No Waste Milk Titration

[[...]]

I used to do the no waste liquid titration with PG. I dislike having to waste any benzo.

I am doing the milk taper now and wonder how long milk would be good. I was thinking 3-4 days.

I think I have figured the math out.

My am dose is .375mg. Instead of pulling off .125mg or 12.5cc, I would create 1.5mg k in 15cc of milk for a .1k/1mg ratio. That would give me 4 days worth of k. I would pull of 3.75cc and drink it.

I still intend to decrease the afternoon dose to .375mg from .5mg. I am still trying to get used to this.

I hope that I have made sense.

I am not sure how long the milk solution will last. I am thinking 3-4 days max.

 

Thanks,

 

Dana

[[Li...]]

Hello, Dana.

 

Per usual, your calculations look AOK to me. 

 

Re: how long a milk/clonazepam suspension will last …

 

Given that the stability of homebrew liquids over time is untested and therefore unknown, I am a proponent of making smaller rather than larger batches.  (I also prefer smaller batches because you are putting less of your benzodiazepine supply ‘at risk’ if something goes awry.)

 

fwiw … when I was experimenting with water-based homebrew clonazepam liquids, I noticed that the appearance of the liquid began to change around the 4-5 day mark.  At least one other member (who had experience as an analytical chemist) shared a similar observation.

[[...]]

Thanks Libertas.

I made a 4 day batch for the milk. I feel like it is the max I want to do. When I used the PG, I would go 10 days without a problem. I think milk would be very iffy after 4 days as far as going bad.

I did go ahead and do 1.5mg/150cc for a .01mg/cc. I will drink 37.5cc per morning instead of the initial plan. I don't know if really makes a difference.

When I am ready for the afternoon titration, I will have to figure that out a far as the math.

I feel like with the no waste that I am getting all of the Benzo in 4 days. No waste and less reason for withdrawal issues.

Again, thank you so much.

[[Li...]]

You are welcome, Dana.  Four days sounds reasonable to me.  Using 150mL of milk versus 15mL also sounds reasonable.  If you’re interested in learning more about the solubility of diazepam in milk, I’ve included a link below to a post by a member who recently researched this topic (regrettably, I am not aware of similar research for clonazepam).

 

Link:

http://www.benzobuddies.org/forum/index.php?topic=267260.msg3372864#msg3372864

Scroll down until you see the section titled: Cow milk (homogenized, skim and whole).

 

Edit: Added link to member post

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Libertas,

 

The 1.5mg/15cc would make a .1mg/1cc concentration. I just decided on going .01mg.

I am not sure how dilute it should be or how the ratio affects the dosing. I sure don't want any issues, if I can avoid them.

Again, much gratitude.

 

Dana

[[Pa...]]

Hi Dana, did you get your concentrate diluted?

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Hi Pamster,

 

I sure did.

 

thanks

[[Ma...]]

Hi - I'm down to .1875mg daily, divided into three doses, for my ativan withdrawal. It's getting harder to do this as little chunks even with my scale, so I'm considering using liquid. Is there a reason we cannot just use water? My naturopath suggested diluting pills in water, didn't mention milk, and I have been dairy-free for many years now due to autoimmune. I don't want to drink glycol or even alcohol; just wondering why water mixed well isn't suggested? Thanks, as always. MamaRaven

[[Pa...]]

Hi - I'm down to .1875mg daily, divided into three doses, for my ativan withdrawal. It's getting harder to do this as little chunks even with my scale, so I'm considering using liquid. Is there a reason we cannot just use water? My naturopath suggested diluting pills in water, didn't mention milk, and I have been dairy-free for many years now due to autoimmune. I don't want to drink glycol or even alcohol; just wondering why water mixed well isn't suggested? Thanks, as always. MamaRaven

 

You can use water as long as you understand this isn't considered a solution but a suspension so it must be vigorously agitated before drawing out the medication you need to discard and again as you drink the remainder because the pill particles don't dissolve.  Its also important to add more liquid to your container so you can drink the particles that stick to the sides.

[[Ma...]]

Hi, Pamster - My goodness you stay busy answering all of our queries! Thank you to you and Kate08 and all the other elves behind the scenes.

 

So, I wasn't going to toss any away. I was going to measure out a day's dose, turn the dose to dust, add it to water, divide it into 3 sections and drink a section for my three daily doses. This is what the naturopath suggested, but it's different from everything I have read here. I have a referral to a psych NP about all this stuff, but with the wheels of bureaucracy and no doubt covid impacts on staffing and playing catch up, I haven't heard back yet and am about ready to go to water doses. I just like to verify what a doctor has told me to do on this site as this is the place that seems to have the expertise, hard won.

[[Pa...]]

Hi, Pamster - My goodness you stay busy answering all of our queries! Thank you to you and Kate08 and all the other elves behind the scenes.

 

So, I wasn't going to toss any away. I was going to measure out a day's dose, turn the dose to dust, add it to water, divide it into 3 sections and drink a section for my three daily doses. This is what the naturopath suggested, but it's different from everything I have read here. I have a referral to a psych NP about all this stuff, but with the wheels of bureaucracy and no doubt covid impacts on staffing and playing catch up, I haven't heard back yet and am about ready to go to water doses. I just like to verify what a doctor has told me to do on this site as this is the place that seems to have the expertise, hard won.

 

Don't give me too much credit MamaRaven, I really struggle with titration issues because I don't have personal experience but I did reach out to another member about your plan and got a thumbs up. 

 

Good for you for going in a direction that makes sense to you.

[[Ma...]]

Thanks, pamster. Which always makes me think of hamster, which is a nickname for one of my sons. It's cute and makes me smile. Anyhow, I will start this in two days and your double-checking gives me the security that I have been lacking.

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I have decided to stop the no waste taper and just pull off my benzo and drink the rest.

I have a feeling that this is not as accurate. I started doing the liquid at the end of May just to get my body used to it. I kept my morning dose at .375mg/milk and was drinking .48mg out of .5mg in the afternoon. I started the .02mg decrease last Friday, the 10th. I started getting symptoms on the 14th.

They have really progressed and I am pretty sick, so I just think it is the way I am doing it and/or my body is acclimating. I plan to do my am dose in pill form again. My afternoon dose I will use the milk. I am going split the .5mg and take half in tablet and the other half liquid and titrate from that. I saw a link that posted that Libertas suggested to JessicaLynx and it makes great sense.

I wonder if the liquid is less potent than the pill in that it loses some efficacy.

I will also not cut so much. I thought of cutting .02mg every 10 days, but that proves to be too much. Totally insane. I am just too sensitive and have probably not allowed my brain to recover from last years stress and a .125mg cut in Nov.

Just thought I would update. How many more times? 

 

Dana

[[Li...]]

Thank you for updating us on your taper, Dana.  I’m sorry you are not feeling well.

 

Were you doing ok with the milk-based liquid up until the time you made the 0.02mg reduction last Friday?

 

As I’m sure you know, some individuals have issues when they switch from dry to liquid dosage forms.  My understanding is that the pharmacokinetics of the drug may be slightly different (e.g. onset of action, duration of action, and most notably bioavailability).  This is why we suggest that members (a) refrain from making a reduction in dose at that same time they switch forms,  (b) hold for a period of time after making the switch to evaluate how they respond, and © if symptoms dictate, consider a small updose.

 

Accuracy is always a question mark with any homebrew liquid made with regular tablets.  Per our Titration: FAQs, homebrew liquids have not been professionally analyzed so we simply do not know how much of the active drug substance is contained in any given amount of the liquid.  This is why we suggest that members consider these liquids to be suspensions and treat them accordingly (shake well before using, measure quickly before any particles of undissolved drug or excipients settle out of suspension). Changing from measure/ingest (what you refer to as ‘no waste’) to measure/discard may allow you to measure more quickly. 

 

Using a combination of solid dosage forms and liquid is also a great strategy.

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Hi Libertas,

 

Thanks so much for your response. I really got whacked with symptoms. It is so insidious. I do journal so I have looked back and have seen the uptick in the symptoms. It feels like I cut by .125mg or larger.

Yes, I can see that my symptoms came on once I did the no waste, but more importantly, the .02mg cut hit me after about 4 days. Should I be doing .002mg/day as opposed to a .02mg cut? I did not think that was too much.

I really am  inclined to believe that what I was getting via the liquid was no where accurate. I sure tried, but failed. No waste just did not work. I like the milk because I think that is the best route as far as liquid. I seem to tolerate it and that is a plus.

My question is should I split my morning dose of .5mg and take .25mg tablet and then dissolve the other .25mg and pull off my .125mg to stay at .375mg or just cut it and do it dry? As far as the afternoon dose of which I have been titrating, can I again, cut the .5mg in half and take .25mg in tablet and liquid titrate the other half? I don't whether to start over with that instead of continuing to cut by the .02mg. Maybe I should just start again doing very small cuts like .002mg every day or so to keep my brain from going through this.

The only other option is dry cutting of which did not seem to do well with me. It was also very tedious to weigh and crush.

I greatly appreciate all of your help, as I am so weary and just can't handle these debilitating symptoms.

 

Dana

[[Li...]]

Tip of the hat for keeping a taper journal and reviewing your data on a regular basis! Doing so is one of the keys to a successful taper.

 

When did you notice the uptick in symptoms?  Did it start before you made the 0.02mg reduction or after?

 

Re: experiencing an uptick in symptoms 4 days after the 0.02mg reduction …

 

The “3/10” is a common withdrawal pattern reported by members who are tapering clonazepam.  They say it takes about 3 days for withdrawal symptoms to peak and about 10 days for symptoms to begin to stabilize (i.e. stop changing).

 

Re: how to proceed …

 

If I were in your shoes, I would probably try to take as much of my total daily dose in solid dosage form as possible and only use the liquid to taper the afternoon dose. I also would try a slight updose.

 

For example, given that you want to hold your morning dose of 0.375mg constant, you could try pill-splitting. See sample pattern below.  Or, if you have a cooperative prescriber, you might consider giving orally disintegrating tablets (ODTs) a try.  (In the US, clonazepam is available in 0.25mg and 0.125mg ODTs from the same manufacturer as your regular tablets — Teva.)

 

Given your goal of tapering your afternoon dose from 0.5mg to 0.375mg, you could use a combination of pill-splitting and liquid.  For example, you could split one 0.5mg into two halves. You could use another 0.5mg tablet to make 50mL of a 0.01mg/mL milk-based clonazepam liquid.  To begin you would divide the 50mL of liquid into two equal portions of 25mL (or 0.25g of drug) each.  On Day 1, you would take the first half of the tablet and drink 25mL of the liquid.  On Day 2, you would take the second half of the tablet and drink the other 25mL of the liquid. 

 

You would repeat the above pattern for 10 days or so to see how you respond.  If all was well, you could begin to reduce the liquid portion of your daily afternoon dose from 25mL to 0mL using the measure/discard technique.

 

You would keep your bedtime dose as is.

 

Sample pill-splitting pattern:

 

Day 1: Split a 0.5mg tablet into quarters.  Take 3 of the quarters. Save the remaining quarter for Day 2.

Day 2: Split a 0.5mg tablet in half.  Take 1 of the half tablets plus the quarter tablet from Day 1.  Save the remaining half tablet for Day 3.

Day 3: Split a 0.5mg tablet into quarters. Take 1 of the quarters plus the half tablet from Day 2.  Save the remaining 3 quarters for Day 4.

Day 4: Take the 3 quarters from Day 3.

Days 5 - 8: Repeat pattern for Days 1-4.

 

* Taking tablet pieces on consecutive days ensures that you consume the entire drug dose in the tablet over just two days.

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Hi Libertas,

 

Thank you so much! I like your plan. I have been trying to figure out the pill splitting for the morning dose for a long time. I am so grateful and hopeful. I think I am so sensitive and little changes really hit me. Now I know how use the tab and get the consistency that I need.

Yes, for the afternoon dose, I actually did the half tab and did the other half in liquid without titrating.

I am going to hold on until I feel better and stabilize before I attempt to taper. Instead of pulling off  .02mg, I will either pull off .01mg every ten days or just do a .002mg per day and see how it goes.

My downfall has been either lack of consistency, accuracy, and/or both.

Can a .02mg drop affect someone who is on a pretty high dose of K? It perplexes me. It just had to be the as above.

Again, we are all different and I know that age really plays a part in the difficulty.

I love the band Crosby, Stills, Nash, and Young. They have a song that has a lyric in it.

"And it gets harder, as you get older". Would have never imagined that being so true.

I thank you again as this gives renewed hope. I have been having a lot of fear, panic, startle, muscle twitching and pain, migraines, depression, heart palps, etc. These have been some of the worst symptoms in a long time, not counting the C/T.  I know that they will abate as they always have, once I stabilize, I just can't give up and won't, because there is a way down without suffering so severely.

 

Much Gratitude,

 

Dana

 

[[je...]]

Dana,

 

I'm not familiar with milk titration but I am doing liquid titration and I just want to add my experience to what Libertas said. I have limited my homebrew mix to as little liquid as possible and I'm taking as much as I can in pill format. So I'm splitting my pill and taking what I can reliably based on the scoreline. I only take liquid for the smallest amount I need to. 

 

I hope you find a way forward as I also really struggled with dry cutting. Liquid I find less cumbersome and time consuming. Good luck!

[[...]]

Dana,

 

I'm not familiar with milk titration but I am doing liquid titration and I just want to add my experience to what Libertas said. I have limited my homebrew mix to as little liquid as possible and I'm taking as much as I can in pill format. So I'm splitting my pill and taking what I can reliably based on the scoreline. I only take liquid for the smallest amount I need to. 

 

I hope you find a way forward as I also really struggled with dry cutting. Liquid I find less cumbersome and time consuming. Good luck!

 

Thanks so much jelly baby for your valuable input and suggestions.

It does make so much sense to have as much accuracy and consistency that we can get.

I hope and Pray that you continue to do well with your taper. We will get there.