From the FDA Drug Label
Treatment should be discontinued gradually, with a decrease of 0. 125 mg bid every 3 days, until the drug is completely withdrawn.
For a patient taking clonazepam 1mg TID, the tapering schedule is not directly provided in the label for this specific dosage. However, based on the available information for panic disorder, a conservative approach would be to decrease the dose gradually.
- Decrease the dose by 0.125 mg every 3 days,
- Given the patient is taking 1mg TID (3mg/day), the tapering schedule would need to be adjusted to accommodate the current dosage.
- A possible tapering schedule could be to decrease the dose by 0.25-0.5 mg every 3-7 days, but this is not explicitly stated in the label. Since the label does not provide a direct tapering schedule for the specified dosage, caution should be exercised when discontinuing clonazepam, and the patient should be closely monitored for any adverse effects 1.
From the Research
A gradual tapering schedule for clonazepam 1mg three times daily (3mg total daily dose) should reduce the dose by approximately 0.25mg every week, as recommended by the most recent and highest quality study 2. To implement this taper, start by reducing the dose to 2.5mg total daily (1mg twice daily and 0.5mg once daily) for 1-2 weeks. Then, decrease to 2mg total daily (0.5mg four times daily, or 1mg twice daily) for 1-2 weeks. Continue with 1.5mg total daily (0.5mg three times daily) for 1-2 weeks, then 1mg total daily (0.5mg twice daily) for 1-2 weeks, then 0.5mg total daily (0.5mg once daily) for 1-2 weeks, and finally 0.25mg once daily for 1-2 weeks before stopping completely. This slow taper is necessary because abrupt discontinuation of benzodiazepines like clonazepam can cause withdrawal symptoms including anxiety, insomnia, tremors, and in severe cases, seizures. The gradual reduction allows the brain's GABA receptors to adjust to functioning with decreasing levels of the medication. If withdrawal symptoms become problematic during the taper, temporarily holding at the current dose for an additional week before continuing the taper may be helpful. This schedule may need adjustment based on individual response, and should be conducted under medical supervision. Some studies suggest that clonazepam can be successfully discontinued without major withdrawal symptoms if the dose is reduced gradually 2, 3. However, the most recent and highest quality study 2 recommends reducing the dosage of clonazepam by 0.25mg every week. It is essential to prioritize the single most recent and highest quality study when making a definitive recommendation, and in this case, the study by 2 provides the best guidance for tapering off clonazepam.