Liquid Compound Taper

[[Buddie]]

Hi,
I have a liquid compound of Clonazapam made from a children’s hospital formula. It is 0.1mg/ml. How do I do a slow taper from there? I was trying a 10% then hold for 14 days. Yesterday was 14 days and I actually felt stronger than I have through this whole process. So I did my second drop to 0.8 mg and woke up with some of the symptoms coming back already. How do I do a micro taper? Do people have more success with that? Do I need a very precise syringe?

I’d appreciate any help.

[[Buddie]]

Hello, [...] (great username by the way).

There are advantages and disadvantages to every approach to tapering,  Each of us has to discover through experimentation what works best for us as individuals.  Given your withdrawal pattern (14 days to stabilization), you might want to consider making a series of small daily reductions followed by a hold for several days.

Would you please give us specifics regarding your daily dosing schedule?

When you began your taper, how many milliliters of the compound did you ingest?  At what times?  Did you use liquid only or did you also take part of your dose(s) in tablet form?  If so, how many milligrams per dose?

Am I understanding correctly that your first reduction was from 1mg to 0.9mg total daily dose (TDD) and your second reduction was from 0.9mg to 0.8mg TDD? If so, then your first reduction was indeed 10% but your second reduction was 11.11%. (We typically calculate percent reductions based on the previous TDD not the starting TDD.)

Addendum:  What is the capacity of the oral syringe you are currently using?  What are the numbers on the barrel?  How many tick marks are in between the numbers?

[[Buddie]]

Hi [...],

I am dosing 4ml/.4 mg  at 9 am and 4 ml/.4 mg at 9 pm. I am using all compound. I waited 14 days because I really don’t know what “stable” means. I felt strong like I could do it on day 14 so I did. My syringe is in ml with 4 ticks between each ml. So its lists .02 ml. I am so nervous of this whole process so any help you can provide is appreciated.

[[Buddie]]

Thank you for the additional information.

I know this process can seem intimidating at first, but you’ll be fine once you get the hang of it.  Indeed, you’re already ahead of the game because you’ve demonstrated key understandings of percent and measurement.

How many days has it now been since you made the second reduction?  How are you feeling?  I ask because I’m trying to get a sense of what percent reduction you might want to try next.

Re: syringes …

I suggest you ask your compounding pharmacy if they can provide you with a 3mL syringe as well a 1mL syringe with 100 ticks (i.e. one tick = 0.01mL).  Using a 3mL syringe vs a 1mL syringe to measure the first 3mLs of your dose improves accuracy.  Using a 1mL syringe with 100 ticks with a 0.1mg/mL will allow you to make reductions in the range of 0.001mL.

If your compounding pharmacy does not have the above syringes in stock, ask if they can order them for you.  Two high-quality manufacturers to look for are Medisca Precise-Dose and BD (Becton-Dickinson).

If your compounding pharmacist won’t/can’t order syringes for you, you can order them yourself.  Several of our members have had good experiences with:

Oral Medicine Syringes | Vitality Medical
https://www.vitalitymedical.com/oral-syringe.html

Just checking ….

Did your compounding pharmacist supply you with a press-in adapter cap for the bottle containing your compound?  If not, I suggest you request this.

[[Buddie]]

I made the second 10% decrease two nights ago. I’m feeling anxious, tired, have tears, and have tinnitus and clogged/popping ears. Also some shakes. I am paranoid because I had a horrific cold Turkey from ativan and so help me God if I go back there I will loose it. I feel like I’m a sitting duck here waiting for the hard symptoms to come. When do they usually appear after a drop? The syringe I have is precise dose and the bottle does have a press in adapter.

[...] did you successfully get off of Clonazapam and live a normal productive life? I need all the inspiration I can get. I’m currently not working and need to get back to my job. I am also doing both talk and cbt therapy.

[[Buddie]]

Your fear is completely understandable. Let’s do a bit of troubleshooting …

How did you transition from using tablets to liquid?  Did you hold your dose constant at 1mg and give yourself at least a week to observe your reaction to the change in dosage form?  Or, to phrase it another way, did you feel stable on the liquid before you made the first reduction?

Is the following correct in terms of your taper timeline:

Feb ? - 7:   10mL (starting total daily dose, all liquid)
Feb 8:        9mL (10% reduction from previous dose)
Feb 22:      8mL (11.11% reduction from previous dose)

If so, you’ve made two largish reductions in dose over a relatively short timeframe.  The symptoms you are experiencing are your body’s way of signaling this may be too much/too fast for you.  One option to consider would be to return to your previous dose (9mL) while you work on a plan for the next phase of your taper.

[[Buddie]]

Hi determie!
-How big is the bottle of Suspension?
-Do you have pills available to combine liquid and pills?
-The reason is that 0.8 mg is quite a bit of a dose and you are gonna need a prescription very frequently.I would say every 12/15 days if you have a 100 ml bottle.
At that dosage I normally combine pills and liquid having the liquid as the reducing dose, Example: If three doses per day -0.300 mg liquid dose in the morning 0.250 mg in the afternoon and 0.250 mg at night. You normally leave the night dose untouched and reduce the day or afternoon depending if you choose two or three doses per day.
I use this program to do the reductions It's very easy. Just choose liquid and fill the info.
https://benzo.alwaysdata.net/
I can walk you thru the program if you need help.
Mice

[[Buddie]]

I took 1 mg in two 0.5 pills from December to February. As soon as I fit the compound I dropped to 0.9. I dropped the morning dose to 0.4. I held there for 14 days. I  dropped the night dose to 0.4 two days ago. I really haven’t felt overly stable since the ativan ct. Actually since before the Ativan CT when I was interdose withdrawing. I am currently very anxious and always very tired. I also cry a lot. I had a great talk with my pharmacist today and he agreed to not rush it. He thinks it is the Paxil that will be making me tired. 🤷🏻‍♀️I really do not want to updose as I want off of this crazy pill and then the Paxil.

[[Buddie]]

It is not uncommon for individuals to experience the switch from solid dosage form to liquid dosage form as a slight reduction in dose.  So you may be feeling that in addition to the two largish reductions you have made.  Your pharmacist is right — tapers cannot be rushed.  I see you have requested and are receiving input on another thread so I’ll sign off.

[[Buddie]]

Hi [...],

I value your input. Thank you so much. When they say to hold what am I supposed to feel like before I wean again? I haven’t felt good or happy or not anxious in months.