Klonopin taper. Could somebody help?

[[Sa...]]

Pat on my back given

[[Li...]]

Pat on the back duly noted  Please give yourself another one for sharing your daily dosing schedule and telling us more about your symptom pattern.

 

Like all members of BenzoBuddies, I am a layperson not a healthcare professional so this is just my opinion ... but it sounds to me like the hold you’ve been on since May is working. You are stabilizing on your current dose and schedule.  If so, that’s encouraging news!

 

I hear you loud and clear - mornings are the worst.

 

Does the 0.1mg you take at 8 am “help” you in terms of relieving the “ton of bricks” symptom?

 

One possibility is the “ton of bricks” symptom is related to the sedation of the clonazepam you took the night before. As you have learned, clonazepam is a potent benzodiazepine and the 0.5mg you are taking at 8pm is a hefty dose.

 

Gathering input from multiple minds is an excellent strategy when developing a taper plan. Let’s wait a bit until other members have time to share their thoughts.

 

[[Sa...]]

Ok, I ve just given myself another pat

I am not sure It the morning dose helps. To be honest I am not sure all my doses are helping, even the 9.5mg in the evening because I don't feel it sedating. For example, when I used delorazepam before it helped me sleeping as my first and main problem has always been insomnia. But klonopin is not helping in that...

[[Li...]]

While we are waiting for other members to provide input ...

 

Am I understanding you correctly that you have a 0.5 mL oral syringe with 50 graduations (marks) between 0.0 mL and 0.5mL?

 

If so, each mark on your syringe equals 0.01 mLs.

 

0.01 mLs of a liquid with a concentration of 2.5 mg/mL is 0.025 mg.

 

If my calculations are correct (looking to other members to check), the smallest reduction in dose you will be able to make using your syringe is 0.025mg.

 

 

[[Ko...]]

Libertas, you're right, as always. 

 

Daily    mg          %

Dose  reduction  change

 

0.675 0.025 3.571

0.650 0.025 3.704

0.625 0.025 3.846

0.600 0.025 4.000

0.575 0.025 4.167

0.550 0.025 4.348

0.525 0.025 4.545

0.500 0.025 4.762

0.475 0.025 5.000

0.450 0.025 5.263

0.425 0.025 5.556

0.400 0.025 5.882

0.375 0.025 6.250

0.350 0.025 6.667

0.325 0.025 7.143

0.300 0.025 7.692

0.275 0.025 8.333

0.250 0.025 9.091

0.225 0.025 10.000

0.200 0.025 11.111

0.175 0.025 12.500

0.150 0.025 14.286

0.125 0.025 16.667

0.100 0.025 20.000

0.075 0.025 25.000

0.050 0.025 33.333

0.025 0.025 50.000

0.000 0.025 100.000

 

[[Sa...]]

Exactly. A syringe of 0.5ml with 50 Marks.  So 0.2ml have 20 marks, and, given the fact that 0.2ml are 0.5 mg and 0.5mg are 5 drops, then 4 marks should be one drop, am I right? Would i be too prudent going down of one mark every two weeks or one month? Would it take too long?

[[Sa...]]

And, of course, any suggestion on how to tackle it, where to start (morning, afternoon or evening) or starting changing the time of the day in which I take the dose would be appreciated.  I mean, should I still take three doses or should i take my klonopin once per day?

Thanks

[[Ko...]]

Please remember to take your taper rate into account--that is, the percent change from the most recent dosage.

 

As you can see from the preceding post, using your proposed schedule, you'll reach 5% at 0.475 mg daily dosage. 

 

Guidelines recommend not to exceed 5-10%.  And the lower your dosage, the safer you are using a lower taper rate.  It's common for people to taper at a rate well below 5% as they near the end of their tapers, in order to minimize uncomfortable withdrawal effects. 

 

 

[[Ko...]]

In other words, the syringe method will work for awhile, but before too long, you might need to consider diluting a measured dose of your concentrated solution with a known volume of water to achieve a lower, known concentration and draw your target dose from that. 

[[Sa...]]

Wow... so if I understood it properly one mark reduction is too much? One mark should be one quarter of a drop. I thought it was ok. If that is too much and one mark of the syringe is the lowest I could go... how should I go to a "half a mark" reduction? It is going to be really complicated as I don't think i could figure out another way than using my syringe:(

[[Sa...]]

Ah ok... if you could assist me with that in the easiest way possible it would be great.

[[Sa...]]

I got what you said... if, and that is just an example, i would like to make a 10% reduction per month I should take, for the first month (just rendering to the evening dose) 18 marks of my syringe. Then, the next month I should take 16,2 marks of the same syringe which would be impissible to calcolate. The next month it should be' 14,58 so yes, I get what you say about the need to use another method later on. And I would need assistance with that if that is not a problem. I would use water and trying to do my best with other instructions if you all will be kind to give them to me. I also have to figure out what to do with the 8 a.m. drop and with the 2p.m. drop.

I should definitely need a solid plan of action.

[[Sa...]]

I noticed that if I go down of 1 mark per month I could roughly be ok till I will reach 7 marks. Than the 10% reduction won't be applicabile anymore

[[Ko...]]

I noticed that if I go down of 1 mark per month I could roughly be ok till I will reach 7 marks. Than the 10% reduction won't be applicabile anymore

 

I'm not sure what you mean.  Are you referring to 10% of your evening dose only?

[[Ko...]]

In the 10% evening dose example you gave, you reduced at a constant rate.  You noticed that, eventually, the syringes become inadequate to the task.   

 

What I was trying to explain earlier is that, by reducing by 0.025 mg of your daily dose at each step, your reduction rate actually increases as your dosage drops, because 0.025 mg is a progressively larger percentage as your dose decreases.  For people who are prone to bad withdrawal effects, it's safest to gradually decrease % reduction from the previous dose, rather than increasing the % reduction.   

 

Anyway, don't worry.  Like I said, the syringes should work for at least the first few taper steps if you just reduce by one mark every few weeks.  That will give you plenty of time to get the hang of the dilution method.  You cleverly devised a way to adapt insulin syringes to your taper plan, and your math aptitude is good, so I know you can do this!   

 

Let's start with a simple example, ok?

 

Pretend you have already tapered down to 0.1 mg daily. 

You want to reduce your dosage by 1% (0.001 mg).

Your target dose will be 0.100 mg - 0.001 mg = 0.099 mg.

 

To achieve your target dose of 0.099 mg: 

1)  Measure 100 mL of water into a glass.

2)  Add 1 drop (0.1 mg) of klonapin solution to the water and stir.

3)  The concentration of your dilute solution is 0.1 mg/100 mL = 0.001 mg/mL

4)  Using a 1 mL syringe, remove 1 mL (0.001 mg) from the glass and discard the syringe contents.

5)  The glass now contains 99 mL x 0.001 mg/mL = 0.099 mg of klonapin.

6)  Drink the dilute solution, rinse the glass, and drink the rinse water.

 

That wasn't so bad, was it? 

 

 

[[Sa...]]

Yes,only the evening dose. Roughly speaking, if I apply the 10% reduction per month, based on the 20 marks , it would be: 20 marks, 18 marks, 16,2 marks, 14,58 marks , 13,122 marks, 11,80 marks  , 10,62 marks, 9,558 marks  , 8,60 marks and so on. Given the fact that it would be impossible to apply that I guess that a 1 mark reduction per month would pretty much satisfy the 10% reduction program till I will reach 7 marks (more or less).

Of course i will have to figure out what to do with the morning and afternoon dose.

[[Sa...]]

Thank you Koko lee for your last reply. It was very helpfull and appreciated. It does make sense. Thank you very very much. Do you suggest to start tapering the afternoon 0.1mg I am taking(following dr ashton rules)? Snd, if so, I will d what you suggested in your last reply with another syringe and I will mix my drop in water

[[Ko...]]

If you want to get started as soon as possible with your taper, I actually think you should use your insulin syringe for now so that we (you and Libertas and I and anyone else that wants to offer advice) have time to iron out any issues with your taper. 

 

In my opinion, you have two immediate choices. 

1)  Reduce your evening dose by one mark, or 0.025 mg, equal to a 3.571% reduction from your previous dose of 0.7 mg or

2)  Reduce your evening dose by two marks, or 0.050 mg, equal to a 7.143% reduction from your previous dose of 0.7 mg

 

You sounded very worried about withdrawal effects, so to be safe, you should go with the first choice.  If you want to throw caution to the wind, go with the 2nd.

 

I know you feel you should cut your afternoon dose, but if your evening dose isn't helping you sleep, and it's much bigger than the other doses, why not cut that one for starters?  As Libertas pointed out, maybe that's what's making you so sluggish in the morning.     

[[Ko...]]

Incidentally, the reason you are not supposed to use the dropper to deliver the medication directly into your mouth is that the dropper can disconnect from the neck of the bottle, causing overdose.  That's why the instructions say to put the drops in a spoon first.  https://www.medsafe.govt.nz/Consumers/CMI/r/rivotril.pdf

[[Sa...]]

Ok, you guys are giving me hope and that is really great. I am kinda moved you are spending your time assisting me in this journey. Ok, I will start tackling the evening dose. It does make sense in order to reach at some point three doses of 0.1mg per day and I guess that would be better for my body so I won't experience any peak in the serum level. Yes, I am worried about the withdrawal symptoms but I guess that going from 15 drops per day to 7 drops per day in a matter of 40 days like I did(doctor's advise) was way too much and it was pretty obvious to feel the awful withdrawals I felt. I don't want to experience anything like that anymore so I will take it easy following your suggestions. I will try the 2 mark option for one month and I will see how it will go. Given the half-Life of klonopin I guess that if I will experience some withdrawal I would start to feel it after 5-6 days(maybe I am wrong). So ok... it's time to get started. It is ok to be cautious but I don't have to be dominated by fear so I will go for the second choice, reducing my evening dose by two marks.

Crossed fingers

 

[[Ko...]]

Of course i will have to figure out what to do with the morning and afternoon dose.

I don't mean to keep putting off this question.  It's just that your tapering situation is complicated and I keep getting sidetracked on other aspects of it.

 

My partner is tapering clonazepam.  He tries to keep his dosage as even as possible throughout a 24 hr period.  He actually splits his daily dose into 6 doses--one every 4 hours!  That's a little extreme, but it seems to work for him. 

 

Have you considered moving one of your evening drops to morning?  If you could do it without causing withdrawal symptoms, it would be a start in keeping your klonapin blood levels more constant. 

 

I think when Dr. Ashton says to get rid of the afternoon dose first, she's assuming that you're very near the end of your taper and that your morning and evening doses are close to identical.  If I'm wrong about that, I hope someone will speak up.  Meanwhile, I'll look for that in the manual.

 

 

[[Ko...]]

Ok, you guys are giving me hope and that is really great. I am kinda moved you are spending your time assisting me in this journey. Ok, I will start tackling the evening dose. It does make sense in order to reach at some point three doses of 0.1mg per day and I guess that would be better for my body so I won't experience any peak in the serum level. Yes, I am worried about the withdrawal symptoms but I guess that going from 15 drops per day to 7 drops per day in a matter of 40 days like I did(doctor's advise) was way too much and it was pretty obvious to feel the awful withdrawals I felt. I don't want to experience anything like that again so I will take it easy following your suggestions. I will try the 2 mark option for one month and I will see how it will go. Given the half-Life of klonopin I guess that if I will experience some withdrawal I would start to feel it after 5-6 days(maybe I am wrong). So ok... it's time to get started. It is ok to be cautious but I don't have to be dominated by fear so I will go for the second choice, reducing my evening dose by two marks.

Crossed fingers

 

I'm so glad you feel good about your plan.  Please keep communicating so we can work out any kinks in your taper. 

 

Good luck to you! 

 

[Guest [ba...]]

To add another layer to the measurement discussion...

 

You could purchase a micropipette to do the dosing.  They're very precise/accurate if used properly.  Graduations on a 1 ml model run every 2 microliters, so 5x more precise than a syringe.  When dosing gets really low, you could switch to a model that accurately measures fractions of a microliter.

[[Sa...]]

Hello badsocref. I don't know if I could find it here but I will try to check if I could. I am trying to figure out how to do this process and even though it seems i am not that bad calculating things, I still find It hard to proceed with proper tools and understanding how to work things out so, even if i could look dumb, I would really need a very accurate explanations

I ve checked again the ashton manual and it clearly says (after the substitution of klonopin with diazepam) to tackle the afternoon dose first, then the morning one and then the evening one. But i will do as suggested earlier.

Regarding moving some drops in the morning I remember, when I was on 0.5mg per day, that the morning dose was the one that caused me a lot of problems with nausea and lack of balance. I don't think it would be a good idea, given Aldo the fact that i could have withdrawals

[[Li...]]

Hello again, Salazar77. 

 

I’m impressed by your careful reading and referral to the Ashton Manual.  It’s an excellent resource but please be aware that the hallmark of the Ashton Method was individualization.  Each of us must chart our own course for discontinuing benzodiazepines and, just as in sailing, we must make adjustments in our course throughout our journey.