TRANXENE WITHDRAWAL AND TAPERING HELP

Benzodiazepines are widely used for a variety of conditions including anxiety and insomnia, but also for muscle tightness, pre-surgical sedation, detoxification from alcohol and the anxiety experienced with cardiovascular or gastrointestinal conditions.

Withdrawal of the drug can result in the receptor becoming hypoactive, producing symptoms worse than what the patient originally sought treatment for. If Benzodiazepines are suddenly stopped or reduced too rapidly, the calcium floods into the cell. This can cause intense withdrawal symptoms and be life-threatening due to the seizure risk. 

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TRANXENE WITHDRAWAL SYMPTOMS MAY INCLUDE:

abdominal pains, aching, agoraphobia, anxiety, blurred vision, body vibrations, changes in perception, diarrhea, distended abdomen, feeling of unreality, flu-like symptoms, flatulence, food cravings, hair loss, heart palpitations, heavy limbs, increased allergies, increased sense of smell, insomnia, lethargy, loss of balance, metallic taste, muscle spasms, nightmares, panic attacks, paranoia, persistent & unpleasant memories, severe headaches, shaking, short term memory loss, sore mouth and tongue, sound & light sensitivity, speech difficulties, sweating, suicidal thoughts, tinnitus, unusually sensitive, fear 

TRANXENE SIDE EFFECTS MAY INCLUDE: 

drowsiness, blurred vision, depression, difficulty in sleeping or falling asleep, dizziness, dry mouth, double vision, fatigue, genital and urinary tract disorders, headache, irritability, lack of muscle coordination, mental confusion, nervousness, tremors, skin rashes, slurred speech, stomach and intestinal disorders, tremor 

TRANXENE ADVERSE REACTIONS: per PDR 

Severe: suicidal ideation, neonatal abstinence syndrome, teratogenesis, neonatal respiratory depression 

Moderate: tolerance, physiological dependence, psychological dependence, withdrawal, amnesia, memory impairment, depression, ataxia, dysarthria, confusion, jaundice, elevated hepatic enzymes, blurred vision, urinary retention, urinary incontinence, hypotension, respiratory depression  

Mild: dizziness, drowsiness, anxiety, fatigue, headache, insomnia, nightmares, irritability, tremor, xerostomia, diplopia, menstrual irregularity, rash 

TRANXENE BOXED WARNING:  per PRD

Chronic obstructive pulmonary disease (COPD), CNS depression, coadministration with other CNS depressants, pulmonary disease, respiratory depression, respiratory insufficiency, sleep apnea

The most serious reactions of clorazepate are CNS depression and respiratory depression. As with other benzodiazepines, clorazepate should not be used in patients with known respiratory depression. Use with extreme caution in patients with severe pulmonary disease or conditions associated with compromised respiratory function or respiratory insufficiency such as sleep apnea or severe chronic obstructive pulmonary disease (COPD). Additionally, avoid coadministration with other CNS depressants, especially opioids, unless no other alternatives are available as coadministration significantly increases the risk for respiratory depression, low blood pressure, and death.

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Per the FDA:

Physical and Psychological Dependence: Withdrawal symptoms (similar in character to those noted with barbiturates and alcohol) have occurred following abrupt discontinuance of clorazepate. Withdrawal symptoms associated with the abrupt discontinuation of benzodiazepines have included convulsions, delirium, tremor, abdominal and muscle cramps, vomiting, sweating, nervousness, insomnia, irritability, diarrhea, and memory impairment. The more severe withdrawal symptoms have usually been limited to those patients who had received excessive doses over an extended period of time. Generally milder withdrawal symptoms have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation of clorazepate should generally be avoided and a gradual dosage tapering schedule followed.

Caution should be observed in patients who are considered to have a psychological potential for drug dependence. 

Evidence of drug dependence has been observed in dogs and rabbits which was characterized by convulsive seizures when the drug was abruptly withdrawn or the dose was reduced; the syndrome in dogs could be abolished by administration of clorazepate.

 References: 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/017105s076lbl.pdf

https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/017105s076MedGuide.pdf

https://www.tandfonline.com/doi/abs/10.3109/00952998209002608

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