Klonopin and Clonazepam Withdrawal and Detox
Benzodiazepine use for as little as three to six weeks, even when adhering to therapeutic doses, is associated with the development of physical dependence. An estimated 15% to 44% of chronic benzo users experience protracted moderate to severe withdrawal symptoms upon cessation of the drug, including new anxiety and depressive symptoms. The severity of withdrawal symptoms following discontinuation of clonazepam appears to be influenced by several factors including the duration of use, dosage and the rate of drug-tapering. Other factors include higher pretreatment of anxiety and depression, personality pathologies, panic disorder diagnosis and a history of alcohol/drug abuse.1 Klonopin should not be withdrawn abruptly because there is a risk of seizures, confusion or paranoid psychosis. However, abrupt cessation may be warranted if an extremely adverse side effect occurs during detox.2
Klonopin Withdrawal Symptoms
- Concentration problems
- Crying spells
- Heart palpitations
- Memory problems
- Mood swings
- Muscle spasms
- Panic attacks
- Seizures (even in those without a seizure disorder)
- Sleep problems
- Suicidal thoughts
Klonopin Detox Treatment
The keystones of benzodiazepine withdrawal treatment include slow tapering of the dose and psychological support. Benzodiazepine tapering is commonly a lengthy process requiring several weeks or months. Some experts suggest reducing the total daily dose by 0.125 mg (1/8 mg) on a weekly basis. If a person was taking 1 mg of Klonopin per day, it would take an estimated two months to achieve complete cessation of the drug.3 Detox tapering is far safer and efficacious than stopping abruptly (cold turkey). Nevertheless, it is often associated with significant withdrawal symptoms and craving, which can lead to relapse. As such, there is a critical need to find effective pharmacotherapeutic interventions for benzodiazepine dependence.1
Flumazenil was originally identified as a benzodiazepine blocker in 1981. The drug has a half-life of just seven to 15 minutes, making it useful for quickly reversing an overdose. It was approved by the U.S. Food and Drug Administration for that purpose in 1991. A number of studies since the 1990s have analyzed the role of flumazenil in the management of persistent withdrawal symptoms following cessation of benzos. These studies suggest flumazenil may help in the management of benzodiazepine withdrawal. Moreover, early evidence shows slow delivery of low-dose flumazenil either via subcutaneous implant or transdermal delivery via creams or patches may be able to reverse the adverse physical and psychological effects associated with long-term benzo dependency.1,4
A case study was conducted on a 40-year-old man with a 20-year history of being treated for schizophrenia, schizoid disorder, social phobia, anxiety disorder, alcohol abuse and more recently, benzodiazepine dependence. As a long-acting benzodiazepine agonist, clonazepam is sometimes used to ease symptoms of short-acting benzodiazepine withdrawal, such as Xanax (alprazolam). Administration of clonazepam prevented severe withdrawal symptoms despite the discontinuation of alprazolam, which has a relatively short half-life. Gradual withdrawal of clonazepam with almost daily monitoring of serum levels and an increase in gabapentin minimized physical signs and symptoms of withdrawal.2
- Hood SD, Norman A, Hince DA, Melichar JK, Hulse GK. Benzodiazepine dependence and its treatment with low dose flumazenil. Br J Clin Pharmacol. 2014;77(2):285-294. doi:10.1111/bcp.12023.
- Kacirova I, Grundmann M, Silhan P, Brozmanova H. A Case Report of Clonazepam Dependence: Utilization of Therapeutic Drug Monitoring During Withdrawal Period. Barkin. R, ed. Medicine. 2016;95(9):e2881. doi:10.1097/MD.0000000000002881.
- Klonopin (Clonazepam) Withdrawal Symptoms + Duration. Mental Health Daily website. http://mentalhealthdaily.com/2014/06/13/klonopin-clonazepam-withdrawal-symptoms-duration/ Published June 13, 2014. Accessed February 12, 2017.
- Independent website. Is this a groundbreaking cure for opiates and ‘benzos’ addicts? http://www.independent.co.uk/life-style/health-and-families/features/is-this-a-groundbreaking-cure-for-opiates-and-benzos-addicts-10190635.html Accessed February 12, 2017.