Please, Help with tapering off clonazepam, 3 times a day

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Please help! This isn't for me personally. I've been off benzo for 10 months and very happy about it. It's for my benzobuddy. She is tapering off clonazepam, 3 times a day - 0,5/ 0,5/0,75. Her doctor got confused and is trying to avoid her with her benzo issue as much as possible. She's crying and at a loss.

Could anyone tell me:

How to go about this tapering process when a few dosages of benzo are taken per day;

Which dosage is to be tapered first;

Or where i can look for such information? 

Thank you in advance l'd really appreciate any answer to the point.

Edited February 1 by [...]

[[je...]]

@[...] would it be possible for your friend to open her own account? We need to ask questions about her history, medications, symptoms etc. It will be much easier to communicate with her directly. 

[[...]]

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

@[...] would it be possible for your friend to open her own account? We need to ask questions about her history, medications, symptoms etc. It will be much easier to communicate with her directly. 

@[je...], thank you for responding. Unfortunately, she is't in the condition to interact here right now( 

She's been taking clonazepam and duloxetine for about 4 years because of a pinched nerve. First the treatment helped and now the pain is back after her trying to taper off clonazepam. She did it according to her doctor's orders but the doctor is now unwilling to help...

Ok. I understand that i'm not the right person to ask on her behalf but I thought, perhaps, there are some general recommendations on tapering or some articles to the point.

Edited February 1 by [...]

[[je...]]

What has her reductions been for the past three months?

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

What has her reductions been for the past three months?

Thank you once again. I'll ask her to write it and then i'll post it here.

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18 hours ago, [[j...] said:

What has her reductions been for the past three months?

@[je...], i asked her and she gave me rather too much of information but she's desperate. Originally i didn't intend to be too involved. I just wanted to tell her some general recommendation how to go about tapering benzo taken 3 times a day. 

But here is goes:

July,29-31.                   1.5/1.5/1.5

August,1-Octobee,6.   1/ 1/ 1

October,7-December,31 1/0.5/1

January,1-31.            0.5/0.5/0.75

February,1-...            0.5/0.5/0.5                                                               or 0.25/0.5/0.75 - her doctor couldn't make up his mind and gone out of touch ever since.

She's also been taking duloxetine twice a day.

All in all, she's been taking various bebzos as needed since 2015 and taking clonazepam, 2 mg, daily since 2020, sometimes diazepam on top of it because clon didn't help anymore.

By and by, she was getting worse and had a kind of fit in July,2023. It was then that the doctor guessed something was wrong and suggested tapering but got lost...

 

 

Edited February 2 by [...]

[[je...]]

Her January cut was a 30% cut and her doctor is now suggesting a 14% cut if my maths are correct. I don't know how she's tapering - I assume she's doing cut and hold. If that's the case it might be tough to make these cuts in one go. Instead of making 0.25 cuts  she could go 0.125mg cuts at a time for now. But she needs to keep an eye on her percentages as she's going down. 

Usually people will try to keep all three doses equal. Unless she's struggling with sleep then she might have her night dose slightly higher. But you do want all three to remain in range within each other and not just taper two otherwise you'll end up eliminating two doses and struggling with interdose withdrawal. 

[[...]]

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

Her January cut was a 30% cut and her doctor is now suggesting a 14% cut if my maths are correct. I don't know how she's tapering - I assume she's doing cut and hold. If that's the case it might be tough to make these cuts in one go. Instead of making 0.25 cuts  she could go 0.125mg cuts at a time for now. But she needs to keep an eye on her percentages as she's going down. 

Usually people will try to keep all three doses equal. Unless she's struggling with sleep then she might have her night dose slightly higher. But you do want all three to remain in range within each other and not just taper two otherwise you'll end up eliminating two doses and struggling with interdose withdrawal. 

Thank you @[je...]. I personally think her doctor isn't familiar with benzo tapering process, no wonder. I've never met a doctor who really knows the issue. Perhaps, that's why he's hiding now.

She says she sleeps too much during a day and doesn't sleep at night.

So it's recommended to cut proportionally all three dosages at once, is it? Like:

now - 0.25/ 0.5/ 0.75;

next cut - 0.2/ 0.45/ 0.7.

Total - 0.05+0.05+0.05 = 0.15

0.15 - 10% of her current dosage (1.5). 

Is it correct?

And you say the cut should be 0.125 (~0.04+0.04+0.04). Is it?

Edited February 2 by [...]

[[je...]]

[[...]]

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

No, not cutting each dose at once. I'm saying rotate between the doses every time a cut is due so that one dose is not getting substantially too big. So one cut will be evening, next cut morning, next cut afternoon for example. 

She can theoretically cut all three doses at once but practically that will be a pain in the butt once you start shaving and weighing. 

So she has already gone ahead with this cut?

Oh, i understand. Thank you @[je...], again and again) i agree about a pain in the butt.

Yes, she has cut according to her doctor's last order. Now it's her 3d day of this dosage and she is in hospital to have her pinched nerve checked up.

And how long should she stick to one dosage? About 2-3 weeks or more?

[[je...]]

I suggest she holds for at for at least 2 weeks but she can hold for up to 4 weeks. It's up to her.

Going forward she can try and reduce 0.125mg for a few cuts, but just check the percentages don't get too high and that she tolerates the symptoms. 

I would also suggest she tapers the night dose because it's quite high in relation to the morning dose. 

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10 hours ago, [[j...] said:

I suggest she holds for at for at least 2 weeks but she can hold for up to 4 weeks. It's up to her.

Going forward she can try and reduce 0.125mg for a few cuts, but just check the percentages don't get too high and that she tolerates the symptoms. 

I would also suggest she tapers the night dose because it's quite high in relation to the morning dose. 

Thanks @[je...], this all is new to me. I'd never guess it  myself and the girl is in no condition to figure out anything right now. She's immensely grateful to you and BB. 
So, if she feels ok+-, she gonna make the next cut on February,15 or a bit later and it'll be
 .........................................(Now: 0.25/ 0.5/ 0.75)
Next ct Feb15 (up to Feb29): 0.25/ 0.5/ 0.625
the cut is 0.125 ~ 8%
Next ct March, (3 wk later):0.25/ 0.375/ 0.625
the cut is 0.125 ~ 9%
And the next cut is 0.125 (exactly 10%) but which dosage should be reduced then? Perhaps, it's important she says she feels down and sleeps too much during a day and can't sleep at night.
Sorry for all this meticulosity but since it's not personally for me, i try to be careful.

Edited February 3 by [...]

[[je...]]

It seems fine, I just haven't checked your percentages. 

The sedation during the day - I'm not sure how she ended up on 3 doses. Is she having interdose withdrawal? If not, then she can work towards eliminating one of the daytime doses first. But you need to make sure she's not having interdose withdrawal. 

[[...]]

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

It seems fine, I just haven't checked your percentages. 

The sedation during the day - I'm not sure how she ended up on 3 doses. Is she having interdose withdrawal? If not, then she can work towards eliminating one of the daytime doses first. But you need to make sure she's not having interdose withdrawal. 

Thanks @[je...]. I'll tell her. You helped greatly!) I think it'll be more clear in about two weeks. I mean the interdose withdrawal. She's just started her routine on the new dosage. 

I'll ask here then if there are some troubles.

Edited February 3 by [...]