QUESTION: I’m seeking your advice for a very motivated patient to taper off his ambien. He’s been using Ambien for approximately 5 years, so I know it will need to go slow. He uses 5 mg before bed and another 5 mg when he wakes up during the night. I’ve tried gaba, theanine, glycine, naturalcalm, and slow and quick release melatonin to no avail. I’m considering baclofen as a step down and wanted to ask how you would proceed with the taper of ambien and starting the baclofen…. 10mg qhs in place of the 5 mg ambien before bed….?
Or more? Any contraindications to using both the baclofen and ambien at night such as 10mg baclofen before bed and 5 mg ambien when he wakes up in the night?
ANSWER: I’d do the following (only watching for hyper-somnolence or AM grogginess as a reason to speed up the Ambien taper):
Keep the natural meds going. Add Taurine 1 Gram BID Then on a schedule of 2-4 weeks per each taper (up to 8 weeks if things need to go slower) do the following:
STEP DOWNS:
- Ambien – 5mg bedtime and 5 mg at night
Baclofen – 10 mg at dinner and 10 mg at bedtime - Ambien – 2.5 mg bedtime and 5 mg at night
Baclofen – 10 mg at dinner and 10-20 mg at bedtime (20 if the 2.5 Ambien seems not enough) - Ambien – None at bedtime and 5 mg at night
Baclofen – 10 mg at dinner and 10-20 mg at bedtime (20 if trouble getting to sleep) - Ambien – None at bedtime and 2.5 or none as needed
Baclofen – 10 at dinner and 10-20 mg at bedtime
* As this progresses add in 5-20 mg Melatonin as needed for sleep induction.