tolerance

Hi!

 

What is the best plan if I'm in tolerance? I see a benzo aware Dr next week and I want to be sure I know what you folks think is best. How should a prescriber stabilize?

 

Thank you

 

 

 

taking 0.5 Clonazepam 3 x/day currently

What is your definition of ‘stabilize’?  In this community we define it as ‘withdrawal symptoms are not changing in nature or number and are tolerable.’

 

If you have become tolerant to the clonazepam (i.e. the drug no longer has the same or any therapeutic effect), the only way to resolve this is to increase the dose.

HI,

Thanks for your reply! Yes the medication is no longer working. I have appt to start a slow taper and I was asking this community what they feel I should be looking for from the prescriber.

when someone is intolerance and has interdose withdrawals, do they updose and then start t taper?

 

I'm new to all of this, so I may not be using the correct language, I read about tolerance and folks need to be " stabilized" ( i guess meaning they are not have withdrawal symptoms)

Stable around here does not mean symptom free, its as Libertas described, your symptoms have settled a bit and you can perform your daily tasks, you’re functioning but not feeling great.

 

I would say if you’re in tolerance and suffering from interdose then a taper, not an increase in dose is called for. 

 

How many times a day do you dose?  What you might look for in a prescriber is someone who will allow you to do a patient led, symptom based taper much like we see suggested here. Colorado Consortium Benzodiazepine Deprescribing Guidance

Pamster,

 

Thank you for your reply. Yes, I am going next week to make a taper plan. I'm functioning fine, but I feel like I'm in a constant state of panic. No major physical symptoms. Ironically, started these meds for occasional panic attacks. I am meeting a new prescriber, whom I vetted after the advice of this forum. (Thank you)

I'm glad I knew what to ask. Seeminglbenzo, this person is benzo aware and familiar with the Ashtom manual. ( or symptom-based with flex)

 

Has anyone used a compounding Pharmacy? Pros and cons. ( I do know they are expensive)

 

Thank you .

 

 

 

 

 

 

 

).5 clonazapam 3/daysince 2020

0/2 2x/day since 2009

 

no other meds

I also have read that bc I'm at tolerance and have interdose, possibly the switch to Valium may better serve me? Thoughts?

 

Many have used compounding pharmacies with great success, if Libertas drops by again hopefully she’ll provide her steps for properly vetting one.  I’ll keep an eye out to see if she sees your question.

Thank you so much!

 

Is the consensus the same that If in intolerance and have interdose withdrawals, best to taper drug you're on or move to valium?

 

seems like valium has a longer half-life and might bridge the gap between doses to get onto feeling better ?

 

Does anyone have experience with this?

I’m not sure there’s a consensus about much of anything other than discontinuing benzodiazepines can be very challenging for some individuals. We have members who have had positive experiences with substituting diazepam for clonazepam as well as members who have had negative experiences.  The same applies to using a compounding pharmacy — some members have had positive experiences whereas others have not.

 

Members who invest sufficient time and effort to find and properly vet a compounding pharmacy tend to have better outcomes. Here’s a link to a recent post I wrote with suggestion on how to accomplish this:

 

http://www.benzobuddies.org/forum/index.php?topic=275420.msg3437647#msg3437647

 

Re: your perception that compounding is expensive …

 

Insurance may cover part or all of the costs (contact your insurance provider to request specifics), the compounding pharmacy may offer discount programs for long-term customers (be sure to ask), and there are strategies you can use to reduce costs (e.g. use a combination of regular tablets and compounded liquid instead of all liquid). My personal opinion is that spending money on a professionally formulated and prepared, high quality compound is a better investment than spending hundreds of dollars on supplements with unknown quality/effects or thousands of dollars on unproven therapies.

Thank you! I agree- The right compounding pharmacy is def worth the expense if needed.

 

Pamster- My symptoms are worse than ever but not as bad as some describe here for sure. Your opinion was if I'm having interdose and tolerance, taper is best plan.  Libertas_ were you thinking upping the clon to stabilize is the best plan? Just making sure I understand the opinions given. (it's very possible I misunderstood ). NO matter what, I will be getting off of these meds and am glad to find a helpful resource like you all.

 

Thanks for the vetting info- I printed it and will use it when I call.

The rationale for updosing is not to ‘stabilize’ (at least not according to BB’s definition of stabilize — see my post and Pamster’s on this) but rather to determine if increasing your dose will provide the desired therapeutic effect(s) you are no longer experiencing because you have developed tolerance to the drug.  Updosing may or may not accomplish this. For example, one study found that clonazepam reached optimal effect for panic disorder at around 1mg; doses higher than that were less effective and associated with more adverse effects.

Thank you! I agree- The right compounding pharmacy is def worth the expense if needed.

 

Pamster- My symptoms are worse than ever but not as bad as some describe here for sure. Your opinion was if I'm having interdose and tolerance, taper is best plan.  Libertas_ were you thinking upping the clon to stabilize is the best plan? Just making sure I understand the opinions given. (it's very possible I misunderstood ). NO matter what, I will be getting off of these meds and am glad to find a helpful resource like you all.

 

Thanks for the vetting info- I printed it and will use it when I call.

 

I’m sorry about the confusion calisurfing20, starting a taper from a place of stability is the right call, but only you can define what that is for you. 

Liberatas,

Thank you for your reply!  I guess I'm a bit confused. In your opinion, is it best for my prescriber to updose to see first to see if I reach the therapeutic level? 

 

I meet with Dr today and just want to be sure I do this as correctly as possible.

 

thank you

Pamster,

Thank you for your reply. What I want is to be off of these meds but I also want to do it correctly and safely. I've read updosing is never a  good idea but I don't know if they mean once you start taper or at all ever?  I guess that's where I'm stuck. I think the Dr will have their own ideas but I know this community is a wealth of knowledge too!

My opinion about updosing is the same as my opinion about just about everything related to benzodiazepine cessation — it works for some people but not for others.

 

Potential advantages to updosing are that therapeutic effect may be re-established and tolerance-related withdrawal symptoms may be lessened/eliminated.  However, it is unknown how long this situation will last because the individual may become tolerant to the new, higher dose.

 

Potential disadvantages to updosing are that it may not work and the individual will then find themselves at a higher dose from which to taper.

 

Here’s what Reg Peart (see note) had to say about updosing back in the 1990s (his thinking on this may or may not be correct):

 

In situations where high tolerance withdrawal has occurred i.e., someone has stayed on the same dose for several months or simply ‘hit the wall’ as we sometimes call it, these people can consider updosing.  How much and how fast is going to be very variable but a very general rule would be to updose 1-2 mg per day for 2-3 days and see how one feels at that point.  (This is speaking to the person on Valium only.) 

 

One of the biggest problems with updosing is when it doesn’t help.  This is usually seen in the person who is creeping the dose up too slowly in the hopes they will feel better without having to increase too much.  This is often a mistake and actually allows the tolerance w/d to literally follow the person up as they increase the dose; thus pretty much insuring a failed updose situation. 

 

Source:

Crossover Schedules

http://www.benzosupport.org/crossover_schedules.htm

 

Note: Peart was a benzodiazepine withdrawal survivor who then dedicated himself to helping other individuals who wished to discontinue their benzodiazepines.

I agree with Libertas, it appears your doctor may have intentionally given you a higher dose, speaking with her before making changes might be prudent.  We’re not used to knowledgeable doctors around here so unfortunately we make assumptions.

HI,

Ok. THANKS GUYS! I DID JUST GO AHEAD AND TAKE THE 2.5MG OF VALIUM LAST NIGHT BUT, I SEE YOUR POINT ABOUT LOADING DOSE AND SHE MIGHT HAVE HER REASONS FOR DOING WHAT SHE DID. I GUESS MY FAITH IN DR'S ISNT HIGH, SO I WAS JUST LOOKING OUT FOR MYSELF ON THE HIGHER DOSE.

 

WILL GO BACK TO HER PLAN TONIGHT AND MEET WITH HER 3/1 TO DISCUSS IT