diazepam back to k for remainder of taper? Frustrating recent Hospital visit

[[Buddie]]

Hi [...],

I substituted my nightly dose of 4mg diazepam for .25mg of clonazepam before bed and although I got some sleep (5hrs), both mornings I have awoken with much worse anxiety. It’s so very confusing. I’m not sure what to do from here…. reinstate the nightly diazepam and battle through a slower or faster taper or continue to evaluate the clonazepam over a longer period. All I know is that the anxiety I experience when I woke up these last couple of mornings is more intense than I’ve previously experienced. I now have doubts about my decision to crossover and wonder if I’m just in a situation where I will have to struggle day to day regardless of which way I go.

I dosed at 10pm both nights and awoke to intense anxiety about 5 hrs later.

Maybe I should just stick to tapering from the diazepam and endure the suffering the best I can.

Do you have any thoughts?

Could it possibly be that the clonazepam just needs time to build up in my body?

[[Buddie]]

How many nights have you taken the clonazepam?

[[Buddie]]

Just the last 2 nights

[[Buddie]]

Clonazepam can take a while to reach steady blood serum levels.  The general rule of thumb I’ve read is that it takes 5 to 5 1/2 times the half-life of the drug.

It sounds like the good news is you finally got some sleep but the bad news is you are experiencing an uptick in anxiety. 

The decision on how to proceed is totally up to you.  Questions you might want to consider include:

Might my concern over making a change in medication be contributing to my morning anxiety?  If so, are there coping techniques I could use to address this?

Is the uptick in anxiety tolerable or not?

What’s more important to me — getting a little more sleep or eliminating the morning anxiety?

Is the morning anxiety more or less ‘acceptable’ to me than the negative effects I experience after dosing diazepam?

[[Buddie]]

Yes, exactly… gained sleep at the expense of anxiety.

So what I think you are saying is -  it may be that it will take some time to level out as blood serum levels climb, after which, possibly the anxiety might decrease?

I don’t know if this means anything, but waking after the first night, I felt like I was waiting impatiently (craving) to reach the time of my morning dose. Then this morning, although the anxiety was just as intense, maybe I wasn’t as impatient to reach the time of my morning dose.

Because I substituted my night dose before bed, it’s really difficult to gage how I feel on the clonazepam, because I go to sleep very soon after dosing, as apposed to dosing the clonazepam in the morning (instead of diazepam) and see how I feel on it throughout the day.

I guess I have to make a decision as you say.

The other thing I have to take in to consideration is - am I still experiencing withdrawal from my last taper cut of diazepam 9mg down to 8mg (13 days ago)

I know it’s probably different for everyone when it comes to the duration of withdrawal timeline between taper cuts, but I was wondering if there’s any difference depending on the half life. What I mean is - does the withdrawal timeline between taper cuts on diazepam take longer than a shorter half life benzo? If one person was tapering clonazepam and another diazepam, would the person tapering clonazepam go through withdrawal sooner post cut, therefore levelling out sooner than the person tapering diazepam with the longer half life, or is it pretty much the same?

Reconexion told me that 2 weeks is an absolute minimum wait between taper cuts, but 3 to 4 weeks is much more likely needed.

I do understand that this is the very reason you urged me to do a taper journal, because it can be difficult to gage whether you’re feeling any better from one day to the next, especially if your normal baseline is still quite symptomatic.

It’s very difficult to know when I’m ready to taper, and along with that, an element of fear of the thrust back into a highly symptomatic state, knowing how hard I get hit after each cut.

Thanks [...], I know I have to make my own decision on how to move forward, but it’s so comforting to have someone much more knowledgeable to bounce these thoughts off.

[[Buddie]]

So what I think you are saying is -  it may be that it will take some time to level out as blood serum levels climb, after which, possibly the anxiety might decrease?

Yes, it can take some time before the clonazepam reaches steady state.  For example, according to one source I read, the average half-life of clonazepam is 30 hours.  So, using the rule of thumb I mentioned earlier, it could take from 150 to 165 hours for the drug to reach steady state.  Whether or not the anxiety might decrease is a different question — you may wish to consider adding a daily (or maybe twice) daily rating of your anxiety level in your taper journal so you can look for trends.

The other thing I have to take in to consideration is - am I still experiencing withdrawal from my last taper cut of diazepam 9mg down to 8mg (13 days ago)

Nice catch on your part. That’s a plausible hypothesis.

I know it’s probably different for everyone when it comes to the duration of withdrawal timeline between taper cuts, but I was wondering if there’s any difference depending on the half life. What I mean is - does the withdrawal timeline between taper cuts on diazepam take longer than a shorter half life benzo? If one person was tapering clonazepam and another diazepam, would the person tapering clonazepam go through withdrawal sooner post cut, therefore levelling out sooner than the person tapering diazepam with the longer half life, or is it pretty much the same?

You are correct — withdrawal patterns/timelines are unique to the individual.  However, having said that, it is my understanding and observation that the shorter the half-life of the benzodiazepine being tapered, the shorter the ‘feedback loop’ between a dose reduction and the onset of withdrawal symptoms.

Thanks [...], I know I have to make my own decision on how to move forward, but it’s so comforting to have someone much more knowledgeable to bounce these thoughts off.

You are most welcome, [...].  I know how difficult it is to make these types of decisions.  Although it may not seem like it to you, you are approaching this in a very level-headed and thoughtful manner so please give yourself a pat on the back!

[[Buddie]]

Awesome reply, [...]

all my questions answered!

Given the amount of time it takes for clonazepam to reach a steady state (150 to 165hrs) as you mentioned was preferable in an earlier reply, I would be better giving it longer than the the 3 days before thinking about also switching the daily dose. Maybe 6 or 7 days.

I’ll keep monitoring my symptoms + any potential changes (better or worse) in my taper journal.

Much gratitude!

[[Buddie]]

Hi [...],

Sorry I took so long to reply after my trial switching back to clonazepam. I decided to stick with diazepam the day after we last spoke, but you can read more about it on the thread I just replied to … “paradoxical after 4 weeks…”

Could use some of your advise (if you find the time) on how to use 2mg diazepam tabs to do a DMT or much smaller cuts more often so I’m not hit so hard after large cuts.

Thanks [...]

[[Buddie]]

Hello, [...].

Good to hear from you.  That’s interesting you decided to stay with the diazepam.

If you’d like input from members about strategies for making ‘small enough’ reductions in dose using 2mg diazepam tablets, would you please:

(1) update your signature (please include your current taper rate, your current daily dosing schedule, the reductions you have made since your last update as well as any other relevant information)

(2) start a new thread on the Titration board requesting feedback (this board is focused on Substitution)

It also would be helpful if you would let members know what approach to titration you are interested in trying.

The likelihood of obtaining accurate and precise doses is highest with a commercially manufactured oral solution followed by professionally formulated and compounded oral solutions, suspensions, or mini-tabs (e.g. Tapering Strips). 

Do-it-yourself (DIY) approaches include:

Diluting a commercially manufactured oral solution
Pill-splitting
Pill-shaving
Weighing pill pieces, pill powder, or pill powder mixed with filler to increase the weight being measured
Suspensions made with regular tablets as the drug source

At this point in time, the accuracy and precision of DIY approaches is unknown.  Some individuals find these approaches to be ‘accurate enough’ and ‘precise enough’ whereas others do not.  My personal observation is that diazepam seems to be more ‘DIY friendly’ compared to other commonly prescribed benzodiazepines perhaps due to its low potency, long half-life, and/or unique physiochemical properties.

[[Buddie]]

Thanks [...],

Will update my signature, work out my preferred taper approach, and then start a new thread on titration board.

Many thanks!