Tapering off Xanax via transferring to Klonopin

[stalmalexia]

I'm currently tapering off Xanax with the help of my doctor. I was originally at 4mg/day, for about 8 months, split into 1mg doses every 4 hours (occasionally a 5th mg right before bedtime so I could sleep through the night).

After two weeks I'm down to 2.5mg/day, in five doses of .5mg. My body is finally adjusting, I think, to the .5mg doses, but each day is still like a rollercoaster between doses and at night especially. Around hour 3 I'm staring at the clock waiting to take my next dose. If I wake up in the middle of the night I basically have to dose again. Doc also put me on 50mg hydroxizine 3/day which she has now increased to 100mg 3/day. It's definitely helping with rebound anxiety but if I have a panic attack (the reason I was put on Xanax in the first place) it isn't much help.

Anyways I am seeing my doctor again to come up with a slower taper plan for the remainder and also to discuss switching me to Klonopin. The switch to Klonopin seems advantageous because of the longer half life and duration, so that I'll be able to sleep through the night and not have interdose withdrawal symptoms. Doc didn't seem open to switching to Valium on the phone, but I'm still going to bring it up. I've read the Ashton Manual cover to cover, in fact I have a printed copy of it.

Is it even worth it at this point to switch to Klonopin? I don't want to end up taking 2-3 weeks just to adapt to it from the alprazolam, although it seems this isn't as big of an issue with Klonopin as it is with Valium. And some people say that getting completely off the Klonopin will be harder than Xanax.

For someone taking 5 .5mg doses a day, purely because of the short duration and half-life of Xanax, what kind of dosing schedule would I want to be on? I don't know yet how long the Klonopin is going to last for me or indeed how it will affect me. I'd love to be able to get away with just morning and evening doses. Whatever I do, I absolutely do not want to inadvertently re-raise my tolerated benzo dose while adapting to the Klonopin, erasing all the work of the past couple weeks. Since I am near stable on .5mg Xanax, only needing to take so many doses throughout the day because it wears off so quickly, should I be taking .5mg Klonopin 2-3 times a day? That would be a fairly large drop in total daily dosage, which worries me, but again I'm okay on the .5mg Xanax... for 3 hours at a time...frankly I don't know how I'd split 2.5mg into 2 or 3 doses without bringing my baseline back up to 1mg, and any more doses of Klonopin in one day seems like they would start stacking and again bring my baseline back up.

If anyone could provide some advice on making the switch to Klonopin from Xanax as part of a taper I'd really appreciate it. I'm not sure if it's the right thing to do at this point, even though the stability is very attractive compared to the constant ups and downs of Xanax. Again the last thing I want is to inadvertently go backwards while trying to figure out dosing. I'm trying to decide if it would be best to switch to the Klonopin or just stick it out with the Xanax and a slower schedule like .25mg/week reduction. I am blessed to have a psych who is very compassionate and listens to what I say and wants me to be comfortable during the taper. I'm really happy with the progress I've made so far and don't want to screw things up and go backwards.

For what it's worth I'm also taking Lexapro (escitalopram) 5mg/day for about two weeks now. I've had horrible experiences tolerating SSRIs before, so she started me on 2.5mg/day, moved me up to 5mg/day, with plans to further increase dosage, slowly, to see how I react. I honestly never thought id let another doctor put me on SSRIs but at this point I'm willing to give them another shot if there's any chance it will help with my GAD and panic disorder. I've completely cut all caffeine out, stopped smoking cannabis due to it being a primary agonist of my panic attacks, and am trying to avoid any GABAergic substances and supplements.

Thanks all and sorry for the long post.

 

[d1nach]

Id stick to what works if you are making progress why rock the boats. But im not a doctor so what do i know take what i say with a grain of salt.

 

[Keif' Richards]

Stalmalexia, as I see this is your first post, allow me to hitch up my donkey and bring out the welcome wagon. We're happy to have you and hope your experience and progress will be helpful to others in similar situations! Let me start by saying, I believe that it is a totally reasonable suggestion to switch to a longer-acting Benzodiazepine like Clonazepam (Klonopin). Considering one of your main issues is awakenings in the middle of the night, I would say it's even more reasonable. Not all sleep is equal, as I'm sure you're aware. Simply having your eyes closed does not equal restful, restorative sleep. Waking up in the middle of the night is not good for your sleep hygiene and who knows how the loss might be affecting you throughout your day.

I hear you regarding the Diazepam (Valium) and I think that this is probably a reasonable choice as well, the only issue that I might find with this, is that Diazepam has a pretty wide variability in terms of its effects from person to person. It requires a pretty extensive metabolic process that, depending upon your enzyme activity and other factors, can produce metabolites that last for several days, like Desmethyldiazepam (Nordazepam), which is a prescribed Benzodiazepine in its own right. Clonazepam tends to have a more predictable effects profile from person to person. Being that stability is key for you here, I feel that it would be best to stick to the more predictable options.

Would it be possible for you to give the Clonazepam a try? I think it couldn't hurt to try. Clonazepam and Alprazolam (Xanax) are considered to be equally potent, so there should not be a lot of confusion when trying to find the appropriate dose. Try it for a night even. Granted, you won't know fully if it will work for you, but I think it is a good place to start. I would ask your prescriber about what we have talked about here and get back to us.