What is a recommended tapering schedule for a patient taking 0.5 mg of clonazepam (Klonopin) daily?

Clonazepam Tapering Schedule for 0.5 mg Daily Dose

For a patient taking 0.5 mg of clonazepam daily, the recommended tapering schedule is to reduce the dose by 0.125 mg every 3 days until complete discontinuation. 1, 2

General Tapering Principles

• A decrease of 10% of the original dose per week is a reasonable starting point for tapering benzodiazepines, though this should be individualized based on patient response 3, 1
• For patients on clonazepam for extended periods, slower tapers (such as 10% per month) may be better tolerated 3, 1
• The FDA-approved labeling for clonazepam specifically recommends "treatment should be discontinued gradually, with a decrease of 0.125 mg bid every 3 days, until the drug is completely withdrawn" 2

Specific Tapering Schedule for 0.5 mg Daily

• Week 1: Reduce from 0.5 mg to 0.375 mg daily 1, 2
• Week 2: Reduce from 0.375 mg to 0.25 mg daily 1, 2
• Week 3: Reduce from 0.25 mg to 0.125 mg daily 1, 2
• Week 4: Reduce from 0.125 mg to complete discontinuation 1, 2

Alternative Approaches Based on Duration of Use

• For patients who have been on clonazepam for many years, an even slower taper might be warranted 3, 1:
  • Consider reducing by 10% of the current dose per month (rather than per week) 3, 1
  • For 0.5 mg daily: Reduce by 0.05 mg monthly, which may require tablet splitting or liquid formulation 1

Managing Withdrawal Symptoms

• Common withdrawal symptoms include anxiety, insomnia, tremor, headache, and muscle aches 4
• If severe withdrawal symptoms occur, return to the previous well-tolerated dose and slow the taper further 3, 1
• Tapers may need to be paused if significant withdrawal symptoms develop, and can be restarted when the patient is ready 3, 1

Special Considerations

• For the final reduction from 0.125 mg to zero, consider an even slower taper using liquid formulation or tablet splitting to achieve smaller decrements 1
• Patients with a history of seizures require particularly careful monitoring during the tapering process 5
• Document the patient's response to each dose reduction before proceeding to the next step 1

Potential Pitfalls to Avoid

• Avoid abrupt discontinuation, which significantly increases risk of withdrawal symptoms 3, 4
• Do not use a rigid "one-size-fits-all" approach; be prepared to adjust the tapering schedule based on individual response 3, 1
• Be aware that withdrawal symptoms may be delayed, with rebound insomnia potentially occurring on the third night after a dose reduction 6