size of taper

I want to decrease my afternoon dose of clonazepam. It's a .5 mg tablet. What would I need to cut off for a ten percent reduction? Thank so much in advance.

Hi sally1956

 

You'll need to cut 0.15mg off your dose. If you can tell us how much your pill weighs then we can calculate that in grams.

Greetings sally1956.

 

I’d like to check that the percent reduction you’re considering (i.e. 10%) is in the right ballpark for you given your medication/drug history. To do so, I have several important questions to ask.  You already answered the first one in your Introductions post — you have been taking clonazepam for 12 years (i.e., a long time). 

 

Here are the questions:

 

- How long have you been taking your benzodiazpine? (12 yrs)

- Have you ever had to increase your dose to achieve the same therapeutic effect?

- Do you experience withdrawal symptoms in between doses?

- Do you have a history of taking/discontinuing this or another benzodiazepine?

- Do you have a history of taking/discontinuing other psychotropic drugs (e.g. z-drugs, antidepressants, stimulants, mood stabilizers, antipsychotics)?

- Are you taking any other drugs or supplements that might interact with your benzodiazepine or impact your discontinuation and recovery? (See links below to check.)

 

PS Given that you are on a relatively high, possibly supratherapeutic dose, have you considered pill-splitting as an option for your first three reductions?  (After that, you might need to consider other options to keep your percent reduction in your target range — e.g. pill-shaving/weighing, pill-powder/weighing; if you are in the US, clonazepam is available in 0.125mg and 0.25mg orally disintegrating tablets as well as a stability-tested formulation for a compounded 0.1mg/mL oral clonazepam suspension; we also have members who have made do-it-yourself liquids.) 

 

In your case, you could begin by splitting your 0.5mg afternoon tablet into quarters and taking 3 of them. Then you could do the same with your morning and evening doses.  Here’s what your daily dosing schedule would look like:

 

Stage 1: TDD (Total Daily Dose) = 1.375mg; 8.33% reduction from starting TDD of 1.5mg

0.5mg

0.375mg (split tablet in quarters, take 3 of the 4 quarters)

0.5mg

 

Stage 2: TDD = 1.25mg; 9.09% reduction from previous dose

0.375mg (split tablet in quarters, take 3 of the 4 quarters)

0.375mg (same as Stage 1)

0.5mg

 

Stage 3: TDD = 1.125mg, 10% reduction from previous dose

0.375mg (same as Stage 2)

0.375mg (same as Stage 1)

0.375mg (split tablet in quarters, take 3 of the 4 quarters)

 

In case you’re interested in learning more, I’ve included a link to information about pill-splitting as well as easy-to-use tables you can use in conjunction with this approach.

 

Links:

 

Medications and Supplements of Concern on Benzodiazepines

https://www.benzoinfo.com/medications-and-supplements/

 

Drug Interaction Checkers

https://go.drugbank.com/drug-interaction-checker

https://www.drugs.com/drug_interactions.html

 

Pill-Splitting Taper Plans

http://www.benzobuddies.org/benzodiazepine-withdrawal-methods/direct-taper/

 

You can use the following steps to calculate how much to reduce your afternoon dose:

 

(1)  Use a jeweler's scale to find the total daily weight of your tablets.  For example, the total weight of your 3 doses could be .510 grams.

(2)  Multiply the total weight  by .10 (representing a 10% reduction).  Using the example, the math would be .10 X .510 grams = .051 gram

(3)  Take the average weight of your doses (would be .170 grams in the example) and subtract from it the .051 gram calculated in step 2.  .170 - .051 gram = .119 gram.

4)  Shave or break down the afternoon tablet until it weighs .119 gram (the weight calculated in step 3.

Thanks so much for the replies. I am now looking into getting a jeweler's scale.

 

 

- How long have you been taking your benzodiazpine? (12 yrs)

 

- Have you ever had to increase your dose to achieve the same therapeutic effect? Yes, once.

 

- Do you experience withdrawal symptoms in between doses? If I am very late taking my morning dose.

 

- Do you have a history of taking/discontinuing this or another benzodiazepine?  I've never discontinued clonazepam, but I tapered from 4 mg to 1 mg several years ago which was very difficult (ended up in the ER) until I found a physician that was willing to do a very slow taper. Then about five years ago my PCP increased my dosage to 1.5 mg.

 

- Do you have a history of taking/discontinuing other psychotropic drugs (e.g. z-drugs, antidepressants, stimulants, mood stabilizers, antipsychotics)?  I have tried and discontinued several antidepressants but only two long enough to require a taper.

I took Prozac for a year and a half in the eighties and then abruptly (stupidly) stopped taking it and suffered a serious migraine headache event. Much more recently I took Paxil for almost two years and tapered slowly until I was able to discontinue.

 

- Are you taking any other drugs or supplements that might interact with your benzodiazepine or impact your discontinuation and recovery?  Not currently. But I could easily end up on another antidepressant.

 

Thank you for responding to my questions, sally1956.  Your answers suggest that a cautious, conservative approach to reducing your dose is indicated.  The Colorado Consortium’s benzodiazepine deprescribing guidance document for prescribers (linked below) suggests a small test reduction of ≤5% of your current total daily dose.

 

I strongly encourage you to keep a daily taper journal so you can monitor your response to the reduction.  Examples of data to record on a daily basis include:

 

- The date

- Time(s) and amounts(s) of drug ingested

- Daily rating of your withdrawal symptoms (0 = no symptoms; 10 = intolerable symptoms)

- Daily rating of your functionality (0 = no issues performing essential daily tasks; 10 = unable to perform any essential daily tasks)

 

Link:

Benzodiazepine Deprescribing Guidance Document (2022)

https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf

Libertas you never cease to amaze me with your well thought out, helpful plans. I wish you were my doctor!!!

Libertas you never cease to amaze me with your well thought out, helpful plans. I wish you were my doctor!!!

 

Thank you for your kind remarks, Missfrida. Like all members of our community, I just try to do whatever I can to help others in their quest to discontinue and recover from benzodiazepine use.

Well I would love any insight you might have into my situation. I am currently on .5 Ativan 3x a day. I am converting the evening dose to Diazepam per the Ashton Manual (but longer than a week) but really unsure if i should move to Diazepam or taper directly from Ativan. I've only been on the Ativan since end of Sept but due to on and off benzo use (mostly Diazepam with no dependence issues) i am pretty kindled. Complicating all of this is a dependence on Ambien that is now up to 40mg at times every night. I am trying to stabilize at 30mg before i taper. If you have any insight into what i should taper first (or doing both at the same time) or how I would really appreciate it. I have an understanding Pdoc who is helping me but he doesn't really understand the nuances of how to do this with the least amount (hopefully) of sx though he does understand that my nervous system is highly sensitized and i am not like his other patients. I am really worried that a big dose of Diazepam will be dreadful for me (it behaves totally differently in my system now that the Ativan is there) but also worried about how short acting the Ativan is. I would ideally love to keep whatever I taper as simple as possible (liquid from pharmacy?) to keep things as simple as possible.I know i am likely being naive here, i just can't imagine c utting pilsl or making my own liquid formula. I have major dyscalculia and all math is incredibly hard for me.

 

Sorry to bust in on this thread. I am happy to post this elsewhere if that's easier!

 

Best,

Sherri

sally1956: My apologies for temporarily hijacking your thread.  Please let us know if you have additional questions or wish further assistance.

 

Missfrida: I see you have received input from other members on the Valium/Diazepam Support Group thread.  I’ll read through their posts to see what, if anything, I can contribute.  In the interim, I can answer your question about using a liquid to taper.  In the US, diazepam is available as an FDA-approved 5mg/5mL (1mg/1mL) oral solution (see link to the drug label from one manufacturer below). Many of our members have used this to taper. Members starting from higher total daily doses often begin their tapers by using a combination of regular tablets and the oral solution.

 

Link:

DailyMed - DIAZEPAM solution

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e85abed-1a8b-4762-a31f-f2c7f196b8af

Thank you so much for reading through and helping! I know to expect this process to be rocky as hell but I have to try to work through it as i am my only source of income and as a freelancer cannot get disability. Working also distracts me which is good, but i see most people cannot work through a taper (and most even after) and I am so worried about that. All of it. My biggest worry right now is crossing over to valium as there are SO many horror stories about it but i cannot see myself going down from Ativan. I am so scared and tired and overwhelmed by all of this. Thank you again for your help Libertas!!!

 

Sherri

Thank you for responding to my questions, sally1956.  Your answers suggest that a cautious, conservative approach to reducing your dose is indicated.  The Colorado Consortium’s benzodiazepine deprescribing guidance document for prescribers (linked below) suggests a small test reduction of ≤5% of your current total daily dose.

 

I strongly encourage you to keep a daily taper journal so you can monitor your response to the reduction.  Examples of data to record on a daily basis include:

 

- The date

- Time(s) and amounts(s) of drug ingested

- Daily rating of your withdrawal symptoms (0 = no symptoms; 10 = intolerable symptoms)

- Daily rating of your functionality (0 = no issues performing essential daily tasks; 10 = unable to perform any essential daily tasks)

 

Link:

Benzodiazepine Deprescribing Guidance Document (2022)

https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf

 

Just so you're aware, Libertas, they did finally add another copy of this document with the typo in the filename fixed a couple months back. The lack of a typo definitely makes it feel more professional if sent to someone.

Thanks for the heads up, hereforhelp.  I haven’t visited their website for a while.

 

For other interested readers, the link sans the typo in the URL is:

 

https://corxconsortium.org/wp-content/uploads/Benzo-Deprescribing.pdf