Desperate for help switching to compounded liquid taper

[[Cy...]]

 

I am looking 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?  Assuming I should alternate reductions between the am and pm doses on alternating days since it would not be possible to split a .001 reduction between both doses.

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 will be making an adjustment to make my am and pm doses more even over the next few days, prior to switching. I know not to start the compound until I stabilize, and, to give time to adjust to the compounded form before making any cuts. How soon is it typical to feel sxs from the difference in forms, and how long do they typically last?

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)   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.

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!

 

[[Li...]]

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

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?

Your compounding pharmacist should be able to answer these questions.

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

From what I've seen, a 1:1 ration, mg to ml is what is recommended.

Clonazepam is a very potent benzodiazepine and you are taking a ‘small-ish’ dose.  A lower concentration (say in the range of 0.1 mg/mL or even 0.01mg/mL) might be indicated.  Again, your compounding pharmacist should be able to advise you on this.

It’s getting late here so I will defer to other members to address your other questions.

Addendum:
Compounding pharmacists can be valuable allies during benzodiazepine withdrawal!  You might ask your compounding pharmacist if they would be willing to consult The Maudsley Deprescribing Guidelines to support you in your taper.  

[[Cy...]]

On 22/04/2024 at 20:13, [[L...] said:

Clonazepam is a very potent benzodiazepine and you are taking a ‘small-ish’ dose.  A lower concentration (say in the range of 0.1 mg/mL or even 0.01mg/mL) might be indicated.  Again, your compounding pharmacist should be able to advise you on this.

It’s getting late here so I will defer to other members to address your other questions.

Addendum:
Compounding pharmacists can be valuable allies during benzodiazepine withdrawal!  You might ask your compounding pharmacist if they would be willing to consult The Maudsley Deprescribing Guidelines to support you in your taper.  

@[Li...]

The pharmacist that I spoke to told me that all info needed to come from the doctor.  I'm not sure how familiar he is with tapering clonazepam.  I will have to find out if anyone there is familiar enough to make recommendations.

In the meantime, no one else has responded to my questions.  If there is any additional info you can provide, I would greatly appreciate it.

Thank you!