support for tappering from 0.25 clonazepam

[[ji...]]

Hi,

 

I had used benzodiazepines in the past. When I stopped, and after months of occasional use, I felt better. Last May I had to start again due to an emergency. I want to quit slowly now from 0.3-0.25 of clonazepam where I am now. I'm thinking to start switchingto diazepam tommorow and taper from there. Thanks for the help.

[[Pa...]]

Hello jinjima, Welcome to BenzoBuddies!

 

We're glad you found us, may I ask, did you experience any withdrawal symptoms the last time you stopped taking the benzo?  Just wondering if you're one of the lucky ones who can quit these drugs without problems. 

 

We can certainly help you taper from the Clonazepam, is there a reason why you want to make the switch to Diazepam, there are many who can taper directly from it.  Do you have a Dr willing to prescribe the Diazepam? 

 

Sorry for all of the questions, we like to know as much as we can so we can make suggestions.  For starters though, you can take a look at our Planning your Taper board to see what methods we support and when you're ready, feel free to start a thread on the Withdrawal Support (during your taper) board to get support from our other members.

 

Let us know what we can do for you.

 

Pamster

 

[[ji...]]

Hi Pamster

 

Thanks for accepting me. Many people say it's  easier with diazepam.  It comes in 2 mg  pills so the pill can be  cut into halves  or quarters. You can't do this with clonazepam drops. In order to go down to 0.25 I have  to alternate between  0.20 and 0.30.Alternate is like a roller coaster,  isn't it?

[[Pa...]]

Yes, Diazepam is better because it's longer acting and the pills come in smaller sizes, however most experience side effects from the Valium at first such as depression and sedation.  If you can power past these things then you'll do fine.  Are you going to use the Ashton manual for your guide then? https://www.benzo.org.uk/manual/bzsched.htm

 

You're also correct that a slow steady taper is best, no roller coasters but our members get very creative, they crush and weigh their dose, they get a compounded version or a liquid version or they use liquid titration.  Whatever works best for you is what we'll support.

[[sh...]]

Hi Pamster

 

Thanks for accepting me. Many people say it's  easier with diazepam.  It comes in 2 mg  pills so the pill can be  cut into halves  or quarters. You can't do this with clonazepam drops. In order to go down to 0.25 I have  to alternate between  0.20 and 0.30.Alternate is like a roller coaster,  isn't it?

Welcome to BenzoBuddies Jinjima!

Good to hear that you already managed to lower your clonazepam to a nice, low dose.  Some people do switch over to Valium when they can no longer split their clonazepam to smaller pieces toward the end of their taper. However, some people succeed by using a scale and measure their pills after shaving, cutting a small piece off of their clonazepam. Perhaps before you make the transition to valium consider using a scale if that is available to you.

[[ji...]]

Thanks  for your replies.  I was thinking of a gradual  crossover.  Keeping at first the 2  drops  at bedtime and adding 2 x 0.5 of diazepam during the day. That  makes it 5 mg equivalent in total right? Is this mixing bad or dangerous? If this works, I could substitute each drop of clonazepam with 2 mg of diazepam. I'mean also on fluvoxamine and I take 2mg circadian at night. I'be tapering fluvoxamine  too. Maybe, it'seems not a good idea to taper everything at the same time. What do you think? Thanks

 

 

 

[[sh...]]

Jinjima,

The link below, should take you to the Ashton Manual where the crossover from Clonazepam to Valium is explained. Everyone is different and react differently to changes.

https://www.benzo.org.uk/manual/bzsched.htm#s6

Please share your thoughts and experiences with your BenzoBuddies on the different posting boards.

Since you are planning to taper from multiple medication it is a good idea to discuss you plans with your prescribing physician or pharmacist.

 

 

[[Pa...]]

jimjima, is your Clonazepam in liquid form?

[[ji...]]

Yes it is. This is why I'm struggling to taper. From 3 drops (0.10 each, 0.30 total) at bedtime, I took for more than a week the following scheme: 2 days 3 drops, 1 day 2 drops. So I tapered down to 0.266. Now I alternate between 0.30 and 0.20 to take the average of 0.25. But it's not the correct way. This is why I'm considering to crossover gradually to diazepam which comes in pills of 2 mg. The other issue is that I want something for the day. I could take 0.5 or 1 mg diazepam during the day to take the edge off. I can't do this with the clonazepam drops

[[Pa...]]

Liquid titration is a great way to taper, what about adding your drops to water and tapering this way?  I've seen other members dilute their compounded solutions in order to taper slower.  This would also allow you to take additional doses during the day to counter inter-dose withdrawal.

 

Titration FAQs

[[ji...]]

Thank you Pamster,

 

I read the info but I can see how can I split 2 tiny drops. I already add the drops to a little water. It's very little, should I mix with a hand mixer? Anyway it sounds difficult. The precision scale and the diazepam pills looks easier. May I ask about those scales? What cost range should they be to do the work. For instance I found some ssupposing to weigh down to 0.01 and they cost 15-30 euros (almost same amount in $). Are they any good or we need more expensive scales to do the job? And another question please. You say that most experience side effects from the Valium at first such as depression and sedation, Is this transitional? Thank you

[[Pa...]]

Do you know the Diazepam equivalent to your dose of liquid Clonazepam, does the medical professional you're working with for the crossover know, I'd be interested since I don't have any idea.

 

I've heard many members use a Gemini scale purchased through Amazon for around $20.00, they don't have to be lab accurate because when members get down to very low doses, they'll weigh maybe 10 pills at a time then take an average.

 

I've heard for most the switch to Valium and the side effects it brings is temporary but some it isn't and they have to switch back.

 

If you don't mind, I'd still like to pursue a liquid titration, I'd like to ask some other members to chime in just in case they can make it sound easier for you.  I hate to see you crossover when it may be possible to taper directly from it.

[[ji...]]

Thanks,

I  just asked another member at another post how she does it

[[Pa...]]

I just answered my question about what dose you're on, you state in the subject title it's .25 mgs, sorry about that. So the equivalent of .25 mgs of Clonazepam is 5 mgs of Valium, right?

 

Just saw your post, I plan to ask around too. 

[[ji...]]

Yes, that correct, the equivalent is 5mg diazepam. You guys are very helpful, that's fantastic

[[Pa...]]

I see you're working with Libertas on the other thread, this is very good news! 

[[Li...]]

Hello, jinjima.  Please look below my signature for my first pass at your case history.  Does this look right to you? Libertas

 

Benzodiazepine: clonazepam

 

Drug formulation: prescription oral solution (Rivotril), 2.5mg/1mL

 

1mL = 25 drops = 2.5mg clonazepam

25 drops = 2.5mg clonazepam

1 drop = 0.1mg

 

Initial taper plan: Started oral solution in early March. Took 8, 6, 5, 4 and finally 3 drops. Cuts were about at every 10-20 days.

 

Dose History from early March 2020 to mid-May 2020:

 

8 drops = 0.8mg of clonazepam

6 drops = 0.6mg

5 drops = 0.5mg

4 drops = 0.4mg

3 drops = 0.3mg

 

Reduction History from early March 2020 to mid-May 2020:

 

.8 -> .6 = a 25% reduction

.6 -> .5 = a 16.67% reduction

.5 -> .4 = a 20% reduction

.4 -> .3 = a 25% reduction

 

Reduction Summary:

 

.8 -> .3 = a 62.5% reduction in dose over approximately 2 months

 

Observation:

 

You have been able to make large reductions in dose from a very potent benzodiazepine in a relatively short time period.  However, it appears you cannot sustain such large reductions moving forward (fyi - this is not uncommon).

 

Questions:

 

Are the withdrawal symptoms you are experiencing at 0.3mg tolerable?

 

If your withdrawal symptoms at 0.3mg are not tolerable, what dose were you taking the last time they were tolerable?  When were you taking that dose?  (From what date to what date?)

 

[[ji...]]

As I told you, I alternate between 0.30 and 0.20. I think at 0.30 they were marginally tollerable. At 0.4 better

[[ji...]]

I can't remember when the exact dates when I cut down. But generally, at 0.4 I was ok

[[Pa...]]

If I were in your shoes, I would:

 

(1) Stop alternating between 0.2 and 0.3mg.  Take 0.3mg for a few days to see if symptoms stabilize.

 

(2) If symptoms don’t stabilize and you're still less than a few weeks out from when you were at 0.4mg, you could consider an updose ... but there is no guarantee that this will work.

 

(3) Use the time while holding to do research.  Contact the manufacturer (if it’s brand Rivotril then the manufacturer is Roche) or consult with a trusted, knowledgeable pharmacist about whether or not it would be safe to dilute your Rx oral solution with water.

 

If so, what ratio could you use.  For example, would it be ok to put 1 drop of Rivotril (0.04mLs of liquid or 0.1mg of drug) in 9.96mLs of water to yield a liquid with a concentration of 0.01mg/mL?

 

Or, you could proceed as you planned and crossover to Valium. 

 

 

 

 

[[ji...]]

I will do as you say. I ll go back to 0.30 and if needed, to 0.4. From there, I ll see my options again. Thank you for telling me that it''s not uncommon to face unsurmountable difficulties  when it comes down  to such low doses. I didn't  expect  this. I didn't  have  major problems from 1 mg to 0.3-0.4 mg. I can'tell believe  that this happens  now. Do you  know why this happens?

[[Pa...]]

I've seen many members have difficulty when they get to the lower doses, they slow it down to keep functioning.  I'm not sure why it happens for some people and not others, there is so much about this process that's unpredictable and frustrating, I'm sorry you're facing this.

 

There is much healing to be done when you're completely off of the drug, I want to prepare you for this as well. 

 

Please keep us posted how you're doing, we'll help you figure out your taper from here when you hopefully stabilize.

[[Li...]]

Hello again, jinjima.

 

(1) The question of why individuals discover they need to make increasingly small reductions in dose as they near the end of their tapers is an intriguing one.

 

You might find the article below of interest, especially the section titled Neurobiology of withdrawal and its management. Lest you are wondering what an article about tapering SSRIs (antidepressants) has to do with benzodiazepines — the concept of hyperbolic dose reduction described by the authors is derived from Professor Ashton’s work on benzodiazepine withdrawal.

 

(2) I hope you will follow Pamster’s suggestion about researching the possibility of diluting your prescription oral solution of clonazepam further with water.  If it’s safe to do so, this would allow you to make increasingly small reductions in dose as you complete your taper.  I’ve included a citation and link below you might find of interest, see the Preparation section.

 

Citation 1:

Tapering of SSRI treatment to mitigate withdrawal symptoms

Horowitz, Mark Abie and Taylor, David (2019)

The Lancet Psychiatry, Volume 6, Issue 6, 538 - 546

Accessed online 12May20 at:

https://www.mentalhealthexcellence.org/tapering-of-ssri-treatment-to-mitigate-withdrawal-symptoms/

 

Horowitz is completing (or by now may have completed) his psychiatry training in Sydney, Australia.  Before that he earned a PhD in the neurobiology of antidepressants at the Institute of Psychiatry at King’s College, London. His research work focuses on pharmacologically informed ways of tapering patients off of medication. Taylor is a Director of Pharmacy and Pathology at the Maudsley Hospital and Professor of Psychopharmacology at King's College, London.

 

Citation 2:

Neonatal Medication Monograph on Clonazepam

King Edward Memorial Hospital & Perth Children’s Hospital Neonatology

Department of Health, Western Australia, 2019

Accessed online 12May20 at:

https://www.wnhs.health.wa.gov.au/~/media/Files/Hospitals/WNHS/For%20health%20professionals/Clinical%20guidelines/NCCU/Drug%20Protocols/Clonazepam.pdf

[[ji...]]

Thank you Libertas,

 

I read both articles and still find it it difficult to dilute such small quantities. For instance, the article says Take 0.1mL (250 micrograms) of oral Clonazepam drops and dilute in 1mL of Water for Irrigation. Let's say that I multiply by ten, so I'l have to dilute 1 ml (1 drop) in 10 ml of water. That's doable. How can someone get a consisten solution? Do I have to stir with a spoon, or a hand mixer? I see at your signature that you're tapering with the help of  tablets and stability-tested, prescription compounded oral suspension. Can you please explain more about the prescription compounded oral suspension?

 

Thank you very much