Really need help/opinions with method of tapering K

[[or...]]

This is an excellent point @[Ad...], that @[Co...] has talked about and what I learned from him.  It's about the tablet, and where the actual drug may accumulate in different areas of the tablet, more here, less there.  He would describe it more appropriately but I don't know where the thread is where he discussed that right now.

This makes perfect sense to me because it's like baking a cake and being sure everything is mixed in equally, I think for me, impossible to be sure.  Pharmacists can be slightly off as we know, and we can see that by the same brand of pill weight differently, so we do the "average of say, 10 pills" and go with that.

I just think it's futile for me anyway, to try to be perfect, but yes, as close as I can be, and the proof will be in how we feel.  For me it's about 5 or so days after tapering when I notice worse wd sxs, if there are gonna be any Then I continue to go by how I feel before I taper again, and maybe less maybe more.  I'm on 3% taper, meaning 1% 3 X per month.  That's all my body says to do oregonlady

[[Co...]]

Attached, a study on drug content uniformity. Most of it is about uniformity to the point of reaching the tablet press, but there is some information about uniformity after this point. (Though, I've only skimmed it, so I am uncertain if the paper is very helpful.)

pharmaceutics-13-01909.pdf

[[De...]]

On 07/03/2024 at 07:29, [[L...] said:

Hello @[Cy...]. Based on six years of experience in this community, my observation is that the most common reasons individuals experience issues switching from tablets to liquids in general (not just compounded liquids but also manufacturer’s liquids and do-it-yourself liquids) include:

(1) They do not give themselves sufficient time to adjust to the new dosage form (e.g. the bioavailability of liquid formulation may be different from that of the solid dosage form).

(2) They make a reduction in dose at the same time they switch to the liquid.

(3) They make math/measurement errors (e.g. in converting milligrams of active drug to milliliters of active drug; in selecting an oral syringe with the appropriate capacity and graduation marks to measure the target dose as accurately as possible, in filling the oral syringe to the correct dose).

@[Li...] I think this happened to me I was taking lorazepam 0.5 a day twice sometimes just once but mainly in the am  went ct for about 30 hrs in a failed clonaz switch switched quickly back to Ativan after that  and two days later tried to pre start practicing a water taper three times a day  had to to drop those 0.5 lorazapema doses to 0.3333 to accommodate the three doses I was gonna be taking figured it wasn’t that much but I think I was wrong now suffering withdrawal like symptoms if I hold taking the dosage as is will I eventually improve? ( currently 13 days in pre water taper no reductions besides the adjust to make three doses possible days 1-8 anxiety rls pacing acid reflux those improved but day 10 hypn jerks kept me up didn’t sleep then that went away after a day but the muscle spams twitches jerks face head and all over body that have not gone away…I don’t think I can switch back now but if I hold will these symptoms improve as I adjust ?)

Edited March 10 by [De...]
Forgot info…

[[Cy...]]

@[Co...]

Thank you!

[[Cy...]]

On 08/03/2024 at 09:15, [[F...] said:

Hi again, @[Cy...].  Sorry I am just responding to your messages.  To receive proper feedback, it would be best to update the 'History' section of your profile.  For example, I just read through some of your past posts (since you joined one month ago) and came across some pertinent information:

1) It appears you have reduced your daily clonazepam dose from .5mg to .375 in about one month.  This is a 25% reduction in dose over the previous month, and would cause most members here to experience intensified withdrawal symptoms.  

2) Are you also on gabapentin and zoloft?  Is this accurate and are there any other medications/supplements you are taking?  What is your past history with using/discontinuing these medications and any other psychotropic medications?

In essence, my opinion would be it sounds you are 'stable enough' to not updose, but I would recommend holding for at least one month prior to making a change to your taper strategy.  If it were me in your shoes, and I were to change taper strategies (after keeping all medications/supplements stable for 1-3 months), I would follow the advise @[je...] provided regarding inquiring into the possibility of using a professionally compounded 0.1mg/ml Clonazepam Oral Suspension.

On 08/03/2024 at 10:46, [[L...] said:

Hello @[Cy...].

@[Fa...] has made an important point about the amount of your last reduction plus has asked important questions about your current and past use of other psychoactive medications and supplements.  

I agree with him and @[je...] that investigating the use of a professionally compounded liquid would be a good option for you to consider.

While you’re waiting to stabilize from your last reduction, you may want to devote some time to finding and vetting potential compounders.  A reputable compounder will be able to answer the questions you’ve asked about bioavailability, formulations, and conversions plus tell you exactly what would be needed from your doctor in terms of a prescription.

Here’s a tool you can use to begin your search:

Find A Compounder - PCCA - Professional Compounding Centers of America

Hi @[Fa...] and @[Li...]

So sorry for the delay in responding.

My psychiatrist did not give me any guidelines whatsoever ("just start taking less") to this daunting process. Therefore my first 2-3 cuts were eyeballed and definitely larger than they should have been. After doing some research and finding this site, I bought the scale, did as best an estimate as I could to the starting line and started sticking to 5% cuts.

History: Zoloft- won 100 mg for almost 30 years. Worked well for me, and stopping was never discussed with me.  Everything changed in spring of 2020.  After getting debilitating breakthrough anxiety from several major stressors in my life, Zoloft was increased to 150 mg.  Soon after, I started seeing a psychiatrist and was given Clonazepam. Dose was .5 mg at bedtime, .25 mg morning, .125 mg, late afternoon. In spring of 2021, with some major life changes before me, he decided to try a different SSRI.  We went thru 4-5 over a 7-8 month period.  Lexapro, Luvox, Paxil and 1-2 others I can't remember.  Only the Luvox really helped the anxiety, however, it created severe gastro issues, so I could not continue. During this time, I sold my home and my son and I moved out of state. My new GP where I landed, tested my thyroid (I have Hashimoto's) and found that I needed a significant reduction in the dose of the thyroid med. We thought that may solve the anxiety issue, however, it did not.  In December 2021, I was put back on Zoloft and titrated to 150 mg.  I was just starting to feel really good, when in early January 2022, I had an "event", like a breakdown. Severe panic, racing and severely pounding heart.  I could suddenly not tolerate either the Zoloft or my thyroid med.  I had to immediately cut from 150 mg Zoloft down to 50 mg, and cut my thyroid med by about 50% as well, and it took about 2 weeks or so to stop the racing heart and palpitations.  The panic never went away. To this day, I have not been able to tolerate increasing the zoloft or the thyroid meds.  All the doctors have been stumped, including my psychiatrist. Unfortunately, Hashimoto's is still out of control.   Anyway, in the spring of 2022, Gabapentin was added as another option to treat the anxiety and panic without increasing the Clonzapam. I was prescribed 100 mg of gabapentin.  I could not tolerate it; combined with the clonazepam, it made me sleep all day.  I was prescribed the liquid solution instead and landed at approximately 25 mg at night and 30 mg in the morning.  It did help, but at the expense of losing my brain functionality and feeling depressed and suicidal at times.  I was told by the psychiatrist to cut back on the clonazepam where I could and try to increase/rely on more on the gaba if I could.  I cut the morning dose to .125 mg,  dropped the afternoon dose, and cut the bedtime dose to .375 mg.  I did go back to adding in a very tiny afternoon dose if/when necessary, but stopped it when I started the taper. Again, all before knowing anything about the harm this could cause.  So all this time, I've been going thru significant tolerance withdrawal. The psychiatrist claimed to have no idea what was going on, and even had me do genetic testing to determine if I was incompatible with the meds.  When I was finally made aware of benzo issues by my therapist, I went back to the psychiatrist and was told it was ridiculous because I was following his protocol, not increasing the clonazepam dosage or misusing it. This is a Harvard trained psychiatrist.   

The only other medication I've used is very low dose naltroxone, prescribed by a naturopath to help with the thyroid issues.  It did not work for me, and I only used it for a week to 10 days. It put me to sleep if I took it in the morning, revved me up at night, and ultimately worsened the anxiety. 

Sorry for the long explanation. In a nutshell, after starting tapering off clonazepam, I am currently on:

Approximately .375 mg clonazepam total, .25 bedtime, .125 in the morning.  Approximately 25 mg. liquid gabapentin solution at bedtime, 30 mg in the morning.  50 mg. zoloft daily.

As for supplements, I used to take many. I developed severe gastro issues over the last year + due to these meds; IBS, severe histamine intolerance and salicylate intolerance.  For the last 6 months, I have only been able to eat 5 foods, and am limited to those foods every day, 3 times a day, therefore struggling with malnutrition. Each supplement has had to be discontinued, the last of which were vitamin D3, Magnesium, Zinc and Theanine due to their gaba influence. I still take Vitamin C. No doctor knows how to help me and although they have made the connection with the stress/anxiety, they have not made the connection with the benzos and gaba.

The amount of gabapentin I take is less than a child's dose, however, it has a horrible impact on me. I am cognitively disabled every day untiI the gabapentin wears off in the evening. I have become allergic to the inactive ingredients in the gaba oral suspension.  I mention this because I am considering pausing the clonazepam taper to taper the gaba first in order to get some brain functionality back.  However, I don't want to cause issues with the clonazepam taper by doing that.  Even at such a small dose, it could take some time to taper the gaba safely. I've heard that the gaba taper is brutal and wondered whether it would be helpful to be on clonazepam to go thru it. 

Such a mess!! I apologize if I gave too much info!

FYI, I do have a compounding pharmacy that I have used in the past, that will formulate without using any fillers or ingredients that may be allergy inducing.

Thanks so much for your assistance and any suggestions!

[[Fa...]]

Hi again, @[Cy...].  Thank you for outlining your history for anyone that may want to provide feedback.  I'm so sorry you have had such a difficult time the past few years!

So you are certain the gabapentin oral suspension is causing you the most issues?  If you do decide that the gabapentin oral suspension is causing you the most issues, and you would like to proceed with that taper first, I would recommend holding everything steady for a little while prior to commencing.

You have made a fairly large reduction in your clonazepam dosage over the past month+, and that reduction in dose would be causing most members here difficulty.  I would want to make certain my system was as stable as possible from this change in dosage amount before I began tapering gabapentin.

You may consider using the search tool in regards to searching for people's experiences tapering gabapentin or start a new thread in the health matters forum regarding the topic.

I'd also like to mention that not everyone has difficulty discontinuing other medications, such as gabapentin, so please do not expect the worst.  I, for example, paused my diazepam taper and successfully tapered off my prescribed baclofen dosage with no ill effects. 

[[Cy...]]

On 07/03/2024 at 11:13, [[o...] said:

I have a cheap little jewelry scale that lands on the right number often, usually I get exactly the weight I want, like I recently went from .095g weight of TEVA Tablet, down to .094. 

Hi @[or...].  Just fyi, I ordered the scale that you referenced.  Received it today, and am pleasantly shocked!  It has FAR more consistent readings than the one I have been using. Repeated readings hardly vary at all.  I am now much more confident that the weight is accurate and valid.  Thanks so much for your help!!

[[or...]]

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

Hi @[or...].  Just fyi, I ordered the scale that you referenced.  Received it today, and am pleasantly shocked!  It has FAR more consistent readings than the one I have been using. Repeated readings hardly vary at all.  I am now much more confident that the weight is accurate and valid.  Thanks so much for your help!!

That's so great, thank you for letting me know @[Cy...] I know about that confidence when it hits the number we are shooting for

[[Cy...]]

On 08/03/2024 at 16:57, [[j...] said:

Hi @[Cy...]

I'm not very good with liquid maths/conversions. I did not do my own maths. I'll explain to you my own limited understanding. Luckily there are very knowledgeable people on this thread, so I'm sure they'll correct me if I go wrong here (in fact, I'm relying on it!). My understanding is that the 0.1mg/ml refers to how much Clonazepam is in the suspension. So it means for every 1ml there is 0.1mg Clonazepam. 

I'm attaching a screenshot of my reductions when I got to 0.125mg and I was making 0.001mg reductions. If you see it visually it may make a bit more sense.

The first reduction was to 0.124mg. To do that I needed to take 1.24ml. With a 1ml syringe I took 1ml of the solution and then another 0.24ml. That total equalled 0.124mg Clonazepam. Does this help?

Hi @[je...],

Long overdue response.  Thank you for this info.  Can you tell me how you measured the additional ml?  Specifically, the "odd" amounts such as .23, .21, etc.  I have 1 ml syringes, but they are only subdivided into .02 increments. Is there a specific syringe you used?

Thank you!

[[Cy...]]

On 08/03/2024 at 16:57, [[j...] said:

Hi @[Cy...]

I'm not very good with liquid maths/conversions. I did not do my own maths. I'll explain to you my own limited understanding. Luckily there are very knowledgeable people on this thread, so I'm sure they'll correct me if I go wrong here (in fact, I'm relying on it!). My understanding is that the 0.1mg/ml refers to how much Clonazepam is in the suspension. So it means for every 1ml there is 0.1mg Clonazepam. 

I'm attaching a screenshot of my reductions when I got to 0.125mg and I was making 0.001mg reductions. If you see it visually it may make a bit more sense.

The first reduction was to 0.124mg. To do that I needed to take 1.24ml. With a 1ml syringe I took 1ml of the solution and then another 0.24ml. That total equalled 0.124mg Clonazepam. Does this help?

@[je...]

Hi Jelly baby,

I'm revisiting a thread dated March 7.  Hoping you can help me.   I am closer to moving forward with a liquid compounded formula.  I'm currently at .389 mg. of clonazepam (.5 tab strength).

Is the above table available somewhere on the site? 

I read another thread recently regarding whether this should be tapered in a linear method, or recalculated to drop by a certain percentage.  I believe that you stated that it should always be recalculated until the amount is too small to do so.  Also, you mentioned accumulators and the need to add time to hold. Can you explain both?  What did your process look like when you switched over at .4 mg?

Want to make sure I get this right to minimize wd sxs.

Thanks so much!

[[je...]]

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

Is the above table available somewhere on the site? 

No, it's an online calculator I used.

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

I read another thread recently regarding whether this should be tapered in a linear method, or recalculated to drop by a certain percentage.  I believe that you stated that it should always be recalculated until the amount is too small to do so.  Also, you mentioned accumulators and the need to add time to hold. Can you explain both?  

There is linear tapering and then there's exponential tapering. (There's also hyperbolic tapering, but that's a completely differently discussion and for that you need to buy Dr Horrowitz's book). Linear tapering means you reduce by a fixed amount for example each week you'll reduce by 0.125mg. If you keep reducing by a fixed amount it means each time you reduce your percentage will increase for example lets say your starting dose is 0.5mg

0.5 -0.125= 0.375 (25% reduction)

0.375-0.125 =0.25 (33% reduction)

0.25 -0.125 =0.125 (50% reduction)

To avoid this we generally recommend that people do not follow a linear taper but rather do an exponential taper which means you recalculate your reduction based on the percentage and new dose. It will look like this:

0.5 - 10% =0.45

0.45-10%=0.40

0.40-10%=0.36

Accumulation means that previous cuts caught up with you. Basically your body remembers previous reductions and while you might have been okay up to a certain point, at some stage your body can't manage the continuous reductions. For example, I had determined that my max taper rate was 7.5% cuts every two weeks. I wanted to see if I could speed it up. I tried to make 10% cuts via cut and hold. When I made the first 10% cut I was perfectly fine. There was no difference in symptoms than when I made 7.5% cuts. But then when I made the second 10% cut I struggled immensely and functionality was very hard. Why was I okay with the first 10% but not the second? The logical explanation is the accumulation effect of cuts.  Sometimes it happens even when we reduce within the recommended range. The body sometimes cannot manage continuous cuts. It's like a moving conveyor belt with packages on it and the packages keep coming and you have to to stack those packages. If it moves too fast, you can't keep up and the packages will drop on the floor. If the conveyor belt stops, then you'll have time to properly stack the packages before resuming the moving conveyor belt. The body is the same. Sometimes you need to give holding times so your body has time to process the previous cuts.  

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

What did your process look like when you switched over at .4 mg?

I did DMT at 7.5% every two weeks. But at this stage I had already established that 7.5% was the max I could taper. I knew this percentage would work for me based on a couple of months tapering and experimenting before. I did this for about 4 months. Then I got Long Covid. It was difficult to taper and monitor my symptoms because my LC symptoms were very similar to benzo withdrawal. Because I was sick and I needed to recover to go back to work, I adjusted my taper. I still tapered at 7.5% every two weeks but I tapered for 7 days, then holding 3 days. This basically slowed my taper down to 5% every two weeks, but it felt that I was doing better with holding days inbetween rather than continuous tapering. It's hard to say how effective this was because of the LC symptoms. By around October 2022, I think I was mostly recovered from LC. 

I tapered like this until I got to 0.125mg. When I got to 0.125mg, I changed it up again. This post explains how I tapered the end.

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

Want to make sure I get this right to minimize wd sxs.

There really is no magical formula to get it right, other than ensuring your reductions are small enough for your body to manage. What worked for me, might not work for you. I do believe what helped me was a thorough understanding of tapering and related concepts. If you educate yourself and understand the potential pitfalls of different tapering methods, you know what to look out for. 

[[Cy...]]

On 27/04/2024 at 21:34, [[j...] said:

I did DMT at 7.5% every two weeks. But at this stage I had already established that 7.5% was the max I could taper. I knew this percentage would work for me based on a couple of months tapering and experimenting before. I did this for about 4 months. Then I got Long Covid. It was difficult to taper and monitor my symptoms because my LC symptoms were very similar to benzo withdrawal. Because I was sick and I needed to recover to go back to work, I adjusted my taper. I still tapered at 7.5% every two weeks but I tapered for 7 days, then holding 3 days. This basically slowed my taper down to 5% every two weeks, but it felt that I was doing better with holding days inbetween rather than continuous tapering. It's hard to say how effective this was because of the LC symptoms. By around October 2022, I think I was mostly recovered from LC. 

I tapered like this until I got to 0.125mg. When I got to 0.125mg, I changed it up again. This post explains how I tapered the end.

On 27/04/2024 at 17:22, [[C...] said:

Want to make sure I get this right to minimize wd sxs.

There really is no magical formula to get it right, other than ensuring your reductions are small enough for your body to manage. What worked for me, might not work for you. I do believe what helped me was a thorough understanding of tapering and related concepts. If you educate yourself and understand the potential pitfalls of different tapering methods, you know what to look out for. 

@[je...]

Thanks for all the info!  I'm amazed that you were able to taper thru LC and working as well. Wow!

What do you consider to be the pitfall(s) of the liquid compounded micro taper method?   Do you know of any resources available to learn more about this method, aside from Dr. Josef Witt?  Is there a resource to get a handle on the math for this?

Curious, when you dropped to a 5% taper, were you dropping at the .001 daily rate?  How did you land on tapering 7 days, holding 3? 

How often did you recalculate your reduction? After each holding period, once a month?

I'm confused by the math. I also want to go into this with some plan as to the best "schedule"  for me to start this process.  I'm pretty sensitive, so I know it would need to be much different than where you landed. 

Sorry for all the questions.  Thanks so much for your help!