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Lookng for experienced microdose advice for new taper: interdose withdrawal


[Je...]

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I can't believe I find myself back here as I did an extremely slow liquid taper (3 years) with Valium 7 years ago very successfully and never thought I'd go back on benzos. What worked then was INCREASING my dose to stabilize for two weeks and then a very long micro taper...I switched from Ativan to Valium and mixed with milk in three daily doses.

The new story: I have ovarian cancer. I had an incredibly stressful two week hospital stay and surgery. When I came home I had extreme insomnia and anxiety and broke down to take .5 mg Klonopin which worked great...for about a month. I went to my first chemo appointment, had some side effects, more anxious, increased my Klonopin to 1 mg. I figured I'd just take it until my chemo was over and then do another long slow taper.

However, what's new this time around is my tolerance withdrawal is fast. Four days ago, I upped my dose to 1.5 mg: .75 at night for sleep, .25 upon waking and then at 2 pm .5 mg (which I was already doing)..trying to keep them spaced apart even but weighted towards sleep at night. I'm already waking with a racing heart and feel myself dropping off my am dose. After four days!

I've only been on the Klonopin for about 6 weeks. Previously, I took the Ativan for years and slept fine on .5 mg. so I never thought this could happen.

I'm so weak with jelly legs that I'm bedbound and obviously can't get to chemo! I wish I could do what I did the first time: stabilize for two weeks at a higher dose, which would pull me out of the interdose withdrawal for a nice slow taper. My goal the first time was to feel good no matter how long it took to get off. I was mostly symptom free the whole way down. That's even more important now as I need to get to chemo! However, increasing my dose doesn't seem so likely for stabilizing based on the speed of the interdose withdrawal, does it?

Questions: What's the best way to stabilize to normalize my energy given this situation? (Way more important than getting off the drug quickly.) Do I need, say, more frequent doses that are the same amount (will I sleep if cut it at night yikes?) Does Klonopin get mixed with water rather than the milk I used for valium? Other advice?

Please don't point me to the Ashton manual. I'm looking for seasoned micro taperers who understand the goal of stabilizing with interdose withdrawal to regain (Hopefully!) some function.

 

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Hello @[Je...] Welcome to BenzoBuddies. Or is it welcome back? Either way, I appreciate that you'd prefer to not need to be here.

You've had a tough time of it. But I feel sure you will receive the help you seek here.

If you are looking to quit, I suggest that you reverse your increased dose from four days ago. After fours days, you are not yet habituated/dependent upon this higher dose. So reversing that now (no need to taper - just go back your previous dose) is a relatively easy win. I am not suggesting that it will be plain sailing, because you upped your dose for a reason. But if you have no intention of staying at that dose, there are only downsides to putting of the reversal. Leave it much longer and you will need to taper down to your previous dose, unnecessarily stretching out your withdrawal.

Once you have done this, we can look at the options available to you to taper down your dose.

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That sounds like a promising first step. And Colin I recognize you from before! Love that you are still here helping people. 

I guess my only question is: If I am not dependent on the .5 I added four days ago, why did I sleep okay 1 to 2 nights and then wake up with anxiety and also notice low grade anxiety after my morning dose wore off? Because if I cut this out, that's 1/3 of my dose. Feels risky. What is my back up plan if I have severe withdrawal?

Edited by [Je...]
clarify
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Also re-looked at my calendar and while it's true I only added the extra .5 4 days ago on 9/2. I DID also take an extra .5 for one to two days on 8/18, ie 2 weeks earlier. Does your advice still hold?

 

 

 

Edited by [Je...]
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Hello @[Je...] One-off and very short term use does not create dependency. Similarly, if you increase your dose for a short period, you do not become physically dependent upon the increased dose in the shorter term.

Dependency does not occur suddenly, but it can be quite rapid. So, within a couple of weeks of starting or increasing your dose, it is generally accepted that no (added) dependency will occur. But as you go beyond that point, you start to risk developing dependency, and, for some - it would seem - they could develop a deep dependency within another few weeks.

To answer your question more specifically, your one-off dose from the middle of August does not change my suggestion to you. If you are looking to quit benzodiazepines, reversing this very recent increase in dose would seem a sensible first step. I am not suggesting that you will experience no difficulties, but you will not experience physical withdrawal by returning to your previous does. But, the longer you leave it, the more you risk increasing your dependency and adding to the time you require to complete a successful taper.

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12 hours ago, [[J...] said:

That sounds like a promising first step. And Colin I recognize you from before! Love that you are still here helping people. 

I guess my only question is: If I am not dependent on the .5 I added four days ago, why did I sleep okay 1 to 2 nights and then wake up with anxiety and also notice low grade anxiety after my morning dose wore off? Because if I cut this out, that's 1/3 of my dose. Feels risky. What is my back up plan if I have severe withdrawal?

That's not dependency. That's just the increase in medication doing what we hope it will do. But tolerance to the new dose are all but assured, and the benefits you are experiencing now will disappear.

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But it if it's not dependency and just the medication doing what we hope it will do, shouldn't the benefits increase for more than a night or two?

My hope was to stick at a dose throughout chemo over the next six months and THEN taper afterwards because tapering in the midst of chemo side effects sounds like a recipe for disaster. But now I'm wondering if I'm likely to develop tolerance withdrawal during that time period?

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I decided to drop .25 mg. I also decided to create four doses of the remaining 1.25 into milk, spaced evenly through waking hours. (I sure hope I still sleep though) to hopefully end the interdose withdrawal. I think I tapered from Valium before and thought of trying to slowly swap it once I feel stable and out of the interdose withdrawal. I'm just unsure about all this during chemo. Am I less likely to experience tolerance withdrawal, over say six months on Valium than Klonopin in your experience if I wanted to taper post-chemo?

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3 hours ago, [[J...] said:

But it if it's not dependency and just the medication doing what we hope it will do, shouldn't the benefits increase for more than a night or two?

My hope was to stick at a dose throughout chemo over the next six months and THEN taper afterwards because tapering in the midst of chemo side effects sounds like a recipe for disaster. But now I'm wondering if I'm likely to develop tolerance withdrawal during that time period?

I can't possibly comment on whether or not you should hold off until after your chemo therapy is complete. But I will say is that there are sometimes greater priorities than quitting benzodiazepines. I don't think quitting benzodiazepines is a great goal in of itself. What are your underlying reasons for wishing to quit? If they are not particularly strong, and withdrawal is going to rub against something else more important, the potential benefits might not outweigh the potential downsides of quitting.

What does your doctor suggest?

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43 minutes ago, [[J...] said:

I decided to drop .25 mg. I also decided to create four doses of the remaining 1.25 into milk, spaced evenly through waking hours. (I sure hope I still sleep though) to hopefully end the interdose withdrawal. I think I tapered from Valium before and thought of trying to slowly swap it once I feel stable and out of the interdose withdrawal. I'm just unsure about all this during chemo. Am I less likely to experience tolerance withdrawal, over say six months on Valium than Klonopin in your experience if I wanted to taper post-chemo?

Interdose or tolerance withdrawal? Or both?

There is no way to know who might develop 'tolerance withdrawal' effects, over what timeframe, or if there is a greater or lower likelihood with any particular benzodiazepine.

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Why do you not think quiting benzos is not a great goal in itself? I was on them for 10 years and they began to cause all kinds of problems including tolerance withdrawal (Doesn't that eventually happen to us all?) and were impossible to get off of with so much suffering until I did a slow 3 year daily microtaper off basically 10 mgs Valium which was completely painless. I was 100 percent functional the whole time.

That was almost 10 years ago and I never thought I'd go back on them but my medical anxiety in extreme situations like cancer created awful anxiety and insomnia. I recognize that I'm going to need some benzo support through the next few months and then I hope to do a slow swap to Valium for another long taper. Wish I would've just started with the Valium in the first place. I forgot how well it worked for me.

For those who do wish to discontinue, I think a l ot of people get obsessed with getting off as quickly as possible, missing the point that it's far better to feel fine on a long slow taper then suffer through withdrawal by rushing it. Just my personal experience on what worked for me though.

I'm hoping my new dosing schedule with even doses at regular intervals takes care of the interdose withdrawal. I just hope I don't find myself with tolerance withdrawal that needs to be addressed during the next few months as I'd rather not taper now.

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4 hours ago, [[J...] said:

Why do you not think quiting benzos is not a great goal in itself? I was on them for 10 years and they began to cause all kinds of problems including tolerance withdrawal (Doesn't that eventually happen to us all?) and were impossible to get off of with so much suffering until I did a slow 3 year daily microtaper off basically 10 mgs Valium which was completely painless. I was 100 percent functional the whole time.

Because it is too abstract. The questions I would ask myself about taking (or quitting) any medication is: what are the potential benefits and downsides, and how likely are they to occur? If there is little benefit to continuing a medication, there are risks with continuing, and low risk from quitting, then the equation is easy to solve. But if the mix is different, then a more considered approach is appropriate.

The reason for my comments and questions were because benzodiazepine withdrawal can be very tough. And if you have other significant problems in your personal life or health, they might (or should) take priority. You have been through withdrawal already, so you have a good idea of what to expect. But you should be aware that subsequent withdrawals are sometimes tougher. You might be fine - it is even probable. But there is an unquantifiable risk that the next withdrawal could be significantly more tough for you than the first.

4 hours ago, [[J...] said:

That was almost 10 years ago and I never thought I'd go back on them but my medical anxiety in extreme situations like cancer created awful anxiety and insomnia. I recognize that I'm going to need some benzo support through the next few months and then I hope to do a slow swap to Valium for another long taper. Wish I would've just started with the Valium in the first place. I forgot how well it worked for me.

Well, that would seem like a good reason to take benzodiazepines for a limited period of time. But after a relatively short period of use, I question the utility of switching to Valium with the intention of tapering from there. In your shoes, after 6 weeks of use and was intending to quit, I'd follow an accelerated taper plan and get off before I risked developing significant dependence. Again, there are no hard and fast rules. But the majority of people seem able to complete accelerated tapers after relatively short-term use.

4 hours ago, [[J...] said:

For those who do wish to discontinue, I think a l ot of people get obsessed with getting off as quickly as possible, missing the point that it's far better to feel fine on a long slow taper then suffer through withdrawal by rushing it. Just my personal experience on what worked for me though.

Yes, this happens sometimes. But, after short term use, this is the best first option, since most can complete it, and the longer we take benzodiazepines (even when tapering), the more we risk developing dependency and a more difficult withdrawal. Of course, you would play it by ear. If the taper is too tough, slow it down.

4 hours ago, [[J...] said:

I'm hoping my new dosing schedule with even doses at regular intervals takes care of the interdose withdrawal. I just hope I don't find myself with tolerance withdrawal that needs to be addressed during the next few months as I'd rather not taper now.

If you are suffering from interdose withdrawal effects, then yes, spreading out you dose over the day would seem entirely reasonable.

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So what I HAD been doing was heavily weighting my 1.5 mg heavily towards nighttime, with .75 at bedtime, .25 around 8 am, and .5 at 2 pm. But upon looking at my schedule, I realized over the 5 weeks I'd been taking itI'd been up and down at different doses for short periods.

And my main problem that made me know there was an issue was waking with a racing heart in the middle of the night, even just a few days after increasingi from .5 which I'd been sleeping great on.

So yesterday, I dropped the .125 and evened out my doses to four at 7 am , noon, 5, and 10 pm at .132 each (in milk). I was pretty sedated all day. I decided to move them a little today so that I'd wake up and take the first one at 4 am instead of 7 am in hopes of addressing the sleep issue.

And that did work...I woke up more during the night (on essentially half my former dose) but fell back asleep as I did after my 4 am dose. BUT then 2 hours later when I woke I had a lot of rebound anxiety. Does this seem like a normal adjustment that would even out with time or a sign that my new plan might not work?

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@[Co...] I’d love your advice as I was on .25mg for a month then three weeks ago upped to .5-1mg during a time of crisis. I have every day and dose tracked if that’s helpful. Could you help me see where I should begin my taper as I’m on 1mg a day past 4 days but took only .5mg a day for a week before that and for a week before that took 1mg, so I don’t know where I’m at or where to begin my taper. 

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One more thing Colin...Yesterday I think I was so sedated because the new day time doses were on top of the previous night's .75 mg. Today I'm noticing the opposite. In my effort to space out the doses, I almost halved my night dose and today I'm noticing more anxiety even with the daytime doses. This should even out over next days, right? I mean I did cut out that .25 but otherwise the total dose is the same.

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@[Je...] Honestly, I really don't know. You should keep a diary of your dosing and record how you feel. This will allow you better understand how your affected and what works best for you. You probably should expect to experience some disruption with any changes you make to your medication. It will probably take a few days or longer for things to settle down.

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One more question: I wanted to pose this question to someone knowledgeable about alternative therapies but couldn't figure out how to post it there. So if there's someone you recommend and can point me to them or know the answer yourself, pl let me know.

I have some custom made tea from a master herbalist which should help with my cancer, anxiety, and all kinds of other things. However, it is definitely designed to detox the liver. Is that a disastrous idea when taking benzos if you're trying to get to an even concentration of the drug? Aren't benzos metabolized in the liver? He's not concerned at all, but hey, just like the many MDs I've encountered in my benzo journey advising to dry cut pills quickly, I'm far more inclined to take advice from a knowledgeable person in this forum.

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@[Je...] I would caution against anything pseudo-medical given your serious health concerns. Do you know what's in herbal tea?

'Detox' is not really a thing outside of medicine (more properly referred to as detoxification). Still, some herbs can and do have real effects and could (I would guess) affect the liver. That's why I ask what's in the tea. I strongly suggest that you talk with your oncologist about any alternative treatments you might try.

https://www.health.harvard.edu/staying-healthy/the-dubious-practice-of-detox

https://www.theguardian.com/lifeandstyle/2014/dec/05/detox-myth-health-diet-science-ignorance

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This herbalist specializes in oncology and has excellent results and is well published, presenting at many oncology conferences. The herbs are prepared based on my custom issues. So that wasn't really my question. I'm comfortable with all of that. I'm not naive about "detox"/pseudo magic medical cures. Of course I'd speak with my oncologist but they're not benzo savvy.

My question is the effect of benzo detoxification in the liver since that is one of the effects which is why I was interested in hearing from someone who had used herbs while on benzos.

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Also FYI, my daughter is a fourth year medical student (well-published herself) and would be researching each of the herbs for me if I elected to go this route. Just wanted someone benzo-herb savvy with personal experience to weigh in.

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Colin—I changed my dosing schedule to every six hours (i.e 4x per day) five days ago (which included dropping the .25 mg. Remember I was on 1.5 for four days with most of it weighted at night and getting break through anxiety middle of the night ). Things feel pretty uneven still with breakthrough anxiety at some times and feeling overly sedated at others. 

What is the consensus on how long it takes to see if this kind of change to even dosing will even out the interdose withdrawal?  

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