What is a recommended taper schedule for a patient taking Klonopin (clonazepam) 0.25 mg?

Clonazepam 0.25 mg Taper Schedule

For a patient on clonazepam 0.25 mg daily, reduce by 0.125 mg (half the current dose) every 2 weeks, completing the taper over approximately 4 weeks. 1

Specific Tapering Protocol

Week-by-Week Schedule:

• Weeks 1-2: 0.25 mg daily (current dose)
• Weeks 3-4: 0.125 mg daily (50% reduction)
• Week 5 onward: Discontinue completely 1

This follows the CDC-recommended approach of reducing by 10-25% of the current dose every 1-2 weeks for patients on benzodiazepines less than 1 year. 2 For patients on clonazepam ≤1 mg/day specifically, the Mayo Clinic recommends 0.25 mg reductions per week, which translates to a 50% reduction every 2 weeks at your dose. 1

Critical Safety Warnings

Never stop clonazepam abruptly—this can cause life-threatening seizures, delirium, and death. 1, 3 The FDA explicitly warns that abrupt discontinuation or rapid dosage reduction can precipitate acute withdrawal reactions, including seizures, which can be life-threatening. 3

If You've Been on Clonazepam >1 Year

Slow the taper to 10% of the current dose per month rather than the schedule above. 2, 1 This means:

• Month 1: Reduce from 0.25 mg to 0.225 mg daily
• Month 2: Reduce to 0.20 mg daily
• Continue reducing by 10% monthly until complete discontinuation 2

This slower approach minimizes withdrawal symptoms and improves completion rates. 2

Monitoring During the Taper

Follow up at least every 2-4 weeks during the taper. 1 At each visit, assess for:

Common withdrawal symptoms to monitor:

• Anxiety, tremor, insomnia, sweating, tachycardia 2, 3
• Headache, weakness, muscle aches, nausea 2, 4
• Confusion or altered mental status 2

If withdrawal symptoms become severe: Return to the previous well-tolerated dose, stabilize for 2-4 weeks, then attempt a smaller reduction (e.g., 0.0625 mg instead of 0.125 mg) or extend the time between reductions to 4-6 weeks. 5, 1

Adjunctive Strategies to Improve Success

Cognitive-behavioral therapy (CBT) during the taper significantly increases success rates and should be incorporated as the primary long-term anxiety management strategy. 2, 1

For specific withdrawal symptoms:

• Insomnia: Trazodone 25-200 mg at bedtime (short-term, non-addictive) 2, 5
• Autonomic symptoms (sweating, rapid heart rate): Consider clonidine 5
• Muscle aches: Acetaminophen or NSAIDs 5
• Anxiety symptoms: Gabapentin 100-300 mg at bedtime or three times daily, titrated by 100-300 mg every 1-7 days as tolerated 2

Critical Pitfalls to Avoid

Do not reduce by a fixed percentage of the original dose—always calculate reductions as a percentage of the current dose to prevent disproportionately large final decrements. 2, 1 For example, if you reduce by 0.125 mg from 0.25 mg, the next reduction should be calculated from 0.125 mg, not from the original 0.25 mg.

Do not set arbitrary time limits for completing the taper. 5 The goal is durability of the taper, not speed. 2 Some patients may need to pause at a particular dose for weeks before proceeding.

Do not abandon the patient if tapering is unsuccessful. 2 Consider maintenance at a reduced dose rather than complete discontinuation—the target dose does not have to be zero. 1

Special Populations

If also taking opioids: Taper the clonazepam first due to higher risks associated with benzodiazepine withdrawal compared to opioid withdrawal. 2, 5

If history of seizures: Requires particularly careful monitoring and possibly specialist involvement during the taper. 5

If pregnant: Do not taper during pregnancy without specialist consultation, as withdrawal can cause spontaneous abortion and premature labor. 2

When to Refer to a Specialist

Immediate specialist referral is indicated for: 2

• History of withdrawal seizures
• Unstable psychiatric comorbidities
• Co-occurring substance use disorders
• Previous unsuccessful office-based tapering attempts

Expected Outcomes

Successful withdrawal is typically followed by improved psychomotor and cognitive functioning, particularly in memory and daytime alertness. 6 In a study of 73 patients tapering from a mean dose of 2.7 mg/day, 68.9% were medication-free after 4 months using a protocol of 0.5 mg reductions every 2 weeks until 1 mg/day, then 0.25 mg per week. 4 Improvement in panic disorder symptoms and general well-being was maintained during both taper and follow-up phases. 4