Clonazepam Taper: Can you dry cut the orally disintegrating type pill?

[[St...]]

Using Drugs.com it looks like the only 0.125mg clonazepam pill in current production is the orally disintegrating type by Sun Pharmaceutical Industries.  There were other 0.125mg tablets on Drugs.com but they appear to be discontinued.

 

https://www.drugs.com/imprints/c-1-8-26430.html

 

Data sheet says they're 8mm which in I'm guessing is large enough to dry cut with relative accuracy (?...)

 

My prescription is 0.5mg scored tablets.  I have two shots at getting a prescription for 0.125's to use in a Direct Simple Taper: provider (nurse practitioner) at counseling practice that prescribed my 0.5's, or my primary care doctor who happens to be a DO not an MD, with whom I've already discussed tapering.

 

Going to try both tomorrow (Monday) and will report back.  Of course if the 1st one I call agrees to prescribe 0.125's then I won't have to try both.  I'll offer to turn in all my remaining 0.5's if they will call in an 0.125 script to use in tapering. 

 

Big question mark will be if the pharmacy stocks or can obtain these particular tablets AND if the orally disintegrating type can be dry cut. 

 

 

 

[[Pa...]]

We've had members use ODT's but they're very small and crumble easily, some will use razor blades to cut them, they're not scored.  We can help you taper from the .5 mg if you're interested.

[[St...]]

Thanks Pamster,

 

Thanks!  Titration advice would be very welcome.

 

Short version:  I need to titrate down from total of 0.25mg daily taken as 0.125mg (1/4 tablet) morning and 0.125mg evening, and total time on clonazepam will be 8 weeks next week.  I am so hoping that this smallish dose and the relatively short time span eases my tapering journey and final jump off. 

 

Long version: Been doing the 0.125mg (1/4) twice daily for I don't know maybe week or ten days now and feel relatively ok.  Only noticeable symptom is getting a deep breath like a yawn can be a coin toss-- might on 1st try, might take a few tries and raising my arms up over my head to get that yawn completed... my lungs just have a a certain slight heaviness to them even on 0.125mg x2 daily.  Healthwise I'll be 60 next month, physically fit and at a medically healthy body weight, decent foundation of good health. I don't take any other meds neither prescription nor over-the-counter. 

 

I tried skipping the morning 0.125mg dose and postponing next one as long as possible but by late afternoon I can feel symptoms beginning to manifest (tight throat, indigestion, start feeling edgy).  I've held on to evening dose like that twice now but it gets uncomfortable. 

 

My biggest concern is the provider.  The NP that prescribed it is not cooperative about tapering. She may have even lied to me when I offered to trade-in my remaining 0.5's for a prescription to 0.25mg tablets which I could achieve better cut accuracy with.  She said that 0.25mg tablets are not made.  I may be able to obtain more to use for titration from primary care doctor.  But a long taper is going to require refilling my dwindling 30 day bottle.

[[Pa...]]

I can't imagine a provider agreeing to exchange pills and if you got them through your insurance company they may refuse to fill until the allotted time has passed, we can help you taper with the .5 mg tablets.  You mention titration, are you thinking about using a jewelers scale to weigh your dose or are you thinking make a liquid and tapering that way?

 

It sounds like that elephant that used to hang out on my chest has found you, that pressure is uncomfortable and prevents those deep breaths. 

 

Please take your doses at the same time each day, a gradual timed reduction of the medication is the best way to prevent symptoms. 

[[St...]]

Sorry for the delay in replying.  As is usual with my innate trait of being hard headed I ended up getting on with it and dry tapered to cessation probably too quickly.  As of today it will be 200 hours (@ 5pm) since last dose, which was 0.125mg x once daily which I'd reduced from 0.125mg x twice daily.  I ran the once daily dose for about 5 days, then cessation on Monday March 27th.  Not the best idea, I know.

 

I felt fine Tuesday (28th), Wednesday, Thursday, and Friday.  No symptoms.  Good sleep each night.

 

Saturday the 1st of April (ironically, April Fool's Day) withdrawal symptoms began.  Mostly a return of the anxiety driven "fight or flight" amped up feeling of adrenalin flowing when it shouldn't be.  Insomnia with wake-ups through the night with heart beating fast.  Able to get heart rate down to normal by sitting on edge of bed and talking myself down to relative calmness. Oh, and the stomach upset.  Not nausea, but the bloating that would've occurred if I didn't constantly belly-pat and burp myself.  Sunday was kind of brutal, I was throwing heart palpitations like crazy and was very fatigued.  Saturday and Sunday night each only about 3 - 4 hrs sleep the quality of which was below average. 

 

Today (Wednesday April 5th) is day 5 of withdrawal.  Today is not terrible, mainly just slight sensation of tightness in the chest and lower neck. Yesterday (Tuesday) was not good but mainly due to pretty much zero sleep Monday night... I was so wired-up and anxious yesterday however as long as I kept busy doing things outside it wasn't too bad. It was when I had down time that I got real anxious and edgy.  Went to bed early soon as it got dark and actually slept fairly well, got an estimated 7 or 8 hrs worth. 

 

YESTERDAY WHEN i WAS SO AMPED AND ANXIOUS FROM THE INSOMNIA I CONSIDERED REINSTATING. 

 

Had you not warned me about KINDLING, I might have gone through with the VERY BAD IDEA of reinstating out of desperation.  I was like "Going to reinstate, level off, then do it right with a proper liquid taper method."  But the possibility of the kindling phenomena kept me from doing it. 

 

Today I felt pretty good until about 1pm when I just started feeling tired, but so far that's about it. We will see if this day 5 of withdrawal is the downhill side or not.  I know symptoms can ebb and flow in waves.  Could be more bad days ahead. 

 

NOTE:  I have certified blood pressure monitor unit at home and bp is not elevated above my normal range (yet).  Been keeping eye on it. 

 

 

 

[[Pa...]]

You jumped from a pretty high dose, I'm glad to see you're managing so far but please understand, if you reinstated now, I don't believe we'd see kindling come into play, the cessation has to be for more than a few days.  I'm telling you this to give you options in case things get too rough.  I of course hope you don't reinstate but others have after jumping too soon and went on to complete their taper. 

[[St...]]

Don't think reinstating will go over well with my wife, she wants me to dispose of the remaining clonazepam.  I've  got bottle of about 26 quarter tablets  (0.125mg each) which I produced one day just sitting at the kitchen counter and carefully precision cutting 1/2 tablets (0.25mg) with a fine serrated knife. 

 

Is there a  consensus on how long cessation has to be before kindling will occur if you reinstate?  March 27th being my last dose.

 

Today, Friday is day 7 after first withdrawal symptoms appeared last Saturday.

 

I've been hoping that since my period of use was only about 7 weeks, that withdrawal symptoms will peak after one week and then begin to decline during week two of withdrawal. 

 

Do you have any tips on managing the indigestion?  That is really the symptom that is causing sleep deprivation for me.  I've always had heart palpitations as PVC's my entire life and bad indigestion sets them off.  It's that which prevents me from drifting into sleep.  I'll start to drift off and my belly will rumble or churn and cause a heart skip or flutter and it jolts me awake, spins up some anxiouness, until I calm down then lather rinse repeat for most of thenight.  That is really the one thing that had me to thinking about reinstating-- the sleep problem. 

 

I now wish I would have chosen to taper by the liquid method.  That sounds relatively precise vs. dry cutting.

 

But Monday April 10th will be two weeks since cessation so probably at this point the risk of kindling is increased.

[[Pa...]]

I can't say definitively what your body would consider a few missed doses vs complete cessation but typically members will say it's okay to reinstate within two weeks time but really, what do we know for sure?  I'm afraid I can't offer any help for what we call benzo belly (anything digestive related), its a common but miserable symptom.  It sounds like yours complicates your life and sleep but you might post on the Post-withdrawal  Recovery Support board to ask what others do for it.

 

I'm hoping that after only 7 weeks of use that you'll recover in weeks and months not months and years like those who took the drug long term have to endure, your timeline may be a bit hopeful but there's nothing wrong with that.

 

As for the general topic of reinstatement, while I understand hoping for a better outcome the next time, I'll usually point to what Professor Ashton said. The Ashton Manual

Reinstatement, updosing

 

A dilemma faced by some people in the process of benzodiazepine withdrawal, or after withdrawal, is what to do if they have intolerable symptoms which do not lessen after many weeks. If they are still taking benzodiazepines, should they increase the dose? If they have already withdrawn, should they reinstate benzodiazepines and start the withdrawal process again? This is a difficult situation which, like all benzodiazepine problems, depends to some degree on the circumstances and the individual, and there are no hard and fast rules.

 

Reinstatement after withdrawal? Many benzodiazepine users who find themselves in this position have withdrawn too quickly; some have undergone 'cold turkey'. They think that if they go back on benzodiazepines and start over again on a slower schedule they will be more successful. Unfortunately, things are not so simple. For reasons that are not clear, (but perhaps because the original experience of withdrawal has already sensitised the nervous system and heightened the level of anxiety) the original benzodiazepine dose often does not work the second time round. Some may find that only a higher dose partially alleviates their symptoms, and then they still have to go through a long withdrawal process again, which again may not be symptom-free.

 

Updosing during withdrawal? Some people hit a "sticky patch" during the course of benzodiazepine withdrawal. In many cases, staying on the same dose for a longer period (not more than a few weeks) before resuming the withdrawal schedule allows them to overcome this obstacle. However, increasing the dose until a longed-for plateau of 'stability' arrives is not a good strategy. The truth is that one never 'stabilises' on a given dose of benzodiazepine. The dose may be stable but withdrawal symptoms are not. It is better to grit one's teeth and continue the withdrawal. True recovery cannot really start until the drug is out of the system.

 

Pharmacologically, neither reinstating nor updosing is really rational. If withdrawal symptoms are still present, it means that the GABA/benzodiazepine receptors have not fully recovered (see above). Further benzodiazepines cause further down-regulation, strengthen the dependence, prolong withdrawal, delay recovery and may lead to protracted symptoms. In general, the longer the person remains on benzodiazepines the more difficult it is to withdraw. On the whole, anyone who remained benzodiazepine-free, or has remained on the same dose, for a number of weeks or months would be ill-advised to start again or to increase dosage. It would be better to devote the brain to solving individual symptoms and to finding sources of advice and support. Advice about how to deal with individual symptoms is given in the Manual (Chapter 3).

 

[[St...]]

Pamster,

 

Thank you for the Ashton Manual excerpt !!  That seals it for me, I'm not going to reinstate.  I'll check out the recovery support board.  Thanks again !!