Switching to liquid doses.

I reach half of my taper of K using liquid and pills as you can see in my signature.

I'm using a suspension with Ora Plus of 0.1mg /ml. I crush 10x0.5mg  Accord tablets to get the suspension.

I'm having a difficult time after last reduction.

I was using the liquid dose of 0.125 in the morning as reduction dose. Then took the 0.250 in pill form at night.

Now I want to switch all the doses to liquid.

Question:

-Have you switch from pill form to liquid?

-Have you done it gradually?

-Any symptoms you experience during switching...

 

Thanks a lot in advance for any comments on this issue!

 

 

 

 

I switched directly from pill to liquid late in my taper.  I made my own suspension using water only and I had no problems with this change-over but I used the same pills I had been tapering from but I crushed them and put them in water.  I hope some other members will give their experiences.

When I switched to all liquid (per my signature I use a professionally formulated and prepared compounded oral clonazepam suspension), I held my dose constant for about a week to gauge how I would respond to the change in dosage form.  My observations were:

 

(1) The taste of the liquid was less than wonderful.

(2) The liquid had a slightly faster onset of action compared to the solid dosage form.

(3) The liquid had a slightly shorter duration of action compared to the solid dosage form.

 

Happily, I adjusted to all three differences quickly. 

Thanks both for answering my question. It's hard to find people in the forum talking about this kind of issue.

Libertas, I hear what you say about the differences related to liquid and pills. YES, it tastes bad. I use the one without the  the sweet stuff in it. I've heard also that the percentage of the drug goes down somewhat in liquid form and when switching you might need to increase your dose a tiny bit to compensate that. I guess holding the dose for some time may give the same result.

As you know I'm struggling now after my last cut a week ago. It's an up and down situation. I can sleep relatively well so far but the afternoons have been really challenging in my case. I wonder if holding, thing that I'm doing now, may bring some relief in the near future. I heard it may take 10 days. I still couldn't figured that numbers relationship so far...

 

Libertas/Kate, how many doses you have daily when you switch to liquid. How you did your reductions before the switching? Did you combine them with liquid or where dry cut?

Hello again, micedana.

 

Thank you for adding your signature.  This is very helpful.  However, I’m confused.  In past posts, you indicated you have been dosing three times a day.  Your signature indicates twice.  Have you changed your dosing schedule?  If so, when?

 

Also, can you tell us what your taper rate has been for the past three months?  If you’re not sure, we can calculate this for you.  Just fill in the blanks below:

 

May 1: [insert your total daily dose on this date here]

May 31:

June 1:

June 30:

July 1:

July 31:

Aug 1:  0.35mg

 

Re: increasing your dose when switching from a solid to a liquid dosage form …

 

My personal experience and general observation is that this is not necessary in all cases.

 

When an individual reports that a liquid isn’t as ‘strong’ as the solid dosage form, I often discover other factors are in play.  For example, (1) the individual did not give themselves enough time to adjust to the change in dosage form, (2) the individual made a reduction in dose at the same time s/he switched to liquid or (3) the individual is using a do-it-yourself (DIY) liquid and did not take steps to minimize drug loss during preparation and/or use of the liquid. 

 

Even if such factors aren’t in play, the bioavailability of the liquid dosage form may indeed be different than the solid dosage form (see link below for more information about bioavailability). This is why it’s prudent for individuals to trial the liquid at the current dose to determine how they respond.  If an increase seems to be indicated, they can then trial a small increase (e.g. 5% or less).

 

Re: feeling worse in the afternoons …

 

Is it possible you are experiencing interdose withdrawal between your (now lower) morning dose and your next dose? See link below to learn more about interdose withdrawal and how to resolve it.

 

Re: your question about how long to hold …

 

Everyone is different.  However, a common withdrawal pattern reported by members discontinuing clonazepam is what I have dubbed the ‘3/10.’  After a reduction, it takes about 3 to 5 days for withdrawal symptoms to fully emerge and peak and about 10 to 14 days for symptoms to stabilize (in the context of benzodiazepine withdrawal, stabilize means symptoms stop changing in number and/or intensity, not disappear entirely). 

 

In closing …

 

Your decision to hold your dose constant while we investigate what might be causing the symptom uptick is a sound one.  One of my working hypotheses is that you may need to adjust your taper rate downward.  If memory serves, you have taken and discontinued clonazepam twice before.  I do not wish to alarm you, but you should be aware that repeated use and discontinuation of benzodiazepines has been reported to result in more severe withdrawal symptoms in some cases (see Kindling link below).

 

Links:

 

Drug Bioavailability - Merck Manuals Professional Edition

https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-bioavailability

 

Interdose Withdrawal - Benzodiazepine Information Coalition

https://www.benzoinfo.com/interdose-withdrawal/

 

Kindling - The Alliance for Benzodiazepine Best Practices

https://benzoreform.org/kindling/

 

-Hi Libertas! Thanks again for your time and efforts!

 

Below the plan reduction I had started on 04/19 (step #1). It may answer your questions about my the taper rate and how I was reducing.

I'm feeling a bit better but still up and downs.

As per the taper, I always used the first dose (liquid) as reduction dose. My plan was to switch to all liquid at step 100 and start liquid even doses during the day. I'm wondering because I didn't do it before, it probably became a factor for the symptoms now, besides the fact that I'm a bit less than half way from the end and that's when to push the brake pedal a bit.   

 

-I had two holds for traveling, plus the last 6 days of this week, for aprox. a total of 28 holding days. That's why I'm still at 0.350 mg (step 80).

 

-My symptoms started aprox. at step 73 of the taper. After the symptoms mildly appear I tried to split the 1/2 pill night dose in 1/4's (afternoon and night) but that impact my sleep. Went back to 1/2 pill a night afterwards. That's why I wrongly put different info in my profile and what I posted to you. 

 

-Definitely I would like to have even doses once the storm passes. All liquid is going to be my option for now.

 

-The issue will be the transition and how many doses a day. Two may help reducing each dose daily and I will use the same

program. If three , I probably had to rotate the cut on each dose every other day as you say.

I could also start with three doses adding a liquid one in the afternoon and leave a quarter of a pill for the night as a transitional way of doing it. Then perhaps go to two.

 

Libertas I'll really appreciate you opinion on all this.

Let me know if there is any use with the graphs.

I should know better because I did this two years before. But with this poison every taper is unique and I even can't remember how I did it. 

 

Thanks,

 

Mice   

 

Ps: < Hitting on graphs make them larger>

 

 

Is there a reason you chose linear reductions instead of percentages? That's probably one of the biggest issues I can see. Every time you keep going down in fixed increments, your percentages increase.

 

It's really important to stay on top of your percentages.

jelly baby:  I couldn’t agree more! 

 

micedana:  You have just experienced one of the major downsides of tapering by fixed amounts instead of using a taper rate (and your symptoms) to guide your taper.  Your initial taper rate was 10% every two weeks (aggressive, but do-able by some individuals).  By the time you began to experience issues, your taper rate had increased to 16.67% every two weeks.

What jelly baby just said is important!! Libertas, also!! I followed Ashton, who does fixed reductions and got into a world of trouble. Boy, was I sick! When I switched to a DLMT and % reductions, everything went smoothly.

 

Hope this helps,

 

Katz

Thanks for the comments!

Yes, Is true. The cuts should have gone down when I reach the 0.500mg. I thought about that. Looking at Ashton guidelines I was in compliance starting at 9 % but it was on the higher side for sure. I had the concept that you can go and cut higher at the beginning given the relative short time of use and slow at the end.

I thought too that planning holds, that I was going to do, would make the percentage go down as it did to average 7 + % every 14 days in my 100 day of taper.

Hope the flag was raised at the right moment and there is a point of return. 

As I said I was doing relatively ok until a week ago and I understand the issue of doing it slowly. I'm kind of an old school BB where percentage was not much considered and the taper had to be somehow proportional to the time of use meaning long use long tapers. Short use shorter tapers.

Well, and now what? I guess I have to keep waiting to stabilize and then start a more comprehensive slow reduction with more even doses and low cuts.

I know I probably screwed up. I'll welcome any any strategies you guys may come up with as of how to continue with this .

Thanks for the time and patience with me!

Mice

You did not ‘screw up,’ micedana.  Benzodiazepine discontinuation is a trial and error process for all of us.

 

The good news is you are taking the first step toward getting your taper back on track — that is, holding your dose constant to determine if your withdrawal symptoms will stabilize at the current dose. 

 

Re: next steps ….

 

Have you been keeping a daily taper log?  If not, might I encourage you to do so?  It can be a simple as the date, the times and amounts of your doses, and two ratings: one for your withdrawal symptoms and one for your functionality level that day.  For example, you could use a scale of 0 = no symptoms, fully functional to 10 = intolerable withdrawal symptoms, completely non-functional.

 

If I were in your shoes, I would keep my evening dose at 0.25mg in tablet form and use the DIY suspension for your morning dose. 

 

Although you’ve only been taking clonazepam for a relatively short time this time, please bear in mind that your two previous instances of use/discontinuation have the potential to make a third discontinuation more challenging. 

 

Consequently, if you are able to stabilize at your current dose, I suggest you consider restarting your taper at a conservative rate, perhaps 5% or even 3% to ‘test the waters.’  If all goes well, you can then increase your taper rate.  Generally speaking, it is far easier to speed up a ‘too slow’ taper than it is to slow down and recover from a ‘too fast’ taper.

 

 

micedana, of course you did all of this with the best of intentions, so don't beat yourself up too much. It's just important to be flexible with your taper. The biggest drawback of DMT is cuts catching up with you which I think happened in this situation. We cannot foresee everything, but at least if we taper with percentages we know when we go out of range it might get tough and be prepared to intervene sooner rather than later.

 

I think you should hold for a couple of weeks. I don't think it was a catastrophic mistake. I think you'll be able to recover. And then I think you should slow your taper down and monitor your percentages. That's what I would do. (And I also agree with all of Libertas' suggestions).

 

Thanks for your encouragement and advice Jelly!

 

Looking at your profile when you started DMT, your total dose reduction during the three plus months period looks similar to my taper history, although I held during that time and the rate was probably way higher than yours (9.3). I'm curious, what was the reason that  made you take such a long hold? Noticed too that you reduced your taper rate a bit afterwards. Give or take I'm going thru a similar situation with the Qty reduced number and timing. Could you share with me the numbers and what kind of taper reduction were you on (percentage?). How did you reacted to DMT? How many doses x day?. 

Thanks,

Mice

 

 

04/23 start DMT

05/06 0.821

05/19 0.731

06/07 0.653

06/20 0.600

07/04 0.546

07/16 0.507

07/31 0.459

08/14 0.425

08/24 0.400 (hold)

10/15 0.374

Gosh,  I'm trying to remember with benzo and Covid brain. 

 

I think my cuts caught up with me. It was just too much. I struggled with severe headaches and pressure and needed to hold. It took about 4 weeks before I started to feel any improvement and another 2 weeks to feel stable.

 

I could never manage filing and weighing so decided to try DMT. For the most part it worked. I've also done some  cut and hold in-between to test my percentages and see what I'm comfortable with.

 

I dose only once a day. Hope that answers your questions.

Thanks Jelly!

I had covid too! it was last June. I was overseas! Lasted for a week thank GOD. It made the withdrawal symptoms to ramp up big time! No issues after three weeks.

I'm still in a valley of symptoms that come and go now. I feel VERY sensitive to everything. I think the high anxiety induced by the withdrawal is the main factor in my situation specially late in the morning after my liquid dose. It last way into the afternoon, then it fades. I don't want to blame the liquid itself but Cortisol picks up during that time too. I work swing shift starting at 1 pm so, the perfect storm. I was wondering if the dose is not big enough. I'm leaving the 0.250mg -pill-for late at night. So far sleeping has not been an issue. Even the doses will imply switching all to liquid and I don't think is the time yet.

Talked to my doctor and she agreed to continue holding. She suggested to go up a bit to 0.125 mg in my morning liquid dose of 0.100 mg. That would put me back to the dose I had before the storm started. Decided to hold the same quantity for now.

Did you symptoms plateaued during your hold?

Noticed in one of your comments that your symptoms ramp up in the afternoons also and lessen at night like me. Are you still experiencing the same?

You are so close to the end! Hope you have a soft landing!

Thanks for the help!

Mice

I do remember last year my symptoms were more prominent in the morning and seem to lessen in the afternoons. This year I've barely noticed any symptoms as I've slowed my taper right down due to long Covid. I've been very sick with long Covid and I just couldn't handle those symptoms with withdrawal on top of it. So I've managed to taper and see some very good improvements in my long Covid symptoms.

 

It is really difficult to pin point what might be causing setbacks. In my experience most of the time if you're able to connect it to percentages, then I'd say it's probably a taper that's been too fast. When I was holding, initially I was very discouraged because I did not see any improvement whatsoever. Then it started getting better very slowly and once recovery started, it picked up speed and within 2 weeks I felt ready to taper again. However, this is a very individualised journey. I see some people who need to hold for much longer and others who turn a corner much earlier.

 

I know this is frustrating, but I do think you're doing the right thing by just holding for now and not making any changes. Please keep us updated on how things are going. 

Hi everybody.

-It's been almost three weeks holding and I feel somewhat stabilized with ups and downs but tolerable. Anxiety is high sometimes but I'm functional and can go to work

normally. 

-I decided to continue holding probably till the end of the month.

-In the mean time I decided to switch the night dose, while on hold, from 0.250 mg to a liquid dose of 2 ml (0.200 mg). The remaining 0.050 mg taken from the night dose I

added them to the late morning liquid dose that went from 0.100 ml to 0.150ml. The reason was that most of my symptoms have been in the afternoon and there was not only

a long time between doses but also a size and media differences.

-The other issue is that sooner or later I'll have to start reducing and I'll get to a point where pill cuts are not going to be precise when I reach less than 0.250 mg , those will

be 1/4's not scored from from half of 0.5 mg pill. So turning the night dry dose to DMT is risky but had a lot of sense to me.

-It's been two days and so far I noticed a relief in symptoms during the afternoon. Feel somewhat different, more sedated but ok. I'll be on hold for a week or so and see how it

goes. Hopefully it'll continue this way!

-Wish me luck!

 

Mice

 

 

 

Thank you for the good news update, micedana. Tip of the hat for taking such a thoughtful and considered approach to your taper.

 

It sounds like you are benefitting by evening out your doses. 

 

Am I understanding correctly that your new daily dosing schedule is:

 

1.5mL of a 0.1mg/mL liquid in the late morning (0.15mg of drug)

2.0mL of a 0.1mg/mL liquid in the evening (0.2mg of drug)

 

Thanks libertas,

 

Yes, as you mentioned my "late morning" dose is now 0.150 ml,  it was 0.100 ml before.

 

The night dose was 0.250 mg (half of a 0.5 pill) and now is 0.200 ml.

 

I thought of switching 0.025 mg instead of 0.050 mg. May be it was a little aggressive to not only do that qty change (0.050) but also convert the whole night dose to liquid.

It's been only 1 night. Do you think just stay the course and only "IF" it gets ruff go to to a lesser change of say 0.025 mg instead?

so in this case the doses would be: 0.125ml in the morning and 0.225ml at night. I could do that progressively in a week or so...

Let me know what you think

Thanks

 

So sorry Libertas! I'm messing things up with "ml" and "mg" 

My doses are 1.5 ml in the morning and 2 ml at night.

My suspension ratio  is 0.1mg/ ml.

My total daily dose is 0.350 mg that in liquid form is 3.5 ml.

As you could see my obsession is with "mg".

So where you saw 0.100 ml I meant 1 ml.

Hope the above has more sense.

SORRY!

 

No apologies needed.  I just wanted to make sure I understood your doses before I responded to your question. 

 

To summarize ….

 

Your Previous Dose was:

Morning 0.100mg in liquid

Night 0.250mg in pill form

 

Your New Dose is:

Morning 0.15mg in liquid

Night 0.2mg in liquid

 

Changes made: Increased morning dose by 0.05mg, decreased night dose by 0.05mg and changed dosage form of night dose from pill to liquid.

 

Observation: You made multiple changes at the same time so if issues occur, we won’t be able to determine which one might have caused them.

 

I’m the cautious sort, so I probably would have made the changes in stages as follows:

 

Stage 1: Change night dose from pill to liquid; evaluate reaction

Morning 0.100mg in liquid

Night 0.250mg in liquid

 

Stage 2: Move 0.025mg of night dose to morning; evaluate reaction

Morning 0.125mg in liquid

Night 0.225mg in liquid

 

Stage 3: Move another 0.025mg of night dose to morning, evaluate reaction

Morning 0.15mg in liquid

Night 0.2mg in liquid

 

Thanks Libertas! You are my guard angel in the forum!

 

That was exactly what I was thinking today! The fact that it has been rough in the afternoons turn me towards to have a more robust dose during this time period without taking account of the other variables like night dose switching to liquid and the 0.050 mg dose change somewhat large.

It's only been one night since the change. I noticed a difference and that is I'm more sedated during the day. Last night was the first time I took the whole liquid dose already reduced.

I really don't feel comfortable going forward with the changes now that we talk about it. That's why I posted the plan.

I will continue the switching of the night dose to liquid. The thing is if I should go to the original 0.250 mg (2.5 ml) directly tonight or just step down to 0.225 mg first and reach the original dose of 0.250 mg tomorrow. Same thing with the morning dose 0.125 first and then 0.1 (1ml).

I can take the late morning dose at noon and have the night dose a bit earlier. That may help shorten the big gap I had between the morning and night dose that could have caused some symptoms besides the difference in Qty with the night dose.

Please let me know your opinion on this.

Mice

 

 

 

You are most welcome, micedana.  I’m glad I can help in some small way.

 

Your idea of a more gradual change back to your original dose makes sense to me as does a gradual adjustment in the timing of your doses.

 

Please keep us posted!

Hi Libertas!

 

Finally I went back on Sunday to my original form and Qty dose of 1 ml / 0.25 mg (1/2 of a 0.5 pill). I feel somewhat better. The past week changes probably would have worked if I pushed it but with this monster is always better to stand in known waters.

As you know the intended change was to make the doses more even and have a more robust dose in the afternoon where my symptoms are more noticeable.

I work swings shift starting at 1PM so driving and facing 10 hs of work could be an issue too. I know stress situations triggers my symptoms big time. I'm still blessed I can do it!

 

Regarding the possible causes of those symptoms increase besides work and low liquid dose, I noticed that Ora plus has an ingredient called  Carrageenan. I investigated further and to my surprise the consumption of it elevates Glutamate like MSG does. We know here that increasing glutamate doesn't help at all in our condition.

I don't know exactly if the qty on Ora plus is big enough to have a big impact in our mood with such low doses. BUT is something we should be aware of.

I enclose an article below describing Carrageenan. It's effects and what foods to avoid.

Let me know your opinion on this issue.

Thanks,

Miguel

 

https://unblindmymind.org/carrageenan-and-the-glutamate-connection/

 

https://www.angelfire.com/tn/moonlodge/carrageenan-msg.htm