Should I opt for a titration taper plan?

[[gi...]]

Hello everyone,

 

I am new to the forum, a few days ago I published my post in the "General Taper Plans" forum section and received several very valuable responses from some members, some very experienced that I will surely find again in this section of the forum.

 

The pianogirl forum administrator suggested that I publish this new post in this section because it is more appropriate and told me that there are people well prepared to advise me here.

 

The fact is that of the three existing plans the Titration Taper Plan is the one that I consider most appropriate to my circumstances, although I have some doubts, for example I am not sure if my doctor, although it is very open and dialoguing, would be willing to approve and collaborate .

 

As you can see in my signature I take 6mg daily of Klonopin distributed in 3 daily doses of 2mg, I am not sure of it but I am almost convinced that at the beginning of the process, respecting the norm of not exceeding 10% could reduce 0.5mg every 2 weeks directly from my pills until I reach a daily dose of 3.5mg. Of course there is also the possibility of starting the Titration Taper Plan from the beginning of the process because this drug is very potent, I was just weighing the possibility of saving some time.

 

In the middle of next month I have a visit with my doctor, I hope she accepts the Titration Taper Plan. Even so, I have several doubts about the operation and mechanism of this plan, although as I mentioned earlier some members of the forum already answered me in the "General Taper plans" section there are some things that I don't understand very well yet.

 

I would be grateful if you could explain to me in the most understandable way possible how I should apply the Titration Taper Plan to my specific needs, that is, taking into account my personal doses of Klonopin, if it is more successful to start the method from the beginning or start when I have reached the daily dose of 3.5mg after reducing directly from the pills.

 

I need to know which daily microdose would be adequate to complete the process in about a year. What tools do I need to prepare the daily solution, how to prepare it, whether or not it needs refrigeration, with what liquids the mixture is made, you must take into account that I am allergic to milk, so I have been able to read in my case it should be used propylene glycol. How the ingredients are mixed, how the syringe is prepared, how should I take it ...

 

If my doctor finally decides not to provide support, I have prepared a "General Taper Plan" for the reduction from the Klonopin pills themselves, with a percentage of 10% every 2 weeks and in some cases I will need to make a combination with the drops of Klonopin brand itself. By the way the minimum dose of each of these drops is 0.1mg, so if I choose this method when I reach the dose of 1mg I can only make 0.1mg reductions: 0.9, 0.8, 0.7, 0.6, 0.5, 0.4, 0.3, 0.2 and 0.1. You think it would be enough or there would be a possibility to mix the drops to make the doses a little smaller.

 

I know there are many questions, I'm sorry. If you help me together, I will be infinitely grateful from the depths of my heart. I am from Spain, here it is time to go to bed, I read you tomorrow.

 

Your friend

[[Li...]]

Hello, G and welcome to the forum.  Thank you for sharing such a thoughtful and thorough summary of your situation.  It is very helpful!

 

You are fortunate to live in a country where a prescription oral solution of clonazepam is available. In my opinion, using a liquid that has been tested for safety, efficacy, stability, etc. by the manufacturer and approved by the appropriate regulatory agency is a wise choice (if you decide to use liquid titration).

 

What is the lowest strength tablet of clonazepam available in your country?  Is it 0.5mg?  I ask because in some countries, lower strength tablets are available (e.g. 0.25mg and 0.125mg). 

 

Would your physician be willing to support your use of a combination of prescription tablets and prescription liquid to taper?  There are members here who have tapered successfully using such an approach.

 

[[bu...]]

It's all a very simple process.

 

You make a liquid by combining 3 ingredients, klonopin, PG, and water.  Its about as complicated as adding cream and sugar to your morning coffee.

 

Use a ratio of 1mg K : 2ml PG :9ml water.  I emphasize ratio, because you can make any quantity, using that ratio.  A good practice is to prepare a 10-14 day supply.  At 2mg current dose, that would be 10mg + 20ml PG + 80ml water.

 

That ratio will give you a finished solution of .1mg = 1ml.  That will allow you to easily measure doses/reductions to .01mg.

[[gi...]]

It's all a very simple process.

 

You make a liquid by combining 3 ingredients, klonopin, PG, and water.  Its about as complicated as adding cream and sugar to your morning coffee.

 

Use a ratio of 1mg K : 2ml PG :9ml water.  I emphasize ratio, because you can make any quantity, using that ratio.  A good practice is to prepare a 10-14 day supply.  At 2mg current dose, that would be 10mg + 20ml PG + 80ml water.

 

That ratio will give you a finished solution of .1mg = 1ml.  That will allow you to easily measure doses/reductions to .01mg.

 

Hi builder,

 

Are you sure that the water will not spoil in 10-14 days? I thought you had to prepare the mixture every day.

 

On the other hand, in the example you have given 100ml each ml is equivalent to 0.1mg, how do you reduce it to 0.01mg? I did not quite understand it very well.

 

[[gi...]]

Hello, G and welcome to the forum.  Thank you for sharing such a thoughtful and thorough summary of your situation.  It is very helpful!

 

You are fortunate to live in a country where a prescription oral solution of clonazepam is available. In my opinion, using a liquid that has been tested for safety, efficacy, stability, etc. by the manufacturer and approved by the appropriate regulatory agency is a wise choice (if you decide to use liquid titration).

 

What is the lowest strength tablet of clonazepam available in your country?  Is it 0.5mg?  I ask because in some countries, lower strength tablets are available (e.g. 0.25mg and 0.125mg). 

 

Would your physician be willing to support your use of a combination of prescription tablets and prescription liquid to taper?  There are members here who have tapered successfully using such an approach.

 

Hi Libertas,

 

That's right, here in Spain the oral solution of Clonazepam is available by prescription. Each bottle contains a total of 2.5mg, each drop equals 0.1mg.

 

As for the tablets there are two presentations, bi-slotted tablets of 2mg and mono-slotted tablets of 0.50mg. This means that the 2mg tablet can be divided into 4 portions of 0.50mg, and the 0.50mg tablet can be divided into 2 portions of 0.25mg. They are very easy to divide simply with your fingers.

 

I have a good relationship with my doctor, besides he has an open and dialogant character. I think my doctor would be willing to prescribe tablets and fluids to decrease.

 

 

 

 

[[bu...]]

 

Hi builder,

 

Are you sure that the water will not spoil in 10-14 days? I thought you had to prepare the mixture every day.

 

Absolutely!  You have 3 ingredients, none of which are perishable.  Benzos are some of the most stable compounds on the planet, water really has an infinite shelf-life, and PG lasts for years.  There are Rx benzo liquids with PG that have a mfgr's shelf life 3 years.  Making a new batch every day is silly, labor intensive, and wasteful.

 

On the other hand, in the example you have given 100ml each ml is equivalent to 0.1mg, how do you reduce it to 0.01mg? I did not quite understand it very well.\

 

If your liquid is .1mg = 1ml, and you measure out .1ml, that's .01mg.  Actually, you can pretty easily measure out to .01ml which would be .001  (one/thousandth) mg, but that really isn't usually necessary.

 

[[/i]

[[gi...]]

 

Hi builder,

 

Are you sure that the water will not spoil in 10-14 days? I thought you had to prepare the mixture every day.

 

Absolutely!  You have 3 ingredients, none of which are perishable.  Benzos are some of the most stable compounds on the planet, water really has an infinite shelf-life, and PG lasts for years.  There are Rx benzo liquids with PG that have a mfgr's shelf life 3 years.  Making a new batch every day is silly, labor intensive, and wasteful.

 

On the other hand, in the example you have given 100ml each ml is equivalent to 0.1mg, how do you reduce it to 0.01mg? I did not quite understand it very well.\

 

If your liquid is .1mg = 1ml, and you measure out .1ml, that's .01mg.  Actually, you can pretty easily measure out to .01ml which would be .001  (one/thousandth) mg, but that really isn't usually necessary.

 

[[/i]

 

Then you are absolutely right in the world, it is much more practical to prepare a batch every 10-14 days than to do it daily. As for the mg contained in the liquid I think I understood, it all depends on the concentration of benzo in the water and measure the dose you want to obtain.

 

 

[[gi...]]

Hello, G and welcome to the forum.  Thank you for sharing such a thoughtful and thorough summary of your situation.  It is very helpful!

 

You are fortunate to live in a country where a prescription oral solution of clonazepam is available. In my opinion, using a liquid that has been tested for safety, efficacy, stability, etc. by the manufacturer and approved by the appropriate regulatory agency is a wise choice (if you decide to use liquid titration).

 

What is the lowest strength tablet of clonazepam available in your country?  Is it 0.5mg?  I ask because in some countries, lower strength tablets are available (e.g. 0.25mg and 0.125mg). 

 

Would your physician be willing to support your use of a combination of prescription tablets and prescription liquid to taper?  There are members here who have tapered successfully using such an approach.

 

Hi Libertas,

 

That's right, here in Spain the oral solution of Clonazepam is available by prescription. Each bottle contains a total of 2.5mg, each drop equals 0.1mg.

 

As for the tablets there are two presentations, bi-slotted tablets of 2mg and mono-slotted tablets of 0.50mg. This means that the 2mg tablet can be divided into 4 portions of 0.50mg, and the 0.50mg tablet can be divided into 2 portions of 0.25mg. They are very easy to divide simply with your fingers.

 

I have a good relationship with my doctor, besides he has an open and dialogant character. I think my doctor would be willing to prescribe tablets and fluids to decrease.

 

Hi Libertas, are you studying a plan for me? Thanks.

 

[[Li...]]

Hello, G.  Have you made a decision about using a prescription liquid versus making your own? L

[[bu...]]

 

Then you are absolutely right in the world, it is much more practical to prepare a batch every 10-14 days than to do it daily. As for the mg contained in the liquid I think I understood, it all depends on the concentration of benzo in the water and measure the dose you want to obtain.

 

You are correct!  The ratio (conversion factor) mgs to mls is at your discretion.  For what should be obvious reasons, a ratio of  .1mg=1ml, or .01mg = 1ml is the simplest, because there really is no math on the conversion.

 

BTW,  the term "benzo in the water" bothers me.  You can NOT make a benzo solution with just water.  You must start with a solvent like alcohol (vodka) or propylene glycol.

[[gi...]]

 

Then you are absolutely right in the world, it is much more practical to prepare a batch every 10-14 days than to do it daily. As for the mg contained in the liquid I think I understood, it all depends on the concentration of benzo in the water and measure the dose you want to obtain.

 

You are correct!  The ratio (conversion factor) mgs to mls is at your discretion.  For what should be obvious reasons, a ratio of  .1mg=1ml, or .01mg = 1ml is the simplest, because there really is no math on the conversion.

 

BTW,  the term "benzo in the water" bothers me.  You can NOT make a benzo solution with just water.  You must start with a solvent like alcohol (vodka) or propylene glycol.

 

It is clear, understood. Thanks builder!

 

[[gi...]]

Hello, G.  Have you made a decision about using a prescription liquid versus making your own? L

 

Hi Libertas,

 

Actually I do not care because my doctor will approve both if I decide to do a Titration Taper Plan on my own or if she has to prescribe me the liquid. In any case I will have to take control of the process because my doctor is in the discipline of general medicine, she is not a psychiatrist or expert in reducing benzos although she can prescribe them to me.

 

The pianogirl administrator recommended me to come to this section of the forum, she told me that there are very experienced people here who can advise me on a Titration Taper Plan appropriate to my needs.

 

As I mentioned in my previous posts I am currently taking 6mg of clonazepam divided into three 2mg doses.

 

Clonazepam tablets available in my country are 2mg (divisible in 4 servings of 0.50mg) and 0.50mg (divisible in 2 servings of 0.25mg). The liquid is available in 2.5mg bottles and each drop equals 0.1mg.

 

I want to make a Titration Taper Plan because the forum members who have used this procedure comment that it is the mildest way to reduce benzos without experiencing withdrawal symptoms. This would be very convenient for me considering that the drug I am taking is quite potent.

 

I must confess that sometimes I get a little mess with the numbers, especially when I see them expressed in those tiny amounts of mg. or ml I want to make it clear that I am not clumsy but sometimes these figures create confusion, I suppose it is a matter of familiarizing yourself with them.

 

Instead of making more abrupt cuts of the tablets every 2 weeks, it seems that the benefit of a liquid solution lies in a more uniform daily decrease.

 

I do not know if the bottles available by prescription from Clonazepam would serve to carry out my Titration Taper plan until the end. If this were possible, I would personally prefer it, I suppose it would be more convenient and practical.

 

That said, I do not want to condition you and I would appreciate it if you elaborate a personal plan, indicating the specific guidelines to follow and explaining the process of preparing the liquid solution.

 

Many thanks,

g

[[Li...]]

Hello again, G.

 

Builder is the math master for liquid titration so I’ll defer to him.  He also has experience with tapering using a combination of tablets and a prescription liquid.

 

Have you decided if you want to begin with the direct taper method (i.e. pill-splitting) until you get to the 3.5mg total daily dose you indicated in an earlier post?  Given that your total daily dose is relatively high and that you dose multiple times a day, this approach might work well for you.  I’ve included a sample schedule for your consideration below my signature.  The basic strategy is to reduce one of your daily doses by 0.25mg at each step in the schedule.

 

Before I turn the wheel over to builder, I want to emphasize the importance of letting your symptoms be your guide as you taper and adjusting your taper schedule accordingly - as opposed to creating an entire taper schedule up front and expecting that you will be able to follow it from start to finish.

 

Oh, I almost forgot, in case you haven’t already discovered it, there is a new group of folks who are fluent in Spanish at:

 

Bienvenido al grupo Español - Welcome to the Spanish Group

http://www.benzobuddies.org/forum/index.php?topic=228003.0

 

If you need assistance with translation from Spanish to English and vice versa, I’m sure someone there would be willing to lend a helping hand.  Buddie Redevan is the Moderator so you could send him a PM (personal message) for details.

 

Sending all best wishes your way for a successful taper! L

 

Step 0

2.0, 2.0, 2.0 = 6 (three daily doses of 2.0mg each for a TDD of 6 mg)

 

Step 1

1.75, 2.0, 2.0 = 5.75 (4.17% reduction from starting dose)

(hold at the above dose for 10- 14 days or longer if needed)

 

Step 2

1.75, 1.75, 2.0 = 5.5 (4.35% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 3

1.75, 1.75, 1.75 = 5.25 (4.54% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 4

1.5, 1.75, 1.75 = 5 (4.76% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 5

1.5, 1.5, 1.75 = 4.75 (5% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 6

1.5, 1.5, 1.5 = 4.5 (5.26% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 7

1.25, 1.5, 1.5 = 4.25 (5.56% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 8

1.25, 1.25, 1.5 = 4 (5.88% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 9

1.25, 1.25, 1.25 = 3.75 (6.25% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Step 10

1.0, 1.25, 1.25 = 3.5 (6.67% reduction from previous dose)

(hold at the above dose for 10-14 days or longer if needed)

 

Edit: Updated name and location of new Spanish Group.

[[gi...]]

Hi Libertas,

 

I will start reducing directly from the tablets by decreasing 0.5mg every two weeks. I have decided to start with this reduction dose until I reach 3.5mg daily for two reasons. First, at no time will it exceed 10%. Second, I take Escitalopram 10mg for four months prescribed by my doctor, I am doing very well for anxiety since this medication works by modulating serotonin in the brain and it seems that my brain does not produce enough serotonin. I am much better since taking Escitalopram and it was prescribed precisely to help with the withdrawal of Clonazepam. If at any time I notice that I am going too fast I will reduce 0.25mg every two weeks as you propose.

 

I want you to know that I understand that this process is not an exact science, that it should be gradual and that the symptoms should be the main guide.

 

You can pass the information to builder. I will begin to decrease in liquid form from 3.5mg. It is very important that you provide me with all the information related to the preparation of the liquid, if you need refrigeration, tools necessary for its preparation, how the liquid solution is prepared, if I will need a syringe to extract my doses, etc ...

 

In these days that I have been in the forum I have been able to read some builder, he recommends preparing batches every 10-14 days. As for the daily dose of decrease because I really do not know, I prefer to leave it in the hands of builder. In any case, a constant daily dose that allows a mild decrease over an approximate period of one year would be good for me.

 

I really don't know, but I suppose that when you take the liquid doses, a single daily dose will suffice, sure builder will know better. It would also be interesting if you informed builder of the existence in my country of original Clonazepam liquid cans of 2.5 mg each, the concentration is 0.1mg per drop. Maybe builder could rate this option, I don't know.

 

Finally, if my doctor does not accept that I prepare the liquid solution, then I show the continuation of my direct reduction plan from the tablets. Each dose would continue to be maintained for 2 weeks and in some cases it would be a combination of tablets and drops of Clonazepam. I would like you to tell builder to know his opinion.

 

3.5 mg

3.1 mg

2.8 mg

2.5 mg

2.2 mg

2.0 mg

1.8 mg

1.6 mg

1.4 mg

1.2 mg

1.0 mg

0.9 mg

0.8 mg

0.7 mg

0.6 mg

0.5 mg

0.4 mg

0.3 mg

0.2 mg

0.1 mg

 

Many thanks,

g.

[[CA...]]

Wow!  Sounds like you really have this down gianitbo.  I was so confused and clueless at first and am sure I drove a few of the buddies crazy. 

 

I certainly wish you the best and will look forward to you reporting your progress.

 

 

[[gi...]]

Hi CAgirl, your comment made me very funny 

I have not started the process yet but of course I will report on my progress.

Many thanks for your good wishes, I also wish you the best 

 

[[Li...]]

Hello, G!  I am not in communication with builder.  However, he is quite active on this board so it’s likely he will respond to your questions soon. L