Tapering clonazepam before methadone treatment

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Caitrin
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Location: New Jersey

Tapering clonazepam before methadone treatment

Postby Caitrin » Wed Aug 21, 2019 1:39 pm

I have been taking 2 mg. clonazepam for 25+ years and am having difficulty tapering so that I may start taking methadone. This is per my long awaited consultation with doctor at Yale Sleep Medicine Center. He will also be tapering ropinirole from 2 mg. to 0 mg. once clonazepam taper completed. I will begin on low dosage of methadone. I am currently experiencing insomnia and nightmares, among other adverse side effects, on ropinirole after severe skin reactions on 2 mg. Neupro patch. I must now move on to the opiate methadone as I have refractory RLS. Any comments or suggestions will be very much appreciated. Thanks for your continuing support since I became a member of this Board.

Stainless
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Re: Tapering clonazepam before methadone treatment

Postby Stainless » Wed Aug 21, 2019 3:00 pm

I tampered off Clonazepam a couple of years ago. It was really tough. My doctor gave me 400 mg Gabapentin and told me over three months to taper 3, 2,1, 0 mg. It started out well but I did not sleep for a week when I went to 0. After that scary week I took 1 mg and slept 24 hours. Over the next three months I tapered about 1/8 mg every week by cutting 1 mg pills while still on Gabapentin. My doctor wanted me to do it faster but I assure you slow is the ticket. I had severe side effects like freezing feet and kneecaps. Some people dissolve a pill in vodka accurately measured in a graduated beaker and consuming a portion which is more accurate at low doses like 1/4 or 1/8 mg. It was a miserable 3 months but I got off. Unfortunately Gabapentin did not continue to work, then I went through the Dopamine Agonists and then the extended DAs.It was a miserable year. Finally at the advise of my doctor (who was not about to prescribe opioids) I went back on 2 mg Clonazepam. Now I had pain in my thighs that I never had before as well as lingering effects of withdrawal (even years later). First the doctor prescribed addition of Gabapentin and then a neurologist put me on Lyrica. I did well on Clonazepam alone for 20 years and only quit because of memory issues associated with benzodiazepines. Not to scare you but I wish I had never attempted to quit. Go slow!

Stainless
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Re: Tapering clonazepam before methadone treatment

Postby Stainless » Wed Aug 21, 2019 3:02 pm

And best of luck with whatever you do. Rick

QyX
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Re: Tapering clonazepam before methadone treatment

Postby QyX » Wed Aug 21, 2019 6:31 pm

2 mg Clonazepam for +25 years is a long time. The easiest way to get rid of this might be to follow the Ashton Manual, which recommends switching to an equivalent dose of Diazepam.

Diazepam would make tapering easier due to the longer half-life and smaller steps you can take while reducing the dose. Clonazepam is a relatively high potent Benzodiazepine.

You might wanna give this a read: https://benzo.org.uk/manual/ (I highly highly recommend it!)

Also there is no real reason not to start with the Methadone while you are taking Clonazepam. It might take forever to get rid of the Benzodiazepines completely. I would not be surprised if this takes you longer than a year and even when you stopped it, it might still take many months until you fully recovered from Benzodiazepines.

Of course, everyone is different but unfortunately getting rid of Benzodiazepines after such a long time is a nasty business. I've been taking Benzodiazepines several times for up to 6 months and every withdraw just sucked, even when I did it slowly.

Good luck to you and please educate yourself what you are about to do. It is the right decision for sure!

ViewsAskew
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Re: Tapering clonazepam before methadone treatment

Postby ViewsAskew » Wed Aug 21, 2019 6:54 pm

I second QyX's suggestion - I used the Ashton Method and while it took a long time, it worked. I joined their forum and followed suggestions there.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Caitrin
Posts: 50
Joined: Thu Nov 05, 2009 2:49 am
Location: New Jersey

Re: Tapering clonazepam before methadone treatment

Postby Caitrin » Wed Aug 21, 2019 7:41 pm

Thanks to all for your comments and suggestions. What I want to do now is read the article recommended by QyX. I'm going downstairs to print it and any related articles. My depression and forgetfulness continued today after three weeks of trying to taper. I am in a quandary about what to do as I am 73 yrs. old and very active playing golf and engaging in other activities with my husband and friends. For now I will continue with the DA and clonazepam and try the methadone at a later date when I have figured all of this out.

QyX
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Location: Berlin / Germany

Re: Tapering clonazepam before methadone treatment

Postby QyX » Wed Aug 21, 2019 8:31 pm

Okay, so let me add a few pieces of information I learned over the years: Clonazepam is a bit of special Benzodiazepine. There are sometimes people who tolerate it quite well, even when taken for years. But it also could be that the forgetfulness you are experiencing is nothing new and you are just recognizing it more because you started to reduce the Clonazepam.

You have to understand that Clonazepam is a really potent Benzodiazepine and 2 mg of Clonazepam equal 30 to 40 mg of Diazepam. For me Clonazepam was always way too potent to taper it off slowly. I switched to 40 mg Diazepam and reduced the dose from there. Starting with 2 mg every 2nd day until I reached 30 mg. From there I went 1 mg every 2nd until I reached 15 mg.

And from there I went much slower, approx. 2 mg every 1-2 week and once I was at 5 mg it was only 0.5 mg every 1-2 weeks.

I always responded horrible to Benzodiazepines, suffered from anxiety, depression, libido loss, being super tired and lazy. I was not functioning at all when taking Benzodiazepines for a longer period of time.

But again, everyone is different and especially for Clonazepam there are sometimes patients who can take them without much problems, even over many years. (But I still believe most patients would have a better quality of life without them as long as alternative treatments are available).

It is very important that you do not pressure yourself with reducing the dose. If you do it too fast, you will experience truly nasty and horrible withdrawal symptoms which might not go away for week and months. When you are on those drugs for +25 years, there is no need to rush this process and opioids can be taken together with Benzodiazepines just fine, especially when somebody is a long-term user of Benzodiazepines and on a stable dose.

There is no real medical reason to delay opioid treatment when someone is still taking Benzodiazepines. I can see why some doctors don't want to do this but when someone is on a stable dose for so many years, the body and central nervous system will have adapted.

I would look into having a 2nd conversation about this issue with your doctor. Stopping Clonazepam is not something you will be able to do in a few weeks or months. The webpage and forum I linked you, too is a great resource and those people there will know about all the problems and issues when it comes to stopping Benzodiazepines after a long time.

Caitrin
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Joined: Thu Nov 05, 2009 2:49 am
Location: New Jersey

Re: Tapering clonazepam before methadone treatment

Postby Caitrin » Wed Aug 21, 2019 8:50 pm

My husband and I were a few minutes ago discussing what you point out about not needing to rush this and yes I will have another conversation with my doctor about the possibility of taking the 5-7.5 mg methadone he proposes while continuing on the clonazepam or gradually switching to Diazepam. I am about to print the information you kindly forwarded. Thank you the additional suggestions.

QyX
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Re: Tapering clonazepam before methadone treatment

Postby QyX » Thu Aug 22, 2019 9:43 pm

Caitrin wrote:My husband and I were a few minutes ago discussing what you point out about not needing to rush this and yes I will have another conversation with my doctor about the possibility of taking the 5-7.5 mg methadone he proposes while continuing on the clonazepam or gradually switching to Diazepam. I am about to print the information you kindly forwarded. Thank you the additional suggestions.


As long as your Diazepam dosage is equivalent to your current Clonazepam dosage, you can switch completely within just one day.

Diazepam is way more sedative than Clonazepam, especially when you are not used it. You did not say if you take the 2 mg of Clonazepam all at once or if you split the dose. Because Diazepam has such a long half-life, it is no problem to take the complete dose at night.

How much Diazepam you exactly need is hard to tell but it will be something in the area of 20 to 40 mg. All you have to know is that your future Diazepam dosage is high enough to avoid any withdrawal symptoms. In your age it is not good to stress your CNS with unnecessary withdrawal symptoms.

And once you made the switch to Diazepam, all you have to care about is that you slowly reduce the dose. It doesn't really matter how fast you do it as long as you always cut a little bit from the dose every 1-2 weeks.

I saw a lot of patients fail because they put themself under too much pressure or got too much pressure from their doctor. At least in the U.S. doctors are a bit more liberal when it comes to Benzodiazepines compared to Germany.

There are also a few doctors who believe it is not really necessary to switch to Diazepam when stopping Benzodiazepines. Clonazepam is one of those Benzodiazepines who have a much longer half-life than your average Benzodiazepine. So when you have Clonazepam in a liquid form, you could do the initial tapering with Clonazepam solution. For some patients this works, however it never worked for me.

If I wanted to get rid of Benzodiazepines, I always had to switch to Diazepam. Other methods were simply too difficult for me. I am not saying they don't work but most people with experience most likely would agree that tapering with Diazepam is by far the easiest way.

The Ashton Manual I linked is a very good reference and when you study it careful, you will find all the information you need to be successful.

Caitrin
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Joined: Thu Nov 05, 2009 2:49 am
Location: New Jersey

Re: Tapering clonazepam before methadone treatment

Postby Caitrin » Mon Oct 07, 2019 1:42 pm

Thank you for the link to The Ashton Manual. After studying the entire manual I began a slow taper given the many years I was taking 2 mg. clonazepam. I was able to taper to 1.5 mg and a few times to 1 mg. the past six weeks and have not yet considered the switch over to diazepam. Unfortunately, my doctor at Yale will not prescribe the methadone without a total withdrawal from clonazepam. I am hoping that he will give me more tapering time and I can continue as his patient. On the other hand, I am considering whether it is wise for someone my ag, 74, with a fair amount of stress in my life, to make the switch. Suppose, I am thinking, the methadone does not work well for me. What then? In any event I have been able to taper the clonazepam and will continue to do so at a slow pace perhaps never being able to completely withdraw.

ViewsAskew
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Re: Tapering clonazepam before methadone treatment

Postby ViewsAskew » Mon Oct 07, 2019 6:31 pm

Caitrin wrote:Thank you for the link to The Ashton Manual. After studying the entire manual I began a slow taper given the many years I was taking 2 mg. clonazepam. I was able to taper to 1.5 mg and a few times to 1 mg. the past six weeks and have not yet considered the switch over to diazepam. Unfortunately, my doctor at Yale will not prescribe the methadone without a total withdrawal from clonazepam. I am hoping that he will give me more tapering time and I can continue as his patient. On the other hand, I am considering whether it is wise for someone my ag, 74, with a fair amount of stress in my life, to make the switch. Suppose, I am thinking, the methadone does not work well for me. What then? In any event I have been able to taper the clonazepam and will continue to do so at a slow pace perhaps never being able to completely withdraw.


That infuriates, me, Caitrin. You shouldn't have to be in this position. I wonder if you sent him the info on the Ashton method and said that this was working and would he HELP you do it, that he would?

I cannot imagine the methadone not working - it seems to be almost universal, unless someone cannot take opioids. Have you taken opioids successfully, say, for surgery or dental work?
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

QyX
Posts: 619
Joined: Wed Mar 13, 2013 12:53 pm
Location: Berlin / Germany

Re: Tapering clonazepam before methadone treatment

Postby QyX » Tue Oct 08, 2019 4:25 am

Caitrin wrote:Thank you for the link to The Ashton Manual. After studying the entire manual I began a slow taper given the many years I was taking 2 mg. clonazepam. I was able to taper to 1.5 mg and a few times to 1 mg. the past six weeks and have not yet considered the switch over to diazepam. Unfortunately, my doctor at Yale will not prescribe the methadone without a total withdrawal from clonazepam. I am hoping that he will give me more tapering time and I can continue as his patient. On the other hand, I am considering whether it is wise for someone my ag, 74, with a fair amount of stress in my life, to make the switch. Suppose, I am thinking, the methadone does not work well for me. What then? In any event I have been able to taper the clonazepam and will continue to do so at a slow pace perhaps never being able to completely withdraw.


So you being able to reduce Clonazepam so much with Clonazepam alone is very encouraging but the lower the dose gets, the harder it will be to reduce the dose even further. It is very very important that the steps of reduction are small enough to avoid physical withdrawal symptoms. When you are already close to 1 mg Clonazepam, that can become very difficult.

So at this stage I would definitely recommend making the switch to Diazepam. Since you had no major problems with dose reduction so far, I am optimistic and would say you definitely will able to stop Benzodiazepines completely, if you choose to do so.

About Methadone: personally I don't believe Methadone is a good first-line opioid for RLS. Because of some of the side effects Methadone can have (depression, fatigue, loss of energy, libido loss and prolonged QT interval) I believe other opioids like Oxycodone, Morphine, Hydromorphone and Hydrocodone should be used first. Yes, those opioids can have similar side effects, however in almost all patients those classic opioids are tolerated better than Methadone.

Nobody will be able to predict if Methadone works for you and if it will be an improvement over your current situation. However there is no harm in trying when you are not happy with your health situation. Opioids generally work very well for RLS. The only major issue they have for us RLS patients is that they can cause insomnia ... and sometimes this forces patients to use Benzodiazepines or those Z-drugs (Zopiclone, Zolpidem, ...) again.

There are other solutions for this, drugs like Lyrica or Gabapentin but quite a significant amount of people don't tolerate those drugs.

I would recommend speaking about all those issues with your doctor.

What he does is honestly a bit silly but makes sense under the current climate in the U.S. but it might make sense to go down this route because when you get opioids to work, they are far superior to Benzodiazepines. Actually, it would be surprising if you still have any 'real' medical benefit from Clonazepam. So most likely you should be able to do better on opioids.

Caitrin
Posts: 50
Joined: Thu Nov 05, 2009 2:49 am
Location: New Jersey

Re: Tapering clonazepam before methadone treatment

Postby Caitrin » Sat Nov 02, 2019 12:48 pm

Your last paragraph QyX has been on my mind for several weeks. I was wondering if, as you suggest, I begin the methadone treatment while still on a small dose of the clonazepam or diazepam if I do try the latter and am permitted to switch, I will no longer need these once the methadone begins to work. I would be willing to take the methadone alone and then discover I do not need these benzodiazepines. I will reach out to my doctor at Yale and see if he would be willing to give me a script for methadone for only a week or possibly two as a test and assure him I will take no other meds during this trial. I do not think so but I will nevertheless take this up with him the coming week.

Caitrin
Posts: 50
Joined: Thu Nov 05, 2009 2:49 am
Location: New Jersey

Re: Tapering clonazepam before methadone treatment

Postby Caitrin » Sat Nov 02, 2019 3:03 pm

Answering Ann's comments, yes, I have taken opioids before. In fact, I was given scripts over a three years period for severe back pain prior to my operation. It worked very well for my RLS as well as the pain. I never increased my dose and remained on clonazepam.

QyX
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Re: Tapering clonazepam before methadone treatment

Postby QyX » Mon Nov 04, 2019 3:34 am

There is no guarantee that Methadone will improve your situation over Clonazepam. Methadone itself can have a lot of side effects and there is a significant amount of people who do not tolerate Methadone at all and suffer from sedation, depression, fatigué, prolonged qt interval, libido loss etc.

The classic opioids like Oxycodone & Morphine are often tolerated better.

I am saying this because you should not put all your hopes on Methadone but more on the hole group of opioids. If Methadone is not working it doesn't mean you won't benefit from opiods in general. It is important to keep that in mind.

That your doctor expects you to do a complete withdrawal from Benzodiazepines before starting is a bit silly in your situation. You are not taking super high doses were respiratory depression would be a concern. But I honestly don't see a way to change his mind. Some physicians have a absolute position when it comes to combining opioids with Benzodiazepines.


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