Really need help switching to liquid compound taper (see most recent post in thread)

[[Cy...]]

I'm on .375 mg of clonazepam at this point; .25 mg at bedtime, .0125 mg in the morning, and wondering if I may need to adjust my dosing.  I unknowingly went thru about two years of tolerance wd before starting a taper a couple of months ago which caused me to suffer from high anxiety and panic attacks every morning when waking up and, still continues. After my most recent cut of 5% about a month ago now, my panic attacks have risen to an extremely unbearable level, especially in the last 2 weeks, and my morning dose is no longer providing any relief.  I'm now wondering if I need to adjust/reset my dosages to be closer in level.  Has anyone experienced this?  If I adjust the dosages, should I expect wd sxs from the significant shift away from the bedtime dose? Any other thoughts of what may be causing this?  I have kept my morning dose lower in order to help prevent intense brain fog and lack of functionality.

Thanks all!

[[Do...]]

Hi, i was having the same problem due to AD wd, panic atacks were daily and over the top but i manage to overcome anxiety in a couple of months with the help of Claire Weekes therapy in her book Self Help for the Nerves.

You might read the books or find info in YouTube, there are a few channels that talk about it widely.

It worked for me and now i am suffering benzo withdrawal for the benzos i was having during that process but i am not suffering any anxiety and i am panic free. This is the only advice i could give you.

About the morning dose, i am in the opposite hesetation, wondering if i can reduce my morning dose as it makes me too sedated or i have to keep tapering both dose at the same time.

[[El...]]

It is my understanding that it is best to keep your doses as even as possible. This will keep your blood serum levels steady, as opposed to peaks and valleys.

I think it is be probable that if you switch to more even dosing, you will experience some wd by lowering your evening dose. Perhaps you could consider doing so in a stepwise fashion. Perhaps start with 0.20 mg pm and 0.175mg am and see how that affects you.

Just by way of a question. When you did your last reduction, did you only reduce your morning dose, or did you reduce both doses for a total reduction of 5%? My doctor originally suggested I reduce only one dose at a time. As a result, I suffered terrible interdose withdrawal. I am doing much better by reducing all doses evenly, but making sure the total dose still makes up the percent reduction I want.

Another suggestion. Perhaps, since you are at a fairly low dose, you should consider a less percent reduction. Even though I still have a long way to go, I have had to lower my percent reductions. I was reducing 3% at a time, then holding at least 1-2 weeks. Now I reduce 3 days in a row by 0.4%, 0.25%, 0.4%...then hold for a 3-4 days. It is working for now…but who knows what tomorrow will bring!

 

[[...]]

Hi Cyndi,

I am so sorry about your panic attacks!  I agree with Dolvian that behavioral techniques are super helpful, though if your symptoms are out of control you might be cutting too fast or getting interdose WD.  
 

In my experience tapering clonapin, the cuts accumulate and there is a delay of about a month before my symptoms ramp up.  I have to hold longer when this happens, until the symptoms improve.  
 

I also have the same problem with the morning dose sedation. Initially I was trying to keep that dose smaller, but found evenly dividing the total daily dose was better overall.
 

BIC is a great resource  https://www.benzoinfo.com/benzodiazepine-tapering-strategies/#recommended-taper-rate

To accommodate for the sedation, I have adjusted my morning dose to about 4 am and take the evening dose at 6 pm.  It took a few weeks of staying on the same TDD after shifting the doses evenly before I could resume tapering.

I hope you start to feel better soon! Hang in there!

Edited April 12 by [...]
Added link

[[Cy...]]

On 11/04/2024 at 15:51, [[E...] said:

I think it is be probable that if you switch to more even dosing, you will experience some wd by lowering your evening dose. Perhaps you could consider doing so in a stepwise fashion. Perhaps start with 0.20 mg pm and 0.175mg am and see how that affects you.

Just by way of a question. When you did your last reduction, did you only reduce your morning dose, or did you reduce both doses for a total reduction of 5%? My doctor originally suggested I reduce only one dose at a time. As a result, I suffered terrible interdose withdrawal. I am doing much better by reducing all doses evenly, but making sure the total dose still makes up the percent reduction I want.

Another suggestion. Perhaps, since you are at a fairly low dose, you should consider a less percent reduction. Even though I still have a long way to go, I have had to lower my percent reductions. I was reducing 3% at a time, then holding at least 1-2 weeks. Now I reduce 3 days in a row by 0.4%, 0.25%, 0.4%...then hold for a 3-4 days. It is working for now…but who knows what tomorrow will bring!

@[El...]

Hi Ellie,

So you saying drop .05 mg from the pm and add to the am? Can you tell me what that is in gram weight? That seems like a pretty large drop from the pm, even though TDD would stay the same, I would anticipate possible severe wd symptoms.

How did you come up with your current taper strategy days/%?  Very interesting to me, and I may want to do something similar.  Considering going to a liquid micro taper.

Thank you!

[[El...]]

@[Cy...] Are your pills 1 mg or 0.5 mg? If you can let me know that and also the average weight of your pills, I can do the calculation for you…or give you the equation, whichever you prefer.

If you think 0.20 mg pm and 0.175 mg am is too much of a reduction for the pm dose, you could try 0.225 pm and 0.150 am first. I guess the goal is to not increase your wd in the pm too much, but, hopefully gain some relief in the am.

As to how I arrived at my current dosing…I even tried 1% reductions. But I always felt the effects of these reductions for at least a week. I really wanted to eliminate the longer (and painful, uncomfortable) holds. I actually tried 4 days in a row of 0.25% reductions followed by a 2 day hold and I felt really good throughout. Unfortunately, my doctor is really pushing me to taper faster. So, I am trying to step it up gradually and trialing this new set of reductions in the hopes I can speed up a little. The first 0.4% reduction goes pretty well and I don’t seem to notice the 0.25% reduction. Sometimes the last 0.4% reduction gets a little "hairy", but then I have the relief of my 2-3 day hold. I actually did a 0.5% reduction instead today.  So, we'll see how that goes.  If this schedule does not work, my next plan is 0.4%, 0.25%, 0.25%, and 0.25% for 4 days then hold 2-3 days.

Anyway…hoping you had a good day! And I am very glad to do the calculations if you want me to.

 

[[Ca...]]

Are these valium tapers? Won't it be an endless taper reducing by such small percentages? I am in tolerance withdrawal anyway and was reducing by microtaper one mg a month and I took it from the morning dose and then the next mg from the evening dose. A 5 percent reduction was suggested but I am at 14 mgs and think I will be tapering forever.

[[Cy...]]

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

Are your pills 1 mg or 0.5 mg? If you can let me know that and also the average weight of your pills, I can do the calculation for you…or give you the equation, whichever you prefer.

If you think 0.20 mg pm and 0.175 mg am is too much of a reduction for the pm dose, you could try 0.225 pm and 0.150 am first. I guess the goal is to not increase your wd in the pm too much, but, hopefully gain some relief in the am.

As to how I arrived at my current dosing…I even tried 1% reductions. But I always felt the effects of these reductions for at least a week. I really wanted to eliminate the longer (and painful, uncomfortable) holds. I actually tried 4 days in a row of 0.25% reductions followed by a 2 day hold and I felt really good throughout. Unfortunately, my doctor is really pushing me to taper faster. So, I am trying to step it up gradually and trialing this new set of reductions in the hopes I can speed up a little. The first 0.4% reduction goes pretty well and I don’t seem to notice the 0.25% reduction. Sometimes the last 0.4% reduction gets a little "hairy", but then I have the relief of my 2-3 day hold. I actually did a 0.5% reduction instead today.  So, we'll see how that goes.  If this schedule does not work, my next plan is 0.4%, 0.25%, 0.25%, and 0.25% for 4 days then hold 2-3 days.

Anyway…hoping you had a good day! And I am very glad to do the calculations if you want me to.

@[El...] That's a really creative strategy.  I like it.  So you are dividing these tiny reductions between two doses? Now I understand why the high quality scale was critical for you.  I forgot to answer your question re cutting on one or both doses.  I've been cutting on just one dose, and have actually been focused on only the pm dose, because of the discrepancy between the two doses. You're saying that it helped to cut both doses at the same time by dividing the total cut between the two. This is the first I've heard about doing this.  I thought the usual was to alternate between the doses.  It's certainly worth trying.

So the pills are .5 mg, at an average weight of .171 g.  I would love it if you wouldn't mind giving me both the equation as well as the calculation, so I can learn how to do the math.  I think .225 and .150 are more reasonable, as I am quite sensitive as well. The most recent cut of 5% really threw me for a loop.  I could always do this twice to get to the end result. The goal is, as you said, to reduce the pm dosage with the least amount of wd sxs while gaining stability and relief from addition to the am dose.

Hope the .5% worked out well for you.  Thanks for your help!

[[Cy...]]

On 11/04/2024 at 14:57, [[D...] said:

Hi, i was having the same problem due to AD wd, panic atacks were daily and over the top but i manage to overcome anxiety in a couple of months with the help of Claire Weekes therapy in her book Self Help for the Nerves.

You might read the books or find info in YouTube, there are a few channels that talk about it widely.

It worked for me and now i am suffering benzo withdrawal for the benzos i was having during that process but i am not suffering any anxiety and i am panic free. This is the only advice i could give you.

About the morning dose, i am in the opposite hesetation, wondering if i can reduce my morning dose as it makes me too sedated or i have to keep tapering both dose at the same time.

@[Do...]

Congratulations on beating your anxiety!  I've been working on this for a couple of years now (way too long, but didn't realize that I had been suffering from tolerance withdrawal all that time. I will have to check out Claire Weekes.  Is the program based on CBT, brain retraining, or something entirely different?

These meds tend to make me "zombie-like" during the day. I know it is suggested to even out dosages during tapering to help with stability but I've been avoiding this so as not to have to suffer additional wd, and delay continued cuts. I'm finding how detrimental it is to lack stability.

Wishing you well with your dosing!

[[Cy...]]

[[El...]]

@[Cy...] Feeling a little “rocky” this morning. My tinnitus, nausea and headache all ramped up in the night…always a sign that I cut too much or I need to hold…“sigh”.

Anyway, to do your calculations for 0.225 mg and 0.150 mg.

For 0.225 mg, you would use the following formula: 0.5/0.171 = 0.225/×. × = 0.07695 grams rounded to 0.077 grams ( for your scale).

For 0.150 mg, you would use the following formula: 0.5/0.171 = 0.150/×. × = 0.0513 grams rounded to 0.051 grams.

This, unfortunately, is going to lead to a small reduction, because you total dose now would be 0.374 mg. But, it is probably close enough.

Again, you can always use the above formulas just by inserting the new mg value on the right side of the equation. So, for example, if you wanted your new pm dose to be 0.20 mg: 0.5/0.171 = 0.20/×. × = 0.0684 grams or rounded to 0.068 grams.

I dose 3 times per day and I try to make my reductions across all doses. Sometimes, if it is a very small reduction, I only reduce across 2 doses. But, my body seems to crave consistency so I try to keep them as equal as possible.

Hope this helps and that you get some relief in the am! Let me know how it goes.

 

[[Do...]]

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

@[Do...]

Congratulations on beating your anxiety!  I've been working on this for a couple of years now (way too long, but didn't realize that I had been suffering from tolerance withdrawal all that time. I will have to check out Claire Weekes.  Is the program based on CBT, brain retraining, or something entirely different?

These meds tend to make me "zombie-like" during the day. I know it is suggested to even out dosages during tapering to help with stability but I've been avoiding this so as not to have to suffer additional wd, and delay continued cuts. I'm finding how detrimental it is to lack stability.

Wishing you well with your dosing!

@[Cy...]

I did defeat anxiety while in WD of the benzos despite i didnt know it yet. I started to taper my lorazepam fast as i started to feel less anxiety and at a certain point i was really intrigued why i had those horrible symptoms despite i wasnt feeling any anxiety whatsoever. In fact i might have never found out i was in WD if i hadnt beat anxiety first cause i would have thought it was just the anxiety that was hitting me with those symptoms wich are most very similar to a panic/anxiety disorder.

What Claire Weeks uses is of course, as most of all, CBT but is is really helpfull and it realy works, i am the living evidence.

Check this Youtube channel out, it is where i first heard of Claire Weeks thearapy and the have really long videos talking about it.

https://www.youtube.com/@TheAnxiousTruth

they have a whole series dedicated to her book

I hope it can help you.

Edited April 13 by [Do...]

[[Cy...]]

On 13/04/2024 at 16:23, [[D...] said:

Check this Youtube channel out, it is where i first heard of Claire Weeks thearapy and the have really long videos talking about it.

https://www.youtube.com/@TheAnxiousTruth

they have a whole series dedicated to her book

@[Do...]

Thank you for this!  I will definitely check it out and hope it can help with relief.

[[Cy...]]

On 13/04/2024 at 12:05, [[E...] said:

Feeling a little “rocky” this morning. My tinnitus, nausea and headache all ramped up in the night…always a sign that I cut too much or I need to hold…“sigh”.

Anyway, to do your calculations for 0.225 mg and 0.150 mg.

For 0.225 mg, you would use the following formula: 0.5/0.171 = 0.225/×. × = 0.07695 grams rounded to 0.077 grams ( for your scale).

For 0.150 mg, you would use the following formula: 0.5/0.171 = 0.150/×. × = 0.0513 grams rounded to 0.051 grams.

This, unfortunately, is going to lead to a small reduction, because you total dose now would be 0.374 mg. But, it is probably close enough.

Again, you can always use the above formulas just by inserting the new mg value on the right side of the equation. So, for example, if you wanted your new pm dose to be 0.20 mg: 0.5/0.171 = 0.20/×. × = 0.0684 grams or rounded to 0.068 grams.

I dose 3 times per day and I try to make my reductions across all doses. Sometimes, if it is a very small reduction, I only reduce across 2 doses. But, my body seems to crave consistency so I try to keep them as equal as possible.

Hope this helps and that you get some relief in the am! Let me know how it goes.

@[El...]

Hope this finds you feeling better!

Thank you for the math/equations.   I haven't done anything yet; I ended up having to updose slightly, so I'm back to holding steady for now.

Do you happen to know the math for converting grams back to mg?  I've gotten used to just working in gram weight only.  I know I'm very close to .375 mg, but would be helpful to know exactly my intake in mg.

Thanks again!

[[Li...]]

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

Do you happen to know the math for converting grams back to mg? 

Hello @[Cy...].

To make it easier for other members to respond to your question above, would you please provide the following information:

1. How many milligrams of clonazepam are in the pills you are using (e.g. 0.5mg, 1mg)?
2. What is the average weight of the pills you’re using in grams?
3. What is your current total daily dose in grams of pill weight?

[[PE...]]

Most people, including me, have mornings with anxiety and more symptoms. I'm 6 months off but still got it. 

So it's very common 

[[PE...]]

There are many ideas why it's worse in the morning.. I haven't personally tried doing anything about it. Mabey glutamine to lowered glutamate levels? But I don't think anyone is totally sure why it is like this.

I just get up very fast and drink my morning coffee and it settles down.

Edited April 16 by [PE...]

[[Cy...]]

11 hours ago, [[L...] said:

To make it easier for other members to respond to your question above, would you please provide the following information:

1. How many milligrams of clonazepam are in the pills you are using (e.g. 0.5mg, 1mg)?
2. What is the average weight of the pills you’re using in grams?
3. What is your current total daily dose in grams of pill weight?

@Libertas

I'm on .5 mg tablets, average weight is .171 grams and my current total daily dose is .133 grams.

[[El...]]

@[Cy...] I hope you feeling some relief after your updose!

To calculate your mg dose you would use essentially the same equation as mentioned before...just putting in the grams instead: 0.5/0.171 = ×/0.133.  × = 0.3889 mg.  So 0.3889 mg (or rounded on your scale to 0.389 mg) is your current dose of active ingredient.

Please keep me updated on how you are getting along!

[[Cy...]]

 

I need to switch to a compounded liquid micro taper from my current cut and hold method.  My doctor has no knowledge of compounded tapers or micro tapers of any kind for that matter; not a surprise.  I've read a few posts, but need help/advice so I can move this forward, as well as provide the doctor with the required info for a prescription. I do have a compounding pharmacy that will be using a pure  clonazepam powder (no added fillers or inactive ingredients).  Is anyone able to advise me on what the prescription needs to state? Is it just total volume to dispense, with TDD taken over two doses?  Is the usual expiration 30 days or 60?

From what I've seen, a 1:1 ration, mg to ml is what is recommended.  I am currently on a TDD of .389 mg of a .5 mg tablet of clonazepam and dose twice daily, AM and bedtime.  What is the total amount of ml I should have the prescription written for, and how do I calculate that moving forward?  

I've been reducing at 5% and generally holding for 2 weeks.  However my last cut of 5% affected me with worse wd sxs than usual. I've been in a holding pattern for about 6 weeks now.   I know not to start the compound until I stabilize, and, to give time to adjust to the compounded form before making any cuts. Should I be use bot pills and compound to make the transitions? How soon is it typical to feel sxs from the difference in forms?

Is the recommendation to taper at .001 per day?  If not, how much/how often? (I understand that it's up to me to make the ultimate determination) Is the recommendation to reduce from both doses daily, or to alternate days?  I understand there may be a delayed accumulative effect??  Do I try to plan a hold to prevent that before it hits?  My goal is to taper with the least amount of sxs/dysfunction as possible.  My husband has developed a serious medical issue and I need to stay as functional as possible.

How do I calculate how often to cut if I want to target a specific % cut per month?  

I want to ensure that I fully understand the math. I really need help with the calculations explained in the most simplistic way possible so that my poorly-functioning brain can grasp it.

Thanks in advance!

 

[[Cy...]]

On 12/04/2024 at 19:50, [[E...] said:

@[Cy...] Are your pills 1 mg or 0.5 mg? If you can let me know that and also the average weight of your pills, I can do the calculation for you…or give you the equation, whichever you prefer.

If you think 0.20 mg pm and 0.175 mg am is too much of a reduction for the pm dose, you could try 0.225 pm and 0.150 am first. I guess the goal is to not increase your wd in the pm too much, but, hopefully gain some relief in the am.

@[El...]

Hi Ellie,  I am just re-reading this thread from a couple weeks ago.  Can you explain why I would be reducing .225 from the pm dose, but only adding .150 to the am dose?  Wouldn't that be a reduction in the total daily dose?  I'm about to start this change, and want to make sure I understand and get it right.

Thank you!

[[El...]]

@[Cy...] hope you are feeling better!

It is my understanding that your currently dosing at 0.25 pm and 0.125 am... for a total daily dose of 0.375.  I think we talked about keeping your total dose the same while you tried to stabilize on a more even dosing between the pm and am. So, if you reduced your pm dose to 0.225, you would need to increase your am dose to 0.15.  This would then keep your total daily dose of 0.375.  

Correct me if I have misunderstood you and we can rework the numbers.

[[Cy...]]

27 minutes ago, [[E...] said:

It is my understanding that your currently dosing at 0.25 pm and 0.125 am... for a total daily dose of 0.375.  I think we talked about keeping your total dose the same while you tried to stabilize on a more even dosing between the pm and am. So, if you reduced your pm dose to 0.225, you would need to increase your am dose to 0.15.  This would then keep your total daily dose of 0.375.  

Correct me if I have misunderstood you and we can rework the numbers.

@[El...]  Hope you're feeling better as well and that your .5% reduction worked for you.

No, this was correct.  So, is the % added to the am dose smaller because the dose is smaller?  I guess I'm being too simplistic.  For example, if I were to cut .010 grams off the pm dose (from .086 to .076), couldn't I just add that .010 to the am dose (.043 to .053)?  Clearly, it's been waaaay too many years since I've used my knowledge of algebra!

If you wouldn't mind, I up-dosed since the initial calculation and added it to the am dose.  The am dose is now .047 grams. PM is still .086 grams.  Would you mind re-calculating for me based on those numbers?

Thank you!!

[[Cy...]]

@[El...]

Sorry to be so needy!  My husband had a medical crisis this past week, and I am very stressed out, so not thinking clearly at all.  I really appreciate you recalculating for me.

Thank you.

[[El...]]

@[Cy...]Sorry this has taken so long.  I hope your husband is OK!  My daughter and her husband went away for the weekend and I am caring for my small grandson.  He has kept my hands full, for sure.  But I know you are anxious...and you are not needy!

You can, of course, subtract 0.01 from your pm dose and add 0.01 to the pm dose.  That would give you essentialy the same overall daily dose.

For your new mg daily intake, you are still at 0.25 in pm , but with updose are at 0.137 mg am.  This would be a total of 0.387 for your daily dose.

Hope this helps.  Let me know how you (and your husband are doing).