Brief Answer:
Please see details below.

Detailed Answer:
Hi,

I read your query and do understand your difficulty that you are facing in stopping clonotril.

Clonotril is Clonazepam which is a benzodiazepine used as a sedative and anxiolytic. Clonazepam is a drug which can cause withdrawal symptoms when one tries to stop. The symptoms that you have mentioned are known withdrawal symptoms of benzodiazepines. Although the dose of 0.25 mg/day is a very mild dose, you are suffering form withdrawal symptoms because you have been taking it for 7 long years. Another thing to keep in mind is that the symptoms are both physiological (due to the drug itself) and psychological (feeling that you can't do without the drug).

I would have liked to know the reason for which you started clonazepam. When it is taken for anxiety, the symptoms of anxiety occurs as rebound which makes it difficult to stop clonazepam. In that case it is important to treat the primary cause, like anxiety disorder or depression. If the primary cause is not treated, the symptoms persists and it becomes difficult to stop clonazepam. Depending on the symptoms, medication like mirtazapine or sertraline would help.

Since, you have been taking it for very long time, I would suggest tapering the medicine very gradually. Initially, it would be advisable to reduce it to half 0.125 mg for 2-3 weeks. If you are able to tolerate it without any problem, then you can start taking 0.125 mg every alternate day for another 2-3 weeks and then stop. In case you still have anxiety symptoms, mirtazapine can be started at dose of 7.5 to 15 mg /day as it would take care of anxiety as well as sleep.

In addition, you should also start exercising daily as that will help you relax. Avoid day time sleeping and minimize your intake of tea/coffee if you use it.

Hope, I was able to answer your query. In case of any further questions, please feel free to ask. I would be glad to offer help.

Best wishes and happy quitting,

Dr. Sunil Gupta

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Brief Answer:
Please see details below.

Detailed Answer:
Dear Mr. XXXXXXX

Thanks for following up and updating me on your condition. It a good thing that you are doing exercise daily and maintiaing a regular sleep-wake cycle.

From what you have mentioned, it seems that you are quite prone to worry about certain situations. In addition you are also having certain symptoms like forgetfulness which implies impaired attention ad concentration. These symptoms suggest that you do have underlying anxiety.

Your clonazepam should have been stopped long back. It takes care on anxiety only as a symptom and doesn't do anything for the underlying disorder as such. it is usually recommended for short periods of time. I would suggest that you start a medicine for the anxiety together with tapering off clonazepam as advised in my last reply.

My first option for medication would be a selective serotonin reuptake inhibitor like sertraline (starting at 50 mg/day). It will help with your anxiety symptoms and improve attention and concentration.

I hope that answers your query. Please don't hesitate to ask any further query that you might have.

Best wishes,

Dr. Sunil Gupta

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