Should I divide my dose up?

[[Mi...]]

Since 2012 I have taken a benzo “as prescribed” for sleep.  Only until I tried to get off did I realize the big mistake I’d made.  For 10 years I took 0.125 at night - main complaint was I dealt with a lot of daytime fatigue. 2 years ago I switched to Xanax at bedtime.  Big mistake.  Horrible interdose withdrawals.  In late December 2023 I up-dosed from 0.5 Xanax to 0.75 klonopin - I also increased trazadone from 25mg to about 80mg.  From late December 2023 to Late March 2024 - I was switching from Prozac to cymbalta, increasing cymbalta, trying to reduce klonopin (too much anxiety); then I did the dumbest thing which was to reduce trazadone in one week by about 50mg.  Ever since this time I have had trouble napping, I’ve had random panic attacks, I’ve been very sensitive to coffee. I’ve reinstated quite a bit of the trazadone - about 24mg.  I have to be very careful about exercise or coffee intake or I will have an anxiety attack.  It now seems I am having interdose withdrawals again.  I am scared - that I’m in withdrawal tolerance.  Splitting up my dose and taking 0.125 Klonopin at lunch helps but I would much prefer to only take it at night.  Taking 80mg of trazadone with all of this medication makes me very very tired as well.  Any advice on what to do? Main advice - it seems more feasible to me I’m having interdose withdrawal rather than tolerance withdrawal - especially because the 0.125 klonopin almost instantly stops my anxiety.  Could it be because of “kindling” or the period of time on the Xanax dealing with interdose withdrawal - that this is just the new normal for now? It just baffles me that for so long I could be on a much lower dose that lasted me through the day (to an annoying degree because it made me tired) and now a higher dose doesn’t last as long.  I do have a lot of additional stressors - perimenopause, young children on a summer schedule and this medication situation has majorly scared me and stressed me out. Sorry for the rambling post.  TIA for any wisdom you can offer.  

[[Cr...]]

Dividing up your dose may help you figure out whether tolerance or interdose withdrawal is the bigger factor for you. But it appears you have already tried that since you said you took .125 at lunch and got relief. Are you asking if you should keep your dose divided or return to single dosing?

The fact that you still get some relief after taking a dose alludes to interdose being a problem, but with the decently long half-life that klonopin has it also makes me think it could be tolerance. Possibly a combo of the two. Tolerance doesn't always mean ineffective, but could also mean less effective in regards to duration and potency.

You recently updosed on Cymbalta and readjusted your Trazadone dose, so that too may be contributing to some of your symptoms.

There are several factors at play in your situation with 2 meds changing types (Xanax -> Klon, Prozac -> Cymbalta) and 1 med changing doses (Trazadone 25 -> 80 -> 50 ->74). All within past 6 months.

Edited June 12 by [Cr...]

[[Mi...]]

On 11/06/2024 at 19:33, [[C...] said:

Dividing up your dose may help you figure out whether tolerance or interdose withdrawal is the bigger factor for you. But it appears you have already tried that since you said you took .125 at lunch and got relief. Are you asking if you should keep your dose divided or return to single dosing?

The fact that you still get some relief after taking a dose alludes to interdose being a problem, but with the decently long half-life that klonopin has it also makes me think it could be tolerance. Possibly a combo of the two. Tolerance doesn't always mean ineffective, but could also mean less effective in regards to duration and potency.

You recently updosed on Cymbalta and readjusted your Trazadone dose, so that too may be contributing to some of your symptoms.

There are several factors at play in your situation with 2 meds changing types (Xanax -> Klon, Prozac -> Cymbalta) and 1 med changing doses (Trazadone 25 -> 80 -> 50 ->74). All within past 6 months.

Thank you Crono & question for you or anyone else - so my doctor had me go up on my cymbalta by 10mg last night - this seems to have helped.  I slept much better and I’m not really feeling anxious this morning.  I am hoping I can stabilize and then months from now start a very slow liquid taper that will take me years.  I really hate taking klonopin during the day.  I Tried it for 2 days - yes it did help with anxiety - but it just makes me feel weird.  Basically tired but wired.  First day 0.125 mid day was enough to get me to the rest of my evening dose.  Second day (yesterday) I was very anxious - I took 0.125 at lunch hoping I could take a nap (could not fall asleep - this is crazy because ever since I started medication I have not been able to get through the day without a nap); I took another 0.125 (per my doctors advice) at 3pm.  This seemed to make me feel better.  I had a decent afternoon.  Took rest of my dose 0.5 at bedtime and increased my cymbalta.  Slept much better, legs were not shaking all night because of anxiety.  So I guess my question is - based on this info does it sound like it’s tolerance plus interdose withdrawal? First day 0.125 was enough, second day needed .25… Im seeing 2 additional psychiatrists next week for second and third opinions.  I’m leaning towards (at some point) crossing over to Valium in the hopes that I can only take at bedtime.  I take trazadone for sleep. I’m hoping the cymbalta and trazadone will help me with anxiety and sleep - while I (once again) very slowly get off Valium.  I’d like as many opinions on this as possible.  So anyone please feel free to chime in.  And thank you.