When should I jump off klonopin?

[[Ta...]]

Apologies if this has been answered a million times. I have been on benzos for 22 years. I was on .5 klonopin for the last 10 years. I’ve been tapering for about 3 years very slowly using a liquid taper. I’m now down to .015. Its a small drop of liquid.  Is this a proper time to jump? I don’t mind continuing but these are ridiculously small quantities. 

[[Co...]]

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

To clarify: do you mean 0.15mg, or 0.015mg? If the later, that is indeed a very small dose, will be having no therapeutic effects, and is smaller dose than most when finally reducing their dose to zero.

If on the other hand you take 0.15mg, in your shoes, I would continue to taper. We have many members who have struggled when quitting from a quarter of 0.5mg Klonopin tablet (0.125mg).

Is the liquid of your own devising, or is it commercial, or compounded by a pharmacist?

[[Ta...]]

It’s .015. It’s a liquid I make based on instructions from this site. By no therapeutic effects, does that mean Ive basically jumped already? 

Edited April 9 by [Ta...]

[[Li...]]

@[Ta...]

Just double-checking …

What is the unit of measurement for 0.015 - milligrams or milliliters of liquid?

If milliliters of liquid, what is the concentration of the liquid you are using?

If milligrams of drug, 0.015 is a subtherapeutic dose as @[Co...] has indicated. Subtherapeutic means the dose is below what is used to produce an optimal therapeutic effect.  This does not necessarily mean that the dose is not having any effect. 

Consequently, the decision about when to jump should be guided by your experience.  Are you currently experiencing any withdrawal symptoms?  Have you tolerated the last month or so of reductions without issues?  

A favor for the benefit of the community …

What instructions have you been using to prepare your liquid? Members have shared multiple different instructions over the years so it would be helpful to know which ones you used.

[[Ta...]]

Sure. I take .015 ml which equals .015 mg.

What I do is drop 10 .5 mg of klonopin pills into a cup. To make the solvent, I combine 10 ml. of vegetable glycerin with 40 ml of water. Then I pour the 50 ml of solvent into the cup and let the pills dissolve. I then use 1 ml oral syringes to measure the dose, so five 1.0 ml syringes = .5 mg, and one = .1mg. I started by taking five 1.0 ml syringes daily. I’m now down to one syringe that I fill to the .15 line, which is .015 mg if I did the math correctly. As I said, its a drop and increasingly smaller drops aren’t  measured with accuracy. My only withdrawal symptom is impaired short term memory but it’s manageable. I’ve tolerated recent reductions very well. I also take nardil which increases gaba levels. That may be helping as well. 

[[Co...]]

Hi @[Ta...]

Your math(s) seems correct to me. And 0.015ml (which in you case equals 0.015mg) is indeed a low dose. There is no therapeutic effect, and most people find that there is no need to continue tapering down from that kind of dose.

Having said that, some feel they do benefit from continuing with the taper. But you are best judge of how your taper has progressed and how you have been coping on the low dose. Prof. Ashton was of the opinion that very low doses only serve to perpetuate dependency, so the taper should not be drawn out for longer than necessary.

I might suggest that you continue with the taper, but perhaps with the aim to finish it soon. In the same manner as you have probably already progressed your taper, make reductions and continue according to how you react. Given that you feel mostly fine and have tolerated well recent cuts, the chances are that you will continue to feel fine.

What taper have been following over the past few weeks?

[[Li...]]

Thank you so much for sharing the instructions you’ve been using to make your do-it-yourself clonazepam liquid with us, @[Ta...]! I’m delighted this has worked for you.

Your math and measurements appear to be correct to me as well.  Well done!

You are correct that you cannot measure 0.15mL with accuracy or precision (consistency) using a 1mL syringe.  (Accuracy and precision begin to decrease when the volume being measured drops below 50% of the nominal capacity of the syringe — i.e. 0.5mL in the case of a 1mL syringe.)

In case you are not aware of it, 0.5mL syringes are available (see link below).  This would improve accuracy and precision somewhat if you are concerned about this.  The below-referenced 0.5mL syringe has graduation marks every 0.01mL just like the 1mL syringe you are using but is easier to read. (The barrel is smaller so the distance between the marks is greater.)

Link:

BAXA ExactaMed Oral Liquid Medication Syringe 0.5cc/0.5mL 10/PK Clear Medicine Dose Dispenser With Cap Exacta-Med BAXTER Comar Latex Free
https://a.co/d/eA0LYwt

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

What I do is drop 10 .5 mg of klonopin pills into a cup. To make the solvent, I combine 10 ml. of vegetable glycerin with 40 ml of water. Then I pour the 50 ml of solvent into the cup and let the pills dissolve. I then use 1 ml oral syringes to measure the dose, so five 1.0 ml syringes = .5 mg, and one = .1mg. I started by taking five 1.0 ml syringes daily. I’m now down to one syringe that I fill to the .15 line, which is .015 mg if I did the math correctly. As I said, its a drop and increasingly smaller drops aren’t  measured with accuracy. 

 

[[Ta...]]

Generally, I’ve been tapering down by .01 every 2 days the last few months, so for example .18 for two days, then .17 and so on. Early on I reduced the dose by .01 every 4 days but saw that I could tolerate a quicker taper and reduced it to 3 and now 2. 

Thanks for confirming the schedule and suggestion to get a .05 ml syringe. I’ll keep tapering and at some point jump and see how it goes. :-) 

[[Li...]]

You’re welcome @[Ta...].  It sounds like you have a good handle on symptom-guided tapering.  

Just to clarify for other readers of this thread, the capacity of the syringe I referenced is 0.5mLs not 0.05mLs (darn, those pesky decimal points).  0.5mLs is the lowest capacity “off the shelf” oral syringe I’ve encountered.  Microliter syringes and micropipettors are available but they can be pricey.

[[...]]

How does taperjoe store the 50ml solution. Does it keep well ? It seems like a lot for the small doses so I would imagine it could be used over an extended period?  I understand the math. What is reason for veggie glycerin? Would making up a smaller solution make any sense?

Edited April 13 by [...]

[[Li...]]

[[...]]

Not encouraging for a diy batch.  If done by a compounding pharmacy is it a solution that can be made up in larger amounts and stable for extended period. If not it seems that a dry taper is better way to go even though it is labor intensive. 

[[Li...]]

[[cu...]]

        @[Ta...] In the Maudsley Deprescribing Guidelines the slowest schedule reduces by up to 1,4% receptor occupancy per step (and Maudsley is super careful, I can do a faster taper than suggested for a scenario like mine and I still only have some vertigo sometimes). They do note that some people need to take it even slower, but judging from your mild withdrawal symptoms, I don't think this applies to you. According to the receptor occupancy graph, 0,015mg gives a receptor occupancy % of...well it's a guess, because it's almost zero, 0,2mg=5% receptor occupancy, so you must be somewhere around 0,5% receptor occupancy. It seems super safe to quit now, I would not even call it a jump, rather a tiny step to zero.

Edited April 14 by [cu...]

[[...]]

I am concerned that my gem 20 scale is not going to be accurate enough as I continue to taper lower doses. I am currently at .038 mg x 3 = .115 mg a day. The scale has a tolerance of 1 or 2 mg which could end up being a pretty large %.  Considering buying a scale with accuracy of .1 mg.  Its a bit expensive but may be worth it.  I think a lot of members issues may be with inaccurate and inconsistent dosing if dry tapering due to this issue. Any thoughts ?

[[Co...]]

[[...]]

Error can be additive or subtractive. If I can eliminate one of the variables with more accurate measurements it may help. I seem to be very sensitive to variations. Think I am going to give the .1mg scale a shot.  Cant hurt except in the pocket book. 

[[Ma...]]

On 14/04/2024 at 14:25, [[c...] said:

0,2mg=5% receptor occupancy, so you must be somewhere around 0,5%

I don’t have the guidelines but was curious when I read this.  I’m on around 0.3 mg Clonazepam which would also seem to have a pretty low occupancy %.  If that’s correct I wonder why people can’t jump from higher doses.  

[[Li...]]

28 minutes ago, [[M...] said:

I don’t have the guidelines but was curious when I read this.  I’m on around 0.3 mg Clonazepam which would also seem to have a pretty low occupancy %.  If that’s correct I wonder why people can’t jump from higher doses.  

GABA receptor occupancy is a proxy for brain effect in hyperbolic tapering models.  Like most CNS-active drugs, benzodiazepines affect multiple receptors/neurotransmitters; all of which need to return to homeostasis as the benzodiazepine is withdrawn.  

[[Ma...]]

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

GABA receptor occupancy is a proxy for brain effect in hyperbolic tapering models.  Like most CNS-active drugs, benzodiazepines affect multiple receptors/neurotransmitters; all of which need to return to homeostasis as the benzodiazepine is withdrawn.  

I’m just a little shocked that 0.2 Clonazepam would only be 5%.  I’ve watched one of Dr Horowitz’ videos and he seemed to suggest larger receptor occupancies (like 50-60%) until one got down to very low doses.  The theory as I understood it, was that very low doses become hard to taper because of this.  I guess we all have different experiences at different doses but I was a little curious because I had much worse problems at .5/.6 than I’m having at .3 now (for which I am very, very grateful)  I realize it could all come crashing down with the next cut but I also don’t want to drag this out for 2-3 years if I don’t have to.  😑

[[cu...]]

Edited April 19 by [cu...]

[[Li...]]

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

I’m just a little shocked that 0.2 Clonazepam would only be 5%.  I’ve watched one of Dr Horowitz’ videos and he seemed to suggest larger receptor occupancies (like 50-60%) until one got down to very low doses.  The theory as I understood it, was that very low doses become hard to taper because of this.  I guess we all have different experiences at different doses but I was a little curious because I had much worse problems at .5/.6 than I’m having at .3 now (for which I am very, very grateful)  I realize it could all come crashing down with the next cut but I also don’t want to drag this out for 2-3 years if I don’t have to.  😑

I am of the opinion that focusing too much on GABA receptor occupancy may risk missing the forest for the trees.  As you’ve noted, hyperbolic tapering is a theory (although I would be delighted to learn otherwise, to my knowledge, it has not as yet been empirically validated for benzodiazepines). 

The most important lesson I’ve taken away from The Maudsley Deprescribing Guidelines about tapering thus far is:

”Ultimately, it is the patient’s experience of withdrawal that should guide the rate of taper.”  (Horowitz & Taylor, 2024, p. 390)

[[...]]

Curious cat:  there are scales precise to .1 mg and they are between $200-$500 on either amazon or ebay.  I am having one delivered next friday so we shall see.  It is my opinion that the 1mg scales can introduce too much % error (1-3mg). With the other possibilities for error I want to control what I can and cut out one variable. My method will be to finely crush pills, weigh with .1mg scale and load capsules. I am hoping this is very accurate and helps with wd symptoms. 

[[...]]

Colin.   Thx for the thoughts. I think you are leaving too much to chance.  Also if you crush several pills at once it should even out active ingredient amount difference pills.  I think this is my physics/math background kicking in. I taught those subjects for 25 years. So I ordered a .1 mg scale and hoping it helps wd symptoms. I have seen positive feedback from members that have gone this route. Will keep you informed. 

[[Ta...]]