Clonazepam (Klonopin, Rivotril)

How are your hearing aids tuned? Do they play low-level pink noise or are they tuned to amplify certain frequencies? Have they helped with hyperacusis?

 

Benzos are pure poison and will make things much much worse. Stay off this RAT POISON!

 

I take either the full 0.5 mg or cut it in half for 0.25 mg. It depends if the noises are super loud or not. Today they are loud so I took the 1/2 pill. If I can't sleep, I take the full pill.

How did you develop tinnitus?

 

I find Clonazepam helpful to suppress a spike. Right now I'm on 0.75 mg. If needed, I can go up to 2-3 mg. You can't keep taking that amount continuously or you will get really hooked and won't be able to get off. Plus the next spike, you will have no resource.

 

Not certain, but unilateral severe to profound high-frequency hearing loss. Labyrinthitis or noise or both. Then I got pain hyperacusis and worse tinnitus from a noise trauma in January 2022.

 

Clonazepam has been the only drug for me that has remotely moved the needle so to speak, with no real side effects other than minor lethargy. I take it in a similar fashion to @Nick47, no more than twice a week; GP agreed this is the best way to take it.

 

Good God, a GP in England agreed to it.

 

Are you guys still taking Clonazepam 1-2x per week? I was prescribed 0.5 mg to take on days when I have to commute to the office. Meanwhile the Mirtazapine I thought was helping has actually begun to exacerbate my hyperacusis at 22.5 mg. I was doing better on 7.5-15 mg with 100-300 mg Gabapentin mixed in as needed.

 

Yes, that's how I've taken Clonazepam. I've taken in the past a low dose (0.25 mg) for a week, then none for 7-10 days, then for 2 days in a row, then 5 days later for 1 day. I also vary the dose (0.5 mg - 0.75 mg - 1 mg) and basically take it to my needs. I have no set pattern. On days I don't take Clonazepam, I can take 2 mg of Diazepam and some Gabapentin. I also take Mirtazapine 30 mg as a daily medicine.

 

Just debating whether to get on Clonazepam full time now as the off days are giving me quite severe depressive symptoms when the reactive tinnitus catapults back.

 

I understand. Can you take a low dose of Diazepam + Gabapentin on the off days? Or even Pregabalin?

How often are you taking Clonazepam and what dose?

Was it you who had the meeting with Dr. Bance, who suggested Carbamazepine if the Gabapentin does not work?

I've been close to your thoughts time and time again, however so far resisted daily use. I also have a theory that based on the long half-life taking it first thing in the morning may be better. It may reduce interdose withdrawal as you don't need it when sleeping. I have meant to ask @linearb why he doses in the morning, as it's often suggested to take at night.

So far I have tried to cycle things, so 3-10 days of 2-3 mg Diazepam with 300-600 mg of Gabapentin, then 2-3 days of Clonazepam, then 2-3 days of Deanxit etc.

Maybe I'm stupid, I'm no doctor, but I look at monthly doses as an indicator of dependence and would rather have very low dependence on several medications than high dependence on one.

I take 30 mg of Mirtazapine as a daily regular medication at night with 300 mg of ALA in the morning.

Looking through posts, people seem to rotate or have a regular 'stack'.

 

Yes, I saw Dr. Bance. He suggested, given I'd had some success with Clonazepam, to try a 3 month course of 0.5 mg a day. He quoted the fact many are on it all their life for epilepsy with no issues.

However, he advised his preferred routes of Gabapentin and Carbamazepine.

You may recall I have severe reactive electrical sensation tinnitus in the left ear, particularly aggravated by white noise. On top of that I have reactive morse code like beeps that ride on other sounds in both ears.

I gave the Gabapentin a go for a fortnight and felt it was making the left ear worse so I stopped - not sure if this was a long enough chance to give it, but it wasn't helping the slightest.

Next came the Carbamazepine, initially I thought it was helping the reactive morse element but the strangest thing happened, it started giving me the electrical reactive spasming in the right ear as well - it was definitely the Carbamazepine doing this as it ceased when I stopped taking it. I'm still not convinced there isn't a stapedial myoclonus element to one part of my problem based on this and the physical sensation I get.

Anyway, back to Clonazepam. That's quite a combo you have there, I'd imagine it's not a UK GP that's prescribed you both Diazepam and Clonazepam and you've had to source them elsewhere.

I take them for 1 or 2 days a week. They aren't as effective as initially when a single 0.5 mg tablet would knock out the left ear reactive electrical spasming, now I have to take say 0.5 mg Friday night, then Saturday morning and then maybe again Saturday afternoon to get the same effect. I sometimes take an extra 0.5 mg in the week on the odd day, which I know is stupid, but out of pure desperation as my symptoms are so distressing.

I've done a fair bit of research on Clonazepam lately and certain things stuck out. The first is the recent studies on how the bad reputation benzos have received doesn't stack up to the science and 50 years of study. It summarised that they're as effective for anxiety as SSRIs, have similar withdrawal issues and that their anxiolytic properties don't build tolerance contrary to popular belief.

→ Benzodiazepines - It's Time to Return to the Evidence

Another report I read was from a long serving MD who discussed how they had positively changed many of his patients' lives after being put on them long term.

→ Benzodiazepines - A Perspective

I'd also draw attention to Clonazepam's rating on the Drugs.com website, it is consistently in the 9s and most comments are from long-term users. The SSRI ratings pale in comparison.

I'm not for one second discounting that benzos are powerful drugs and that withdrawals can be immense, but my current situation is untenable. I'm almost 8 months in, struggling with work every day, and have pulled away from most social situations as it's unbearable. My only concern taking Clonazepam long-term is if it stops working as then I truly am in limbo land. If I could guarantee it would have the same effect the next 20 years, I'd be on it permanently tomorrow, even if it meant I was dead at 60 and could have 20 semi-decent years of life. I actually don't think a UK GP would even allow that, they've battened down the hatches on benzos in the UK outside of epilepsy and that ain't going to change.

One last question, slightly off topic, do you find the Mirtazapine has made any actual difference to your mood and struggles?

 

Yes, some medications get a bad rap. Remember it's negativity that sells. Think MSM. People like to moan and post negativity.

All but Gabapentin and Mirtazapine I sourced myself.

The Mirtazapine helps with sleep initiation and maintenance. Not sure about anything else.

Gerald Brooke at Harley Street prescribes Clonazepam. Many do well on here and some don't like it.

 

On my first trial with Gabapentin it made my tinnitus worse. On a second trial it helped reduce my tinnitus. There was about a year in between, so I'm not sure what caused the change. I always made sure to only take consistently for a week or so, then have a washout of 10-14 days as tolerance hasn't really been studied and I was afraid I would lose the effect.

I've only ever been able to get my hands on 10 doses Valium and a few Xanax. It's been nearly impossible to get where I have been in US. And now I'm having difficulty getting a Gabapentin prescription filled. I'm not about to doctor hop and have "drug seeking" put on my medical record.

 

Anxiolytic properties don't build tolerance? That contradicts everything I've heard. I take a low dose benzo (Ativan, i.e. Lorazepam) for anxiety and limit my usage specifically because I don't want to build tolerance, which I've read can happen with the anxiolytic effects within a few weeks with daily use, and the sedation effects even faster.

No surprise about the SSRIs having lower reviews. Most people don't benefit, it takes weeks to help even if they work, plus the side effects right from the start, and they don't always subside. That's why I didn't stay on them long - no help and just side effects several weeks later.

My doctor wouldn't prescribe Xanax (Alprazolam). I never asked about other benzos. And I'm taking Ambien (Zolpidem) every night, which is cross tolerant with benzos.

 

Yes, it's nonsense to claim benzos don't cause tolerance.

They ABSOLUTELY DO, and some very quickly. You just need to read BenzoBuddies and that's the tip of the iceberg.

Good for you keeping the dose limited.

 

Just so it’s clear, I’m not claiming anything folks, I’m just referencing the British Journal of Psychiatry, in particular this paragraph:

I guess everyone has their own unique experiences on them.

 

You will regret it...

 

Hi @Cmspgran! I think you may be the only person who has described one of their tinnitus tones as exactly what I experience. My left ear has morse code like beeps that ride on other sounds. So, especially things like white noise (including refrigerators, air conditioners), the beeps both react in terms of volume (i.e. they get louder) but also they sound like they are coming from the source of the external noise. For example, my morse code like beeps will start to sounds like they're coming from the aircon vent in a hotel room. This kicks in above a very low volume threshold, usually around 26 dB.

I've also found Clonazepam provides relief by lowering volume. I'm also considering Mirtazapine - but I am wary of the usual stories of it-caused-my-tinnitus.

 

Your situation is almost identical to mine. I also find Clonazepam lowers the tinnitus intensity and volume, although it can take 24 hours to work. I take it once or twice a week.

 

I didn’t realise you had the reactive Morse code beeps over white noise sounds, too @Nick47. It's a total nightmare, isn’t it?

Have you found anything else medication-wise that helps? It saddens me to say this, but Clonazepam is definitely losing its effectiveness for me, and I take it three times a week max, usually twice.

 

Besides Clonazepam, Gabapentin helps a little, and Cyclobenzaprine as well when I tried it. I've been using a cocktail approach.

 

Is Clonazepam losing its effectiveness in lowering your tinnitus and anxiety? Does it seem like your tinnitus is rebounding to a new higher baseline after coming down off the Clonazepam? It seems like that might be happening with my Lorazepam (Ativan), despite taking only one 0.5 mg pill every three days, on average, over the last several months.

 

You are probably right about Clonazepam losing its effectiveness, @Cmspgran. Two to three times a week might be too much. My ENT consultant advised that I only take Clonazepam when the tinnitus is severe. If taken too regularly, the body quickly habituates to it, and more of the drug needs to be taken to be effective. This can lead to unpleasant side effects.

Fortunately, in the 13 years I have been taking Clonazepam, it has always been effective in reducing my tinnitus from severe to moderate, mild, or complete silence over 12 hours. However, in February, my tinnitus ramped up to very severe levels, which was reminiscent of the darkest days of my life with tinnitus from 2008 to 2012. I have written about this on another thread.

It was then I ordered the Cleanhearing Sono tinnitus device. I haven't had an easy ride with it. I hoped to give an update in May or June. Unfortunately, this will now have to be put off to a later date. The people at Cleanhearing Sono have helped me a lot with their advice, as I have been going through a difficult time. For some reason my tinnitus has changed but I'm hopeful things will improve.

I hope you start to feel better soon.

Take care,
Michael

 

I think it’s a double-edged sword; I know I’ve been taking it too often, and I’m convinced it’s causing a rebound effect. I would have been really interested to see the difference in progress over the last year since obtaining reactive tinnitus/distortions had I not used Clonazepam. Sadly, I’ll never have an answer.

I’ve resorted back to using 7.5 mg of Mirtazapine for sleep, and I’m going to do my best to try and stop using Clonazepam for a month or two (which is a big ask with my current condition) to see what the difference is.

With regards to losing its effect on both anxiety and tinnitus, it’s hard to tell. I see them as inextricably linked as the Clonazepam reduces my reactiveness and distortions, and as a result, my anxiety reduces; it’s a vicious, horrible circle.

I’ll report back with monthly updates here.

Thanks for your kind words.

 

I know what you mean. I've only been taking Ativan (less potent & lower shorter life than Clonazepam) once every three days, and I feel like it's already less effective, but the worst part is that when my tinnitus is a squealing single tone, it's even louder than it used to be, and that's driving my anxiety higher. I'm dealing with a separate chronic pain issue, which compounds the problem. I was doing a lot better last August.

I used to be able to take an hour bike ride last summer, and although the tinnitus would get louder for a few hours, my anxiety actually dropped after I recovered for a little while. Yesterday, the tinnitus screamed so loud after biking that my anxiety increased.

Thank goodness you have that to help you sleep. I'm still using Zolpidem overnight to help with that and have had to use more than usual three out of the last five days, so that's another concern. My doctor isn't too keen on prescribing things that he doesn't usually prescribe.

 

I'm really sorry you are going through all of this; trust me when I say I can relate to your distress. I remember saying you were in your 50s. Are you retired? I hope so, as it's one less stress. My biggest fear after the tinnitus itself is losing the ability to work.

I don't understand why your doctor would favor continued Ambien use, which is habit/dependence forming, rather than prescribe low-dose Mirtazapine for your sleep, which isn't habit forming. I had a box of Ambien, and they worked well initially, but by the end of the box, they were clearly starting to lose their effectiveness.

I've been off the Clonazepam for a week now. My tinnitus has stabilized (ha, if you can call it that) compared to the wild swings between doses I was encountering. The real test is whether I can go to work and not pop a couple; we'll find out on Thursday as I'm on-site. I will keep you posted.

 

My job was outsourced. I'm at least temporarily retired for close to a year, so I'm not working now after working full-time through my first 16 months of severe tinnitus. Working in the morning helped cut my morning anxiety, but it was still difficult performing on the job with this condition and insufficient sleep. Not working helps in some respects, such as allowing me to try to sleep more, but I have had multiple worsening conditions since.

My doctor has been a doctor for a long time, so he is kind of set in his ways about what he prescribes. Ambien is something he originally prescribed when I reported major sleep issues, and I always make my 30-day supply last at least 1 1/2 months or longer over more than two years of using it. I mentioned Mirtazapine once. I think he said he never prescribes it but had some patients who were already on it. The side effects and withdrawal seem bad with Mirtazapine. I don't have any side effects with Ambien. There have been times I skipped some days without a problem.

He just took me off of Ambien because I wanted to try Quviviq (Daridorexant), which is a sleep med in the dual orexin receptor antagonist (DORA) class, like Dayvigo (Lemborexant). I don't think anyone here has mentioned taking Quviviq, and the reviews elsewhere are very mixed and not really very good for the most part, but some people really like it. So, he prescribed 25 mg. My initial night using it actually reduced my sleep rather than helping. It wasn't a good experience. I'll give it a little longer.

Ativan (Lorazepam) is the benzo he prescribes, not Clonazepam. He specifically told me he doesn't prescribe Xanax. I'm skipping it today for the third day straight, although my tinnitus is squealing, and my anxiety is high.

Good luck with your time off Clonazepam.

 

It's bizarre prescribing, speaking as someone from the UK. Here, Mirtazapine is seen as one of the safest antidepressants. They prescribe it to old people. It's also good for sleep. They don't like benzos except for the short term, and then it's only Diazepam, as it has a very long half-life. They would never prescribe short-half-life medications like Lorazepam or Alprazolam. Clonazepam also has a long half-life, so it is less addictive and has efficacy in tinnitus treatment.

Zopiclone is also only prescribed for a few weeks.

 

It’s similar in Canada, or from my experience, anyway. I’ve been able to get my doctor to prescribe 0.5 mg Lorazepam, but only ten at a time at first, and now it’s down to seven. I only call for a refill about once every 3-4 months now, and every single time, he tries to give me a lecture.

I tried to ask about Clonazepam, and he dismissed me with, ‘It’s the same as Lorazepam; they all work the same.’ I would love to try it.