Ashton Manual Taper Schedule 5 Klonopin substitution with diazepam

[[Buddie]]

Hi,

I spoke with my psychiatrist today and I asked if he would be willing to guide me through substituting diazepam for Klonopin.  I am currently on 1.5 mg (.5 mg 3 times daily). 

I e-mailed him a copy of the chart, but I am still leery about the substitution method. 

How have other people felt about substitutions? 

If this isn't the right way to taper,  then how should I proceed to dry taper? should it be the morning, afternoon, or night dose first? 

I am very concerned, because the last time I tried tapering, I hit a wall in March 2019 (I eliminated the afternoon dosage after seven months), and had shaking, psychosis, insomnia, sensitivity to lights, sound, paranoia. 

I really want to know how to do this on a very slow, equal basis, so that my body doesn't miss any doses. 

Do some of you split up the lowered doses equally times three? 

Also: I imagine it is in my best interest to keep a log book of my taper, so that I know when I have to hold.  Fortunately,  I do have a compounding pharmacy one mile down the road from me, so I could always do liquid klonopin later after I get down to very small dosages. 

Thanks for your help in advance.

[...]

[[Buddie]]

I don't know a lot of people who crossover from Klonopin to Diazepam, and I suspect it's because Klonopin has such a long half-life. Most seem to taper it directly. Usually we would not recommend a crossover if you're tolerating your current benzo. May I ask why you want to crossover?

I decided against a crossover since I've read a lot of people having complications with it and I am doing okay on Klonopin. I'd rather stick with the symptoms I know than risk more or getting stuck on a crossover I can't handle. I started tapering from 1mg and I have been functional throughout.

[[Buddie]]

I wanted to crossover because of the emotional lability, the depression, the irritability, the cognitive fog, the change in mood when I take a dose.

perhaps its not in my best interest, since I've been on K for 31 years.  I want my life back.

I am probably going to change my mode of thinking and speak with my psychiatrist again soon to do a dry taper, as I do NOT want to deal with coming off another benzo. 

Ideally, I want to have an ideal tapering plan in place, so that things go smoothly. 

It's a bit harder to split three doses.

Again, is there a model that I can follow to slowly taper off three separate doses of K? 

Thanks,
[...]. 

[[Buddie]]

It sounds to me that you might have developed tolerance after all these years on benzo's and that it's not working for you anymore.

I only dose once a day so I don't have experience with multiple doses but I think most people try to keep their doses even when tapering. You could either dry taper or you could go with the compounding pharmacy you mentioned.  Which method do you feel more comfortable with?

[[Buddie]]

well, I did a dry taper over three years ago, then I had a bad experience when the middle dose was cut out (hallucinations, insomnia, sensitivity to light and sound, paranoia, etc.). 

I really do not know if I should start with the dry taper, then switch over to the compounding method when it gets too hard to accurately make dose cuts. 

I did call back my psychiatrist and told him I want to proceed with the gradual taper without substitution. 

Also, I am perplexed about how to taper off evenly...it might be beneficial to me to do this with a compounding pharmacy since they could reduce the dosage three ways for every time I make a reduction. 

[[Buddie]]

Hello, [...].

Are you considering compounded capsules or compounded liquid?

Although capsules definitely can work, an advantage of liquid is that it gives you more flexibility.  You can decide how to split your doses, how much to reduce from each dose, and when to make reductions.  Another advantage of liquid is that a stability-tested formulation for a compounded 0.1mg/mL clonazepam oral suspension is available (see link below).

Do you have experience working with compounding pharmacies?  If not, here’s a link to a post I wrote for another member on tips for finding and vetting them:

http://www.benzobuddies.org/forum/index.php?topic=270601.msg3396443#msg3396443

Link:
0.1mg/mL Clonazepam Oral Suspension from Nationwide Children’s Hospital
https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

Edit: corrected typo to ensure proper username redaction

[[Buddie]]

I am going to try the liquid way.  I talked to the pharmacist yesterday and she told me she could make up anything that the doctor orders. 

I am unsure how the compounding works.  Is it just a set dose of medicine mixed in with water?  And I take it with a syringe? 

This is all very new to me, but I am more than willing to give it a try, because I previously tried cutting via dry taper and it didn't go so smoothly.

With three dosages per day, I feel that the liquid taper is the way to go. 

Thanks.

[[Buddie]]

Thank you for the update.  Your decision to try a compounded liquid is a sound one.

Does the pharmacist with whom you spoke specialize in compounding?

If so, s/he can and should teach you exactly what you need to know and do to use your liquid, including how much of the liquid to ingest for each dose and how to properly measure that amount using an oral syringe. S/he should also provide you with all the necessary tools including a tinted medication bottle fitted with an adapter cap as well as a supply of oral syringes with the appropriate capacity (e.g. 0.5mL, 1mL, 3mL, 5mL, 10mL).

In the interim, here’s a video from Dana-Fabre Cancer Institute that will give you an idea of what you’ll be doing:

Using the Right Liquid Oral Syringe and Giving the Correct Amount
https://youtu.be/j0wBWoC44Kw

[[Buddie]]

Yes, she mentioned that all the pharmacists at the pharmacy have expertise in compounding.   She did day that she would give me a syringe. 

Thanks.  That video was helpful.  I knew quite a bit already about a syringe, as I used to give my cat medicine years ago. 

[[Buddie]]

I’m glad the video was helpful.  One of its major strengths is the segment about using the right capacity syringe to optimize dosing accuracy.  I’ve also found that using a press-in bottle adapter as shown in the video makes life much easier.

Have you asked your pharmacist what formulation she plans to use?  Has it been potency- and stability-tested? Will it yield a solution or a suspension? What will its concentration be?  Will she be using regular tablets as the drug source or the pure Active Pharmaceutical Ingredient (API)?  If the former,  I strongly encourage you to find out if she will be willing to use tablets from the same manufacturer you are currently using.

Two other suggestions to consider when switching from tablets to liquid …

(1) Avoid the trap of making a reduction in dose at the same time you switch to a new dosage form.  If you do this and experience issues, you won’t be able to determine root cause (i.e. new dosage form vs reduction in dose). Instead, hold your dose constant when you switch then wait for at least a week to see how your body reacts.

(2)  Some — but not all — individuals notice differences between the solid and liquid dosage forms.  For example, some members report that the onset or duration of action is different or they feel a difference in potency.  If you fall into this camp, one option to consider is to titrate your dose upwards to see if that helps.  In the past, some members have advised a 10% increase to begin, but I personally would start with a smaller increase (e.g. 2-3%) then titrate upward from that.