Tapering table

[[Ch...]]

Charlene,

 

Just in case I am out of town this weekend, please print out these instructions so you know what to do:

 

For your 300 day taper:

1 - Just before bed, put the 2mg of drug into the jar.

2 - If you are ok with alcohol, then drip a few drops of Vodka over the pills to help them break down.  Just enough to do the job

3 - Fill the jar with 300 mL of water

4 - 30 minutes before bed, stir it up good and remove 1mL of mixture and throw it away

5 - Stir it again and drink 1/2 of it.

6 - Read until your eyes want to close on their own. 

7 - Put your head on the pillow and count your breaths.  Do not think about anything, just keep counting your breaths.

8 - Anytime you wake up during the night, stir and drink another 1/4 of the mixture

9 - If any is left in the morning, drink it and also rinse the jar and drink the rinse water

 

Day 2 of your taper is the same except you remove 2mL in step 4

Day 3 of your taper is the same except you remove 3mL in step 4

and so on for 300 days.

 

PS - I currently think Magnesium Taurate works better than Magnesium Glycinate - you might try it.  I take 2 pills of Magnesium Taurate two hours before bed.  Here is a link https://smile.amazon.com/gp/product/B0045CFN24/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1 

 

Bob

I looked up Magnesium Taurate and won't work for me because it lowers blood pressure.  I have pretty low blook pressure as it is.  Glad it works for you though

[[Ch...]]

Charlene,

 

Just in case I am out of town this weekend, please print out these instructions so you know what to do:

 

For your 300 day taper:

1 - Just before bed, put the 2mg of drug into the jar.

2 - If you are ok with alcohol, then drip a few drops of Vodka over the pills to help them break down.  Just enough to do the job

3 - Fill the jar with 300 mL of water

4 - 30 minutes before bed, stir it up good and remove 1mL of mixture and throw it away

5 - Stir it again and drink 1/2 of it.

6 - Read until your eyes want to close on their own. 

7 - Put your head on the pillow and count your breaths.  Do not think about anything, just keep counting your breaths.

8 - Anytime you wake up during the night, stir and drink another 1/4 of the mixture

9 - If any is left in the morning, drink it and also rinse the jar and drink the rinse water

 

Day 2 of your taper is the same except you remove 2mL in step 4

Day 3 of your taper is the same except you remove 3mL in step 4

and so on for 300 days.

 

PS - I currently think Magnesium Taurate works better than Magnesium Glycinate - you might try it.  I take 2 pills of Magnesium Taurate two hours before bed.  Here is a link https://smile.amazon.com/gp/product/B0045CFN24/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1 

 

Bob

I looked up Magnesium Taurate and won't work for me because it lowers blood pressure.  I have pretty low blook pressure as it is.  Glad it works for you though

 

I know you asked me very nicely not to look at numbers or percentages, but being that I've been on Klonopin 2X already and am having trouble sleeping already, I was wondering what you thought of speeding it up slightly unless you think I would sleep better at the 1ML slower rate we have.  So my thought was to take 1.5 ML out for the first 48 days.  That would technically get me from 2MG to 1.5 MG, a drop in one .5 mg pill ---It looks like if we keep as  is 1 ML it takes me about 74 days just to get one pill out of the way.  Versus about 48 days if we do 1.5 ML for this 1st pill.  Then after the first pill is done that leaves my solution with 1.5 MG of which I would then do the 1 ML tapering from there to the end.  You let me know if you think that's dumb or you think it's too fast. or if my math is wrong again.

 

0.01005 (1.5ML =.01005MG)

Date Day # ML Daily reduction MG Daily Reduction Running total Start amt

                        2

3/20/2022 1 1.5 0.01005 0.01005 1.98995

3/21/2022 2 3 0.03015 0.0402 1.9799

3/22/2022 3 4.5 0.045225 0.085425 1.96985

3/23/2022 4 6 0.0603 0.145725 1.9598

3/24/2022 5 7.5 0.075375 0.2211 1.94975

3/25/2022 6 9 0.09045 0.31155 1.9397

3/26/2022 7 10.5 0.105525 0.417075 1.92965

3/27/2022 8 12 0.1206 0.537675 1.9196

3/28/2022 9 13.5 0.135675 0.67335 1.90955

3/29/2022 10 15 0.15075 0.8241 1.8995

3/30/2022 11 16.5 0.165825 0.989925 1.88945

3/31/2022 12 18 0.1809 1.170825 1.8794

4/1/2022 13 19.5 0.195975 1.3668 1.86935

4/2/2022 14 21 0.21105 1.57785 1.8593

4/3/2022 15 22.5 0.226125 1.803975 1.84925

4/4/2022 16 24 0.2412 2.045175 1.8392

4/5/2022 17 25.5 0.256275 2.30145 1.82915

4/6/2022 18 27 0.27135 2.5728 1.8191

4/7/2022 19 28.5 0.286425 2.859225 1.80905

4/8/2022 20 30 0.3015 3.160725 1.799

4/9/2022 21 31.5 0.316575 3.4773 1.78895

4/10/2022 22 33 0.33165 3.80895 1.7789

4/11/2022 23 34.5 0.346725 4.155675 1.76885

4/12/2022 24 36 0.3618 4.517475 1.7588

4/13/2022 25 37.5 0.376875 4.89435 1.74875

4/14/2022 26 39 0.39195 5.2863 1.7387

4/15/2022 27 40.5 0.407025 5.693325 1.72865

4/16/2022 28 42 0.4221 6.115425 1.7186

4/17/2022 29 43.5 0.437175 6.5526 1.70855

4/18/2022 30 45 0.45225 7.00485 1.6985

4/19/2022 31 46.5 0.467325 7.472175 1.68845

4/20/2022 32 48 0.4824 7.954575 1.6784

4/21/2022 33 49.5 0.497475 8.45205 1.66835

4/22/2022 34 51 0.51255 8.9646 1.6583

4/23/2022 35 52.5 0.527625 9.492225 1.64825

4/24/2022 36 54 0.5427 10.034925 1.6382

4/25/2022 37 55.5 0.557775 10.5927 1.62815

4/26/2022 38 57 0.57285 11.16555 1.6181

4/27/2022 39 58.5 0.587925 11.753475 1.60805

4/28/2022 40 60 0.603 12.356475 1.598

4/29/2022 41 61.5 0.618075 12.97455 1.58795

4/30/2022 42 63 0.63315 13.6077 1.5779

 

[[...]]

I checked your math in my head and it looks ok - I really would need to spend more time to be 100% - but my first pass sees nothing wrong.

 

But the math isn't too important.  You will start with 2mg in 300 mL of water.  There are many ways to reach zero.  Absolutely you can try 1.5 mL per day.

 

The important thing, is every day, write down what you are dong (1mL of 1.5ml) and how you feel and also any external life stress (e.g. work).

 

Then, as the days and weeks pass, you can look back and see if you need to adjust your taper.

 

Everyone is different.  You must take good notes and listen to your body.

 

Good luck.

[[Li...]]

Keeping a daily journal as Bob7 has suggested is one of the keys to a successful taper.

 

Another key to success is to keep an eye on your taper rate.  This is especially important when reducing one’s dose by a fixed amount as you have planned.

 

Per the table above, you will be making a 15.66% reduction in dose over the first month of your taper.  Given your history, that may (or may not) be a tad aggressive. For example, the Colorado Consortium suggests an initial trial reduction in the range of 5-10%. Generally speaking, it’s far easier to increase a taper rate that is ‘too slow’ than it is to decrease and recover from a taper rate that is ‘too fast.’

 

Here’s an easy-to-use tool you can use to check your taper rate:

 

Percentage Change Calculator

https://www.calculatorsoup.com/calculators/algebra/percent-change-calculator.php

[[Ch...]]

I checked your math in my head and it looks ok - I really would need to spend more time to be 100% - but my first pass sees nothing wrong.

 

But the math isn't too important.  You will start with 2mg in 300 mL of water.  There are many ways to reach zero.  Absolutely you can try 1.5 mL per day.

 

The important thing, is every day, write down what you are dong (1mL of 1.5ml) and how you feel and also any external life stress (e.g. work).

 

Then, as the days and weeks pass, you can look back and see if you need to adjust your taper.

 

Everyone is different.  You must take good notes and listen to your body.

 

Good luck.

 

Thanks Bob for checking this out.  Unfortunately I've been on disability since all of this happened.  Again I appreciate your thoughts and prayers. 

[[Ka...]]

It turned out for me that this sort of liquid taper worked very well but the lack of math was the best part for me!

 

Kate08

[[Ch...]]

Keeping a daily journal as Bob7 has suggested is one of the keys to a successful taper.

 

Another key to success is to keep an eye on your taper rate.  This is especially important when reducing one’s dose by a fixed amount as you have planned.

 

Per the table above, you will be making a 15.66% reduction in dose over the first month of your taper.  Given your history, that may (or may not) be a tad aggressive. For example, the Colorado Consortium suggests an initial trial reduction in the range of 5-10%. Generally speaking, it’s far easier to increase a taper rate that is ‘too slow’ than it is to decrease and recover from a taper rate that is ‘too fast.’

 

Here’s an easy-to-use tool you can use to check your taper rate:

 

Percentage Change Calculator

https://www.calculatorsoup.com/calculators/algebra/percent-change-calculator.php

 

Thank you so much Libertas.  Yes, 15% is a lot.  I know I'm trying to hurry with my 4th (first) pill since I thought is was easier to withdrawel faster at first and then you really need to be slower as you get down more.  I'm not sleeping very good now even at 2 MG because of being on this 2X before.  I don't know if that's kindling or tolerance, but I thought making a faster taper in the beginning would get me off a little quicker and then my sleep would return.  But I'm not sure if that's true.  Thank you so much for checking and I'll do some thinking about that.  It's all about the sleep and the fact I was on this before...I'm scared and I appreciate your thoughts.    Please if you have any more suggestions or knowledge, throw them at me. 

[[Ch...]]

It turned out for me that this sort of liquid taper worked very well but the lack of math was the best part for me!

 

Kate08

 

That's great Kate.  Glad it worked for you!!

[[Li...]]

You are most welcome, Charlene.  Although some individuals are able to make larger percentage reductions at the beginning of their tapers, this is not true for all individuals.  Indicators that a lower rate might be called for include a history of unsuccessful discontinuation attempts and signs of drug tolerance. 

 

However, this is your taper so it’s your call on how to proceed. One strategy you might consider is introducing a brief hold (3 or so days) after the first two weeks (or so) of your taper.  This would give your body a chance to ‘process’ the reductions you’ve made up to that point while you carefully review the data in your journal and make a decision as to whether or not a rate adjustment is needed.

[[Ch...]]

You are most welcome, Charlene.  Although some individuals are able to make larger percentage reductions at the beginning of their tapers, this is not true for all individuals.  Indicators that a lower rate might be called for include a history of unsuccessful discontinuation attempts and signs of drug tolerance. 

 

However, this is your taper so it’s your call on how to proceed. One strategy you might consider is introducing a brief hold (3 or so days) after the first two weeks (or so) of your taper.  This would give your body a chance to ‘process’ the reductions you’ve made up to that point while you carefully review the data in your journal and make a decision as to whether or not a rate adjustment is needed.

Sounds like a plan to perhaps do a brief hold.  So do you think I can factor in that I was on 2.5 mg a month ago and tapered the entire amount within a month with little problems except for sleep (so I did a week of 3/4 of the .5mG pill, then 1/2 of my pill the 2nd week and 1/4 the 3rd week and now nothing this week.  It seemed to go fine except for the sleep thing.  Sunday the 20th is when I start the liquid taper.  Thanks again.

[[Li...]]

Might I encourage you to add the information about your recent 20% per month reduction in dose to your signature?  The way it’s currently written suggests you have been taking a dose of 2mg since at least the beginning of this year.

 

Am I understanding correctly that your only withdrawal symptom is ‘the sleep thing’?  If so, during the past week, has this symptom gotten better, worse, or stayed about the same?

[[Ch...]]

Might I encourage you to add the information about your recent 20% per month reduction in dose to your signature?  The way it’s currently written suggests you have been taking a dose of 2mg since at least the beginning of this year.

 

Am I understanding correctly that your only withdrawal symptom is ‘the sleep thing’?  If so, during the past week, has this symptom gotten better, worse, or stayed about the same?

I'm sorry Libertas, I don't recall how to change that, it's been years. I'm sure it's pretty easy though to do.

 

Also, it's been slightly worse.  That pill was always taken in the morning when I woke up.

 

[[Ch...]]

It turned out for me that this sort of liquid taper worked very well but the lack of math was the best part for me!

 

Kate08

 

Hi Kate - would you mind if I asked you about your experience in tapering since you were on for quite a while?

[[Ka...]]

It turned out for me that this sort of liquid taper worked very well but the lack of math was the best part for me!

 

Kate08

 

Hi Kate - would you mind if I asked you about your experience in tapering since you were on for quite a while?

 

Sure Charlene, I'll share.  I used the water method that Bob7 outlined for you.  Math isn't my strength (or my love) so knowing I only had to remember how much water to remove worked great for me.  I kept a journal so I knew where I was each day in terms of dose reductions and how I was doing.  And the withdrawl symptoms along the way were tolerable.   

[[Li...]]

Here are the instructions for Add your history/signature.  (If you need help, a team member will be happy to assist you.)

 

Summarizing your drug and tapering history in your signature helps other members help you. (Our members are all peer volunteers; most do not have time to read through another member’s posts to gather this critical information themselves.) In addition to adding the information about your recent reduction in dose, it would also be helpful to include your daily dosing schedule (dose/doses and time/times) in your signature.  It sounds like you may have changed your dosing schedule at some point. 

 

The fact that your sleep issues have become slightly worse suggests you may not have stabilized from the 20% reduction you made last month.  Note that ‘stabilize’ means your withdrawal symptom(s) stop changing, not that they go away. (Sleep disturbance is one of the most common withdrawal symptoms; if you have not already done so, I encourage you to learn more about non-drug techniques you can use to cope with this.)

 

I’ll close by reiterating my earlier comment about the importance of first discovering and then monitoring your taper rate throughout your taper.  One of the disadvantages of daily microtapering by fixed amounts is that the taper rate increases over time.  Although some individuals can tolerate the increasing rate, others cannot.  Instead, they reach a tipping point where the rate becomes too fast; members describe this as ‘hitting a brick wall’ or ‘crashing and burning’.  (Monitoring taper rate is especially important when tapering drugs with relatively long half-lives such as clonazepam due to the delayed feedback loop.)

[[Pa...]]

Here are the instructions for Add your history/signature.  (If you need help, a team member will be happy to assist you.)

 

Happy to help get this critical information into your signature Charlene. 

[[Li...]]

Pamster: Why am I not surprised by your swift and generous offer to help Charlene with her signature?  Thank you for all that you do to support our community!

 

Charlene: I thought of another suggestion I wanted to share.

 

In addition to the two risk mitigation strategies for using homebrew liquids I mentioned upthread (i.e., shake vigorously, measure quickly), there is a third one that applies when switching from a solid dosage form (e.g. tablets, capsules) to any type of liquid (e.g. commercial solutions, compounded solutions, compounded suspensions, homebrew).

 

When switching from a solid to a liquid dosage form, it is not uncommon for members to report that the liquid does not ‘perform’ exactly the same way as the solid.  For example, some members report slight differences in potency, onset of action, and/or duration of action of the drug.  To determine if you will experience such differences, you will need to conduct an experiment.  Switch to the liquid while keeping your dose constant.  Then hold for several days (see note below) so you can get a clear read on the impact of the change plus give your body sufficient time to adjust to it.  Then, if all is well, begin making reductions.

 

Sending all best wishes your way for a successful taper …. Libertas

 

Note: The number of days for the hold/adjustment period depends, in part, on the properties of the benzodiazepine you are using and how you metabolize it.  For example, a common withdrawal pattern for individuals tapering clonazepam is 3/10 — it takes about 3 days for withdrawal symptoms to manifest after a taper change and about 10 days for those symptoms to peak and then stabilize (i.e. stop changing, become ‘tolerable enough’ to make the next reduction).

 

[[Ch...]]

It turned out for me that this sort of liquid taper worked very well but the lack of math was the best part for me!

 

Kate08

 

Hi Kate - would you mind if I asked you about your experience in tapering since you were on for quite a while?

 

Sure Charlene, I'll share.  I used the water method that Bob7 outlined for you.  Math isn't my strength (or my love) so knowing I only had to remember how much water to remove worked great for me.  I kept a journal so I knew where I was each day in terms of dose reductions and how I was doing.  And the withdrawl symptoms along the way were tolerable.   

 

Glad all worked for you

[[Ch...]]

Here are the instructions for Add your history/signature.  (If you need help, a team member will be happy to assist you.)

 

Happy to help get this critical information into your signature Charlene. 

Thank you Pamster for the nice instructions.  Worked perfectly. 

[[Ch...]]

Pamster: Why am I not surprised by your swift and generous offer to help Charlene with her signature?  Thank you for all that you do to support our community!

 

Charlene: I thought of another suggestion I wanted to share.

 

In addition to the two risk mitigation strategies for using homebrew liquids I mentioned upthread (i.e., shake vigorously, measure quickly), there is a third one that applies when switching from a solid dosage form (e.g. tablets, capsules) to any type of liquid (e.g. commercial solutions, compounded solutions, compounded suspensions, homebrew).

 

When switching from a solid to a liquid dosage form, it is not uncommon for members to report that the liquid does not ‘perform’ exactly the same way as the solid.  For example, some members report slight differences in potency, onset of action, and/or duration of action of the drug.  To determine if you will experience such differences, you will need to conduct an experiment.  Switch to the liquid while keeping your dose constant.  Then hold for several days (see note below) so you can get a clear read on the impact of the change plus give your body sufficient time to adjust to it.  Then, if all is well, begin making reductions.

 

Sending all best wishes your way for a successful taper …. Libertas

 

Note: The number of days for the hold/adjustment period depends, in part, on the properties of the benzodiazepine you are using and how you metabolize it.  For example, a common withdrawal pattern for individuals tapering clonazepam is 3/10 — it takes about 3 days for withdrawal symptoms to manifest after a taper change and about 10 days for those symptoms to peak and then stabilize (i.e. stop changing, become ‘tolerable enough’ to make the next reduction).

 

Thanks Libertas.  I'm going to try the liquid to night.  I'm not using vodka, just water.  Do you know if I should crush first or just let them disolve.  I was going to let them disolve for 1/2 hour.  I understand I will see yellow particles in there.  Thanks so much

[[Li...]]

Thanks Libertas.  I'm going to try the liquid to night.  I'm not using vodka, just water.  Do you know if I should crush first or just let them disolve.  I was going to let them disolve for 1/2 hour.  I understand I will see yellow particles in there.  Thanks so much

 

My understanding is that compounding pharmacists who prepare clonazepam suspensions using regular tablets as the drug source typically grind the tablets into a fine powder before adding the suspending vehicle. However, some members have reported that their tablets disperse (fall apart, disintegrate) into fine, equal size particles without grinding. Tablets from different manufacturers use different ingredients and are made using different manufacturing processes; some disperse more quickly/evenly than others. 

 

You are correct that there will be visible particles in your homebrew suspension.  Contrary to what you may have read here on the forum, these particles are not just ‘binders’ and ‘fillers’ that ‘don’t matter.’  For example, the particles may contain undissolved drug molecules as well as water-insoluble excipients.  Per the article cited below, “Excipients are functional ingredients that facilitate the therapeutic function [e.g. bioavailability, pharmacokinetic profile] of the API [active pharmaceutical ingredient] not just inert ingredients in a formulation.” 

 

Citation:

Excipient selection for compounded pharmaceutical capsules: they’re only fillers, right?

https://www.medisca.net/pdf/published-articles/AJP%20Aug%2017%20-%20Practice%20Update%20-%20Excipient%20selection%20for%20compounded%20pharmaceutical%20capsules-%20they're%20just%20fillers%20right.pdf

 

[[Ch...]]

Thanks Libertas.  I'm going to try the liquid to night.  I'm not using vodka, just water.  Do you know if I should crush first or just let them disolve.  I was going to let them disolve for 1/2 hour.  I understand I will see yellow particles in there.  Thanks so much

 

My understanding is that compounding pharmacists who prepare clonazepam suspensions using regular tablets as the drug source typically grind the tablets into a fine powder before adding the suspending vehicle. However, some members have reported that their tablets disperse (fall apart, disintegrate) into fine, equal size particles without grinding. Tablets from different manufacturers use different ingredients and are made using different manufacturing processes; some disperse more quickly/evenly than others. 

 

You are correct that there will be visible particles in your homebrew suspension.  Contrary to what you may have read here on the forum, these particles are not just ‘binders’ and ‘fillers’ that ‘don’t matter.’  For example, the particles may contain undissolved drug molecules as well as water-insoluble excipients.  Per the article cited below, “Excipients are functional ingredients that facilitate the therapeutic function [e.g. bioavailability, pharmacokinetic profile] of the API [active pharmaceutical ingredient] not just inert ingredients in a formulation.” 

 

Citation:

Excipient selection for compounded pharmaceutical capsules: they’re only fillers, right?

https://www.medisca.net/pdf/published-articles/AJP%20Aug%2017%20-%20Practice%20Update%20-%20Excipient%20selection%20for%20compounded%20pharmaceutical%20capsules-%20they're%20just%20fillers%20right.pdf

 

Thank you Libertas

[[Ka...]]

Charlene, I did a water taper and I crushed my clonazepam tablets as best I could and then added the water.  A lot of the particles settled to the bottom so I stirred it very well, withdrew the correct amount for that particular day, and then took the rest immediately, before too much settling occurred again.

[[Ch...]]

Bob,

Thank you so much.  At some point, will I get the schedule so I know where I'm at MG wise and how fast I am tapering.  When I did my dry scale method I reduced 10% every 7 days of the previous dose (not the original dose).  So I think that means for the water titration as I go down, I'm not slowing down in tapering (this is more linear) as I go down. I'm nervous since I've been on this 2X before, but I'm assuming we could make the tapering slower as I went down. 

 

Another question, should I put the 2 MG pills in about 1/2 hour before I take in order to break up.  I doubt I'll use the vodka.  Thanks for the tip on magnesium.

 

One more question if you look at this link the person says that 1 drop = .1 mg.  (a little after the middle of the video).  Is this true?  Just wondering in case I have trouble. 

 

 

Thank you so much

Each mL you remove from the 300mL, takes out 0.0067 mg of drug.  BUT PLEASE, try to stop thinking about the numbers and do not try to figure out percentages.  The whole reason we designed this taper for you was so you do not THINK.  Thinking creates anxiety.  Anxiety makes withdrawal symptoms.

 

Just follow the instructions and trust because you are doing a very mild and slow taper.  Do not try to compute anything else about it.

 

One drop is close to 0.1mg - it depends on the size of the drop.  You should use your syringes to measure, do not use drops.

 

You need to experiment to see how long it takes to dissolve your benzo.  It depend on if you use alcohol.  If you stir, it should break down fast.  You may see little pieces the water.  Those are filler material.  Do not worry about them.

 

Hi Bob, once I hit 1.5 Mg, I can kind of start over with the table and only ask my doc for a prescription of 1.5 MG, correct?

 

Also, I have this burning pain symetrical below my stomach.  I started putting my full dose in liquid Saturday night (so two nights ago).  I'm assuming if the pain is benzo related it would be due to the tapering of my first pill when I was at 2.5%, not the change to liquid (that would be too soon), although Libertas kindly shared with me that particules within the water might not be just fillers so it got me wondering if my pain is the result of the liquid even though it's only been two days and I'm still using the full 2.0 percent.  thanks much.

[[...]]

Sure, when you to 1.5 mg, you can switch to 1.5mg pills.

Then instead of adding 3 pills, you just add one.

I think symptoms very - you might just have anxiety about changing to a liquid.