Tapering advice

[[la...]]

Its been a long long road so far. A really hard one. from CT to reinstating too low to getting off too fast to reinstating once again. I went back and fourth on how to get off the remain of my klonopin. A doctor switched me to valium today but also insisted I went up. I really didn't want to listen to him about going up and didn't for a while but I eventually got fed up with not sleeping and went up from .125mg to .25mg of klonopin (still not sleeping). Today I did the valium switch, I wasn't experiencing interdose withdrawals but I was just having a hard time getting the pill smaller. I now know I could have done a water taper but at the time it seemed scary. I also had a consultation with Dr. Josef Witt and he believes I have protracted withdrawals. I really dont think it was from the CT but after I jumped off .125mg (now I know this was too high) - I have not slept, and I literally mean that. I dont hit REM or nREM (deep sleep) - its been hell. 

I actually had AI write me a taper plan and I'm wondering if anyone can check over it or give inputs on it. This is what it wrote for me. 

 

Based on your requirements, we'll hold at 5 mg until August 10 and then taper by 5-10% every 1-2 weeks until reaching 1 mg by the end of December. Here’s a plan that balances the need for a gradual taper with the goal of being off Valium by the end of December:

Tapering Plan

1. **Days 1-19 (July 23 - August 10)**: Remain at 5 mg daily

Weekly Reduction Phase

2. Week 1 (August 11 - August 17)**: Reduce by 10% of 5 mg (0.5 mg) = 4.5 mg

3. Week 2 (August 18 - August 24)**: Reduce by 5% of 4.5 mg (0.225 mg) = 4.275 mg

4. Week 3 (August 25 - August 31)**: Reduce by 5% of 4.275 mg (0.21375 mg) = 4.06 mg

5. Week 4 (September 1 - September 7)**: Reduce by 10% of 4.06 mg (0.406 mg) = 3.654 mg

6. Week 5 (September 8 - September 14)**: Reduce by 5% of 3.654 mg (0.1827 mg) = 3.47 mg

7. Week 6 (September 15 - September 21)**: Reduce by 10% of 3.47 mg (0.347 mg) = 3.123 mg

8. Week 7 (September 22 - September 28)**: Reduce by 5% of 3.123 mg (0.15615 mg) = 2.967 mg

9. Week 8 (September 29 - October 5)**: Reduce by 10% of 2.967 mg (0.2967 mg) = 2.67 mg

10. Week 9 (October 6 - October 12)**: Reduce by 5% of 2.67 mg (0.1335 mg) = 2.536 mg

11. Week 10 (October 13 - October 19)**: Reduce by 10% of 2.536 mg (0.2536 mg) = 2.282 mg

12. Week 11 (October 20 - October 26)**: Reduce by 5% of 2.282 mg (0.1141 mg) = 2.168 mg

13. Week 12 (October 27 - November 2)**: Reduce by 10% of 2.168 mg (0.2168 mg) = 1.951 mg

14. Week 13 (November 3 - November 9)**: Reduce by 5% of 1.951 mg (0.09755 mg) = 1.853 mg

15. Week 14 (November 10 - November 16)**: Reduce by 10% of 1.853 mg (0.1853 mg) = 1.668 mg

16. Week 15 (November 17 - November 23)**: Reduce by 5% of 1.668 mg (0.0834 mg) = 1.585 mg

17. Week 16 (November 24 - November 30)**: Reduce by 10% of 1.585 mg (0.1585 mg) = 1.426 mg

18. Week 17 (December 1 - December 7)**: Reduce by 5% of 1.426 mg (0.0713 mg) = 1.355 mg

19. Week 18 (December 8 - December 14)**: Reduce by 10% of 1.355 mg (0.1355 mg) = 1.22 mg

20. Week 19 (December 15 - December 21)**: Reduce by 10% of 1.22 mg (0.122 mg) = 1.098 mg

21. Week 20 (December 22 - December 31)**: Maintain at 1 mg

By the end of December, you will be at 1 mg and can safely discontinue according to your plan. 

 

Let me know any thoughts on this plan. Thank you 

Note: I suck at math so I'm not sure if the AI did this correctly, Secondly I dont have access to liquid valium because my doctor sucks so I'm not exactly sure how to get the cuts down. I just know I dont want to drop more than lets say 12% each drop. 

Edited July 26 by [la...]

[[Li...]]

The math appears to be correct, @[la...].

I have one point for you to ponder and several questions.

Following a fixed taper schedule can be problematic.  Successful tapers are flexible (i.e. they are adjusted based on the individual’s response to reductions).  For example, a quit dose of 1mg diazepam may or may not be appropriate in your case (it depends on your response to previous reductions).

What is the rationale for flip flopping between a 5% and a 10% taper rate? Might this inconsistency cause issues?

Did you do a ‘cold switch’ or a gradual cross over from clonazepam to diazepam? 

What is the strength of the diazepam tablets you were prescribed?  2mg?  5mg?

Re: techniques for down-titrating your dose: 

Titration - Benzodiazepine Withdrawal Support

[[la...]]

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

The math appears to be correct, @[la...].

I have one point for you to ponder and several questions.

Following a fixed taper schedule can be problematic.  Successful tapers are flexible (i.e. they are adjusted based on the individual’s response to reductions).  For example, a quit dose of 1mg diazepam may or may not be appropriate in your case (it depends on your response to previous reductions).

What is the rationale for flip flopping between a 5% and a 10% taper rate? Might this inconsistency cause issues?

Did you do a ‘cold switch’ or a gradual cross over from clonazepam to diazepam? 

What is the strength of the diazepam tablets you were prescribed?  2mg?  5mg?

Re: techniques for down-titrating your dose: 

Titration - Benzodiazepine Withdrawal Support

Thank you @[Li...]  you make a lot of great points. 

I wasn't advised to do a cross over but I'm taking it in my own hands. I'm taking .125mg Klonopin and 2.5mg of Valium for 7 days and then completely switching to 5mg Valium. I have 5mg tablets. 

the 5-10% drops were just at random and directions to the Ai because I know I dont want to drop more than 10% each drop. I'll def listen to my body and adjust how I can. The thing is my doctor doesn't understand what I'm dealing with and thinks I'm having rebound insomnia and so I'm working with his prescriptions (30 pills per month). If he starts to micromanage my taper, Ill have to find a new doctor asap because I've already done a rapid taper and it didn't work. 

I thank you for your response. 

[[Ma...]]

It’s a reasonable plan, just be flexible about it.  If you’re having a rough time, hold for a week or two to see if it evens out.  If you’re doing no worse, stay the course.  I’m on .25 Clonazepam and learning how tricky these low doses are.  My last cut to .225 (a 10% cut) was too much.  I’m now going to do a smaller cut (5%) and just see how it goes.  

[[Li...]]

You’re welcome, @[la...]. 

I strongly encourage you to use a consistent taper rate as opposed to flip flopping between two different rates per the AI generated plan you shared in your opening post.  You can then adjust the rate upward or downward as needed depending on your response to reductions.

In terms of selecting an initial taper rate to trial, The Maudsley Deprescribing Guidelines (MDG, Horowitz & Taylor, 2024) has a section on estimation of risk of withdrawal and corresponding size of the initial dose reduction you might find of helpful (pages 350-352).  

Given that your current prescriber sounds less than fully informed about benzodiazepine withdrawal, you might consider purchasing a copy so you can educate yourself. For example, MDG addresses protracted withdrawal syndrome as well as how to distinguish withdrawal symptoms from return of an underlying condition.