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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by gadchik on May 1, 2012, at 14:01:53
Tapering Clonazepam in Patients With Panic Disorder After at Least 3 Years of Treatment
Nardi, Antonio E. MD, PhD; Freire, Rafael C. MD, MSc; Valença, Alexandre M. MD, PhD; Amrein, Roman MD; de Cerqueira, Ana Claudia R. MD, MSc; Lopes, Fabiana L. MD, PhD; Nascimento, Isabella MD, PhD; Mezzasalma, Marco A. MD, PhD; Veras, André B. MD, MSc; Sardinha, Aline Psy, MSc; de Carvalho, Marcele R. Psy, MSc; da Costa, Rafael T. Psy, MSc; Levitan, Michelle N. Psy, MSc; de-Melo-Neto, Valfrido L. MD, MSc; Soares-Filho, Gastão L. MD, MSc; Versiani, Marcio MD, PhD
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Abstract"High-potency benzodiazepines, such as clonazepam, are frequently used in the treatment of panic disorder (PD) because of their rapid onset of action and good tolerability. However, there is concern about their potential to cause withdrawal symptoms. We aimed to develop a protocol for safely tapering off clonazepam in patients with PD who had been receiving treatment for at least 3 years. A specific scale for judging withdrawal was also developed, the Composite Benzodiazepine Discontinuation Symptom Scale. We selected 73 patients with PD who had been asymptomatic for at least 1 year and who wished to discontinue the medication. The trial consisted of a 4-month period of tapering and an 8-month follow-up period. The dosage of clonazepam was decreased by 0.5 mg per 2-week period until 1 mg per day was reached, followed by a decrease of 0.25 mg per week. The mean dosage at the start of tapering was 2.7 ± 1.2 mg/d. In total, 51 (68.9%) of the patients were free of the medication after the 4 months of tapering according to the protocol, and 19 (26.0%) of the patients needed another 3 months to be free of medication. Clonazepam discontinuation symptoms were mostly mild and included mainly: anxiety, shaking/trembling/tremor, nausea/vomiting, insomnia/nightmares, excessive sweating, tachycardia/palpitations, headache, weakness, and muscle aches. The improvement in PD and general well-being was maintained during both the taper and follow-up phases. Clonazepam can be successfully discontinued without any major withdrawal symptoms if the dose is reduced gradually. We recommend reducing the dosage of clonazepam after intermediate-term use by 0.25 mg/wk"
I dont think the discontinuation symptoms seem mild! .25mg/wk taper would have me undone.
Posted by ron1953 on May 1, 2012, at 14:24:11
In reply to They Make it Sound So Easy..., posted by gadchik on May 1, 2012, at 14:01:53
That's why I ended up going cold turkey. After unsuccessfully trying the (long, drawn-out, uncomfortable) taper method a couple of times, I figured cold turkey would be more severe but a helluva lot shorter. So, I bit the bullet.
Like they say - no pain, no gain.
But NOT recommended.
Posted by gadchik on May 1, 2012, at 14:27:52
In reply to Re: They Make it Sound So Easy..., posted by ron1953 on May 1, 2012, at 14:24:11
I had to do that with zoloft.I kept trying to get smaller and smaller pieces.Finally,I threw caution to the wind,and just stopped.It was better that way.I suspect I will eventually be doing that with klonopin.
Posted by ron1953 on May 1, 2012, at 14:50:46
In reply to Re: They Make it Sound So Easy... » ron1953, posted by gadchik on May 1, 2012, at 14:27:52
But be prepared - benzos seem to be a real biatch compared to other stuff. I've never had what I would call withdrawal symptoms stopping any of the meds I used to take, and none with cigs or alcohol, either. But Klonopin........ Oy vey!
Posted by gadchik on May 1, 2012, at 15:01:55
In reply to Re: They Make it Sound So Easy... » gadchik, posted by ron1953 on May 1, 2012, at 14:50:46
But you survived it,and that's good to know!
Posted by Phillipa on May 1, 2012, at 15:58:23
In reply to Re: They Make it Sound So Easy... » ron1953, posted by gadchik on May 1, 2012, at 15:01:55
Oh good to hear about the zoloft as would like off ad's but after how many years and dose? As for Klonopin don't forget some take as high as 20mg for other ailments. Right now down to .25mg xanax and 7.5mg of valium. Just seems like don't need them anymore. I wonder if aging contributes. Tonight no lexapro then. How come you want off? Phillipa
Posted by gadchik on May 1, 2012, at 16:37:07
In reply to Re: They Make it Sound So Easy... » gadchik, posted by Phillipa on May 1, 2012, at 15:58:23
p,I got down to 12.5mg zoloft,and kept trying to break it into pieces.I finally read about a dr who just has his pt's stop when they get that low,he says it increases and prolongs withdrawal to keep going lower and lower once you get down so far.I was on up to 37.5mg,so not a big dose,for about 2 or 3 yrs.Ive lost almost all the weight I gained from it!Just stopping it was easier than prolonging the taper.Now,the benzos are a whole diff. thing,so I dont know what to expect.I do know I dont like it at all when I try to taper klonopin.I feel miserable.I just know that I dont want to be on any pill for the rest of my life,and I know this one's gonna be tough,so I want to keep giving it a shot.I do so many things to help with my anxiety and depression,esp exercise,nutrition.I want to rely on those things to keep me straight.I want to rely on klonopin as needed, not daily.That's my goal.I believe I will always have a benzo in my back pkt. since anxiety will be a part of my life forever.Worrying about taking the klonopin is worse to me, than staying on it.But,Im still on it,so difficult to stop it.
Posted by linkadge on May 1, 2012, at 16:55:05
In reply to They Make it Sound So Easy..., posted by gadchik on May 1, 2012, at 14:01:53
Clonazepam discontinuation symptoms were mostly mild and included mainly: anxiety, shaking/trembling/tremor, nausea/vomiting, insomnia/nightmares, excessive sweating, tachycardia/palpitations, headache, weakness, and muscle aches.
Yeah, they sure sound 'mild'.....yeah, I'm having nightmares....but they're just mild ones.
Linkadge
Posted by gadchik on May 1, 2012, at 17:11:30
In reply to Re: They Make it Sound So Easy..., posted by linkadge on May 1, 2012, at 16:55:05
yeah,all that's ok as long as it's mild,huh?!
Posted by linkadge on May 1, 2012, at 19:54:16
In reply to Re: They Make it Sound So Easy..., posted by linkadge on May 1, 2012, at 16:55:05
heh yea,
or I got "excessive sweating"...but it was only "mild" excessive sweating.
Linkadge
Posted by sigismund on May 1, 2012, at 20:27:10
In reply to Re: They Make it Sound So Easy..., posted by linkadge on May 1, 2012, at 16:55:05
About as hard as withdrawing from opiates.
Different but just as hard.
Posted by Phillipa on May 1, 2012, at 21:11:07
In reply to Re: They Make it Sound So Easy..., posted by sigismund on May 1, 2012, at 20:27:10
I feel that's a good goal!!!! Phillipa
Posted by Beckett on May 1, 2012, at 22:47:07
In reply to Re: They Make it Sound So Easy..., posted by Phillipa on May 1, 2012, at 21:11:07
Withdrawal from Xanax was hell. I needed to restart it was botched so badly. And I needed a CT scan as well. AD and hydrocodiene discontinuation pale in my experience. Those I accomplished. Xanax is my monkey.
Posted by sigismund on May 1, 2012, at 23:03:03
In reply to Re: They Make it Sound So Easy..., posted by Beckett on May 1, 2012, at 22:47:07
Yes, you may have a point.
I managed to withdraw from methadone but have not managed to withdraw from Valium.
Posted by papillon2 on May 2, 2012, at 4:49:51
In reply to Re: They Make it Sound So Easy... » Beckett, posted by sigismund on May 1, 2012, at 23:03:03
A personal favourite of mine is Pzifer's original prescribing literature stating that one could withdraw from the maximum dose of Effexor in 2 weeks.
Bahahahahahaha
Yeah, well, took me 2.5 months to taper from 450mg and the latter half of that was inpatient where they can taper far more quickly.
Amongst other horrible discontinuation symptoms, my whole spine was shaking from side to side. I was paraded around to the nurses as a rare exhibit. I laugh about it now but it was hell. I'd do it all again for the 7 years of relatively side-effect free stability, though.
There's this show in Aus called the Gruen Transfer which has a section where advertising folk create ads to 'sell the unsellable'. I'd love to see them do one on withdrawing from Benzos, Effexor, Paxil, etc.
Posted by gadchik on May 2, 2012, at 9:26:11
In reply to Re: They Make it Sound So Easy..., posted by papillon2 on May 2, 2012, at 4:49:51
>>There's this show in Aus called the Gruen Transfer which has a section where advertising folk create ads to 'sell the unsellable'. I'd love to see them do one on withdrawing from Benzos, Effexor, Paxil, etc.
Now that,I would love to see!!
Posted by gadchik on May 2, 2012, at 9:40:08
In reply to Re: They Make it Sound So Easy..., posted by Beckett on May 1, 2012, at 22:47:07
Im gonna call Klonopin my lion,it roars with displeasure whenever I try to sneak away.
Posted by gadchik on May 2, 2012, at 10:12:48
In reply to Re: They Make it Sound So Easy... » Beckett, posted by gadchik on May 2, 2012, at 9:40:08
I hate to say so many negatives about klonopin.I must also say that it calmed me and gave me strength to get thru the things I needed to get thru to get well.I was able to lean on it,and I definately needed it at the time.But,it's the getting off of it that I so loathe.I know,for some its a walk in the park,why not for me???
Posted by Beckett on May 2, 2012, at 10:56:31
In reply to Re: They Make it Sound So Easy..., posted by gadchik on May 2, 2012, at 10:12:48
gadchik, I agree with you. It's difficult not to fret about anxiety meds :) My case was an extreme one. When the time comes I know now to come of very slowly and to do so with a very competent doctor. I do not consider it impossible. The taper study that started this thread was exactly the kind that sent me to the ER. If more doctors understood that there is a larger margin of patients than usually acknowledged for whom that taper will not work, than tapering would be safer. And not impossible and scary. Just slow. Give your lion the respect it is due ; )
Posted by gadchik on May 2, 2012, at 13:52:46
In reply to Re: They Make it Sound So Easy... » gadchik, posted by Beckett on May 2, 2012, at 10:56:31
Im thinking this:)
Posted by Beckett on May 2, 2012, at 14:00:10
In reply to Re: They Make it Sound So Easy... » Beckett, posted by gadchik on May 2, 2012, at 13:52:46
OMG they were the first band I ever saw in concert!
Posted by Beckett on May 2, 2012, at 14:05:09
In reply to Re: They Make it Sound So Easy... » Beckett, posted by gadchik on May 2, 2012, at 13:52:46
Bachman Turner Overdrive, Foghat, and Trooper :)
Posted by herpills on May 2, 2012, at 14:42:56
In reply to They Make it Sound So Easy..., posted by gadchik on May 1, 2012, at 14:01:53
That's interesting, because when I tried to do this exact same taper (as instructed by my pdoc) I ended up depressed and suicidal...
Posted by gadchik on May 2, 2012, at 15:39:55
In reply to Re: They Make it Sound So Easy..., posted by herpills on May 2, 2012, at 14:42:56
Any tips for me on tapering this lovely drug?
Posted by ron1953 on May 2, 2012, at 15:48:35
In reply to Re: They Make it Sound So Easy... » herpills, posted by gadchik on May 2, 2012, at 15:39:55
> Any tips for me on tapering this lovely drug?
Quality info can be found here: http://benzo.org.uk/
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