From the Guidelines
I strongly advise against quitting clonazepam 0.5 mg abruptly, even with intermittent use of three times a week for three months, due to the risk of withdrawal symptoms and potential severe complications. Clonazepam is a benzodiazepine that can cause physical dependence and withdrawal symptoms, even with intermittent use over several months 1. The risk of withdrawal symptoms, such as anxiety, insomnia, irritability, tremors, or in severe cases, seizures, exists even with your current dosing pattern.
Recommended Approach
To safely discontinue clonazepam, a gradual tapering schedule is recommended, which might involve reducing your dose or frequency over several weeks. A commonly used tapering schedule is a reduction of the benzodiazepine dose by 25% every 1–2 weeks 1. It is essential to consult with your healthcare provider before stopping this medication, as they can evaluate your specific situation and determine the best approach for tapering or discontinuing clonazepam.
Considerations
Your doctor will consider why you were prescribed clonazepam initially and help determine if it's appropriate to discontinue the medication and how to do so safely. They may also recommend evidence-based psychotherapies, such as cognitive-behavioral therapy (CBT), or specific anti-depressants or other nonbenzodiazepine medications approved for anxiety, if needed 1. It is crucial to prioritize your safety and well-being by following a gradual tapering schedule under medical supervision.
From the FDA Drug Label
The continued use of benzodiazepines, including clonazepam, may lead to clinically significant physical dependence. Abrupt discontinuation or rapid dosage reduction of clonazepam after continued use, or administration of flumazenil (a benzodiazepine antagonist) may precipitate acute withdrawal reactions, which can be life-threatening (e.g., seizures) To reduce the risk of withdrawal reactions, use a gradual taper to discontinue clonazepam or reduce the dosage
It is not recommended to quit clonazepam abruptly, even if taken only 3 times a week for 3 months.
- The risk of withdrawal reactions is still present, and seizures can be life-threatening.
- A gradual taper should be used to discontinue clonazepam or reduce the dosage to minimize the risk of withdrawal reactions 2.
- Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use 2.
From the Research
Quitting Clonazepam
- The decision to quit clonazepam 0.5 mg, taken only 3 times a week for 3 months, should be made with caution and under medical supervision, as benzodiazepine withdrawal syndrome can occur even with low doses and short-term therapy 3, 4.
- The risk of developing withdrawal symptoms is generally higher with higher doses and longer treatment duration, but symptoms may still occur in patients receiving recommended doses and/or short-term therapy 3.
- Withdrawal from normal dosage benzodiazepine treatment can result in a number of symptomatic patterns, including a short-lived "rebound" anxiety and insomnia, a full-blown withdrawal syndrome, and the return of anxiety symptoms 4.
Discontinuation Strategies
- A slow taper condition, either alone or in conjunction with cognitive-behavioral therapy, can be an effective strategy for discontinuing benzodiazepine treatment 5.
- A novel intervention that masks the daily dose of benzodiazepine receptor agonist during tapering and augments cognitive behavioral therapy for insomnia (CBTI) with novel cognitive and behavioral exercises targeting placebo effect mechanisms may improve benzodiazepine receptor agonist discontinuation 6.
- Cognitive-behavior therapy (CBT) for insomnia, combined with a supervised medication taper, can facilitate withdrawal, but there is limited evidence on long-term outcome after discontinuation 7.
Relapse Rates
- A substantial relapse rate following benzodiazepine discontinuation has been observed, with 42.6% of participants resuming benzodiazepine use within 2 years 7.
- Predictors of relapse include treatment condition, end of treatment insomnia severity, and psychological distress 7.
- CBT booster sessions might enhance compliance with CBT and prove useful in preventing relapse 7.