Has anyone ever switched to Klonopin from Valium?

[[Md...]]

28 minutes ago, [[K...] said:

Did you switch from cut and hold to daily microtapering?  That is the advantage of having Dr Witt-Doering as your doc as he is open to different ways of tapering and really gets it.  I have read that with the daily microtapering sometimes you need to hold as the dosages catch up with you so I guess that's what you are wondering about?

Mine doesn't rush me but she does not understand all the nuances of benzo tapering as those of us who are forced to do a crash course in it. 

Was your agitation physical or mental? Sorry to hear about that.

I am also sorry for your dilemma about your painful condition.  Keep us posted on how things go. This is a lonely experience.

Here’s an example of what a microtapering schedule looks like. It all corresponds to the lines on a syringe. As you can see, you’re dropping every single day in very small increments. That way it’s not so much a shock to your system if you were to cut maybe 1mg and hold until the symptoms reside.

It’s so weird, because i was feeling fine doing this, until i got sick about a week or so ago. Not sure if there’s a correlation or just coincidence.

[[Ko...]]

@[Md...]I really should be out there shoveling the 6 inches of snow that we got today...I get stuck in these forums looking for the best solution to getting off of this stuff without losing functioning more than I already have.  I guess its an indicator of how lonely this process is too.

[[Md...]]

4 minutes ago, [[K...] said:

A few more questions- do you find the microtapering to be simple and is the liquid valium palatable? How much do you reduce per day? Is it like the water tapering that so many people on facebook do?

The liquid valium reminds me a bit of Nyquil or cold medicine or something. It’s not hard at all to wash down.

[[Md...]]

6 minutes ago, [[K...] said:

@[Md...]I really should be out there shoveling the 6 inches of snow that we got today...I get stuck in these forums looking for the best solution to getting off of this stuff without losing functioning more than I already have.  I guess its an indicator of how lonely this process is too.

It sucks. Completely sucks. But i just keep telling myself that it’s only temporary and that things will get better.

I’m not gonna lie, i do envy those who didn’t get on this medication because they were in excruciating pain.

Either way, we all have our own crosses to bear. Some people just have it easier than others in different aspects of life, and i guess it’s all about being grateful for what we have while we have it. Maybe that’s part of the healing processes.

Edited January 19 by [Md...]

[[Ko...]]

19 minutes ago, [[M...] said:

Here’s an example of what a microtapering schedule looks like. It all corresponds to the lines on a syringe. As you can see, you’re dropping every single day in very small increments. That way it’s not so much a shock to your system if you were to cut maybe 1mg and hold until the symptoms reside.

It’s so weird, because i was feeling fine doing this, until i got sick about a week or so ago. Not sure if there’s a correlation or just coincidence.

So you decrease by .01 mg daily?  Do you take tablets in addition to the liquid?  The liquid is 1 mg/ml? Because that would be like a little over 5 mg of valium in  liquid, correct? And your total dosage is closer to 30 mg daily, right? Sorry for all the questions- I am just trying to wrap my head around using the liquid.

Have you thought about dosing more at night since it makes you so tired? I only take mine at nighttime to try and help me sleep.

I guess you could be feeling poorly due to the aftermath of being sick or from accumulation of cuts?

[[Li...]]

2 hours ago, [[K...] said:

I am hoping to make it down to 5 mg first before going to part liquid. My prescriber is fine with switching to a portion of the dosage in liquid but still wanted to keep it cut and hold. She even expressed that drops of .1 mg seemed ridiculous. Easy for her to say!

Understood @[Ko...].  

It sounds like you might want to share Horowitz and Taylor’s new book on deprescribing with your prescriber when it is released (see title below). It does a good job of explaining why benzodiazepines need to be tapered gradually, guided by the patient’s response to reductions.

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (The Maudsley Prescribing Guidelines Series) 1st Edition, by Mark Horowitz (Author), David M. Taylor (Author) 

 

 

 

[[Md...]]

1 hour ago, [[K...] said:

So you decrease by .01 mg daily?  Do you take tablets in addition to the liquid?  The liquid is 1 mg/ml? Because that would be like a little over 5 mg of valium in  liquid, correct? And your total dosage is closer to 30 mg daily, right? Sorry for all the questions- I am just trying to wrap my head around using the liquid.

Have you thought about dosing more at night since it makes you so tired? I only take mine at nighttime to try and help me sleep.

I guess you could be feeling poorly due to the aftermath of being sick or from accumulation of cuts?

Yeah, that’s basically the gist of it.  1ml liquid is equal to 5mg of valium. So i taper using the liquid, then take a 5mg pill. I do this 3 times a day. 

I might be able to dose more at night, but then I would need to redo the math for my other doses. That’s a great question.

Not sure if my current state of being is due to being sick for a week or the accumulation of cuts that finally caught up to me. I just know i was feeling much better before i got sick.

Edited January 19 by [Md...]

[[Ko...]]

@[Li...]I may have to do just that. So far, she has been very accommodating- she was on a list from the BIC website but I have found that basically means she knows the Ashton Manual, is comfortable switching to valium, and let's you go at your own pace. She is fine with me doing 5% monthly  which I am tolerating so far. 

I think she will work with me if I am struggling with the cut and hold as I work in health care and she knows I have a lot of responsibilities on my plate with the type of work I do. I shared with her the Mark Horowitz information about the slow valium titration and she was fine with that. I don't know if he gets into the nuances of microtapering in his book.

[[Li...]]

@[Ko...] I do not know Horowitz’s current position on microtapering.  In his 2019 Lancet paper, he seemed to be a proponent of minitapering, at least for antidepressants.

You’ve probably already picked up on this but just in case not, @[Md...] is currently using the 5mg/mL diazepam Intensol/concentrate. When you switch to liquid at 5mg, you’ll want to use the 1mg/mL diazepam solution.   

 

DailyMed - DIAZEPAM INTENSOL solution, concentrate
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1aaf9375-ae3d-4fed-9cd1-24102e00be1a

DailyMed - DIAZEPAM solution
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e85abed-1a8b-4762-a31f-f2c7f196b8af

 

[[Li...]]

Hello @[Md...].  I want to make sure I understand the entries in your taper log.

When you were taking tablets, you’ve indicated your daily dosing schedule was:

10mg tablet
10mg tablet
10mg tablet

When you started to use the 5mg/mL liquid, was your initial daily dosing schedule:

1mL liquid + 5mg tablet (entered in your taper log as 1mL)
1mL liquid + 5mg tablet (entered in your taper log as 1mL)
1mL liquid + 5mg tablet (entered in your taper log as 1mL)

Or was it …

 

1mL liquid + 1mL liquid + 5mg tablet
1mL liquid + 1mL liquid + 5mg tablet
1mL liquid + 1mL liquid + 5mg tablet

 

[[Md...]]

1 hour ago, [[L...] said:

Hello @[Md...].  I want to make sure I understand the entries in your taper log.

When you were taking tablets, you’ve indicated your daily dosing schedule was:

10mg tablet
10mg tablet
10mg tablet

When you started to use the 5mg/mL liquid, was your initial daily dosing schedule:

1mL liquid + 5mg tablet (entered in your taper log as 1mL)
1mL liquid + 5mg tablet (entered in your taper log as 1mL)
1mL liquid + 5mg tablet (entered in your taper log as 1mL)

 

This is basically correct, except I immediately switched to liquid when i started tapering, so the first 3 days looked like this…

Day 1

1st dose: 0.99 + 1mL

2nd dose: 1mL + 1mL

3rd dose: 1ml + 1ml

Day 2

1st dose: 0.99 + 1mL

2nd dose 0.99 + 1mL

3rd dose 1mL + 1mL

Day 3

1st dose: 0.99 + 1mL

2nd dose 0.99 + 1mL

3rd dose 0.99 + 1mL

Hopefully this pattern makes sense. Each 1mL is equal to 5mg, and you’re shaving off just a little bit each day. I honestly had to get a magnifying glass, because the lines on the syringes are so small.

I’ll also add that it was not only very difficult to find a pharmacy that had liquid diazepam, but the ones that did hated the fact that Dr Josef was prescribing both pills and liquid (after I requested it), even though it was the exact same dosage. 

Pharmacies and pharmacists seem to be in a state of hysteria regarding controlled substances ever since the opioid epidemic, so we had to find a local compounding pharmacy that was willing to do this. It wasn’t easy, but we eventually found one.

Just one more reason to get off this medication.

 

 

Edited January 20 by [Md...]

[[Li...]]

Thank you for the clarification, @[Md...].  Your references to taking a 5mg tablet and your log entries indicating a reducing dose of 2mL of a 5mg/1mL liquid coupled with your earlier comment that the liquid ‘hit you hard’ made me wonder if you might have unintentionally updosed. I’m greatly relieved to learn this is not the case.

Yes, the 0.01mL graduation marks on the 1mL syringes are tiny and difficult to read but it’s do-able with a magnifying device.  Also, as I’m sure Dr. Witt-Doerring has advised, you can switch to a 0.5mL syringe when you reach a volume of 0.5mL  — the distance between the graduation marks on the 0.5mL syringe is slightly longer so it is (somewhat) easier to read plus accuracy is improved (below 50% of its nominal volume, the accuracy of a syringe declines with the volume measured).

I share your concern about how some pharmacies and pharmacists are handling the dispensing of controlled substances, especially for ‘unusual’ prescriptions requiring a combination of benzodiazepines, benzodiazepines of different strengths, or liquid dosage forms. Requests for a specific manufacturer are also sometimes viewed as problematic.  

Although I have never had issues with my dispensing or compounding pharmacy (both are independently owned and operated), I’ve read here and elsewhere that many individuals have (e.g. @[Ko...]’s current issue obtaining both 2mg and 5mg tablets). I’m delighted you were able to locate a compounding pharmacy that was willing to help you!  

[[Md...]]

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

Thank you for the clarification, @[Md...].  Your references to taking a 5mg tablet and your log entries indicating a reducing dose of 2mL of a 5mg/1mL liquid coupled with your earlier comment that the liquid ‘hit you hard’ made me wonder if you might have unintentionally updosed. I’m greatly relieved to learn this is not the case.

Yes, the 0.01mL graduation marks on the 1mL syringes are tiny and difficult to read but it’s do-able with a magnifying device.  Also, as I’m sure Dr. Witt-Doerring has advised, you can switch to a 0.5mL syringe when you reach a volume of 0.5mL  — the distance between the graduation marks on the 0.5mL syringe is slightly longer so it is (somewhat) easier to read plus accuracy is improved (below 50% of its nominal volume, the accuracy of a syringe declines with the volume measured).

I share your concern about how some pharmacies and pharmacists are handling the dispensing of controlled substances, especially for ‘unusual’ prescriptions requiring a combination of benzodiazepines, benzodiazepines of different strengths, or liquid dosage forms. Requests for a specific manufacturer are also sometimes viewed as problematic.  

Although I have never had issues with my dispensing or compounding pharmacy (both are independently owned and operated), I’ve read here and elsewhere that many individuals have (e.g. @[Ko...]’s current issue obtaining both 2mg and 5mg tablets). I’m delighted you were able to locate a compounding pharmacy that was willing to help you!  

Yeah, there wasn’t any up-dosing. 

Each pill = 5mg 

Each syringe, which is 1mL = 5mg

So that’s a total of 10mg per dose, which is what i was originally taking before i began tapering. 

The liquid bypasses your gut, so no digestion occurs, which is why it hits harder. It’s somewhat similar to taking a pill sublingually vs digesting one. 

Edited January 20 by [Md...]

[[Li...]]

Understood, @[Md...].  You started by taking pills. Then you switched to liquid only. You are currently taking a combination of pills and liquid.

You might find this information about drug bioavailability of interest:

Drug Bioavailability - Clinical Pharmacology
Merck Manuals Professional Edition - 2022
https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-bioavailability

Edit: Amended approaches used per member

[[Md...]]

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

Understood, @[Md...].  You started by taking 10mg pills. Then you switched to taking one 5mg pill plus 1mL of a 5mg/mL liquid.  You are now taking liquid only.

You might find this information about drug bioavailability of interest:

Drug Bioavailability - Clinical Pharmacology
Merck Manuals Professional Edition - 2022
https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-bioavailability

Actually (and not that it really matters), but I’m taking pills and liquid. 5mg in pills, and tapering using the liquid. I originally started on just the liquid, but it was too sedating, which is why i switched to pills and liquid (which helped quite a bit). Sorry for the confusion. 

And thanks for the link. 👍

Edited January 20 by [Md...]

[[Li...]]

1 hour ago, [[M...] said:

And thanks for the link. 👍

You’re welcome @[Md...]. I’ve edited my previous post per your feedback to avoid confusion on the part of future readers of this thread.  

[[Md...]]

On 18/01/2024 at 17:31, [[B...] said:

I hope you get a response soon from someone who has experienced switching from Xanax to Valium and then to liquid form of Valium.  

In the meantime, here's my two cents: from what I've seen from other members it can take some time to adjust to a different form of a med eg. pill to liquid. And as I'm sure you know,  sedation and depression are common effects  from valium that are intolerable for some individuals but for others those effects lift over time so that members who have crossed to valium are glad they did.  My sense is that you may need to give it longer than a month for to adjust to the liquid. What dose are you at right now?

I’m so sorry. I managed to gloss over your post.

I appreciate your response! The thread covers the details, but ive been tapering off 30mg of Valium for a little over a month. Half pills, half liquid.