Tapering help please... Clonaz .4MG - Been on 2 years

[[...]]

Hi everyone, my doctor has prescribed me Clonaz to taper off of, been on it for 2 years now. Initially on 1mg, moved to .5 easily, and now down to .4mg and been sitting at this dose for about a year, maybe more. I need to taper down with a liquid solution I have from the pharmacy and need help with a taper plan that will be easiest. I have severe Tinnitus and hyperacusis as well to note. 

 

Can anyone point me in the right direction to get a good taper plan asap?. 

 

Thank you so much!. 

[[je...]]

Hi @[...]

Welcome to BenzoBuddies!

You have made some really good progress with your taper - congrats! We can certainly help you with your taper. We just need you to answer a couple of questions please. Is there a reason why you held your dose at 0.4mg for a year and do you feel stable at this dose? How long have you been using your liquid solution? What is the concentration of the liquid? Are you on any other meds?

 

[[...]]

1 minute ago, [[j...] said:

Hi @[...]

Welcome to BenzoBuddies!

You have made some really good progress with your taper - congrats! We can certainly help you with your taper. We just need you to answer a couple of questions please. Is there a reason why you held your dose at 0.4mg for a year and do you feel stable at this dose? How long have you been using your liquid solution? What is the concentration of the liquid? Are you on any other meds?

Thank you very much for this. I have been sitting at .4mg for over a year because I have not had the chance to taper down, and I do now. I am stable, but not stable at the same time. I have been on the liquid solution for about a year and a half. The concentration of the liquid is .4mg = .4ml 

 

I am also on Gabapentin, Trazodone and Benadryl. 

 

Thank you, I really appreciate the response and hoping to get some taper advice . method. 

[[je...]]

Thanks for the information. What do you mean when you say you're stable but not stable at the same time?

[[...]]

20 minutes ago, [[j...] said:

Thanks for the information. What do you mean when you say you're stable but not stable at the same time?

I mean I am stable at this dose with whatever kind of symptoms I am having , tinnitus etc. I guess it's WD still I am going through with the sort of stable auditory symptoms. I have had hyperacusis and tinnitus way before benzos, and I don't feel any effects from the med at all, and want to taper completely off. 

 

Edited August 30, 2023 by [...]

[[je...]]

If you've had these symptoms prior to benzo's then my guess would be you are stable at this dose and I think you are good to start tapering.

Generally we recommend reductions of no more than 5-10% of each new total daily dose, every two weeks. I am going to see if I can get someone to help you with the maths. I'm not good with maths on liquid concentration.

In the meantime, let's get some more information. How have you been reducing your liquid to date? What do you use to measure your liquid - a syringe? What is the measurement on the syringe?

[[Li...]]

Hello, @[...]. @[je...] asked me to stopped by.

The liquid you are using is quite concentrated given that clonazepam is a very potent benzodiazepine — 0.4mg/0.4mL = 1mg/mL.  Would it be possible for you to obtain a liquid with a lower concentration, say 0.1mg/mL (see link to a stability-tested formulation below)?  Using a less concentrated liquid would make it much easier for you to measure and ingest ‘small enough’ reductions in dose.

Given that we don’t have your complete medication history yet (see note below), my inclination would be to start with a conservative taper rate of 5% (or 95% of your current total daily dose) to gauge how you respond.  Here’s the math:

95% of 0.4mL equals 0.38mL (0.95 x 0.4 = 0.38)

Link:
0.1mg/mL Clonazepam Oral Suspension
https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

Note:
To help us help you, would you please fill in your medication history and taper details per the instructions below?  That way, we’ll have all of your relevant information in one place and won’t have to keep asking you questions. 

 

[[ro...]]

I need help with my liquid taper  .  Please

[[...]]

On 30/08/2023 at 17:09, [[j...] said:

If you've had these symptoms prior to benzo's then my guess would be you are stable at this dose and I think you are good to start tapering.

Generally we recommend reductions of no more than 5-10% of each new total daily dose, every two weeks. I am going to see if I can get someone to help you with the maths. I'm not good with maths on liquid concentration.

In the meantime, let's get some more information. How have you been reducing your liquid to date? What do you use to measure your liquid - a syringe? What is the measurement on the syringe?

The measurement of the syringe is 8ml. When I was going down before, was going down on a smaller syringe, by 10 percent. 

[[...]]

On 30/08/2023 at 19:23, [[L...] said:

Hello, @[...]. @[je...] asked me to stopped by.

The liquid you are using is quite concentrated given that clonazepam is a very potent benzodiazepine — 0.4mg/0.4mL = 1mg/mL.  Would it be possible for you to obtain a liquid with a lower concentration, say 0.1mg/mL (see link to a stability-tested formulation below)?  Using a less concentrated liquid would make it much easier for you to measure and ingest ‘small enough’ reductions in dose.

Given that we don’t have your complete medication history yet (see note below), my inclination would be to start with a conservative taper rate of 5% (or 95% of your current total daily dose) to gauge how you respond.  Here’s the math:

95% of 0.4mL equals 0.38mL (0.95 x 0.4 = 0.38)

Link:
0.1mg/mL Clonazepam Oral Suspension
https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

Note:
To help us help you, would you please fill in your medication history and taper details per the instructions below?  That way, we’ll have all of your relevant information in one place and won’t have to keep asking you questions. 

Also .4mg = 4ML in that solution that I have. So I guess going down by 5-10 percent and the .38 makes sense. If I have been on for 2 years now, which is quite a long time, and just over a year at .4mg, sitting at this dose. How often should I make cuts?. Thank you so much for this all, it is well appreciated, sorry for the delayed response, I am recovering from surgery I had last week. Hope to hear back from you soon, thank you kindly!. 

[[Li...]]

[[...]]

5 minutes ago, [[L...] said:

No apology needed, @[...].  I hope you have a swift and complete recovery from your recent surgery.

Before we proceed further, we need to make sure we have the concentration of your liquid correct.  In the above copied post, you indicated it was 0.4mg/0.4mL or 1mg/mL.  In your latest post, you’ve indicated it is 0.4mg/4mL or 0.1mg/mL.  That’s a big difference.  Would you please double check what is written on the label of your medication bottle and let us know what it says?

Also, I’m puzzled by your syringe capacity of 8mL. Here in the US, oral syringes typically are available in 0.5mL, 1mL, 3mL, 5mL, and 10mL capacities.  Would you please double-check both the capacity of your syringe and also let us know how it is calibrated?  The capacity will be the highest number marked on the barrel of the syringe.  Here’s a document from the good folks at The Withdrawal Project on how to understand/read the calibration marks:

Using Syringes
https://withdrawal.theinnercompass.org/taper/using-syringes

Thank you for the well wishes on the recovery, slowly but surely over here, will take a few weeks, maybe months. 

 

The concentration on the label of the bottle says. "Shake well and take 4ML (=0.4mg)

 

I double checked the syringe that I have, and it indicates that the highest number on the syringe is 8ML I need to get a new syringe as this one is fading actually. I can take a picture if needed as well. 

[[Li...]]

You’re welcome.  I’m glad we double-checked the concentration of your liquid.  As I mentioned in a previous post, clonazepam is a very potent benzodiazepine, so using a less concentrated liquid to taper is preferable.

I’m also glad you included the exact instructions on your medication bottle.  Why?  Because they tell us that the liquid you are using is a suspension not a solution.  The ‘giveaway’ is the instruction ‘Shake well.’  Shaking a suspension well before each use is important to ensure the active pharmaceutical ingredient (API) is distributed throughout the liquid as homogeneously as possible so the doses you measure are as accurate as possible.

Obtaining new oral syringes would be a smart move on your part.  In your shoes, I would call the pharmacist to request oral syringes with capacities and graduations appropriate for the volume of liquid to be measured (e.g. 3mL, graduated in 0.1mL; 1mL, graduated in 0.01mL).  Also, did your medicine bottle come equipped with a press-in adapter cap?  If not, I’d request one of those as well.  If your pharmacist cannot provide oral syringes, you can purchase them online.  Two of the more reliable manufacturers are Baxa ExactaMed and BD (Becton Dickinson).  (PS To prevent the markings from wearing off syringes, place a piece of clear tape over them.)

Now, let’s talk about taper rate and taper interval.

What taper rate do you wish to try? A general suggestion is to make reductions in the range of 5-10% depending on the individual’s dose, duration of use, medication history, age, general health, risk tolerance (and other factors). 

You’re on a moderate dose but you’ve been on it for a while now.  Is this the first time you’ve taken and discontinued a benzodiazepine or other psychiatric drug?  If so, did you have difficulty doing so?  Are you under or over age 40?  Is your general health ok or not?  Are you taking any other medications or supplements that interact with your benzodiazepine in some way?

What taper interval do you with to try?  Do you wish to make a ‘small enough to be tolerable’ percentage based reduction in dose and then hold at that dose so you can evaluate your response?  Do you wish to make a series of micro reductions adding up to your target taper rate and then hold to evaluate your response?  Do you wish to make daily micro reductions adding up to your target taper rate?  Like most things in life, each of these approaches has advantages and disadvantages. 

[[...]]

On 01/09/2023 at 15:03, [[L...] said:

You’re welcome.  I’m glad we double-checked the concentration of your liquid.  As I mentioned in a previous post, clonazepam is a very potent benzodiazepine, so using a less concentrated liquid to taper is preferable.

I’m also glad you included the exact instructions on your medication bottle.  Why?  Because they tell us that the liquid you are using is a suspension not a solution.  The ‘giveaway’ is the instruction ‘Shake well.’  Shaking a suspension well before each use is important to ensure the active pharmaceutical ingredient (API) is distributed throughout the liquid as homogeneously as possible so the doses you measure are as accurate as possible.

Obtaining new oral syringes would be a smart move on your part.  In your shoes, I would call the pharmacist to request oral syringes with capacities and graduations appropriate for the volume of liquid to be measured (e.g. 3mL, graduated in 0.1mL; 1mL, graduated in 0.01mL).  Also, did your medicine bottle come equipped with a press-in adapter cap?  If not, I’d request one of those as well.  If your pharmacist cannot provide oral syringes, you can purchase them online.  Two of the more reliable manufacturers are Baxa ExactaMed and BD (Becton Dickinson).  (PS To prevent the markings from wearing off syringes, place a piece of clear tape over them.)

Now, let’s talk about taper rate and taper interval.

What taper rate do you wish to try? A general suggestion is to make reductions in the range of 5-10% depending on the individual’s dose, duration of use, medication history, age, general health, risk tolerance (and other factors). 

You’re on a moderate dose but you’ve been on it for a while now.  Is this the first time you’ve taken and discontinued a benzodiazepine or other psychiatric drug?  If so, did you have difficulty doing so?  Are you under or over age 40?  Is your general health ok or not?  Are you taking any other medications or supplements that interact with your benzodiazepine in some way?

What taper interval do you with to try?  Do you wish to make a ‘small enough to be tolerable’ percentage based reduction in dose and then hold at that dose so you can evaluate your response?  Do you wish to make a series of micro reductions adding up to your target taper rate and then hold to evaluate your response?  Do you wish to make daily micro reductions adding up to your target taper rate?  Like most things in life, each of these approaches has advantages and disadvantages. 

Hi, thank you so much for this, sorry for the delayed response as I am still recovering from surely I had done last week. I am going to get new syringes from the pharmacy on Tuesday as Monday is a holiday, thank you for the suggestions, I will be grabbing those syringes mentioned above. 

I have discontinued a muscle relaxer years ago, and that was very hard as it worked on the brain as well, called baclofen. It was rather difficult, did not see an end in night, but it worked. I am turning 40 years old this coming October. My general health is not the greatest, I have acid reflux, hyperacusis and tinnitus, back pain, face pain, tmjd previous history of lymphoma in remission from 2018. . I am also taking gabapentin 700 mg per day, trazodone 37.5 mg and Benadryl 50mg. 

I wish to try the easiest taper method as possible, it doesn't matter if I have to go slow or not. If I have to deduct 5 percent and hold for a cpl of weeks to a month then so be it, seeing I have been on for a long time. Also another thing I wanted to point out seeing Clonazapam is a very potent benzo, maybe switching to valium might be easier but I also am worried about the hyperacusis and tinnitus symptoms switching over, I hear from people that clonazapam when reducing is very hard on the ears and maybe valium might be better, I am not sure. Wanted to get your take on that as well. All in all, I just want off and off of the other medications I am on as well subsequent. 

 

Hope to hear back from you soon, and have a great day!. 

 

David Vance. 

[[Li...]]

Hello @[...].  Thank you for the additional information.  It’s late here and I have plans for tomorrow but I will respond as soon as I can.  Given your experience with discontinuing baclofen, age, and health status, I agree with you that slow is the way to go.  

[[...]]

13 hours ago, [[L...] said:

Hello @[...].  Thank you for the additional information.  It’s late here and I have plans for tomorrow but I will respond as soon as I can.  Given your experience with discontinuing baclofen, age, and health status, I agree with you that slow is the way to go.  

Thank you so much, looking forward to hearing back from you, much love!. 

 

David

[[...]]

17 hours ago, [[L...] said:

Hello @[...].  Thank you for the additional information.  It’s late here and I have plans for tomorrow but I will respond as soon as I can.  Given your experience with discontinuing baclofen, age, and health status, I agree with you that slow is the way to go.  

I also have a diff syringe that is 10 ml as well that I found last night, if this helps at all. Will be getting the other syringes on Tuesday. 

[[Li...]]

 

Greetings, @[...].   My apologies for the delay in response. Given that you are new to our community, you may not be aware that members of the BenzoBuddies team are all volunteers.  Moreover, we live in 4+ different time zones and several of us are navigating the unpredictable and sometimes stormy seas of benzodiazepine withdrawal and recovery.  The net is that we provide as much support as we can when we can.

As I stated in my previous post, given your medication history, general health status, and age, I agree with you that a slow, cautious taper is indicated.  I also encourage you to consider having a conversation with a trusted pharmacist about the combination of medications you are taking with the goal of risk minimization (e.g., as I’m sure you already know, the medications you are taking all have CNS and/or respiratory-depressant effects).

In terms of your clonazepam taper, I neglected to ask about your dosing schedule.  How many milligrams of drug do you take at what time(s)?

In your shoes, I’d begin by trialing a conservative 5% reduction in dose.  Your current dose is 0.4mg so a 5% reduction would be 95% of 0.4mg or 0.38mg (0.95 x 0.4 = 0.38).

Your liquid has a concentration of 1mL = 0.1mg so your target reduced dose would be 3.8mL of the liquid.  

The next question to address is what reduction interval you wish to trial.   You could make the reduction all at once and then hold at the reduced dose for 2 weeks or so.  Or, you could make a series of smaller reductions and then hold.  In your case, I’m leaning toward the second option.  Why?  Because it will give us an early warning signal if a taper rate of 5% is too high for you (I have no idea if it is or isn’t but the fact that you had issues discontinuing baclofen which — like clonazepam — is GABAergic suggests caution).  

There are many ways you could implement the ‘series of small reductions followed by a hold’ approach.  Here’s just one example:

Starting dose: 4mL
Day 1: 3.96mL
Day 2: 3.92mL
Day 3: 3.88mL
Day 4: 3.84mL
Day 5: 3.80mL (target reduction dose)
Hold at 3.80mL for at least 10 days to give your brain and body time to process and adjust to the reductions.

If you experience an uptick in withdrawal symptoms at any point in the reduction series, you would hold at that dose until the symptoms stabilize (i.e. stop changing in number or nature).  

As you’ve probably already surmised, keeping a daily taper log is key to a successful taper.  Examples of data to record include: 

• The date
• Time(s) and amounts(s) of medication(s) ingested
• Daily rating of your withdrawal symptoms (0 = no symptoms; 10 = intolerable symptoms)
• Daily rating of your functionality (0 = able to perform all essential daily tasks; 10 = unable to perform any essential daily tasks)

Re: your question about crossing over to diazepam …

Like just about everything related to benzodiazepine withdrawal and recovery, this works for some individuals but not for others.  It sounds like you are stable on the clonazepam so in your shoes I would be inclined to ‘dance with the devil you know’ and at least try to taper directly from it.

In closing … I’ve written a novel here so will pause to give you time to process all of the above.  Please do let me know if you have questions.  I’ll be thinking of you on Tuesday when you pick up those new oral syringes!

 

[[...]]

On 03/09/2023 at 15:33, [[L...] said:

Greetings, @[...].   My apologies for the delay in response. Given that you are new to our community, you may not be aware that members of the BenzoBuddies team are all volunteers.  Moreover, we live in 4+ different time zones and several of us are navigating the unpredictable and sometimes stormy seas of benzodiazepine withdrawal and recovery.  The net is that we provide as much support as we can when we can.

As I stated in my previous post, given your medication history, general health status, and age, I agree with you that a slow, cautious taper is indicated.  I also encourage you to consider having a conversation with a trusted pharmacist about the combination of medications you are taking with the goal of risk minimization (e.g., as I’m sure you already know, the medications you are taking all have CNS and/or respiratory-depressant effects).

In terms of your clonazepam taper, I neglected to ask about your dosing schedule.  How many milligrams of drug do you take at what time(s)?

In your shoes, I’d begin by trialing a conservative 5% reduction in dose.  Your current dose is 0.4mg so a 5% reduction would be 95% of 0.4mg or 0.38mg (0.95 x 0.4 = 0.38).

Your liquid has a concentration of 1mL = 0.1mg so your target reduced dose would be 3.8mL of the liquid.  

The next question to address is what reduction interval you wish to trial.   You could make the reduction all at once and then hold at the reduced dose for 2 weeks or so.  Or, you could make a series of smaller reductions and then hold.  In your case, I’m leaning toward the second option.  Why?  Because it will give us an early warning signal if a taper rate of 5% is too high for you (I have no idea if it is or isn’t but the fact that you had issues discontinuing baclofen which — like clonazepam — is GABAergic suggests caution).  

There are many ways you could implement the ‘series of small reductions followed by a hold’ approach.  Here’s just one example:

Starting dose: 4mL
Day 1: 3.96mL
Day 2: 3.92mL
Day 3: 3.88mL
Day 4: 3.84mL
Day 5: 3.80mL (target reduction dose)
Hold at 3.80mL for at least 10 days to give your brain and body time to process and adjust to the reductions.

If you experience an uptick in withdrawal symptoms at any point in the reduction series, you would hold at that dose until the symptoms stabilize (i.e. stop changing in number or nature).  

As you’ve probably already surmised, keeping a daily taper log is key to a successful taper.  Examples of data to record include: 

• The date
• Time(s) and amounts(s) of medication(s) ingested
• Daily rating of your withdrawal symptoms (0 = no symptoms; 10 = intolerable symptoms)
• Daily rating of your functionality (0 = able to perform all essential daily tasks; 10 = unable to perform any essential daily tasks)

Re: your question about crossing over to diazepam …

Like just about everything related to benzodiazepine withdrawal and recovery, this works for some individuals but not for others.  It sounds like you are stable on the clonazepam so in your shoes I would be inclined to ‘dance with the devil you know’ and at least try to taper directly from it.

In closing … I’ve written a novel here so will pause to give you time to process all of the above.  Please do let me know if you have questions.  I’ll be thinking of you on Tuesday when you pick up those new oral syringes!

Sorry for the later reponse, still recovering from surgery. I Started to taper the other day. Tuesday. I took 5 percent off using a 10 ml syringe, the pharmacist suggested to go down one bar on my morning dose, and leave the night dose the same, then every 2 weeks to switch. I did this and last night I barely slept, and my sound sensitive and Tinnitus was so unbearable. I did a NO NO and I took the 2 5 percent doses this morning as I could not handle it. I'm not sure what to do now, and can feel more ringing in my ears. Maybe try to settle back on the .4mg dose and try to taper again but going slower than a 5 percent reduction or take it off of the am and pm doses, instead of just the morning dose. All of this above is so helpful thank you, most appreciated! You guys are great here!. 

 

Kindest, 

David 

[[...]]

[[Li...]]

Ouch.  Might I ask why you started your taper before you have fully recovered from your surgery?  Tapering can be quite challenging to our bodies so it’s best to start from a position of strength and stability.

Why do you think you are in tolerance withdrawal? 

In your shoes, I would return to your 0.4mg per day dose and wait until you have fully recovered from your surgery.  This will also give you time to make adjustments in your taper plan.  Per my previous post, my inclination in your case would be to try a series of small reductions followed by a hold.

We can help you with the math and measurements if needed, but first we would need to know:

(1) Your daily dosing schedule.  How many milligrams (or milliliters) of clonazepam do you take at what times?  

(2) The capacity of the syringes you have and how they are graduated.  A 10mL syringe is not the best tool to use for measuring volumes below 5mL.