Jump to content

Liquid Compound Taper


[De...]

Recommended Posts

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.

Link to comment
Share on other sites

Hello, Determinedtoheal22 (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?

 

 

Link to comment
Share on other sites

Hi Libertas,

 

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.

Link to comment
Share on other sites

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.

Link to comment
Share on other sites

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.

 

Libertas 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.

Link to comment
Share on other sites

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.

Link to comment
Share on other sites

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

 

Link to comment
Share on other sites

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.
Link to comment
Share on other sites

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.
Link to comment
Share on other sites

Hi Libertas,

 

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.

 

Link to comment
Share on other sites

The bottle is 240 ml and I would prefer to just do the liquid. I am trying to slowly walk off the benzo if I can. At this point I am 3 days in taking .4ml/.4mg in the morning and .4ml/.4mg at night.

 

I understand to take 10% is daily dose but how does a micro taper work? Is it easier on the body?

 

We can take 10% of daily dose forever or it will take forever to get to 0.025.

 

Any ideas?

 

Thanks.

 

Link to comment
Share on other sites

Libertas,

How would you lay out a micro taper? I am at .8 mg. I have a 240 ml bottle and I have 10ml syringes with 0.2 ml tickets between each ml. I asked the pharmacist for a 1 ml syringe with 100 ticks but he did not have one. He said going down 1 ml every two weeks is a micro taper. I want to be able to slow it down and dose out even smaller once I get to 3 ml and 1 ml I think.

 

This forum is filled with so many horror stories and I want to try to avoid them as I have my own horror storey with the ativan withdrawal that I am still healing from. That’s why I was put in Clonazapam.

 

Thanks,

Trena

Link to comment
Share on other sites

Tapering is all about experimentation. Each of us has to discover what works for us as unique individuals through trial and error.

 

Here’s one way you could approach this.  I hope other members will share other approaches for your consideration.

 

Given your measuring device and the concentration of your liquid, you could try reducing your dose by 1 line/mark per day for 30 days.  You could alternate the reductions between your two daily doses (on Day 1, reduce your morning dose by 1 mark; on Day 2, hold your morning dose at the same level as Day 1 and reduce your evening dose by 1 mark, etc.).

 

I strongly encourage you to keep a daily taper log, including global ratings of your symptoms and functionality.  If you notice an uptick in symptoms or a decrease in functionality, hold your dose constant until they return to baseline.

Link to comment
Share on other sites

If I do one tick mark a day for 30 days that will be well above the 10% decrease. Do people find micro tapers work better? I know everyone is different I am just so sick of feeling this intense sadness and fear. I want to be me again and get back to work.
Link to comment
Share on other sites

My apologies.  I based my initial calculations on a liquid with a different concentration than yours.  We have many members and it’s challenging to keep up with who is doing what.  It would be very helpful if you would add the concentration of your liquid as well as your taper history (dates, dosing schedule, amounts) to your signature so all members can see your current status at a glance (instead of having to read through multiple posts).

 

One line/mark on your current syringe = 0.2mL

 

0.2mL of a 0.1mg/mL liquid equals .02mg or 20 micrograms

 

That’s the smallest reduction you can make given your current measuring device (unless you feel comfortable eyeballing between the lines).

 

To decrease the taper rate, you could change your taper interval from daily to whatever works for you.

 

Or you could get a 1mL syringe with 100 lines/marks.

 

ADDENDUM:

 

Upon further reflection, here’s how you could reduce your dose by 10% over 28 days using a microtaper with a one-week reduction interval and your current measuring device:

 

Starting Dose: 8mL

Reduce to 7.8mL, hold for 7 days

Reduce to 7.6mL, hold for 7 days

Reduce to 7.4mL, hold for 7 days

Reduce to 7.2mL, hold for 7 days

 

At any point, if your symptoms began to increase or your functionality began to decrease, you would continue the hold until you returned to baseline.

 

Alternatively, if you decide you wish to make smaller reductions more frequently, you could ask your compounding pharmacist about ordering 3mL and 1mL syringes from Medisca at:

 

https://www.medisca.com/products/compounding-equipment/applicators-and-dispensers/syringes

 

Link to comment
Share on other sites

From the experience here do people find micro tapering more tolerable? Also to keep the drug stable in my blood would I alternate the drop between morning and night? And if I remember correctly the drop off point for Clonazapam is 0.025 correct? So if I got down to 0.02 I would be able to walk off ( hopefully). Also, when you refer to baseline do you mean my normal self? I have not been stable at my normal self for quite some time. I was inter dose withdrawing on the Ativan. Really I haven’t felt like myself since August.
Link to comment
Share on other sites

Microtapering works for some individuals but not for others. The only way to know if it will work for you is to try it.

 

Would you feel comfortable eyeballing between the lines on your 10mL syringe so you could reduce both your morning and evening dose by approximately 0.1mL each? If not, then alternating 0.2mL reductions between your morning and evening dose makes sense.

 

In this community, baseline does not mean ‘return to your normal self.’  Instead, we define baseline (also referred to as ‘stability’ or ‘being stable’) as (1) withdrawal symptoms are not changing in number or nature and are tolerable and (2) able to perform essential daily tasks (needless to say, these vary by individual … for example, you’ve shared that you are the mother of two young children so your essential daily tasks are quite different from those of a older person who is retired and lives alone).

 

My understanding is that the 0.025mg quit dose for clonazepam you’ll read about here on the forum is a ‘guesstimate’ based on Heather Ashton’s suggested diazepam quit dose of 0.5mg.  As far as I know, there is no empirical evidence to substantiate this. 

 

What is your definition of ‘walk off’?  If it’s ‘return to my normal self,’ then there is no such guarantee.  Taking a benzodiazepine changes the structure and chemistry of the brain/nervous system.  After you have removed the drug, the brain/nervous system has to ‘undo’ these changes.  This takes time.

Link to comment
Share on other sites

Isn’t the point of a slow taper to allow you brain and cns to adjust to the decrease? It’s disheartening that we go through such agony to taper and then have bad withdrawal anyway. I’m not sure I can do it.
Link to comment
Share on other sites

The point of a slow, gradual taper is twofold: (1) to keep withdrawal symptoms tolerable and (2) maintain the requisite level of functionality while discontinuing the drug.  Although it is thought that some ‘repair work’ occurs during the tapering process, the collective experience of this community is that there is still work to be done after the drug has been eliminated from the body.  One of our members wrote a post about this a while back that you may find of interest:

 

Four Phases of Withdrawal

http://www.benzobuddies.org/forum/index.php?topic=156111.msg2089263#msg2089263

Link to comment
Share on other sites

Half life of clonazepam in plasma concentration  is between 40 to 50 hours. Some lower that value as low as 20 and as max as 60.

The effect of the decrease in dose is individual. As a rule of thump clonazepam starts to act after 1 hour and reach it's max pick in about 4 hours. It's effects last an average between 6 and 12 hours depending of the individual.

Nobody can tell if this values can apply to you. It's only a reference from manufacturer information and medical experience.

Psychological and physical conditions affect how this numbers play on you.

In my experience, is primordial to have a plan, stick to it, tweak it as the time goes by and be less obsessive about what others do.

Hope this help you!

Mice

Link to comment
Share on other sites

With clonazepam on average people seem to start feeling the decrease in dosage around day 3 and level out around day 10. I had my first safe cut and that was exactly what seemed to have happened to me. I'm just struggling from a previous too rapid withdrawal.
Link to comment
Share on other sites

×
×
  • Create New...