How to taper Klonopin (clonazepam)

Clonazepam (Klonopin) Tapering Protocol

Clonazepam should be tapered gradually with a reduction of 0.25 mg per week to minimize withdrawal symptoms, with slower tapering for patients on long-term therapy. 1, 2

Understanding Clonazepam Withdrawal Risk

Clonazepam is a high-potency benzodiazepine that can cause significant physical dependence with continued use. Abrupt discontinuation or rapid dosage reduction can precipitate acute withdrawal reactions that may be life-threatening, including seizures 1.

Common withdrawal symptoms include:

• Anxiety and irritability
• Tremors/shaking
• Insomnia and nightmares
• Nausea/vomiting
• Excessive sweating
• Tachycardia/palpitations
• Headache
• Muscle aches and weakness

Recommended Tapering Schedule

The optimal tapering schedule depends on the current dose, duration of treatment, and individual factors:

For Standard Tapering (Most Patients):

• Reduce dose by 0.25 mg per week 2
• For patients on higher doses (>2 mg/day), consider:
  • Initial reduction of 0.5 mg every 2 weeks until reaching 1 mg/day
  • Then slow to 0.25 mg per week until complete discontinuation 2

For Long-Term Users (>3 years):

• Consider a slower taper of 5-10% reduction every 2-4 weeks 3
• Once reaching the smallest available dose (0.125 mg), extend the interval between doses (every other day, then every third day) before stopping completely 3

Managing Withdrawal Symptoms

Adjunctive medications can help manage specific withdrawal symptoms:

• For anxiety/agitation: Trazodone or mirtazapine 4, 3
• For insomnia: Low-dose trazodone 4, 3
• For sympathetic hyperactivity: Clonidine (starting with small doses due to potential hypotension) 4, 3
• For gastrointestinal symptoms: Loperamide 4, 3
• For muscle aches/pain: NSAIDs or acetaminophen (not exceeding 3000mg daily) 3

Monitoring During Tapering

• Schedule frequent follow-ups (at least monthly) during the tapering process 3
• At each visit, assess for:
  • Withdrawal symptoms severity
  • Changes in mood or anxiety
  • Suicidal thoughts
  • Sleep quality
  • Use of other substances

Important Considerations and Pitfalls

1. Never discontinue clonazepam abruptly - this can lead to severe withdrawal symptoms including seizures 1

2. Pause the taper if needed - If withdrawal symptoms become significant, pause the taper or return to the previous dose before proceeding with a slower taper 3

3. Avoid concurrent opioid tapering - Concomitant use of benzodiazepines and opioids increases risk of respiratory depression and death; tapering both simultaneously requires special caution 1

4. Be aware of protracted withdrawal - Some patients may experience withdrawal symptoms lasting weeks to more than 12 months after discontinuation 1

5. Consider cognitive-behavioral therapy - Concurrent CBT increases rates of successful discontinuation and duration of abstinence 4

6. Recognize high-risk patients - Patients with a history of seizures, alcohol use disorder, or prior difficult benzodiazepine withdrawal may require more gradual tapering and closer monitoring 3

Success Rates

Research shows that with proper tapering protocols, approximately 69% of patients can successfully discontinue clonazepam within 4 months, and another 26% within 7 months 2. The improvement in overall well-being is typically maintained during both the taper and follow-up phases when properly managed.