Dread My Morning Dose

[[Fa...]]

Hi All,

I’ve searched this before…don’t think I found anything of any substance about it. Gonna try here…again, maybe??  Honestly, can’t remember if I have posted about it…maybe just mentioned it somewhere.

As the subject reads, I dread my morning dose.  It feels just horrible.  It was the dose reinstated when up-dosed last November in hospital after following the Ashton schedule haphazardly.  Huge mistake…the up-dose.

I take it…I wait for it.  Almost every time, I go south fast.  Feels like I’ve been slipped something in my drink.  I feel heavily drugged.  Can’t keep my eyes open…almost comatose…catatonic.  DP/DR gets brutal…can’t walk, dizzy, extreme fatigue.  It takes about 4 hours to start to ease up.  But, with AKA, have to keep moving within this messed up state.  It’s terrible.  As I just took it now, I thought ‘Oh, God…here I go again’.

I can’t really talk during this time period.  I can type.  I force myself to type to stay awake…not that I could sleep ‘cause my body is still racing as this is going on as my mind slips further and further away.  Just want to swear right now, ‘cause it is so friggin’ messed up.

Anyone else experience adverse dose reactions?  Maybe morning dose?  Maybe the cortisol plays a factor in this in the morning hours as it’s at its peak?  I dunno…really don’t.  To me, it is my body saying ‘get this s*** out of me!’

And, here we go…the countdown begins.

Warmly,

F

 

[[Ho...]]

Oh I am so sorry to hear this! I know this "I can barely stand but I can't stay still" thing. It's awful! You say they updated you in the hospital? Oh my gosh, they do the worst things to people in benzo withdrawal. What you say about the morning cortisol could be adding to it—it makes sense! Hopefully someone with experience in this will hop on and give a more detailed and helpful response. Hang in there! 

[[Li...]]

I’m sorry you are experiencing this, @[Fa...]. 

The 4 hours before the effects begin to ‘ease up’ makes sense given that maximum plasma concentrations of clonazepam are reached within 1 to 4 hours after oral administration. 

Do you take any other medications or supplements at the same time as your morning dose?

Have you been able to tolerate a morning dose in the past?  If so, what was your daily dosing schedule at that time (times and amounts)?  What is your current daily dosing schedule (times and amounts)?

 

[[Fa...]]

@[Li...]  I take 20mg Propranolol with the morning dose as well as Estrogen (topical) and Progesterone.

This reaction has been the same since I was up-dosed in November.  When admitted, I was taking .5mg in evening.  When I left, .5mg was added as a morning dose.  That morning dose has been having that reaction since it was added.  Making my total daily dose 1mg after up-dose.

Prior to getting down to .5mg, my dosing schedule had included a morning, afternoon and evening dose.  During taper, I was left with only the evening dose of .5mg.  Then hospitalization and up-dose.

There are sporadic days that this severe reaction does not happen, but very rarely.

Starting Dosing Schedule:

7 am - .5mg

2 pm - .5mg

7 pm - .5mg

Current Dosing Schedule:

7:30 am - .43mg

7:30 pm - .43mg

Thank you, Libertas.

[[Li...]]

Am I understanding correctly that, you were able to tolerate the morning dose ok before you began your first taper?  Were you taking the same medications then as you are now?

Have you checked for interactions among and between the meds you are taking in the morning?  It looks like there’s one between clonazepam and propranolol. 

[[Fa...]]

Yes, was able to tolerate all doses before I began my taper.

My night dose is fine…no intense reaction, and I take 20mg of Propranolol with my night dose as well.

[[Li...]]

Here’s what I’ve learned about the clonazepam-propranolol interaction.

According to the DrugBank Online interaction checker, “Propranolol may decrease the excretion rate of clonazepam which could result in a higher serum level.”

I wonder if at least some of the morning effects you’re experiencing … 

”Feels like I’ve been slipped something in my drink.  I feel heavily drugged.  Can’t keep my eyes open…almost comatose…catatonic.  DP/DR gets brutal…can’t walk, dizzy, extreme fatigue.” 

… might be due (in part) to the bump in clonazepam serum level caused by the propranolol and a resulting intensification of clonazepam’s sedative-hypnotic effects?  I also wonder if you might not notice these as much after your night dose because such effects are ‘desired’ for sleep?

Needless to say, the above is just speculation on my part.  

Were you taking the propranolol back when you were able to tolerate your morning dose?  Is there anything else that’s changed between then and now that might be relevant?

Your idea about cortisol is worth exploring. If you have not already done so, you might want to check PubMed to see if there’s any literature on this. 

 

 

 

[[Fa...]]

Hi Libertas,

I have to agree with what you have written.  It makes sense.  Thank you for the work you have done.  I very much appreciated the time you have taken.

I was not started on Propranolol at the beginning of my taper.  I was placed on it later into the taper when AKA became very severe.  And, I cannot remember at what point that was.  I don’t believe I even made a note of it.  And, I do not remember if I had noticed a difference after dosing when I started taking it.  I don’t remember a lot during that time.

My concern is this…I cannot taper from it now.  It would be impossible.  So, if this the cause, it looks as though I may not be able to do anything about it.  It may be something I have to deal with during the remaining time of my taper.  I do believe your speculation is more than likely correct.

As you probably know, Propranolol will need to be tapered very slowly when the time comes.  I’m already in a precarious place within this taper.  Having this knowledge at least answers my question as to why. 
 

Thank you, again.

Warmly,

F

[[Li...]]

You’re most welcome.  Just because what I’ve shared makes sense doesn’t mean it’s correct. I’ll continue to mull this over and encourage you to do the same.  

You might want to ask your doctor and/or pharmacist if staggering the times of your morning clonazepam and propranolol doses is an option.  Per StatPearls (link below), propranolol has a relatively short elimination half-life of 3 to 6 hours in patients with healthy renal systems.  (I’ve also now learned its adverse effects include nausea, drowsiness, fatigue, and hallucinations). 

Propranolol - StatPearls - NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK557801/