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Hi - Titration Plan - Help please


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Any help is greatly appreciated - I've been on the .125mg for 11 full days now

 

Start date- as soon as possible

 

Daily dose right now -  .125 mg Clonazepam

 

Tablet dose - .25 mg orally disintegrating tablet

                    .125 mg orally disintegrating tablet

 

Number of tablets - .125 mg orally disintegrating tablet at night only

 

Taper rate - not sure what's reasonable

 

Cylinder - 100 ml with 1 ml increments from 10 - 100 (no marks below 10 ml)

 

Thanks for the help

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As I was going to write in my topic (good thing to post your own.)

 

Sure, but well, there's a lot of options here. You sound as if you want to taper as low as you possibly can? How quickly do you want to do it? There are few rules at this point. If you have few symptoms, which seems to be the case, my recommendation would be to go as low as you want...

 

You could throw that .125mg in 100ml's and remove say 2ml's a day for a 50 day taper or 3 for a ~month long one.

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[07...]
Thanks xenofears....since I did too big of a jump 11 days ago (from .25mg to .125mg) and had w/d s/x....I'm wondering which plan is better? I seem more stable today then yesterday (the hair loss thing really ramped my anxiety up) ..I'm not sure  :(
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Hi Clementine:

 

That's very good news indeed.  Hopefully, you are stabilizing from that cut.  I will write up a plan and get back to you with it by latest tomorrow.

 

Draftsman

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Draftsman,

 

I think she's looking for several opinions. Do you mind sharing roughly how fast she'll be titrating to what before jumping if you don't post the schedule here?

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Hi Clementine,

 

What antibiotic were you given, was it in the Quinolone family?  If it was, that combined with the steroids you were given could have set you up for a difficult time and an extremely slow taper wouldn't really help you at this point.  I hate to see you take another few months to get off of the drug when you've only been on it about 4 and a half months.  Could you let us know what antibiotic you were given so we can give you the best possible suggestions for how to proceed from here?

 

Pam

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Draftsman,

 

I think she's looking for several opinions. Do you mind sharing roughly how fast she'll be titrating to what before jumping if you don't post the schedule here?

 

Hi Xenofears:

 

I will make another post on this thread with a schedule.  It's always good to have several options.  I'll go into a bit of detail on this, because I think it's good to go over it a bit here in the forum once in a while.  Plus it helps me think about it.  When the team comes up with ideas for taper and titration plans, the general guideline used is "10% every 7-14 days."  That guideline comes from Professor Ashton's work.  Having said that, the guideline is only intended to be a rough one, and can be varied to suit individual needs.  The neat thing about titration is that you can easily vary your rate by increasing or decreasing the ml of benzo solution you subtract from your cylinder each day.  For example, lets say you want 10% every 10 days which happens to fall nicely within Professor Ashton's guidelines.  With a 100ml cylinder you automatically have 10% every 10 days assuming you are cumulatively subtracting 1ml of benzo solution per day.  If in theory you wanted to increase the rate to 20% every 10 days, you would cumulatively remove 2ml of benzo solution each day.  If you wanted to reduce to 5% every 10 days, you would cumulatively subtract 1 ml every other day.  There are all kinds of different applications and ways to think about this.  As far as a jump off point is concerned, one could jump at any point they wished.  But the titration process usually does it automatically by providing you with a done date when you have cumulatively exhausted all your benzo liquid.  This is often the 100th day, for those using a 100ml cylinder.  Ultimately, titration as used in this forum allows you to make further controlled reductions with your benzo when you can no longer effectively continue dry cutting tablets.  It's helpful because benzos are extremely powerful medications most of which are not adequately manufactured in lower dose ranges.

 

Draftsman

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10% every 10-14 days from .125mg of Klonopin is waaayyy outside Prof. Ashton's guidelines :) .. the 10% rule disappears faster and faster each cut from the 10mg diazepam equivalent. But she was using dry tablets, the thought of titration wasn't in her realm of possibilities.

 

She also really frowned upon this idea of endless tapering and that you should jump at 1mg to 0.5mg diazepam.

 

Not arguing with you at all... just having a conversation about the different possibilities. I posted in my thread where Clementine was asking.. lots of people say jump off .125mg. Other people do half (.06mg) for a few days or a week or two. (Both of those choices aren't really titration ones though.) Other people taper to 0.025 to 0.05mg and jump off that. Other people taper endlessly until it's physically impossible to continue. I really don't think there is one answer to the question at this point, all are tried, all have varying results.

 

One thing about the endless tapering choice, as you get down to the single ml's of liquid.. there is way too much margin of error there. Better to stop at like 20ml's at the lowest from .125mg IMHO.

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Hi Clementine,

 

What antibiotic were you given, was it in the Quinolone family?  If it was, that combined with the steroids you were given could have set you up for a difficult time and an extremely slow taper wouldn't really help you at this point.  I hate to see you take another few months to get off of the drug when you've only been on it about 4 and a half months.  Could you let us know what antibiotic you were given so we can give you the best possible suggestions for how to proceed from here?

 

Pam

 

Hi Clementine:

 

Pam's post makes me think you should really talk more to your doctor about your situation.  I have personally known people who have experienced severe complications with steroid use.  And then the antibiotic situation adds even more complexity to the mix.  That's a lot of stuff to try to factor out.  I will post your schedule here, but it would seem to be wise to get a few different opinions and to talk to your doctor about what you should do.

 

So... here is a titration plan you can review with your doctor.  It’s a schedule for a 2% daily reduction based on your current .125mg dose.  Since the majority of your taper from an initial dose of 1mg. is already completed, there can be much more flexibility with the rate at which you do this titration.  If you feel you are doing well, you can always speed it up.  The following titration plan will take you about 50 days to complete.

 

Everyday, you will dissolve and titrate one orally disintegrating wafer (.125).

 

Dissolve the wafer (.125mg) into liquid and mix it thoroughly with 100ml (cc) liquid.  Each day, you will start with this original mixture (.125mg Clonazepam in 100mls liquid).  Each day you will cumulatively remove and discard 2ml from this mixture immediately upon mixing vigorously in the manner described below. 

 

So....

 

Day 1: make your original mixture and remove 2ml.  If applicable, divide the remaining into your daily doses.

 

Day 2: make your original mixture and remove 4mls.  Divide the remaining into your daily doses.

 

Day 3: make your original mixture and remove 6mls.  Divide the remaining into your daily doses.

 

Day 4: make your original mixture and remove 8mls.  Divide the remaining into your daily doses.

 

Day 5: make your original mixture and remove 10mls.  Divide the remaining into your daily doses.

 

...and so on.

 

Make sure to keep a log of your cuts so you don't lose track.  You may wish to split your dose into two daily doses.  If you do so, we recommend you space your two doses 12 hours apart.  You can keep unused doses in covered glasses in the fridge for up to 3 days.  As mentioned, your taper can easily be adjusted.  If you find you are doing well, you can speed it up by increasing your daily cuts to 3ml.  This would then take you about 33 days to complete and still be in an acceptable reduction range based upon your original dose of 1mg.  Conversely, you can always slow it down!  Just play it by ear.  You mentioned your 100ml cylinder has no marks below 10ml.  A 5ml baby dropper, available at most drug stores will be helpful with this.  A 3ml plastic pipette is also helpful.  I hope things go well for you.

 

Draftsman

 

 

 

 

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Well Clementine you asked my opinion so I'll give it to you, sounds like a plan to me, but like I said I really don't see a point in having to go to 10ml's and below from .125mg of K. But really, that should be something to visit when you get there.

 

Your doctor probably knows nothing about the complications of steroid and quinolone antibiotic use (well, maybe the later..) but you should DEFINITELY bring it up anyway. Want to share here what you are taking and why, maybe we can tell you a little more?

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[07...]

Hi all - Thank you very much for the replies. I can't even begin to express how much I appreciate the support. The antibiotic I was given was Erythromyocin. I took 4 of the 7 days prescribed due to adverse/severe side effects. Erythro is hard on most stomachs, etc - my response was severe dizziness, terrible g.i. response, swelling in the back of my head, etc....The antibiotic was administered 3 weeks after my steroid injection...it was another 3 weeks after that when the tremors/sever anxiety set in. Another piece of this puzzle was that I received 3000 units x3 (in 9 months) of botox injections to help with my back spams. In hindsight, of course, we pieced together the effects of my progesterone levels from the steroid injections/botox in combination of ramping the anxiety over 18 months - and the antibiotic seemed to break it all loose. In the midst of all this my dad passed away and adding to the anxiety.

 

I'm 37 years old....I'm under strict suprevision of a doctor and a therapist right now. I have been building/rebuilding my systems very intensely with supplements, diet, and toxin detoxing all while using the klonopin to stabilize. I've had every blood work under the sun to keep checking and rechecking levels as I bring supplements up and klonopin down. I'm also a Fibromyalgia patient. A month ago or so - the klonopin was no longer offering a decrease in anxiety but instead was making me very tired. We suspect that the supplements were ramping my system too quickly and the klonopin was only working mildly - upping the klonopin dosage wasn't an option for me because I have a very sensitive system and tend to suffer from most side effects (as seen even with the withdrawals).

 

With all that said (which is a lot, sorry) the regimen I'm on right is

Glutathione sublingual and honey

vitamin c

Kavanice

zinc

I just removed Vitamin B (thanks to a suggestion from this group)

selenium

l-lysine

magnesium

multi vitamin

natural progesterone

 

This is the regimen right now - it seems to change weekly based on the response my body has as I slowly rebuild/heal it. (And I should mention - the doctor's care I am under is NOT he same doctor who did the injections or the antibiotic) I've had very stable weeks with my supplements and the low dose of klonopin. But when I cut the dosage from .25mg to the .125mg I seemed to have knocked myself off the mark with the withdrawal s/x. And the hair loss really threw me for a loop and adding all sorts of panic and depression over the last week (which would have ben days 3 to 10 at the .125 mg dose). However, I found so much support on this board yesterday and seemed to quickly restabilize by the afternoon and slept great last night....thanks all.....So, with all that said, I'm very appreciative of any suggestions. Do I titrate? Do I dry cut....stay where I'm at? I'm so confused.

 

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[07...]
Oh....also had thyroid checked (came back in normal range first time) and rechecked again this week...waiting for newest results. Should have them by Monday
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Hi--

 

10% every 10-14 days from .125mg of Klonopin is waaayyy outside Prof. Ashton's guidelines :) .. the 10% rule disappears faster and faster each cut from the 10mg diazepam equivalent. But she was using dry tablets, the thought of titration wasn't in her realm of possibilities.

Right, the 10% rule runs into problems with Zeno's paradox, but that's philosophical not practical.  It depends where you apply the rule set- at the very beginning of the taper via the original dose or at other points later on.  The 10% rule also needs to be put into context with a person's symptoms and how they want to taper.

 

She also really frowned upon this idea of endless tapering and that you should jump at 1mg to 0.5mg diazepam.

Fortunately, this will work for most people.  Most people who are tapering diazepam will never need to titrate.  But there can still be flexibility for those people who want other options.  We try to keep plans flexible.  There is one member of BB who has been tapering Klonopin for 2 years now.  That's certainly outside the norm here, but if that approach makes the person comfortable, then more power to them.

 

Not arguing with you at all... just having a conversation about the different possibilities.

I appreciate your input, you bring up some interesting points.  However, I disagree with some.

 

I posted in my thread where Clementine was asking.. lots of people say jump off .125mg. Other people do half (.06mg) for a few days or a week or two. (Both of those choices aren't really titration ones though.) Other people taper to 0.025 to 0.05mg and jump off that. Other people taper endlessly until it's physically impossible to continue. I really don't think there is one answer to the question at this point, all are tried, all have varying results.

Most people should be okay with jumping off at .125 especially if they have been cutting in increments of .125.  Others will probably want to jump off at a later point depending at what increment they are cutting at.  I myself would not want to jump at .125 next week if I had been cutting at .0625 increments the previous weeks.  I would want to jump at .0625.  Again, it depends on context.

 

One thing about the endless tapering choice, as you get down to the single ml's of liquid.. there is way too much margin of error there. Better to stop at like 20ml's at the lowest from .125mg IMHO.

I don't agree on this one.  I don't think the error margin is significant, certainly not by clinical report in the forum here.  I'm not sure what you base your idea of margin of error on.  I can't see why it would be better to stop in the 20s, unless a person has been reducing in 20ml increments.

 

Thanks for your input.

 

Draftsman

 

 

 

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Hi Clementine:

 

Interesting what you say about your antibiotic.  I was sent to the hospital once for what turned out to be severe gastrointestinal problems as a result of amoxicillin.  They gave me an iv solution of atropine, compazine, and benadryl.  It calmed things down immediately.  It was actually quite amazing.  I'm so glad to hear that you stabilized.  It will definitely be interesting to see what you decide to do.  Please let us know.

 

Draftsman

 

 

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[fc...]

A margin of error is simply when titrating, you're not going to get the same dose, but close enough, with a +/-% which is a margin of error.

(error / R x 100ml = % error).

 

I use the term margin of error a lot with titration because there are margin of errors, although I'm not saying it's wrong.

When I titrate, yes I know there are margin of errors.

 

Note: Even though there's a +/-, you can titrate &c... slowly and get off Benzo's.

I just wanted to clear that up... since I use it a lot. With tapering Benzo's, there will be margin of errors, unless you perfectly cut.

 

Also after so many days of titrating, and it's total range &c... you will find a margin of error. You're also dealing with intervals.

 

S#

 

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Sigma, that's interesting.  Wouldn't the margin of error be pretty consistent throughout the entire titration though? 

 

Draftsman

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I'm going to stay out of further discussion as I think I may have rubbed the wrong way and started a more...heated.. debate than I intended to. Anyway, this is Clementine's thread.
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[fc...]
Wouldn't the margin of error be pretty consistent throughout the entire titration though?  

 

Yes.

 

The only way you're not going to get a +/- is by perfectly cutting.

The cuts add up, and I'm very sure there's a +/- %, or within the cuts, especially via titration. In the long run, if you cut a big enough + or - +/- you're bound to feel it.

 

Apart from that-

 

BUT at the same time, it's sensible to taper the Benzo using Titration. Does that make sense?

 

I wasn't saying titration is wrong because of margin of errors, just saying there will be one, either big or small, likely a small one... which really doesn't matter, and is nothing to worry about unless the cut is either too big or small daily, as the days add up into weeks, and so on... I put that the best way I can at this time.

 

S#

 

PS- Clementine, are you understanding the margin of error?

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S# I didn't get the "margin of error" concept from you. It's just words that came to me naturally using common sense.

 

BUT I still think that it's likely that the K dissolves and there really isn't much of a margin-of-error at ALL if you make it properly. So it's all pretty moot, shouldn't have brought it up.

 

Clementine -- please ignore all this, it's not really relevant to you :) .. we've gone off in a technical discussion, and it's my fault, sorry.

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[fc...]
BUT I still think that it's likely that the K dissolves and there really isn't much of a margin-of-error at ALL if you make it properly.

 

Oh you can find a +/- over time via titration.

It can be proven, but I'm not going to write an expression to do it.

 

And I put-

 

BUT at the same time, it's sensible to taper the Benzo using Titration.

I wasn't saying titration is wrong because of margin of errors, just saying there will be one, either big or small, likely a small one

 

I'm not arguing, Xeno. I'm just trying to clear that up.

 

I'll post no further here about a margin of error.

 

Thank you.

 

 

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BUT I still think that it's likely that the K dissolves and there really isn't much of a margin-of-error at ALL if you make it properly.

 

Oh you can find a +/- over time via titration.

It can be proven, but I'm not going to write an expression to do it.

 

I'd like to see it -- for fun -- not here! :)

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Like I said, draftsman -- a team member for this board -- gave you a good plan. Let us know how you travel Clementine!
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