Help with taper plan. Liquid Clonazepam.

[[Ko...]]

Hi Ben!

 

I think you mentioned you have an insulin syringe?  Do you know what gauge the needle is?  Have you tried drawing up some of your medication with it yet? 

 

Insulin syringe needles are typically 28 to 31 gauge--these have a smaller inner diameter than the 22 gauge needle commonly used for 50 microliter gastight syringes.  So if an insulin syringe needle works, a 22 gauge needle should work as well.   

 

Koko Lee

[[Be...]]

Actually I had to remove the needle because of the viscosity...need to check the micropipette. 

[[Be...]]

I've done viscous liquids with a micropipette many many times.  If that's how you want to go, I'll go into more detail.

 

I had to remove the needle of my insulin syringe, so; yes I was doubting it could work with a micro:/

[[Ko...]]

I experimented using syringes (bought for my goats' veterinary needs) equipped with 22-gauge, 20-gauge, and 18-gauge needles to draw up vape juice (70:30 propylene glycol:vegetable glycerine).  The idea was to approximate the worst-case viscosity scenario for propylene glycol-based Rivotril solution.

 

What I found was that a 22-gauge needle is too thin, a 20-gauge needle works (barely), and an 18-gauge needle works very well. 

 

Then I visited the Hamilton Company website.  Their ready-made 50 uL gastight syringes are equipped with  22-gauge blunt-tipped needles and cost $43.  However, they will custom-make one with an 18-gauge blunt-tipped needle for $65, a process that takes 7-10 days.

 

If you want to check out the custom syringe, go to the following link https://www.hamiltoncompany.com/laboratory-products/syringes/80908

50 µL, Model 1705 SN SYR, Cemented NDL, Custom gauge, length, point style

Point Style: 3  (3 is the blunt tip)

Gauge: 18 gauge  (the largest inner-diameter needle they offer for this syringe style)

Needle Length: 2 inches  (you can change this to any length you want in mm or inches)

 

For another $100, they'll calibrate your syringe, too.  I doubt that's necessary.  Hamilton is a reputable company.  Even if the accuracy is a hair off (and it won't be by much), the syringe will be precise if properly used. 

 

If your heart's set on going the syringe route, there is a Hamilton Company location in Spain--maybe it would be easier to order through them than from the US.

Hamilton Iberia SLU

Phone

+34 930 186 262

Fax

+34 930 186 261

Address Pol. Ind. Les Guixeres

C/ Electrónica, 5

E-08915 Badalona (Barcelona)

https://www.hamiltoncompany.com/support/global-headquarters-subsidiaries

 

The syringe has pros and cons

Pros

*  Can tell by looking at it if it's broken or if you drew up an air bubble.

*  Can measure the tiny amounts you need.

*  Few moving parts.

 

Cons

*  May cost more than a used Eppendorf.

*  The glass barrel can break.

*  Must be cleaned well after each use

*  Custom-made only in the US and must be shipped to Spain at unknown cost

*  Don't poke yourself with it.  It's a blunt tip, but still...

 

_____________________________________________________

 

Basocref's suggestion--using an Eppendorf pipette--has merit.  These devices are typically calibrated for use with aqueous solutions.  Using them for measuring atypical liquids, such as your viscous Rivotril, will require you to practice a technique called "reverse pipetting".  You can read more about that, as well general instructions for use, starting with this link. 

 

https://handling-solutions.eppendorf.com/liquid-handling/faqs/

Be sure to check out the "related files" listed to the right of the FAQ answers.

 

The Eppendorf pipette has pros and cons

Pros

*  No cleanup--just throw the tip away after each use

*  Can measure the tiny amounts you need

*  Easy to use, with some practice

*  A 10 uL-100 uL version is available, with many offered on ebay. 

 

Cons

*  Can't tell just by looking at the liquid in the plastic tip if the device is working properly and/or if you're using it correctly.

*  Consistent technique is essential to ensure correct dose of drug concentrate

*  Steeper learning curve than syringe.

*  A used Eppendorf may not be reliable.

*  Will probably need to order the proper tips separately.

 

Sorry about the long post.  Whatever you choose, you'll be using it twice a day for quite a while, so it needs to work for you.

 

Koko Lee

 

[Guest [ba...]]

Here's a little more info about doing this with a micropipette...

 

The easiest and most accurate way to do this is with a positive displacement micropipette, but it can be done with a regular micropipette with a little practice.  Brief write-up of the two types here:  https://www.thermofisher.com/us/en/home/life-science/lab-plasticware-supplies/lab-plasticware-supplies-learning-center/lab-plasticware-supplies-resource-library/fundamentals-of-pipetting/liquid-handling-selection/air-vs-positive-displacement-pipettes.html

 

If you use a positive displacement pipet, you can just suck up the viscous liquid and dispense it into your mouth.  If you use a regular (air displacement) pipette, you'll cut a small bit off the end of the tips to make the opening larger.  Just cut off a 2-3 millimeters using a regular pair of scissors.  Doesn't have to be precise.  The 'reverse pipetting' is quick to learn.

 

I have access to both types and could even do a rudimentary video for you.  I need to spend a little time at the lab anyway.  One of our employees' boyfriends contracted covid, so I've stayed away from there lately.  But it's been a few weeks so all should be fine again.  Let me know what you want.

[[Be...]]

Thank you Badsocref for your willingness to help. You are awesome. At the moment I want to try Koko Lee’s suggestion of reducing 20% in the morning (from 0.125 to 0.10 mg) using my syringe and liquid (10% of the total dosage) and then after 3 weeks do the same with the nighttime dosage.

 

I’m really overwhelmed and anxious because I feel the current dosage (0.25 mg) is constipating me a lot. I also feel my feet burning and cold at the same time.

 

So now I have to balance between keeping the current dose and lessening my tinnitus but having other unpleasant symptoms as well (I know you can totally understand me).

 

I’m also a little bit overwhelmed and anxious and I want an unrealistic easy way out...I can barely think or analyze anything...and I don’t like being a lazy pessimistic.

 

After I try Koko Lee’s plan, I’ll go slower on the smaller doses.

 

I would appreciate if you can show me the simplest way to reduce my dosage using a Micropipette available on Amazon that would work for my current situation (starting from the equivalent of 0.125 mg in the morning and 0.125 mg at night), assuming Koko Lee’s first plan is too abrupt.

 

A link showing the ideal micropipette and an illustration/video would be immensely appreciated. Hope the people at the lab gets well soon from Covid and you take care of yourself. I had Covid myself and due to the prolongue quarantine I started taking benzos to help me sleep...

 

Anyways; once you have the time, and it’s safe enough for you I’d like to see a video showing the ideal pipette and how to taper. There are some terms that I don’t understand, like reverse pipetting...

 

I’m also scared to see how imprecise and rudimentarily I’m trying to taper...I’m so scared of the anxiety/symptom windows but so desperate to get out...

 

Here's a little more info about doing this with a micropipette...

 

The easiest and most accurate way to do this is with a positive displacement micropipette, but it can be done with a regular micropipette with a little practice.  Brief write-up of the two types here:  https://www.thermofisher.com/us/en/home/life-science/lab-plasticware-supplies/lab-plasticware-supplies-learning-center/lab-plasticware-supplies-resource-library/fundamentals-of-pipetting/liquid-handling-selection/air-vs-positive-displacement-pipettes.html

 

If you use a positive displacement pipet, you can just suck up the viscous liquid and dispense it into your mouth.  If you use a regular (air displacement) pipette, you'll cut a small bit off the end of the tips to make the opening larger.  Just cut off a 2-3 millimeters using a regular pair of scissors.  Doesn't have to be precise.  The 'reverse pipetting' is quick to learn.

 

I have access to both types and could even do a rudimentary video for you.  I need to spend a little time at the lab anyway.  One of our employees' boyfriends contracted covid, so I've stayed away from there lately.  But it's been a few weeks so all should be fine again.  Let me know what you want.

[[Ko...]]

 

After about two weeks on 0.250 mg clonazepam, you should be more stable--not less.  Is your prozac dosage still changing?  If not, exactly when did it stop changing and at what dosage?  Adjusting to Prozac (which takes 1-2 weeks to begin taking effect and 4-6 weeks to take full effect) is going to complicate the process of knowing when you're stable enough to begin tapering clonazepam. 

 

Since you're now experiencing tinnitus again, I can't endorse a taper that involves cutting by the maximum recommended amount of 10%.  It's simply too risky to cut that much given that you're now struggling to balance two different medications.  I understand you're desperate for the tinnitus and other symptoms stop, but making any drastic changes to your clonazepam dosage is only going to get you into more trouble.

 

 

My syringe is a U-100 insulin that goes from 0.3 ml (maximum), and it has on the same mark: 30 units (how can I send you a picture as attachment?). Here's a link, but it does not show all the divisions:

 

[nobbc]https://www.totmedical.com/jeringas-de-insulina-con-aguja/73-jeringa-de-insulina-de-03-ml-con-aguja-de-03-x-80-mm-g30.html?gclid=CjwKCAjwtNf6BRAwEiwAkt6UQmM3H4EOgFloJpihFl9U9j0bhLTiUuxdW7694xZb-OIpU44j0sz0JBoC5B8QAvD_BwE[/nobbc]

 

0.3 ml represents 30 units, then goes to 25 units, 20 units, etc. Between each unit, it has 10 separation lines (very small and difficult to see).

 

10 units would represent: 0.25 mg. 5 units would be 0.125  mg. Going from 10 units to 5 units it has 10 separation lines, and going from 5 units to 0 it has 10 separation lines as well (of course!).

 

So from 0.125 mg it would allow: 0.125 mg, 0.112 mg, 0.10 mg, etc (10% reductions).

The only inconvenience it's too small and require great pulse, and not suitable for smaller reductions once I'm reaching the lowest dose before jumping off. I don't think it has such small reductions.

 

So I will carefully  read the alternative plan proposed by you and Badsocref.

 

Edit: Deactivated commercial link.

 

Hi Ben,

 

Based on the statement in bold type above, I think it would be safer for you to reduce to 0.112 mg rather than 0.100 mg.  I would have suggested this initially had I realized your syringe was set up in such a way as to make that an option.

 

Since you're currently switching antidepressants, it's probably not the best idea to make such a large (10%) cut of your daily dosage. 

 

Of course, it's your taper, so it's up to you.  But please be clear that, under the circumstances, I do not recommend it, so it's not "Koko Lee's plan".   

 

Koko Lee

 

 

 

[[Be...]]

Hello Koko Lee;

 

Hope this message finds you well. I’m still recovering from 10% total dose  reduction of liquid  Clonazepam (20% morning reduction-from 125 mg in the morning to 0.10 mg using the syringe). I reduced the dosage in September 15, and started feeling bad (increased tinnitus, burning feet and anxiety) around September 18-19.

 

Today, September 27 I have a little bit less anxiety, I’m eating, but I have a loud tinnitus that sounds like ssssssssssssshhhhhhhhh (like a loud hissing).

 

I’m taking an Antidepressant (Brintellix 5 mg) for 2 weeks (haven’t noticed major difference regarding my T). I still have brain zaps despite my doctor prescribed me Vitamin B complex.

 

So from this situation I can conclude 2 things: it seems that my T will stay the whole journey and beyond (hopefully will fade after a few months after jumping from Benzos).

 

I need to taper as soon as possible but can’t go into big dose reductions...so I feel the best method is the aqueous solution you proposed.

 

Since I already decreased 10% of the total dose, I’ll go into phase 2 once I’m ready to resume taper.

 

Just want to make sure I grasped the general idea regarding this plan: the aqueous solution consists of pouring water into the graduated cylinder, then adding 0.05 ml (0.125 mg) of liquid clonazepam, stirring well, and then reducing one line from the graduated cylinder each and drinking the rest, but in any case the aqueous solution will always consists in just water and 0.05 ml (0.125 mg) of Clonazepam, is that correct?

 

Sorry for this long e-mail, I’m looking forward to your answer and any other input you feel necessary. 

 

Thank you for all your help:)

Ben

[[Ko...]]

Hi Ben,

 

I'm sorry that your tinnitus and brain zaps persist but am relieved to hear that you're able to eat and are less anxious. 

Since I already decreased 10% of the total dose, I’ll go into phase 2 once I’m ready to resume taper.

Right, you'll start with Phase 2. 

Just want to make sure I grasped the general idea regarding this plan: the aqueous solution consists of pouring water into the graduated cylinder, then adding 0.05 ml (0.125 mg) of liquid clonazepam, stirring well, and then reducing one line from the graduated cylinder each and drinking the rest, but in any case the aqueous solution will always consists in just water and 0.05 ml (0.125 mg) of Clonazepam, is that correct?

Yes, that's the general idea. 

 

My original dilution instructions called the diluted medication an "aqueous solution".  It's more correct to call it an aqueous suspension, since clonazepam isn't very soluble in water.  All we know from the Rivotril instructions is that it can be added to water and must be drunk immediately.  So we must assume that some or all of the clonazepam might precipitate upon dilution.  Thus, the suspension must be stirred well immediately before measuring any volumes of it.   

 

It's probably not feasible to fully stir the suspension within the tall, narrow graduated cylinder.  So you'll need a container in which to prepare the suspension.  The ideal container would be something with a pour spout like a beaker or a glass 400 mL liquid measuring cup.   

 

Here's an approach you could follow for your Phase 2 morning doses: 

1)  Measure 100 mL water the graduated cylinder.

2)  Measure 0.05 mL Rivotril into the glass measuring cup.   

3)  Pour the 100 mL water from the graduated cylinder into the glass measuring cup

4)  Stir the aqueous suspension well. 

5)  Immediately pour 20 mL of the suspension from the measuring cup into the grad cylinder and discard. 

6)  Drink the remaining suspension from the measuring cup.

7)  Slosh some fresh water around in the measuring cup to rinse it, and drink the rinse water.

 

And for your first Phase 2 evening dose:

1)  Measure 100 mL water the graduated cylinder.

2)  Measure 0.05 mL Rivotril into the glass measuring cup.   

3)  Pour the 100 mL water from the graduated cylinder into the glass measuring cup

4)  Stir the aqueous suspension well.

5)  Using a 10 mL oral syringe, remove 1 mL of the suspension and discard.

6)  Drink the remaining suspension from the measuring cup.

7)  Slosh some fresh water around in the measuring cup to rinse it, and drink the rinse water.

 

To measure volumes less than 10 mL, I suggest using a plastic 10 mL oral syringe instead of the grad cylinder.  To measure 10 mL or more, use the grad cylinder.  This is where the beaker or measuring cup with pour spout is helpful--it'll keep you from spilling any suspension during transfer.

 

(At the risk of confusing you, I'll add that another method is to pour the amount you want to drink into the grad cylinder, rinse the grad cylinder and drink that rinse water, and then discard what's left in the cup.  Either way you decide to do this,  be consistent, so you don't get mixed up about what to drink and what to discard.) 

 

Always remember to treat the diluted medication as a suspension by stirring it immediately before measuring volumes.   

 

Does all of this make sense, Ben?  If anyone has objections, suggestions, or questions, please don't hesitate to speak up.

 

Good luck, and please keep us informed of how you're doing.

 

Koko Lee

[[Be...]]

Thank you Koko Lee for your prompt reply. The tinnitus and anxiety today are really bad. I suspect the culprit was the vitamin B complex I took today (I’ve read it doesn’t go well with benzo withdrawal).

 

I’m a little bit overwhelmed today, so I’ll print the instructions for the aqueous solution and read them later when I feel better. I hope these symptoms are temporary and I don’t have to updose again. I’m concern that these brain zaps mean I already developed too much tolerance

 

Just one question, would it worked if I used a long stirrer in the graduated cylinder or shake it like a cocktail so I can prescind using the other container?

 

I hope I feel better tomorrow. Thank you Koko Lee.

[[Ko...]]

Hello Ben,

The tinnitus and anxiety today are really bad. I suspect the culprit was the vitamin B complex I took today (I’ve read it doesn’t go well with benzo withdrawal).

I’m a little bit overwhelmed today, so I’ll print the instructions for the aqueous solution and read them later when I feel better. I hope these symptoms are temporary and I don’t have to updose again. I’m concern that these brain zaps mean I already developed too much tolerance

Yes, I hope you don't have to updose.  Please give yourself more time if you can.  At <2 weeks out since your 10% cut, you aren't out of the woods yet.  You posted on Sept 23 that your doctor wants you to postpone tapering for another couple of weeks to allow the AD to kick in.  Maybe by then you'll adjust to your dose reduction. 

 

I don't know exactly when you started having brain zaps.  Could they be from Prozac discontinuation rather than benzo tolerance?

 

Just one question, would it worked if I used a long stirrer in the graduated cylinder or shake it like a cocktail so I can prescind using the other container?

It should work if you're careful.  Since you'll be diluting twice daily for quite a while, I was trying to suggest ways to make the process less of a pain and thought you might already have something like what I described.

 

The goal is to thoroughly mix the suspension while minimizing losses.  Using a long stirrer in the grad cylinder won't guarantee uniformity throughout the water column. 

 

That leaves the option of shaking it.  Inverting the cylinder several times ensures a better mix than shaking.  Will you be putting your hand over the top in lieu of a stopper?  I recommend adding Rivotril to the cylinder first, then carefully add water just to the 100 mL mark.  Read to the meniscus. https://sciencenotes.org/how-to-read-a-meniscus/ 

 

Leaking of the contents during inversion could throw off your dosage.  Say you're supposed to drink 99 mL but lose 5 mL.  Your dose will be short 4 mL (0.005 mg), assuming the suspension was uniformly mixed when the loss occurred.  It might help to do a practice run with plain water to hone your technique before you dose via this method. 

 

Lastly, you'll need to clean your labware after each use.

 

I hope I feel better tomorrow. Thank you Koko Lee.

       

You're welcome, Ben.  I wish I could be more help.  Please feel better soon!

 

Koko Lee

 

[[Be...]]

Hello Koko Lee and everyone,

 

Yesterday I had a really bad night. The Tinnitus and anxiety reached a whole new level. I threw up because of anxiety and desperation. Thank you for the information about reading the meniscus, it's really useful.

 

Yes, I was planning to use my hand for stirring the liquid, but then again, I do have a measuring cup, so once I calm down I'll consider that option again.

 

I had brain zaps before taking Prozac and the current antidepressant.

 

My Doctor prescribed me a Vitamin B complex along with the antidepressant. I started the Vitamin B complex this week.

 

I took the vitamin B complex and I feel my symptoms worsened big time...I'm not sure if it's my imagination, but it seemed like if it had increased the benzo withdrawal symptoms ten times worse.

 

I have more brain zaps, louder tinnitus, and heightened anxiety...now, I don't know the cause...is it the antidepressant (Brintellix 5 mg) that I started taking on September 15?, or the Vitamin B complex of 500 mg. In any case, I suspect the main culprit is the vitamin B complex.

 

However, if the antidepressant is the culprit, does anybody know how to taper this medication (5 mg of Brintellix) also known as Trintellix/Vortioxetine? considering I started taking it on September 15?

 

Thank you so much for reading me.

[[Ko...]]

Dear Ben,

 

I'm sorry your symptoms are so intense.  I don't know about B-complex specifically, but a lot of BenzoBuddies advise against taking any kind of supplements during tapers.

 

You've said you didn't think you could taper clonazapam without an antidepressant.  Given your experiences with Prozac and Brintellix, do you still feel that way? 

Maybe you weren't on Prozac for long enough to feel it's benefits (assuming it might have had any). But while it may not have helped you, it has nevertheless affected your taper in ways you may not be aware of. 

 

Prozac and its active metabolite have relatively long half-lives.  So though you stopped taking it roughly 3 weeks ago, you have been experiencing its effects (and the consequences of its elimination) ever since.  https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/018936s076lbl.pdf

Page 3

  "The relatively slow elimination of fluoxetine (elimination half-life of 1 to 3 days after acute administration and 4 to 6 days after chronic administration) and its active metabolite, norfluoxetine (elimination half-life of 4 to 16 days after acute and chronic administration), leads to significant accumulation of these active species in chronic use....Plasma concentrations of fluoxetine were higher than those predicted by single-dose studies, because fluoxetine’s metabolism is not proportional to dose. Norfluoxetine, however, appears to have linear pharmacokinetics. Its mean terminal half-life after a single dose was 8.6 days and after multiple dosing was 9.3 days.

  "The long elimination half-lives of fluoxetine and norfluoxetine assure that, even when dosing is stopped, active drug substance will persist in the body for weeks (primarily depending on individual patient characteristics, previous dosing regimen, and length of previous therapy at discontinuation). This is of potential consequence when drug discontinuation is required or when drugs are prescribed that might interact with fluoxetine and norfluoxetine following the discontinuation of Prozac."

 

Furthermore, did you know that Prozac can increase levels and effects of benzodiazepines in your system? 

https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Fluoxetine-(Prozac)

So, discontinuing Prozac just before beginning to taper clonazepam eventually caused your clonazepam levels to drop more steeply than intended, worsening your withdrawal symptoms. 

 

Regarding Brintellix/Trintellix/vortioxetine, here are some of the conclusions from one meta-analysis:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351824/

"We found no evidence of a dose effect for vortioxetine with the exception of adverse effects. The 20-mg dose was approved as the target dose by the FDA because it was the only dose with at least two trials showing efficacy in the US population. "[/b]

 

What I glean from this is that upping the dose, while unlikely to improve your response, will probably worsen the drug's side effects (the most common being nausea and vomiting).  I'd be wary of increasing my dosage of this drug, if I were you.

 

Considering you have been taking just 5 mg, and only for 2 weeks, it seems ridiculous to have to taper.  But since you already suffer from various nasty side effects and/or WD symptoms and seem hypersensitive to changes in your meds, it's safer not to stop abruptly. 

 

To find out more about tapering Brintellix, I visited Suriving Antidepressants, where I found this post by an administrator.

https://www.survivingantidepressants.org/topic/10246-tips-for-tapering-vortioxetine-trintellix-brintellix/

 

Apparently, a liquid version of Brintellix is available in some countries.  Contact your pharmacy and see if they offer it.  If not, you could ask your doctor to write a prescription for Brintellix compounded suspension.  Other options are dry-tapering or preparing a homebrew. 

 

Brintellix is similar to SSRIs and SNRIs in that, the longer you take it, the harder the taper is likely to be.  So if you're certain you want to get off of it, try not to wait too long. 

 

Since tapering clonazepam and Brintellix at the same time could ramp up withdrawal effects for both drugs, please consider postponing your clonazepam taper for as long as it takes to get off of Brintellix. 

 

To summarize, Ben, adding and subtracting antidepressants seems to be doing more harm than good by destabilizing your neurochemistry and interrupting your clonazepam taper.  If you can wean off of Brintellix and resist adding any more psych drugs, you can focus on a slow, steady benzo taper.

 

All my best to you, 

Koko Lee   

[[Be...]]

Dear Koko Lee, thank you so much for the valuable information; it all makes sense now. I have an appointment with my Doctor tomorrow and honestly I don’t know what to tell her other that I want to wean off everything...

 

I’ve been taking Brintellix 5 mg for 15 days...so I guess I’m still on time...But I want to hear what my Dr has to say.

 

You’re awesome, I really appreciate it.

 

Ben

[[Be...]]

Hello Koko Lee,

 

Hope this message finds you well. I've decided to wean off Brintellix. Since I've been taking 5mg for 15 days I'm going to taper using my criteria, but also not delaying excessively. I think you, and others in the Forum are right regarding the use of AD and the importance of been med free to give time to heal.

 

For that, I've been splitting the 5mg in half (I will do that for 4 days) and then, in another 4 days will take the half 5mg every other day.

 

I hope that's enough not to cause too much havoc for I've been taking the minimum dosage for less than a month.

 

As soon as I wean off the AD I will continue tapering the benzo (night time dose) using the aqueous solution (suspension?) method.

 

My question regarding the suspension is, for whole long do you recommend stirring up water with the liquid clonazepam  (I will use the measuring up as you suggested), so I make sure its contents are really integrated. My second question would be, how fast after the stirring should I drink it.

 

Sorry about my obsessive/kind of weird questions, but I'm traumatized about this benzo withdrawal situation. I'm even trying some hearing devices for tinnitus, and I'm afraid I'll have to buy them to ease the pain even though they are terribly expensive...I'm also trying relaxation techniques, music, walking, and crossing my fingers.

 

Looking forward to your wise answer as usual. Please anyone else has anything to add is more than welcome.

 

Thank you so much for your help.

Ben

 

Thank you Koko Lee for your prompt reply. The tinnitus and anxiety today are really bad. I suspect the culprit was the vitamin B complex I took today (I’ve read it doesn’t go well with benzo withdrawal).

 

I’m a little bit overwhelmed today, so I’ll print the instructions for the aqueous solution and read them later when I feel better. I hope these symptoms are temporary and I don’t have to updose again. I’m concern that these brain zaps mean I already developed too much tolerance

 

Just one question, would it worked if I used a long stirrer in the graduated cylinder or shake it like a cocktail so I can prescind using the other container?

 

I hope I feel better tomorrow. Thank you Koko Lee.

[[Ko...]]

Hello Ben, 

 

I've decided to wean off Brintellix. Since I've been taking 5mg for 15 days I'm going to taper using my criteria, but also not delaying excessively. I think you, and others in the Forum are right regarding the use of AD and the importance of been med free to give time to heal.

 

For that, I've been splitting the 5mg in half (I will do that for 4 days) and then, in another 4 days will take the half 5mg every other day.

Thank you for the update.  Tapering off of Brintellix before you develop a strong(er) physical dependency on it will save you a lot of problems later. 

 

Regarding your Brintellix taper strategy, I'll offer the following comments:

   

1)  Allowing yourself only 4 days to acclimate to a 50% reduction is asking a lot, considering that the drug's half-life is 66 hours (2.75 days).  By the time you feel the full effects of your initial cut, you will already have reduced your dosage by even more. 

   

2)  For the 2nd reduction, is there any way you can accomplish this that doesn't involve skipping days?  I understand that, having returned your mg scale, you'll have to eyeball cuts--a process complicated by the fact that 5 mg Brintellix tablets are teardrop-shaped (https://www.wellrx.com/brintellix/drug-images/).  But while many doctors suggest skipping doses to taper psych meds, that practice isn't recommended by anyone with AD withdrawal harm-reduction expertise.   

https://www.survivingantidepressants.org/topic/22958-never-skip-doses-to-taper/

 

I hope that's enough not to cause too much havoc for I've been taking the minimum dosage for less than a month.

Honestly, it's tantamount to quitting cold turkey.     

 

A rough rule of thumb is that it takes about 5 times a drug's half-life for that drug to leave your system. 

In this case, that's (66 hrs x 5)/24 hrs per day = 13.75 days  (about as long as it takes to achieve steady-state plasma concentration with consistent Brintellix dosing.)

 

Rather than tapering rapidly and hoping this doesn't cause havoc, please consider holding your first cut for a minimum of 2 weeks, and then cut by half again, holding for a minimum of 2 weeks.  Even if the cuts aren't exact, your daily doses won't vary as much as they would if you skipped alternate days.   

 

As soon as I wean off the AD I will continue tapering the benzo (night time dose) using the aqueous solution (suspension?) method.

 

Please think about giving yourself at least two weeks after stopping Brintellix before resuming your clonazepam taper. 

 

My question regarding the suspension is, for whole long do you recommend stirring up water with the liquid clonazepam  (I will use the measuring up as you suggested), so I make sure its contents are really integrated. My second question would be, how fast after the stirring should I drink it.

Try it this way:

Before you prepare the solution, have everything you'll need within reach and be certain you understand exactly what how much you'll need to discard and how much you need to drink.  Write out step by step directions.   

 

Measure 100 mL water in the graduated cylinder and pour that into the clean glass measuring cup.  Measure 0.050 mL Rivotril into a spoon, and stir that into the water for about 15 seconds.  Check the spoon.  If you can see that a "blob" of medication remains on the spoon, continue stirring until the spoon comes out clean. 

 

Once you're satisfied that the suspension is uniformly mixed, measure the liquid as called for in the taper plan.  This should be done immediately after stirring ("immediately" meaning within a minute or two.)

 

Once you have measured the amount you need to drink, you can take a few minutes to double-check your process before actually dosing.  Remember to rinse the container you drink from and then drink the rinse water.         

 

Let me know if there's anything that doesn't make sense to you. 

 

Sorry about my obsessive/kind of weird questions, but I'm traumatized about this benzo withdrawal situation. I'm even trying some hearing devices for tinnitus, and I'm afraid I'll have to buy them to ease the pain even though they are terribly expensive...I'm also trying relaxation techniques, music, walking, and crossing my fingers.

 

Please don't apologize!  I understand tinnitus can be utterly debilitating.  It's great that you're working on coping techniques.  I wish I could offer other solutions, as well.  All I can suggest is to ease off of Brintellix a little more gradually than you had planned, and give yourself time to stabilize before resuming your clonazepam taper.  Your body seems to be begging you for a vacation from any changes at all in meds or dosages. 

 

Hang in there, Ben, and try not to get discouraged.  I know it seems like this will take forever, but you'll get through it.

 

Koko Lee

[[Be...]]

Dear Koko Lee,

 

Thank you for your prompt answer. What you're saying makes sense to me, but I'm kind of worried by the fact that prolonging so much the tapering for the Antidepressant might cause getting deeper into the medication.

 

Also, postponing the benzo taper so much, having been taking it for so many weeks, isn't it a possibility of developing more tolerance/dependence and therefore risking more protracted symptoms? (please notice this is a question, not a criticism to your system).

 

I showed your  benzo tapering plan to my Doctor and she totally liked it/agreed with it. However, she doesn't know I'm weaning off AD and she wanted to add in fact, other drugs, which I declined.

 

I wasn't expecting I had to taper for so long the antidepressant. As you can imagine, this makes me nervous/anxious, for I feel more trapped/impatient/and desperate.

 

So far I have not felt the effects of the AD tapering besides being more irritable and impulsive (definitely, because I'm usually mellow and more self-controlled), and increase in appetite. For the rest, so far so good....but we know how medications can give more pleasant surprises.

 

If necessary, I can cut the tear shape pill horizontally (taking the bottom), and then the upper part which is smaller...still, like I said I'm concerned about getting deeper into the medication. I wish there was an alternative to that long taper...

 

Also, developing benzo tolerance by the time phase 3 of 4 is a real fear. I'm not working at the moment, and I'm completely focused in the withdrawal/taper process, so I was wondering if there was an alternative..

 

The other issue I'm having (probably due to the AD and the benzos) is feeling anger at myself (I'm not proud at all to tell you this).

 

I'm angry for having such a delicate system, for not being able to withdraw faster, for having tinnitus, for being trapped in this situation in the worst moment in history...I always try to remember what a member in this forum told me (Be kind to yourself)...but sometimes I forget and become hash on me.

 

I cannot thank you enough for being there and for all your valuable advice.

 

 

 

 

 

[[Ko...]]

Dear Ben,

 

Please don't be so hard on yourself.  It's not your fault that you're in this predicament.  And the fact that you declined your doctor's offer to put you on more drugs is the best news I've heard all day! 

 

I think we agree that it's sensible to withdraw from Brintellix first, since you have been on it such a short time.  The million dollar question seems to be, how quickly can you do this without exacerbating your tinnitus--or worse? 

 

I still maintain that weaning over the course of 8 days is much too fast--and much riskier than spending an extra month at 0.225 mg clonazepam.  Going faster is not necessarily best when it comes to withdrawing from ADs and benzos.  (As is often said on this forum, "It's a marathon, not a sprint.")  But if you're absolutely determined to take this drastic approach to getting off of your AD, what can I say?  Good luck?  If nothing else, I hope you at least rethink your plan to dose on alternate days. 

 

Please keep us informed of how you're doing, Ben.  I'll keep you in my thoughts.

 

Be kind to yourself   

Koko Lee     

[[Be...]]

Thank you for your honest advice and being so supportive and kind

 

Making my tinnitus worse due to weaning off the AD so fast is a really scary thought. I will not skip doses. I'll cut the tear shaped pill in 4. I'll add a few days taking the wider part of the pill (the bottom), and then the upper part.

 

I haven't read that weaning off too fast from this particular antidepressant causes/exacerbates tinnitus; however, I believe it's possible. I hope with all my heart it doesn't. I could add a few days. I'll let you know how I feel as I believe flexibility is key in the process.

 

I'll keep you posted. Thanks for the reminder

 

Dear Ben,

 

Please don't be so hard on yourself.  It's not your fault that you're in this predicament.  And the fact that you declined your doctor's offer to put you on more drugs is the best news I've heard all day! 

 

I think we agree that it's sensible to withdraw from Brintellix first, since you have been on it such a short time.  The million dollar question seems to be, how quickly can you do this without exacerbating your tinnitus--or worse? 

 

I still maintain that weaning over the course of 8 days is much too fast--and much riskier than spending an extra month at 0.225 mg clonazepam.  Going faster is not necessarily best when it comes to withdrawing from ADs and benzos.  (As is often said on this forum, "It's a marathon, not a sprint.")  But if you're absolutely determined to take this drastic approach to getting off of your AD, what can I say?  Good luck?  If nothing else, I hope you at least rethink your plan to dose on alternate days. 

 

Please keep us informed of how you're doing, Ben.  I'll keep you in my thoughts.

 

Be kind to yourself   

Koko Lee   

[[Be...]]

Hello Koko Lee and everyone,

 

I'm sending this message to you and everyone to keep you posted regarding the clonazepam liquid tapering.

 

I tapered directly with the 1 ml syringe the morning dose, reducing it to 0.10 mg (that was weeks ago). I had very bad withdrawal symptoms for a week so I held it for a few weeks.

 

Now moving forward, I'm planning next week to start tapering the evening dose using the aqueous solution method, directly going to phase 2 (since I already reduced the morning dose weeks ago), and focus on the evening dose only until I've reached minus 20 ml on the graduated cylinder.

 

To start tapering the nighttime dose using the aqueous solution method I'm doing the following:

 

1. Pour 100 ml of water in the graduated cylinder.

2. Add the equivalent of 0.125 mg of Clonazepam (0.05 ml) into a short glass.

3. Pour the 100 ml of water into the short glass.

4. Immediately stir with a spoon for about 20-30 seconds. The liquid clonazepam (in Spain is green/bluish) completely mixes with the water. The water does not change color, nor any drop or clonazepam liquid is seen. Everything looks transparent.

5. With a 10 ml syringe I'll substract 1 ml one day, 2 ml the second, 3 ml the third, and so forth and throw it away.

6. Immediately, after substracting whatever corresponds that day I'd drink the glass of water with the clonazepam suspension.

7. I'd some more water into the glass to make sure I drink everything in the glass.

 

If I had to remove 20 ml I would do the following:

 

Assuming I'm on step 5. with the 10 ml syringe I would substract 10 ml from the glass of water with the suspension and pour them into the graduated cylinder, and then repeat the process. Would make sure that in the graduated cylinder are 20 ml of aqueous solution.

 

Then will continue to step 6. and 7. Immediately would throw away the liquid from the graduated cylinder so I don't drink it by accident.

 

I hope the change to the liquid suspension works well and I can reduce the dose everyday with no problems. I would keep the morning dose with the same amount and technique (straight from the 1 ml syringe) until I reach phase 3, if that's ok.

 

Looking forward for your input/feedback.

 

Thank you so much for helping me!

Ben.

 

 

 

 

[[Ko...]]

Hi Ben!

 

That all looks really good!  I'm impressed that you took the time to practice the dosing steps in advance so you could troubleshoot.  You must be eager to get this show on the road.   

 

Just a couple of questions--

 

1)  Way back on page 1 of this thread, you mentioned having bought a 0.3 mL syringe, which badsocref had suggested as a way to improve dosing accuracy/precision.  Do you still have it?  I'd be a whole lot more comfortable with you using that, as opposed to a 1 mL syringe, to measure your concentrate, whether for dosing undiluted medication or for the purpose of preparing suspension.  (Salazar77 in Italy, who is also on Rivotril 2.5 mg/mL, says his Rivotril comes with a dropper that delivers 0.100 mg per calibrated drop.  Apparently, your Rivotril isn't equipped with the same drug delivery system?)

 

2)  If you've been taking your concentrate straight from the syringe, it might be helpful to start dosing in the evening using the full 100 mL of the same 0.00125 mg/mL suspension that you'll be preparing routinely for your taper.  That way, you'll be aware of any changes in response or absorption rate that may result from diluting the medication.  If necessary, you could allow a few days to adjust to the suspension before resuming dose reductions. 

 

Please allow a day or two for others to post any additional suggestions before starting your taper, and keep us apprised of how you're doing.

 

XOXO

Koko Lee

[[Be...]]

Hello!

 

Yes, I do have the 0.3 ml for the concentrate and I definitely use it for it (the other syringe is too wide). Here in Spain, I have not seen that special dropper.

 

An advice for everyone the liquid method: do get several syringes, as the marks tend to peel off...at least that has been my experience with the ones I've gotten in Madrid.

 

I believe I'll use the 10 ml syringe for the suspension because I did an experiment that worked well: I substracted 100 ml from the short glass to the graduated cylinder, and it was very precise. I was able to fill the cylinder pretty quickly.  I don't think it took more than 2 minutes, a minute an a half. I'd have to time it again, but it was pretty quick (and we're talking about the maximum water subtraction).

 

However, I have not developed the skill to pour exactly 100 ml of water into the graduated cylinder (from the mineral water bottle to the graduated cylinder).  I always have to tinker here and there to reach the exact mark...I'm definitely not good to work in a Lab or as a Bartender.

 

As to the syringes: the 10 ml syringe is wide, it gets the liquid quickly, and it's easy to handle, so for now, I'll experiment using the 0.3 ml for the Rivotril concentration in the morning and keeping the 10 ml for the Rivotril suspension in the evening. If I have a bad reaction, I'll let you know.

 

For everyone: I'm in phase 2 regarding the liquid clonazepam taper using the aqueous solution:)

 

Regarding the Brintellix Taper, since I was taking the minimum dosage 5 mg for less than 21 days.

 

It seems that my 8 day quick taper went well (It's been more than a week, and so far so good). I did experience some irritability the first 3 days, a day with flu like symptoms (only 1 day). I did not have any runny nose, or headache. I don't think my tinnitus was affected. I do have brain zaps (but I've been experiencing them for months, probably due to benzo tolerance).

 

Yes Koko Lee, I'm definitely extremely impatient to wean off benzos like you have no idea....wait, you do have an idea! I even have the graduated cylinder visible in the living room to remind myself I'm doing something to get off benzos... :

 

Hope this update is informative, thank you for being there.

 

Ben.

 

 

 

Hi Ben!

 

That all looks really good!  I'm impressed that you took the time to practice the dosing steps in advance so you could troubleshoot.  You must be eager to get this show on the road.   

 

Just a couple of questions--

 

1)  Way back on page 1 of this thread, you mentioned having bought a 0.3 mL syringe, which badsocref had suggested as a way to improve dosing accuracy/precision.  Do you still have it?  I'd be a whole lot more comfortable with you using that, as opposed to a 1 mL syringe, to measure your concentrate, whether for dosing undiluted medication or for the purpose of preparing suspension.  (Salazar77 in Italy, who is also on Rivotril 2.5 mg/mL, says his Rivotril comes with a dropper that delivers 0.100 mg per calibrated drop.  Apparently, your Rivotril isn't equipped with the same drug delivery system?)

 

2)  If you've been taking your concentrate straight from the syringe, it might be helpful to start dosing in the evening using the full 100 mL of the same 0.00125 mg/mL suspension that you'll be preparing routinely for your taper.  That way, you'll be aware of any changes in response or absorption rate that may result from diluting the medication.  If necessary, you could allow a few days to adjust to the suspension before resuming dose reductions. 

 

Please allow a day or two for others to post any additional suggestions before starting your taper, and keep us apprised of how you're doing.

 

XOXO

Koko Lee

[[Ko...]]

Hi Ben,

 

You're so right about the markings wearing off of the syringes.  FYI, putting a piece of cellophane tape over the marks increases their longevity.   

 

So if I understand your intentions, you plan to use the 0.3 mL syringe to measure concentrate and the 10 mL syringe to measure aqueous suspension--that all sounds good.  What threw me was this:   

 

I would keep the morning dose with the same amount and technique (straight from the 1 ml syringe) until I reach phase 3, if that's ok.

 

Sorry if I seem to be beating a dead horse--I just want to be sure we're on the same page.

Koko Lee

[[Ko...]]

PS--Oh, and congratulations on having successfully tapered off of Brintellix.  I'm ecstatic that you experienced minimal WD effects!! 

[[Be...]]

Hello Koko Lee!

 

Not at all, thank you for wanting to make sure we're on the same page (you're doing me a great favor). You understood correctly: I'm using the 0.3 ml syringe to measure the concentrate, and the 10 ml to measure the aqueous suspension.

 

Ideally, I should've tapering using the aqueous solution method since the beginning  (phase 1-morning dose: bring it from 0.125 mg to 0.10 mg gradually).

 

However, weeks ago, I reduced my morning dose abruptly using the concentrate with the 0.3 ml syringe (I went down 2 lines): that's the equivalent of 0.025 mg. In other words: I went from 0.125 mg in the morning to 0.10 mg in the morning.

 

I was able to stand the withdrawal effects but it was painful week. Luckily, I didn't need to updose (but it got kind of ugly that week).

 

I've been holding my morning dose (0.10 mg) ever since. Now, I started tapering the nightime dose using the aqueous solution method.

 

I understand I need to reduce 20 ml of the aqueous solution before resuming the taper of the morning dose.

 

Now, I understand the reduction I made in my morning dose going down two lines using the concentrate with my 3 ml syringe was the equivalent of what I would've made if I had tapered using the aqueous solution method and graduated cylinder in a time frame of 20 days (0.00125 mg) per day, going from 0.125 mg to 0.10 mg.

 

Going down 2 lines represent 20% of 0.125 mg=0.025 mg/20 days: 0.00125 mg, that's the equivalent of the same daily reduction using the aqueous solution method. The only difference is that I made the total taper from phase 1 using the concentration from one day to another and holding it for weeks (I would say about 20 days). So that's why I started directly on phase 2 (nighttime dose), but this time using the aqueous solution method instead of doing it abruptly, my goal in this phase 2 is that my nighttime dose is the same as my daytime dose  (0.10 mg).

 

Please, correct me if I'm wrong, I apologize for all this mumbo jumbo explanation...

 

In any case the main idea is that I already completed phase 1: tapered my morning dose from 0.125 mg to 0.10 mg using the concentration in my 3 ml syringe. Now I'm in phase 2, getting my 0.125 mg nighttime dose to 0.10 mg too. Once, phase 2 is concluded, I will start phase 3, this time using the aqueous solution method for both: morning dose, and nightime dose. Does that make sense? I'm I aware I might sound like a broken record, but I want to make sure I explained myself correctly 

 

Hi Ben,

 

You're so right about the markings wearing off of the syringes.  FYI, putting a piece of cellophane tape over the marks increases their longevity.   

 

So if I understand your intentions, you plan to use the 0.3 mL syringe to measure concentrate and the 10 mL syringe to measure aqueous suspension--that all sounds good.  What threw me was this:   

 

I would keep the morning dose with the same amount and technique (straight from the 1 ml syringe) until I reach phase 3, if that's ok.

 

Sorry if I seem to be beating a dead horse--I just want to be sure we're on the same page.

Koko Lee