feeling awful on cross taper from klonopin to valium.

[[Ko...]]

@[Fa...] I have had a look at your taper schedule. Do you reduce by .02mg/ml or .01mg/ml every day for 2 weeks then hold for a few days? 

Or do you make these reductions everyday until you start to feel increased symptoms and then wait for them to settle?

Just trying to wrap my head around all of this. Its a lot!  

I saw that you had referenced a couple other members' taper schedules but I don't know how to find these now that the website has been updated? I did see Maugham1's schedule that started out with 0.1 mg reductions every 2 weeks or so?  Do you have these saved anywhere?

[[Fa...]]

Hi, @[Ko...].  I am basically reducing by .1mg/ml per week currently, via daily reductions of .02mg/ml and .01mg/ml.  For example, alternating equates to a .105mg/ml reduction per week.  

If I notice a trend towards worsening sleep (my worst symptom), I start reducing more days by .01mg/ml instead of .02mg/ml or even hold for a few days.  The longest I've held since starting daily liquid reductions was 13 days.  I plan to hold longer than this at 8mg tablet form as I stated above.   

Maugham1's schedule that @[Li...] shared on my taper thread is still there.  Feel free to use mine as a reference as well.  You will most likely be different than both of us.  

Here's my suggestion based on my experience:

1) Once fully cross tapered to 10mg diazepam, hold for one month.  This will ensure you are fully crossed over and feel 'stabilized'.

2) Drop a 2mg tablet, add 2mg/2ml liquid, and hold for 10-14 days.  This will ensure your body has adjusted to the liquid vs. the tablet.

3) If all is well, you could for example start reducing by .02mg/ml per day for 2 weeks and hold for 10-14 days.  This would be a conservative reduction of 2.8% reduction over 2 weeks.  This would fit into your initial goal of reducing by 5-10% per month, and give you some preliminary data. 

Again, this is so personal and you are just listening to your body.  You may very well be able to move faster than I.  You are on the right track!  As frustrating as it is (trust me), Libertas advice is the only universal correct advice I've read to-date regarding tapering: make ‘small enough’ reductions in dose on a ‘gradual enough’ schedule to keep withdrawal symptoms tolerable and maintain high functionality.

[[Ko...]]

thank you for your help. @[Fa...]

I am barely functional now due to fatigue , malaise, and poor motivation.  I work a high level job and am a single parent. But I do the minimum I need to do and that was never how I was before. I used to go the extra mile with everything....

I don't see the NP for another 2 weeks. I am supposed to fully transition to the 10 mg of valium tonight. I so wish there was a way of knowing if I truly need the full 10 mg. 

I will see if she lets me start with the liquid or if she wants to do a test reduction of  0.5 mg via a 2 mg tablet first.  

[[je...]]

@[Ko...] I just wanted to say I'm really sorry this is so hard. This process is so unfair. I know what it feels like to be 'less than the minimum' version of yourself in all areas of life. You will pull through. At the old forum I had a quote under my avatar saying "your present is not your future". Hold on to that. 

[[Ko...]]

@[je...] thank you for your kind words. I am still working on acceptance of my situation. I feel that so many of the things that I have enjoyed in my life have been taken from me- silly things like coffee in the morning, going to microbreweries, enjoying a hard daily workout. 

I have a lot of fear and anxiety about the withdrawal process and all the unknowns. I am hoping the slow taper will keep me functional.  I am also stressed working with this NP as she does not support microtapering so will have to work around that by saying I am decreasing by a certain amount each month and then doing the microtaper instead of a big cut at once. On the plus side, she did say that I could go as slow as I would like.  am definitely going to need some math support!

[[Fa...]]

@[Ko...] I can completely relate to everything you said.  This is a tough deal, but you are doing a great job!

I do believe you need the full 10mg diazepam as you'd rather err on the high side for functionality purposes.  The sedating effect will wear off and you need to keep your NP on your 'team'.  If I were to address anything, it would be to kindly ask your NP if you could follow the 3 suggestions I gave you.  Kindly remind her that your desire to remain functional is imperative. 

I wish you the best and keep us posted!  Keep asking questions as they arise.

[[Ko...]]

Just an update. I met with the nurse practitioner today. I have been at 10 mg of diazepam for a few weeks and am still very sleepy during the day.  We decided to try a 5% drop to 9.5mg daily  using tablets to see how I tolerate that before moving on to the liquid. I see her again in 3 weeks.  If I am feeling relatively ok after 2 weeks at 9.5 mg, do you think its ok to try to decrease to 9 mg? 

I do intend to do the liquid in the near future.

[[Fa...]]

Hi, @[Ko...].  Good to hear from you!  It does appear that it has been 2 weeks today since you fully crossed over to 10mg diazepam.  This would be the absolute earliest I would consider starting to cut - possibly wait another week or two to cut if possible due to the long half lives of clonazepam and diazepam. 

I see no issue with starting with a .5mg cut via tablets only and holding for 2 weeks.  You very well may handle the cut ok, in which I would suggest you try it again.  One step at a time however. 

[[...]]

Feeling relatively ok. I would try the 9. Expect the best. 

Looks as though you picked the best way to get off benzos.

And it looks as though you've comparatively been good. Considering many BBs.

Keep going, don't rush. You might be paradoxically tired for a while, even after full discontinuation.  Maybe not. 

My opinion is rather be tired than wired.

Don't let the job ruin you. 

Don't doubt yourself. There is enough data that a slow taper is the proper way. 

You don't want to experience a super bad journey.

Best wishes to you.

 

Edited September 21, 2023 by [...]

[[An...]]

On 24/08/2023 at 16:36, [[K...] said:

Hello,

I am in process of crossing over from klonopin 0.5 mg to valium 10 mg at the advice of my NP who supposedly follows the Ashton Manual.  I am currently on 0.25 mg klonopin and 5 mg valium and will move to 0.125 mg klonopin and 7.5 mg valium for a week then drop the klonopin and be on valium 10 mg.  I feel pretty exhausted and depressed but I also felt that way on the 0.5 klonopin. 

I need to work and try and be somewhat functional at home. Presuming I get to the 10 mg of valium, how long should I stay on that dosage and any advice on tapering from there? I will likely need to go slowly as I believe I have tolerance withdrawal symptoms and really need to stay functional so would that be to taper by 5-10% once a month?

Any advice on how to do  this when you get to the lower mg?  I guess you can pill split down to 0.25 mg with the 2 mg tablets but then what. Dry cutting or water tapering? I may have to sort of hide and DIY methods from the NP as she did not look fondly on the DIY methods... But, she did say she would not rush me through the tapering process. 

I am just splitting my valium tablets by hand using a razor blade. I have only got scored 5 mg tablets. I am able to split one tablet into 10 pieces. This is not the most accurate way but it seems to be working for me ATM. Best of luck @[Ko...]. You should get stable on the valium after a brief Klonopin washout period. After I got released from inpatient detox in 2006 after about a month of no klonopin (essentially a CT), I was able to get my PCP to put me on 10 mgs of valium and it slowly worked and I became stable. The mistake I made was I decided to just stay on the valium after being traumatized by the whole Klonopin ordeal. In hindsight now, that was a huge mistake.

[[Ko...]]

I appreciate the responses and support. My NP has my pill supply on a tight leash though. She certainly supports going slowly but I only get enough pills until next appointment so I don't have the supply to do any tinkering on my own. I am amazed that some people seem to have an infinite amount of pills. This makes a taper even more stressful.  I even have to go for a urine drug screen next week. I am a 53 year old professional single mother who would love to not be taking benzos. 

On a positive note, I know she will prescribe the liquid but I will need to talk to her to see if she would support prescribing partly tablets and partly liquid formulation as suggested in the thread.  

 

[[Fa...]]

@[Ko...] No real ‘tinkering with tablets’ is necessary to reduce to 9.5mg, so try not let this stress you.  Simple pill splitting should be all that is required.

You have a good plan in place and are doing great.  Please do keep us posted and continue to reach out with questions when/if you have them.

[[Ko...]]

@[Fa...]Thank you for your feedback. I have been on the 9.5 mg dosage for the past 5 nights and don't notice much difference yet. I guess it's early though. If I feel okay after the full 2 weeks I guess I will try a drop to 9.0. 

I watched the Mark Horowitz video on hyperbolic tapering and his proposed slow diazepam taper based on GABA occupancy changes. It basically drops by 0.4mg every 2 weeks (basically a little more than .02 mg drop per day) from 10 mg until 4 mg then decreases to 0.2 mg drops (.01mg drop per day)every 2 weeks. 

How are you finding the daily taper? What is your pattern of making decreases versus needing to hold?

[[Fa...]]

Hi, @[Ko...].  That’s great you have reduced to 9.5mg and don’t feel much different after 5 days!  I believe you will handle the reduction just fine and can proceed to 9mg via all tablet form after 2 weeks.  Do not seek out symptoms.

I believe you may have found my recently updated taper thread since posing the above questions (liked my updated taper thread post after posting questions here to your taper thread).  If that is not the case please do read as it will answer your questions. 

[[Ko...]]

@[Fa...]yes- I did see your detailed thread. It is helpful to me to see how another person who needs to stay highly functional is doing this in real time.  Is there a way of doing this and not feeling anxious about it?  I am nervous to make plans to travel anywhere while I am tapering as I feel like I don't know if I will be feeling ok?  Since you have gotten into a pattern with your taper, are you feeling more confident?

It has now been 8 days since my first drop and I don't feel much of a difference- still with low appetite, mild tinnitus, mild muscle aches, fatigue, and depressed.  I notice a little bit of internal trembling in the morning.

Next week I will have to decide whether to decrease by 0.25 or 0.5 (don't have any liquid yet)

[[Fa...]]

Hi, @[Ko...].  I'm glad you found my taper thread helpful.  It was not my intent when I started the thread, however, I too realized it would most likely be helpful for myself, and others, if I continued the thread with 'real-time' updates.  

This is an individual journey/process in which we are continuously attempting to adjust, and fine-tune, our taper/experiment based on the data we are obtaining (what our bodies are telling us).  You will become less anxious, and more confident, as you figure out what 'small enough' reductions, on a 'gradual enough schedule', looks like for you.  Implement holds when you feel uncertain (or need to travel for example).  Try to stay ahead of the cuts accumulating.  I would encourage you to start slow and steady.  It is easier to speed up one's pace then it is to slow one down in my opinion.

With that said, like I, functionality seems to be important to you.  It appears you are off to a good start with your first reduction to 9.5mg from 10mg.  You cross-tapered to the 'high-end' of the valium equivalency which I believe to have been wise.  As a result, my gut tells me you will be able to handle another .5mg cut down to 9mg (after holding at least 2 weeks at 9.5mg).  I would then offer to you the same suggestions I gave from above in your thread (except to start with 8mg tablet and 1mg/1ml liquid instead of 8mg tablet and 2mg/2ml liquid).

[[Ko...]]

Hi- I have been on 9.5V for the past 2 weeks. I haven't noticed any changes in the way I feel (baseline seems to be fatigue, depression, poor motivation). I guess I am looking for reassurance to decrease to 9 mg. I see my NP about a week after I make the change. 

So after 2 weeks on 9mg V,   if I do not feel any withdrawal symptoms, should I try to get to 8.5 or not chance it and switch to liquid. 

Once I start the liquid part of this is there a recommendation for daily cuts? Start with .02mg daily decreases? How often do you hold? 

   Is there anyone who can help me as I go along with making these reductions? I am so anxious about everything as I am a single mom and work full-time.  This is such a lonely and arduous journey. 

Feeling overwhelmed.....my NP thinks I am overly anxious and doesn't support daily microtapering so she won't be able to help other than to prescribe the liquid.

[[Pa...]]

HI @[Ko...], I’m glad to hear you haven’t suffered an increase in symptoms due to your reduction, I wonder if you should hold off making a switch to another taper method when things seem to be going well at the moment?  

[[Ko...]]

@[Pa...]actually, I wouldn't say things are going well as I am barely functional...I don't think I have had a real increase in symptoms with the reduction but I feel poorly most of  the time with muscle aches, low grade headache, depression, fatigue, and lack of motivation. The reason for the change to liquid is that it will be hard to keep my percentage reductions low enough after I reach 9 mg by splitting the 2 mg valium tablets into anything less than a 0.5. It would be lovely if I could tolerate a modified Ashton method until I get a bit lower but I don't know if that is possible and not sure if I should risk it.

I found my prescriber specifically for tapering purposes and she doesn't support the DIY methods using scales or water tapering so she had proposed using the liquid valium to make the next series of reductions.  The one good thing is that she said I could take as long as I wanted to taper.

I had been in discussion with @[Fa...]and @[Li...] about the liquid tapering with the valium liquid.  Like @[Fa...] I have to try and stay as high- functioning as I can as I support my daughters on my own and work full-time at a job that requires me to be cognitively intact.  

 

 

[[je...]]

It sounds like you managed the reduction without an increase in symptoms. It's really up to you whether you want to hold another week but it looks like you're okay to make another cut.

Regarding your liquid question. You probably know we recommend you switch to liquid without making a reduction at the same time. This is to determine how you tolerate the liquid. 

When were you thinking of switching to liquid?

[[Ko...]]

@[je...]I somehow missed your reply until tonight. I went ahead and reduced from 9.5 to 9 mg of valium on schedule 5 days ago. I have noticed some new mild symptoms of intermittent chest muscular pain and sleep disruption along with ongoing  troublesome morning fatigue and depression with dark intrusive thoughts.  

I have my next appointment in 2 days so that would be the time that I need to decide about converting a portion of my dosage to liquid vs sticking with pills. My question is  if I should keep trying the 0.5 mg cuts every 2 weeks until I get down to the 7-8 mg range or should I ask my NP for the liquid to start doing smaller cuts?    

It seems many people can handle a modified Ashton method (for me this would be 0.5 mg cuts every 2 -3weeks) until around 5 mg?   I don't want to go slower than I need to.

On the other hand, I don't want to suddenly hit a wall of symptoms and crash. 

I have to admit I am scared to start the liquid for a variety of reasons...the taste, the unknowns of tolerability, the measuring and fears that I will screw it up, dealing with the pharmacy who told me they would have to special order it for me.

I hate having to go through this so much. It has made me into an anxious wreck. I want my old life back.

[[je...]]

@[Ko...], I'll share my thoughts with you. It sounds like you're saying at some point during your taper you will eventually switch to using liquid because cutting by 0.5mg will not be sustainable. You just don't know when that time should be. It also sounds to me

you have a lot of anxiety about when you should be making the switch. As you know, whether or not to switch and when to do so, is entirely your decision. What I'm thinking is if you are going to switch anyway you might as well try it now and get yourself out of your misery. That is the misery the anxiety is creating. Otherwise you're going to go through this "when-to-switch process" after every single cut. And gosh, we don't need to torture ourselves, we've got enough to deal with.

Doing a pill-liquid combo is probably the best option and as you know we suggest you don't make reductions when you switch to liquid. The fears you list are legit. The taste - probably the least of your concerns - so what if it sucks? Unknowns of tolerability - yes, no one knows how you'll react, and there are no guarantees unfortunately. Measuring and screwing it up - I did liquid (I even made my own homebrew stuff) and I did not screw it up and if I can do it, you can too! Dealing with the pharmacy - you just go in and get the stuff, they have to order it, it's their job. The best thing is, they'll help you to measure your liquid and guide you through it! And you don't even have to make your own concoctions at home! I know when we feel sick and we have so much on our plates, that these things feel like mountains to conquer. I was there. You have all my empathy. I'm not trying to dismiss your fears, I'm trying to encourage you that you can overcome these. You are really brave and now you need to decide whether you feel up to making this transition or not.  

[[Th...]]

My advice regarding taste is to have a flavored drink at hand. My liquid doesn’t taste foul but it tastes odd, and I find it much easier to squirt the liquid in and then instantly follow it up with flavored drink (OJ, apple juice, whatever) to wash it down. Then I have to draw some water into the syringe 3-4 times and squirt that into my mouth to make sure I’ve gotten it all; by that point the flavor is minimal because it’s just a tiny film coating the inside of the syringe. 

Keep in mind that anxiety is a near-universal symptom of the withdrawal process, so the fact that you’re fretting about every aspect of the switch is 100% normal and to be expected. Trying to remember that - that these worries are biochemical processes, not necessarily an accurate reflection of reality - can allow you to pull back from them and say, “Yes, it might taste weird, but I’ll find ways to deal with that if it does. Yes, the measurements might feel challenging at first, but the pharmacists will give me special syringes and show me the dosage lines to use. I can bring tape or a Sharpie with me to mark on the syringes exactly where the pharmacists say to draw the liquid, or hold a paper up to that line and take a picture of it with my phone to reference later. The pharmacists do this all day every day, and it doesn’t bother them at all to do this.”

If you interrupt your anxieties and talk them through logically each time they start crowding your mind, you reinforce to yourself that there are solutions for these problems and they’re not as insurmountable or stressful as your withdrawal-brain makes them feel. It does help over time.

 

[[Ko...]]

I just met with my NP. I have been on 9mg of v for the past week and have not noticed much change- main problems are lack of motivation, fatigue, depression, and sporadic twinges of pain.  We decided to try and hold off on the liquid with the hopes that I can get to 8 mg via 0.5mg reductions over the next several weeks. 

Then I will start with the liquid so I can make smaller reductions of 5% every 2 weeks (and hopefully tolerate that)

She did agree to prescribe both pills and liquid so that's a positive. She also mentioned that being on these boards is not healthy and just feeds anxiety and dread-says there's another patient of hers on here that is at 1 mg valium and reducing more slowly than she thinks is necessary.  Of course I could understand the patient's perspective and am trying not to worry about this yet as I have a ways to go until I am that low. I would love to be down to the last 1 mg of this stuff.

[[Pa...]]

Your NP sounds great to work with and its good advice not to spend too much time here if it ramps up anxiety and fear, we understand the horror stories can be overwhelming.  I believe we can taper too quickly and too slowly but we each should have the freedom to determine what works for us.