Clonazepam advice

[[Al...]]

It started about 5 days ago. It went away and then came back yesterday. I don't feel it all day long. It has mainly been in the afternoon. I'm still trying to figure out if there are any specific triggers like eating or walking.

[[je...]]

That’s weird. I don’t know what is causing it and the fact that it mainly shows up in the afternoon is baffling. The coming and going of it is also perplexing. You should document this in your diary. Hopefully with time it will become clearer.

[[Al...]]

Hi @[je...]

I'm now at 0.47 mg. Does the following micro taper plan for the next 15 days seem okay to you? Is there anything you would change? It's a 10% reduction with a three day hold at the end. The reduction per day is 0.004 mg. The alternative is a 5% reduction schedule. The reduction per day in that case would be 0.002 mg. Do you think 5% would be safer? I've been on the medication for 3 months in total now.

Day 1: 0.470 mg (AM: 0.235 mg, PM: 0.235 mg)

Day 2: 0.466 mg (AM: 0.233 mg, PM: 0.233 mg)

Day 3: 0.462 mg (AM: 0.231 mg, PM: 0.231 mg)

Day 4: 0.458 mg (AM: 0.229 mg, PM: 0.229 mg)

Day 5: 0.454 mg (AM: 0.227 mg, PM: 0.227 mg)

Day 6: 0.450 mg (AM: 0.225 mg, PM: 0.225 mg)

Day 7: 0.446 mg (AM: 0.223 mg, PM: 0.223 mg)

Day 8: 0.442 mg (AM: 0.221 mg, PM: 0.221 mg)

Day 9: 0.438 mg (AM: 0.219 mg, PM: 0.219 mg)

Day 10: 0.434 mg (AM: 0.217 mg, PM: 0.217 mg)

Day 11: 0.430 mg (AM: 0.215 mg, PM: 0.215 mg)

Day 12: 0.426 mg (AM: 0.213 mg, PM: 0.213 mg)

Day 13: 0.422 mg (AM: 0.211 mg, PM: 0.211 mg)

Day 14: 0.422 mg (AM: 0.211 mg, PM: 0.211 mg)

Day 15: 0.422 mg (AM: 0.211 mg, PM: 0.211 mg)

 

[[Co...]]

Hi @[Al...]

You appear to be on a dose of just below 0.5mg/day clonazepam. How long to do you anticipate your taper taking to complete? Because by my estimation, you appear to planning for it to take about 500 days. That's a very long taper for a very moderate dose. Please let me know if I have misunderstood.

If you need to taper at such a slow rate, then you should do that. But sometimes members do not properly appreciate how long it will them to complete the taper at the chosen taper rate - I just wish to be sure that you understand how long it will take for you to complete your planned taper schedule.

[[je...]]

A couple of things. May I ask why you’re considering DMT and not cut and hold? You’ve not really started to taper your dose yet and you haven’t determined what percentage you can reasonably manage. In my experience (I’ve done both methods) it’s easier to know how your body reacts to cuts via cut and hold than through DMT.

To add to what Colin said, it took me about 19 months to taper 1mg and I was a long term user who also had to slow down my taper due to Long Covid issues.

[[Al...]]

On 05/07/2024 at 02:06, [[C...] said:

Hi @[Al...]

You appear to be on a dose of just below 0.5mg/day clonazepam. How long to do you anticipate your taper taking to complete? Because by my estimation, you appear to planning for it to take about 500 days. That's a very long taper for a very moderate dose. Please let me know if I have misunderstood.

If you need to taper at such a slow rate, then you should do that. But sometimes members do not properly appreciate how long it will them to complete the taper at the chosen taper rate - I just wish to be sure that you understand how long it will take for you to complete your planned taper schedule.

Hi @Colin

Maths isn't my strong point. I was under the impression that it would take about 150 days if reducing by 0.004 mg per day in a linear taper with 3 day holds every 15 days.

0.5/0.004 = 125 days. (+25 days of holds)

Is your calculation for a hyperbolic taper?

Any advice would be appreciated. As you can see, I need some help with the taper planning.

[[Al...]]

On 05/07/2024 at 03:51, [[j...] said:

A couple of things. May I ask why you’re considering DMT and not cut and hold? You’ve not really started to taper your dose yet and you haven’t determined what percentage you can reasonably manage. In my experience (I’ve done both methods) it’s easier to know how your body reacts to cuts via cut and hold than through DMT.

To add to what Colin said, it took me about 19 months to taper 1mg and I was a long term user who also had to slow down my taper due to Long Covid issues.

Hi @[je...]

I'd read quite a few threads on this site recommending a DMT over cut and hold, but it may be that they were recommending DMT for later in the taper. I also thought starting off cautiously by micro tapering 10% of my dose and holding there would be safer than cutting 10% straight away. I was going to micro taper for 15 days and then reevaluate based on how I feel. Please let me know what you think. I am very open to suggestions, which is why I wanted to check with you before starting the taper.

[[Co...]]

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

Hi @Colin

Maths isn't my strong point. I was under the impression that it would take about 150 days if reducing by 0.004 mg per day in a linear taper with 3 day holds every 15 days.

0.5/0.004 = 125 days. (+25 days of holds)

Is your calculation for a hyperbolic taper?

Any advice would be appreciated. As you can see, I need some help with the taper planning.

Nope. It seems that maths isn't my strong point.  I'm not sure what I did there. But you are correct, of course - it will take about 125 days to complete.

Although that's a slow taper, it falls within what I'd consider a normal range.

At low doses, a linear taper is appropriate. Else, the taper does indeed to tend to end up ridiculously long, where the member is on a very low dose for a very long time (I've seen examples of years-long tapers proposed for 0.5mg clonazepam by one website in the past).

[[Co...]]

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

Hi @[je...]

I'd read quite a few threads on this site recommending a DMT over cut and hold, but it may be that they were recommending DMT for later in the taper. I also thought starting off cautiously by micro tapering 10% of my dose and holding there would be safer than cutting 10% straight away. I was going to micro taper for 15 days and then reevaluate based on how I feel. Please let me know what you think. I am very open to suggestions, which is why I wanted to check with you before starting the taper.

Yours is not a 'cut and hold' taper. When people use that phrase, they usually mean much larger cuts, and then hold at that dose for at least week (and often two weeks or more).

[[Al...]]

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

Yours is not a 'cut and hold' taper. When people use that phrase, they usually mean much larger cuts, and then hold at that dose for at least week (and often two weeks or more).

Yeah, I thought I'd start off with a micro taper to ease myself in and then hold once I have cut by 5 or 10% to see how my body reacts. Given your advice and the advice from @[je...] I think I may hold for at least a week to give the cuts a chance to accumulate.

[[Al...]]

For reference, the Maudsley deprescribing guidelines for a medium paced taper recommend the following reductions every 1 to 4 weeks.

4 - 2 mg...0.25 mg reductions

2 - 1.25 mg..0.125 mg reductions

1.25 - 1.05 mg...0.1 mg reductions

1.05 -0.4 mg...0.05 mg reductions

0.4 - 0.2 mg...0.04 mg reductions

0.2 - 0 mg...0.02 mg reductions

 

Edited July 6 by [Al...]

[[Co...]]

Hi @[Al...]

Given the size of you cuts, and that it will take about 125 days to taper off 0.5mg clonazepam, there is no need to slow down the taper unless you are experiencing withdrawal effects. From an initial dose of 0.5mg, and reducing the dose by 0.028mg (7 x 0.004mg) every week, that's a weekly taper rate of just 5.6%. This is usually (though, not always) quite tolerable.

[[Co...]]

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

For reference, the Maudsley deprescribing guidelines recommend the following reductions every 1 to 4 weeks.

4 - 2 mg...0.25 mg reductions

2 - 1.25 mg..0.125 mg reductions

1.25 - 1.05 mg...0.1 mg reductions

1.05 -0.4 mg...0.05 mg reductions

0.4 - 0.2 mg...0.04 mg reductions

0.2 - 0 mg...0.02 mg reductions

A few points to consider:

• That's 10 times your daily rate. So your taper rate falls within the maudsley guidelines of making a reduction of 0.04mg every 7 to 28 days.
• You are making even smaller reductions each day rather than larger reductions every 1-4 weeks (smaller, more frequent reductions are generally better tolerated than larger, less frequent reductions).
• Maudsley is a highly theoretical framework, without a proper study in patients.

[[Al...]]

Do you know why the Maudsley guidelines say every 1-4 weeks. That seems like a very wide range to me.

[[Co...]]

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

Do you know why the Maudsley guidelines say every 1-4 weeks. That seems like a very wide range to me.

I don't. Maudsely, as I understand it, is supposed to reflect theory about receptor occupancy. But the stated withdrawal rate (range) guidelines seems much the same as others, where there is variability and a symptom-based, patient-lead approach is advised.

[[Al...]]

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

I don't. Maudsely, as I understand it, is supposed to reflect theory about receptor occupancy. But the stated withdrawal rate (range) guidelines seems much the same as others, 

Yes, the rates do seem similar to those already recommended elsewhere. I think one of the main aims is to educate doctors who will hopefully be more receptive to the guidelines given the Maudsley name.

[[Ma...]]

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

For reference, the Maudsley deprescribing guidelines recommend the following reductions every 1 to 4 weeks.

4 - 2 mg...0.25 mg reductions

2 - 1.25 mg..0.125 mg reductions

1.25 - 1.05 mg...0.1 mg reductions

1.05 -0.4 mg...0.05 mg reductions

0.4 - 0.2 mg...0.04 mg reductions

0.2 - 0 mg...0.02 mg reductions

Interesting.  I haven’t read the guidelines myself.  I am at .25 myself and about to make a cut but haven’t decided how much yet.  It’s taken me almost a year now to get from 1 to .25 with a couple longer holds.  I know some people do like .01/week which seems reasonable depending on your symptoms.  

[[Li...]]

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

For reference, the Maudsley deprescribing guidelines recommend the following reductions every 1 to 4 weeks.

4 - 2 mg...0.25 mg reductions

2 - 1.25 mg..0.125 mg reductions

1.25 - 1.05 mg...0.1 mg reductions

1.05 -0.4 mg...0.05 mg reductions

0.4 - 0.2 mg...0.04 mg reductions

0.2 - 0 mg...0.02 mg reductions

Might I offer a clarification, @[Al...]?  The information you’ve provided is taken from the moderate taper regimen for clonazepam presented on page 392 in The Maudsley Deprescribing Guidelines.  Regimens for faster and slower tapers are provided on page 391 and 393 respectively.

In my opinion, the most important information about tapering clonazepam is given on page 390:

 

“Please note that none of these regimens should be seen as prescriptive — that is, patients should not be compelled to adhere strictly to them.  They are given as example regimens and are not ‘set and forget’ but should be modified in order to ensure that the withdrawal symptoms are tolerable throughout a taper … Ultimately, it is the patient’s experience of withdrawal that should guide the rate of taper.” 

 

 

[[je...]]

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

From an initial dose of 0.5mg, and reducing the dose by 0.028mg (7 x 0.004mg) every week, that's a weekly taper rate of just 5.6%. This is usually (though, not always) quite tolerable.

I just want to clarify - you are proposing a 0.004mg per day reduction and @[Co...] post above refer to 0.004mg per week. 

On 04/07/2024 at 16:52, [[A...] said:

The reduction per day is 0.004 mg

 

[[Co...]]

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

I just want to clarify - you are proposing a 0.004mg per day reduction and @[Co...] post above refer to 0.004mg per week. 

I don't really follow, @[je...].

[[je...]]

Oh sorry, that’s my bad, I didn’t look at the actual calculations, I just read per week. 

[[Al...]]

10 hours ago, [[M...] said:

Interesting.  I haven’t read the guidelines myself.  I am at .25 myself and about to make a cut but haven’t decided how much yet.  It’s taken me almost a year now to get from 1 to .25 with a couple longer holds.  I know some people do like .01/week which seems reasonable depending on your symptoms.  

Hi @[Ma...]

Just thought I'd point you in the direction of the following thread by @[je...]. It will be a useful reference  once you get down to the low numbers around 0.125 mg.

 

[[Al...]]

Hi @[je...] and @[Co...]

Where I am Clonazepam is available in a fine granule form, so my doctor has given me it in this form to help with tapering. The manufacturer is the same as for the tablets I was using before, and looking at the ingredients, the only difference is that the granules have less fillers (no talc for example). Do you think it will be okay to taper using the granules rather than the tablets I was previously using? I'm just wondering if absorption, dose consistency and bio-availability will be the same, or if there might be any other issues that I haven't thought of. The advantage of the granules is that I can weigh out the dose directly without having to cut and shave the tablets, but I don't want to use them if there's a risk they might destabilize my taper. I'd appreciate any thoughts/advice you can give on this.

 

Edited July 7 by [Al...]

[[Co...]]

Hi @[Al...]

You might notice some differences due to, as you say, bioavailability and the like. My suggestion is that if you switch across - for the potential advantages you identified - that you you stabilise your dose for a while. My general suggestion is that - where possible - make only one change at a time. So, avoid tapering while you are still adjusting to the switch from pill to powder forms.

[[Ct...]]

23 hours ago, [[M...] said:

Interesting.  I haven’t read the guidelines myself.  I am at .25 myself and about to make a cut but haven’t decided how much yet.  It’s taken me almost a year now to get from 1 to .25 with a couple longer holds.  I know some people do like .01/week which seems reasonable depending on your symptoms.  

@[Ma...] I’m not good with math. How do you calculate reducing .01 mg per week using a .5mg C tablet that weighs .173 g? I’m not as far along as you are at .25 mg but would like to learn the math for future reference. Thanks Ctlady