1. 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
Clonazepam
Withdrawal success rating
This study was fully funded by the Brazilian Council for Scientific and Technological Development (CNPq) Grant /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 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,
[2] Nardi, A.E., et al., Clonazepam for the treatment of panic disorder. Curr Drug Targets 14,
[3] Nardi, A.E., et al., A randomized, naturalistic, parallel-group study for the long-term treatment of panic disorder with clonazepam or paroxetine. J Clin Psychopharmacol 32,
No conflict of interest.