Crossing from 10mg Valium Suppository to Oral Klonopin for taper

Hello, everybody (anybody?)

I have a long history of benzodiazepine use, and with the onset of complex medical issues, it has finally caught up with me to an extent that makes me extremely fearful.

From 2010-2013 I frequently took klonopin at varying doses, prescribed by a psychiatrist for anxiety (to take up to 3 times a day as needed). This quickly turned into an unhealthy situation, though I was successfully able to cut cold turkey with very little repercussions. Shortly after discontinuing the klonopin (or maybe even before discontinuing - I do not remember), I was then prescribed 10mg valium suppositories (1 at bedtime) for pelvic floor disorder, and was told that the medication only worked locally to relax the pelvic floor muscles, and wouldn't impact my body systemically. In 2020, I inadvertently stopped taking the valium suppositories due to a GI illness, and repeatedly ended up in the ER for chest pain and difficulty breathing, tinnitus, vertigo, extreme nausea, GERD, and insomnia. After a few horrific weeks I casually mentioned to my PCP that I hadn't been using the suppositories due to the nature of my illness, and she told me to reinstate them immediately. Shortly afterward I felt much, much better, and realized I had formed a serious physical dependency problem.

During this time I was also diagnosed with POTS (a syndrome that indicates a faulty autonomic nervous system), and MCAD (a disorder that indicates loss of tolerance and potential allergic response to pretty much anything at any time).

About a week ago (and after roughly 10 years of using the Valium suppositories), I started experiencing an allergic response after using them. I was forced to discontinue the medication immediately, and have been sent into a tailspin with supervising doctors who know absolutely nothing about benzodiazepine withdrawal. First I tried oral ativan in an attempt to alleviate my symptoms, but reacted to that as well and did nothing to roll back my withdrawal symptoms (nausea, inability to eat, insomnia, body pain, head pressure, brain zaps, disassociation, hands going numb, massive eye strain and inability to focus cognitively, heart palpitations, internal vibrations, major chest pressure, throat tightening, congestion). Now I seem to have successfully reintroduced klonopin, but am struggling to figure out a dose/dosing schedule that is as similar to the 10mg Valium suppositories as possible, and how to implement a taper schedule that is as safe as possible, considering the long duration of my benzo use and medical complexities. I just started 0.5mg of klonopin twice daily (though I am unsure if I need to add more doses to mimic the long half-life of the Valium, as taking only one dose at night definitely is not enough at the moment). I am planning on using a compounding pharmacy to help me with the dosing. ANY advice would be so, so appreciated, as I am really freaked out. Thanks, y'all.

I think I misread your post on another thread, are you taking .5 mgs of Klonopin twice a day to make up for the 10 mgs Valium or .25 twice a day?

I'm taking 0.5mg twice a day - that's my big question. Is it too much? Should I be taking 0.25mg twice a day to add up to 0.5mg a day?

That may be too much, and I'd hate to see your body acclimate to that high of a dose.  I'm so sorry I didn't catch this sooner, how many days have you taken the 1 mg of Klonopin?

 

Its just to difficult to know how to approach a cross from vaginal to oral while switching benzo's at the same time! 

According to the Benzodiazepine Equivalents Calculator linked below, the average equipotent dose for 10mg of diazepam is 0.75mg of clonazepam.  HOWEVER, the range is quite large — from 0.5mg to 4mg. 

 

How many days have you been taking 0.5mg twice a day?

 

How are you feeling?  Does the above dose feel like too much?  Too little?  About right?

 

 

Link:

Benzodiazepine Equivalents Conversion Calculator

https://clincalc.com/Benzodiazepine/

I had my first 0.5mg dose last night, and my second this morning. I do feel spacey, but my body feels like crap right now anyway so it's difficult to know how to proceed.

Would 0.25mg three times a day make more sense? I just read that that is more of a standard dosing schedule for klonopin? I don't know if what I'm experiencing right now is inter-dose withdrawal, or heightened sensitivity from my MCAD.

Hmmm … two doses doesn’t give us much to go on.  Your statement “Now I seem to have successfully reintroduced klonopin” lead me to think you’d been taking it for longer than that. 

 

Pamster makes a good point about avoiding taking too high of a dose, but you also want to avoid taking too low of a dose. Regrettably, the only person who can determine what the right dose is for you is you.

 

Taking 0.25mg three times a day would give you a total daily dose of 0.75mg.  That’s the average dose suggested by the calculator.  That might be a good compromise between 0.5mg and 1mg.

 

 

Should I try 0.25mg for my dose tonight (at midnight) and again for my dose in the morning (8 hours apart instead of 12), to see if it's ok? My next dose otherwise would be 0.5mg at 11pm and I'm feeling pretty shaky and nauseated

Did you try your 0.25mg experiment?  How did it go? 

Thank you for checking back in!! I took 0.25mg last night before bed and had insomnia and heart palps, and just took my second 0.25mg 45 minutes ago. I think I'm finding that at the very least, my dose has to be more than 0.25mg twice a day. I think 3 doses a day may make the most sense, I just need to get the amount correct

You are most welcome.  Given your reaction, it sounds like the bedtime dose of  0.25mg may not be enough for you.  If 0.25mg three times a day does not work, one option would be to try a slightly higher bedtime dose.  Whatever you decide to try, please bear in mind that it can take as long as 10-12 days for clonazepam to reach steady state with chronic (daily) dosing.