I have 0.5 lorazepam left to taper off but will go more slowly this time and now that my sleep is manageable I think I'll be able to do it. One interesting fact I learned is that 1 mg. lorazepam is equivalent to 10 mg. valium - it was much more potent than I had realized.

Good luck!

Hi @Mary, I have just tuned into this thread and so am catching up.

I have been doing a taper from @10 mg of zopiclone - long term use ie @8 years.

I started in April and have been cutting and weighing with a jewellers scale - @1% cut per day of the current dose....so increasingly smaller amounts.

I reached @1 mg of Zopiclone this way and then the pieces were just too tiny and so had the compounding pharmacy make up some caps of .5 mg strength (with my doc's approval, of course). I have been on them the last 10 days of more and am experiencing significant withdrawal problems. Bad headaches, migraine, very tight muscles all over body but especially in neck and shoulders, digestion off and sleep much more difficult.

I can't believe that such a tiny cut (and such a small amount of the drug) could be having such an effect but I know that many withdrawing from these drugs have post-withdrawal symptoms for months and sometimes years.Very sobering thought!

I feel the problems of the moment are very related to Zopiclone withdrawal but wonder sometimes if I hadn't known/read about people's WD that perhaps I would not be primed for these results.

However, generally I have felt much much better as the amount of Zopiclone decreased. Much less cog fog, much better word recall and cognitive functioning, better sleep for most part although some sketchy stretches.

I have been active on benzobuddies.org - mostly on the Z-drug thread. Z-drugs have problems of their own as they are very short acting but effects of WD are long lasting!

You said, "So what I'm taking are all things which primarily help produce GABA or stimulate GABA receptors (and a few other things): Niacin, niacinamide, choline/inositol, inositol by itself, glycine, l-theanine, Theanine Serene by Source Naturals, and melatonin. "

I find this interesting. I have read that WD is not a problem of not getting enough GABA but that the receptors have down-regulated from having excess from the benzo. Therefore taking more GABA producing supplements only prolongs the process. However, be that as it may, if it gives a smooth ride off the drug then great.

I'm wondering which of the supps you are taking are helping the receptors that have down-regulated?

I am very interested in your list. I do take melatonin and sometimes some RelaxMax by Xymogen which I think has the l-theanine, taurine...not sure what else. I do get some of the niacin, niacinamide, choline/inositol etc in my multi but should consider how much.

I will follow your path with interest. Many thanks for posting in detail. It is good to know that others are succeeding with their withdrawal. Oci

 

[Oci]

Hi again, In reading the next posts...I see

Mary wrote..."Relora can be helpful to help normalize high cortisol. I think rhodiola rosea is probably good also, and there are other herbs. Some people have good results with ashwaganda. Whether it's high cortisol or norepinephrine, I don't know..."

Thanks for the reminder. I used to take it. I also think that the 3 a.m. awakening can be from low blood sugar. I find that if I eat carbs when I wake that I may be able to get back to sleep. A high cortisol feeling is different. Sometimes I get that too.

Mary also said: "Yes, GABA doesn't cross the BB brain barrier; however, l-theanine does, and l-theanine helps the brain produce GABA. And there are GABA receptors in other parts of the body (e.g., the gut) so taking plain GABA is not useless. And re glycine and inositol and niacin and niacinamide - they are all helping me with sleep. The niacinamide especially stimulates GABA receptors, and inositol too (though niacin is also helpful). And glycine is calming. So I would not write them off. I was in bad shape 2 months ago due to lack of sleep from a lorazepam taper and I'm now getting 7- 8 hours a night with all of these."

Hmmm. @Mary How much of these various things are you taking and are they in separate caps or have you found a good combo?

Thanks for the info...very helpful. Oci