Clonazepam (Klonopin, Rivotril)

[RunningMan]

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.

Yeah, this varies in the U.S., depending on the doctor. My doctor won't prescribe Gabapentin or Pregabalin for sleep or anxiety. He only wants to prescribe SSRIs and SNRIs when it comes to antidepressants, or Trazodone as an alternative sleep medication option, although an NP in the same office once prescribed me Nortriptyline, which is a tricyclic (TCA) antidepressant. My doctor wouldn't have.

A friend of mine has used Xanax (Alprazolam) for sleep for years. When she moved, the new doctor wouldn't prescribe it, so she had to go back to her old doctor, who also just prescribed her Ambien as well.

I should note that I was talking about a PCP. I haven't seen a psychiatrist, although my doctor would refer me if I wanted. The psychiatrist might be open about prescribing different things like Clonazepam and Mirtazapine.

 

[Michael Leigh]

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.

I wish you the best of luck when you return to work @Cmspgran. I'd like to give you some advice and hope you don't mind. I realize that you want to stop taking Clonazepam, and I commend you for this. However, don't push yourself too hard. Returning to work can be stressful which could increase your tinnitus temporarily. Since you are not taking the Clonazepam, perhaps take some preventive measures by taking Kalms. It is mostly plant-based and contains Valerian root. It's good for relieving stress and anxiety. Available from Boots chemist, Holland & Barrett, ASDA, and online.

It is nonaddictive and doesn't have to be taken long-term.

Take care,
Michael

 

[BB23]

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.

Even the manufacturers and the package inserts say you shouldn't be on benzos for more than 10-14 days.

Your doctor is a very good one; they know their stuff unlike most others.

Even though your situation is dire because of tinnitus, benzo addiction could make your tinnitus seem very mild compared to how many neurological problems it could cause.

 

[RunningMan]

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.

My doctor also gave me a lecture about my 0.5 mg Lorazepam. He said I wasn't taking it as prescribed - 3 times per day. When I called in a few weeks earlier and spoke to one of the nurses in the office, she said not to take it that much because that's how you get addicted. I told the doctor that, and he said that I needed to because I have anxiety. He said lots of people do, for years, sometimes four times per day, and even 1 mg. He's clearly trying to convince me, but I'm still skipping multiple days between doses.

Even the manufacturers and the package inserts say you shouldn't be on benzos for more than 10-14 days.

That insert I get with mine from the pharmacy doesn't give a specific time frame—it just says to take it only as prescribed by the doctor, along with all the other warnings. Apparently, the FDA approves Lorazepam for up to 4 months, but that dependency can happen in days or weeks. Clonazepam is apparently approved for only nine weeks. Of course, it's more potent per mg and has a much longer half-life.

 

[SamRosemary]

Even the manufacturers and the package inserts say you shouldn't be on benzos for more than 10-14 days.

Your doctor is a very good one; they know their stuff unlike most others.

Even though your situation is dire because of tinnitus, benzo addiction could make your tinnitus seem very mild compared to how many neurological problems it could cause.

I don't get package inserts with mine; they come in a prescription bottle. But having 7-10 pills every 3-4 months isn't being on them for 10-14 days. They are used very minimally/when needed. My perception label actually says to use one a day (which I don't).

 

[Varda]

Can sporadic use (taking 2 ~ 8 pills a month on random days) of benzodiazepines induce withdrawal tinnitus?

If you want to stop completely, what sort of taper schedule should you use if you are not using them regularly, to begin with?

Can you experience the tinnitus withdrawal effect without feeling any other of the benzo withdrawal symptoms?

Do the Z-drugs (Ambien/Zolpidem) also induce tinnitus on withdrawal?

 

[Nick47]

Can sporadic use (taking 2 ~ 8 pills a month on random days) of benzodiazepines induce withdrawal tinnitus?

If you want to stop completely, what sort of taper schedule should you use if you are not using them regularly, to begin with?

Can you experience the tinnitus withdrawal effect without feeling any other of the benzo withdrawal symptoms?

Do the Z-drugs (Ambien/Zolpidem) also induce tinnitus on withdrawal?

I have two friends who tapered off Diazepam after daily use. One had used 10 mg/day for 5-6 years and tapered down to 2 mg in 6 months. No issues with it causing tinnitus. It can happen, but doesn't happen to most.

At your usage it should not be an issue.

You write as if you do not have tinnitus. I assume, being on here, you do?

 

[BB23]

Can sporadic use (taking 2 ~ 8 pills a month on random days) of benzodiazepines induce withdrawal tinnitus?

If you want to stop completely, what sort of taper schedule should you use if you are not using them regularly, to begin with?

Can you experience the tinnitus withdrawal effect without feeling any other of the benzo withdrawal symptoms?

Do the Z-drugs (Ambien/Zolpidem) also induce tinnitus on withdrawal?

There is no difference between Z-drugs and benzos. All work on GABA receptors and signaling. They say Zopiclone, in particular, since it has a short half-life (5-6 hours), could throw you into withdrawal more easily than other benzos.

Side effects wise nobody can guarantee you what could happen. Even one pill can cause an adverse reaction, OR you could experience no side effects at all. You could go years on these medications and quit cold turkey, and nothing could happen, and you can go on with your life. Or you might suffer crippling side effects for years and years; nobody can make any claims as to what could happen. Do your own research on this.

Yes, you could experience tinnitus as the only withdrawal symptom.

As for the rest of your questions, you see, people here are not really equipped with enough knowledge or experience to answer you. They'll be like, "Nah, it will be fine." Go on withdrawal forums like BenzoBuddies or some other place, and read the information yourself. Don't ask it here; you'll likely get the same answers from the same bunch of people.

 

[Varda]

Do your own research on this.

I did. I really like this one:

→ Protracted Tinnitus after Discontinuation of Long-Term Therapeutic Use of Benzodiazepines

The most illuminating things I've noticed from this study are that:

1. Benzo addicts definitely can tell the difference between getting their fix and a placebo.

2. The benzo-tinnitus lasts a horrifying amount of time. For one patient, it took a full year to go away, and for another patient, it didn't even fully go away after a year.

3. The superhero patient #3 is popping benzos every four hours every day. "It makes my tinnitus go away, so I'm going to keep taking it for the rest of my life." "The patient refused treatment mainly because of the incapacitating tinnitus."

At your usage it should not be an issue.

You write as if you do not have tinnitus. I assume, being on here, you do?

I've recently developed tinnitus after taking a 1000 mg dose of Azithromycin.

For years, I have very sporadically used benzos for rare panic attacks or high anxiety days. My usage never exceeds three days in a row or more than eight days total in a month. After finding out about the association between benzos and tinnitus, I wonder if I am playing with fire by even touching them at all... but they are such a lifesaver for those nights when I can't get to sleep or am about to freak out. I'm going to go ahead and make the bet that if I do not slip into a pattern of daily use of benzos, I should be fine, and they won't make my tinnitus any worse. I'm assuming most people here who will testify they got tinnitus or had it worsened from benzo withdrawal were using them daily, and I won't be able to find any evidence of tinnitus caused or worsened by sporadic use.

Oh... also, every ENT I've seen so far has tried to gaslight me that it's "impossible" to get tinnitus from a single dose of Azithromycin. I've developed a 1% doubt that maybe my tinnitus was actually triggered by the years of sporadic benzo use, and it's just a big fat coincidence. It just happened to start two days after I took four big fat pills of Azithromycin.

 

[Ant_BXL]

When having a bad tinnitus spike that lasts for days, is the best option to take Clonazepam twice a week to ensure it decreases?

 

[RunningMan]

Do the Z-drugs (Ambien/Zolpidem) also induce tinnitus on withdrawal?

I haven't had any issues when I skip Zolpidem. I have averaged less than 3 mg per night over the last two years, and I have skipped it four of the last five nights.

Regarding Z-drugs, according to the equivalency chart, my typical max dose of 3 mg of Zolpidem is equal to 0.075 mg of Clonazepam, and I often take about half that much. Also, Zolpidem has a much shorter half-life, so your system is not under the influence nearly as long as with Clonazepam. It has been a non-issue, keeping the dosage low.

I occasionally take 0.5 mg of Lorazepam once every few days and have not noticed any withdrawal effects. I'm not certain if it's affecting my tinnitus since it is variable and cycles. Lorazepam is about half the potency of Clonazepam per mg and has a shorter half-life.

 

[BB23]

I guess Clonazepam is effective because it has another action on 5HT1, based on this paper. It also affects 5HT2A, which most of you should be aware of.

By the way, I have read the entire thread. I don't like what I see, and I don't know what to do. In an ideal world, I would take Clonazepam two times a week, but many people fell victim to it, like @Brian P and more recently @D'Angelo, and I don't like how it affected the old users in the first pages.

Maybe I should start with Zopiclone first.

 

[RunningMan]

I guess Clonazepam is effective because it has another action on 5HT1, based on this paper. It also affects 5HT2A, which most of you should be aware of.

By the way, I have read the entire thread. I don't like what I see, and I don't know what to do. In an ideal world, I would take Clonazepam two times a week, but many people fell victim to it, like @Brian P and more recently @D'Angelo, and I don't like how it affected the old users in the first pages.

Maybe I should start with Zopiclone first.

If falling asleep or just getting back to sleep is your primary concern rather than anxiety or a temporary reduction in tinnitus, I would go with Zopiclone over the benzo. It's targeted for sleep. I have a Z-drug (Zolpidem) and a benzo (Lorazepam) myself, but it takes more than the dosage equivalent of the benzo to be effective for getting me back to sleep, so Zolpidem seems a lot more effective for getting me to sleep. However, the half-life is much lower with my Zolpidem than with Lorazepam.

I wait until I wake up overnight to take a partial tablet of Zolpidem sublingually, which also takes effect faster than the benzo. I keep my dosage low and don't seem to have built up much of a tolerance over the many months of taking it most nights. I still don't get enough sleep. I've been taking Quviviq 50 mg for a few weeks, and I can't say it's really helping, either.

 

[AfroSnowman]

I don't use these medications frequently (less than once a week), and I find them of limited value, but I've tried both Clonazepam and Alprazolam over the years when I'm truly miserable. Maybe they reduce the suffering by 5% or 10%, which is well within the placebo effect range, and sometimes they seem to reset the tinnitus to a less intense level when I wake up the next day (though not always).

Unlike most people here, I've found Alprazolam to be slightly more effective for me. I'm going to see my GP for my annual exam and plan to ask for a refill of the Alprazolam. Are there any other benzodiazepines worth trying? I'm still secretly hoping that some form of relief in a pill exists, and I just haven't found it yet.

 

[RunningMan]

I don't use these medications frequently (less than once a week), and I find them of limited value, but I've tried both Clonazepam and Alprazolam over the years when I'm truly miserable. Maybe they reduce the suffering by 5% or 10%, which is well within the placebo effect range, and sometimes they seem to reset the tinnitus to a less intense level when I wake up the next day (though not always).

Unlike most people here, I've found Alprazolam to be slightly more effective for me. I'm going to see my GP for my annual exam and plan to ask for a refill of the Alprazolam. Are there any other benzodiazepines worth trying? I'm still secretly hoping that some form of relief in a pill exists, and I just haven't found it yet.

Reduce suffering? I take Lorazepam (Ativan) about once per week, sometime twice, but I only take a 0.5 mg dose when I do, and it helps more than 10%. I can go from feeling high anxiety to low anxiety, and that dosage is half the potency of an equal size dose of Clonazepam and Alprazolam (Xanax). I tried other recommended supplements that didn't work. Neither did TCA or SSRI antidepressants. Placebo effect doesn't work for me. So the Lorazepam definitely helps, but I limit usage. I'm not sure it really affects my tinnitus, which is quite variable on its own.

 

[sspencermo]

I don't use these medications frequently (less than once a week), and I find them of limited value, but I've tried both Clonazepam and Alprazolam over the years when I'm truly miserable. Maybe they reduce the suffering by 5% or 10%, which is well within the placebo effect range, and sometimes they seem to reset the tinnitus to a less intense level when I wake up the next day (though not always).

Unlike most people here, I've found Alprazolam to be slightly more effective for me. I'm going to see my GP for my annual exam and plan to ask for a refill of the Alprazolam. Are there any other benzodiazepines worth trying? I'm still secretly hoping that some form of relief in a pill exists, and I just haven't found it yet.

This has been my experience, too. Clonazepam supposedly lowers the loudness of tinnitus for most people -- I guess you and I are among the unlucky few it doesn't work for. Do you find Alprazolam lowers tinnitus loudness?

 

[AfroSnowman]

Do you find Alprazolam lowers tinnitus loudness?

Nothing makes a notable difference in the actual symptoms, but it probably does a slightly better job of lowering my distress.

 

[Morgoth51]

I've recently tried Rivotril (Clonazepam) and it did reduce the loudness of my tinnitus. I'd say by 25-30%. I won't continue as I've pretty much habituated to it but I'll keep it in case of a major setback.

 

[Furetto]

So you're telling me that the improvements I've recently experienced aren't because I'm healing, but only because I've started taking Rivotril (3+3 drops a day)?

 

[Nick47]

So you're telling me that the improvements I've recently experienced aren't because I'm healing, but only because I've started taking Rivotril (3+3 drops a day)?

How many milligrams are 3+3 drops?

 

[HighleyTall]

2.5 mg / ml, a drop is 0.05 ml x 6 = 0.3 ml = 0.75 mg.

Take my advice and quit drumming.

 

[Cmspgran]

A dose of 0.75 mg is fairly high. I usually manage on 0.25 mg per day and only increase to 0.75 mg twice a week.

 

[Furetto]

A dose of 0.75 mg is fairly high. I usually manage on 0.25 mg per day and only increase to 0.75 mg twice a week.

Fairly high? I'm sorry, but the initial dose is up to 1.5 mg per day, and I'm only taking half of that.

Are you saying you take just 1 drop per day? That's almost nothing.

Anyway, I watched Dr. De Ridder live yesterday, and he said something very interesting. He explained that Rivotril is not addictive, but it is habituating. The difference is that with something like alcohol, which is addictive, you need more and more to get the same effect. Rivotril doesn't work that way. Instead, your body becomes habituated to it, which means you can't stop taking it abruptly—you need to taper off gradually. However, you won't build a tolerance to it.

 

[WilRic]

Anyway, I watched Dr. De Ridder live yesterday, and he said something very interesting. He explained that Rivotril is not addictive, but it is habituating. The difference is that with something like alcohol, which is addictive, you need more and more to get the same effect. Rivotril doesn't work that way. Instead, your body becomes habituated to it, which means you can't stop taking it abruptly—you need to taper off gradually. However, you won't build a tolerance to it.

Some people will build a tolerance to various aspects of the drug, but that's not the same thing as addiction (see, for example, this concise paper). I'm glad Dr. De Ridder made that point. The "benzos are poison" refrain you constantly hear is a major bugbear of mine in relation to tinnitus treatment.

If you're taking benzos to "feel good" for psychological issues, it's easy to see how addiction can develop, as De Ridder said. However, it's a different story with brain issues. People with severe status epilepticus can take very high doses of benzodiazepines for extended periods without turning into drug addicts.

The same is true for tinnitus. Nobody wants to be on a "brain drug" at all. But if it's working to actually lower your tinnitus (in the same way it can abate seizures), why wouldn't you use it? Often people tolerate the sedating and anxiolytic effects of clonazepam fairly rapidly. They may be able to take it consistently at a stable dose to lower their tinnitus. Conversely, they may start tolerating the anti-tinnitus effects over time (in the same way epileptics become refectory to benzos). They then have to taper, as Dr. De Ridder pointed out, or alternatively try cycling through benzos.

The point is, it's a totally different situation for people who are popping Xanax for anxiety and end up getting addicted because they need more and more to "feel good" because that effect of benzos (in simplified terms) is rapidly tolerated. I don't mean to minimize that situation, and benzodiazepine withdrawal is absolute hell (and can make tinnitus worse). However, the fearmongering about benzos in relation to that scenario often means that people don't understand the usefulness of that class of drugs in a neurological context.

 

[Nick47]

The "benzos are poison" refrain you constantly hear is a major bugbear of mine in relation to tinnitus treatment.

It's one of my frustrations too, and it's very inconsiderate. By all means, please share your experiences; we want to hear them. However, this behavior makes you a detriment to the community, offering zero useful information.

People often forget that, in addition to tinnitus, many in this community also deal with comorbidities like epilepsy, migraines, schizophrenia, depression, anxiety, cancer, multiple sclerosis, and more. These individuals need medications. How do you think they feel when you put on your CAPS LOCK and shout, "All medications are poison!"?

I also read that for every product purchased, a person shares a bad experience with an average of eight people, while a good experience is shared with only one to three.

Have a bit of respect!

 

[RunningMan]

A dose of 0.75 mg is fairly high. I usually manage on 0.25 mg per day and only increase to 0.75 mg twice a week.

Agreed. I occasionally take 0.5 mg of Lorazepam, which has an equivalent potency to 0.25 mg of Clonazepam, and also a shorter half-life. I try to limit my usage to once per week because benzodiazepines can lead to very rapid tolerance. A dose of 0.75 mg of Clonazepam would be equivalent in potency to three of my Lorazepam doses combined, and would have a much longer half-life!

Fairly high? I'm sorry, but the initial dose is up to 1.5 mg per day, and I'm only taking half of that.

Are you saying you take just 1 drop per day? That's almost nothing.

Anyway, I watched Dr. De Ridder live yesterday, and he said something very interesting. He explained that Rivotril is not addictive, but it is habituating. The difference is that with something like alcohol, which is addictive, you need more and more to get the same effect. Rivotril doesn't work that way. Instead, your body becomes habituated to it, which means you can't stop taking it abruptly—you need to taper off gradually. However, you won't build a tolerance to it.

I haven't seen it, but are you sure Dr. De Ridder specifically stated that you don't build tolerance to Clonazepam? Or was that just your interpretation? Clonazepam absolutely does build tolerance, and it can happen very quickly if you take it daily. Look back a few pages here and check the information and studies available online. Even people on Tinnitus Talk have reported Clonazepam losing its effectiveness for lowering their tinnitus volume after only a few consecutive daily doses.

I'd recommend taking at least a few days off between doses of any benzodiazepine. Once you build tolerance, you can reach a point where you need to take it just to avoid rebound effects, with potentially little additional benefit. While building tolerance is problematic, withdrawal can be especially tough once a dependency has developed.

As others have pointed out, benzodiazepines aren't poison and can be necessary in some cases. However, I wanted to correct the misinformation about not building tolerance. Be careful with these medications.

 

[grate_biff]

I have a lot to say about this, but I'm too sick right now because of the benzos.

The hard truth about tolerance, or what I like to call the "window of effect," is that it's so incredibly individual, it's scary. We're all right and wrong, no matter what we claim!

 

[RunningMan]

I have a lot to say about this, but I'm too sick right now because of the benzos.

Indeed, I've read your posts in the past. Sorry for what you've been through with benzodiazepines.

 

[WilRic]

haven't seen it, but are you sure Dr. De Ridder specifically stated that you don't build tolerance to Clonazepam? Or was that just your interpretation? Clonazepam absolutely does build tolerance, and it can happen very quickly if you take it daily.

If you go to 1:24, he talks about addiction not being the real problem but 'habituation' (which I take to mean tolerance of the positive effects). You then have to taper down because it's just not working anymore.

I think that's what you mean by tolerance, but it is slightly important to remember that "tolerance" means tolerating individual effects. That's why if you tolerate the anxiolytic effects, that can be great for tinnitus because you're no longer taking it to get zonked out of your brain. The best-case scenario is that you end up tolerating all the negative side effects, but it still has a positive impact.

I'm currently on Clobazam (a lesser-known benzo) on the advice of a neurologist. While I'm at a pretty high dose (60 mg), I seem to be in that situation. Initially, I built up a rapid tolerance, but a dose of 60 mg all at once seems to help significantly and has stabilized at that dose for some time with only mild, temporary side effects. However, I am very, very cautious about building up further tolerance and am monitoring the dosage carefully. You really have to do the same with any benzo. If you reach a point where you have to take enormous amounts of Clonazepam, you may need to taper. On the other hand, I've seen epileptics with myoclonia get up to 20 mg of Clonazepam, which is an enormous dose, but it works for them.

Brains are weird.

 

[Cmspgran]

Some people will build a tolerance to various aspects of the drug, but that's not the same thing as addiction (see, for example, this concise paper). I'm glad Dr. De Ridder made that point. The "benzos are poison" refrain you constantly hear is a major bugbear of mine in relation to tinnitus treatment.

If you're taking benzos to "feel good" for psychological issues, it's easy to see how addiction can develop, as De Ridder said. However, it's a different story with brain issues. People with severe status epilepticus can take very high doses of benzodiazepines for extended periods without turning into drug addicts.

The same is true for tinnitus. Nobody wants to be on a "brain drug" at all. But if it's working to actually lower your tinnitus (in the same way it can abate seizures), why wouldn't you use it? Often people tolerate the sedating and anxiolytic effects of clonazepam fairly rapidly. They may be able to take it consistently at a stable dose to lower their tinnitus. Conversely, they may start tolerating the anti-tinnitus effects over time (in the same way epileptics become refectory to benzos). They then have to taper, as Dr. De Ridder pointed out, or alternatively try cycling through benzos.

The point is, it's a totally different situation for people who are popping Xanax for anxiety and end up getting addicted because they need more and more to "feel good" because that effect of benzos (in simplified terms) is rapidly tolerated. I don't mean to minimize that situation, and benzodiazepine withdrawal is absolute hell (and can make tinnitus worse). However, the fearmongering about benzos in relation to that scenario often means that people don't understand the usefulness of that class of drugs in a neurological context.

I think this is one of the most sensible posts I've read on benzodiazepine use and the reality of the severe symptoms people face, weighed against the benefits that medications like Clonazepam can provide. For many, the choice comes down to being unable to function or go to work, which was certainly the case for me. I realize that at some point, I'll need to taper off, and I plan to do an extremely long, slow, and gradual taper. However, for now, a low dose of clonazepam, coupled with a low dose of Gabapentin, has been a lifesaver for me. It has allowed me to keep working, resume my social life (albeit quietly), and continue with everyday activities.

Half of the UK population is on SSRIs, and coming off them after prolonged use isn't exactly a smooth process. They're handed out almost like candy at GP surgeries. Like anything in life, it's about weighing calculated risks versus benefits, and the "rat poison" narrative is unfair. 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.

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).