Klonopin Withdrawal


Klonopin (clonazepam) is a member of the benzodiazepine class of drugs. Klonopin is a Schedule IV controlled substance, meaning that it has legitimate medical uses—such as managing panic disorder and certain types of seizures—but also has a known potential for abuse and dependence.1,2 Clonazepam is one of the top 5 most prescribed benzodiazepines in the United States, and one of the most commonly diverted for illicit, nonmedical use.3

Klonopin’s Mechanism of Action

Benzodiazepines like Klonopin work by potentiating the inhibitory activity of a neurotransmitter in the brain known as gamma-aminobutyric acid (GABA).4,5 Inhibitory neurotransmitters modulate or slow down the firing rates of other neurons in the brain and spinal cord when active.

This mechanism of action accounts for the therapeutic or medicinal effects of benzodiazepines, but it also helps to contribute to the development of physical dependence and the subsequent phenomenon of withdrawal when these substances are no longer used after a period of consistent, if not prolonged or excessive use.5,6

Physical Dependence on Klonopin

Physical dependence develops as the body acclimates to the persistent presence of the substance in question. Though the neurochemical and structural/morphological changes that underlie such a phenomenon are complicated, it can be thought of as the body making adjustments to maintain a state of balance or homeostasis in its functioning. When an individual begins to use a drug that disrupts the body’s natural set point, it may readjust to account for the prolonged influence of the substance.

Consistent use of a drug like Klonopin results in a move toward increased inhibitory GABA signaling in the brain. After a time, it’s abrupt discontinuation can result in a temporary swing toward a pathologically excitatory state—complete with the characteristically unpleasant symptoms of withdrawal.

Some individuals who misuse prescription drugs like Klonopin will take far higher-than-recommended doses of the drug, take it more frequently than prescribed, and may combine it with other drugs—potentially hastening the development of dependence and worsening/complicating the associated withdrawal syndrome.8

 

Klonopin Withdrawal Symptoms

The American Society for Addiction Medicine (ASAM) asserts that a significant withdrawal syndrome is most likely to develop after discontinuation of a sedative medication (such as Klonopin) after 4-6 months of consistent use at therapeutic doses, or after 2-3 months of high dose (2-3 times above therapeutic range) use, though some withdrawal effects may be experienced at any point that physical dependence has developed.6

Withdrawal will vary in terms of timeline and severity depending on several factors such as the amount of the drug being regularly used, the overall length of time that it has been consistently used, and the duration of action of the drug in question.6 When it comes to a medication like Klonopin—a relatively longer-acting benzodiazepine—withdrawal might be expected to develop within 5 days and peak anywhere from 1 to 9 days after the last use, according to ASAM.7 Other individual factors such as the presence and severity of significant mental health issues (e.g., anxiety disorders), advanced age, and whether Klonopin was used Klonopin in conjunction with alcohol or other drugs (such as opioids) can attentionally influence the magnitude and character of withdrawal.7

Withdrawal from any benzodiazepine can present significant challenges due to certain risks—such as that of seizure development, which may require intensive medical management to keep a patient safe. Other potential symptoms of Klonopin withdrawal include:1,8,9

  • Increased anxiety.
  • Agitation.
  • Insomnia.
  • Cravings.
  • Poor concentration.
  • Confusion.
  • Hallucinations.
  • Delirium.
  • Psychosis.
  • Dizziness.
  • Hyperreflexia.
  • Muscle cramping.
  • Problems with movement.
  • Slurred speech
  • Headaches.
  • Fever.
  • Sweating.
  • Increased heart rate and blood pressure.
  • Tremors.
  • Convulsions.

Medical Detox

Many treatment programs will incorporate a supervised, medically managed withdrawal process, or a medical detox at the start of the recovery process. As the acute withdrawal syndrome associated with benzodiazepines can be quite unpleasant and, in some cases, present some risks to an individual’s health, a supervised detox protocol is commonly sought to keep people in early recovery as comfortable and safe as possible. Medically managed Klonopin withdrawal might include:9

  • A tapering schedule: Barring instances of just a few days of use, benzodiazepine withdrawal will likely proceed with a tapered schedule rather than an abrupt discontinuation of the medication. A slow, controlled tapering may take place with Klonopin itself over a few weeks to a few months to minimize the impact of acute withdrawal. Another long-acting benzodiazepine—such as chlordiazepoxide (Librium)—may also be substituted prior to initiating this taper.
  • Additional medical & behavioral management: In some cases, individuals may experience symptoms that require additional anticonvulsant therapy or other issues that require medical intervention. A variety of therapeutic approaches (e.g., cognitive-behavioral therapy, etc.) may also be utilized to complement the medication taper already underway. Such techniques can help to manage any negative thoughts about Klonopin discontinuation, as well as provide non-pharmacologic alternatives for issues such as anxiety and sleep disruptions.
  • Treatment of any associated co-occurring conditions: As psychiatric comorbidities (e.g., anxiety disorders, other mood disorders) may be present in individuals with a sedative, hypnotic, or anxiolytic use disorder (the clinical term for an individual with a substance use disorder as a result of Klonopin abuse), these issues will need to be simultaneously addressed as recovery efforts begin and detox proceeds.

Ideally, withdrawal management will serve as only the initial stage of recovery for any individual with any type of substance use disorder. One goal of the detoxification process is to ready a patient for more comprehensive addiction treatment.9 Successful withdrawal management, while important in early recovery, is not a “cure” for a substance use disorder.

Whether part of an inpatient/residential or outpatient rehabilitation program, ample counseling or therapy sessions, as well as a solid plan of aftercare and relapse prevention efforts, can help people successfully adjust to life without compulsive benzodiazepine use to better maintain long-term recovery.8,9

References

  1. U.S. Department of Health and Human Services—Food & Drug Administration. (2013). Labelling-Medication Guide: Klonopin.
  2. United States Drug Enforcement Administration. (n.d.). Drug Scheduling. United State.
  3. Drug Enforcement Administration—Diversion Control Division. (2019). Benzodiazepines.
  4. Soyka, M. (2017). Treatment of Benzodiazepine Dependence. New England Journal of Medicine; 2017; 376:1147-1157.
  5. Griffin, C. E., 3rd, Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2013). Benzodiazepine pharmacology and central nervous system-mediated effectsThe Ochsner journal13(2), 214–223.
  6. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  7. Herron, A. J. & Brennan, T. K. (2015). The ASAM Essentials of Addiction Medicine, Second Edition. Philadelphia: Wolters Kluwer.
  8. National Institute on Drug Abuse. (2018). Prescription CNS Depressants.
  9. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.


About The Contributor

Scot Thomas, M.D.
Scot Thomas, M.D.

Senior Medical Editor, American Addiction Centers

Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More


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