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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 3990
Experience:  MD Psychiatry
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Klonopin tapering.......My 16 year old son diagnosed with schizophrenia

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Klonopin tapering.......My 16 year old son diagnosed with schizophrenia has been on Klonopin 0.5mg in the morning and 0.25mg in the evening since June 2008.   He has recently had an increase of Zoloft to 75mg from 50mg. I spoke to his psychiatrist who agrees with me that we should start tapering off the Klonopin and just leaving him with Zoloft. We hope to start tapering off the evening doasge first and eventually the morning until he is completely off the Klonopin. He also takes Risperdal 2mg twice a day and Cogentin 0.5mg twice a day. I am aware of the withdrawal side effects which is why I want to do this ever so slowly over a period of months if need be and I need the proper advice/direction. He does, on occassion takes Ativan 0.5mg when extremely agitated since schizophrenics seem to respond quite well to this fast acting drug. Can you help me with a calendar plan?
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 5 years ago.
<p>Hi there,</p><p> </p><p>             Welcome to Just Answer !</p><p> </p><p>             Well, I agree with you that Psychotropic drugs be it benzodiazepines , or anti psychotics or anti depressants need to be tapered slowly before they can be stopped completely. So, in case of your son the tapering of the doses of Klonopin should be carried out over a period of 2-3 weeks .</p><p> </p><p>In evening, he has been placed on 0.25 mg Klonopin , and in morning he takes 0.5 mg Klonopin. Well, 0.25 mg Klonopin is a very basic mild dose of klonopin , but still , considering the fact that we do not want to have any kind of Withdrawl symptoms while tapering the dose, So theevening dose of 0.25 mg is to be reduced to 0.125 mg ( that is half a tab of 0.25 mg klonopin) and the morning dose of 0.5 mg is to be reduced to 0.25 mg. Keep these doses of 0.25 mg in the morning and 0.125 mg in the evening for 1 week . Then , at the start of second week , you may stop the evening dose of 0.125 mg , while the morning dose is to be reduced from 0.25 mg to 0.125 mg and maintain the morning dose of 0.125 mg for 1 week . Then , at the start of third week you may stop the morning dose of 0.125 mg klonopin completely . </p><p> </p><p> So, in this way , you taper the dose of klonopin ,without any apprehension , as such gradual slow withdrawl will not cause any withdrawl (discontiuation) symptoms.But, do make it a point to discuss this and let your psychiatrist know about the withdrawl process that you are going to embark upon, as he must be involved for guidance and approval.</p><p> </p><p>Now, you have also mentoned that your son has difficulty in sleeping , plus the nightmares disturb him as well, so i suggest you discuss one very good drug with your doctor , which is fda approved and is used world over for sleep induction , that is AMBIEN . Ambien is available both as plain and in CR (controlled release) forms, so you may discuss this drug for your son's sleep problem and ask him the dose to place him on , and also whether plain or CR ambien is to be started and do not worry this drug has least side effects , does not cause next morning drowsiness, sloppiness, plus , there is no addiction as well.If your psychiatrist agrees to start your son on ambien , just ask him to start on a low dose only.</p><p> </p><p> So, i suggest you may discuss the above mentioned tapering process , with your doctor and do the needful. I am quite sure that the tapering will be as safe as possible, with no untoward withdrawl symptoms.</p><p> </p><p>I wish your son best of health.</p><p> </p><p>I hope my answer serves your query according to your satisfaction.</p><p> </p><p>Please press the ACCEPT button if you are satisfied with the answer , as only then i will be credited for my service.</p><p> </p><p>Warm Regards.. </p>
Customer: replied 5 years ago.
Dr. Kaushik, I wanted to mention that I read on the Clonazepam literature that a suggested tapering off the dosage in half every 3 days was advisable. What are your thoughts on this suggestion?

We hoped to taper off the evening dosage FIRST slowly for about a month and then the morning dosage SECOND for another month. Do you suggest we do both the morning and evening tapering simultaneously? If so, why? Is it more advantageous to do the morning tapering off FIRST since he takes Zoloft 75mg QAM?

His psychiatrist and I work very closely together. My son is 100% compliant with his medications dealing with the horrible side effects like a real adult. Although I feel his illness has passed him a death sentence, I am hopeful that because of his perseverance at adhering to the daily regimen, his symptoms will eventuall abate. Any thoughts you can suggest about my earlier questions regarding starting evening first or morning first, would be helpful. He occassionally suffers from temporary amnesia and I know this is because of the Klonopin. Sometimes he comes home from school and cant remember what happened the entire day. Sometimes he calls me from a place and has no idea how he ended up there. I know Klonopin can cause this. Fortunately, his memory always seems to return eventually. Any thoughts on my questions?

Expert:  Dr. Kaushik replied 5 years ago.
YES, you are right in saying than it is usually advised to reduce the dose of klonopin by 0.125 mg every 3 days , before stopping it eventually , but here i am asking you to give some more time to tapering , as, if we do the same thing over 1 week that we can do every 3 days , i do not think any harm would be there, but as i said this will only ensure safe withdrawl.

Also i have asked to directly reduce 0.25 mg dose in the morning in the first week , this is simply because he has already been placed on zoloft ( sertraline ) which itself is a good anti anxiety agent , so here we do not have to worry about the anxiety ,while reducing the morning dose by 0.25 mg, as the anxiety will be taken care of by zoloft.

Now, as far as the confusion regarding whether to decrease both morning and evenng doses simultaneously or decreasing the evening dose first followed by morning dose , i would say both the options are alright and safe , and that is upto your doctor to decide , but if you ask me reducing the doses simultaneously will be safe and have no withdrawl symptoms whatsoever , but i leave the decision to your psychiatrist .

I hope my answer serves your pupose well.

Please press the ACCEPT button if you are satisfied , as only then i will be credited for my service.

Warm Regards..
Customer: replied 5 years ago.
One final question...would you suggest using, on occassion ( as in sparingly) ATIVAN 0.5mg to help ease any AGITATION or ANXIETY he may get ( maybe he won't) in the daytime due to withdrawals? In other words, PRN. My son is very good with wisely deciding wether or not to take the ATIVAN which is why the 30 day supply we had has lasted 10 months and we stil have about 20 pills left.
Expert:  Dr. Kaushik replied 5 years ago.
<p>Yes he may take the 0.5 mg tablet of lorazepam ( ativan) , as you have mentioned he has been using it as when required , So, no problem in taking it to allay his anxiety . But you also supervise its use , as till now he has not abused it , but since he is a teenager , we need to be cautious , but as of now , i do not think there will be any problem in using ativan 0.5 mg as per the need.</p><p> </p><p>Warm Regards...</p>
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 3990
Experience: MD Psychiatry
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