7-Week Clonazepam Discontinuation Protocol
For a 7-week clonazepam taper, reduce the dose by 0.25 mg per week after reaching 1 mg/day, with slower reductions of 0.5 mg every 2 weeks for higher doses. 1
Structured Tapering Schedule
Initial Phase (Weeks 1-4, if starting dose >1 mg)
- Reduce by 0.5 mg every 2 weeks until reaching 1 mg/day 1
- For example, if starting at 2.5 mg/day:
- Weeks 1-2: 2.0 mg/day
- Weeks 3-4: 1.5 mg/day
- Weeks 5-6: 1.0 mg/day 1
Final Phase (Last weeks to reach zero)
- Once at 1 mg/day or below, reduce by 0.25 mg per week 1
- This slower reduction at lower doses is critical because withdrawal symptoms intensify as the dose approaches zero 2, 3
- Example final taper from 1 mg:
- Week 5: 0.75 mg/day
- Week 6: 0.5 mg/day
- Week 7: 0.25 mg/day
- Week 8: Discontinue 1
Important Dosing Principle
- Calculate each reduction as a percentage of the current dose, not the original dose 3
- This prevents disproportionately large final reductions that can trigger severe withdrawal 3
Evidence Quality Note
The most rigorous study specifically examining clonazepam tapering found that 68.9% of patients successfully discontinued using a 0.25 mg/week reduction protocol after reaching lower doses, with an additional 26% requiring 3 more months 1. This study used a 4-month taper for patients on average doses of 2.7 mg/day, which can be compressed to 7 weeks for lower starting doses 1.
Managing Withdrawal Symptoms
Expected Symptoms (Mostly Mild)
- Anxiety, tremor, insomnia, sweating, tachycardia/palpitations 1
- Headache, weakness, muscle aches, nausea 1
- These symptoms are generally well-tolerated with gradual tapering 1
Pharmacological Adjuncts
- Gabapentin: Start 100-300 mg at bedtime or three times daily, increase by 100-300 mg every 1-7 days as tolerated 3
- Carbamazepine or pregabalin can help mitigate withdrawal symptoms 3
- SSRIs (particularly paroxetine) for underlying anxiety during tapering 3
- Clonidine for physical symptoms 2
Non-Pharmacological Interventions (Critical for Success)
- Cognitive-behavioral therapy during taper significantly increases success rates 3, 4
- Patient education about benzodiazepine risks and withdrawal expectations improves outcomes 3
- Relaxation techniques, mindfulness, and psychotherapy should be incorporated 3
- Complete the drug taper before psychological treatment concludes 4
Monitoring Requirements
- Follow up weekly during the taper given the 7-week timeframe 3
- Monitor for withdrawal symptoms, mood changes, and suicidal ideation 3
- Screen for depression, anxiety, and substance use disorders that may emerge 3
- Assess for both acute withdrawal and protracted withdrawal symptoms 2
Critical Safety Warnings
Absolute Contraindications to Rapid Taper
- Never abruptly discontinue clonazepam—this can cause seizures and death 5, 3
- Pregnant patients should not taper without specialist consultation due to risk of spontaneous abortion and premature labor 3
- History of withdrawal seizures requires specialist referral, not primary care management 3
When to Pause or Slow the Taper
- The taper rate must be determined by the patient's tolerance, not rigid adherence to schedule 3
- If significant withdrawal symptoms emerge, pause the taper and maintain the current dose until symptoms resolve 5
- Some patients may need to extend beyond 7 weeks—this is acceptable and often necessary 3
Special Populations Requiring Slower Tapers
- Patients on clonazepam >1 year may need 10% monthly reductions rather than weekly 3
- Elderly patients require more gradual tapers with smaller dose reductions 3
- Unstable psychiatric comorbidities require specialist involvement 3
Common Pitfalls to Avoid
- Do not reduce by a fixed percentage of the original dose—this creates dangerously large final reductions 3
- Avoid concurrent CNS depressants during the taper period 2
- Do not dismiss patients or make "cold referrals" during tapering—this constitutes abandonment 5
- Warn patients about increased overdose risk if they return to previous doses after tolerance is lost 3