Author Topic: diazepam back to k for remainder of taper? Frustrating recent Hospital visit  (Read 2221 times)

[Buddie]

Hi all,

I know I really need to make my own decision in regard to how I move forward with my taper, but it is comforting to know that BenzoBuddies are here to offer compassion and support, compassion and support that seems to be severely lacking elsewhere.

3 nights ago I got a cab to hospital about midnight because I felt I could no longer continue on with my diazepam taper after constantly experiencing a significant increase in symptoms within 1hr post dosing. Within that hour, anxiety would increase, breathing would become fast and erratic, I would become increasingly agitated and aches and pain in my body would increase, along with numerous other symptoms, all culminating in severe insomnia. Gradually, over a period of about 7-9 hours, the symptoms would ease and I would feel settled enough to finally sleep some. But then I was only 3 - 5 hrs from my next dose. Iíd always felt horrid on the diazepam.

It was one thing to endure the taper cuts without having ever stabilised from switch directly to 10mg diazepam after 19 day cold turkey from 1mg K, but to also endure this paradoxical reaction after each dose (morning and evening) just became too much for me in addition to taper withdrawals.

As concerned as I was (and still am) about the idea of switching back to clonazepam, having been 11 - 12 or so weeks since my last dose, I just couldnít see any way around it.

So,

I went to the hospital, and eventually got to see a psychiatric doctor in attempt to switch back to clonazepam. I explained the situation regarding paradoxical effects of the diazepam and she eventually agreed to switch me back to clonazepam to continue the taper. I told her that I wanted to switch to the equivalent dose to the diazepam I had been on (8mg) so as not to extend my taper out any longer. I also convinced her to prescribe liquid clonazepam because here in Australia we only have 0.5mg clonazepam tabs unlike other countries where 0.25 is accessible. However, once she had done the prescription for the liquid, she realised she had made a calculation mistake and it was too difficult for her to figure out taper dosages with the liquid (which Iím sure I could have found guidance for here), so she went back to her office and eventually came back with a script for 200 x 0.5 mg clonazepam tablets. I tried to explain that there was no way I could taper from these tablets as 0.5 mg clonazepam was estimated to be the equivalent of 10mg of diazepam, which is exactly where it really went down hill. She insisted that between 1 - 2mg of clonazepam was the equivalent of 10mg diazepam and that I should start off taking 3/4 of a tablet at night and 3/4 of a tablet of a day and then remove 1/4 of a tablet each week, or two weeks if necessary. I tried to explain that she was essentially upping my dose from the equivalent of 8mg diazepam to about 15mg diazepam (almost double), and that what she was asking me to do was cut the equivalent of 2.5mg diazepam every week or two which would be nightmarish and a potentially dangerous, but she insisted that she had 30yrs experience in her profession and that all my information and equivalency charts were all misinformation.Ö which is pretty much the same response I have received from other doctors. They simply donít like being questioned, even though the patient is only being careful, looking out for their own welfare. The more knowledge you seem to display, the more their ego seems to be challenged. So in the end I had to just accept the 0.5mg tablets, knowing full well they were useless for tapering, especially from the equivalent of 8mg diazepam, and leave allowing her to believe she must be right i I must be wrong for the sake of not escalating a potential argument which neither of us wanted to have.

The interesting thing that further backs up my paradoxical effect theory is that although I took my morning dose of diazepam to the hospital with me, I actually didnít take it because I didnít know whether Iíd be switching benzos that day, and the more time that passed, the better I felt. I got home at about 2pm that day and decided Iíd just wait until my night dose, and the more time went by, the better I felt. I could see that everything was clearing. I could still feel how unstable my CNS was, but I hadnít felt that relaxed and clear in the head for months. Even though the frustration of the hospital visit was there, I felt like I could experience joy and pleasure in simplicity. Then later I had my night time dose of diazepam when I went to bed and I fell asleep immediately having had had no sleep for a couple of days, but I woke up 3 hrs later after the dose feeling absolutely terrible again.

Itís funny how a doctor can make you doubt yourselfÖ. I knew I was right, but just to be absolutely sure about conversions, once I got home, I went to my local chemist store and asked my chemist to do an equivalency search and print out, and sure enough, she came back with a chart and  0.5 mg clonazepam is equal to 10mg diazepam.

So now Iím stuck with a prescription I havenít bothered filling because they seem to be useless unless I can also find access to the liquid clonazepam to use in conjunction.

All this because she wasnít sure how to calculate doses of liquid clonazepam

I donít suppose anyone knows a way of making use of the 0.5mg tabs in my taper?

Otherwise, Iím stuck suffering on the diazepam for who knows how long.
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[Buddie]

Iíd just add that the psych doctor also said that my previous doctor did exactly the right thing by not reinstating the clonazepam to stabilise and do a slow crossover to Valium while deep in cold turkey withdrawals. She said 19 days would have had it out of my system and putting me straight on to diazepam was the absolute right call. But it didnít fare too well for me, thatís for sure. I guess I knew it wouldnít go too well from there on, No one wants to have a disagreement or argument with a doctor, but surely we should have the right to research and gain knowledge surrounding our own illness to minimise potential mistakes by either ourselves or doctors. I donít know if this is true, but Iíve heard that doctors are meant to get a memo on GOD COMPLEX.

Im not the kind of person to take any interest in disagreements, but surely we have to stand up for ourselves when we can see that a doctors ignorance or lack of knowledge is putting us in harms way. Surely!!

Of course, itís all pointless in the end, because they are the doctor and you are the patient, and so you couldnít possibly have anything of worth to offer in regard to your own health and welfare.

Hopefully Iíll find an open minded doctor soon. One who doesnít mind researching and following up on a patients offerings.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

You've had a rough time of it dealing with your doctor but you confirmed your suspicions about the Valium so I count that as a victory. 

I'm happy she prescribed so many pills and I know it wasn't what you hoped for but you can still make them work for you.  What about titration, have you used this method in the past? Titration FAQ's
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Thank you so much for your reply, [...]

Firstly, I appreciate your pointing out the victoryÖ. I do forget to do this.

Secondly, you and I had discussed this cross back to clonazepam recently, and although it was one of my options, I was actually quite reluctant to do so, and although those feelings havenít changed (after both agreeing that it may not be the best option at the time), Iím much more clear about these reactions and just canít see any other option available to me.

Thirdly, no, I havenít actually looked in to titration, but thank you for the link. I will have a good read through it today.

Itís about 10am here now, and again no sleep, so I might just rest for a bit and then have an good look at it.

It would be great if I could learn how to use such a method. 

Will reply again later after Iíve read the link

Blessings
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Iím sorry you had such a difficult experience, [...].

According to ARTG, Rivotril clonazepam 2.5mg/mL oral solution (ARTG ID: 13758 ) is available via prescription in your country.  We have several members who are using/have used this to taper.

If obtaining the commercial solution is not an option,  I wonder if compounding might be?  If so, there is a professionally developed, potency- and stability-tested formulation for a 0.1mg/mL oral clonazepam suspension.

Members who wish to minimize the amount of liquid (either solution or suspension) ingested, sometimes use a combination of regular tablets and liquid.  For example, according to ARTG, the commercial 0.5mg clonazepam tablets in your country have a functional score line.  Consequently, you could split the tablet in half then take one-half of your dose (0.25mg) in tablet form and the rest in liquid form. You would make reductions using the liquid.

Members have also used a variety of do-it-yourself (DIY) approaches to taper.  For example, we have members who dilute the commercial oral solution to achieve a liquid with a lower concentration.  We also have members who use the aforementioned formulation for a clonazepam suspension to make a DIY suspension.

Other members have used digital scales or analytical balances to weigh pieces of tablets or powder from crushed tablets.  Lastly, we have members who make DIY liquids consisting of regular tablets and a liquid (e.g. water, milk, cosolvent).

A caveat regarding DIY approaches is that they involve drug manipulation/modification. Per our Titration: FAQs, drug manipulation conveys risk. For example, the impact of drug manipulation on dose accuracy and the stability and bioavailability of the active drug substance are unknown at this time. Drug manipulation may also increase the risk of measurement and/or dose calculation errors.
« Last Edit: June 27, 2022, 02:22:59 am by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Sorry for such a long delay in my reply

Itís been a rough couple of days.

Thank you for the info, [...].

Iíve been having a think about what my options are based on the information you have kindly provided and have come to the decision that I will switch to clonazepam tomorrow.

I have a doctors appointment (new doctor) on July 5th, and hope he will prescribe the Rivotril clonazepam 2.5mg/mL to use alongside the 0.5 tabs. Failing this, I will have to move on to one of the DIY approaches you provided. Im thinking Iíll move to using digital scales and crushing the tablets. I will have to get someone to help do the math and calculate reductions as I have substantial cognitive impairment and donít really trust myself when it comes to avoiding mistakes. I feel I have at least some understanding around this approach as apposed to the preparation of DIY liquids.

If thereís any additional information you could provide on calculating a sensible taper, it would be greatly appreciated. I need all the help I can get at this point.

I tapered from 9mg to 8mg diazepam 12 days ago and Iím trying to make a decision around the dose of clonazepam I should switch to. I would really like to avoid stretching out my taper timeline any further, so Iím thinking of switching to 3/4 of a 0.5 tablet to start. Does this sound sensible as a starting point? keeping in mind that I donít have the digital scales to make smaller or larger adjustments.

I noticed that the clonazepam tablets I have left over from cold turkey are scored both ways so you can cut quarters.

One other thing Iím not sure about is that I have been dosing twice a day with the diazepam and wonder if it would be a problem taking  (0.25)  half tab in the evening and (0.125) quarter tab in the morning, or vice versa.

I realise it would probably be better to take 0.25 morning and night and just make up the difference in each dose with the Rivotril, but itís unknown at this point whether I will succeed in acquiring a prescription.

I did visit a compounding pharmacy yesterday to discuss both the Rivotril 2.5mg/mL and the compounded clonazepam 0.1mg/mL and the pharmacist suggested the Rivotril because it was much cheaper than the compounded clonazepam.

One last question -

Could you give me an idea on how to dilute the Rivotril to make smaller cutsÖ I keep thinking in terms of diazepam equivalency, and if my calculations are correct, going by most conversion charts, the Rivotril 0.1mg/drop = 2mg diazepam. If this correct, how would I go about diluting to get a liquid with a lower concentration in terms of the ratio?

Actually, Iím also open to the idea of DIY liquid from regular tablets if thereís information available on how I can do it if I canít get the Rivotril.

Any additional information you could provide would be so helpful.

Thanks, [...].


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[Buddie]

No apology needed, [...].  Itís clear youíve had a Ďgood thinkí about your options. 

Might I suggest you take things one step at a time?

You have indicated you wish to crossover from Valium/diazepam to clonazepam.

What is your current daily dosing schedule for diazepam?  How many milligrams of drug do you take at what times? 
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[Buddie]

Thanks [...]

Iím taking 4mg diazepam at 10am and 4mg at 10pm.

What are your thoughts on how I should proceed?
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[Buddie]

You are welcome, [...].

Given what youíve shared with us about your case Ö

If I were in your shoes, my first two priorities would be to (1) conduct a Ďtestí substitution to ascertain how I will respond to taking clonazepam again and (2) if all goes well with the test, get as stable as I can on the clonazepam before initiating my taper ó even if it means taking a higher dose than I might prefer to begin.

So, for example, I would consider substituting 0.25mg of clonazepam for one of my two daily diazepam doses (either the morning or the evening, whichever one I think would Ďhelpí me the most).  I would then wait at least 3 days (preferably longer given clonazepamís relatively long half-life) to evaluate my response to the clonazepam (see note below). If all went well, I would probably Ďerr on the side of stabilityí and substitute 0.25mg of clonazepam for my other diazepam dose. 

Note: If you are not already doing so, I strongly encourage you to start keeping a daily taper journal and get into the habit of reviewing the data youíve collected whenever you reach a decision point in your taper. The daily entry can be as simple as the date; the times and amounts of your doses; and holistic ratings of your symptoms and functionality that day (e.g. 0 = no symptoms, high functionality; 10 = intolerable symptoms; no functionality).  If youíre a visual learner, you can graph these holistic ratings to reveal patterns/trends.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Thank you, [...]

I canít express how much I appreciate the guidance.

I think I should substitute the night dose to start with, as I havenít slept in days. The diazepam just causes such a horrible wired feeling and terrible insomnia.

I will definitely start a taper journal, as you suggest.

Iíll reply here again once Iíve had time to assess my response to the initial substitute dose.

Again,

Many thanks!




Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.