Clonazepam and Doctors

[Caitrin]

My primary called me yesterday afternoon to discuss my concerns about her so-called taper. I told her that I needed a slow taper having taken the clonazepam for 30 plus years, never increasing the dosage, and proposed a reduction from 2 mg. to 1.5 mg. per day. When she agreed to this but only for one week and then a reduction to .25 daily starting the second week I would not agree and suggested that I wanted more time tapering on this dosage, e.g., four weeks, and then a further but small taper and asked that she write the script for three .5 mgs. tablet. She reluctantly agreed. She had, of course, never heard of the Ashton Manual so I printed the chapter containing the tapering schedules. I will update this post regarding my progress. I do not know if I'll ever be able to reduce the dosage to less than .25 mg a day. I think that would be a reasonable goal.

[Polar Bear]

Well done that you stood your ground with your doctor and managed to agree a more suitable taper of your clonazepam.

You mention splitting your Ropinirole dose of 1.5mg to reduce to 1 mg.
Please be careful. I don't think I would reduce the two medications at the same time.

When and if you start to reduce your ropinirole, be careful not to reduce this too quickly.
Also if I remember correctly Ropinirole is a domed shaped pill and is not easy to split. I used a pill cutter and it was impossible to get an accurate cut.
Have you discussed reducing the Ropinirole with your doctor. With her support you could get pills prescribed to suit your taper.

Bear in mind that as you taper your clonazepam, and also think about tapering your Ropinirole, you may need to consider other medication options.

Please do keep us updated on your progress.

[Stainless]

I hope you find a way out. Let us know.

[Caitrin]

My primary called me and asked that I return the script she wrote for .5 mg/day and agreed to write another for three .5 mg./day for one month and if after one month it would not be possible for me to taper to .5 mg./day for one week followed by .25 mg./week then she would refer me to a psychiatrist. I replied "I do not need a psychiatrist" and handed her a copy of Chapter II of the Ashton Manual which she reluctantly accepted. That day I began a taper to 1.5 mg daily and for the past week have been in a fog. I haven't felt like "myself," have lost my appetite and sit in my recliner attempting to read my latest book and have to reread several pages due to lack of concentration. I have a few extra pills now and will pick up the new script Tuesday. I'm wondering if I should try finding on my own a doctor who specializes in benzo withdrawal and tapering, maybe a behavioral physician or group. Thank you in advance for your input.

[Caitrin]

As suggested I will probably not taper the Ropinirole until I can successfully taper the Clonazepam which has been very difficult the past two weeks. When my doctor handed me the new script I was shocked at the reduction from 2 mg to .5/day. She had mentioned at that appointment she could lose her medical license if she continued to prescribe the 2 mg I had been taking for 30 years. I do not understand why my doctors continued to prescribe this if they were concerned about this issue. I wonder if there are new guidelines for doctors regarding this medication. In any event I will try but know that it may take several months to complete the taper and not one month.

[Polar Bear]

Caitrin - I live in the UK and so am not fully aware of USA 'new rules' etc.
However, I am aware that doctors are very much under the microscope of relevant Authorities with regard to the prescribed dosing of certain medications. I would guess that your doctor was not prescribing 'while concerned with this issue', but more that the overseeing bodies are taking a watchful eye on the GPs and giving guidelines.

[Rustsmith]

Caitrin, your doctor's statement about losing her license for prescribing Clonazepam sounds rather fishy to me. Clonazepam is a Schedule IV drug, which is the same category as Ambien and tramadol. These are drugs that the DEA says are less likely to be abused than Sch III drugs, which includes codeine and testosterone. Of course, we don't know what is going on in her practice that may have your doctor scared. Is she prescribing too many scheduled drugs so that she fears attracting the attention of the DEA and has decided that you are a good place to cut back? My guess is that this has nothing to do with your use of clonazepam and everything to do with something that your doctor isn't telling you about.

[Caitrin]

Betty and Steve, I would certainly appreciate it if my doctor could give me an honest reason for not wishing to prescribe Clonazepam but I do not think she will be forthcoming. I was shocked that she wanted to cut the dose from 2 to .5 mg a day considering she has been prescribing it for 5 years when I first became her patient. Nor did my previous two doctors have an issue with the dosage having taken the same for 30 years for RLS (?). She also prescribes ambien nightly. My pain management doctor in my surgeon’s practice prescribes two daily 5-325 mg hydrocodone for my spinal stenosis. I have had two lumbar fusions, am 76 years old and surgery is no longer an option. Could it be that taking both meds is the problem my primary? My pain management doctor is aware of all my meds. I continue to experience withdrawal symptoms while trying to taper to 1.5 mg and will suggest to my primary I want to remain on this schedule for another week. If she refuses I will look for a pharmacological doctor who can help with the taper. In fact I will make inquiries beginning tomorrow. Thank you both for your input.

[Polar Bear]

Caitrin, I also had an issue with a GP over the dosage of medication although it was because of a change of medical practice. I had been prescribed Codeine for RLS for about 15 years without issue. Having moved house I eventually had to change to a new medical practice. I stayed at my old practice as long as possible, travelling some distance, because they understood me.
Upon ordering my first repeat prescription at the new medical practice one of the doctors prescribed half the Codeine dose. (I believe our system here in the UK is very different. When we move to a new medical practice our medical records follow us). When I phoned up to discuss this reduction the doctor said she wanted me off Codeine all together. Needless to say I launched myself, citing the withdrawals that would occur, (she should know this) asked her what was her experience of dealing with RLS. I asked her what she proposed to prescribe instead of the Codeine and she said 'nothing'. I referred to my Codeine history which my previous GP was happy with. She knew nothing of RLS and after I had blinded her with details of treating RLS, the horrors that she would be putting me into, the walking the floors all night every night, she eventually agreed a reduction in the meantime. Since that time, a year ago, I have seen a Movement Disorder Consultant who has sent a letter to the Medical Practice and has reassured me that she will back me up. This particular GP doctor in the practice hovers on my periphery like a dark cloud.
Keep fighting your corner.

[badnights]

This particular GP doctor in the practice hovers on my periphery like a dark cloud.

I have noticed that young, inexperienced doctors who have been trained in the midst of the so-called opioid crisis tend to have knee-jerk reactions to hearing you're on opioids. I bet it's similar how some doctors react to people on benzos. Dealing with the knee-jerk negativity is hard, but it's even harder when they refuse to change their outlook once they've been presented with new information.

[Caitrin]

Hi again, The good news is that I was accepted by and have an appointment with a psychiatric nurse in two weeks when I will need a refill on my Clonazepam med. She is local to my area and is familiar with the Ashton method of tapering my 2 mg/day Clonazepam. The bad news is that I have experienced a worsening of my RLS symptoms having taken 1.5 mg/day for two years and in past week have had to increase to 2 mg/day. This I did not expect because I am taking 7-325 mg hydrocodone for my chronic lumbar stenosis. I am thinking that the two meds together are causing this but require a possible explanation. Any help? Thank you. Kathy

[Caitrin]

Just to clarify my previous post, I do believe that the hydrocodone/acetaminophen 7.5-325 tablets twice daily for chronic back pain has enabled me to remain on the 1.5 mg Ropinirole the past 1-1/2 years. Of course it is an opioid but not the one indicated for RLS treatment. My lumbar stenosis is being treated successfully with the current med and coincidentally helped with my RLS PLMD. Prior to taking Ropinirole I had taken the Neupro patch until It severely irritated my skin and I was forced to discontinue that med. There are other DAs and assume they all cause augmentation. Several years ago I was prescribed carbadopa/levodopa again with augmentation. I also took 600-1200 mg gabapentin but with no relief. I have today made an appointment with my neurologist who has heretofore refused to prescribe an opiate per the State of NJ guidelines. So I have a double whammy with RLS and pain management. I appreciate being able to voice my predicaments on this forum. Thanks for listening.

[Rustsmith]

I have today made an appointment with my neurologist who has heretofore refused to prescribe an opiate per the State of NJ guidelines

Logic and reason have little to do with what doctors are willing to do these days when it comes to prescribing opioids. But perhaps you might get a bit more consideration if you share this document that was prepared a couple of years ago by a number of RLS experts for just this purpose.

https://www.mayoclinicproceedings.org/a ... X/fulltext

[Caitrin]

Thank you, Steve, and of course I agree with your statement. I will print the article and read it this evening.

[ViewsAskew]

I am so over these doctors. They have no idea how many lives are lain to waste with such proclamations. I hope the nurse is more helpful.