Help with badly devised taper schedule off Clorazepate (Tranzene)

[[Ma...]]

Hi @[Co...] I really appreciate your offering to help me fix my mess of a taper.

I Have been on 15 mg Clorazepate for 20 years.

Summary of my taper so far: instead of reducing my dose relative to my total dose, I have been tapering off a single pill of 5 mg at a 10% rate every 20 days or a bit more with a long hold in the middle of about 50 days. It was planned to reduce every 15 days, but some withdrawal symptoms have changed schedule. I started tapering in June and have only reduced a bit less than 3 mg up to now.

Now taking a 10mg capsule + approx. 2,2 mg      
I would like to go on with a slow tapering (as, although I can put up with physical symptoms like GI issues, I am really afraid of panic related ones) 
I read in one of your posts that you believe frequent small cuts are better than bigger ones more separatedin time, but l am unable to devise a plan from the point I am now (you know, having taken 5 mg as the amount to reduce instead of the total 15 mg I am on).

 

[[Co...]]

Hi @[Ma...]

Apologies, I've only just seen this. I will try to respond later today.

How are you feeling?

[[Ma...]]

59 minutes ago, [[C...] said:

Hi @[Ma...]

Apologies, I've only just seen this. I will try to respond later today.

How are you feeling?

Hi @[Co...], what a timely question! I was just going to write a post about something that has just happened to me. I usually drink a little wine during lunch (Spanish lunch, the biggest meal of the day), but today I had two glasses as we were celebrating. I wasn’t able to finish my second glass as I felt suddenly really dizzy in my head. It was very unpleasant and so sudden!  I am still not feeling very well. You know, I have been reading a lot but there are lot of things that I don’t understand like this response of my brain to alcohol.

As for my tapering off Clorazepate, after a long hold of 50 days,  I made a cut about 8 days ago:

-5 mg capsule weigh 0,165g

- cutting 10% each time

- imposible to weigh the small cuts I should be doing, so cutting 0,010g each time (everything approximate, though scales not very bad)

- on 0,065g now- 12mg of 

The thing is that my plan was not well devised, as it was relative to one capsule of 5 mg instead to my total initial dose of 15 mg. The reason was that, as I was taking a capsule of 10 mg + one capsule of 5 mg, it seemed more convenient to start with the 5 mg capsule first. I thought that it would be the same, but I later realised that when the time comes to start reducing the 10 mg I will have left, the first 10% cut will mean a sudden big cut. I have been thinking a lot about this and have contemplated two options: starting a new tapering plan for 12 mg or starting a new plan for 10 mg when I finish my current schedule for a capsule of 5 mg.!The second one is more convenient because it’s easier to get a prescription for two 5 mg capsules than for three capsules ( the 10 mg capsule weighs the same as the 5 mg one). The cuttings will have to be based on a 3%, 4% or maybe 5 % reduction rate so as to go on reducing at the same rate as now

I hope I will have made myself clear enough ( a bit hard in English) for you. I am not in a hurry for an answer, there is a lot of time ahead because I’ m going so slowly! Many thanks 😊 

[[Ma...]]

Hi again @[Co...], I think my reasoning about needing 3 capsules to start a taper relative to 12 mg is nonsense. I just need to know their weight together, but don’t need to actually weigh them. Their weight is 0,165 x 3= 0,395 (say 0,390 for practical purposes). Then a taper of 4% relative to 12 mg would go like this:

-1st cut- take out 0,48 mg, that is a reduction from 0,390 to 0,374, which means a reduction of 0, 016 g

I am currently reducing 0, 010geach time and I am not in a position of increasing my cuts. Does  this mean that I will have to go on with this 0,010g cut until I drop off my 12 mg for good? It would be a linear tape, wouldn’t it? 
I am a bit confused with the math behind all this, could you please give a hand? Thank you so much

[[Co...]]

On 19/12/2023 at 16:51, [[M...] said:

Hi again @[Co...], I think my reasoning about needing 3 capsules to start a taper relative to 12 mg is nonsense. I just need to know their weight together, but don’t need to actually weigh them. Their weight is 0,165 x 3= 0,395 (say 0,390 for practical purposes). Then a taper of 4% relative to 12 mg would go like this:

-1st cut- take out 0,48 mg, that is a reduction from 0,390 to 0,374, which means a reduction of 0, 016 g

For 'practical purposes', I think I would call that 0.4g. I would then reduce the dose by 0.01g every x-number of days. This will allow you to make forty reductions to your dose.

I assume you mean to crush three pills and take your three daily doses from this single pile of crushed powder. If so, this seems reasonable to me.

Clorazepate is one of the least potent benzodiazepines, probably equating to about 8mg Valium. It also has a similar half-life to that of Valium. Being able to make forty reductions to what is a fairly modest dose and from that particular benzodiazepine should work for most people.

This would mean your first new daily dose would be 0.39g of crushed pill (to be clear, not the dose of clorazepate). This would equate to 0.13g of crushed pill three times per day. Of course, your starting amount of powder will not be exactly 0.4g, but it should be fine to make the first new daily dose of 0.39g over the day (if one of the daily doses slightly light, this is surely nothing to worry about). And whatever is left over is to be disposed.

Of course, as your dose reduces, you might be tempted to save what is left over from the previous day of powder (from three crushed pills). I think that would be OK. You would make up a new batch and add from that what's needed for your total daily dose. But it might not be a good idea to do this when your dose gets low and your three crushed pills would be enough for many days. In any case, once you get down to 26mg of powder, this equates to about two pills, so you should probably switch to crushing two pills (less waste). At this point, you would just continue with your taper - reducing by another 0.01mg of powder each x-number of days.

Example:

Three crushed pills = 0.395mg (this figure way vary a little)
Step 1: 0.39mg/day (0.13mg/dose - three times per day)
Repeat this for x-days
Step 2: 0.38mg/day (0.12g | 0.13g | 0.13g)
Repeat this for x-days
Step 3: 0.37mg/day (0.12g | 0.12g | 0.13g)
Repeat for x-days
Step 4: 0.36mg (0.12g | 0.12g | 0.12g)
Repeat for x-days
Step 5: 0.35mg (0.11g | 0.12g | 0.12g)
Repeat for x-days
(...)
Step 13: 0.27g/day (0.09g | 0.09g | 0.09g) - from THREE crushed pills
Repeat for x-days
Step 14: 0.26g/day (0.08g | 0.09g | 0.09g) - from TWO crushed pills
Repeat x-days
(...)
Step 26: 0.14g/day (0.04g | 0.05g | 0.05g) - from TWO crushed pills
Repeat for x-days
Step 27: 0.13g/day (0.04g | 0.04g | 0.05g) - from ONE crushed pill
Repeat for x-days
(...)
Step 37: 0.03mg (0.01g | 0.01g | 0.01g)
Repeat for x-days
Step 38: 0.02mg (0g | 0.01g | 0.01g)
Repeat for x-days
Step 39: 0.01mg (0g | 0g | 0.01g)
Repeat for x-days
Step 40: 0g
Repeat for life!

Of course, as your taper progresses, you might make even smaller reductions to your daily dose, but in all probability, this will not be required (especially given clorazepate's long half-life).

On 19/12/2023 at 16:51, [[M...] said:

I am currently reducing 0, 010geach time and I am not in a position of increasing my cuts. Does  this mean that I will have to go on with this 0,010g cut until I drop off my 12 mg for good? It would be a linear tape, wouldn’t it? 
I am a bit confused with the math behind all this, could you please give a hand? Thank you so much

What I described is a linear taper (or discrete cuts (of the same size), not relative cuts (which become smaller as the taper progresses)). It is unlikely you that will need to make smaller cuts to your dose. Instead of making smaller cuts, you might instead allow more days between each step - in this case, we probably should not refer to it as a linear taper, as the amount cut over two similar time periods will differ.

You should decide upon what is a reasonable timeframe for tapering off your fairly modest dose. Use this to best guess a suitable number of days to allow between each of your forty reductions to dose. If you find it becomes too difficult, you would allow more time between reductions. If you find it goes very well, you might try decreasing the number of days between reductions.

[[Co...]]

I've added some extra steps in the example in my previous post to improve clarity.

[[Ma...]]

6 hours ago, [[C...] said:

I've added some extra steps in the example in my previous post to improve clarity.

Hi @[Co...], your very first paragragh was a very straightforward and summarised proposal of a tapering plan. The only thing is that I am not crushing three pills, but emptying  a capsule💊 . I told you in my first post (but  in the microtapering thread, my mistake). In Spain, Tranzene is only available in capsules. So what I do is open a capsule, take out the amount of powder to be dismissed so that the amount of powder remaining is the amount I have to take. At the beginning it was relative cuts to a 10% reduction rate, but as the quantities to be taken get smaller, I have started to take out always the same amount and that was one of my main concerns, having to change to a linear tape. You have more than reassured me that it is fine and I have understood (finally!) how everything works, how discrete tapers for x-days is just simple and perfect for my low potent benzodiazepine.  Your explanations are very  reassuring and enlightening. You have dismissed all my doubts and I also have learnt lots of things. Thank you for taking the time to write such a long list of steps in your example ( I just take a dose at night, but it was my fault to say that I might need three capsules later in my taper, I use two capsules of different mgs ). The only thing that I have been ruminating last night is that whenever you say mg I thought it was grams. I still don’t get it, but never mind, I spend hours trying to understand math and decimal numbers make me crazy. I know what to do now and this is what it matters.

Thanks  again for taking the time to help me when I was somehow stuck and a bit worried. You help people here a great deal and reading your answers to other members is always interesting as I learn lots of different things.
 

[[Co...]]

On 20/12/2023 at 18:24, [[M...] said:

Hi @[Co...], your very first paragragh was a very straightforward and summarised proposal of a tapering plan. The only thing is that I am not crushing three pills, but emptying  a capsule💊 . I told you in my first post (but  in the microtapering thread, my mistake). In Spain, Tranzene is only available in capsules. So what I do is open a capsule, take out the amount of powder to be dismissed so that the amount of powder remaining is the amount I have to take. At the beginning it was relative cuts to a 10% reduction rate, but as the quantities to be taken get smaller, I have started to take out always the same amount and that was one of my main concerns, having to change to a linear tape. You have more than reassured me that it is fine and I have understood (finally!) how everything works, how discrete tapers for x-days is just simple and perfect for my low potent benzodiazepine.  Your explanations are very  reassuring and enlightening. You have dismissed all my doubts and I also have learnt lots of things. Thank you for taking the time to write such a long list of steps in your example ( I just take a dose at night, but it was my fault to say that I might need three capsules later in my taper, I use two capsules of different mgs ). The only thing that I have been ruminating last night is that whenever you say mg I thought it was grams. I still don’t get it, but never mind, I spend hours trying to understand math and decimal numbers make me crazy. I know what to do now and this is what it matters.

Thanks  again for taking the time to help me when I was somehow stuck and a bit worried. You help people here a great deal and reading your answers to other members is always interesting as I learn lots of different things.
 

Hi @[Ma...] Apologies - I somehow missed your post. Yes, you are correct, I somehow kept writing 'mg' when I meant to to write 'g'. I've edited my previous post to correct for this.

How's your taper progressing?

[[Ma...]]

Hi @[Co...], thanks for asking. I’m currently on a long hold after getting down to 10 mg ( have tapered off 5 mg in 8 months!!! A bit slow, indeed 😂) but why should one be in a hurry after all these years? I mean, all of us want to be free of benzos once and for all as soon as possible, but healing will take the same amount of time whether you go slowly or hurry up. Your brain needs the same time to get used to not getting whatever substance has been there for such a long time! I’m doing quite fine, only feeling really tired and low energy, some brain fog, palpitations now and then, nothing serious. And, as everybody says, symptoms come and go and don’t follow a pattern that can give you a feeling of steadiness. See you around.

 

[[Co...]]

Hi @[Ma...]

I agree - after very extended use, there is little to be gained by pursuing a very aggressive withdrawal schedule. And, as you indicated, there appears to be (for very many of us at least) a maximum rate of recovery for the GABA system. So a rapid withdrawal only results in a heightened withdrawal state for extended period after our last dose as our GABA system only (slowly) catches up and returns to normal functioning.

It seems that you are making good progress. And 'good' is not only measured by speed, but quality of life too.

Good luck for the remainder of your taper, and keep us updated of your progress.