Just started liquid taper of klonopin

Hi,

 

I had my klonopin prescription mixed by a compounding pharmacist and I was given a syringe along with the solution.

 

After taking the initial dose for 1 week of 5 ml three times daily, I decided to go down to the next increment of 2 cc lower, making it 4.8 ml three times daily. This is a cut of 4 percent overall.

 

I find it very hard to get the dosage exact (lining up the medication suspension to the proper line).  Any suggestions? 

 

Thanks. 

Can you tell us more about the difficulty you are experiencing?  For example:

 

Are you having difficulty seeing the level of liquid in the syringe barrel?

 

Are you having difficulty moving the syringe plunger to the desired graduation mark?

 

Something else?

 

Also, did your compounding pharmacist provide you with a press-in bottle/syringe adapter?

I am having trouble with seeing the the level in the barrel,

 

And difficulty moving the syringe plunger to the desired graduation mark.

 

 

 

I don’t know.  I received a plastic piece that stays in the bottle so when I take the bottle out of the fridge I just measure the amount each time.

I’m glad the compounding pharmacist included a press-in adapter with your medicine bottle.

 

Re: seeing the level of liquid …

 

Three thoughts:

 

(1) A hands-free, lighted magnifying device might help.  For example:

 

YOCTOSUN LED Head Magnifier, Rechargeable Hands Free Headband Magnifying Glasses with 2 Led, Professional Jeweler's Loupe Light Bracket and Headband are Interchangeable (available from Amazon USA at https://a.co/d/j2sB7xd)

 

(2) Are your syringes clear or amber colored?  I personally find the former easier to read than the latter.

 

(3) Is your liquid colorless?  If so, you could ask your compounding pharmacist if it would be possible to add a colorant.

 

Re: moving the syringe plunger …

 

Possible causes of this include a defective syringe or loss of lubricant inside the syringe barrel.

 

Did your compounding pharmacist provide you with multiple syringes?  If so, have you tried using a different one to see if you have the same issue?

 

Have you been rinsing or washing the syringe after each use?  If so, the lubricant inside the barrel may be wearing away.  Ways to address this include using a new syringe or dabbing a tiny amount of food-grade mineral oil on the rim of the plunger piston.

 

A question and a suggestion …

 

What is the nominal volume of the syringe you are currently using?  5mL?

 

As the volume of liquid you are measuring decreases, I encourage you to ask your pharmacist to supply you with 3mL, 1mL, and perhaps even 0.5mL syringes to improve measurement accuracy (to learn more, see link below).  Also, in case you aren’t aware of it, 1mL are syringes available with graduation marks every 0.01 milliliters.

 

Link:

Using the Right Liquid Oral Syringe and Giving the Correct Amount

I did call up the pharmacist and she was very nice.  I told her my problem.  She gave me two 1 ml syringes that have .1 ml gradations which makes it much easier for me to measure the remaining part of a dose.  I put 4 ml in the larger syringe and .8 ml in the smaller syringe.  Seems to work. 

Thank you for the update, kestrel28.  It sounds like you have a supportive compounding pharmacist!

starting on 4.6 ml 3 times per day as of today.  yes, i am nervous,  but, i think keeping it in three dises for now is going to be okay and prevent complications.  at some pint down the road, i want to make the jump to twice daily, but that won't  be until a few more weeks until i figure out the logistics. 

 

right now, i need to learn not to stress mysekf out with taking on too many things.  currently undergoing tms therapy.  mood is better but anxiety and irritability sometimes is still there.

 

sleep is good.

 

 

 

Hello again, kestrel28. Thank you for touching base.  Rest assured you are not alone in experiencing anxiety over making a reduction in dose.  However, you have a sound tapering strategy in place and are making a reduction that is well within our 5-10% guideline (actually, a bit lower at 4.2%).

 

Might I ask why you want to change your daily dosing schedule from 3 times a day to 2 times a day? 

 

You are spot on that keeping your stress level as low as possible is important.  I hope the tms therapy is helping you and am delighted your sleep is good.

 

Something that helps if you have a press in adapter in the bottle, meaning that liquid doesn't come out when you take the cap even turning the bottle upside down, is to insert the syringe placing the plunger half way out before insert it and then pushing the air inside the bottle, bottle must be upright. Then pulling the plunger will make the liquid fill the syringe barrel without bubbles or air gaps at all.

In my experience with liquid I noticed marks on the syringe may worn out after a while needing to replace syringes more often. They are in the exterior of the syringe. To avoid that you can wrap the exterior of the syringe with clear package type of scooch tape.

Below a site (I don't have any commercial or business relations with it) with different type of syringes with 0.001 ml marks. It will help if you have to reduce by 0.001's.

Hope all this also helps,

Mice

 

https://www.vitalitymedical.com/oral-medication-syringes-with-catheter-tip-by-monoject.html

It’s a real bother to be taking benzos three times a day in liquid form.  Before, it was easier to take the pill wherever I was and then take it. Now I have to worry about refrigeration of the liquid? I am tired of my life revolving around this awful substance. 

I hear you about not wanting your life to revolve around tapering.  Let us know if you’re interested in kicking around ideas on how to make using the liquid less onerous.  Also, just checking … are you aware that changing your dosing schedule has the potential to cause interdose withdrawal? 

Yes I’m fully aware of interpose w/d.  Have experienced it for years.  Perhaps if there is a way I can keep my 2nd dose cold in a portable cooler or 2nd dosing syringe then I would be amenable to that.  This being new to me, if I ever went away for a weekend stay I would have to inquire about refrigeration.  Anyone ever have a portable refrigerator? I have seen them for cars but do not know if they are effective.  I live in the northeast u.s., so keeping something cold is less of a problem than being in another area with high temperatures.

If you have not already done so, you might want to ask your compounding pharmacist about how strictly you need to adhere to refrigeration after a dose has been loaded into the syringe.  If refrigeration is definitely required, one option to consider would be to use an insulin cooler travel case.  Amazon offers multiple types/sizes.

Yes, I know what you mean having to dose three times a day and try to keep it refrigerated. 

I don't know what kind of media suspension you are using. In my case I use Ora plus. I called the manufacturer and they told me that once opened it can be kept at room temperature up to 2 months. They said that refrigeration is better but not necessary.

As far as the 3/2 doses, I pushed it at the very beginning and I'm taking two a day. Ashton advises in her manual to skip - if possible- the third dose if taking a long 1/2 life benzo. It is a way to avoid getting stick to the drug physically and psychologically and get use to coupe without the drug. I have a gap between 8/10 hs. between doses. So I take the first dose before going to work and the last dose when I get back home at night. In this way I can leave the bottle in the fridge. Although as I said no necessarily. (see STORAGE in the link below).

Hope it helps,

Mice

 

http://inphonet.albertahealthservices.ca/pharmacy/ahs_recipes/viewrecipe.asp?id=45

 

Yes, I know what you mean having to dose three times a day and try to keep it refrigerated. 

I don't know what kind of media suspension you are using. In my case I use Ora plus. I called the manufacturer and they told me that once opened it can be kept at room temperature up to 2 months. They said that refrigeration is better but not necessary.

As far as the 3/2 doses, I pushed it at the very beginning and I'm taking two a day. Ashton advises in her manual to skip - if possible- the third dose if taking a long 1/2 life benzo. It is a way to avoid getting stick to the drug physically and philologically and get use to coupe without the drug. I have a gap between 8/10 hs. between doses. So I take the first dose before going to work and the last dose when I get back home at night. In this way I can leave the bottle in the fridge. Although as I said no necessarily. (see STORAGE in the link below).

Hope it helps,

Mice

 

http://inphonet.albertahealthservices.ca/pharmacy/ahs_recipes/viewrecipe.asp?id=45

 

Thank you for lending a helping hand to kestrel28, micedana!

 

I wonder if you would be so kind as to direct me to the section in the Ashton Manual where she indicates it’s advisable to skip a third dose of clonazepam for the reason stated above in bold?

 

The only section I’ve found on this topic is this one where she references diazepam, not clonazepam:

 

Diazepam is very slowly eliminated and needs only, at most, twice daily administration to achieve smooth blood concentrations. If you are taking benzodiazepines three or four times a day it is advisable to space out your dosage to twice daily once you are on diazepam. The less often you take tablets the less your day will revolve around your medication.

 

 

 

Libertas,

You are right! Ashton made the reference to Diazepam and not clonazepam. This was a mistake of my part and good you brought it up.

I had read the text long time ago and I thought it would also apply to Clonazepam being it also a long 1/2 life Benzo as Diazepam (Clonazepam has a 1/2 life of 18-50 hs. compared to Diazepam 20/80).

I still think, and is just my experience that the same concept of dosing (twice a day) may be applied to Clonazepam given the similar 1/2 life in a 24 hs. span. It depends of course of each individual situation.

Thanks again for the correction. I can't trust my benzo ruined memory as yet! 

Mice

 

Thank you for the clarification, micedana.  Here’s what Ashton has to say about clonazepam:

 

Some doctors in the US switch patients onto clonazepam (Klonopin, [Rivotril in Canada]), believing that it will be easier to withdraw from than say alprazolam (Xanax) or lorazepam (Ativan) because it is more slowly eliminated. However, Klonopin is far from ideal for this purpose. It is an extremely potent drug, is eliminated much faster than diazepam … It is difficult with this drug to achieve a smooth, slow fall in blood concentration, and there is some evidence that withdrawal is particularly difficult from high potency benzodiazepines, including Klonopin.

 

Here’s what the Benzodiazepine Information Coalition has to say about dosing multiple times a day:

Depending on the half-life of their particular benzodiazepine, many patients find it helpful to take a dose several times per day (while keeping their total daily dose the same). Patients who dose evenly and at regular intervals may be more likely to complete a successful benzodiazepine taper because they don’t experience peaks and valleys in drug serum levels throughout the day that may make discontinuation intolerable.

 

For example, some patients taking diazepam benefit from evenly dividing their doses and taking it two or three times a day; some on clonazepam benefit from dosing three or four times a day; and some taking lorazepam need to dose four or five times a day. Some patients on alprazolam require five or six doses a day just to maintain steady serum levels. Where possible, all doses should remain as even as possible (measured in milligrams) as well.

 

Citation:

Benzodiazepine Tapering Strategies and Solutions - Benzodiazepine Information Coalition

https://www.benzoinfo.com/benzodiazepine-tapering-strategies/#dosing-multiple-times-per-day

 

You are correct that the bottom line is each individual has to discover what dosing schedule works for them.  What works for one individual may not work for another — we’re all different.

yes, thank you for posting that ashton manual description. 

 

Looking back, what got me into real trouble over three years ago was when I eliminated the middle dose of Klonopin.  Well, what was in good faith turned out to be a nightmare. 

 

After that middle dose was stopped, I went into a psychosis for many days (slept as little as one hour per day, did weird stuff, got extremely paranoid, didn't feel safe, and was having hallucinations.  I know for a fact that this can happen during withdrawal, and it was so bad that I had to go inpatient for them to stabilize me back on k. 

 

So, I probably am not going to jump from three doses to two;  it's too risky for me,  especially since I've been on this for 31 years. 

 

I suppose I can ask my pharmacist if the medication needs to be refrigerated, but, as I see on the bottle, it says "shake well and refrigerate" so I think that answers my question regarding portability--I will have to take an extra syringe(s) in a cooler when I go away for the day. 

 

 

You are welcome.  Given what you experienced when you eliminated your middle dose three years ago, I agree with you that trying this again would be risky.

 

Re: refrigeration …  the formulation micedana shared with us earlier indicated the compound produced  ‘Can be stored at room temperature or refrigerated.’  This makes me wonder if a syringe  ‘pre-loaded’ with the desired volume of compound could go without refrigeration for a few hours if protected from light (clonazepam is subject to photolysis).