Taper schedule

Hello.  I am new to this forum and am actually terrified at this point.  I am not certain I can/want to begin a taper but I do feel like it would help to think about this if I had a plan of action.  I have read the Ashton Manual.  I have no desire to switch to diazepam, but would just want to switch to liquid and decrease SLOWLY.  I have been on 1.5 mg clonazepam for 17 years.  Yep, 17 years.  I have multiple medial issues so I am not even certain it is safe or me to attempt, but I do feel I have become somewhat tolerant and I am afraid.  Can someone assist by showing me a sample taper schedule of decreasing from 1.5 mg of clonazepam in liquid form with a very slow taper?  Thank you and best wishes to all of you!

 

Edit: Title

You mention doubting whether its even safe for to do this, if this is the case its important for your doctors to be aware of your intention to taper from the drug.

 

We don't have sample tapers, each member's situation is unique as are their tapers so what we do is work with the member to determine the best course of action for their needs.

 

You mention using liquid, if this is the case then we'll need to determine if you'll be using your Clonazepam pills and making your own homebrew or if you'll be using a compounding pharmacy.  If you use a pharmacy, your doctor will need to write you a script, would they be willing to do that?

 

Have you watched any YouTube video's about liquid titration yet, it would probably be a good idea so you can see the actual process.  Here are a few Titration FAQ's.

 

You mention going slow, this is a good idea but how slow would you like to go?  We suggest reducing between 5-10%, you could try 5% for your first cut to see how that goes then decide what your next reduction might be.  We believe in symptom based tapers, we ask you to record your reductions and document your symptom severity with each cut, this will inform your next reduction.  So maybe you can see why we don't provide sample tapers, we're all so different so no two tapers are the same.

 

I'm glad you're asking questions, this is the time for you to educate yourself so you can decide if you want to do this.  Lets keep talking, we want to help you figure out what to do.

I agree with Pamster.

 

Each of us has a unique biological profile as well as unique health, medical, and medication profiles.  Consequently, each of us has to discover through self-experimentation what works in terms of a taper schedule (i.e. taper rate and taper interval).  Equally important, we need to be prepared to adjust our taper schedule to keep our withdrawal symptoms tolerable and our functionality at whatever level we need to perform essential daily tasks.

 

For example, individuals who have been taking a high-potency benzodiazepine for many years and have a complex health/medical/medication history may find they need to withdraw very slowly over the course of a year or more.

 

Here’s how long it would take to reach a quit dose of 0.025mg clonazepam starting from a total daily dose of 1.5mg clonazepam using a taper rate of 10% a month, with the 10% calculated on the previous months’ dose (not the original dose).  CAVEAT: This example assumes that adjustments are NOT needed along the way — many/most individuals find they need to adjust their taper rate and/or interval at various points in their taper.

 

Month 0: 1.5mg total daily dose

Month 6: 0.75mg

Month 12: 0.375mg

Month 18: 0.1875mg

Month 24: 0.09375mg

Month 30: 0.046875mg

Month 36: 0.0234375mg

 

Have you decided what taper rate and interval you wish to try?

I had seen other taper schedules and questions regarding taper schedules in other areas and advice being offered so I assumed it was something that was given. I appreciate your listening. I’m really lost. I have a good relationship with my primary care doctor and am certain she would give me this Rx at a compounding pharmacy for the liquid. Due to my other health issues, I would prefer to go as slow as possible. Probably 5%? I need it to be as bearable as possible but of course we all wish for that. So yes, needing to titrate off 1.5 mg using liquid at a rate of 5%. Can anyone give me an idea of what that would look like? And I understand I may need to institute holds, etc on my own. Thank you again for any help. This is hell.

As far as intervals, I’m uncertain? I see an example above showing a 3 year taper. That seems really lengthy, but maybe I’m not understanding? I would like to drop a dose, hold 2 weeks to a month, drop a dose, etc. I’m just horrid at figuring out how this would look. I’m NO mathematician,

To reduce your total daily dose (TDD) by 5%, multiply your current TDD by 0.95 (100% - 5% = 95%).

 

For example:

 

1.5mg x 0.95 = 1.425mg

Thank you. So the next cut would be 1.35 correct? Then take 1.35 x 0.95? And just continue.

You’re welcome.  Yes, your math for the second 5% reduction is correct assuming that all goes well with the first 5% reduction.

 

‘All goes well’ means:

 

- your withdrawal symptoms are stable and tolerable*

- you are able to perform essential daily tasks

- you feel you are ready to make another reduction

 

*Although everyone responds differently to reductions, a common withdrawal pattern for clonazepam is the ‘3/10.’  It takes about 3 days for withdrawal symptoms to fully emerge and about 10 days for symptoms to to stabilize (or begin to stabilize). Stabilize means ‘stop changing’ in type and/or intensity. 

 

Monitoring your symptoms and functionality on a daily basis and discovering your unique withdrawal pattern are important components of tapering.  I strongly encourage you to keep a daily taper journal to record your dose as well as ratings of your symptoms and functionality level (e.g. 0 = no or completely tolerable symptoms, no issues with performing essential daily tasks; 10 = intolerable symptoms, major issues with performing essential daily tasks).

Thank you. It sounds overwhelming as far as getting a correct dose. Liquid sounded easier than a dry taper. I know my physician will order a liquid….I’ll just search for a compounding pharmacy that will make it up for me. I have no idea what the dosage of a liquid preparation should be to get the 1.5 mg daily or what kind of dropper will measure to such accuracy. I want to do it correctly but my mind is a bit scrambled right now.

Learning about benzodiazepine discontinuation and developing a taper strategy take considerable time and effort.  Please try your best to take things one step at a time and avoid rushing into anything without fully understanding what you’re doing.

 

Finding and vetting a compounding pharmacist is an important step. I’ve included suggestions below on what to look for and questions to ask followed by a link to a stability-tested formulation for a 0.1mg/mL oral clonazepam suspension. (Compounding pharmacists may have access to other formulations with different concentrations.  Clonazepam is a potent benzodiazepine so liquids with lower concentrations may be helpful to individuals who discover they need to make very small reductions in dose.)

 

Suggestions for Finding and Vetting a Compounding Pharmacist

 

(1) Gather leads.

 

- Ask your prescriber.

- Ask your pharmacist.

- Contact pharmacies associated with hospitals (especially children’s hospitals) as well as those that work with long-term care facilities.

 

(2) Begin the vetting process (online search).

 

- Does the pharmacy specialize in compounding?

- Is the pharmacy USP 795 compliant? USP 797 compliant?

- Is it accredited (e.g. PCAB)?

- Does it belong to one or more professional associations (e.g. PCAA)?

- Is there any evidence the pharmacy has ‘issues’ (e.g. unhappy customers, quality concerns, business problems)?

 

(3) Continue the vetting process by contacting the pharmacy. 

 

Ask to speak to the lead pharmacist not a tech.  Explain that you are looking for a compounding pharmacy to work with long-term on a gradual, symptom-based taper from whatever benzodiazepine you are taking.  (Compounding pharmacies are businesses.  Learning that you are a potential long-term customer should get their attention.)

 

Questions to ask:

 

- Do you have access to a stability-tested liquid formulation for my benzodiazepine? Does the formulation yield a solution or a suspension? What is the concentration? What are the ingredients?

- What does the formulation use as the drug source? API (active pharmaceutical ingredient) or commercial product (tablets, capsules)?  If the latter, will you be willing to use tablets/capsules from my current manufacturer?

- Do you or a member of your staff have experience preparing this formulation?

- What steps would you take to ensure that the liquid you prepare will have consistent properties from batch to batch?

- Will you fit the dispensing bottle with an appropriately sized press-in bottle adapter to make it easier to measure the liquid?

- Will you provide me with high quality oral syringes with the appropriate nominal volume and graduations to measure the liquid as accurately as possible? Will you instruct me on how to properly use these devices?

- Will you be willing to help me with math if needed?

- My prescriber does not have experience with compounding. Would you be willing to tell me exactly what s/he would need to write on the prescription?

- Can you give me an estimate of how much my out-of-pocket cost will be per fill?  With my insurance?  Without insurance?

- Do you offer a discount or program for long-term customers?

 

Link

0.1mg/mL Clonazepam Oral Suspension from Nationwide Children’s Hospital

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

I am terribly confused and looking for direction. I don’t know how to add my history so I do understand it makes it easier to reply once I’ve done that, and I’ll attempt it later today.

I haven’t started the taper process. I’ve been on 1.5 mg clonazepam for 17 years. I’m also a person with multiple autoimmune system issues and one of them is quite serious. I read this forum and think….this will kill me. This withdrawal hell will kill me. The problem is, I was running every day, living my happy life being a grandma and mom and wife until suddenly I became sick. I saw every type of physician possible. Everything was normal. I finally came to the horrendous realization that I was withdrawing from my clonazepam while still ON it. This has gone on for 6 months and it is almost to get me. The worst is the internal vibrations, worse at night. Also inability to do anything (I mean even walk to the restroom) without my heart rate jumping up crazily. I’ve lost my life and I was stable 16.5 years!

When I see people advised to “hold” until stable, how can I ever begin if I’m not stable on my starting dose after 17 years? Will I ever BE stable? Im just feeling hopeless. Im not ok on it, I’m reading it will be worse hell trying to get off it, and even after completion it sounds like it’s still hell. So……what would stable look like? I love my 4 kids more than anything on this earth, but I can’t have them see me like this indefinitely. I was such a good momma and now I’m just sitting on the sidelines watching. Please help. I’m not ok.

The good thing is you now know why you've felt like this for so long and you can find a solution and it looks like the solution you've decided on is to free yourself, I'm glad.  I understand you have some other medical issues but I wonder if the Clonazepam tolerance has made them worse, could tapering the medication and recovering from your use actually benefit you in other ways?  I believe it will so this should provide you with even more determination to be free.

 

The Clonazepam is no longer a medicine for you, its a poison so the first thing you need to do is let go of that thinking, it can no longer save you and never will again.  Once the switch is flipped, we can never go home.

 

There are thousands of us who have recovered and you can too, we've gone on to live happy and healthy lives so please know that this is possible for you too.

 

I've seen many members actually feel better once they start to reduce after being tolerant to their dose, are you ready to give it a try?

I’m sobbing and having difficulty swallowing due to making a jump to say yes. But do I want rid of this hell? Yes! The problem is that for 16.5 years I was healthy and happy and waiting to retire so I could travel! Now here I am, and my life fell apart because my med suddenly stopped on me. And not one doctor has even asked hmmm you still on clonazepam? You think it’s still working? Not one. I figured this out on my own. I don’t have 5 years to feel like hell. That’s what I read here and that’s my fear. I have battled SO much illness and want to treasure every day and how I do that with the type of crippling withdrawals I read about is beyond me?

I don’t know how to start. It’s all so confusing. Ashton method? Just decrease my clonazepam by 0.5% every 2-4 weeks? Liquid or dry taper? It almost is so much to just get a taper plan that I feel like forget it, I’ll just increase my dose. But I know that’s not a long term solution.

Can you help with thoughts on how to even begin tapering? Whether liquid or dry is better? If I stand in a bathroom shaving little pills a portion of my day I’m afraid that will cause crippling anxiety as well. Where to begin so I can wrap my mind around taking the leap. Thank you

I understand you're overwhelmed, this is what the drug does to us, we can't feel joy, love or happiness, the only emotions available to us are fear, anger and sorrow.  The key is to break down each task you're facing into manageable chunks, I used to say I can't eat this elephant but if I do it one bite at a time, I can.

 

I don't know if I've asked you before but what size are your pills?

I haven’t started a taper and tonight I was so horribly miserable and terrified I took an extra 0.5 to see if upping it would help the withdrawals I’m having while still taking this med. it was just one dose but it certainly did nothing. Right now the most scary thing I’m experiencing is a sudden bout of POTS. I get up to walk and my HR jumps to 120. It’s so scary! My body has been ruined and just 6 months ago I was happy and living my life. I’m fighting here to know whether I go to an ER? But they’d try to put me in a detox where they taper you off in 4 weeks time. I still don’t have a taper liquid routine so I don’t know where to begin but tonight is horrifying. I’m so ashamed I took an extra dose but I thought ok I am tolerant and withdrawing so I need to increase. Obviously No. Any help would be so appreciated, I’m terrified.

My pills are 1 mg. I’m withdrawing severely while ON the 1 mg pills. I am not sure I will make it without an ER visit today. I can’t do one thing without my heart rate going through the roof. I can’t get up to go the restroom without my pulse jumping up 60 bpm. The vibrations are horrid. I haven’t played with my dose. I’ve done nothing that should make this withdrawal occur except obvious tolerance, but I can’t get anywhere NEAR stable. I don’t know how to begin to taper while I’m so severely in withdrawals. It started 6 months ago and I didn’t piece together that I was in withdrawals until a week ago. I had no idea you COULD withdraw while still taking the drug. So I assume I begin a taper from 1 mg tablets while I’m in this much misery? Because I can’t get out of it. I dread going to an ER because they never help but this HR is scaring me and I can’t even stand.

I will need to withdraw from 1 mg tablets. I can use the liquid if that’s easiest? I know my doc would prescribe it and we do have a compounding pharmacy in town. I have no idea right now how to make a taper schedule for myself or how to begin. I just know I can’t stay in this place. If someone could help me know what strength of liquid to request, and if I went slow at 5% each dose holding for 2-4 weeks depending, how would that look? Something has to give today. Today is the day. But my inability to stand also has to be addressed. Im terrified. Absolutely paralyzed with fear.

You can either start tapering, or go up to 1.5mg but what i know and what im feeling , tapering and getting rid of that poison is much better although it's hard, but i think this hard journey worth it. That drug is like a prison and you have to make your way for freedomn

Can you see your doctor instead of going to the ER, that would be a much better because they can perhaps prescribe something to help your heart rate and you could ask for smaller dose pills which would allow you to dry cut until you get to the lower doses. 

Hello formy4kids, do you still need help?

I have been looking at starting to week off of 1.5 mg clonazepam that I’ve been taking for 17 years. I’m terrified after reading these stories. I’m 58 and I want to enjoy my early retirement the klonopin just isn’t working anymore and I’m not wanting to increase.

Looking at decreasing each dose by 5% and holding two weeks will take YEARS. It feels as if I will spend all my time weening and withdrawing. Is that what I have to look forward to? My life will consist of weening, withdrawing and misery? The Ashton protocol looks quicker but I wasn’t excited about switching to diazepam. Is 10% too much early on? I’m trying to play this out I’m detail before making a move because not having it laid out makes me anxious. Any help would be appreciated.

Some members say the Ashton method is too fast so they have to slow it down but really, you should be okay to taper directly from the Clonazepam.  I'm thinking that it might be a good idea to reframe your thinking if can.

 

The Clonazepam is no longer working and you don't want to go up in dose so that leaves tapering off.  The purpose of a slow taper is to hopefully be able to live your life as you rid yourself of the drug.  Looking at this in terms of how long you'll be tapering isn't where you should put your focus.  You might try to see the taper in different terms, you'll be using the drug to rid yourself of the drug, you'll be making it work for you.  We have a member who has been able to enjoy life while tapering, wouldn't it be great if you could do this too?

 

As for how quickly to start out, if you're this nervous I'd go for a 5% cut the first time.  Its important to record the reduction and any associated symptoms and their severity so you can use this information to inform your next reduction as well as how long you hold it.  We're all different and how we react is very individual so having a set standard for tapering isn't practical so using your own experience to make decisions is best.

I’m not navigating this site well so please forgive me. I’m still very confused. I’m wanting to taper from 1.5 mg clonazepam daily going slowly such as 5%. I think I can get my provider to order this in a liquid form or can compounding pharmacies just make tablets in the amount of your next cut? No matter how small? I couldn’t handle the weight scale method. I don’t know about the tapering strips. I really would love to use the Ashton method but am scared to switch from clonazepam to diazepam. It’s just such a straight forward schedule. All these small numbers of cuts give me anxiety because I’m not a numbers person. Could you tell me if you’ve seen pharmacists make like 2 weeks supplies of pills in the amount needed for each cut? I’ve read that detox clinics say this slow method is bad because we spend all of our time thinking about our benzo. But I also know I would buy a slow taper that allows me to be a mom and wife and not hiding under my blanket if possible. Thanks for any help.

Although I’ve read about 1 or 2 members who have used compounded capsules to taper,  this approach can be a bit ‘fiddly’ from a math perspective; it also does not allow as much flexibility in dosing as a compounded liquid.  See my previous post on this at:

 

http://www.benzobuddies.org/forum/index.php?topic=272907.msg3417490#msg3417490

 

PS: An advantage of finding and working with a a good compounding pharmacist is that s/he can help you with the math.

If you're in the US, Clonazepam doesn't come in liquid form but it is available in smaller size pills than .5, maybe you could ask your doctor for the .125's, that way you could put off switching to liquid awhile longer.

Not sure if it helps but I have a liquid compound of Klonopin from a local compounding pharmacy. I order 1ml syringes on Amazon and easy peasy as far as that part goes.