In August This Year, I Had 3-4 Nights Of Reduced

Posted on Fri, 27 Dec 2019

Question: In August this year, I had 3-4 nights of reduced sleep. I was anxious in the day time and BP was raised at 150/90. My city doctor started 1) Nexito 5 mg, 2) Clonazepam 0.25 mg 3) Olmasarten 20 mg daily. The nexito was increased to 10 mg after 2 weeks. During this time I used to get headaches and panic occasionally. After 1 month the symptoms got much better. Following this, in November I visited apollo hospitals XXXXXXX for a thorough check up. My heart angiogram, brain ct, blood tests, ecg, echo etc were done. Everything was normal. The neurologist advised continue Olmasarten and stop clonazepam and nexito slowly . He advised to take clonazepam half tablet (0.25 mg) for 5 days and then take half on alternate 5 days and stop. Same for Nexito 10 mg. And after stopping all start Feliz 5 mg for 3 months. Yoga, breathing exercise, pranayam were also suggested. Following this, initially I have started stopping clonazepam first and following the prescribed schedule as mentioned above. After this I am planning to taper Nexito. I am having mild panic with headache sometimes which is less compared to earlier. Kindly advise whether I am following the tapering schedule properly or not? Quitting clonazepam first then nexito is Ok or not? Please note that I am also taking Gabantin Plus for my low back pain.

Answered by Dr. AJEET SINGH (3 hours later)

Brief Answer:
TAPERING DOWN OF ANTI ANXIETY MEDICATION

Detailed Answer:
Hi....
Welcome to "Ask a doctor" service.
I am Dr Ajeet XXXXXXX

I have gone through your query and here is my opinion.

Clonazepam is habit forming (has abuse potential) and it's sudden discontinuation can precipitate severe withdrawal effects.
It can be safely discontinued without any major withdrawal symptoms if the dose is reduced gradually.
Recommend reducing (tapering) dose of it is usually 0.25 mg/wk.
Safe tapering down usually takes between 2 and 3 weeks.

Once you are off clonazepam,you can start tapering Nexito,if your anxiety symptoms remain under control.

Nexito is usually tapered by 2.5 mg per 1 to 2 weeks ,depending upon the anxiety symptom control.
A too rapid tapering may cause rebound anxiety and at times,with higher intensity.

Be watchful about rebound anxiety,insomnia,severe fatigue,muscle pains, sweating and panic attacks during the tapering schedule and report to your clinician immediately.

Be regular with your drugs,don't default.
Continue your anti hypertensive medication,as before.

As emphasized by your clinician,role of yoga,meditation,deep breathing exercises-belly breathing,pranayam,daily sun exposure,exercise,good sleep,good hydration,vitamin (specially D and B12)supplementation etc can not be under emphasized.

Hope that I have answered your query.

Stay healthy and stay blessed.
Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. AJEET SINGH (1 hour later)

Sir, as I was taking 0.25 mg clonazepam at night everyday(for 3.5 month), so my schedule of reducing it in half for consecutive seven(7) days and then half for alternate seven days(7) is correct or not? If reduction rate of 0.25 mg / week is followed then it will take, 5-6 weeks for complete discontinuation whereas in my schedule it is taking 2-3 weeks only.

Sir, as I am having anxiety/headache, if the taper down is not successful what should I do? I know that, taking clonazepam for a long time is harmful and abusing and I also want to quit it.

Kindly advise.

Answered by Dr. AJEET SINGH (18 hours later)

Brief Answer:
TAPERING DOWN OF ANTI ANXIETY MEDICATION

Detailed Answer:
Welcome back.

I would advise you to reduce clonazepam by 0.25 mg per week.
It may take, 5-6 weeks for complete discontinuation but would be more tolerable for you.
As you are under direct medical supervision,according to his clinical judgement,your doctor will tailor your tapering schedule according to your history,symptoms,severity of disease and improvement goals attained.

Keep a positive thinking.
In most of the instances,clinicians are able to taper down the drugs successfully.

Meditate and read motivational study material.
Get psychological cancelling.
Interact and take help of your family members and peer.
You will definitely get the benefits.

Happy living.
Regards.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Nagamani Ng