Klonopin to valium crossover

[[...]]

I am currently tapering K and am at .05mg x 3 per day.  I believe that is 1 mg of valium 3 times a day.  Having back surgery 4/9. Hospital and rehabs giving me hard time about producing the tiny amounts necessary for me so I may have to cross to valium.  I have looked over Ashton.  Anyone make this journey.  How tough was it for you and can it be done in 5 weeks. I have to have surgery.  Cant be postponed.  Lots of pressure 

[[Li...]]

Hello @[...].

First and foremost, how are you feeling at your current dose?  Are your symptoms stable and tolerable?  Are you as functional as you need to be?

Crossing over to diazepam at this stage of the game seems risky to me. Some individuals do not respond well to diazepam plus 5 weeks may or may not be enough time to perform a gradual, response-guided crossover.  

Have you asked the hospital and rehabs if they would be willing to prepare and administer a professionally compounded suspension of clonazepam?

 

[[...]]

Hospitals so far have said I have to be admitted before they can make that decision.  That would be too late for me.  Wd start within hours.  Still having symptoms.  I manage but its rough. Headaches are worst.  Been told K is more likely to cause headaches than valium. I will continue to ask hospital about compounded suspension. So crossover bad idea ?  Is it harder to cross at the lower doses ?

[[Li...]]

It sounds like you are struggling a bit, @[...]. As we’ve discussed elsewhere, it’s important for you to be as stable as possible before your surgery.  What was the last total daily dose where you felt ‘OK’?

Have you discussed the problems you’re having with discontinuing clonazepam with your doctor?

How would your doctor/hospital respond to a gentle reminder about the FDA Black Box Warning re: the risks associated with abrupt cessation of clonazepam?

Also, I read in another one of your posts that you’ve purchased a copy of the Maudsley Deprescribing Guidelines.  Have you considered sharing a copy of the section on clonazepam with your doctor/hospital?  In particular, you could refer to the slower taper schedule on pages 393-394.  Receptor occupancy is still 10.8% at a total daily dose of 0.15mg.  (The fact that clonazepam is available as a 0.125mg orally disintegrating tablet is further evidence that clonazepam still packs a wallop at low doses — the manufacturers would not produce ODTs in that strength if it did not have an effect.)

Speaking of the 0.125mg clonazepam ODTs …

Would the hospital be willing to disperse one ODT per each of your doses in water and measure an aliquot from that?  Or would they be willing to split the ODT in half and give you 0.0625mg three times a day?  (This would involve an updose from 0.15mg to 0.1875mg.)

I do not have personal experience with Valium crossovers. So let’s wait for other members to provide input.  

[[...]]

I really appreciate your support.  I am at my grand kids house and driving home in a bit. Will respond a little later tonight.  Thank you much. 

[[Li...]]

You’re welcome @[...].  I need to take a break so won’t be around to respond for a bit.  I’m sure other members will stop by to comment.

[[...]]

Libertas
I am clear on all your comments. I have decided there is not enough time to continue taper before surgery. Also not enough time to cross to valium. So I have started to up dose today. Going from 16mg of powder to 18 mg three/day.  If this doesn’t slow wd after a week will go to 20 mg.  First change 11%.   Second change 10%   Will try to reach an amount that hospital can accommodate.  After surgery will attempt to micro-dose following your worksheet.   
16mg = .047 mg K   18mg = .054 mg K

20 mg =  .059 mg K

Think my calculations are correct   
when you get time, your thoughts 

 

[[...]]

Libertas

Just an observation, your worksheet approximates the integration of a differential which would create a smooth curve (almost) with very small steps. Makes sense to stay as close to the homeostatic curve as possible. Hope my body agrees  

[[...]]

Opps. It was Bob7 that sent me the worksheet for micro dosing.  

[[...]]

I can email you the worksheet.  Its a great tool to share. It runs on micro soft excel

 

 

[[Li...]]

@[...]  Ah ha!  I was scratching my head about your worksheet reference.  You are correct - that isn’t my worksheet.  It also does not calculate hyperbolic reductions.  The taper schedule I referenced upthread is the one from the Maudsley Deprescribing Guidelines which is based on hyperbolic reductions.

Did you updose?  If so, when?  How are your symptoms and functionality?  About the same?  Better?  Worse?  

Fyi Depending on how you metabolize clonazepam, it can take up to 12 days for a clonazepam dose change to take full effect. 

 

 

[[...]]

I updosed yesterday (sat). No change yet.  Symptoms are headache, nausea, palpitations, rapid heart beat, chills and night sweats. Agree, going to wait 2 wks. The updose was 10%.  Hoping things settle down before surgery. If symptoms ease in 2 wks was planning to updose another  10%. 

[[...]]

Another symptom showed up today bad tmj.  Could that be from updosing ?

[[Li...]]

[[...]]

I updosed sat. and sunday.  Symptoms got worse. Last night (sun) went back to last dose. Dont have time to keep screwing around with dose. Plan on staying on this dose and praying I can stabilize by April 9.  
calling Jefferson Hosp.  today to try and get something definitive re: dosing in hosp. 

[[Li...]]

I’m sorry you’re struggling @[...].  As we’ve discussed, it can take a while for a dose change to take effect and stabilize.  Please do let us know what you find out from the hospital.  

I just checked your History and noticed several things:

(1) Unless you are engaging in behaviors associated with addiction (now known as Substance Use Disorder), you are not addicted to the clonazepam.  Instead, you have developed physical dependence and possibly tolerance to it.  I’ve included a link below to a recent discussion I had with another one of our older members about this topic.  As noted, words matter.  Mislabeling yourself as being addicted to the clonazepam can trigger a cascade of negative consequences.

(2) We don’t have an updated History for you.  Here’s a topline summary of what’s there now.  Would you please fill in the blanks for us after Dec 2023?  

History of taking and discontinuing opioids after 12 back surgeries
Sept - Nov 2023: took 0.5mg of clonazepam every 3 or 4 days
Dec 2023: began taking 0.125mg two times a day

What happened taper wise after Dec 2023?  For each change in dose, please give the date, the total daily dose, and the dosing schedule.  Also, are you currently taking any other medications or supplements?

(3) It does not appear you were stable at 0.125mg two times a day.

 

 

[[...]]

I updated my profile. Not sure what you mean by addicted. I changed that to tolerated.  It was not 12 back surgeries.     There were 5 rotator cuffs, 1 knee, 3 hernias, 3 back surgeries.  Was on opioids for 5 rotator cuffs,knee and back surgeries. 
Had to detox twice.   No opioids for last back surgery on 5/1/23    No opioids  for about 2 years now.    Took them for pain not pleasure.  Dont intend to take them more than a couple days for this surgery  

[[Li...]]

Thank you for so much for updating your History, @[...].  You have created multiple topics on the Taper Strategies forum so it’s difficult to keep up with everything.  Now that you have an up-to-date History, all we have to do is refer to that. 

Re: the use of the word addiction and reference to 12 surgeries, I just copied and pasted what you had in the earlier version of your History.  

In case you’re interested …your history of starting and stopping opioids is significant because opioids — like benzodiazepines — affect our brain/nervous system.  Some individuals are able to start and stop psychotropic medications multiple times without issues until a tipping point is reached and are subsequently unable to do so.

Based on what you’ve shared with us, it sounds like you became physiologically dependent on the clonazepam after short-term, PRN use.  It’s unclear if you also developed tolerance.  When you were taking the clonazepam PRN, did you have to increase the amount of medication you took over time to get the same therapeutic effect?  Or, did the amount and frequency of use remain about the same?

That’s amazing you did not take opioids for your last back surgery. You must be one tough cookie!

[[...]]

I didnt feel much when i was taking the .5 mg.  I dont think i even thought about it much.  So no increase in dose to help more. 
Just knew what opioid wd were like so decided pain was a better choice than pain meds.  This surgery will be much bigger so not sure what i can handle.    Worried that benzos will make this trip much more difficult. 

[[Li...]]

Hello again, @[...]. The fact that you didn’t increase the amount or frequency of your dose back when you were taking the clonazepam PRN suggests you had not developed tolerance at that point in time.

I share your concerns about the impact your current benzodiazepine quandary might have on your surgery.   As we’ve discussed before, you’ll want to be as stable as possible before you undergo what sounds like a very long and complicated procedure.

Based on what you’ve told us, you weren’t stable when you switched from PRN dosing to a daily dose of 0.25mg a day.  Per your History, you then made a 25% reduction followed by reductions of 5.92%, 9.86%, and 11.32%.  I wonder if those reductions were too large and too fast for your nervous system to handle given that it may have already been sensitized by prior use/cessation of another psychoactive medication?

You’ve indicated you didn’t feel much when you were taking 0.5mg clonazepam PRN.  Does this mean you were not experiencing any of the negative effects you’ve experienced since you switched to daily dosing and began making reductions?

 

 

[[...]]

Just some chills between doses. But at the time didnt connect the dots. Thought it might be something else. Since meds didnt seem to do that much i just never considered it could be the K  since I was spacing doses out around 3 days. Never heard of inter dose wd. 

[[Li...]]

Interesting, @[...].  I wonder if the chills you experienced while taking PRN doses were a sign of dependence/withdrawal or perhaps a kindling reaction?  Per Framer (2021), “The drug blood level fluctuations from intermittent dosing are highly effective in engendering kindling reactions.”

I suspect you have fully briefed your prescribing doctor and surgical team about your situation.  What are their recommendations on how to proceed?

Reference:
Framer A. What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications. Ther Adv Psychopharmacol. 2021 Mar 16;11:2045125321991274. doi: 10.1177/2045125321991274. PMID: 33796265; PMCID: PMC7970174. Accessed online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970174/

 

 

[[...]]

Met with doctor. He wrote letter and also notes on a script. Meeting at hospital on monday for pre admission. Hopefully get an answer then.   On another note just realized a measurement mistake. Assumed all capsules were same mass  They vary by 6-7mg. Need to tare scale with empty capsule first. My dose has been variable so might explain wd. Hopefully will stabilize now

[[Li...]]

@[...] Tip of the hat for meeting with your doctor. It sounds like he is on your side.  Yes, capsules vary in weight so variations in dose may have been contributing to your issues.  

Have you given any thought to the idea of trialing a professionally compounded suspension made using tablets from your current generic manufacturer?  My hypothesis is that the hospital and rehab center would be more comfortable administering ‘unusual’ doses from a professionally made dosage form vs do-it-youself.

[[...]]

Will see what they say at pre admission mtg If they say no I will suggest a compounding pharmacy.