How long does Clonazepam Withdrawal take to start?
November 2, 2013 7:30 AM   Subscribe

I usually take 1.5 mg twice a week but this week I took it 3 times plus another .5 mg. I want to stop now. When do I know I am in the clear as far as withdrawal goes? I really would like to avoid withdrawal, if it isn't too late. I took my last dose last night.
posted by Jack V to Health & Fitness (14 answers total) 1 user marked this as a favorite
1.5mg twice a week seems more like an "as needed" prescription, and you probably are okay as far as withdrawal goes.
posted by xingcat at 7:34 AM on November 2, 2013 [4 favorites]

Speaking from my own experience, I don't think you'll face any withdrawal issues with that dosage. Should be okay!
posted by pemberkins at 7:39 AM on November 2, 2013 [1 favorite]

This is just my experience, but having previously taken clonazepam daily, I had no withdrawal whatsoever when I moved to an as-needed dose.
posted by mittens at 7:39 AM on November 2, 2013 [1 favorite]

I know that this is the boring / rote answer, but have you talked to your doctor? Stopping any prescribed "management" medication will have side effects. I'm not sure if you were taking C. for seizures, anxiety, mania, or other - but having some medical guidance and support will make the transition off the meds safer and less uncertain for you. Good luck.
posted by falldownpaul at 7:46 AM on November 2, 2013 [4 favorites]

Yeah talk to your doc. Your use is going up, yeah? Maybe another drug is in order, one without the bad things that c has
posted by angrycat at 8:11 AM on November 2, 2013 [1 favorite]

I took .5 twice a day for 2 years and there was no withdrawal for me. Ymmv
posted by KogeLiz at 8:33 AM on November 2, 2013 [1 favorite]

You should call your doctor or pharmacist, but if you're not even taking it daily, I (not a health care professional) suspect withdrawal isn't a major risk here.
posted by J. Wilson at 9:02 AM on November 2, 2013

How did things go when you tried this in June?
posted by mireille at 9:34 AM on November 2, 2013 [3 favorites]

Do not quit cold turkey. You should slowly taper your dosage. From Wikipedia:

"Abrupt or over-rapid withdrawal from clonazepam may result in the development of the benzodiazepine withdrawal syndrome, causing psychosis characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations. Sudden withdrawal may also induce the potentially life threatening condition status epilepticus. Antiepileptic drugs, benzodiazepines such as clonazepam in particular, should be reduced slowly and gradually when discontinuing the drug to reduce withdrawal effects."

To spell that out even more clearly: clonazepam is one of the few drugs that can kill you from quitting cold turkey (along with alcohol).

That said, how long have you been taking the drug? The effects of quitting cold turkey increase with time and dosage. You don't take a very high dose, and if you haven't been on it long, I doubt you would have any issues. But why risk it? Talk to your doctor, and taper your dose down over an appropriate time period.

Also, this isn't just theoretical. I know people who have had serious issues with quitting cold turkey. As in hospitalized with psychosis. Be safe.
posted by User7 at 10:11 AM on November 2, 2013

I admit people to a detox unit.

Your withdrawal symptoms are heavily dependent on 1. Any physical/medical issues you may have (history of seizures, hypertension,etc) and the frequency/length of time in which you took the medication. 3 times in one day is very different than 3 times in one week. If those doses were spread out about 24 hours apart, I doubt you will have any noticeable withdrawal symptoms. If they were all within 24 hours, but you have had no long term abuse/over use, you might not feel great for the next day but I doubt you would be in the danger zone for seizures and such unless you have medical issues.

A taper is your best bet. I would say if you aren't feeling any symptoms in the next 24 to 36 hours you will be OK (so, total of 72 hours after your last dose). If you are nervous about this, take a .5mg dose about 24 hours after your last dose and monitor yourself over the next 24 hours. A taper ends with a .5mg dose every 24 hours anyway, so there's really not a lower step, although if you are a LONG term abuser (we're talking 2 mg several times a day) your taper would last several more days or be managed differently by a medical detox using other meds. IANAD, this is not medical advice (but our addiction specialists at the hospital have taught us some things over the years).

Honestly, 1.5 mg three times a week wouldn't even make our doctors blink, unless there are other issues present. They would most likely say taper to 1 mg for your next dose then .5mg for the next one, then be done just to make you feel more at ease. Mainly that's to make sure your anxiety doesn't slap you in the face and cause you to overuse. You may notice some increase irritability and sleep disturbance, maybe an upset stomach, but that's not dangerous. High blood pressure, seizures, and significant mental changes are the danger zone.

And as always, call your doctor for advice if you are unsure. They will have an answering service or your insurance may have a nurse line for advice. And if your frequency/amounts are untrue above, this information wouldn't apply to you. I have seen patients lie about the amounts they are using because they are ashamed, and we medicate them based on what they tell us, then all of a sudden they are really sick because they under reported their use. Don't underreport your use if you seek medical help...doctors can't read your mind.

IANAD, TINMA, seek treatment at your nearest ER if you feel you are in danger.
posted by MultiFaceted at 1:47 PM on November 2, 2013 [1 favorite]

I took more than you (1mg/night every night for a year and a half) and had no physical withdrawal symptoms, just rebound anxiety.

If you need something over-the-counter to take the edge off, large doses of diphenhydramine (Benadryl) have an anti-anxiety effect.
posted by Jacqueline at 2:43 PM on November 2, 2013

You are completely in the clear as far as withdrawal from the medication goes.

You should still talk to your doctor about this, because it sounds like in addition to whatever caused you to take more than usual last week, you are now anxious about the medication itself. Your doctor can help you establish a therapeutic regimen, either with this medication or a new one.

(I am not a doctor, this is not medical advice. I am a nurse, for what that's worth.)
posted by RainyJay at 3:03 PM on November 2, 2013 [1 favorite]

Unless you are also taking something that leverages the effects of the benzodiazepines (like another benzo or alcohol), I can't imagine there will be any issues. You normally take 3mg a week, and this week you took 5mg. Barely double over the course of a week.

If I did that, I would have zero concerns about any kind of withdrawal. I might experience a little rebound anxiety, but I would know that's part of the process and not "real" if you know what I mean.

Seconding RainyJay. Benzodiazepines don't cure anxiety. They just turn the volume down temporarily so you can work on fixing the root causes of the anxiety. You might have more work to do on this front.
posted by gjc at 5:07 AM on November 3, 2013

Tapering for daily doses is ok at around .5mg less per week til you get to 1mg, then .25 less per week(according to pubmed). There are more conservative recommendations of .125mg, or 10% of total less til you get to .5mg. Most sources say just quit at .5mg per day.

Given you take it as-needed, it is a slightly different situation to a daily dose, but since it has a long half-life (18-50 hours), you could be a bit habituated. Not sure whether you're just wanting to withdraw, or you've run out of meds?
If you still have some, maybe look at taking a smaller dose when it is 'as-needed', say 1mg or .5mg, to ease it out.

When it comes to easing off taking it 'as needed', the advice a friend got from a Dr, was to actually sit and wait 5 minutes after deciding to take it, and see if you start feeling better in that 5 minute window.
People usually have a bit of a placebo response to taking it, ie they start chilling out before it could even have kicked in. (Also, Anxiety 'peaks' are usually pretty short honestly, as are most strong emotions). Also, often the anxiety has peaked already, or you start chilling out because you know you're going to take the meds in 5 minutes and don't have to worry about being 'trapped' in this feeling (also, it's a feeling, and it feels uncomfortable, but it won't kill you, and feelings pass - if that isn't a useful phrase/thing to remember for you, think of something that is).

To tide you over the psychological witchdrawal:
Back off from caffeine and sugar-highs completely for the next few days (snack on protein instead). For caffeine, replace it with a non-caffeinated similar drink, rather than say, cutting out your morning coffee, because that can be a soothing routine. Get some extra rest at night for the next few days, or possibly have a mid-day lie down for 15 minutes, just to let yourself defrag a little, either to instrumental music or say, a relaxation recording.
Or sleep of course, because extra sleep is excellent (unless you are already overdoing it on the hypersomnia. Oh, and half a gram of melatonin is good, don't over do it), but I'm wording it this way because actually, the extra rest (eyes closed, consciously letting your body relax) is almost as good.

Be more conscientious about taking other needed meds as-needed (so antihistamines, normal pain meds if you have headaches etc, without over using anything if you don't need it etc), so you're not dealing with more discomfort than you have to.

A lot of people won't have any withdrawal symptoms on the kind of dose you are on, so don't worry unnecessarily (And User7 makes a point that people aren't aware of when getting on benzos, but don't panic unnecessarily, as yes, it is like quitting alcohol, but there is a difference between quitting drinking from a few glasses a week, versus 4 bottles of wine a day, y'know? It's really really like alcohol, just less drunken-making).
posted by Elysum at 1:50 PM on November 4, 2013

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