A lil help with clonazepam taper, please & thanks 😊

Howdy!

 

I am trying to get from 1.125 mg clonazepam (using 0.5 mg pills) to zero, but no specific timeline.

 

My doctor is very helpful and understanding, but has pushed my ADHD self to commit to 5% reduction every two weeks until our next appointment in July.

 

I got some of the equipment for a liquid taper almost 4 years ago (stainless steel mortar and pestle, graduated cylinders, etc), but haven’t followed through.

 

I’m not tied to a liquid taper necessarily, but when my doc prescribed me 0.25 mg pills last visit the pharmacist called to say that my $9 prescription would now be $99. 😬 So the continued dry taper method didn’t pan out. I am currently splitting my 0.5 mg tablets into four pieces for my morning dose.

 

My goal is to begin on May 6th.

 

Any and all advice or support is much appreciated.

That new cost is prohibitive, I’m glad you’re open to using titration and while I didn’t use it, I’ve heard its a good way to go.  Some members find it easier than shaving and weighing their tablets on a jewelers scale.

 

I’m sorry your doctor forced a commitment on you for 5%, symptom based tapers seem to work out the best but he could have asked you commit to a more rapid taper so we’ll work with you on the 5%.

 

I don’t have titration experience but I’ll watch to see if you get responses and if not, I’ll ask someone to stop by.

Were the 0.25mg pills Orally Disintegrating Tablets (ODTs)?  Did your doctor write the prescription for all ODTs?  If so, you would require 5 0.25mg ODTs a day or 150 a month at your current dose of 1.125mg.  That’s a lot of ODTs …. I wonder if the pharmacy was uncomfortable with dispensing that many tablets at one time?  I also wonder if the pharmacy might have made a mistake regarding the co-pay? 

 

Did you verify the co-pay for the ODTs with your Pharmacy Benefits Manager (insurance provider)? ODTs may be in an higher tier than regular tablets, but $99 sounds excessive.

 

Fyi We have several currently active members who are titrating clonazepam using the shave and weigh technique with regular tablets.

 

We also have members who titrate clonazepam using liquids.

 

Given that you have a helpful and understanding doctor, I wonder if using a compounded clonazepam liquid is an option? 

 

Thanks for the replies!

 

*edited to add that a compounding pharmacy is not covered by my insurance in this case. I already tried that route…

 

 

I did not have insurance at the time so it would have been an out of pocket expense. So no recourse through a benefits manager or etc.

 

Based on your suggestion I called my pharmacy and asked about the 0.25 mg tablets and if they could be prescribed again by my doc if they would be covered by my insurance.

The answer I got was curt (and, as we all know, incorrect), which was that the smallest clonazepam dosage is 0.5 mg.

 

I go to a family-owned pharmacy and value this relationship. While I know I am correct and I could likely get the 0.25 mg dosage, it is not worth the fight quite frankly.

 

So while I greatly appreciate the reminder about the lower dosage and the ease of tapering at that dose, it’s a non-starter.

 

The good news is that I am confident and committed to the taper. A little extra work is a bummer, but I will make the time for it.

Ah ha!  No insurance = high cost.  Thanks for the clarification.  I was concerned readers might get the impression that the ODTs are cost prohibitive in general.  If memory serves, my co-pay for a month’s supply was $16 back when I was trialing them.

 

I hear you loud and clear about not wanting to rock the boat with the family-owned pharmacy you use.  Pharmacists can be valuable allies during benzodiazepine withdrawal.

 

That’s unfortunate your insurance won’t cover compounding (some do, some don’t).  Fwiw I conducted an informal survey a while back about what members were paying out-of-pocket for compounded clonazepam liquids; the average monthly cost was in the $50 range. 

 

If you decide to give dry tapering/titration a try, you might find it helpful to read through past posts by hereforhelp, Rocknroll, and agenthall.

 

You are approaching your taper with a great attitude.  This will serve you well. 

Okay then, that’s settled, have you decided which form of titration you’d be the most comfortable with, liquid or using a scale? Titration FAQ’s

Pamster:

I would prefer to do a liquid titration.

I’ve worked in a chem lab and do water quality work. I don’t like dealing with the powders any more than necessary.

 

I currently have a stainless mortar and pestle, as well as graduated cylinders (10, 25, 50, & 100 ml in 1 ml units), and a dropper (not measured).

 

What else do I need?

So glad you’ve made a decision that works for you, now we just have to find someone to help since I’m lousy at this stuff.

I’m putting this out here because even though I just did it, I’m pretty sure it’s wrong…

 

My goal was to begin the 5% taper to simplify the most complicated part of my dose, which is the 0.125mg portion.

This is a quarter of my 0.5mg pills.

 

I took my 0.625 mg early dose in two parts: the very simple 0.5 mg tablet, and what I will describe below.

 

What I did was:

Fill up my 100 ml graduated cylinder with water.

I then crushed up the 0.125 mg (1/4 of a 0.5mg tablet) with my mortar and pestle.

I added the crushed tablet to the water and stirred/agitated a bit.

I then removed 5 ml of the suspension/solution.

I drank that and then rinsed it and drank the rinse water as well.

 

My mistake was that I only took 5% less of the 0.125 mg. This is not bad, but my goal is to lower my entire dose

Of 1.125 mg daily by 5%.

 

I basically lowered my dose a total of 0.00625 mg today. This is short of the goal of 0.05625 daily amount.

This means I will have to do the above process again this evening using a 0.5 mg tablet, but remove 10ml of the solution from the cylinder.

*edited to change the math by adding the 10 ml of solution vs the 5 ml

 

If anyone is willing and able to check my math it would be greatly appreciated 

Your math is correct.  To recover from the mistake in the morning, you need to remove 10 mL from the 0.5mg in 100 mL mixture.

 

Note, if your biggest problem is insomnia, you may not want to taper the evening dose.

 

Also, why don't you keep it simple by putting all your 0.625 morning dose into 200 mL of water and taper by removing 1 mL of water every day.  It will be nice and smooth reduction.

 

 

Hello and thanks for the advice, Bob!

I heard it from you and read about others that a daily reduction would be beneficial.

I do that and got down from 1.125mg to 1mg per day.

This is all in my long signature (I hope cuz it took forever to write it up…), but I simply took the entire day’s dose, crushed it and added it to 200ml water, and then removed 2ml each day.

 I then held that for about 8 weeks, taking 0.5mg tablets 2x/daily. 
 

I should note here that I stopped the taper because I was having a lot of shaking, unsteady types of symptoms. This was specifically unsettling because I work on roofs and at heights on a regular basis.

 I’m now attempting the same thing, but I’m concerned about my math again. Which is kinda silly because I did it this way to make things simpler 

Does it make sense for me to be removing 2ml each day from 200ml of the water/Clonazepam mixture?

It feels simple - lowering by 1mg/day. That would mean I’m benzo free in 50 days. Which is great, but also seems aggressive when I look at it that way.

Any thoughts, advice, or suggestions are very much welcome.

I appreciate all of you fine folks on this site. Not sure where I’d be without y’all 

What makes sense as far as your taper goes is staying functional and safe and if you're up on roofs, I feel safety should be your number one priority.  

Something to remember, tapering off the drug is just the first step in this process, recovery comes next and that can take as long or longer than the taper so use the drug to mitigate your symptoms while you can.  Easing off the drug will allow your brain to regain the function the drug disrupted, coming off too soon could leave you with intense symptoms without a way to mitigate them. 

Yes, absolutely this!

I’m very much torn on how quickly I want to be *off* of the benzos, and how much time it will take to be *free* of the benzos. This is 100% a LONG process as far as I’m concerned.

So I think my current plan is a bit too aggressive, but I do like the daily micro taper better than the cut and holds.

I think I’ll just try to go with 1ml/day for now and then stop to recover after 7% or so. Does this make sense?

Or am I mucking things up by combining the methods?

Members doing daily reductions will often hold for a bit, sometimes the reductions can pile up on you symptom wise, so holding while things smooth out is a very good idea.  This is all about experimentation and finding what works for you.  But, of course, just when you've found the perfect method, the drug will decide its time to flip things around and you have to change course.  

Just remember to keep good notes of your reductions and your symptom severity, this can help you make informed decisions, it helps take the guessword out of this. 

23 hours ago, [[L...] said:

You’re most welcome, @[dj...] I’m delighted you found the Horowitz video helpful.  Indeed, I hope your post will encourage more members and guests to view it.

My sense is there is currently considerable confusion in the benzodiazepine withdrawal community writ large (i.e. not just here at BenzoBuddies but in other online support communitie as well) about hyperbolic versus exponential versus linear tapering.  Many individuals seem to think hyperbolic tapering is the same as exponential tapering (it isn’t); there also seems to be a misunderstanding that hyperbolic tapering has been proven to be a superior approach via research studies involving human subjects (it hasn’t - at this point it is a largely untested hypothesis, albeit a promising and compelling one; the good news is research is underway in the UK with antipsychotics and in Australia with antidepressants).  

Re: your request for feedback regarding your taper plan …

Here are two comments for your consideration and two questions:

(1) Holding your dose constant for at least a week after you finish the first stage of your taper from 1mg to 0.93mg is a wise move on your part imo.  One of the downsides of daily microtapering is that it does not provide a clear read of what taper rate a given individual can tolerate.  Per Horowitz and Taylor (2019):

“… micro­tapering presents the possibility of cumulative withdrawal effects being super­ imposed on one another. This process would make it difficult to establish which reduction (or set of reductions) was responsible for the symptoms experienced.“

Adding a hold after a reduction (or series of reductions) allows withdrawal effects to fully emerge and stabilize before the next reduction is made. 

(2) If you wish to change from linear to exponential reductions for the next stage of your taper using a 7% per month taper rate, you would reduce your current dose of 0.93mg (not your original starting dose of 1mg) by 7%.

So, your target ending dose for the next month would be 93% of 0.93mg or 0.8649mg.   If all goes well and you decide to continue making exponential reductions at a taper rate of 7% per month, your target ending dose for the next month would be 93% of 0.8649mg or 0.8043mg.

(3) Can you help us understand what you mean by ‘‘will this work without weighing pills’?

(4) Do you have your own taper planning thread?  If not, might I encourage you to create one so we can address your unique-to-you taper questions there?  

Thanks so much for your thorough and thoughtful reply, @[Li...]!

To your points:

1.) I just kind of made up the week timeframe. I’m not sure if this is sufficient, but I suppose I’ll just use trial and error to figure it out. I’m still doing a daily 1ml reduction such that today I’m taking two equal doses of 0.4775 mg for a daily total of 0.955mg. So far I haven’t noticed any significant poor symptoms. It has been exactly one week since I began so I’m not sure what the lag time is for Clonazepam symptoms might be, but I assume they are very individualized. I have also made sure to eat well, stay active, stay social, talk to folks IRL about the tapering (mostly family), and stick to a sleep schedule. The sleep part is a struggle, but that’s always been the case for me. I’m definitely improving.

2.) While I don’t always trust myself with the math, the more complicated part for me is how to get to those smaller numbers that you referenced.

I use a fairly decent glass cylinder set to measure the water and solution, and remove the daily taper amount with a glass pipette. The Clonazepam is crushed in a stainless mortar and pestle. I should say that while I try to be as exacting as is practical, I don’t sweat small amounts, and I’ll always defer to less than more solution to take if I’m guesstimating. (For instance, my solution is transferred to a mason jar with a lid. There are measurements on the side for 100 and 200 ml. I drink about half in the morning and the rest in the evening.) so this takes me to the next point, which is…

3.) I simply meant is it still possible to use my 100ml w/1ml increments for measuring my dose? Or do I need to use dry weight for smaller increments? (Or, along those lines, get a more exact liquid measurement cylinder?)

4.) The thread I started with my current taper is here: 

Thanks again for your advice and suggestions 

Hello, @[dj...].  Now that @[Pa...] has kindly moved your post to your taper planning thread, let’s continue our conversation.

Re: your question …

Quote

3.) I simply meant is it still possible to use my 100ml w/1ml increments for measuring my dose? Or do I need to use dry weight for smaller increments? (Or, along those lines, get a more exact liquid measurement cylinder?)

Are you asking if you need to switch from using a do-it-yourself (DIY) liquid to weighing crushed tablet powder to make exponential reductions in dose?  

Or, are you asking if you need to weigh the crushed tablet powder when you make your DIY liquid?

Or, are you asking if it’s ok to continue to use a 100mL graduated cylinder with 1mL increments to measure the water for your DIY liquid?

If you wish to continue using a DIY liquid, it would be helpful if you could tell us a bit more about it.  I’ve been able to glean some information from your History (tip of the hat for doing such a great job with this!) but have a few questions:

Am I correct that the total volume of water you are using to make your liquid is 200mL? 

What is the strength of the clonazepam tablets you are using?  1mg?  How many tablet(s) do you crush at a time?

What is the volume/capacity of your pipette?  How is it graduated?  Every 0.01mL? 

 

 

I’d like to give thanks as well to @[Pa...] for moving this  

I honestly have no idea about the powder weight method. I realize that I don’t need it.

while my 50 & 100 ml cylinder are in 1 ml increments, my 5 is 0.1ml, and the 10ml is 0.2

I should be fine or close enough…

pipette is not labeled. It does about 1-1.5 ml, but it’s not reliable as a measurement device.

I take two 0.5 mg tablets to equal the 1 mg I am prescribed.