Hyperbolic Taper - Timeline

[[Fa...]]

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

I don't even know if 0.5 is the best starting point for the taper to be honest.

I just wanted to comment on this.

If you are thinking that you may need to start tapering from a higher dosage because you were taking more than .5mg PRN sometimes, if you feel comfortable enough holding longer to just settle into this dose, I feel that may be most beneficial looking long term.  You see how long the taper process takes.  Really consider that.  You could look at this 'time' as a cut in itself...adjusting to strictly .5mg.  Just a thought.  I know what it is like to have a dose increased that was not necessary...but, only you know.  I just wanted to express that.  There are things that had I had expressed to me at the time, I would have had more information and food for thought to make different decisions.

[[Fa...]]

Goodnight, Alpha. 

[[Al...]]

Goodnight, Faith. What you say above makes sense. Maybe I just need to give myself a little time to settle into the .5 mg dose. Thanks again for the advice!

[Guest [Do...]]

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

For reference, the Maudsley deprescribing guidelines for a medium paced taper recommend the following reductions every 1 to 4 weeks. It's essentially a hyperbolic taper composed of linear tapers for each dose range. As the dose range lowers, the reductions get smaller.

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

“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.” 

Hi @[Al...]

Do you know what drug is this table for?

I think is not the same 1mh of clonazepam or diazepam, and same for cuts, not the same the reductions for those drugs.

Thanks

[[Al...]]

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

Hi @[Al...]

Do you know what drug is this table for?

I think is not the same 1mh of clonazepam or diazepam, and same for cuts, not the same the reductions for those drugs.

Thanks

Hi @[Do...] As I understand it, these values are for the medium paced taper of clonazepam. However, I got them from another post on the site and didn't copy them directly from the guidelines myself. Do you think there is a mistake in the values?

[[Al...]]

The values for diazepam would definitely be different.

[Guest [Do...]]

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

Hi @[Do...] As I understand it, these values are for the medium paced taper of clonazepam. However, I got them from another post on the site and didn't copy them directly from the guidelines myself. Do you think there is a mistake in the values?

@[Al...] thanks for the reply

No i don't think there is any mistake, they are probably accurate. I was wondering if you had access to the book cause i am tapering diazepam and 0.5mg of clonazepam are equivalent to 10mg of diazepam according to the ashton manual so i need to find the diazepam number.

Thanks anyways.

[[Al...]]

Just now, [[D...] said:

@[Al...] thanks for the reply

No i don't think there is any mistake, they are probably accurate. I was wondering if you had access to the book cause i am tapering diazepam and 0.5mg of clonazepam are equivalent to 10mg of diazepam according to the ashton manual so i need to find the diazepam number.

Thanks anyways.

Okay, I see. Sorry I can't be of more help.

[[Li...]]

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

For reference, the Maudsley deprescribing guidelines for a medium paced taper recommend the following reductions every 1 to 4 weeks. It's essentially a hyperbolic taper composed of linear tapers for each dose range. As the dose range lowers, the reductions get smaller.

Might I offer a point of clarification @[Al...]?

The tapering regimens in The Maudsley Deprescribing Guidelines are hyperbolic.  However, they are based on GABA-A receptor occupancy not the dose of drug taken.

Per Horowitz and Taylor (2024):

“The relationship between dose of benzodiazepines and their effect on their principal target, the GABA-A receptor, is hyperbolic owing to the law of mass action. The law of mass action dictates that when few molecules of a drug are present, most receptors are unoccupied and so even small increases in the mass of drug present at the site of action produces large effects.  When there is more drug in the system, receptors are increasingly saturated, leading to diminishing returns in effect on target receptors for increases in the mass of drug added.” ( p. 332) 

For example …

In the ‘faster’ regimen for clonazepam, there are up to 5.2 percentage points of receptor occupancy between steps.

In the ‘moderate’ regimen, there are up to 2.5 percentage points of receptor occupany between steps.

In the ‘slower’ regimen, there are up to 1.4 percentage points of receptor occupany between steps.

 

 

 

 

[[or...]]

Just my experience, and opinion, but I've never found a perfect number, or been able to find a perfect plan for tapering any sort of taper.  Plus, I don't like trying to figure it all out, while doing so takes up the little space I have left in my brain. 

I simply tried a recommended amount off my starting dose, then from there, it was trial and error and finding what worked and feeling free to make adjustments as I go. 

I can't recommend more listening to your own wd sxs, testing it out to see how "your" body reacts because it's rare mine ever matches exactly with any "plan" or "number", oregonlady ~ Denise PS I don't believe there is any magic "plan" of tapering, probably why most doctors don't try to figure it out. They don't want to touch it with a 10 foot pole.

[[Al...]]

 

 

@[Li...] Thanks for the clarification!

@[or...] I agree, but sometimes it's helpful to know you are in the "ball park" so to speak.

[[or...]]

The ball-park can change in my experience, especially when one time I do great for 5 days holding a dose, and the next exact same taper works out very different.  You'll get tons of reasons for that happening, because we can't totally take into consideration "life happening", nutrition, other pills, otc's included, exercise (physical activity) or lack thereof.  I think everyone needs a starting point, and mine came from others here, or something I read from a book, but I take what I feel is right, then reserve the right to change according to my wd sxs, or lack of those

In the start of my taper I spent so long trying to find the perfect way to go, I didn't want some of the wd sxs I was reading about, go figure.  I've learned from others, but chose what works for me and will continue on, and I am down to an unbelievable amount I never knew I could get to, and maintained a ton of quality of life, my ultimate goal, oregonlady ~ Denise

[[Fa...]]

@[or...] Exactly.  One size does not fit all.  It can't.  And, the there are text boxes that state that very thing throughout.

“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.” 

I just have an inquiring mind, and I like to learn.  My knowledge and understanding of the Maudsley Guide was incomplete.  Now I know. 

 

 

[[Fa...]]

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

I don't believe there is any magic "plan" of tapering, probably why most doctors don't try to figure it out. They don't want to touch it with a 10 foot pole.

This is the problem.  Doctors have to learn this.  No medical practitioner has the right to prescribe a drug that they do not know how to deprescribe safely.  This knowledge has to get out there.  Most who land here do so in a very painful deficit position as a result of their PCP/Psych advising them poorly of how to taper.  This material can seem redundant to us at this point, but it's not out there in the medical community.  I've worked with Mental Health Care Providers of all kinds.  I've seen behind the scenes.  So, while the guidelines are just guidelines, they are safe guidelines to start with that will not injure patients.

That was a rant.   

[[Fa...]]

@[or...]  Thank for your patience with that one!  Brought to you by 3hrs sleep and a new cut!

[[or...]]

I can relate, been feeling cranky over the power outage, a second one in two weeks, I'm so spoiled.  I'm on the 6th day of a new cut for me too We're gonna make it though not sure what I'll do when my phone/hotspot battery goes out   Someone out there is probably hoping soon, very soon, LOL!!

[[Li...]]

@[Fa...] and @[or...]

If you have not already done so, might I encourage you to submit comments  about the importance of symptom-guided versus algorithmic tapering in response to ASAM’s draft tapering guideline?  Also, if memory serves, you are both older adults.  The draft guideline currently calls for all older adults to be tapered without informing them of the potential harms/risks of tapering or determining if the older adult has risk factors for severe withdrawal (which many older adults have).  You might want to address this as well.   As of yesterday, only 50 patients had submitted comments — that’s not enough.  Patients from all over the world are allowed to comment, not just US residents.

The Benzodiazepine Information Coalition has a thread on Benzos in the News with more information and resources. Here’s a link to the latest post:

 

[[Fa...]]

@[Li...] Yes.  I will be submitting.

[[Li...]]

You just made my day, @[Fa...]! Thank you for participating in the public comment period for the draft tapering guideline. You are a clear thinker and an excellent writer so I’m certain your comments will be excellent.  If you have questions or need help, let me know.

[[Fa...]]

@[Li...]  Thank you for the kind words.  I am finding it challenging to write when it is about my experience, but I'll get 'er done.  I know it has to be expressed a certain way because I do want it to be taken seriously.

Thank you for your offer to help.  I will reach out if I feel I require some guidance.

Warmly,

F

[[or...]]

Hi @[Fa...],

I tried to send you a p.m. but couldn't so I'll just put this out in the open. 

 

I admit I am very hesitant to get involved with the Benzo Guideline thing.  I just don't feel good about doing it, commenting, etc.

I would like your input on it that might help me decide if I should do it or not.  I suppose I don't feel real hopeful about it, like putting out my "story" so to speak, but I realize I only have to comment, not tell my story.  I guess I could use a fake name, it says I can.

I just tapered another 5% and I am doing so well considering I'm 71 and follow a pretty strict diet, and exercise plan, and have such a lot of quality of life for someone who only started doing the Keto & exercise about 4 years ago.  I do have some health issues but all under control without meds, just using the above mentioned.

Anyway, I won't rattle on, I would like to help others but I also admit reading that "guideline" info is overwhelming for me, so I don't know I can even get it done at this late stage.  I fully believe in my slow and steady taper, and honestly think it could benefit long-term users like myself, 35 year plus the 16 months of taper here with BB and down to 39 percent of original dose of 1mg Clonazepam/Klonopin.

If you feel ok with talking to me, I would welcome it,  thank you and hope your are doing well today, Denise alias Oregonlady

 

[[Fa...]]

@[or...]  I will reach out to you.

[[Ma...]]

On 12/07/2024 at 08:31, [[L...] said:

In the ‘faster’ regimen for clonazepam, there are up to 5.2 percentage points of receptor occupancy between steps.

In the ‘moderate’ regimen, there are up to 2.5 percentage points of receptor occupany between steps.

In the ‘slower’ regimen, there are up to 1.4 percentage points of receptor occupany between steps.

In terms of something practical and to the original point of @[Fa...] ‘s post, do they ever talk about going linear at a certain point? I myself am at .225 Clonazepam and considering going linear.

[[Fa...]]

@[Ma...]  It's funny, I was just writing a post about this.

@[je...] started linear from Clonazapam at .125mg.

https://benzobuddies.org/topic/265829-how-i-tapered-the-end/

This is the link that @[Al...] offered me at the beginning of the post before it segued.

 

[[Ma...]]

Thanks @[Fa...], yeah I saw that plan.  All we can really do is try making a cut and see how it goes before we make another.  When I sit down and try to do small percentages hyperbolically it gets a little overwhelming and sometimes ridiculous.  I guess my thinking now is that at some point or points along the way, we hit rough patches and need to slow down and then we steady out and can speed up.