Pharmaceutical Liquid Medicine

[[cc...]]

Hi.

 trying to taper clonazepam now.

Started clonazepam about 20 years ago and was up and down since then.

I was up dosed by doctor to 2.5 from 1.5 because he was trying to merge a short half life restoril benzo, which also doesn’t come in desired denominations; it comes as 15 or 30 mg capsules.

Doctor used a conversion of 30mg r to 1mg c. I tapered from the 2.5 grams n a year (in affect, got rid of the restoril), in a years time.

I had horrible time going lower than 1.5 and I’m stuck at 1.5. I did dry cut and weighing, followed by scraping with sanding paper so I get the correct weight (tablet weight). It worked all along the 2.5 -> 1.5 taper but I’m stuck now.

Did try two weeks ago to do a water taper but seems like I failed miserably. I used a non verified method using pg to water ratio and I’m not sure how much I actually took (either more or less than intended). I intended to try .1% for a week and then go to 2%; cumulative, 3%. The mathematics on the liquid taper was super accurate but the therapeutic amount might not have been. So for instance: if I took 3% off (took 9.1ml), I maybe took less or more medicine depending on the suspension (never mind, I was told it was a solution)!

All in all, I feel horrible and thinking about doing the dry and weigh measure on tablets.

However, @[Li...] has just introduced a pharmaceutical method of taper a different class of medicine (antibiotic for children), and it’s pretty straightforward. The issue is, that they took 500mg pills and make a suspension but the result doesn’t explain the math well. Also, it’s for metronidazole, not clonazepam.

I really wish I can go liquid do to its simplicity and accuracy without guessing pill weights. I would like to take my 1 mg in a 2 .5 tablet and the percentage tapered, from a liquid suspension (not water), using the math of taper. I would convert in my head the tablets to liquid and take a percentage (30ml * .03) and take that number from a liquid made for .5 mg tablets.

I hope it’s not too complicated and I ask that people please help me out. I’d greatly appreciate it. Thanks

[[Li...]]

Thank you for starting your own thread @[cc...].  This makes it much easier for members to respond because they have all relevant information about you in one place instead of having to jump from post to post on different threads to find it.  

You’ve indicted that your total daily dose is 1.5mg.  Are you stable at that dose?  (Stable doesn’t necessarily mean you’re feeling AOK but rather your symptoms are not changing in nature or number and you are able to perform essential daily activities.)

What is your daily dosing schedule?  In other words, how many milligrams of clonazepam do you take at what times? 

Are you taking any other medications or supplements that might be affecting your taper?

Are you in the US?  If so, would your prescriber be willing to write a prescription for clonazepam orally disintegrating tablets?

My apologies for all the questions but members need this information to provide input/suggestions.

[[cc...]]

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

Thank you for starting your own thread @[cc...].  This makes it much easier for members to respond because they have all relevant information about you in one place instead of having to jump from post to post on different threads to find it.  

You’ve indicted that your total daily dose is 1.5mg.  Are you stable at that dose?  (Stable doesn’t necessarily mean you’re feeling AOK but rather your symptoms are not changing in nature or number and you are able to perform essential daily activities.)

What is your daily dosing schedule?  In other words, how many milligrams of clonazepam do you take at what times? 

Are you taking any other medications or supplements that might be affecting your taper?

Are you in the US?  If so, would your prescriber be willing to write a prescription for clonazepam orally disintegrating tablets?

My apologies for all the questions but members need this information to provide input/suggestions.

No problem asking questions.

I was stable for many months when I stopped the taper. I took 1mg in two tablets at night and one .5 in the morning. I was not that active but felt so much better and much more alive. I was doing well in therapy and even started looking for work in Ernest. I did have some apathy and lethargy as I wasn’t always that productive but I was managing quite well; never mind I was not excited going further on tapers.

A while back though, I wasn’t doing so great on tapers (I tried pushing to 1.5), and I was suggested TMS by psychiatrists. It failed and I became somewhat overexcited and too much energy; doctor even changed my diag to bipolar (in the spectrum), because he only saw success in tms and when not, it was a bipolar problem.

I was taking Seroquel for a while but he bumped it up to double the dose, taken in the morning in addition to the night. My withdrawal symptoms went away and I started working on my lifestyle and life in general. Doc was not pushing benzo taper at the time because he wanted to see me with better structure. So my better moods and stop of wd symptoms could’ve been the addition of more Seroquel and maybe made me much more lethargic and tired.

At my last doc appointment, he was still not excited and I must say interestingly, that he didn’t even feel that all the meds were responsible for my lethargy. Well, he started demanding some tapering and seems a bit clueless on this. I’m in good terms and want to stay that way so I want to start the trapeze. I think it’s self understood that I really am not excited to do it although I understand the idea of tolerance because status quo was satisfactory.

I was taking some supps that did NOT have any negative effects and not that much positive when I was in a wave either. My psych meds are as follows:

Lamictal 400mg

Seroquel 400mg

Mirtazipine - increased two weeks ago from 7.5 to 15 mg

Klonopin 1.5mg

 

Regarding under tongue, I’m not sure the benefit since it’s a .25 pill and I’ll still need to cut the pill to get to low tapers. He also wouldn’t hear of compounded liquid or pills.

So in truth, my tapers, even prior to my current 1.5, was made easier with: Lamictal and increase in seroquel. Mirt was just recent. I also added vitamin D at this time. So it’s either: 1. The taper method that messed me up for so many possible reasons (the liquid). 2. The addition of mirt and vitamin D. I’m thinking of stopping d and roll back on mirt. I’m thinking about going back to 1.5 (now on day 3), to stabilise; I was tapering just for about two weeks ago and not sure if my liquid dosage was actually too much or too little.

Sorry for the long post but more information is helpful and gets a better response.

 

[[Li...]]

Thank you for helping us to get a complete picture of your situation, @[cc...].  

That’s quite a cocktail of psychiatric medications you’re taking. 

How long have you been taking the mirtazapine, Lamictal, and Seroquel?  Are you experiencing any adverse reactions to any of these meds or do you feel they are helping you?  (Re: the mirtazapine, if you’re taking it for sleep, my understanding is that it is more effective at lower rather than higher doses.)

Given that you don’t know how much clonazepam you’ve been taking for the past two weeks due to using the ‘mystery liquid,’ my inclination would be to suggest that you return to taking your total daily dose of 1.5mg in tablet form for now.  However, let’s wait to see what other members have to say.

The orally disintegrating tablets (ODTs) are not sublingual.  They are designed to be placed on (not under) the tongue where they quickly disintegrate in saliva (no water needed).  I asked about them for two reasons.  First, they are available in lower doses (0.25mg as well as 0.125mg) so you could potentially use a combination of ODTs and liquid to taper.  Second, they disperse more readily in liquid than regular tablets.

Unfortunately, it sounds like your prescriber is not supportive of alternative dosage forms so you may just need to stay with the regular 0.5mg tablets.

[[je...]]

I agree with @[Li...]. It's important to know how long you've been on these other drugs and if/when you made any changes to them. I also think since you don't know the potency of your Clonazepam liquid you've been using, it's probably best to go back to 1.5mg. 

[[cc...]]

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

Thank you for helping us to get a complete picture of your situation, @[cc...].  

That’s quite a cocktail of psychiatric medications you’re taking. 

How long have you been taking the mirtazapine, Lamictal, and Seroquel?  Are you experiencing any adverse reactions to any of these meds or do you feel they are helping you?  (Re: the mirtazapine, if you’re taking it for sleep, my understanding is that it is more effective at lower rather than higher doses.)

Given that you don’t know how much clonazepam you’ve been taking for the past two weeks due to using the ‘mystery liquid,’ my inclination would be to suggest that you return to taking your total daily dose of 1.5mg in tablet form for now.  However, let’s wait to see what other members have to say.

The orally disintegrating tablets (ODTs) are not sublingual.  They are designed to be placed on (not under) the tongue where they quickly disintegrate in saliva (no water needed).  I asked about them for two reasons.  First, they are available in lower doses (0.25mg as well as 0.125mg) so you could potentially use a combination of ODTs and liquid to taper.  Second, they disperse more readily in liquid than regular tablets.

Unfortunately, it sounds like your prescriber is not supportive of alternative dosage forms so you may just need to stay with the regular 0.5mg tablets.

I’m sure that the other meds aren’t helping the cause. It was always an interesting issue that my depression and anxiety were violent in nature; meaning full with vigor and agitation. I was once on lithium based on a doctor claiming I had agitated depression (I’m sure in diag he must’ve used some bp diagnosis, since AD isn’t a thing).

my current doctor is surprised that I do better on mood stabilisers and anti psychotics. I’m not trying to go the clinical path but lots of work in addition to tapering is needed; maybe lifestyle, diet, genetics, sleep, therapy, and fine tuning the stress response, amongst others).

I’m in this psych state for 30 years with over 50+ drugs along the way. I do feel calmer on the drug concoction but not necessarily happy; maybe that should be a trigger to try med free or less meds?!

We do need to focus on the klonopin I think since even doctors are starting to see how it’s not a good medicine, to say the least. Should I be open to doctor trying to add or adjust treatments, maybe not. For now I’m looking to focus on klonopin without changing anything, including supps I’m using. Let’s look at what changed last.

I agree with the suggestion that I might’ve possibly taken more than 1.5 with liquid (not likely); but most likely a possible reduced amount far more than 3%; in addition to not knowing the mechanics of the liquid transport in my body. I should most likely not try liquid for a while and focus to get back to 1.5 tabs. I’m a bit surprised that I’m not in homeostasis yet. I even took an extra .5 three days ago (most likely not sanctioned), to flood my brain with a bit more so it can stabilise. Why is it taking so long? Is it the increased mirt? It was given for sleep and I’m not sure if I should go back on 7.5 to test. Also, maybe the vit D? Other than that, my diet is the same (not the best); my sleep is the same (not the best either; in the first days of trying the liquid, I suddenly suffered severe fatigue and tiredness and slept many hours in the day). I’m really afraid that a 9.1 ml of liquid might have been more effective than 10ml, which is a .5 dose; I take 2 tablets to make for the 1mg and liquid for the remainder.

i feel lost. Do I need more time? Is it possible for my brain to adjust to the tablet after it became costumed to the liquid ? Please understand my rambling as I’m under benzo brain and also quite despondent. Thanks.

[[je...]]

29 minutes ago, [[c...] said:

I’m sure that the other meds aren’t helping the cause.

Any change in other medications is likely to impact withdrawal symptoms. Therefore it's really important to let us know how long have you been taking each medication and if/when you have made changes to them. 

[[cc...]]

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

Any change in other medications is likely to impact withdrawal symptoms. Therefore it's really important to let us know how long have you been taking each medication and if/when you have made changes to them. 

The only med change was increase of mirt from 7.5 to 15 about 1.5 weeks ago. I was feeling a bit depressed but it was also the same time I was taking the liquid crap. For safety, like I said, I’m dropping mirt to 7.5 (it won’t kill me), and the Vitamin D. I really don’t think there’s anything related to the two but I’ll rule them out. I also started vitamin C and I’ll hold on that too.

[[Li...]]

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

Do I need more time? Is it possible for my brain to adjust to the tablet after it became costumed to the liquid ?

I think so @[cc...]. You have made multiple changes in multiple medications and supplements.  I suspect your nervous system will need a while before it settles back down. In your shoes, I would focus on getting and staying on a consistent medication and supplement regimen for at least two weeks or longer if needed.

I’ve included your introductions post from December 2016 when you joined BB below.  Given your history of stopping, starting, and tapering multiple psychiatric medications, I encourage you to proceed with caution.

For example, in your shoes, I’d want to give serious thought as to what medication(s) I should taper first.  Per previous posts, how long have you been taking each of your current medications?  Are your current medications helping or harming you? 

 

Introductions Post from December 2016:
I'm taking benzos for approximately 23 years, starting with Xanax, taking a 3 year break and then starting klonopin. I'm now on 1.5 mg in the evening and 1 mg in the morning (.5mg pills).

I did some good tapering on other psych meds I'm on:

Cymbalta 30mg from 120mg
Viibryd 12.5mg from 20mg
Seroquel 125mg from 200mg
Wellbutrin 0 mg from 150mg
Klonopin 2.5mg (SAME)

 

[[cc...]]

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

I think so @[cc...]. You have made multiple changes in multiple medications and supplements.  I suspect your nervous system will need a while before it settles back down. In your shoes, I would focus on getting and staying on a consistent medication and supplement regimen for at least two weeks or longer if needed.

I’ve included your introductions post from December 2016 when you joined BB below.  Given your history of stopping, starting, and tapering multiple psychiatric medications, I encourage you to proceed with caution.

For example, in your shoes, I’d want to give serious thought as to what medication(s) I should taper first.  Per previous posts, how long have you been taking each of your current medications?  Are your current medications helping or harming you? 

Introductions Post from December 2016:
I'm taking benzos for approximately 23 years, starting with Xanax, taking a 3 year break and then starting klonopin. I'm now on 1.5 mg in the evening and 1 mg in the morning (.5mg pills).

I did some good tapering on other psych meds I'm on:

Cymbalta 30mg from 120mg
Viibryd 12.5mg from 20mg
Seroquel 125mg from 200mg
Wellbutrin 0 mg from 150mg
Klonopin 2.5mg (SAME)

I need to update my introduction. I’m not taking the first 2 for a while, neither the 3rd in the list.

I’m just on Seroquel and klonopin at a lower dose (klonopin), from this list.

Iv’e been on different cocktails for 30+ years so it’s really irrelevant which meds I was on. Seems like most med cocktails had either mood stabilisers, antipsychotics, or benzos, or a combination.

About tapering other meds, I don’t have support from my physician at this time and I’m wondering why I should shift focus from benzos at this point!

[[Li...]]

There’s no need to update your original post from 2016 @[cc...].  I included it so other members would have a more complete understanding of your history. The fact that you’ve taken, stopped, and restarted a benzodiazepine is important as is the fact that you’ve taken and tapered multiple psychiatric medications.

Cases involving multiple psychiatric medications can be complicated.  For example, it’s important to identify current adverse drug effects to avoid mistaking them for withdrawal symptoms.  

Although we focus primarily on benzodiazepines and z-drugs in this community, my understanding is that the good folks at Surviving Antidepressants have experience working with polypharmacy.  If you have not already done so, you might want to check out what they have to offer at https://www.survivingantidepressants.org/

In terms of your benzodiazepine taper, my suggestions include:

• Establish a consistent medication and supplement regimen.  Once the regimen is established, refrain from making changes in medications, supplements, doses, or dosing schedules.  This includes returning to a total daily clonazepam dose of 1.5mg (0.5mg in the morning and 1mg in the evening, taken in tablet form.)
• Wait at least two weeks to establish a baseline of symptoms/ functionality.
• Implement a trial reduction of clonazepam. Given your history, I suggest a reduction of 5% or less per month to begin.
• Given that your two daily doses are unequal, you might want to consider making reductions in your evening dose to bring it in line with your morning dose.  
• Given that you have had issues with do-it-youself (DIY) liquids in the past, you also might consider using a combination of regular tablets and DIY liquid.  

For example, a ‘Phase 1’ plan might be:

Morning dose:
0.5mg in tablet form

Evening dose:
0.5mg in tablet form + 0.5mg in liquid form, taper liquid to 0 as tolerated

(If your DIY liquid had a concentration of 0.1mg/mL, you would consume 5mL of the liquid to ingest a dose of 0.5mg.)

[[cc...]]

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

There’s no need to update your original post from 2016 @[cc...].  I included it so other members would have a more complete understanding of your history. The fact that you’ve taken, stopped, and restarted a benzodiazepine is important as is the fact that you’ve taken and tapered multiple psychiatric medications.

Cases involving multiple psychiatric medications can be complicated.  For example, it’s important to identify current adverse drug effects to avoid mistaking them for withdrawal symptoms.  

Although we focus primarily on benzodiazepines and z-drugs in this community, my understanding is that the good folks at Surviving Antidepressants have experience working with polypharmacy.  If you have not already done so, you might want to check out what they have to offer at https://www.survivingantidepressants.org/

In terms of your benzodiazepine taper, my suggestions include:

• Establish a consistent medication and supplement regimen.  Once the regimen is established, refrain from making changes in medications, supplements, doses, or dosing schedules.  This includes returning to a total daily clonazepam dose of 1.5mg (0.5mg in the morning and 1mg in the evening, taken in tablet form.)
• Wait at least two weeks to establish a baseline of symptoms/ functionality.
• Implement a trial reduction of clonazepam. Given your history, I suggest a reduction of 5% or less per month to begin.
• Given that your two daily doses are unequal, you might want to consider making reductions in your evening dose to bring it in line with your morning dose.  
• Given that you have had issues with do-it-youself (DIY) liquids in the past, you also might consider using a combination of regular tablets and DIY liquid.  

For example, a ‘Phase 1’ plan might be:

Morning dose:
0.5mg in tablet form

Evening dose:
0.5mg in tablet form + 0.5mg in liquid form, taper liquid to 0 as tolerated

(If your DIY liquid had a concentration of 0.1mg/mL, you would consume 5mL of the liquid to ingest a dose of 0.5mg.)

Thanks for all the info. My psych therapist made me promise that I won't do a liquid anymore. The way it acts as a liquid is unknown and the actual dosage is questioned. This is what he said.

If however I can feel 100% comfortable with a robust liquid conversion, I'd reconsider.

[[Li...]]

You’re welcome @[cc...].  I wish you well however you decide to proceed.