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diazepam back to k for remainder of taper? Frustrating recent Hospital visit


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Hi all,

 

I know I really need to make my own decision in regard to how I move forward with my taper, but it is comforting to know that BenzoBuddies are here to offer compassion and support, compassion and support that seems to be severely lacking elsewhere.

 

3 nights ago I got a cab to hospital about midnight because I felt I could no longer continue on with my diazepam taper after constantly experiencing a significant increase in symptoms within 1hr post dosing. Within that hour, anxiety would increase, breathing would become fast and erratic, I would become increasingly agitated and aches and pain in my body would increase, along with numerous other symptoms, all culminating in severe insomnia. Gradually, over a period of about 7-9 hours, the symptoms would ease and I would feel settled enough to finally sleep some. But then I was only 3 - 5 hrs from my next dose. I’d always felt horrid on the diazepam.

 

It was one thing to endure the taper cuts without having ever stabilised from switch directly to 10mg diazepam after 19 day cold turkey from 1mg K, but to also endure this paradoxical reaction after each dose (morning and evening) just became too much for me in addition to taper withdrawals.

 

As concerned as I was (and still am) about the idea of switching back to clonazepam, having been 11 - 12 or so weeks since my last dose, I just couldn’t see any way around it.

 

So,

 

I went to the hospital, and eventually got to see a psychiatric doctor in attempt to switch back to clonazepam. I explained the situation regarding paradoxical effects of the diazepam and she eventually agreed to switch me back to clonazepam to continue the taper. I told her that I wanted to switch to the equivalent dose to the diazepam I had been on (8mg) so as not to extend my taper out any longer. I also convinced her to prescribe liquid clonazepam because here in Australia we only have 0.5mg clonazepam tabs unlike other countries where 0.25 is accessible. However, once she had done the prescription for the liquid, she realised she had made a calculation mistake and it was too difficult for her to figure out taper dosages with the liquid (which I’m sure I could have found guidance for here), so she went back to her office and eventually came back with a script for 200 x 0.5 mg clonazepam tablets. I tried to explain that there was no way I could taper from these tablets as 0.5 mg clonazepam was estimated to be the equivalent of 10mg of diazepam, which is exactly where it really went down hill. She insisted that between 1 - 2mg of clonazepam was the equivalent of 10mg diazepam and that I should start off taking 3/4 of a tablet at night and 3/4 of a tablet of a day and then remove 1/4 of a tablet each week, or two weeks if necessary. I tried to explain that she was essentially upping my dose from the equivalent of 8mg diazepam to about 15mg diazepam (almost double), and that what she was asking me to do was cut the equivalent of 2.5mg diazepam every week or two which would be nightmarish and a potentially dangerous, but she insisted that she had 30yrs experience in her profession and that all my information and equivalency charts were all misinformation.… which is pretty much the same response I have received from other doctors. They simply don’t like being questioned, even though the patient is only being careful, looking out for their own welfare. The more knowledge you seem to display, the more their ego seems to be challenged. So in the end I had to just accept the 0.5mg tablets, knowing full well they were useless for tapering, especially from the equivalent of 8mg diazepam, and leave allowing her to believe she must be right i I must be wrong for the sake of not escalating a potential argument which neither of us wanted to have.

 

The interesting thing that further backs up my paradoxical effect theory is that although I took my morning dose of diazepam to the hospital with me, I actually didn’t take it because I didn’t know whether I’d be switching benzos that day, and the more time that passed, the better I felt. I got home at about 2pm that day and decided I’d just wait until my night dose, and the more time went by, the better I felt. I could see that everything was clearing. I could still feel how unstable my CNS was, but I hadn’t felt that relaxed and clear in the head for months. Even though the frustration of the hospital visit was there, I felt like I could experience joy and pleasure in simplicity. Then later I had my night time dose of diazepam when I went to bed and I fell asleep immediately having had had no sleep for a couple of days, but I woke up 3 hrs later after the dose feeling absolutely terrible again.

 

It’s funny how a doctor can make you doubt yourself…. I knew I was right, but just to be absolutely sure about conversions, once I got home, I went to my local chemist store and asked my chemist to do an equivalency search and print out, and sure enough, she came back with a chart and  0.5 mg clonazepam is equal to 10mg diazepam.

 

So now I’m stuck with a prescription I haven’t bothered filling because they seem to be useless unless I can also find access to the liquid clonazepam to use in conjunction.

 

All this because she wasn’t sure how to calculate doses of liquid clonazepam

 

I don’t suppose anyone knows a way of making use of the 0.5mg tabs in my taper?

 

Otherwise, I’m stuck suffering on the diazepam for who knows how long.

 

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[19...]

I’d just add that the psych doctor also said that my previous doctor did exactly the right thing by not reinstating the clonazepam to stabilise and do a slow crossover to Valium while deep in cold turkey withdrawals. She said 19 days would have had it out of my system and putting me straight on to diazepam was the absolute right call. But it didn’t fare too well for me, that’s for sure. I guess I knew it wouldn’t go too well from there on, No one wants to have a disagreement or argument with a doctor, but surely we should have the right to research and gain knowledge surrounding our own illness to minimise potential mistakes by either ourselves or doctors. I don’t know if this is true, but I’ve heard that doctors are meant to get a memo on GOD COMPLEX.

 

Im not the kind of person to take any interest in disagreements, but surely we have to stand up for ourselves when we can see that a doctors ignorance or lack of knowledge is putting us in harms way. Surely!!

 

Of course, it’s all pointless in the end, because they are the doctor and you are the patient, and so you couldn’t possibly have anything of worth to offer in regard to your own health and welfare.

 

Hopefully I’ll find an open minded doctor soon. One who doesn’t mind researching and following up on a patients offerings.

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You've had a rough time of it dealing with your doctor but you confirmed your suspicions about the Valium so I count that as a victory. 

 

I'm happy she prescribed so many pills and I know it wasn't what you hoped for but you can still make them work for you.  What about titration, have you used this method in the past? Titration FAQ's

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[19...]

Thank you so much for your reply, Pamster

 

Firstly, I appreciate your pointing out the victory…. I do forget to do this.

 

Secondly, you and I had discussed this cross back to clonazepam recently, and although it was one of my options, I was actually quite reluctant to do so, and although those feelings haven’t changed (after both agreeing that it may not be the best option at the time), I’m much more clear about these reactions and just can’t see any other option available to me.

 

Thirdly, no, I haven’t actually looked in to titration, but thank you for the link. I will have a good read through it today.

 

It’s about 10am here now, and again no sleep, so I might just rest for a bit and then have an good look at it.

 

It would be great if I could learn how to use such a method. 

 

Will reply again later after I’ve read the link

 

Blessings

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I’m sorry you had such a difficult experience, Winters sun.

 

According to ARTG, Rivotril clonazepam 2.5mg/mL oral solution (ARTG ID: 13758 ) is available via prescription in your country.  We have several members who are using/have used this to taper.

 

If obtaining the commercial solution is not an option,  I wonder if compounding might be?  If so, there is a professionally developed, potency- and stability-tested formulation for a 0.1mg/mL oral clonazepam suspension.

 

Members who wish to minimize the amount of liquid (either solution or suspension) ingested, sometimes use a combination of regular tablets and liquid.  For example, according to ARTG, the commercial 0.5mg clonazepam tablets in your country have a functional score line.  Consequently, you could split the tablet in half then take one-half of your dose (0.25mg) in tablet form and the rest in liquid form. You would make reductions using the liquid.

 

Members have also used a variety of do-it-yourself (DIY) approaches to taper.  For example, we have members who dilute the commercial oral solution to achieve a liquid with a lower concentration.  We also have members who use the aforementioned formulation for a clonazepam suspension to make a DIY suspension.

 

Other members have used digital scales or analytical balances to weigh pieces of tablets or powder from crushed tablets.  Lastly, we have members who make DIY liquids consisting of regular tablets and a liquid (e.g. water, milk, cosolvent).

 

A caveat regarding DIY approaches is that they involve drug manipulation/modification. Per our Titration: FAQs, drug manipulation conveys risk. For example, the impact of drug manipulation on dose accuracy and the stability and bioavailability of the active drug substance are unknown at this time. Drug manipulation may also increase the risk of measurement and/or dose calculation errors.

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[19...]

Sorry for such a long delay in my reply

 

It’s been a rough couple of days.

 

Thank you for the info, Libertas.

 

I’ve been having a think about what my options are based on the information you have kindly provided and have come to the decision that I will switch to clonazepam tomorrow.

 

I have a doctors appointment (new doctor) on July 5th, and hope he will prescribe the Rivotril clonazepam 2.5mg/mL to use alongside the 0.5 tabs. Failing this, I will have to move on to one of the DIY approaches you provided. Im thinking I’ll move to using digital scales and crushing the tablets. I will have to get someone to help do the math and calculate reductions as I have substantial cognitive impairment and don’t really trust myself when it comes to avoiding mistakes. I feel I have at least some understanding around this approach as apposed to the preparation of DIY liquids.

 

If there’s any additional information you could provide on calculating a sensible taper, it would be greatly appreciated. I need all the help I can get at this point.

 

I tapered from 9mg to 8mg diazepam 12 days ago and I’m trying to make a decision around the dose of clonazepam I should switch to. I would really like to avoid stretching out my taper timeline any further, so I’m thinking of switching to 3/4 of a 0.5 tablet to start. Does this sound sensible as a starting point? keeping in mind that I don’t have the digital scales to make smaller or larger adjustments.

 

I noticed that the clonazepam tablets I have left over from cold turkey are scored both ways so you can cut quarters.

 

One other thing I’m not sure about is that I have been dosing twice a day with the diazepam and wonder if it would be a problem taking  (0.25)  half tab in the evening and (0.125) quarter tab in the morning, or vice versa.

 

I realise it would probably be better to take 0.25 morning and night and just make up the difference in each dose with the Rivotril, but it’s unknown at this point whether I will succeed in acquiring a prescription.

 

I did visit a compounding pharmacy yesterday to discuss both the Rivotril 2.5mg/mL and the compounded clonazepam 0.1mg/mL and the pharmacist suggested the Rivotril because it was much cheaper than the compounded clonazepam.

 

One last question -

 

Could you give me an idea on how to dilute the Rivotril to make smaller cuts… I keep thinking in terms of diazepam equivalency, and if my calculations are correct, going by most conversion charts, the Rivotril 0.1mg/drop = 2mg diazepam. If this correct, how would I go about diluting to get a liquid with a lower concentration in terms of the ratio?

 

Actually, I’m also open to the idea of DIY liquid from regular tablets if there’s information available on how I can do it if I can’t get the Rivotril.

 

Any additional information you could provide would be so helpful.

 

Thanks, Libertas.

 

 

 

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No apology needed, Winters sun.  It’s clear you’ve had a ‘good think’ about your options. 

 

Might I suggest you take things one step at a time?

 

You have indicated you wish to crossover from Valium/diazepam to clonazepam.

 

What is your current daily dosing schedule for diazepam?  How many milligrams of drug do you take at what times? 

 

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[19...]

Thanks Libertas

 

I’m taking 4mg diazepam at 10am and 4mg at 10pm.

 

What are your thoughts on how I should proceed?

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You are welcome, Winters sun.

 

Given what you’ve shared with us about your case …

 

If I were in your shoes, my first two priorities would be to (1) conduct a ‘test’ substitution to ascertain how I will respond to taking clonazepam again and (2) if all goes well with the test, get as stable as I can on the clonazepam before initiating my taper — even if it means taking a higher dose than I might prefer to begin.

 

So, for example, I would consider substituting 0.25mg of clonazepam for one of my two daily diazepam doses (either the morning or the evening, whichever one I think would ‘help’ me the most).  I would then wait at least 3 days (preferably longer given clonazepam’s relatively long half-life) to evaluate my response to the clonazepam (see note below). If all went well, I would probably ‘err on the side of stability’ and substitute 0.25mg of clonazepam for my other diazepam dose. 

 

Note: If you are not already doing so, I strongly encourage you to start keeping a daily taper journal and get into the habit of reviewing the data you’ve collected whenever you reach a decision point in your taper. The daily entry can be as simple as the date; the times and amounts of your doses; and holistic ratings of your symptoms and functionality that day (e.g. 0 = no symptoms, high functionality; 10 = intolerable symptoms; no functionality).  If you’re a visual learner, you can graph these holistic ratings to reveal patterns/trends.

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[19...]

Thank you, Libertas

 

I can’t express how much I appreciate the guidance.

 

I think I should substitute the night dose to start with, as I haven’t slept in days. The diazepam just causes such a horrible wired feeling and terrible insomnia.

 

I will definitely start a taper journal, as you suggest.

 

I’ll reply here again once I’ve had time to assess my response to the initial substitute dose.

 

Again,

 

Many thanks!

 

 

 

 

 

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[19...]

Hi Libertas,

 

I substituted my nightly dose of 4mg diazepam for .25mg of clonazepam before bed and although I got some sleep (5hrs), both mornings I have awoken with much worse anxiety. It’s so very confusing. I’m not sure what to do from here…. reinstate the nightly diazepam and battle through a slower or faster taper or continue to evaluate the clonazepam over a longer period. All I know is that the anxiety I experience when I woke up these last couple of mornings is more intense than I’ve previously experienced. I now have doubts about my decision to crossover and wonder if I’m just in a situation where I will have to struggle day to day regardless of which way I go.

 

I dosed at 10pm both nights and awoke to intense anxiety about 5 hrs later.

 

Maybe I should just stick to tapering from the diazepam and endure the suffering the best I can.

 

Do you have any thoughts?

 

Could it possibly be that the clonazepam just needs time to build up in my body?

 

 

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Clonazepam can take a while to reach steady blood serum levels.  The general rule of thumb I’ve read is that it takes 5 to 5 1/2 times the half-life of the drug.

 

It sounds like the good news is you finally got some sleep but the bad news is you are experiencing an uptick in anxiety. 

 

The decision on how to proceed is totally up to you.  Questions you might want to consider include:

 

Might my concern over making a change in medication be contributing to my morning anxiety?  If so, are there coping techniques I could use to address this?

 

Is the uptick in anxiety tolerable or not?

 

What’s more important to me — getting a little more sleep or eliminating the morning anxiety?

 

Is the morning anxiety more or less ‘acceptable’ to me than the negative effects I experience after dosing diazepam?

 

 

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[19...]

 

Yes, exactly… gained sleep at the expense of anxiety.

 

So what I think you are saying is -  it may be that it will take some time to level out as blood serum levels climb, after which, possibly the anxiety might decrease?

 

I don’t know if this means anything, but waking after the first night, I felt like I was waiting impatiently (craving) to reach the time of my morning dose. Then this morning, although the anxiety was just as intense, maybe I wasn’t as impatient to reach the time of my morning dose.

 

Because I substituted my night dose before bed, it’s really difficult to gage how I feel on the clonazepam, because I go to sleep very soon after dosing, as apposed to dosing the clonazepam in the morning (instead of diazepam) and see how I feel on it throughout the day.

 

I guess I have to make a decision as you say.

 

The other thing I have to take in to consideration is - am I still experiencing withdrawal from my last taper cut of diazepam 9mg down to 8mg (13 days ago)

 

I know it’s probably different for everyone when it comes to the duration of withdrawal timeline between taper cuts, but I was wondering if there’s any difference depending on the half life. What I mean is - does the withdrawal timeline between taper cuts on diazepam take longer than a shorter half life benzo? If one person was tapering clonazepam and another diazepam, would the person tapering clonazepam go through withdrawal sooner post cut, therefore levelling out sooner than the person tapering diazepam with the longer half life, or is it pretty much the same?

 

Reconexion told me that 2 weeks is an absolute minimum wait between taper cuts, but 3 to 4 weeks is much more likely needed.

 

I do understand that this is the very reason you urged me to do a taper journal, because it can be difficult to gage whether you’re feeling any better from one day to the next, especially if your normal baseline is still quite symptomatic.

 

It’s very difficult to know when I’m ready to taper, and along with that, an element of fear of the thrust back into a highly symptomatic state, knowing how hard I get hit after each cut.

 

Thanks Libertas, I know I have to make my own decision on how to move forward, but it’s so comforting to have someone much more knowledgeable to bounce these thoughts off.

 

 

 

 

 

 

 

 

 

 

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So what I think you are saying is -  it may be that it will take some time to level out as blood serum levels climb, after which, possibly the anxiety might decrease?

 

Yes, it can take some time before the clonazepam reaches steady state.  For example, according to one source I read, the average half-life of clonazepam is 30 hours.  So, using the rule of thumb I mentioned earlier, it could take from 150 to 165 hours for the drug to reach steady state.  Whether or not the anxiety might decrease is a different question — you may wish to consider adding a daily (or maybe twice) daily rating of your anxiety level in your taper journal so you can look for trends.

 

The other thing I have to take in to consideration is - am I still experiencing withdrawal from my last taper cut of diazepam 9mg down to 8mg (13 days ago)

 

Nice catch on your part. That’s a plausible hypothesis.

 

I know it’s probably different for everyone when it comes to the duration of withdrawal timeline between taper cuts, but I was wondering if there’s any difference depending on the half life. What I mean is - does the withdrawal timeline between taper cuts on diazepam take longer than a shorter half life benzo? If one person was tapering clonazepam and another diazepam, would the person tapering clonazepam go through withdrawal sooner post cut, therefore levelling out sooner than the person tapering diazepam with the longer half life, or is it pretty much the same?

 

You are correct — withdrawal patterns/timelines are unique to the individual.  However, having said that, it is my understanding and observation that the shorter the half-life of the benzodiazepine being tapered, the shorter the ‘feedback loop’ between a dose reduction and the onset of withdrawal symptoms.

 

Thanks Libertas, I know I have to make my own decision on how to move forward, but it’s so comforting to have someone much more knowledgeable to bounce these thoughts off.

 

You are most welcome, Winters sun.  I know how difficult it is to make these types of decisions.  Although it may not seem like it to you, you are approaching this in a very level-headed and thoughtful manner so please give yourself a pat on the back!

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[19...]

Awesome reply, Libertas

 

all my questions answered!

 

Given the amount of time it takes for clonazepam to reach a steady state (150 to 165hrs) as you mentioned was preferable in an earlier reply, I would be better giving it longer than the the 3 days before thinking about also switching the daily dose. Maybe 6 or 7 days.

 

I’ll keep monitoring my symptoms + any potential changes (better or worse) in my taper journal.

 

Much gratitude!

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  • 1 month later...
[19...]

Hi Libertas,

 

Sorry I took so long to reply after my trial switching back to clonazepam. I decided to stick with diazepam the day after we last spoke, but you can read more about it on the thread I just replied to … “paradoxical after 4 weeks…”

 

Could use some of your advise (if you find the time) on how to use 2mg diazepam tabs to do a DMT or much smaller cuts more often so I’m not hit so hard after large cuts.

 

Thanks Libertas

 

 

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Hello, Winters sun.

 

Good to hear from you.  That’s interesting you decided to stay with the diazepam.

 

If you’d like input from members about strategies for making ‘small enough’ reductions in dose using 2mg diazepam tablets, would you please:

 

(1) update your signature (please include your current taper rate, your current daily dosing schedule, the reductions you have made since your last update as well as any other relevant information)

 

(2) start a new thread on the Titration board requesting feedback (this board is focused on Substitution)

 

It also would be helpful if you would let members know what approach to titration you are interested in trying.

 

The likelihood of obtaining accurate and precise doses is highest with a commercially manufactured oral solution followed by professionally formulated and compounded oral solutions, suspensions, or mini-tabs (e.g. Tapering Strips). 

 

Do-it-yourself (DIY) approaches include:

 

Diluting a commercially manufactured oral solution

Pill-splitting

Pill-shaving

Weighing pill pieces, pill powder, or pill powder mixed with filler to increase the weight being measured

Suspensions made with regular tablets as the drug source

 

At this point in time, the accuracy and precision of DIY approaches is unknown.  Some individuals find these approaches to be ‘accurate enough’ and ‘precise enough’ whereas others do not.  My personal observation is that diazepam seems to be more ‘DIY friendly’ compared to other commonly prescribed benzodiazepines perhaps due to its low potency, long half-life, and/or unique physiochemical properties.

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[19...]

Thanks Libertas,

 

Will update my signature, work out my preferred taper approach, and then start a new thread on titration board.

 

Many thanks!

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[b7...]

Hi Winters sun,

 

I would like to say that I tend to have other opinions when it comes to withdrawal and Diazepam. I think it's great you have decided to stick with Diazepam! I use liquid and tablets to do microcuts. Perhaps get/buy liquid Diazepam. At 3.4mg. Diazepam currently, my experience is that a 3% reduction is what I can handle.

 

Best of luck,

Naf1983

 

Hi Libertas,

 

Sorry I took so long to reply after my trial switching back to clonazepam. I decided to stick with diazepam the day after we last spoke, but you can read more about it on the thread I just replied to … “paradoxical after 4 weeks…”

 

Could use some of your advise (if you find the time) on how to use 2mg diazepam tabs to do a DMT or much smaller cuts more often so I’m not hit so hard after large cuts.

 

Thanks Libertas

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  • 2 weeks later...

Thanks, Naf1983

 

I’m thinking of tapering at a much slower rate of 5% every 3 to 4 weeks micro cutting daily, but then lowering percentage to 3% as I get lower.

 

I appreciate the input based on your own tapering experience.

 

Best of luck with the remainder of your own taper!

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