Clonazepam (Klonopin, Rivotril)

[RunningMan]

Maybe that's what caused the confusion of the earlier user who said you don't build a tolerance to it. I don't use "habituation" to describe drug tolerance. I actually checked with ChatGTP on this:

Calling drug tolerance "habituation" can be misleading. While both terms relate to changes in response to stimuli, they describe different processes. Tolerance refers specifically to the body's reduced response to a drug after repeated use, often requiring larger doses to achieve the same effect. Habituation, on the other hand, is a form of learning where an organism stops responding to a stimulus after repeated exposure.

So, while there may be some overlap in concepts, using "habituation" to describe drug tolerance might create confusion. It's usually clearer to stick with "tolerance" when discussing drugs.

Then, there is the matter of dependency, which refers to a physical or psychological reliance on a drug, where the body adapts to its presence and experiences withdrawal symptoms without it. Weaning off can be a very lengthy and extremely difficult task, which can worsen tinnitus and related conditions. Some people handle it a lot easier. I've been playing it safe with my Ativan for over a year by just taking occasional doses and Zolpidem for 2 1/2 years by taking frequently but usually at fractional doses of 1.2 to 1.4 mg (of 10 mg tablet).

 

[BuzzyBee]

I was also impressed with Dr. De Ridder and appreciated his insights on Clonazepam. I had thought that it was best to use low doses as needed, but from what I gathered (and I could be mistaken), it seems that he recommends using a low dose regularly. He mentioned that it's the wearing off of the medication that might cause a spike in symptoms, but low doses can be taken for a very long time.

I have friends who take it for various neurological conditions, not just for anxiety or epilepsy, and they understand that they'd need to taper off if they decided to stop. However, they don't see a need to stop since the medication effectively prevents symptoms that are seizure-like in nature.

Another interesting point he made was that Clonazepam helps with REM sleep, which, in turn, helps with tinnitus. While REM sleep is just one part of sleep, and there's a deeper sleep stage as well, you still need a certain amount of REM. I noticed that someone else asked why we sometimes wake up from dreams with tinnitus (I know I do), but he didn't get around to answering it due to time constraints, or perhaps he did, and I missed it.

 

[RunningMan]

When I had my appointment with Professor Bance, he had no issues with a 3-6 month pharmacological trial of Clonazepam. He noted that people with epilepsy take much higher doses for their entire lives without problems, compared to the 0.5 mg dose I was prescribed. He also expressed no concerns about Gabapentin or Carbamazepine, citing similar examples.

My doctor made similar comments to me about Lorazepam, as I noted in an earlier post, stating that some people have been taking it for years, and some take it 4 times per day for years or even 1 mg (double my prescribed dose). At least it works when I need it, unlike the SSRIs I tried for 8 weeks.

For context, Professor Bance is one of the world's leading middle ear specialists and is currently pioneering the first gene therapy for treating childhood hearing loss. His expertise and experience with these medications are extensive, and his preferred option for patients like me is actually Gabapentin. My point is that this is the opinion of a highly qualified expert, not just a random individual (which, I recognize, is what I am).

That's not surprising. Although, Gabapentin isn't a benzodiazepine. It's not without its own tolerance and possible side effects, though.

Hopefully you can continue to get a benefit on that 0.25 mg Clonazepam dose while taking it every day. That's equal potency to my Lorazepam 0.50 mg dose, but I don't take it daily in trying to avoid tolerance.

 

[Nick47]

but I don't take it daily in trying to avoid tolerance.

@RunningMan, have you had issues with tolerance before or just been put off by some of the posts here?

 

[RunningMan]

@RunningMan, have you had issues with tolerance before or just been put off by some of the posts here?

I thought Lorazepam (Ativan) was becoming less effective last April when I was taking it about every third day, but it's hard to say for certain with my variable condition. Due to how the medication works, I was also concerned about cross tolerance with the Z-drug Zolpidem (Ambien), which I was taking more of at that time. I researched into with drug reviews and other online sources as well as Tinnitus Talk, and cut down on my usage as a result.

 

[WilRic]

He noted that people with epilepsy take much higher doses for their entire lives without problems, compared to the 0.5 mg dose I was prescribed. He also expressed no concerns about Gabapentin or Carbamazepine, citing similar examples

I've had exactly the same experience with my neurologist, who I was lucky to find.

I've also recently seen one of the world's leading neurosurgeons and he wasn't freaked out by the high dose I'm taking on the basis that it seems to be working without any issues (at the moment).

I totally agree with you about SSRIs which we are now discovering are by no means "safer" long term.

I see you mentioned GPs. I think the difference may be between America and other places. American doctors do (or have) handed out benzos like candy without monitoring the risks and explaining why checking for tolerance is so important. Conversely in my country asking a GP for benzos is usually treated like you're asking for heroin. Meanwhile they'll happily give you boxes of SSRIs for any medical problem imaginable (and SSRIs can make tinnitus far worse in some people who are sensitive to serotonin effects).

 

[Furetto]

Anyway, I discovered that Clonazepam completely kills my libido and affects my ability to have an erection. I found a study indicating that:

A study on 100 male patients with PTSD did not find any evidence that sexual dysfunction (SD) correlated with the use of lorazepam, alprazolam, or diazepam. However, approximately 43% of the patients treated with clonazepam reported SD.

Because of this, I started tapering off Clonazepam yesterday, reducing by one drop every three days (I currently take six drops a day) until I reach zero.

 

[RunningMan]

Anyway, I discovered that Clonazepam completely kills my libido and affects my ability to have an erection. I found a study indicating that:

Because of this, I started tapering off Clonazepam yesterday, reducing by one drop every three days (I currently take six drops a day) until I reach zero.

Switching to Lorazepam, then?

There was a comment a while back in this thread about Dr. De Ridder saying Clonazepam doesn't build tolerance.

And apparently, he contradicted that earlier in a podcast speaking to @Hazel, saying, "The body ignores it."

 

[Nick47]

And apparently, he contradicted that earlier in a podcast speaking to @Hazel, saying, "The body ignores it."

Yes, I thought the same thing when I heard the interview. Along with the idea of sounds being ingrained in the brain (although not with a cochlear implant), they claimed that hearing restoration wouldn't be effective; otherwise, hearing aids would work. Erm, no.

I'm pretty blasé about what he has to say.

 

[object16]

Clonazepam was a lifesaver for me. I had a massive spike in January 2015, just as I was starting an academic refresher course that was required for me to continue my career. I was in bad shape and out of town.

Luckily, I knew someone from my training period, so I called them, and they gave me a prescription for Clonazepam. They told me, "Don't take it until you're at your apartment. It'll knock you flat on your back."

When I got to my apartment, I took two 0.5 mg tablets. I don't remember what happened next; all I recall is waking up four hours later. My first thought was, "Oh, I slept." Then, "Where did the tinnitus go?"

After a couple of weeks on 1.5 mg, I started sleeping in heavily, so I discontinued it cold turkey. I didn't experience any withdrawal, though my sleep patterns normalized. The tinnitus didn't get worse, and I completed the academic course in the minimum time of five weeks (with a possible extension of two months if needed). Everyone was satisfied at five weeks, and I went back to work.

Currently, I'm taking 0.5 to 0.75 mg and would like to taper down, though it's tough with rebound insomnia. I try to use Clonazepam strictly as an emergency medication for those spikes. When you're not using it regularly, it's much more effective.

I've motivated myself to try tapering further; tonight, I'll go with 0.375 mg and stick to it. I'll report back. Honestly, without this medication, I'd be out of work, very depressed, and struggling financially. More importantly, I love my work, and while Clonazepam is addictive and can be habit-forming, I consider it a lifesaver that I can count on.

Last year, I took up to 3 mg, which is a lot. I know someone who's been on that dose for years with no apparent ill effects, but as per my doctor's advice, I only take the minimum effective dose.

By the way, I'm also on Lyrica, Mirtazapine, Quetiapine, and Carbamazepine, so yes, I take quite a few medications. I also use various cannabinoids like THCV and CBDV. As long as I'm functional, I don't mind. I'm diligent with that minimum effective dose. Always.

 

[ErikaS]

I recently decided to give Trileptal another try, taking 300 mg at night. Although it made me feel sleepy, after about a week and a half, my tinnitus became noticeably louder and harsher. I stopped taking it, and the very next day, my tinnitus was significantly calmer. It seems that Trileptal might not be the right choice for me.

My psychiatrist mentioned that if Trileptal didn't provide any benefits, the next step would be transitioning me from Ativan to Clonazepam. I've been taking Ativan daily since this all started two years ago, with a dosage of 0.5 mg in the morning and 0.5 mg in the evening. My psychiatrist feels I could switch to an equivalent dose of Clonazepam and possibly experience more benefits due to its longer half-life. He also mentioned that when the time comes to taper off, or to reach a point where I can reduce to an "as-needed" basis, Clonazepam would be preferable because of its longer half-life and reduced risk of quick rebound effects.

For a long time, I was apprehensive about switching from Ativan to Clonazepam, fearing I'd be "digging myself in deeper." However, after reading about others' experiences and considering my psychiatrist's advice, I feel more confident about making the change. It's worth noting that since the beginning, Ativan has consistently calmed my tinnitus and reduced its reactivity. While it doesn't have as strong an effect as it used to, I remain disciplined and haven't increased my dose. Like @object16 said, Ativan truly saved my life, especially when I returned to work and a more normal routine during my stable months. Since experiencing a severe spike in August, I'm hopeful that switching to Clonazepam might provide some additional relief and help me stabilize once again.

 

[Nick47]

I'm hopeful that switching to Clonazepam might provide some additional relief and help me stabilize once again.

I believe you'll find Clonazepam to be much more effective than Ativan. Many people who use Ativan report experiencing rebound anxiety due to its shorter half-life. In my experience, Clonazepam doesn't cause that kind of rebound effect, and a single daily dose should be sufficient.

Currently, I'm taking 0.5 to 0.75 mg and would like to taper down, though it's tough with rebound insomnia. I try to use Clonazepam strictly as an emergency medication for those spikes. When you're not using it regularly, it's much more effective.

Are you tapering down from a once-daily dose?

I'm also on Mirtazapine, at 22.5 mg. Do you find that adding Carbamazepine provides additional benefits? I've also heard it may be contraindicated when used with Mirtazapine.

 

[RunningMan]

Yeah, Clonazepam has a longer half-life than Ativan, so a single dose keeps you under the influence of the medication for a longer period. However, because of the much longer effect, I would expect tolerance and dependency to develop more quickly if the doses are of the same potency and taken on the same schedule. But if you cut back to one dose of Clonazepam vs. two per day of Ativan to compensate for the longer half-life, that would help balance things out, but then you aren't gaining anything.

 

[grate_biff]

Do you find that adding Carbamazepine provides additional benefits? I've also heard it may be contraindicated when used with Mirtazapine.

Carbamazepine reduces the plasma concentration of Mirtazapine by 70-80% due to its strong induction of the CYP3A4 enzyme. Carbamazepine is unique in that it's an auto-inducer, meaning it actually reduces its own effectiveness over time. Still, it's the best drug I've ever tried for tinnitus and noxacusis!

I'm currently on 60 mg of Mirtazapine, and I think it's interfering with my benzo recovery.

 

[ErikaS]

I believe you'll find Clonazepam to be much more effective than Ativan. Many people who use Ativan report experiencing rebound anxiety due to its shorter half-life. In my experience, Clonazepam doesn't cause that kind of rebound effect, and a single daily dose should be sufficient.

Fortunately, I've never experienced rebound anxiety with Ativan. Maybe in the earliest months, but who's to say if that was due to the Ativan or simply the sheer panic and downward spiral that many experience when faced with sudden, reactive tinnitus that continues to worsen and turns your world upside down? During my stable months, from January 2024 to June 2024, I even had to start setting reminders to take my Ativan. There was one day when I accidentally skipped my morning dose—no issues. I don't crave it or feel the urge for it; I only actively think about it when my tinnitus is particularly bad, and I need objective, physical relief. This reassures me that I have the discipline and control necessary when using a benzo.

Yeah, Clonazepam has a longer half-life than Ativan, so a single dose keeps you under the influence of the medication for a longer period. However, because of the much longer effect, I would expect tolerance and dependency to develop more quickly if the doses are of the same potency and taken on the same schedule. But if you cut back to one dose of Clonazepam vs. two per day of Ativan to compensate for the longer half-life, that would help balance things out, but then you aren't gaining anything.

I hear what you're saying; time will tell! I've read several articles comparing Ativan and Clonazepam, and what I noted is that Clonazepam is not only more potent but also more widely used as an anticonvulsant than Ativan because of the specific seizures it targets. I feel this could be more beneficial in terms of calming neural activity. Additionally, there is a study on Clonazepam and tinnitus. I also read that if long-term use is being considered, Clonazepam might be the more appropriate choice.

One last thing: for those who watched the Tinnitus Talk Podcast with Brian Fargo, the man who gave Dr. Djalilian a million dollars, he shared in that podcast that he takes 0.5 mg of Clonazepam daily. He said it's the only thing that has allowed him to function and live his life, as it objectively calms his electrical tinnitus. My heart goes out to those who have been negatively affected by benzodiazepines. Every brain is different, and I truly wish we had another option that works as well as benzodiazepines for many but isn't a benzo. However, if it literally keeps someone alive and functioning while we wait for a better option, it's what we have for now. We can always wean off it when a revolutionary treatment or cure comes along.

 

[Nick47]

However, if it literally keeps someone alive and functioning while we wait for a better option, it's what we have for now. We can always wean off it when a revolutionary treatment or cure comes along.

@ErikaS, in my opinion, if the condition is severe enough to cause a disability, then treatment should be considered.

Some of us here, including myself, do not have the responsibilities of paying a mortgage or providing for a family. We have the option to be dysfunctional and avoid daily treatment if we choose.

However, others need to work and support their families. They take medication to function and provide without complaint, and I truly admire them for that. When better treatment options become available, a gradual tapering off can then be considered.

 

[Cmspgran]

@ErikaS, in my opinion, if the condition is severe enough to cause a disability, then treatment should be considered.

Some of us here, including myself, do not have the responsibilities of paying a mortgage or providing for a family. We have the option to be dysfunctional and avoid daily treatment if we choose.

However, others need to work and support their families. They take medication to function and provide without complaint, and I truly admire them for that. When better treatment options become available, a gradual tapering off can then be considered.

This is exactly my position (sadly), but as @Nick47 points out, it's what we do to stay functional and pay the bills. None of us asked to be in this situation; misfortune and circumstance brought us here.

As @Nick47 mentioned, my plan is to wait for Dr. Shore's device and observe results from the sidelines for a few months to see how well it works "in the field" before making any rash decisions to spend over $5K on flights to the USA and the cost of the device. If it looks extremely promising, I'll begin my taper off and make the long trip over. However, if it turns out to be a disappointment or something more viable becomes available in the meantime, I'll be taking the same cautious approach.

 

[Nick47]

This is exactly my position (sadly), but as @Nick47 points out, it's what we do to stay functional and pay the bills. None of us asked to be in this situation; misfortune and circumstance brought us here.

As @Nick47 mentioned, my plan is to wait for Dr. Shore's device and observe results from the sidelines for a few months to see how well it works "in the field" before making any rash decisions to spend over $5K on flights to the USA and the cost of the device. If it looks extremely promising, I'll begin my taper off and make the long trip over. However, if it turns out to be a disappointment or something more viable becomes available in the meantime, I'll be taking the same cautious approach.

@Cmspgran, are you taking your dose in the morning before work?

 

[Cmspgran]

@Cmspgran, are you taking your dose in the morning before work?

Yes, I am. It's the first thing I take upon waking. I found that combining it with 300 mg of Gabapentin boosted the effect somewhat, but I'm hesitant to go back to the GP, as you understand. However, a friend gave me a box of Pregabalin, which was prescribed for their back pain, and it seems to work just as well. I take a 300 mg tablet of Pregabalin before bed and 0.5 mg of Clonazepam when I wake up.

One other thing to note: I've suffered from low-level anxiety all my life and just put up with it. It's incredible how much of a difference this combination makes for that as well. These are two drugs I'd much rather not be taking, but here we are.

 

[Nick47]

Yes, I am. It's the first thing I take upon waking. I found that combining it with 300 mg of Gabapentin boosted the effect somewhat, but I'm hesitant to go back to the GP, as you understand. However, a friend gave me a box of Pregabalin, which was prescribed for their back pain, and it seems to work just as well. I take a 300 mg tablet of Pregabalin before bed and 0.5 mg of Clonazepam when I wake up.

One other thing to note: I've suffered from low-level anxiety all my life and just put up with it. It's incredible how much of a difference this combination makes for that as well. These are two drugs I'd much rather not be taking, but here we are.

That Pregabalin dose is quite high. It's equivalent to about 1200 mg of Gabapentin.

 

[Cmspgran]

That Pregabalin dose is quite high. It's equivalent to about 1200 mg of Gabapentin.

Good shout. I hadn't realized how potent it was. Although I was cleared to go up to 1200 mg of Gabapentin when trialing it, I found that repeated doses gave me stomach issues. A single 300 mg dose of Pregabalin doesn't seem to cause the same problem. I can't take it every night, though, as it's just another GABA-modulating drug I'd risk becoming dependent on. Twice a week before bed is probably my limit. You can imagine the response if I went back to my GP, requesting to stay on Clonazepam indefinitely and, oh, by the way, asking to add a 300mg dose of Pregabalin to the mix...