Clonazepam withdrawal

Jaffe R, Gibson E. Clonazepam withdrawal psychosis [Letter]. J Clin Psychopharmacol 1986 6 193. 

Brown M, Freeman S. Clonazepam withdrawal-induced catatonia. Psychosomatics... 

Clonazepam, a typical 1 4 benzodiazepine, is effective in absence seizures, myoclonic jerks and tonic-clonic seizures and given intravenously it attenuates status epilepticus. It is less sedative than phenobarbitone but tolerance develops and its withdrawal, as... 

Benzodiazepines are used commonly in SAD however, there are limited data supporting their use. Clonazepam has been effective for social anxiety, fear, and phobic avoidance, and it reduced social and work disability during acute treatment.58 Long-term treatment is not desirable for many SAD patients owing to the risk of withdrawal and difficulty with discontinuation, cognitive side effects, and lack of effect on depressive symptoms. Benzodiazepines may be useful for acute relief of physiologic symptoms of anxiety when used concomitantly with antidepressants or psychotherapy. Benzodiazepines are contraindicated in SAD patients with alcohol or substance abuse or history of such. 

Benzodiazepines. Like the barbiturates, benzodiazepines bind to the GABA receptor and are therefore cross-tolerant with alcohol. As a result, they also make suitable replacement medications for alcohol and are widely used for alcohol detoxification. Theoretically, any benzodiazepine can be used to treat alcohol withdrawal. However, short-acting benzodiazepines such as alprazolam (Xanax) are often avoided because breakthrough withdrawal may occur between doses. Intermediate to long-acting benzodiazepines including chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serax), lorazepam (Ativan), and clonazepam (Klonopin) are more commonly utilized. 

The speciflc clinical use of the numerous available benzodiazepines depends on their individual pharmacokinetic and pharmacodynamic properties. Drugs with a high affinity for the GABAa receptor (alprazolam, clonazepam, lorazepam) have high anxiolytic efficacy drugs with a short duration of action (temazepam) are used as hypnotics to minimise daytime sedative effects. Diazepam has a long half-life and duration of action and may be favoured for long-term use or when there is a history of withdrawal problems oxazepam has a slow onset of action and may be less susceptible to abuse. 

A long half-life is needed for a BZ to be effective as an anticonvulsant to avoid a withdrawal effect. Clonazepam, nitrazepam, and nordazepam are the BZs most often used for their anticonvulsant effects, al-... 

Klonopin 8 Clonazepam 1-6 Panic disorder, anticonvulsant, alcohol withdrawal, social phobia, acute mania... 

Discontinuation during and after slow tapering has been shown to be well tolerated ( 79). A slow discontinuation of clonazepam usually results in a benign withdrawal course. Withdrawal from higher doses, particularly rapid withdrawal, however, can be associated with more severe discontinuation symptoms ( 80). 

Albeck JH. Withdrawal and detoxification from benzodiazepine dependence a potential role for clonazepam. J Clin Psychiatry 1987 48[Suppl 10] 43-48. 

Patterson JF. Withdrawal from alprazolam dependency using clonazepam clinical observations. J Clin Psychiatry 1990 5[Suppl 5] 47-49. 

RBD is characterized by a relative absence of the atonia characteristic of REM sleep. This lack of atonia permits the physical acting out of dream mentation, particularly dreams involving confrontation, aggression and violence. RBD is seen most frequently in older men. RBD occurs in both acute and chronic forms. Acute RBD can occur during withdrawal from alcohol or sedative-hypnotics. RBD has also been induced by the tricyclics, SSRIs and venlafaxine. The chronic form of RBD may occur as part of an identifiable underlying neurological disorder, but typically is idiopathic. RBD may also be an initial manifestation of parkinsonism. RBD is very responsive to clonazepam, although this use has not been FDA approved. 

Seizures Clonazepam [kloe NA ze pam] is useful in the chronic treatment of epilepsy, whereas diazepam is the drug of choice in terminating grand mal epileptic seizures and status epilepticus (see p. 149). Chlordiazepoxide [klor di az e POX ide], clorazepate [klor AZ e pate], diazepam, and oxazepam [ox A ze pam] are useful in the acute treatment of alcohol withdrawal. 

Clonazepam (Klonopin), a benzodiazepine tranquilizer, has been used to treat both acute mania and as prophylaxis. It has all the many, sometimes severe, problems associated with the other benzodiazepines, including sedation, rebound and withdrawal syndromes, addiction, and behavioral abnormalities (chapter 12). Neuroleptics remain the mainstay for controlling acute manic reactions. 

Severe withdrawal can occur after relatively short exposures to BZs. I have treated patients who suffered from severe withdrawal problems after only 2 weeks of low-dose exposure to prescribed alprazolam and clonazepam. Lader (1984) and the APA (1990a) task force confirmed that therapeutic doses commonly produce severe withdrawal symptoms. 

Some patients can find it difficult to withdraw from as little as 0.5 mg clonazepam each night for sleep. Even motivated patients have sometimes developed such a fear of trying to go to sleep without BZs that they cannot undertake a serious effort. The fear is usually based on previous disturbing experiences of rebound insomnia. 

This fivefold clinical activity is possessed, to a greater or lesser extent, by all benzodiazepines in current clinical use. The properties of benzodiazepines make them ideally useful for managing anxiety (e.g. diazepam, chlordiazepoxide, lorazepam) insomnia (e.g. diazepam, temazepam, nitrazepam, loprazolam, flurazepam, lormetazepam) epilepsy (e.g. clobazam, diazepam, lorazepam) sports injuries where muscle relaxation is required (e.g. diazepam) and as premedications prior to surgery (e.g. midazolam, lorazepam). The benzodiazepines have a number of other uses, including management of alcohol withdrawal syndrome (chlordiazepoxide, diazepam) and restless legs (clonazepam). Short... 

A 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation was treated as an out-patient with lamotrigine 400 mg/day, clonazepam 0.5 mg tds, and quetiapine 100 mg/day. She gained 9 kg in 6 months and was advised to reduce the dose of quetiapine to 50 mg/day. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude normal daily activities. She was instructed to take quetiapine 75 mg/day, but her symptoms continued and only resolved when she took 100 mg/day. Slower reduction in the dose of quetiapine (by 12.5 mg/day every 5 days) with an antiemetic, ondansetron, also failed. On a third attempt, prochlorperazine successfully reduced her withdrawal symptoms, although moderate nausea persisted for 2 days after complete withdrawal. 

In controlled trials with clonazepam, adverse events were recorded in 60-90% of cases, and led to withdrawal rates as high as 36% (8). The most common effects were drowsiness, ataxia, and behavioral and personality changes. Other problems were hypersalivation, tolerance, and sometimes a paradoxical increase in seizure frequency. 

Withdrawal effects can be troublesome. Of 13 patients taken off clonazepam 0.01-0.5 mg/day because of adverse effects, 8 had withdrawal seizures and 5 had other withdrawal symptoms (SEDA-19, 63). Choreoathetosis was described in one patient completing withdrawal of clonazepam (SED-13,152). 

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