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Klonopin Tapering (Clonazepam)

Last Updated on December 29, 2023 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

We find it both heartbreaking and exasperating that the medical profession, particularly medical detox facilities, well-meaning as they are, still continue to largely miss the mark with Klonopin tapering.

Benzodiazepines like Klonopin cannot be treated in the same manner as other drugs. Klonopin tapering, Klonopin weaning, and Klonopin titration need to be performed with exceptional precision, and an abundance of monitoring.

Do Your Symptoms Require Klonopin?


successful klonopin titration
Alternative to Meds has delivered expert Klonopin tapering and holistic Klonopin withdrawal for nearly 2 decades. We have published evidence demonstrating the success of our clients. While some people seem to be able to taper off benzodiazepines more easily than others, for others it’s not at all easy. For example, a high level of neurotoxicity can impinge on the neurochemistry to the point of extreme agitation and discomfort. In this stressed state, emotional and physical symptoms can be extreme. The level of suffering that can develop without proper care is hard to describe. Clearing that toxic load is necessary before the CNS can regulate. We encourage you to read further to learn how orthomolecular medicine and many other gentle, non-invasive therapies can assist and soften the process. The unique needs of each individual require customized treatment.
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Why Proper Klonopin Tapering Has Become So In Demand

Over the last decade, prescriptions for highly addictive benzodiazepines have significantly surged. JAMA reported a doubling in outpatient benzodiazepine prescriptions in 2019.18

Concerns around the world have surfaced in the news, especially during the recent pandemic situation, resulting in the FDA requiring pharmaceutical companies to place stronger warnings on the drug’s label. At Alternative to Meds Center, we have seen Klonopin tapering become one of the most sought-after treatments requested. Getting off Klonopin is notoriously difficult, especially when attempted without proper help and guidance, and exponentially more difficult when the drug has been taken long-term, similar to alcohol or barbiturates.30,31

We can help.

Klonopin tapering guidelines include:
  • klonopin tapering guidelinesTake a gradual approach, not stopping all at once 1,4,11,15,16
  • If inpatient help is not available to you, work with a prescriber you trust to help you.
  • Modify the diet 28
  • Improve sleep 19
  • Massage, daily exercise, yoga, Reiki, Qi Gong, and Tai Chi are all recommended 20,21
  • Targeted supplementation 20,21
  • Eliminate recreational marijuana, alcohol, and stimulants such as caffeine 25-27
  • Fermented foods, yogurt, and probiotics support gut health 24
  • Eliminate exposure to toxic chemicals found in food, cosmetics, cleaning supplies, etc.23
  • CBT and other counseling for reduction of symptoms 29

More information about these and additional recommendations can be found below.

About Klonopin

Since the drug’s approval in 1982, Klonopin and the generic clonazepam have been prescribed for a variety of conditions, but only 2 got the FDA stamp of approval, namely panic disorders and certain seizure disorders.1

Many other “off-label” uses for Klonopin cover a broad range of conditions and may include migraine headache, acute anxiety, agoraphobia, insomnia, bipolar-related mania, restless leg syndrome, and also to dampen restlessness and involuntary spasms, ticks, rocking, and tremors caused by antipsychotic medications.9-11

Klonopin has an extremely high potential for acquired dependence.4,9 Tolerance leading to Klonopin dependence can develop quickly.16 Weaning from Klonopin is typically nearly impossible to endure without precise and effective guidelines and assistance. A large number of persons may find themselves in a medication trap — unable to endure the adverse reactions to the drug, and yet unable to withstand the harsh effects of stopping. Alternative to Meds Center individually designs a Klonopin tapering treatment program that allows a person to slowly and gradually reduce dosage while significantly softening the harsh symptoms associated with Klonopin taper and withdrawal.

Common Symptoms from Improper Klonopin Tapering

According to the FDA label for Klonopin, it is essential to gradually wean down from Klonopin. The drug insert reports that the consequences of abruptly stopping can be severe, even life-threatening. According to the research of Petursson15 published in the Addiction Journal, improperly done Klonopin tapering and untreated benzodiazepine withdrawal can persist for lengthy periods of time and can induce the following:

  • Grand mal seizures (abnormal electrical activity in the brain)
  • Status epilepticus, seizures lasting more than 5 minutes (life-threatening event)
  • Psychosis
  • Panic attacks
  • Rebound insomnia, disturbed sleep
  • Rebound anxiety
  • Depression
  • Impaired cognitive function
  • Loss of muscle control or coordination, unsteady gait
  • Muscular pain and stiffness
  • Headache
  • Perception changes
  • Difficulty in concentrating
  • Heart palpitations
  • Hand tremors
  • Dry-retching, nausea
  • Weight loss
  • Agitation, nervousness
  • Dizziness
  • Sweating
  • Irritability and increased tension

Background on the FDA Approval of Klonopin

Have you ever wondered how rigorously Klonopin was tested before the FDA approved the drug for sale?

klonopin clinical trialsThe FDA label information on Klonopin1 refers to a meager two clinical trials that preceded FDA approval for this powerful drug. One trial was 6 weeks long and the other lasted 9 weeks. The outcomes of these trials are difficult to decipher as many of the statistical parameters are omitted, except that the label does mention that at the end of the trial there was no difference in outcomes compared to placebo, save in one subclass, which is noted below.* The trial parameters included a period of time in which Klonopin tapering was done after the trial ended, but surprisingly, beyond the brief mention of grand mal seizures to watch out for, little else is mentioned about difficulties the participants may have encountered during weaning from Klonopin. This seems a glaring omission that is further hampered by a paucity of information given in the FDA guidelines.1

*The one exception was reported in one subgroup whose dosage was limited to Klonopin 1mg daily. Comparing this small group to the placebo group, 56% of the placebo patients had no panic attacks at the end of the trial, and 76% of the Klonopin 1mg patients also had no panic attacks in the last week of the trial.

There were no differences in outcome for all other dosage levels, that is, for those participants given dosages higher than 1mg per day. Even more astounding is that even though the drug had not been put through any clinical trials at all for seizure disorders, the drug was also FDA-approved for prescribing Klonopin to seizure patients. The descriptions for these two clinical trials are perhaps too fragmentary to readily explain or comprehend the popularity of this drug. Nonetheless, once a person has developed dependence (or addiction), the most important next step is to find a safe, gentle, and very gradual way to begin Klonopin tapering.

Research on Weaning Off Clonazepam Safely

It seems as though medical practitioners are slowly becoming more aware of the addictive qualities and the harsh reactions to benzodiazepines.2,30 More doctors are becoming familiar with what is sometimes referred to as America’s “other” prescription drug crisis, that of benzodiazepines. Difficulties associated with benzodiazepines can include fatalities, birth defects in babies born to mothers taking benzo drugs, and the problems that arise when trying to stop taking them.

clonazepam titration researchSome physicians, however, still have a sort of blind unawareness when it comes to recognizing adverse reactions to a prescribed drug. A doctor, in haste perhaps, can diagnose a patient by lumping drug reactions together with the original symptoms in a patient’s profile. Often, it is neither efficient nor accurate to label a patient who is experiencing reactions after a reduction of the dosage as “a relapse case,” or to describe that patient as experiencing “latent emerging mental disorders or syndromes.” Those imperfect diagnostic practices can result in multiple prescriptions, potentially fueling further and unnecessary suffering for the patient.15

Yet this still happens too often and it is most unfortunate that it does. Because a patient taking Klonopin who is diagnosed as a “relapse” case, in other words, with increasing anxiety, panic attacks, sexual dysfunction, depression, hallucination, psychosis, disinhibition, self-injurious behavior, aggression, or other known reactions will often have their medication increased instead of decreased, and no attention given to safer alternative treatments.12-14 Sometimes this means being put on additional and even multiple additional medications, which also have their own significant sets of adverse reactions associated with them. Finding oneself in this tsunami of suffering would be one very good reason to consider reducing or eliminating Klonopin, and if needed, reducing other medications in the correct sequence where required.

Done properly, Klonopin tapering can be surprisingly easy to tolerate when it is supported by careful monitoring and a thorough array of supportive actions, using orthomolecular and other complementary and alternative therapies. These can include yoga, CBT, nutritional testing and correction of deficiencies and diet, and herbal medicines to treat anxiety such as valerian, chamomile, lavender, black cohosh, passionflower, and saffron, for example.5,18-21

How Safe is Klonopin According to Studies?

Although benzodiazepines are rarely mentioned in relation to TD (tardive dyskinesia), an agent that depletes GABA or injures receptors in the CNS can cause this condition. The longer a benzodiazepine is taken, the more GABA becomes “spent,” resulting in a deficiency. It is thought this is one reason that TD is linked to benzodiazepines such as Klonopin. Drug-induced tardive dyskinesia has been documented to present on abrupt discontinuation of benzodiazepines such as Klonopin.7

klonopin gaba deficiencyDrug manufacturers seem unaware of such reactions and injuries. However, one can easily access information on even cursory research on safety issues associated with Klonopin and other benzodiazepines.3 We have found at Alternative to Meds Center that rehabilitating neurochemistry is vital in Klonopin tapering.

Of note, the Washington State Dept. of Labor and Industry added Klonopin to their hazardous drug list, citing concerns over the high incidence of birth defects. In rabbits, studies showed Klonopin, administered at very low equivalent-to-human doses, caused consistent congenital birth defects such as deformed body parts, incomplete bone structure, open eyelids, breathing and feeding difficulties, and many others. In human studies, malformations of infants after exposure to Klonopin were calculated to occur 2- to 3-fold over placebo.8

According to research in Italy, weaning off Klonopin before pregnancy is recommended wherever possible.6 There are few studies on pregnancy and prescription drugs, because of safety and ethical reasons but the ones that are available show clearly there is such a risk. Research is enlightening the public and prescribers about the potential risks of birth defects or prenatal injury if the mother were to take Klonopin during her pregnancy.

Neonatal Klonopin withdrawal is a concern where the mother took Klonopin during pregnancy. Signs of neonatal Klonopin withdrawal include difficulty breathing, inconsolable crying, feeding difficulties, diarrhea, hypothermia, tremors, hyperreflexia (over-responsive reflexes, twitching or spastic movements), cyanosis (lack of oxygen which turns the skin blue and causes shortness of breath), and many other Klonopin withdrawal symptoms.16,17

The methods we use at Alternative to Meds Center provide the correct answers to how to accomplish Klonopin tapering safely, gradually, and as comfortably as possible. This can be a relief to a woman who is planning a pregnancy, without the liability of birth defects or Klonopin withdrawal reactions for her child.

Beyond Tapering Klonopin … Finding and Correcting Root Causes for Unwanted Symptoms

klonopin holistic tapering sedona drug rehabAlternative to Meds Center has helped thousands of clients with benzodiazepine tapering and tapering from other medications and has developed a multi-faceted series of program steps that make it possible to reduce and even entirely eliminate medication without the torturous reactions normally associated with weaning off Klonopin and other drugs. But as importantly, we also seek to help our clients discover the root causes of their original symptoms, whether that was social anxiety, panic attacks, or insomnia. This is particularly important when these conditions had a mysterious beginning to them and the causative and contributive factors for them have neither been discovered nor resolved.

The best way forward is a program that allows one to discover and correct the actual reasons for their original symptoms, like panic attacks or insomnia, etc., through a comprehensive holistic program in a comfortable and supportive inpatient setting. At Alternative to Meds Center, we use science-based, holistic protocols that include orthomolecular medicine, metabolic testing, removal of neurotoxins, neurotransmitter rehabilitation, organic diet, nutritional psychiatry, spiritual psychiatry, and many more, to treat and support your recovery.

Please contact us at the center for much more information about how we can help you or your loved one with an individually tailored holistic Klonopin tapering program that can truly help.

Sources:


1. FDA label information Klonopin (clonazepam) [cited 2022 July 26]

2. Dokkedal-Silva V, Berro LF, Galduróz JCF, Tufik S, Andersen ML. Clonazepam: Indications, Side Effects, and Potential for Nonmedical Use. Harv Rev Psychiatry. 2019 Sep/Oct;27(5):279-289. doi: 10.1097/HRP.0000000000000227. PMID: 31385811. [cited 2022 July 26]

3. Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM, “Medication-Induced Tardive Dyskinesia – A Review and Update.” Ochsner Journal 2017 Summer [cited 2022 July 26]

4. “Clonazepam (Klonopin)” NAMI publication, 2019 Jan [cited 2022 July 26]

5. Platt LM, Whitburn AI, Platt-Koch AG, Koch RL. Nonpharmacological Alternatives to Benzodiazepine Drugs for the Treatment of Anxiety in Outpatient Populations: A Literature Review. J Psychosoc Nurs Ment Health Serv. 2016 Aug 1;54(8):35-42. doi: 10.3928/02793695-20160725-07. PMID: 27479478. [cited 2022 July 26]

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8. Gutiérrez-Alvarez AM. Uso de anticonvulsionantes durante el embarazo y el riesgo de malformaciones en el recién nacido: metaanálisis [Use of anticonvulsive drugs during pregnancy and the risk of malformations in the newborn: a meta-analysis]. Rev Neurol. 2003 Dec 1-15;37(11):1022-8. Spanish. PMID: 14669141. [cited 2022 July 26]

9. Maizels M. Clonazepam for refractory headache: three cases illustrative of benefit and risk. Headache. 2010 Apr;50(4):650-6. doi: 10.1111/j.1526-4610.2010.01633.x. Epub 2010 Mar 5. PMID: 20236347. [cited 2022 July 26]

10. Yang HW, Bae JB, Na JI, Kim KW. Clonazepam-induced lichenoid drug eruption: a case report. BMC Psychiatry. 2021 Mar 4;21(1):125. doi: 10.1186/s12888-021-03132-2. PMID: 33663441; PMCID: PMC7934486. [cited 2022 July 26]

11. Basit H, Kahwaji CI. Clonazepam. 2021 Dec 29. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32310470. [cited 2022 July 26]

12. Cohen LS, Rosenbaum JF. Clonazepam: new uses and potential problems. J Clin Psychiatry. 1987 Oct;48 Suppl:50-6. PMID: 2889724. [cited 2022 July 26]

13. Kalachnik JE, Hanzel TE, Sevenich R, Harder SR. Brief report: clonazepam behavioral side effects with an individual with mental retardation. J Autism Dev Disord. 2003 Jun;33(3):349-54. doi: 10.1023/a:1024466819989. PMID: 12908837. [cited 2022 July 26]

14. White MC, Silverman JJ, Harbison JW. Psychosis associated with clonazepam therapy for blepharospasm. J Nerv Ment Dis. 1982 Feb;170(2):117-9. doi: 10.1097/00005053-198202000-00010. PMID: 7057171. [cited 2022 July 26]

15. Pétursson H. The benzodiazepine withdrawal syndrome. Addiction. 1994 Nov;89(11):1455-9. doi: 10.1111/j.1360-0443.1994.tb03743.x. PMID: 7841856. [cited 2022 July 26]

16. Alicja Lerner, Michael Klein, Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development, Brain Communications, Volume 1, Issue 1, 2019, fcz025 [cited 2022 July 26]

17. Hudak ML, Tan RC; COMMITTEE ON DRUGS; COMMITTEE ON FETUS AND NEWBORN; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics. 2012 Feb;129(2):e540-60. doi: 10.1542/peds.2011-3212. Epub 2012 Jan 30. Erratum in: Pediatrics. 2014 May;133(5):937. PMID: 22291123. [cited 2022 July 26]

18. Agarwal D, Landon B, Patterns in Outpatient Benzodiazepine Prescribing in the United States, Jama Netw Open 2019;2(1):e187399. doi:10.1001/jamanetworkopen.2018.7399 [cited 2022 July 26]

19. Petit L, Azad N, Byszewski A, Sarazan FF, Power B. Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments. Age Ageing. 2003 Jan;32(1):19-25. doi: 10.1093/ageing/32.1.19. PMID: 12540343. [cited 2022 July 26]

20. Dumur J, Csajka C, Pavec O, Messaoudi S, Cretignier T, Gaspar F, Lang PO. Quelle alternative aux benzodiazépines, Z-pills et autres hypnotiques pour les personnes âgées ?: Mélatonine, valériane ou clométhiazole [Which alternative to benzodiazepines, Z-pills and other hypnotics for aged people ? Melatonin, valerian, or clomethiazole]. Rev Med Suisse. 2018 Nov 7;14(626):2018-2023. French. PMID: 30422422. [cited 2022 July 26]

21. Yeung KS, Hernandez M, Mao JJ, Haviland I, Gubili J. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res. 2018 May;32(5):865-891. doi: 10.1002/ptr.6033. Epub 2018 Feb 21. PMID: 29464801; PMCID: PMC5938102. [cited 2022 July 26]

22. Appleton J. The Gut-Brain Axis: Influence of Microbiota on Mood and Mental Health. Integr Med (Encinitas). 2018 Aug;17(4):28-32. PMID: 31043907; PMCID: PMC6469458. [cited 2022 July 26]

23. Brown JS Jr. Psychiatric issues in toxic exposures. Psychiatr Clin North Am. 2007 Dec;30(4):837-54. doi: 10.1016/j.psc.2007.07.004. PMID: 17938048. [cited 2022 July 26]

24. Järbrink-Sehgal E, Andreasson A. The gut microbiota and mental health in adults. Curr Opin Neurobiol. 2020 Jun;62:102-114. doi: 10.1016/j.conb.2020.01.016. Epub 2020 Mar 9. PMID: 32163822. [cited 2022 July 26]

25. Broderick P, Benjamin AB. Caffeine and psychiatric symptoms: a review. J Okla State Med Assoc. 2004 Dec;97(12):538-42. PMID: 15732884. [cited 2022 July 26]

26. Kushner MG, Abrams K, Borchardt C. The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings. Clin Psychol Rev. 2000 Mar;20(2):149-71. doi: 10.1016/s0272-7358(99)00027-6. PMID: 10721495. [cited 2022 July 26]

27. Crippa JA, Zuardi AW, Martín-Santos R, Bhattacharyya S, Atakan Z, McGuire P, Fusar-Poli P. Cannabis and anxiety: a critical review of the evidence. Hum Psychopharmacol. 2009 Oct;24(7):515-23. doi: 10.1002/hup.1048. PMID: 19693792. [cited 2022 July 26]

28. Aucoin M, LaChance L, Naidoo U, Remy D, Shekdar T, Sayar N, Cardozo V, Rawana T, Chan I, Cooley K. Diet and Anxiety: A Scoping Review. Nutrients. 2021 Dec 10;13(12):4418. doi: 10.3390/nu13124418. PMID: 34959972; PMCID: PMC8706568. [cited 2022 July 26]

29. Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 2015 Sep;17(3):337-46. doi: 10.31887/DCNS.2015.17.3/akaczkurkin. PMID: 26487814; PMCID: PMC4610618. [cited 2022 July 26]

30. MacKinnon GL, Parker WA. Benzodiazepine withdrawal syndrome: a literature review and evaluation. Am J Drug Alcohol Abuse. 1982;9(1):19-33. doi: 10.3109/00952998209002608. PMID: 6133446. [cited 2023 Jan 23]

31. FDA Benzodiazepine Warning 2020 published online [cited 2023 December 4]


Originally Published Nov 4, 2019 by Lyle Murphy


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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