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Need a titration schedule using milk please


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Hi!

 

I have 1mg Klonopin pills.  I cut them into 0.25mgs using a pill cutter.  My starting dose was 0.5mg of K daily.  I have been curshing the 0.25mg of K and placing into 10ccs of diluted baby food.  My first reduction was done by withdrawing and wasting 1cc or 10% of that suspension and taking the remaining 9css.  I did this twice a day and held for 9 days.

 

Second reduction, I withdrew 2ccs of the suspension and drank the remaining 8ccs.  Held somewhere between 10-12 days.

 

Third reduction, I am withdrawing 3css and drinking the remaining 7ccs.  I am still at this dose currently.  If my math is right, that puts me at 0.35mg daily.

 

I would like a milk titration schedule and believe that I can tolerate making very small cuts daily.  Just would like a smoother reduction instead of the 10% hitting me all at once.  I typically have 2-3 really rough days and then feel better.  I am working and want to be able to continue doing so.  I do have an underlying anxiety issue and am currently on a really high dose of neurontin.  Next med that I will be tapering.

 

Strength of pill: 1mg.....but I was splitting those into 0.5mg halves to begin with as I was only taking 0.5mg daily, which was my starting dose

 

Number of pills: only one strength of 1mg

 

Cylinder type:  100ml with 1ml increments

 

Reduction rate: 1cc daily unless you think I should do something different

 

Thanks,

Cindy

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Hi Cindy,

 

What is your starting dose now?  What is the total amount you are currently taking each day?

 

Draftsman

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Hi Cindy,

 

What is your starting dose now?  What is the total amount you are currently taking each day?

 

Draftsman

 

I am taking a total of 0.35mg daily....I am currently dividing that into 2 doses a day.  I started at 0.5mg daily and have reduced to 0.35mg.

 

Cindy

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I would appreciate feedback from those who are doing a liquid titration and are making daily cuts.  Another forum said they do not recommend the dialy cuts as it does not give the CNS time to stabilize that way...they recommend doing a cut and holding for awhile before doing another cut.  My thought was that daily, miniscule cuts would be easier on the CNS then one bigger cut all of a sudden.

 

Would really love hearing back from those doing it both ways.  I have been doing bigger cuts and holding....this last cut was pretty tough for a few days.  And I have also noticed that having some morning anxiety again and starting not to sleep as well.

 

Thanks,

Cindy

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Is anybody seeing my posts?  I really need some feedback about doing a milk titration.  Is there anybody here that can help?  It would be greatly appreciated.

 

Cindy

 

 

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Hi Cindy:

 

Sorry no one has responded yet.  I will post a schedule and offer some idea to you within 24 hours.  Thanks for your patience.

 

Draftsman

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Hi Cindy:

 

Sorry no one has responded yet.  I will post a schedule and offer some idea to you within 24 hours.  Thanks for your patience.

 

Draftsman

 

Thank you so much Draftsman! :)

 

cindy

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Hi Cindy:

 

I have 1mg Klonopin pills.  I cut them into 0.25mgs using a pill cutter.  My starting dose was 0.5mg of K daily.  I have been curshing the 0.25mg of K and placing into 10ccs of diluted baby food.  My first reduction was done by withdrawing and wasting 1cc or 10% of that suspension and taking the remaining 9css.  I did this twice a day and held for 9 days.

 

Second reduction, I withdrew 2ccs of the suspension and drank the remaining 8ccs.  Held somewhere between 10-12 days.

 

Third reduction, I am withdrawing 3css and drinking the remaining 7ccs.  I am still at this dose currently.  If my math is right, that puts me at 0.35mg daily.

 

So you are now crushing .25 and are currently making 30% cuts.  This means you are currently at .175?  Please clarify.

 

Thanks,

 

Draftsman

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I would appreciate feedback from those who are doing a liquid titration and are making daily cuts.  Another forum said they do not recommend the dialy cuts as it does not give the CNS time to stabilize that way...they recommend doing a cut and holding for awhile before doing another cut.  My thought was that daily, miniscule cuts would be easier on the CNS then one bigger cut all of a sudden.

 

Would really love hearing back from those doing it both ways.  I have been doing bigger cuts and holding....this last cut was pretty tough for a few days.  And I have also noticed that having some morning anxiety again and starting not to sleep as well.

 

Thanks,

Cindy

 

Most people here have done liquid titration via daily cuts (1% when using a 100ml cylinder).  You can hold as long as you like, but most people here hold according to how they feel rather than by a specific rule.  A 1% cut per day should work fine, but you can adjust accordingly to fit your needs.

 

Draftsman

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Hi Cindy:

 

I have 1mg Klonopin pills.  I cut them into 0.25mgs using a pill cutter.  My starting dose was 0.5mg of K daily.  I have been curshing the 0.25mg of K and placing into 10ccs of diluted baby food.  My first reduction was done by withdrawing and wasting 1cc or 10% of that suspension and taking the remaining 9css.  I did this twice a day and held for 9 days.

 

Second reduction, I withdrew 2ccs of the suspension and drank the remaining 8ccs.  Held somewhere between 10-12 days.

 

Third reduction, I am withdrawing 3css and drinking the remaining 7ccs.  I am still at this dose currently.  If my math is right, that puts me at 0.35mg daily.

 

So you are now crushing .25 and are currently making 30% cuts.   This means you are currently at .175?  Please clarify.

 

Thanks,

 

Draftsman

 

I am crushing 0.25mg and am making 30% cuts but....I am doing that twice daily.

 

My head is about to explode, I am so confused about all of this and cannot seem to make sense of it.

 

I was told by a moderator on another forum that I was making too large of reductions.  I understand him to mean that I should  not be withdrawing from both my am and pm dose.  but this is what I have been doing from inception.

 

My intial dose was 0.5mg, which I divided into two 0.25mg suspensions of 10ccs liquefied baby food.

I withdrew 10% from each dose daily.

 

For my second reduction...I increased withdrawing to 20% or 2ccs of the 10ccs suspension

Still crushing the 0.25mg, placing in suspension, withdrawing the 2ccs or 20%

I did this twice a day also.

 

Currently, I am doing the same, only now I am withdrawing 30% or 3ccs of the suspension

Again, I am withdrawing 30% from both am and pm doses.

 

I hope this clarifies...I am so confused and feel stupid that I cannot seem to understand what I am doing wrong and also apparant that I am unable to communicate clearly what I am doing.  By the way, this method was linked to me by the moderator of the other forum.

 

WHAT AM I DOING WRONG?

 

Cindy

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Hi Cindy:

 

I have 1mg Klonopin pills.  I cut them into 0.25mgs using a pill cutter.  My starting dose was 0.5mg of K daily.  I have been curshing the 0.25mg of K and placing into 10ccs of diluted baby food.  My first reduction was done by withdrawing and wasting 1cc or 10% of that suspension and taking the remaining 9css.  I did this twice a day and held for 9 days.

 

Second reduction, I withdrew 2ccs of the suspension and drank the remaining 8ccs.  Held somewhere between 10-12 days.

 

Third reduction, I am withdrawing 3css and drinking the remaining 7ccs.  I am still at this dose currently.  If my math is right, that puts me at 0.35mg daily.

 

So you are now crushing .25 and are currently making 30% cuts.   This means you are currently at .175?  Please clarify.

 

Thanks,

 

Draftsman

 

I am crushing 0.25mg and am making 30% cuts but....I am doing that twice daily.

 

My head is about to explode, I am so confused about all of this and cannot seem to make sense of it.

 

I was told by a moderator on another forum that I was making too large of reductions.  I understand him to mean that I should  not be withdrawing from both my am and pm dose.  but this is what I have been doing from inception.

 

My intial dose was 0.5mg, which I divided into two 0.25mg suspensions of 10ccs liquefied baby food.

I withdrew 10% from each dose daily.

 

For my second reduction...I increased withdrawing to 20% or 2ccs of the 10ccs suspension

Still crushing the 0.25mg, placing in suspension, withdrawing the 2ccs or 20%

I did this twice a day also.

 

Currently, I am doing the same, only now I am withdrawing 30% or 3ccs of the suspension

Again, I am withdrawing 30% from both am and pm doses.

 

I hope this clarifies...I am so confused and feel stupid that I cannot seem to understand what I am doing wrong and also apparant that I am unable to communicate clearly what I am doing.  By the way, this method was linked to me by the moderator of the other forum.

 

WHAT AM I DOING WRONG?

 

Cindy

 

You aren't making 30% cuts, you are making 10% cuts (the first one that is, they are getting slightly bigger each time, which is pretty typical.) I would definitely not say your cuts are too large. You aren't doing anything wrong, and you communicated quite clearly too! You are merely feeling withdrawal, which is inevitable if you have a dependency and making cuts.

 

Some people taper only one dose at a time, but I don't think this is the right thing to do IMHO, it is best to have your blood levels as consistent as possible over time, and this is best done by keeping your doses fairly even. Removing 10% from your AM dose and 10% from your PM dose is still a 10% reduction, not more, and sounds like the right thing to me.

 

With regards to the daily cuts, I am doing them, only because I could not handle a 10% reductions right now, I have not stabilized from .5mg on down. Some people report if you do the daily reductions slow enough and slow down the rate when you have to, you can withdraw with little withdrawals. I honestly don't realistically see this happening. I feel with the daily cuts, it makes thing easier, but I still totally have good days and bad days and good periods and bad periods but it's more spread out. IMHO if you are able to cut and only have w/d for 3-4 days then stabilize, you should keep doing that -- again JMO. But if you want to do the daily cuts because the 3-4 days hurt too bad, well by all means I am certainly doing it and surviving and in fact have only gotten better on a whole not worse (though I did get totally slammed eventually when I first started the daily cuts because I went too fast. You really have to watch your symptom levels or you could wind up in very bad shape from blindly cutting, those cuts can catch up to you.)

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Thanks Xeno and Draftsman!  I was going crazy trying to figure out what I was doing wrong.

 

Xeno, I am sorry that you have had such a rough time and hope that you start feeling better soon and having more good days than bad.  Just wish there was some way that we all could w/d without so much pain and suffering.

 

Cindy

 

 

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Cindy,

 

Sorry it took a while for me to understand what you are doing.  Keep in mind I'm still going through some withdrawals too  :).

Xenofears is correct, there is not really anything wrong with the way you are currently titrating.  But I think it can be simplified a bit, and I agree it would be a good idea to make daily cuts so you can smooth things out. 

 

So if I understand correctly, you have been crushing .25mg in the morning, removing 30%, and taking the rest as your morning dose.  Then in the afternoon you are crushing .25mg, removing 30%, and taking the rest as your afternoon dose.  This means your total current daily dose is .35mg.

 

Here is a schedule for a 1% daily reduction based on your original .5mg dose.  The reduction rate is now applied to your current .35 dosage by starting you out with removing 30mls.  The following titration plan will take you about 70 days to complete.  Everyday, you will crush and titrate one tablet (.5mg).  If you have 1mg. tablets, then just split those in half to get the .5 you need.

 

Crush 1 tablet (.5mg) thoroughly into powder, and thoroughly mix it with 100ml (cc) liquid.  Each day, you will start with this original mixture (.5mg Clonazepam in 100ml liquid).  Each day you will cumulatively remove and discard 1ml from this mixture immediately upon mixing vigorously in the manner described below. 

 

So....

 

Day 1: make your original mixture and remove 30mls.  Divide the remaining into your daily doses, drink first dose, drink second dose 12 hours later.

 

Day 2: make your original mixture and remove 31mls.  Divide the remaining into your daily doses, etc.

 

Day 3: make your original mixture and remove 32mls.  Divide the remaining into your daily doses.

 

Day 4: make your original mixture and remove 33mls.  Divide the remaining into your daily doses.

 

Day 5: make your original mixture and remove 34mls.  Divide the remaining into your daily doses.

 

...and so on.

 

Make sure to keep a log of your cuts so you don't lose track.  We recommend you space your two doses 12 hours apart.  You can keep unused doses in covered glasses in the fridge for up to 3 days.  Your taper can easily be adjusted.  If you find you are doing well, you can speed it up by increasing your daily cuts to 2ml.  Conversely, you can always slow it down by removing 1 ml every other day!  Just play it by ear.  A 5ml baby dropper, available at most drug stores may be helpful.  A 3ml plastic pipette is also helpful.  Here are titration videos for your review. http://www.youtube.com/watch?v=2RzUvM6M55s http://www.youtube.com/watch?v=3Z4vckQcT2M.  Any materials you may need can be found on amazon.com.  Let us know if you have questions.  I hope things go well for you.

 

Draftsman

 

 

 

 

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  • 2 weeks later...

I will be going on a cruise the first part of September, little worried about how I will be feeling then, as I will be close to getting off of the K.  My question is, I think I will need liquid K for the cruise, not going to be able to do the milk thing. 

 

How would the K need to be compounded...what would be the doseage and how would I figure out how much to take at that time.  In other words, what would I need to tell the compounding pharmacist.  I know this is down the road a little, but I want to be prepared.  Already feeling like this cruise is going to be too much for me.

 

Cindy

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Yes it would need to be compounded as they don't make pre-manufactured liquid K. It'll come in a solution that would say Xmg/ml, I'd be happy to help you figure out the math when you get it if I am around, not a big deal, if doing daily cuts you'd just need to dilute it in water (so you'd still need all your measuring tools.) Or you could just hold your dose through the cruise.

 

I wish I could tell you how you'll be feeling, wouldn't we all love a benzo crystal ball? It is most common to feel worse at that end of the taper, but it's far from a certainty (especially doing daily reductions at the proper speed as opposed to big dry cuts), and that worst doesn't necessarily mean non-functional either..

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Thanks Xeno,

 

I know that we cannot predict the future, but I already have days where I am pretty non-functional and I am at 0.35mg now.  I will be really close to the end by the time the cruise comes around.  My husband and I are going with my daughter and son-in-law and I do not want to be a wet blanket on the trip.  Kind of wish we had not agreed to go...but it is already paid for.  My husband and I really need a romantic get-away and I do not want to disappoint him.

 

Another forum does not believe in the small,daily cuts.  Their opinion is that the daily cuts does not give the body time to stabilize because you are reducing daily and that it keeps the body thrown off.  To me, the small daily cuts seems to make better sense than one larger cut at a time.  Is the K so potent that even miniscule cuts are too much?

 

So many opinions!! :)

 

cindy

 

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Thanks Xeno,

 

I know that we cannot predict the future, but I already have days where I am pretty non-functional and I am at 0.35mg now.  I will be really close to the end by the time the cruise comes around.  My husband and I are going with my daughter and son-in-law and I do not want to be a wet blanket on the trip.  Kind of wish we had not agreed to go...but it is already paid for.  My husband and I really need a romantic get-away and I do not want to disappoint him.

 

Another forum does not believe in the small,daily cuts.  Their opinion is that the daily cuts does not give the body time to stabilize because you are reducing daily and that it keeps the body thrown off.  To me, the small daily cuts seems to make better sense than one larger cut at a time.  Is the K so potent that even miniscule cuts are too much?

 

So many opinions!! :)

 

cindy

 

 

So many opinions indeed! The truth is, no one really knows. But that opinion would be based on the assumption that one is able to stabilize. I couldn't below 0.5mg/day. Doing daily reductions may not allow my body to stabilize but it does keep the suffering down much much less and thus throws my CNS for less of a loop. Honestly doing daily reductions I doubt the accuracy is any greater than the amount of the daily reduction anyway.

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HI Cindy

There are a few components to having titration work well. 

 

First Whole Fat Milk is a good option for making your benzo liquid as the benzo will cling to the fat particles so it is "suspended" evenly throughout the liquid.  Therefore when you remove your cut you get greater accuracy.

 

Accuracy is key when you get to the lower doses.

 

Second it is important to find a daily cut rate that does not cause your symptoms to spike.  If you are moving along and your

symptoms begin to grow intense then you need to slow down.  I tapered off of 15mgs of valium and I began tapering at .1mg a day then .05mg, .025mg, .020mg and finally at .50mg i had to drop to .005mg.  The good news is that I felt relatively well and stepped of in great shape.

 

At 5 months off I am 85% back to normal.  Just extremely mild tinnitus every now and then...thats it.

 

I advise you to go slow and listen to your body.  It will "protest" and let you know you are going too fast.

 

Hope that helps!

Mimi

 

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I have been doing the milk titration and now I am currently at 60ccs a day and dividing that into 2 doses, that puts me at 0.30 mgs of K.  I have been reducing by 1 cc a day, but today I reduced it by 2ccs to get to 60ccs total.  I have been feeling really fatigued, though I am still working...but mainly those have been half days.  But I find myself feeling very revved up at night, starting somewhere around 8 pm and still awake into the night.  It has been difficult for me to fall asleep and tonight I am still up and not in the bed at all because I know it would be useless!!

 

Is this part of the titration, w/d process?  When I was making the larger 10% cuts, I would have some bad days, but then I usually was able to sleep pretty well after I stabilized.  I feel like someone has given me a shot of adrenalin, even though I am tired.  I also have a cold sore, feel like I am running a low grade fever, have some joint aches...feel like I have a virus.  AM I really physically sick, or is this w/d.  I am concerned, do not believe that I can do my job without sleep...it is demanding physically and mentally.  I am a nurse, on my feet going all day and need to be mentally sharp also.  I can tell a big difference in the last few days concerning my energy level and my mental clarity.

 

Any ideas or suggestions?  I just feel really off.  I called in sick for tomorrow and my boss is not happy.  But I am wired and feel like I will be unable to sleep at all tonight.

 

Plus, when I work I do not have the energy or desire to to anything else.  This is causing problems with my family members, especially my husband and daughter...they are tired of me being this way.  My house is a wreck, grocery shopping needs to be done, errands run, etc.  I just do not seem to be able to work and do anything else.

 

How does everyone else work, w/d from these meds, keep their life going?

 

Cindy

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On 7/13/2011 I started the milk titration.  I was at 0.35mg daily and did an immediate 5% reduction to 0.33mg.  I had been at 0.35mg for almost a month and felt I needed to go ahead and do this.  I have been reducing by 1cc a day since, except for yesterday and reduced by 2ccs to get to 0.30mg daily.  I have been unable to sleep for the past 2 days and feel physically and mentally unwell.  Have I been reducing too fast?  I had been doing o.k. ,with some bad days, doing the larger cuts and holding.  Am I going too fast or is it just that I am getting lower in my dose?  Was unable to go to work today because I felt so unwell.  My boss was not happy...this was the first time I have called in sick since starting back to work in April.

 

Cindy

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Hi Cindy,

 

I'm not familiar with titration, either the process or the effects of it, but I'm sorry you're feeling so horrible.  It looks like you've had quite a bit of feedback on your technique from some experienced members, so I'll assume your process is correct.  What I do know is that if you're feeling this bad, you need to slow it down, I get the feeling you're trying to make sure you're done with this before your cruise, is that your goal?

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It took you a month to go from 0.35mg to 0.30mg, that's not too fast by any "guideline" standards, but if it's making you very unwell, then it is. You could just be feeling worse as your dose gets lower though, it's hard to say. I have not felt great below 0.5mg/day no matter what I did, but moving slower with daily reductions has been much better for me (than even holding.)

 

I don't think you should make a cut and then immediately start daily reductions though. Maybe try holding for a few days and see if you feel any better?

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Hey Pam,

 

I am worried about the cruise and how I am going to feel during it.  In a way, I want to be done by then, but I am also worried that I will feel badly because of being done or about done by that time.  i know many here have commented that they actually started feeling worse when they were completely off the benzos.  I may try to hold at whatever low dose I am on when it is time to take my trip.  I am concerned about not being able to enjoy it and thereby putting a damper on everyone else's trip.

 

I know I am having a lot of anticipatory fear about how I am going to feel and function the lower I get on my dose.  I just have never done well without rest, and that was pre-benzos or ADs.  I already do not have much energy or desire to do much of anything.  I pretty much work and that is it.  And today, I was unable to go to work because of the way I feel. I have not called into work during the w/d process and concerned about what I am going to do if things get worse.

 

I wish we had not planned this cruise at this time...it is stressing me to think about it and get ready for it and wondering how I am going to do.  Now, I am worried about work and if I am going to be able to handle it as I taper more and more.  I am getting scared about all of this and how it is effecting my family, and my life.  It also makes me very angry.  I mean I took the K for just a couple of weeks and look at what is happening now.  I still find it hard to believe that I am going through all of this because of a drug I took for a short time at a low dose.  It does not make any sense!!! >:(

 

Cindy

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