Has anyone here succeeded in switching from twice a day K dosing to Valium?

Has anyone here succeeded in switching from twice a day Klonopin dosing to Valium?

I ask because the Ashton Manual's K to V schedule starts with three times per day K dosing.  (https://www.benzo.org.uk/manual/bzsched.htm#s5)

This causes one's K levels to stay higher for longer during the switch than if one begins with twice a day K dosing.

Which creates a substantially slower, smoother transition.

The Ashton Manual also says:  "Some people, however, appear to have particular difficulty in switching from Klonopin to diazepam. In such cases it is possible to have special capsules made up containing small doses, e.g. an eighth or a sixteenth of a milligram or less, which can be used to make gradual dosage reductions straight from Klonopin. These capsules require a doctor's prescription and can be made up by hospital pharmacists and some chemists in the UK, and by compounding pharmacists in North America."

Since I've only been on Clonazepam .5 mg twice a day for 7 weeks and I'm already going through absolute withdrawal hell for two hours twice a day, I'm tempted to up my dose to 1.5 mg/day and switch to three times a day dosing. 

It would take me longer to taper, but it would make the switch to Valium smoother and get me out of my twice a day withdrawal hell.

Anyone successfully gone from twice a day K to V?  And how was it?

Your quote from the Ashton Manual about some people having particular difficulty in switching from Klonopin to diazepam reminds me of a question I’ve had for a while …

My understanding is that clonazepam is only approved for a limited number of uses in the UK.  So I wonder how many patients Professor Ashton worked with who were discontinuing it?  For example, according to her 1987 paper below, none of the 50 patients presented with clonazepam use.

Paper:

Benzodiazepine Withdrawal: Outcome in 50 Patients, CH Ashton, DM, FRCP, 1987

https://www.benzo.org.uk/ashbzoc.htm#t2

Libertas is correct. Back in 2004, I tried the switchover from K to V without success and was stuck trying to get off of the V to all of the way back on K. I was on the UK forum, which highly encouraged everyone to switch to V.

Klonopin was not approved for Panic Disorder back then and to my knowledge, mainly approved for Seizure Disorder. That is why Dr Ashton did not work with any K patients.

One member stated that it wasn't necessary to switch from K to V as K's half life was long enough to do a taper.

Dana

Dana: Thank you so much for sharing your understanding of approved uses for clonazepam in the UK (mine is the same — its primary use is for seizure disorders). I’m sorry to learn the crossover from K to V did not work for you.  As you know full well, it works for some individuals but not for others.

scoupier:  I can’t recall if we have any currently active members who switched from twice a day dosing with clonazepam/Klonopin to twice a day dosing with diazepam/Valium.  Have you tried searching for posts from past members on this topic?

We do have members who have experienced interdose withdrawal (IWD) on clonazepam, despite its relatively long half-life.  It sounds like you may fall into this group of ‘fast metabolizers.’

Given that we do not know how you will respond to diazepam, your idea of testing whether the addition of a third, midday dose of clonazepam would resolve the IWD makes sense.

Have you considered gradually moving a portion of your morning and evening doses (say 0.125mg) to create a midday dose?  Or, another option to consider would be to keep these doses as is and titrate the midday dose upward (e.g. you could start with 0.125mg, if that did not resolve the IWD, you could try 0.25mg; if that didn’t work, you could try 0.5mg).

Libertas: yes I've been searching most of the day for K --> V stories.  And many seem to have a very low opinion of it. 

I'm thinking that if the interdose stuff keeps up that I might split my morning dose in half, into morning and afternoon doses spaced eight hours apart, and then start tapering on my evening dose.

Of course I found a story of someone getting interdose withdrawals on 3 x per day K dosing:

I was prescribed clonazepam and have taken it for 8 months daily.  My dose has been 0.25mg three times daily.  Doctors first prescribed 0.5 twice daily, but I was like a drunk zombie on that and could not have stayed awake or driven.

 

It took me a while to realize that I was quite ill on the benzo and that I suffered three times a day from intense tolerance withdrawal.  I really needed more, but refused, despite doctors trying to prescribe more.

What's strange is that the interdose withdrawals seem to peak 4 hours prior to my next dose, it feels like an outer circle of hell, and then greatly subside 2 hours prior to my next dose.  Very strange, one would think that withdrawals would peak right before the next dose.

Dana:  Funnily I just read an approximation of what you wrote on an old post:

Quote

I can shred that 'Valium vs. Klonopin' part of the Ashton manual to pieces. Clonazepam IS different. There are some errors and half truths in the manual about that. In the original study (N=300) nobody was on Klonopin.

For some people, the 'unusual' properties of clonazepam matter.

I had no idea she never studied klonopin users... that explains a lot. The vast majority of those in "protracted" withdrawal seem to have been on klonopin (myself included, and I tapered even slower than Ashton's recommendations). I wish someone would study this more, and look at each drug individually. A study of 300 people is just not enough.

I’m glad you are considering multiple options to address the interdose withdrawal (IWD). Updosing from 1mg to 1.5mg in one fell swoop would be a whopping 50% increase in your total daily dose.

We have had members who dosed clonazepam 4 times a day and even one who dosed 6 times a day.  It all depends on what works for the individual.

The timing of your peak IWD symptoms is interesting.  Here are the pharmacokinetic metrics I have for clonazepam:

Onset of action: 20 to 40 minutes

Max plasma: 1 to 4 hours

Duration of action: 6 to 12 hours

Half life: between 20 and 60 hours (mean 30 hours)

Libertas: yes I've been searching most of the day for K --> V stories.  And many seem to have a very low opinion of it. 

 

I'm thinking that if the interdose stuff keeps up that I might split my morning dose in half, into morning and afternoon doses spaced eight hours apart, and then start tapering on my evening dose.

 

Of course I found a story of someone getting interdose withdrawals on 3 x per day K dosing:

 

I was prescribed clonazepam and have taken it for 8 months daily.  My dose has been 0.25mg three times daily.  Doctors first prescribed 0.5 twice daily, but I was like a drunk zombie on that and could not have stayed awake or driven.

 

It took me a while to realize that I was quite ill on the benzo and that I suffered three times a day from intense tolerance withdrawal.  I really needed more, but refused, despite doctors trying to prescribe more.

 

What's strange is that the interdose withdrawals seem to peak 4 hours prior to my next dose, it feels like an outer circle of hell, and then greatly subside 2 hours prior to my next dose.  Very strange, one would think that withdrawals would peak right before the next dose.

 

Dana:  Funnily I just read an approximation of what you wrote on an old post:

 

Quote

I can shred that 'Valium vs. Klonopin' part of the Ashton manual to pieces. Clonazepam IS different. There are some errors and half truths in the manual about that. In the original study (N=300) nobody was on Klonopin.

For some people, the 'unusual' properties of clonazepam matter.

 

I had no idea she never studied klonopin users... that explains a lot. The vast majority of those in "protracted" withdrawal seem to have been on klonopin (myself included, and I tapered even slower than Ashton's recommendations). I wish someone would study this more, and look at each drug individually. A study of 300 people is just not enough.

Hi Soupier,

Are you stating that those were my quotes. I am just confused. I did not write those.

Switching over to V is such an individual decision. There are people that have been successful and those who have not. My reason for going back to K was that V made me depressed, hurt my stomach, gave me a lot of headaches. Also, I was very tired on it. I knew in my heart that it was going to backfire. I was fortunate to do a water taper back then, after getting rid of the V and tapering down. I did pretty good. I had to, over the course of years go back up due to my Mom's health, gastric ulcers, progesterone induced setback, antibiotic induced setback, and brand switches.

Did you make a cut from 1.5mg of K to 1mg in a short amount of time?

Hi Dana,

No, those were just some quotes that I'd just barely read on another old thread that seemed similar to what you were saying.

And I didn't cut from 1.5 mg.  I was thinking about going up and following the Ashton Manual's K --> V schedule exactly in order to get a smoother transition to Valium, but I was just speculating out loud.  In truth I hate this stuff so much that I'd never go up, short of having another panic attack ER visit.

Thanks for explaining how Valium made you feel, that's really helpful.

So sorry you've been through such a difficult 2+ decades.  I'm sad for you. :'(

Good luck with your current taper.  I pray nothing goes wrong.

Soupier,

All of what you have gone through explains the trips back to the ER. I read your posts and saw where you were put on 1mg of k. Then you were cut by .5mg and reinstated to 1mg? In what time frame was that? At least there is a good explanation of why you are suffering so much. I am really sorry.

There is much hope for you, but you have to be patient and sit tight.

Like Liberta's stated, you could try to move a small bit of your dose to midday, but that is another change.

This a very hard process to deal with.

You have not been on that long, but you still need to stabilize to reduce anymore suffering.

Our brains are so complex and why you have the symptoms you do is so individual.

I am hoping and praying that it will get better and it will. The biggest mistake is to start a taper right now.

My taper will be fine, once I am ready to go at again. Patience is key.

Dana

Libertas,

Thanks for those pharmacokinetics.  I hadn't seen those.  I guess I might want to dose more often.  Where'd you get them?

Four times a day sounds good, maybe I'll try that.  I wonder if the person who did that got any sleep though.  Putting up with withdrawals twice a day might get you more sleep.  Seems to be a trade off there.

Dana,

Yeah Haldol's some super nasty stuff, the second most oxic psych drug in existence.  Haldol was an IM injection, so not really cold turkey.  I must have misspoke.  A tiny amount, maybe 20 mg, is still in me.  I think I'm feeling well enough on that front though to start tapering K soon, we'll see. 

The failed K taper from 1 mg to .5 mg began during the last week in May and ended during the first week of June.  I didn't know what was going on yet, so I kept on the taper after the first ER visit panic attack.  I'm definitely kindled a bit.  It is what it is.  But my tolerance is also going up, so I want to start tapering soon.  This is about my seventh week on K.

Both panic attacks during the taper came after triggers.  One had a major trigger.  One had a very mild trigger, and that one came quite soon before my evening dose, so maybe dosing more often would be good to avoid going into higher states of anxiety like I am now (I just barely dosed).

Thanks for those pharmacokinetics.  I hadn't seen those.  I guess I might want to dose more often.  Where'd you get them?

You’re welcome.  Having a basic understanding of the pharmacokinetics of the benzodiazepine one is taking/discontinuing is important.  It’s also important to understand that different benzodiazepines (and different dosage forms of the same benzodiazepine) have different pharmacokinetics.

One source of pharmacokinetic data is the official FDA-approved drug labels available online at DailyMed:

https://dailymed.nlm.nih.gov/dailymed

Hi Dana,

I need to improve my sig. 

The Haldol was given by I.M. injection in early May.  It was 150mg, a very high dose it would seem.  Its half-life is three weeks, so I'm still on about 20mg.  So I didn't exactly CT.

In late May I'd been on Clonazepam for about two weeks and started tapering.  My first panic attack was on Memorial Day (May 30th) and my second was six days later on June 5th.

As soon as I went to the ER the second time I realized that the panic attacks were benzo related and immediately went back to taking 1 mg/day. 

Eventually I found out about tapering, and then BenzoBuddies, but too late to taper the Haldol.

I'm surely a bit kindled, but that's ok.

I'm still feeling a little anxious from the Haldol wd, but I feel stable and took my first 5% cut this morning.

You can read more about where I'm at now in this post:  http://www.benzobuddies.org/forum/index.php?topic=269376.msg3385447#msg3385447