Tapering Clonazepam 2mg and Trazodone 200mg at Bedtime
For clonazepam 2mg, reduce by 0.25mg every 1-2 weeks following the CDC-endorsed benzodiazepine tapering protocol, which recommends a 25% dose reduction every 1-2 weeks; for trazodone 200mg, reduce by 25-50mg every 1-2 weeks over 10-14 days as recommended for antidepressant discontinuation. 1
Clonazepam Tapering Protocol
Start with clonazepam taper first before addressing trazodone, as benzodiazepine withdrawal carries greater risks including seizures, delirium tremens, and in rare cases death, whereas trazodone discontinuation primarily causes mild withdrawal symptoms 1. The CDC specifically recommends tapering opioids before benzodiazepines when both are prescribed due to the more dangerous withdrawal profile of benzodiazepines, and this principle applies to any concurrent medication tapering 1.
Specific Clonazepam Reduction Schedule:
- Week 1-2: Reduce from 2mg to 1.5mg nightly (0.5mg reduction) 2
- Week 3-4: Reduce from 1.5mg to 1mg nightly (0.5mg reduction) 2
- Week 5: Reduce from 1mg to 0.75mg nightly (0.25mg reduction) 2
- Week 6: Reduce from 0.75mg to 0.5mg nightly (0.25mg reduction) 2
- Week 7: Reduce from 0.5mg to 0.25mg nightly (0.25mg reduction) 2
- Week 8: Discontinue completely 2
This protocol is based on a study of 73 patients with panic disorder successfully tapered from a mean dose of 2.7mg/day, where 68.9% were medication-free after 4 months using 0.5mg reductions every 2 weeks until reaching 1mg, then 0.25mg weekly reductions 2. Given clonazepam's long elimination half-life of 30-40 hours, this gradual approach allows neuroadaptations to resolve 1.
Expected Withdrawal Symptoms from Clonazepam:
Monitor for mostly mild symptoms including anxiety, tremor, nausea, insomnia, excessive sweating, tachycardia, headache, weakness, and muscle aches 2. These symptoms typically do not develop with gradual dose reduction, though withdrawal symptoms can occur upon abrupt discontinuation 1.
Alternative Slower Taper if Needed:
If the patient experiences significant withdrawal symptoms, slow the taper to 10% of the most recent dose per month, which may take 8-12 months but provides better tolerance 3, 4. The CDC guideline supports this 25% reduction every 1-2 weeks as a commonly used schedule that has been safe and moderately successful 1.
Trazodone Tapering Protocol
Begin trazodone taper only after clonazepam is successfully discontinued or stabilized at a lower dose to avoid compounding withdrawal symptoms 1.
Specific Trazodone Reduction Schedule:
- Week 1-2: Reduce from 200mg to 150mg nightly (25% reduction) 1
- Week 3-4: Reduce from 150mg to 100mg nightly 1
- Week 5-6: Reduce from 100mg to 50mg nightly 1
- Week 7-8: Reduce from 50mg to 25mg nightly 1
- Week 9-10: Discontinue completely 1
The American Family Physician guidelines for Alzheimer's disease management recommend discontinuing antidepressants over 10-14 days to limit withdrawal symptoms, though this can be extended if needed 1. Trazodone has a short 3-9 hour half-life, making it suitable for relatively rapid tapering compared to longer-acting agents 5.
Expected Withdrawal from Trazodone:
Withdrawal symptoms are generally mild and may include rebound insomnia, anxiety, or irritability 1. Unlike benzodiazepines, trazodone does not cause tolerance or REM rebound on discontinuation 5.
Critical Safety Considerations
Do not abruptly discontinue clonazepam as this can cause immediate relapse of symptoms, seizures, or severe withdrawal 1. The risk of confusion and falls is particularly high with clonazepam 2mg nightly, with potential for subdural hematoma 1.
Consider cognitive-behavioral therapy (CBT) during the benzodiazepine taper, as it significantly increases tapering success rates and helps patients struggling with discontinuation 1, 3. CBT should be strongly considered as it improves outcomes for both benzodiazepine withdrawal and insomnia management 6.
Monitor for underlying conditions that may worsen during taper, including sleep apnea (which clonazepam may mask), neurodegenerative disorders, or liver disease 1. The American Academy of Sleep Medicine notes that trazodone has low-quality evidence for insomnia treatment, reducing sleep latency by only 10 minutes compared to placebo 1, 6.
Alternative Medications During Taper
If insomnia worsens during the taper, consider:
- Melatonin 3-12mg at bedtime as a safer alternative with fewer side effects 1
- Carbamazepine may have adjunctive properties for assisting benzodiazepine discontinuation, though evidence is limited 3
- Avoid substituting another benzodiazepine or sedative-hypnotic to prevent creating a new dependence 3
The total tapering process should take approximately 8-10 weeks for clonazepam followed by 10-14 days for trazodone, though this can be extended to 6 months or longer if withdrawal symptoms are problematic 1, 2, 3.