Withdrawal success rating Dosing schedule during withdrawal A schedule for tapering out clonazepam in panic disorder patients after long-term treatment Antonio E. Nardi, Roman Amrein, Rafael C. Freire, Sérgio Machado, Adriana Cardoso, Marina D. Mochcovitch Laboratory of Panic & Respiration. Institute of Psychiatry – Federal University of Rio de Janeiro – Brazil antonioenardi@gmail.com www.labpr-ufrj.com Clonazepam Withdrawal success rating This study was fully funded by the Brazilian Council for Scientific and Technological Development (CNPq) Grant 554411-2005/9 Drug intake: once a day after dinner During treatment: clonazepam 2mg tablets During withdrawal period: clonazepam 0.5 mg and 0.25 mg tablets Objectives Dosing schedule during withdrawal to avoid severe withdrawal symptoms during tapering out of clonazepam after long-term treatment by careful tapering out over 16 weeks systematic follow up of all patients over 1 year Design : open Protocol approved by our local Ethics Committee Planned: Treatment suspension within 4 months dose reduction of 0.5 mg every two weeks until 1 mg/day is reached followed by a 0.25mg decrease every week. Inclusion criteria Subjects : n = 73 Male 24 (32.9%) Female 49 (67.1%) Age 48.6 ± 18.1 years (± S.D) Educational level College or more 23 (68.5%) High school or less 50 (31.5%) Marital status Married 39 (53.4) Not married 34 (46.6) Previously met DSM-IV criteria for PD, with or without agoraphobia – SCID -I (First et al., 1997). Men and women, 18 to 65 years of age, Patients treated with clonazepam for at least 3 years participating in specific 3-year study (Nardi et al., 2005) undergoing a naturalistic treatment for PD using only clonazepam for 3 or more years. Willing to quit treatment Informed written consent Conclusion Exclusion criteria It is possible to take the clonazepam slowly out even after a long treatment without any major withdrawal symptom. The dose should be tapering slowly and some adjunct drug may be useful for some cases. We recommend reducing the dosage of clonazepam after intermediate-term use by 0.25 mg/wk. Comorbid psychiatric illnesses current major depression, bipolar disorder, obsessive-compulsive disorder, schizophrenia, delusional or psychotic disorders, organic brain syndrome, epilepsy, or substance abuse or dependence (during the last year) References [1] Freire, R.C., et al., 2014.Current pharmacological interventions in panic disorder. CNS Neurol Disord Drug Target 13,1057-1065. [2] Nardi, A.E., et al., 2013. Clonazepam for the treatment of panic disorder. Curr Drug Targets 14,353-364. [3] Nardi, A.E., et al., 2012. A randomized, naturalistic, parallel-group study for the long-term treatment of panic disorder with clonazepam or paroxetine. J Clin Psychopharmacol 32,120-126. No conflict of interest.