Benzos Clonazepam Reduction: short-acting anxiolytics as aid in anxiety

[adder]

Hey,

I've recently become a participant of the Suboxone maintenance programme. I am also addicted to clonazepam. I've been struggling with tapering down the dose and it's been cut by 50% from 4mg to 2mg when I was in the hospital preparing to enter the programme.

Although buprenorphine definitely helps me a lot for my terrible depression and anxiety. I quit methadone at the beginning of September this year after 3 years of daily use as a substitute. It augmented my depression and anxiety to an unbelievable point. No antidepressant helped a bit, my then clonazepam dose (6mg) was no help either.

Right now I'm on a very low dose of Suboxone (2mg of bupe) and this is to be slowly increased as I can't go to the hospital again and I should have stayed at 4mg. Unfortunately now being outside the ward, I can't get it increased faster than 2mg -> 3mg. I suffer pretty bad from this clonazepam cut, i.e. shaking hands, breaking voice, sweating. This happens mostly during stressful situations and there are plenty of them now as I've got a lot of tests at the university which determine my marks. My doctor told me not to increase clonazepam though and that he will increase the dose of Suboxone so I can control my anxiety. Well, theoretically it's well put out but in practice it's hard not to take even an additional 1mg of clonazepam. Also, I had some estazolam left (3 x 2mg) and I used it up on three different days when I had a panic attack. Estazolam was great for this because it has a fast onset and it has a strong anxiolytic action at the beginning. I don't feel its hypnotic properties so it didn't bother me at the university at all. Then one day I found 4 capsules with 20mg of clorazepate in total. It was enough for one dose. It was good because nordazepam has a long half-life and I felt that it was there working much longer than clonazepam.

I was wondering if using a small dose of alprazolam or bromazepam (or any other short-acting benzodiazepine that is considered purely anxiolytic) would be a bad thing during this clonazepam reduction. E.g. if I'm taking 2mg of clonazepam right now, an equivalent of 0.5mg of clonazepam (thus 0.5mg of alprazolam or 6mg of bromazepam). Alternatively I would further reduce clonazepam to 1.5mg and take aforementioned dose during a panic attack until I get a proper dose of Suboxone a day and they start giving it to me for a week (right now I have to collect it twice a week, sometimes I'm in a hurry between lectures, so I get there with dilated pupils and all wet).

Would it upset the whole process of gradual clonazepam dose reduction much? I know my doctor (who put me on the programme to help me with my depression and keep me away from curing post-withdrawal syndrome effects coming from methadone cessation with weak opioids like codeine) won't prescribe me anything but clonazepam and he wants me to further decrease the dose which is too fast for me, at least when I study and live a stressful life. I would want to get just one pack of either medicine, they all contain 30 pills so it would be enough until I get on the right dose of Suboxone. I just want to hear a more objective opinion as I know I'm hardly objective when it concerns me.

Thanks in advance for any input!

 

[Captain.Heroin]

You are a smart guy, so I'm sure you can use conversion tables to your advantage.

I think you'd be safe to switch to some shorter lasting benzos, as long as you are able to not dose them more often than you are the clonazepam.

Have you tried alternatives to benzos for anxiety, such as antihistamines, beta blockers, exercise, meditation, etc?

 

[Znegative]

Hey adder,
While Im not exactly a benzo expert, I'd like to give my two cents, as I've been in a similar situation to you. The first thing I would like to point out, is that increasing your suboxone dose to 4mg (from 2mg-or was it 3?) is IME, unfortunately not going to intensify the effects of the clonazepam to the point where it will make much of a difference (for some reason though, on methadone I found the opposite to be true-I was taking 1mg, and the methadone made it feel 2x stronger..).

However, I think your plan of replacing a quarter of your clonazepam dose with an equipotent (.5mg clonazepam) dose with a short acting benzodiazepine will help your taper out as well as give you better relief (as long as you are responsible with your benzodiazepine usage). I have in the past, replaced my monthly script of 1mg/day clonazepam with 1mg/day of alprazolam, and after four and a half weeks, I was actually able to switch back to the clonazepam and only use .5mg instead of 1mg. Now I don't know if this was just pure dumb luck, but in a way it makes sense, as alprazolam is so much shorter acting than alprazolam, and although they are equipotent, clonazepam is similar to an extended release medication, in that I have always felt that taking say, 2mg of clonazepam, felt similar to taking 1mg of alprazolam every 3 or so hours for about 12 hours (however, I know many do NOT experience clonazepam this way). Either way, by using a shorter acting benzo for a portion of your dosage, I think that you would possibly be able to lower your tolerance to the longer acting clonazepam.

 

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I don't really expect more buprenorphine to boost clonazepam effects. I know buprenorphine works for my depression and anxiety, that's why I want to increase the dose. This could be that other solution instead of antihistamines or beta blockers. Besides antihistamines and beta blockers work more as sedatives than anxiolytics, I don't want to be dulled. E.g. driving here taking buprenorphine is perfectly fine with law (as opposed to driving taking methadone although traffic police doesn't differentiate them) and you know that after years of using benzodiazepines at some point you stop feeling their sedative action too. I turned to clonazepam when I had to dose lorazepam thrice a day not to shake, so actually I've never felt that infamous clonazepam amnesia. Anyway, I never had luck with sedating antihistamines, there were always more side effects than the desired effects. I want to "exchange" some clonazepam for some short-acting anxiolytic benzodiazepine because although I'm far from getting an epileptic attack, sometimes I'm so nervous that I feel as if I were about to. I know it's caused by anxiety so I don't need more clonazepam or whatever (carbamazepine could be an alternative solution then but it's not that). Clonazepam was simply never a good anxiolytic for me but it was a good solution because of its long half-life (there are BZD derivatives that worked better for me but they're not available in Poland0. Now that I'm at way lower dose, some of it could be replaced. This is something some psychiatrist practise too, even in case of clonazepam. There's a marked difference between diazepam or flurazepam and clonazepam (duration of action at equipotent). But let alone possible future switches, right now I just need something acting quick and leaving my body fast too so it doesn't accumulate and I can lower my clonazepam dose further.

I practised self-hypnosis (I heard so many good things about hypnosis but somehow no specialist could hypnotize me, so I realized it was a matter of subconsciously not wanting to open in front of someone I don't really know), it was quite helpful but after quitting methadone depression and anxiety became so unbearable I can't control myself now as in the past. It feels like a trauma to some point as I could cut myself from the people around me even in crowded places when I needed it (now it sometimes happens when I want to pay attention).

As for exercise, I try spending as much time as I can with horses. These animals always made me feel more calm. I'd like to have more time to go to the gym as I lost a lot of weight during methadone W/D and it's not coming back, especially with this terrible diet I have to stick to (I had a wrong diagnosis and 20 days of taking antibiotics caused candidosis).

 

[Opanaking]

A little bit of xanax shouldn't hurt you. But if you start taking it to often then it will disrupt your taper. Have you considered switching to diazepam? I found it much easier to taper off of then klonopin. Klonopin although it has a long half life is a lot more potent. Valiums long half life and weak potency make it perfect for tapering. It works much better then klonopin when it comes to anti-anxiety effects.

I know your saying you dont want something to accumulate in your body. However, that's actually just what you need. Once valium builds up it becomes easy to make cuts in your dose and taper completely off of it. Alprazolam will give you relief but isn't going to help your taper. It will just make you feel better. Then once it wears off you'll be back where you started.

 

[adder]

There are no 10mg diazepam pills here. And I'm at 2mg of clonazepam a day now so it would be a lot of 5mg pills to take now. Although a partial switch could be made, even nordazepam coming from clorazepate metabolism seemed to have a more anxiolytic action than clonazepam. Like I mentioned there are BZD derivatives, I would switch to but they're not available in my country. Phenazepam or flurazepam are way better for me. I haven't really liked clonazepam ever, I made a switch because lorazepam effects were too short eventually and my dose was so high that only clonazepam was suitable because of potency and relatively long half-life.

I had my Suboxone dose increased and it's much more closer to the perfect spot between speedy feeling and some opioid action, helps my depression which has a big impact on my anxiety. I know it'd be a problem to get alprazolam or bromazepam as Xanax (actually, I'd prefer some cheaper generic, Xanax is expensive for nothing) or Lexotan. I have never practised doctor shopping, I prefer solving the problem myself, it's much less time spent. But I also prefer all that sick stuff I did in the past to stay the past. I don't know if it's worth the bother.

I have a problem seeing my doctor. He told the person giving away methadone and Suboxone at the point to increase my daily dose via phone (hell of a memory to remember about the meeting we talked about last Thursday with one out of ~1,000 regular patients and knowing what it was supposed to be about). He couldn't come to the point. The hospital is at the suburbs in the southern part of the city, the point is north to the centre. And somehow he doesn't seem to be one of these wealthy physicians, he doesn't drive a car, and buses schedules on weekends are terrible. Commuting is generally a nightmare as it were at least Warsaw, especially by buses. And Winter always paralyses traffic although we've got snow every year, it's never a surprise. Nonetheless, I must see him next week because even if he doesn't want to make any switch now, I'm running out of this damned clonazepam. If I'm forced to obtain clonazepam by other means, I might as well make a partial switch to diazepam, true.

 

[adder]

I've had a panic attack again. And it was after increasing Suboxone dose to 4mg. I even started dissolving it in a few drops of Scotch (contrary to the stereotypes I hate vodka and I'm Polish), it hardly helps for my anxiety. I took regular 2mg of clonazepam in the morning and the additional 1mg taken s.l. when the panic attack occurred started acting long after the factor causing anxiety was gone... Earlier today I had failed an exam because of anxiety.

I definitely want to exchange some of my 2mg clonazepam dose for alprazolam or bromazepam. They seem the best out of BZDs available in my country, both are short-acting and won't accumulate. I'd prefer alprazolam as it hits within 15 minutes but I can imagine that my doctor may think I want to get something from him that will make me "high" so I don't know if this is possible at all but I know increasing Suboxone won't do a damn thing for anxiety. And the rest of clonazepam I would exchange for diazepam as I don't think clonazepam is helpful for anything I still take it (no help for insomnia, no help for anxiety). But the problem is there are only 5mg diazepam pills here, no 10mg pills. So total switch is impossible now. Is this passable in your opinion:
- 1mg of clonazepam is kept,
- 0.5mg of clonazepam is substituted by 0.5-1mg of alprazolam (1mg because it's shorter acting so it's only when 0.5mg doesn't work for panic attacks) or 9-12mg of bromazepam (12mg preferable but I want to keep it as low as possible); alprazolam is preferable because of its fast onset and this is what I need,
- 0.5mg of clonazepam is substituted by 10mg of diazepam?

And a 4mg/1mg Suboxone dose is kept of course, no further increase as I don't want to go to the ceiling, I want to keep this dose as low as possible too because I entered the programme until I finish studies, then I want to taper it off if it's possible, if I have problems, I will stay at the lowest possible dose just to control depression.

Sorry for posting under my previous post. Thanks in advance for any input, suggestions and modifications of my plan are very welcome as I'm aware my opinion is very subjective. My goal is to have something I can taper down not lingering + control panic attacks temporarily. I need to be off BZDs as fast as possible without W/D's side effects because I need to have 4 wisdom teeth extracted and I guess clonazepam is a much bigger problem when it comes to anaesthesia than buprenorphine.

 

[brutus]

I think you are trying to taper your benzo dose way too rapidly. I was in the same boat last year and while I managed to get off bupe, I could not stop taking benzos. I felt the exact same way as you are describing but my doctor would not listen.

Try something such as phenibut or l-theanine for your anxiety if your doctor doesn't want you to increase your dose. I also suggest looking up the Ashton Manual for how to taper off benzos.

I've also had my wisdom teeth removed while being on bupe and Klonopin. Just tell your anesthesiologist ahead of time because they will know what to do. You also have the option of not being under anesthesia and having your wisdom teeth removed.

Feel free to PM me because I was in the exact same boat as you.

 

[adder]

Maybe it looks like I want to taper it off too rapidly, maybe I really do. I just know I want to get off it as fast as possible without common side effects because they're much worse than those during opioid withdrawal.

I guess I am now stable at 1.5mg. I talked to my doctor about exchanging part of this dose for something else. He mentioned drugs containing clorazepate and chlordiazepoxide (well, both would eventually be metabolised to nordazepam, but clorazepate would be the best if one wanted a prodrug for nordazepam as far as I know), but also said he would rather not make a switch because clonazepam has a shorter half-life, thus it may be easier tapered down. By "easier" I guess he meant manipulation of the dose... I increased my Suboxone dose to 8mg because there's no difference between 6mg and 8mg concerning the price (well, there's no difference between 6mg and 8mg subjectively for me either), so I just wanted to have 2mg extra so it wears off slower. And as it was on the same day, I didn't want to go on with the conversation about switching from clonazepam. It seems he wants me to get off it as fast as possible. I don't know if there will be any benefits for me if I taper it down e.g. 3 months earlier after 8 years of daily administration.

I should have told him what I mean is a switch to an ever shorter acting one stopping unexpected attacks of anxiety. But I also wonder whether I would be able to control taking a quickly kicking in BZD. Suboxone is hardly more opioid even at 8mg. And sometimes I just want my head off everything. I can't smoke marihuana for that purpose because I need to stay focused and after-effects are relatively long. If he's mentioned clorazepate, then he wouldn't want to go for anything as strong as clonazepam so I guess he wouldn't accept alprazolam. I know every psychiatrist has his/her own habits, I mean medicines he/she prescribes. He doesn't look like a doctor prescribing anything "unusual". Bromazepam is purely an anxiolytic so with him being a psychiatrist specializing in addiction, BZDs used are probably clonazepam, diazepam, and BZDs known and used for a long time producing diazepam and nordazepam as metabolites. I know I could easily exchange with someone if only someone had alprazolam... It's much easier to get it from psychiatrists than clonazepam and clonazepam has a reputation of a BZD being the best for boosting opioids effects. But I don't want to deal with methadone participants, I haven't met even one person on methadone who wants to get clean. Most of them push their daily doses over their needs so they can sell it or exchange it, most of them take additional drugs either causing synergy with opioids or blocking metabolism of methadone to some extent (e.g. clonazepam, phenobarbital, promazine, some even take amitriptyline...).

I'm not anxious all the time, I rather have light panic attacks and I could use something acting immediately rather than something having a longer half-life than clonazepam. I can control all other problems coming from BZD taper-down but anxiety. Estazolam was all right although it hardly is a good substitute for convulsions. But the first thing I used to feel from it and started feeling it to some extent after a long break from taking it was strong anxiolysis (I noticed shaking hands stopped at the same time so it's a result of anxiety and not too low dosage), then some little sedation. It's not a hypnotic for me any more. But now that GPs have a history of prescribed medicines stored in a database, I would have to visit someone in a different clinic which is impossible due to current law (which states a person chooses one clinic and one GP, in practice it doesn't matter which GP I visit, it just have be the clinic I signed in).