Starting Ashton Method - Schedule 5 - 1 mg klonopin with Valium substitution

[[Ca...]]

Hi All,

I have been browsing this forum for quite some time now and this is my first post. It's great to see all the support from this community. So long story short, I've been taking Klonopin for just over 15 years. Over those 15 years I have never exceeded 1 mg per day (current dosage) and have gotten as low as 0.25 mg. I started the medication after acquiring HPPD/Visual Snow from psilocybin. At that time, I was desperate to find a solution and most people with similar symptoms had relief with Klonopin, so I figured I would give it a go. It helped tremendously at first, but as the years passed by I now am realizing it is causing more harm then good. I have had terrible difficulty tapering off klonopin on its own (and sometimes even increasing my prescribed dosage). So I discussed the Ashton Manual with my Psych Doctor and he was willing to get me started on a schedule as follows. I am currently on Day 3 of Week 1. Note, we are using 1mg klonopin : 20 mg valium equivalency as per the AM.

Week 1: 0.75 mg K, 5 mg V

Week 2: 0.625 mg K, 7.5 mg V

Week 3: 0.5 mg K, 10 mg V

Week 4: 0.375 mg K, 12.5 mg V

Week 5: 0.25 mg K, 15 mg V

Week 6: 0.125 mg K, 17.5 mg V

Week 7: 20 mg V

Now I just have some questions from all you experienced buddies!

    1) Given I have been on K for 15 years, do you think this is a reasonable schedule?

    2) I am currently taking my entire K dosage in the morning and V dosage at night. Is it better to slowly try and divide the dosages over the day to say 3-4 times per            day? The problem here is that I think my body is used to me taking all the K first thing in the morning which I have been doing for the majority of the 15 years.

    3) I've noticed the 5 mg V dosage to be somewhat sedating, but hoping this could be manageable. Does it take the body some time to get used to the Valium and             these symptoms may subside? Or would it be beneficial to lower to maybe 3.75 mg to start if I get too tired/sedated. Is Valium usually well tolerated?

Any help would be greatly appreciated!

 

 

 

 

 

 

 

[[Co...]]

Hello @[Ca...]. Welcome to BenzoBuddies.

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

Now I just have some questions from all you experienced buddies!

    1) Given I have been on K for 15 years, do you think this is a reasonable schedule?

Ashton would generally suggest 1-2 weeks between each substitution. Some flexibility is generally welcome. However, having a psychiatric doctor who is generally on board is - in my opinion - far more important than quibbles about if it should be 1 or 1-2 weeks between substitutions.

Further, Ashton would generally have her patients taper during the substitution phase. But since this is not occurring in your schedule, and that your doctor has agreed to substitution value greater than many other doctor would agree, means there is more flexibility built into your schedule than there might have been. You might find that you can even start to taper during the substitution phase if you feel overmedicated (but you would need to discuss this with your doctor).

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

    2) I am currently taking my entire K dosage in the morning and V dosage at night. Is it better to slowly try and divide the dosages over the day to say 3-4 times per            day? The problem here is that I think my body is used to me taking all the K first thing in the morning which I have been doing for the majority of the 15 years.

Was it your or doctor's decision to substitute in this way? Usually, you would take the dose in substitution to correspond with the benzodiazepine being substituted. Having said this, diazepam has a much longer half-life, and is much more forgiving of variation in the time it is taken. But your concern makes sense to me. Might you contact your doctor to ask if you can take the diazepam dose taken in substitution at the same time of your remaining Klonopin? If you have taken klonopin once per day, you probably have less reason to to take diazepam more than once per day.

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

    3) I've noticed the 5 mg V dosage to be somewhat sedating, but hoping this could be manageable. Does it take the body some time to get used to the Valium and             these symptoms may subside? Or would it be beneficial to lower to maybe 3.75 mg to start if I get too tired/sedated. Is Valium usually well tolerated?

 Many people find diazepam sedating. And yes, you probably will adjust. But as I suggested above, if you feel overmedicated, you might discuss with your doctor if it would be appropriate to (gently) taper off during the substitution period. Another reason this might be considered is because diazepam accumulates more than Klonopin. So, for a few weeks, the amount of diazepam in your system will be increasing more than the increase in dose would suggest. (This will eventually level-off).

[[Ca...]]

Hi Colin,

Thank you for the great responses. 

I did discuss possibly tapering the Valium at the same time as this seems to be on the higher end of equivalency and my Doctor was on board with that. At this point, I believe it is best to overshoot just to see how my body reacts to the Valium and can adjust down if necessary if I feel overly medicated. I will probably stick to the scheduled dose of Valium for the first two weeks and monitor how I react accordingly. It's not overly sedating to the point I can't function, but I do feel it come on fairly strong which I assume is just my body's initial reaction and there is most likely an adjustment period.

My doctor did suggest taking the Valium at night for the first couple of weeks as it causes sedation. I'm just concerned right now as I appear to be having inter dose withdrawals about 6-7 hours after taking the first 0.75 mg in the morning but those seem to dissipate once I take the Valium in the evening.

I spoke with my doctor and he recommended spreading the dosages throughout the day. Would it be better to slowly spread out the dosages? I'm just concerned, for example, if I immediately start taking 0.25 mg K at say 6am, 0.25 mg K at 11am, 0.25 mg K at 3pm, then 5 mg V at 7pm I will not be able to function throughout the work day (I work 8-5) given I have been taking one  single dose every morning for years.

Thanks again.

 

 

 

[[Co...]]

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

I spoke with my doctor and he recommended spreading the dosages throughout the day. Would it be better to slowly spread out the dosages? I'm just concerned, for example, if I immediately start taking 0.25 mg K at say 6am, 0.25 mg K at 11am, 0.25 mg K at 3pm, then 5 mg V at 7pm I will not be able to function throughout the work day (I work 8-5) given I have been taking one  single dose every morning for years.

Hi @[Ca...]

Since your doctor is on board with you spreading out your dose, you could try that.

Given that you have only just started taking diazepam, I would not overthink it and perhaps just take your next increase in diazepam (in a few days time) between your morning (K) and evening (d) doses.

Adjust according to how you react is my general advice. But understand - given that you are in the process of substituting one med for another - that things will probably change over the coming weeks even if you do not take additional doses in the middle of the day. What I mean is, avoid becoming obsessed over control and reduce expectations during a period of upheaval (substitution). Try to go with the flow - I expect that you will be fine.

[[Ca...]]

Hi @[Ch...]

Definitely, I feel a lot of this is trial and error with the dosage timing and amounts. For example, yesterday, I had 2.5 mg of the Valium at around 5pm and 2.5 mg before bed. Not only did this ease the interdose withdrawal from the Klonopin but also limited the sedation from the Valium as well. 

Today I spread out the Klonopin in the morning and am feeling pretty good.

And exactly, go with the flow, listen to your body, and try not to overthink is the key! Will keep this post updated as I continue with the substitution/taper.

[[Ca...]]

So I started week 3 of my substitution yesterday: 0.5 mg Klonopin, 10 mg Valium and have been noticing increasing anxiety. It also seems the Valium has been making me somewhat disassociated, maybe even depressed, so the first two weeks have been a bit rocky.

I was actually traveling yesterday with very little sleep the night before so maybe that had something to do with it, as I had a borderline panic attack when landing in NY.

Now my doctor did suggest I could increase up 0.0625 mg K as needed if I’m feeling these increased anxious effects which I did yesterday and helped maybe a little. 
 

I did get about 7-8 hours of sleep last night and am feeling somewhat better this morning after taking the 0.5 mg K, I am just wondering if this is all part of the substitution process (and the fact that I was traveling yesterday) because I’m supposed to be on vacation, with a friend I met here in NY, and can’t be having these panicky, anxious, disassociated symptoms the whole trip.

I think it might be best to call my Doctor and get his opinion? From the Group’s experience how long does it take for the Valium to reach therapeutic levels? Overall I feel the Valium does help but comes with its own set of side effects. Are the first few weeks usually fairly rocky with this substitution method? Any help would be appreciated!

[[je...]]

Hi @[Ca...]

Valium is known for causing depression and sedation. Some members report that it settles somewhat after the crossover. The disassociation might be related to DP/DR. It’s a common withdrawal symptom. 

I don’t have experience with crossing over but you can look into the posts of @[Ko...] who did a Clonazepam to Valium crossover. 

[[Ko...]]

@[Ca...]

Hi- I went from 0.5 mg klonopin to 10 mg valium over a several week period. I had been on .5 mg for sleep for 4 -5 months before I started the cross-over. My provider that I sought out for tapering purposes made me switch as she doesn't condone the DIY methods of using scale or water-tapering.

I was depressed with periods of SI before the crossover- I think a lot of this is due to the situation at hand as I need to keep my job and am a single parent. Lots of stress.

I feel that I was more stressed with crossover than I needed to be- I had a few rough patches but ultimately did ok. I continue to feel overmedicated on valium even though I am down to 6 from 10 at this point.  I feel more sluggish, spacy, and have terrible problems with motivation on the valium but I don't know how much of that is side effect vs withdrawal.

Feel free to ask me any other questions about the crossover.

 

[[Ca...]]

Hi @[Ko...]

i guess that’s the tricky part with the whole process, is it stress with the crossover or withdrawal or your mind manifesting symptoms, who knows. I have an extremely stressful job as well, and wasn’t exactly feeling the best on 1 mg k before I started the substitution so it’s impossible to discern symptoms.
 

I also find the Valium is causing me to be a bit spacy and sluggish as well but it definitely helps with the withdrawals.
 

Glad you did OK, I took a few weeks off from work just to see how my body adjusts to the Valium, did you find the Valium became more manageable or tolerable now vs. when you first started the crossover?

[[Ko...]]

@[Ca...]well, I can tell you that I felt like utter crap on .5 of klonopin with bouts of muscles feeling really tight, burning skin, tinnitus, and fatigue and the switchover helped with everything but the fatigue. It always feels next to impossible for me to get out of bed in the morning no matter how much sleep I get. I generally sleep better.  Once I am up and moving I am somewhat better.

I think the crossover was manageable and tolerable. Now I just have the difficult part of finishing my taper and trying to figure out how slowly to go. I started decreasing by .5 mg every 2 weeks and then changed it to .25 mg every 2 weeks except the last decrease I did .5 mg again as I was feeling overmedicated. This Wednesday I have to decrease again.  I wish there was a way of making this less stressful...

[[Ch...]]

On 23/03/2024 at 19:53, [[K...] said:

@[Ca...]well, I can tell you that I felt like utter crap on .5 of klonopin with bouts of muscles feeling really tight, burning skin, tinnitus, and fatigue and the switchover helped with everything but the fatigue. It always feels next to impossible for me to get out of bed in the morning no matter how much sleep I get. I generally sleep better.  Once I am up and moving I am somewhat better.

I think the crossover was manageable and tolerable. Now I just have the difficult part of finishing my taper and trying to figure out how slowly to go. I started decreasing by .5 mg every 2 weeks and then changed it to .25 mg every 2 weeks except the last decrease I did .5 mg again as I was feeling overmedicated. This Wednesday I have to decrease again.  I wish there was a way of making this less stressful...

It sounds like you’re doing well, considering.  Congrats!!!

[[Ko...]]

@[Ch...]Thanks. How are you feeling?

[[Ch...]]

On 28/03/2024 at 17:23, [[K...] said:

@[Ch...]Thanks. How are you feeling?

Thanks for asking.  I honestly don’t even know.  I rapid tapered and then cold turkeyed off of .35 and was in hell for 3 months.  I reinstated 3 days after CT.  3 months after reinstatement I was debilitatingly depressed - with SI.  Severe.  Planned it.  Couldn’t function.  So I hesitantly accepted a 12.5mg dose of Zoloft.  It helped.  
 

But my life fell apart during those 3 months.  Job, living situation, abuse and gas lighting from family.  And the hell I went through even after reinstating, defies description.  I’m still not feeling stable.  Make me want to do a rapid taper and get it over with.  I don’t know if I have the WILL to slowly taper and manage symptoms and life.  I’m fragile still.  I’m terrified of a fast taper too.  Struggling daily.  Not much support and pressure to get better fast.  Single female with no interests or career, and no reference point of a normal life.  Which drives the SI.  

Major props to you for managing your taper and working and all.  

[[Ko...]]

@[Ch...] I am so sorry for all the misery you have had. I understand and have had a lot of losses in the year since I took my first klonopin. I basically just work and then come home and try to function enough to run household and single parent. I have very little support. The pressure is to remain functional is so high.

I think its important to stabilize somehow before you start a taper.  I want to get off valium as soon as I can as it makes me unmotivated and lazy but everything I read says to go slowly so I have been keeping reductions at .5 -.75 per month. I am at 5.75 mg now.

 

 

[[Ch...]]

@[Ko...]I am on K too, I was put on as a teenager, I’m now 28.  
It sounds like your body is ready to get rid of the Valium, too… That’s amazing being able to do those reductions without too many symptoms (I’m hoping). I couldn’t believe the level of cognitive impairment I experienced during that, it made me feel like I needed to be in a ward - the worst fear I have.  I couldn’t form sentences.  

How slowly did your doctor cross you over to V?  I’m on K .5mg at night.  - never mind I’m just reading your comment above.  

You’re doing great!!!! 
 

 

Edited April 1 by [Ch...]

[[Ko...]]

@[Ch...]  I have only been on these type of meds for year due to severe insomnia and rue the day I started. 

I want to go faster but also scared that I could get burned and end up in a bad place.  I hope things get easier instead of harder as I get lower....I have read that for some people that is the case.

 

[[Ch...]]

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

@[Ch...]  I have only been on these type of meds for year due to severe insomnia and rue the day I started. 

I want to go faster but also scared that I could get burned and end up in a bad place.  I hope things get easier instead of harder as I get lower....I have read that for some people that is the case.

I’ve read that as long as you go super slow in the last few milligrams, maybe even slower than you think is reasonable, is best… but everyone is so different.  I think that’s the toughest part, the uncertainty.  But you’re doing amazing.  I think you will know what is best when that time comes. 

[[Ca...]]

Hi Folks,

Hope all is well in your tapering journeys.

So I finally managed to completely crossover to Valium at 20mg. Yesterday was the first day I didn’t take a Klonopin dosage in 15 years!

The last few weeks have been manageable with the crossover, I almost want to say my symptoms have been better than when I was just strictly taking Klonopin. Not overly sedated, still working with limited anxiety, have been going out with friends, working out, sleeping well, etc.

However, the last couple of days have been rocky at best after the Klonopin jump and switching strictly to Valium. Essentially going from 0.125 mg K and 17.5 mg V (Week 6) to 20 mg V (Week 7). I feel like I’m having similar anxiety and panic levels before I started the crossover. I am sure my body just needs to stabilize as the K is leaving my system or maybe I’m just manifesting symptoms but idk

@[Ko...] How were your symptoms after the last Klonopin Jump? Or any other buddies out there with any insights? The last thing I want to do is go back to K after coming this far with the crossover.

 

 

[[Ko...]]

@[Ca...]You sound as if you are doing well, all things considered. 

My tolerance and withdrawal symptoms were and are very different than yours.  As I transitioned to valium and came off of klonopin, I had times of increased intensity of skin burning, tinnitus, feeling out of it with low motivation, and at times SI.  These all settled down within a few weeks.

The biggest change for me on valium compared to klonopin is that I sleep better, dream more, and have a better appetite.  

Now that I am decreasing the dosage of valium I am dealing with these symptoms again....

 

[[Ch...]]

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

However, the last couple of days have been rocky at best after the Klonopin jump and switching strictly to Valium. Essentially going from 0.125 mg K and 17.5 mg V (Week 6) to 20 mg V (Week 7). I feel like I’m having similar anxiety and panic levels before I started the crossover. I am sure my body just needs to stabilize as the K is leaving my system or maybe I’m just manifesting symptoms but idk

I think you'll eventually stabilize more on the Valium. It is much less potent than Klonopin (hence, the uptick in anxiety) but it also lasts much longer.

How many times a day do you take the Valium? What is your plan for tapering it now that you've successfully crossed over?

I crossed over from 3mg Xanax to 60mg Valium. The taper took 18 months.

[[Ca...]]

@[Ch...]

Right now I’m taking 10 mg in the morning, 5 mg in the afternoon, and 5 mg in the evening. I need to be somewhat functional at work throughout the day, so that’s why I start with a larger dose in the AM.

As for the taper schedule, I’ll probably stay on 20 mg for the next 10 days then 10% reductions every week or two (as per the Ashton Manual). I’ll be discussing with my P Doc on Monday.

My only concern is the increased symptoms after the last Klonopin dose but hopefully I will stabilize on the 20 mg as the K is finally leaving my system.

What % were you typically reducing by when you started your taper?

 

 

 

 

[[Ch...]]

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

@[Ch...]

Right now I’m taking 10 mg in the morning, 5 mg in the afternoon, and 5 mg in the evening. I need to be somewhat functional at work throughout the day, so that’s why I start with a larger dose in the AM.

As for the taper schedule, I’ll probably stay on 20 mg for the next 10 days then 10% reductions every week or two (as per the Ashton Manual). I’ll be discussing with my P Doc on Monday.

My only concern is the increased symptoms after the last Klonopin dose but hopefully I will stabilize on the 20 mg as the K is finally leaving my system.

What % were you typically reducing by when you started your taper?

I followed the Ashton Method. When I got to around 5mg, I cut just .5mg every 14th day.

Eventually, you can dose the Valium just once a day.