Seriously in need of help planning taper off Klonopin!

[[Buddie]]

If you wish to begin tapering before your next appointment with your prescriber, here’s a simple approach for your consideration ….

Take 1mg in the morning and 1mg in the evening as usual.

For your middle daily dose, split a 1mg tablet into quarters using a high-quality pill splitter.  Take 3 of the resulting 4 pieces (about 0.75mg). If you are concerned about the possibility that the Active Pharmaceutical Ingredient (API) in your tablets is not evenly distributed, save the extra quarter tablets from Days 1 -3.  On Day 4, take all three of the extra quarters.  (This will ensure that you consume all of the API in those tablets.) Repeat this process for Days 5-8 etc.

This will be 8.33% reduction in dose.  It is within our general guideline of 5-10% and should be tolerable given your relatively high starting dose.

Keep a daily taper log.  Use the data in the log to determine your withdrawal pattern — that is, how many days does it take for withdrawal symptoms to emerge, peak, and stabilize (i.e. stop changing in nature and number and become tolerable).  Note: Clonazepam has a relatively long half-life; it can take one to two weeks for a dose change to fully ‘register’.

As I shared in a previous post, you sound like a good candidate for a combination approach using lower dose clonazepam tablets and a professionally compounded liquid.  Here’s what Stage 1 of such a taper might look like:

0.5mg in tablet form + 0.5mg in liquid form, taper liquid to zero as tolerable
0.5mg in tablet form + 0.5mg in liquid form, taper liquid to zero as tolerable
0.5mg in tablet form + 0.5mg in liquid form, taper liquid to zero as tolerable

To implement the above plan, you would need to find and vet a compounding pharmacist. Also, your prescriber would need to write two prescriptions — one for the tablets and one for the compound.

Okay, so I’m confused about the bolded part? I take those on the 4th day, but how many days would I be doing at this rate? Also, if I can get a compounded liquid or manufacturer’s liquid would I still really need the tablets too? Or do I really need the liquid? I’m still very stressed about this, why does it have to be so freaking complicated? I’m in tolerance and I’m already miserable and having major mental symptoms so I just need to feel like I’m doing something to get started on tapering without waiting weeks!

[[Buddie]]

You would hold your dose constant at 2.75mg until you stabilize.  At this point, we don’t know how long that will be because we do not know what your withdrawal pattern is.

There are several advantages of using a combination of regular tablets and compounded liquid. Two of them are: (1) it keeps as much of your dose as possible in a form that your body is accustomed to and (2) it decreases cost (tablets are inexpensive; depending on your insurance, there may or may not be out-of-pocket costs for the compound).

[[Buddie]]

You would hold your dose constant at 2.75mg until you stabilize.  At this point, we don’t know how long that will be because we do not know what your withdrawal pattern is.

There are several advantages of using a combination of regular tablets and compounded liquid. Two of them are: (1) it keeps as much of your dose as possible in a form that your body is accustomed to and (2) it decreases cost (tablets are inexpensive; depending on your insurance, there may or may not be out-of-pocket costs for the compound).

Thanks for explaining this to me. I swear I used to not be so dim, but lately I feel like I’m lucky if I manage to get through the day without a full breakdown.    I have such terrible cog fog and so many mental symptoms that I don’t know if I’ll even be able to tell when I stabilize, to be honest. I already have physical symptoms as well so that’s going to be another difficult way to tell. I guess I just gauge it on how much worse I feel? That’s also tough because I have a few not too terrible days once in a good while so I don’t know? I remember when I first started tapering Xanax I was making 0.5 mg cuts and I did fine the first few cuts but I kept making those big cuts as my dose got lower so it caught up on me in a few months really terribly. I definitely don’t want to make that mistake again. So I will start tomorrow with my afternoon dose. I’m going to get my old notebook out and set it up tonight.

[[Buddie]]

You’re welcome.  Your daily taper log will be your best source of data on how you are responding to reductions so tip of the hat for setting up a notebook.  To avoid harming yourself by obsessing/ruminating about your symptoms or current situation, I encourage you to keep it simple.  For example, record the date as well as the times and amounts of your daily doses.  Around the same time each day, record two global ratings — one for your withdrawal symptoms and one for your functionality level.  Use a scale such as 0 = no symptoms, able to perform all essential daily tasks to 10 = intolerable symptoms, unable to perform any essential daily tasks.  Add a brief note about anything that might have affected how you felt/functioned that day (e.g. a stressful event; changes in diet, medications, supplements).  Graphing the global ratings can help you detect patterns in the data over time.

[[Buddie]]

In case you are considering the possibility of using the combination regular tablet and compounded liquid approach I described upthread …

Below is a link on how to find and vet a compounding pharmacist as well as a link to a stability-tested formulation for a compounded clonazepam suspension (your compounding pharmacist may have access to other formulations so be sure to ask).

Links:

How to Find a Compounding Pharmacy
https://www.wikihow.health/Find-a-Compounding-Pharmacy

0.1mg/mL Clonazepam Oral Suspension from Nationwide Childrens Hospital
https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

[[Buddie]]

Well, I can’t get accurate cuts with my crappy pill splitter.    I either eyeball it and end up with little crumbs after the 4th day (which is what happened. Yes I now have 4 messed up pills because I tried it a few times and even by hand.) Or I take uneven pieces. I can get a good “half” but it’s definitely bigger than the other piece so I thought about taking the “bigger half” and then a half of the other half, if that makes sense. Or…. I just wait a few weeks.    I should order a new pill cutter anyway. Any suggestions on a good one?

As far as a compound pharmacy I actually have one near me, a smaller family owned one and they have awesome reviews and have apparently been in business for a long time, and I believe they accept my insurance according to their website. So at least I know that much. I am going to give them a call tomorrow and make sure. Thank you for the questions to ask the pharmacist. It helps because I would have never thought of all those things.

[[Buddie]]

I’m glad the ‘finding and vetting a compounding pharmacist’ questions were helpful.  A caring and competent compounding pharmacist can be a valuable ally during benzodiazepine cessation.

Here’s the pill splitter I used:

EqualSplit Pill Splitter
https://a.co/d/9XMJgeO

[[Buddie]]

Well the compounding pharmacy is out of the question. The pharmacist said he’s never done a benzodiazepine! He said he can but never has as “most people just cut their pills” and he didn’t sound very clued in about tapering with liquid. I’m not even going to mess with that. I guess it’s going to be direct cuts then. I suppose it makes the most sense to wait until I see my psych in a few weeks and get 0.5 tablets.
The pill splitter [...] linked has sort of mixed reviews so if anyone has any suggestions for cutting pills as accurately as possible I’m open.

[[Buddie]]

Point of clarification … you asked me what pill-splitter I had used and I provided the information requested.  I was not making a recommendation. I had some of the same issues reported in the reviews when I was using this product to split a pill for a pet. 

I should note that we do have several other members who are quite satisfied with this device.  I suspect whether or not a given pill-splitter performs satisfactorily has much to do with the properties of the pill being split (my pet’s pill was quite small and brittle). 

I hope you are able to find something that works for you.

[[Buddie]]

Point of clarification … you asked me what pill-splitter I had used and I provided the information requested.  I was not making a recommendation. I had some of the same issues reported in the reviews when I was using this product to split a pill for a pet. 

I should note that we do have several other members who are quite satisfied with this device.  I suspect whether or not a given pill-splitter performs satisfactorily has much to do with the properties of the pill being split (my pet’s pill was quite small and brittle).  I hope you are able to find something that works for you.

I did ask for any suggestions on a pill splitter. I hope I find one that works for me too, which is why I am asking for more recommendations. I don’t want to put money out for one that seems iffy, but I’m sure every one online is going to have some mixed reviews so if there’s a different way to cut pills besides a pill splitter contraption I am also asking about that as well.