Lower dose than Ashton suggests from K--->V

Switching from K to V.

 

I've been on K, 0.25mg 3x a day since oct 2021. My doctor is on board with switching to V for more muscle relaxant properties while I taper prednisone, then to make things a bit smoother when I can finally taper the V. BUT she did not prescribe what Ashton recommends. I've read so many comments and seen so many different calculations.

 

She's essentially saying 0.25mg of K --> 2.5mg of V. I have the option to go up to 10mg daily though.

 

I am very med sensitive and I think this is her reasoning.

 

I'm adjusting my K schedule from 6am/9am/2pm (who knows why I ended up doing this) to 6am/noon/7-8pm so I can hopefully take a larger dose of V at night for sedation factor, and smaller in the am (eventually.)

 

Will I be ok with this dosing!? It's been super fun transitioning to a new schedule. 

 

As a side note, has anyone noticed that V absorbs better being that it is highly lipophilic (more than K)??

I'm sorry to hear your doctor is putting you on the very low end of substitution practices, but its good she's allowing you to increase it up to 10 mgs. https://clincalc.com/Benzodiazepine/

 

Are you positive you want to switch to Valium, are you dealing with interdose withdrawal?  How long do you plan to take to make the cross?  Your new dosing schedule looks very practical for sleep purposes, is the Klonopin helping with that?

My biggest issue now is pain: I have a very complicated medical situation with cystic fibrosis and lung transplant, along with kidney disease as my big issues. I’m tapering from 20 to 5 of prednisone very slowly and the pain gets much worse for me when I drop down. I’ve tried literally everything avail aside from pain meds which I won’t do. So the thought from pain doctor is the Valium should help the muscle pain more, and allow me to avoid adding another med, then once I’m at goal dose of prednisone I can begin the V taper.

 

I have not been taking K at bedtime but instead more daytime. I’d like to switch to bedtime because I hear it’s more sedating.

 

I’ll be honest I don’t know what inter dose withdrawal is! Like the half life isn’t long enough?

I can see your medical history is challenging and I'm sorry for raising doubts about your doctors plan but crossing over to another benzo can be challenging so I wanted to make sure you're doing it for a good reason.  The two most prevalent side effects being sedation and depression but I'm told they disappear once you acclimate.

 

Interdose withdrawal is when a member will begin to feel withdrawal symptoms before their next dose, typically Xanax users, these are the people we generally see crossover because they're miserable and willing to put up with the side effects of switching.

 

 

That makes sense! I do think I've experienced a little bit of it, but I probably also hit tolerance ages ago. I never went past the 0.25mg.

 

The prednisone taper really flares my myofascial pain syndrome, arthritis, and fibromyalgia. I've got all the things.

 

I am SO scared to start the switch over, but hopefully it will help.

 

My plan is to swap out the PM dose first, 0.25mg K for 2.5mg V. Not sure if that's too fast and heavy or if I should quarter each and take both.....

Unfortunately this process is all about experimentation which can be painful but its the only way we've found to do this.  Just remember that Valium builds up slowly so you'll need to give it time to work which means patience.  You may not feel its working but if you wait long enough, you should start to even out. 

 

I'm so sorry to hear what symptoms you're dealing with by reducing your prednisone, members report feeling these same symptoms when reducing benzodiazepines so I'm afraid you have some rough moments.

You know in thinking about it, the dose of Valium you're crossing over to is so small, I'd probably take at least half of your dose of Klonopin at bedtime and the full 2.5 mgs of Valium, that's more in line with the standard equivalency and it might be a good first test of the cross.

You know in thinking about it, the dose of Valium you're crossing over to is so small, I'd probably take at least half of your dose of Klonopin at bedtime and the full 2.5 mgs of Valium, that's more in line with the standard equivalency and it might be a good first test of the cross.

 

Would you do .25 and 2.5 together....or go to 5mg night?? I do have a feeling the equivalency she proposed is a bit low, but I read V is more lipid something or other (absorbs better) which with my cystic fibrosis, means maybe it will "work" better? I'm a poor absorber.

 

And yes, prednisone taper is HARD. Some drops are easy, some are really hard.

If you have the freedom and supply to add in the extra Valium I think that would be the best for your evening dose.  You'll still have the other doses of Klonopin on board to fill in while the Valium is building up. 

If you have the freedom and supply to add in the extra Valium I think that would be the best for your evening dose.  You'll still have the other doses of Klonopin on board to fill in while the Valium is building up.

 

You have been so helpful, I really appreciate it. I figure since she’s allowed me up to 2 (5mg) tabs a day, I can do 5 at night and 2.5 for the other doses when I introduce them. I will keep you posted! Again, thank you. Is there any guidance for how long the Valium takes to build up? I know it has a very long half life

Its difficult to say how long it takes since we all metabolize medications differently, but Professor Ashton gave her patients 1 to 2 weeks for each dose substitution so it's somewhere in that time frame, you'll have to see what it is for you.  You seem like you have a good plan, I hope the Valium helps with your pain, prednisone can be helpful but it comes with baggage.