Can Klonopin (clonazepam) be stopped abruptly?

From the Guidelines

No, you should not abruptly stop taking Klonopin (clonazepam) as it can lead to severe withdrawal symptoms, including anxiety, insomnia, irritability, tremors, muscle cramps, sweating, and in severe cases, seizures or psychosis. According to a recent study published in the Mayo Clinic Proceedings 1, abrupt discontinuation of benzodiazepines is considered high risk and can result in significant morbidity and even death. The study suggests that a gradual tapering approach is recommended to minimize the risk of withdrawal symptoms, with a reduction of 25% of the daily benzodiazepine dose each week, although this may need to be more gradual in some cases.

The EMPOWER trial, which enrolled 261 older adults, demonstrated the success of a gradual tapering approach, with 62% of independent seniors expressing interest in benzodiazepine changes, and 27% of patients stopping benzodiazepines compared with 5% in the control group 1. Another study published in the Mayo Clinic Proceedings 1 emphasizes the importance of avoiding abrupt withdrawal or major dose reduction, as it can lead to unacceptable medical care and increased risk of overdose.

The tapering process typically involves reducing the dose by small amounts (often 5-10% of the current dose) every 1-2 weeks, but the exact schedule should be determined by your doctor based on your specific situation, including your current dose, duration of use, and medical history. This gradual approach allows your brain to adjust to decreasing levels of the medication, as benzodiazepines work by enhancing the effect of the neurotransmitter GABA in your brain, and your brain needs time to restore its natural balance. Even if you've only been taking Klonopin for a short time, consult with your healthcare provider before making any changes to your medication regimen.

Some key points to consider when tapering off Klonopin include:

• Gradual reduction of the dose to minimize withdrawal symptoms
• Close monitoring by a healthcare provider to adjust the tapering schedule as needed
• Consideration of alternative treatments, such as cognitive-behavioral therapy or antidepressants, to manage underlying conditions
• Education and self-empowerment to support the tapering process, as demonstrated by the EMPOWER trial 1.

From the FDA Drug Label

The continued use of benzodiazepines, including clonazepam, may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose Abrupt discontinuation or rapid dosage reduction of clonazepam after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue clonazepam or reduce the dosage Do not stop clonazepam tablets without first talking to a healthcare provider. Stopping clonazepam tablets suddenly can cause serious problems Stopping clonazepam tablets suddenly can cause seizures that will not stop (status epilepticus). Talk to your healthcare provider about slowly stopping clonazepam tablets to avoid withdrawal symptoms.

No, you should not abruptly stop taking Klonopin (clonazepam). Abrupt discontinuation can lead to severe withdrawal reactions, including seizures that will not stop (status epilepticus). To minimize the risk of withdrawal reactions, a gradual taper should be used to discontinue or reduce the dosage of clonazepam, as recommended by a healthcare provider 2, 2, 2.

From the Research

Abruptly Stopping Klonopin

• It is not recommended to abruptly stop taking Klonopin, as this can lead to withdrawal symptoms 3, 4.
• Withdrawal symptoms from Klonopin can include anxiety, shaking, nausea, insomnia, and excessive sweating 3.
• Gradually tapering off Klonopin under the guidance of a specialist is recommended to minimize the risk of withdrawal symptoms 3, 4.
• The rate of tapering can vary, but a common recommendation is to reduce the dosage by 0.25 mg per week 3.
• Studies have shown that gradual discontinuation of Klonopin can be well-tolerated, with minimal symptoms of withdrawal 5.

Risks of Abrupt Discontinuation

• Abruptly stopping Klonopin can lead to a rebound effect, where the symptoms being treated return with increased severity 4.
• Stopping Klonopin abruptly can also introduce interactions with other medications, which can lead to adverse effects 4.
• Certain medications, including beta-blockers, corticosteroids, and proton-pump inhibitors, should not be stopped abruptly due to the risk of withdrawal symptoms or rebound effects 4.

Tapering Off Klonopin

• A study published in the Journal of Clinical Psychopharmacology found that 68.9% of patients were able to successfully discontinue Klonopin after a 4-month tapering period 3.
• Another study published in The Journal of Clinical Psychiatry found that gradual tapering of Klonopin was not associated with symptoms suggestive of withdrawal syndrome 5.
• It is essential to work with a healthcare professional to develop a tapering schedule that is tailored to the individual's needs and medical history 3, 4.