1mg Lorazepam Taper Help- Doctor Switched me to 1mg Klon

[[Du...]]

So I am having a difficult time stabilizing on the 1mg. I start to have real bad palpitations start around 6pm.

 

Could I split my dose at .5mg morning and .5mg night to sleep?

 

Having a tough time. Any advice would be helpful.

 

Thanks

[Guest [ba...]]

Sounds like a dose split might be a good idea.  Doesn't have to be 50:50.  You might want to reserve a little more for sleep.  So can be 40 (am), 60 (pm), or 33 (am), 67 (pm), or 25 (am), 75 (pm), etcetera.

 

Symptoms like the heart palps are likely to pop up as you taper.  Try to see these symptoms as nuisances.  Try your best to not add more anxiety worrying about symptoms.  You're not suddenly going to have a heart condition or MS because you're withdrawing.  Withdrawal symptoms are gonna happen.  Hopefully, you can find a tapering rate that keeps those symptoms to a minimum.

[[Du...]]

It’s with a heavy a Grateful heart that I can post this... I hit tolerance w/d at 1mg of lorazepam and overloaded my system to the point where it got dangerously bad. I self admitted myself into a crisis center and spent 5 days in the hospital psych evaluation center.. they switched my 10mg lexapro over to 60mg cymbalta and my 1mg lorazepam over to 1mg Klonopin. The psychiatrist said I should stay on Klonopin for the rest of my life..... as appealing as that sounds because it was a relief from the tolerance and interdose w/d I was going through. I knew I had just been switched to a high equivalent dose and longer acting Benzo so my symptoms would/should lessen and I would go through hell tapering again and could face tolerance in the future if I stayed on.

 

It’s been 1 1/2 weeks and am stable at the 1mg Klonopin and am searching for a therapist/psychiatrist that will help me slowly taper off of this drug.

 

Now that I have switched, can someone help me with this Klonopin taper? Or provide some guidance for where to start?

 

Thanks, and happy to still be here.

 

 

[[sl...]]

Dukemonroe, thank you for sharing. I'm so sorry to hear what you've been through, and I'm so grateful that you chose to value your life and get help! I had a similar journey myself, though without medication WD involved, and I know how sobering it can be to be in in-patient and at the mercy of doctors to get help.

 

I don't know much about cymbalta, though it was recommended to me. Off the top of my head, I think they basically doubled your dose of benzo from 1mg of Ativan to 1mg of Klonopin.

 

I'm thinking there is a lot of good news in your new situation. For one, should you chose to taper, clonazepam might be much easier than lorazepam for it's longer half-life. And the fact that they've decided you're a "lifer" hopefully means you won't have any trouble filling your script if you decide to taper at home.

 

In my experience, and from reading around the forums, there are very few doctors who know how to taper gently and inexpensively. I know a few who taper gently, and they're extremely expensive. I know many others who taper at rates that I consider patient abuse, but they're in insurance and they usually just use tablets. So while I totally support working with a doctor, I haven't heard of many cases where they're much help.

 

I would be happy to help you taper clonazepam; I'm tapering myself down from 2mg, and it's had a learning curve but is entirely do-able. In my signature is a link called "My Klonopin Tools & Techniques"; the link takes you to three posts, one on doing a liquid/tablet hybrid taper, one on doing a daily micro taper, and one on making a homemade liquid clonazepam. The combination of all three techniques is my current approach and my taper has become incredibly easy and low-symptom as a result.

 

If you read my posts, which are admittedly long and could use some editing, you will get the territory of my approach. It's just one of many approaches, but I find it to be the best for my circumstances and especially for clonazepam. All the daily tapering math is done by a website that makes a custom taper schedule; mixing the liquid medicine requires about $20 in glassware and sourcing a potent form of alcohol (ideally 180+ proof); and the liquid/tablet hybrid keeps the liquid dose TINY, while allowing a very fine degree of reduction.

 

Let me know if I can help in any way.

I'm so relieved that you're stable! You can do this!

[[Du...]]

Thank you for the reply slownsteady! The information you’ve provided and have compiled on here is invaluable.

 

I would like to taper off clonazepam once I have a doc/psych who is on board with prescribing me the meds and supports a taper. I was given the lorazepam by my PCP... who I have had since I was born. He is unfortunately not Benzo wise and does not believe in “withdrawal” which blows my mind. Unfortunately I think he has been burned by addicts and is apart of the fast taper group...

 

I am not sure I am comfortable with doing a liquid taper, is there a way i could do a DMT with the tablets I get from a retail pharmacy?

 

Thanks, again.

[[sl...]]

I hear you'd like to find a supportive doctor while you taper. I hope that goal doesn't impede your efforts; I have a supportive doctor who is prescribing, but buddies are always telling me I'm the exception. I also lost my childhood doctor through this benzo disaster; he vastly over-prescribed and didn't have a clue how to help when I was in severe withdrawal. Looking back, he'd been dismissing my health concerns for over two decades, and I regret not switching sooner.

 

Of course, dry tapering is possible with tablets; it's a little tricky because clonazepam is so potent, but there are methods to make even a dry DMT possible on the cheap mg scales. It's popular around the forum and many people like Bob7 and others can help you, especially if you post in the Titrating tapering board. I find dry tapering fiddly, and anxiety provoking, so sadly I'm not going to be much help there.

 

Do you mind me asking, what are your discomforts about liquid tapering?

[Guest [ba...]]

You can certainly do a daily micro-taper with pills.  You just weigh out chunks/pieces on a scale instead of measuring liquids with a syringe.  The approach is very much the same.  Set up a base tapering rate (e.g. 0.25% per day).  If you're feeling OK, reduce by your base rate for that day.  If you're feeling good, consider doubling the cut for that day.  If you're feeling lousy, maybe just half the cut or hold. 

 

A lot of people order a little GEM-20 balance (roughly $25 on AmazonUS).  It's not a $65,000 microgram laboratory balance, but it will do a decent job for the price.  Use it properly and you can weigh as accurately pharmaceutical standards (within 5%). 

 

I'll say that a little more patience is required to weigh the pill compared to measuring the liquid out, but you don't have to make a liquid suspension out of your pills.  So it kind of evens out.  Just know that it's fine for your dose to weigh out at 0.121 grams when you're trying for 0.122 or 0.120 grams.  It's fine for the weight to be off by a couple of milligrams.  That really bothers some people, but it shouldn't.  One dose you'll be up 0.001 g.  The next dose you may be down 0.002 g.  It all kind of averages out.

[[Du...]]

I hear you'd like to find a supportive doctor while you taper. I hope that goal doesn't impede your efforts; I have a supportive doctor who is prescribing, but buddies are always telling me I'm the exception. I also lost my childhood doctor through this benzo disaster; he vastly over-prescribed and didn't have a clue how to help when I was in severe withdrawal. Looking back, he'd been dismissing my health concerns for over two decades, and I regret not switching sooner.

 

Of course, dry tapering is possible with tablets; it's a little tricky because clonazepam is so potent, but there are methods to make even a dry DMT possible on the cheap mg scales. It's popular around the forum and many people like Bob7 and others can help you, especially if you post in the Titrating tapering board. I find dry tapering fiddly, and anxiety provoking, so sadly I'm not going to be much help there.

 

Do you mind me asking, what are your discomforts about liquid tapering?

 

I think it causes me more anxiety dealing with liquids, rather than a dry method. I just feel more comfortable with weighing, shaving, or using bob7 methods.

[[Du...]]

You can certainly do a daily micro-taper with pills.  You just weigh out chunks/pieces on a scale instead of measuring liquids with a syringe.  The approach is very much the same.  Set up a base tapering rate (e.g. 0.25% per day).  If you're feeling OK, reduce by your base rate for that day.  If you're feeling good, consider doubling the cut for that day.  If you're feeling lousy, maybe just half the cut or hold. 

 

A lot of people order a little GEM-20 balance (roughly $25 on AmazonUS).  It's not a $65,000 microgram laboratory balance, but it will do a decent job for the price.  Use it properly and you can weigh as accurately pharmaceutical standards (within 5%). 

 

I'll say that a little more patience is required to weigh the pill compared to measuring the liquid out, but you don't have to make a liquid suspension out of your pills.  So it kind of evens out.  Just know that it's fine for your dose to weigh out at 0.121 grams when you're trying for 0.122 or 0.120 grams.  It's fine for the weight to be off by a couple of milligrams.  That really bothers some people, but it shouldn't.  One dose you'll be up 0.001 g.  The next dose you may be down 0.002 g.  It all kind of averages out.

 

Okay, thank you. This is the most “stable” I have felt in awhile. The lorazepam half life with interdose w/d and tolerance was unbearable. My plan is to stay at the 1mg klon until I meet with a new doctor and go over my plan. That’s in 2 weeks. Once I have a doctor that is on board with the taper and will prescribe the Klon. I will start tapering. Hopefully my body does not become tolerant in this timeframe... no real way to gauge this I’m assuming. ?

[[sl...]]

Thanks for clarifying your tapering preferences! The liquid compounding is definitely less tangible than dry tapering; there's some chemistry involved, and some trust. I tried to take most of the chemistry out with my guide but the trust part, that's hard. I totally support you doing whatever method you feel most comfortable with, and dry tapering works.

 

You're already dependent on benzos from taking Ativan, so while I understand the updose in your crossover to K is discouraging, I don't suggest rushing. You'll be around three weeks on your new dose by the doctor visit, if I understand your timeline correctly, so I expect you will be physically dependent on your new dose. It's going to be okay!

 

I'm finding tapering, and life in general, is much easier if I take my time. This is counter to the anxiety I feel in withdrawal, so it's a challenge, but very rewarding.

 

Good luck with your doctor visit! I hope you get all the support you need.

You certain deserve it. 

[[Du...]]

Thank you for the support!

[[Du...]]

Frustrating. I met with the new Psych doctor, and his recommended taper is 25% every 2 weeks after I’m on the Cymbalta for 3-4 more weeks... I see his logic with the AD and want to be on an AD to help with my taper. BUT, I’ve already tried the 25% method and failed miserably... It just blows my mind away from that even doctors with so much education and experience fail to see the 25% taper method doesn’t work for everyone...

[[sl...]]

Dukemonroe, I'm sorry to hear your doctor was suggesting such a rapid taper. It sounds like explaining your past experience didn't help the situation. Are they insistent on you getting off of the clonazepam?

 

If they're not insisting a taper, many patients present to their doctors as needing a maintenance dose "indefinitely"; in your case I'd suggest the 1mg you're currently on. You could explain your ongoing or previous anxiety and insomnia, and ask to keep prescribing this dose daily. This kind of arrangement would still allow you to taper at home, and if you get down to 0.25mg or below, you could just say, I'm needing less, I'd like smaller pills, etc. and basically get to run your own taper that way.

 

Sadly, I've yet to hear of an affordable doctor guiding a successful slow taper; if they even KNOW about a slow taper, they're usually an odd duck, and they'd also know not to try to guide the taper themselves. It's a basic rule in good tapering; the patients body dictates the protocol, and that guidance comes day by day, week by week, not according to some plan.

 

If you're eager to being transparent with your doctor, this website has resources for helping them understand benzo withdrawal practices.

 

https://benzoreform.org is the site but I recommend starting with the four 1-page pamphlets listed here: https://benzoreform.org/pamphlet-details-and-references/

 

Just take a look at Pamphlet #1, which says in bold "Allow the patient to decide the rate of taper." Many references are given in the reference pages that are with the pamphlets link, which might help a willing doctor to see this information as reliable.

 

Again, my experience is most doctors don't want to be told how to do their job, and they do not understand benzo tapering. If you want to try for a deeper relationship and it's worth risking needing to ditch and find a new doctor, I'd suggest trying to educate them. If that's too risky or unfeasible, I'd suggest asking for that maintenance dose, then just tapering slowly at home.

 

I know how stressful it feels when doctors and prescriptions are unreliable; I worked very hard to make sure that wouldn't be a challenging factor during my taper. I hope you can get the same kind of ease! 

[[Du...]]

Right now they are not insistent on me getting off the clonazepam, but it seems like they are hesitant to prescribe a "controlled" substance for an extended period of time. Your suggestion about a maintenance dose is great. I may try this if my next appointment does not go well.

 

I reached out to another psychiatrist who I have high hopes for to help and have an appointment on the 26th with him. I plan to bring my DMT plans to him and ask for help and describe how I have been dismissed regarding my concerns around benzo use and my desire to get off. Thank you for the resources and help. Hopefully, I can start my taper soon.... this has really affected my life negatively.

 

Thanks, again.

[[Du...]]

Starting my DMT tonight with a 1% reduction. Wish me luck; here we go again.

[[sl...]]

1%/day is 14%/2 weeks, and may be a bit rough to start. 0.5% would be 7%/2 weeks, and middle-of-the-road for a DMT in my opinon. I taper 0.43% daily and I've been going steady for 19 days with minimal symptoms. I personally prioritize functionality over taper rate.

 

If you don't mind me asking, why are you starting with 1% daily reductions?

I'm wishing you luck! 

[[Du...]]

Absolutely.

 

It’s just to start, I am planning to slow down so it’s 5% per week so 10% the first 2 weeks to gauge how I feel.

 

I also want to leave it open to see if I could do 1% a day so 14% every 2 weeks. Everything will be based on how I feel. If I feel like I’m going to fast I will slow down or hold. If I feel like I’m going to slow I’ll keep at the rate of 1%.

 

Overall, the plan is to keep it slow and not just push it. Stay functional and Try and keep sxs to a minimum if possible.

[[sl...]]

Thanks for sharing more about your plan.

 

A clonazepam DMT might surprise you with it's momentum, given it's much longer half-life compared to lorazepam. I did cut-and-holds previously, and the mentality I practiced with these was "just keep it together until it gets easier". When I switched to DMT, I was still in the habit of hanging tough, waiting for respite. I was cutting 9%/14 days, and by day 10 or 11 I just kept loosing more and more functionality, and when it finally dawned on me to hold I needed almost a week to regain my stability. Out of 19 days cutting at 9%/14 days, 6 were spent holding; the result was a 6%/14 day taper. Now I just cut 6%! And I have been cutting steady at this for 19 days.

 

You seem ready to be flexible and I'm reassured by that.

I'm sure you'll get the hang of it! Keep us posted. 

[[Du...]]

Great insight! Thank you for the reply, yeah, I have to find that % or rate that works for me and my symptoms. If I feel like my functionality is being compromised I will hold then slow it down. Similar to what you stated below.

 

Thanks!

[[Du...]]

Reduced 8.24% week 1 and am feeling good; reducing 1.18% per day. I am on track to reduce the same amount this week and will update. Keeping it slow and will reduce/hold if needed. Wish me luck as I have my first appointment with psych #2 tomorrow to try and explain what is going on and get support…

[[Du...]]

Hallelujah!! My new psych is Benzo wise and has tapered many patients off benzos using both substitution methods and switching to liquid for more exact reductions. He is the first doctor/psych who has brought up Dr.Aston to me.

 

New game plan is to switch over to liquid Klonopin from a compounding pharmacy and do a DMT using liquid instead of a scale and file. Go slow based on symptoms.

 

Will update as I proceed.

[[sl...]]

I'm glad to hear this news! Compounded liquid clonazepam is great. 

 

Tell us what sort of solution or suspension they end up making you, when you find out.

 

 

[[Du...]]

Sounds good!

 

I am a little concerned with figuring out the correct dosage when I switch to liquid. I’m currently at .89mg… do you know how I could calculate this?

 

Thanks!

[[sl...]]

I am a little concerned with figuring out the correct dosage when I switch to liquid. I’m currently at .89mg… do you know how I could calculate this?

 

This would depend on the concentration in mg/ml of the liquid clonazepam they compound for you. I've heard some people updose a little when they switch entirely to liquid, because in some cases it can be a bit of a potency adjustment even if you can tolerate all the compounding ingredients.

 

If your psyche is willing, I suggest considering a liquid/tablet hybrid; this method requires tablets and a liquid medicine, but in my opinion this minimizes some of the risks of trialing a new liquid, minimized the liquid amount consumed and thus the cost for compounding, and if you have multiple doses, this can make things easier by keeping most doses as tablets and only one liquid dose, if desired. I describe how I'm doing a liquid/tablet hybrid in the link in my signature.

 

Either way, just post your mg/ml of clonazepam in the liquid you're prescribed and myself or someone else can walk you through converting your dose into the new medicine.

[[Du...]]

Picked up the solution today and it is a 0.1MG/ML Suspension. They used a premade suspension called suspendit by PCCA. The bottle is 300ml's total.

 

The dosage on the bottle says "take 10mls by mouth each day and taper by .5mls each day as tolerated.

 

I'm just trying to figure out how to transition to the liquid when I have been doing a dry DMT and am down to .86mg currently.  Any help here would be great thanks!