need help with Klonopin taper and titration

Colin,

I need help and someone to help me with the titration method and how much liquid to use and how to cut and by what rate.  I'm a mess right now....i'm at 0.25 mg of Klonopin in the am, 0.25 mg Klonopin in the PM and .125 in the afternnon.  I just made the last cut this past saturday in the afternoon dose.  I have been sick through this whole thing as I was the one who was weaned too fast from ativan and xanax back in may and haven't been right since....i was started on the Klonopin on 5-22 at 0.5 mg 3 x's a day and remeron 15 mg on 6-19....I heard remeron was really bad for people with benzos so I have been tapering from it....currently down to 3.75 mg....I cut the dose by a quarter every 7 to 10 days on the remeron...not sure when to jump off.  I've been sick and homebound and not working....the full klonopin dose never stopped my original symptoms from the over rapid taper of xanax and ativan so I told doc in July I wanted to taper off the Klonopin....He said to cut 1/2 tab every 2 weeks....I asked if I ocud do 1/4 of a tab every 7 to 10 days and he said that was okay....well I'm not doing well....and haven't been.....I'm very spacey and cold....feel like a robot....myheartbeat is down but I'm shaking mroe and feel more manic almost...rapid speech and kinda hyper.....I don't know how to successfully get off this stuff since I never got over the original symptoms....I'm trying to taper from this while still being sick from the other...i don't want to prolong the taper from the Klonopin since I've only taken it since 5-22 but I don't want to go too fast and end up in the stress center like I did with the ativan and xanax so i need help on how much to reduce and how often to reduce....the other thing is that I can't tell a difference in my body now when I take the meds...before I could tell a subtle difference when I took a dose....now it's like I haven't taken anything even when I do take it....what's going on???  Thanks for your help and advice...Pebbles

Hi Pebbles,

What strength tablets do you take?

How much of a reduction do you want to make over how much time? Since you are stuggling, I'd recommend that you aim to cut no more than about 10% every two weeks. You can review thos later.

I need this above information before making the calculations.

Hi Colin,

I need to remind you that I have no stabilization periods and have been homebound and unable to work since april from the xanax/ativan episode.  It's like trying to wean from another benzo when you haven't healed and are sick from the first round.  Can it successfully be done?  Are there people out there who aren't stabilizing and are sick throughout their whole taper and non-funcitonal?  My mental and physical status is bad and I'm beginning to wonder if something is really wrong as I read about others who have symptoms but "stabilize" between cuts and manage to carry out fairly normal routines part of the time.  I'm concerned because I don't seem to have that....

My tablets are 0.5 mg Klonopin tablets.  My current regimen is to take 1/2 in am, 1/4 tab in afternoon and 1/2 tab in pm....I wanted to ask you also why I'm not able to feel anything or tell a difference when I take my meds...it's like i have taken nothing at all.  Thanks for your help.  Pebbles.

Hi Pebbles,

 

What strength tablets do you take?

 

How much of a reduction do you want to make over how much time? Since you are stuggling, I'd recommend that you aim to cut no more than about 10% every two weeks. You can review thos later.

 

I need this above information before making the calculations.

Hi,

It sounds as though you have been tapering too quickly. So, the first thing I'd do in your shoes is to take a break from the taper. Once you are ready to start tapering again, try the following:

You will be titrating one pill only. Your second pill should be quartered and taken evenly over the day. Your titrated pill will be taken with your quartered tablets.

Since you are taking 1 & 1/4 tablets per day, you will be looking to create a titrated dose to replace that one-quarter tablet. It is far better (more accurate) to use a whole pill in titrated liquid and make a first deduction to account for that 3/4 pill extra dose. I'm going to assume a taper rate equivalent to 10% every two weeks.

When I use the formula, it suggests that you use 70ml of titrated liquid. This will include a whole 0.5mg pill though. So, disposing of three-quarters of the benzo-milk liquid will give you that quarter pill starting point. This works out as leaving 17.5ml. That's a bit difficult to measure, so decide on either 17 or 18ml. It might be an idea to use this method to be sure of getting a quarter pill each day during your stabilisation period - just don't reduce the volume from the 17 or 18ml for now. Once you feel able to resume your taper, reduce the volume by an additional 1ml each day. If you feel it becoming a bit much, just stop reducing for a while. Another thing to consider, especially because you will be starting your reductions from just a quarter of the liquid, and the fact that you are working with just two tablets per day, is that as the volume decreases, these small cuts start to account for larger reductions in percentage terms. You are actually tapering at a rate the best part of double of what you would have been if you were titrating from the full two pill dose. It is an inevitable consequence of reducing the dose; it happens with whatever method we use. Anyway, given how you have been feeling, I think it might be prudent to make these reductions every other day at first, and see how you go.

In short:

One whole pill split into quarters to be taken evenly over the day;

One whole pill ground and added to milk to a volume of 70ml;

Dispose of enough liquid to leave 17 or 18 ml;

Divide the remaining liquid up into four doses to take with your quartered pills over the day;

Once you resume you taper, dispose of an additional 1ml from the 70ml every other day. That is to say, assuming a starting point of 18ml, you would reduce the amount to 17ml, then 16ml two days later, 15ml after another two day, etc.

Once you have finished titrating this tablet, we will need to make a new calculation for your remaining tablet. As I've already mentioned, we need to recalculate as our dose reduces. Doing this with each new pill is convenient.

Hi Colin,

I need to remind you that I have no stabilization periods and have been homebound and unable to work since april from the xanax/ativan episode.  It's like trying to wean from another benzo when you haven't healed and are sick from the first round.  Can it successfully be done?  Are there people out there who aren't stabilizing and are sick throughout their whole taper and non-funcitonal?  My mental and physical status is bad and I'm beginning to wonder if something is really wrong as I read about others who have symptoms but "stabilize" between cuts and manage to carry out fairly normal routines part of the time.  I'm concerned because I don't seem to have that....

My tablets are 0.5 mg Klonopin tablets.  My current regimen is to take 1/2 in am, 1/4 tab in afternoon and 1/2 tab in pm....I wanted to ask you also why I'm not able to feel anything or tell a difference when I take my meds...it's like i have taken nothing at all.  Thanks for your help.   Pebbles.

Pebbles,

During my taper I never stabilized, from the minute I took Valium (3.75 mgs) I suffered. About the only thing I can suggest is stay the course and try to stay positive it gets better as time goes on.

Dave

Hi, Pebbles,

The way I got off of Klonopin was to switch to Valium once I was at .25 mg Klonopin. Klonopin is a very potent drug, and my quarter-tablet cuts were causing extreme symptoms. I didn't know anything about titration (dissolving the tablet in milk), so I switched to Valium so that I could make smaller cuts (Valium tablets are much less potent than Klon tablets). If I had stayed off when I had gotten to 0 Klonopin during my first (failed) taper, I assume I would have recovered, though it would have taken a long time, and I probably would have developed conditions secondary to withdrawal (bacterial or viral infections) because I was having terrible anxiety that was running down my system.

Pebbles, even if you can't stabilize, that doesn't mean that you'll have protracted withdrawal. When I was first tapering and was on another benzo support site, they told me that it's hard to get the "withdrawal horse" back in the barn once w/d starts. If you didn't experience any relief when you switched to Klonopin (did the doctor switch you at a 1:1 ratio? in other words, were you on 1.5 mg Xanax before switching?), perhaps your body had been in w/d long enough that it no longer received any significant effect from the Klon, and that's why you're unable to stabilize.

You can try stopping your taper for a while, as Colin mentioned, and see if that makes a difference. Cutting a quarter of a tablet of Klon every week is an extremely rapid taper, so that's probably contributing to the symptoms. I know one member here who stopped his taper for six weeks because terrible symptoms hit him all at once. Since you are getting increased symptoms when you make a cut, the Klon is doing *something*. If you want, you could reverse your last cut, since you've been there presumably less than a week, and hold there to see if things improve before continuing.

I really don't think there's anything wrong with you other than w/d. Not everyone stabilizes between cuts. For some people, the taper is difficult the whole way. Everyone's body is different. I worked part-time during my taper, but that was difficult to do. I can't imagine how anyone could work full-time during it. But everyone experiences w/d a little bit differently.

Therese

Hi Theresa,

It had been about 2 or 3 weeks of being off the meds before they started the Klonopin.  I had been on 1 mg of ativan for 1 month which I think is 10 mg of Valium and 0.25 of xanax 3 times a day for 7 days along with the ativan...so I think that would be the equivalent of 25 mg of valium.  The funny thing is that I did not feel high or especailly sleepy...the ativan and xanax didn't do alot for me.  I am told that I develop a quick tolerance to drugs within a few days and the effects go away.....have you heard of this before and does that mean i'm probably going to suffer through this whole thing?  Is there an advantage to having liquid Klonopin made at a pharmacy with syrup than the titration method?  Thanks, Pebbles

Hi, Pebbles,

 

The way I got off of Klonopin was to switch to Valium once I was at .25 mg Klonopin. Klonopin is a very potent drug, and my quarter-tablet cuts were causing extreme symptoms. I didn't know anything about titration (dissolving the tablet in milk), so I switched to Valium so that I could make smaller cuts (Valium tablets are much less potent than Klon tablets). If I had stayed off when I had gotten to 0 Klonopin during my first (failed) taper, I assume I would have recovered, though it would have taken a long time, and I probably would have developed conditions secondary to withdrawal (bacterial or viral infections) because I was having terrible anxiety that was running down my system.

 

Pebbles, even if you can't stabilize, that doesn't mean that you'll have protracted withdrawal. When I was first tapering and was on another benzo support site, they told me that it's hard to get the "withdrawal horse" back in the barn once w/d starts. If you didn't experience any relief when you switched to Klonopin (did the doctor switch you at a 1:1 ratio? in other words, were you on 1.5 mg Xanax before switching?), perhaps your body had been in w/d long enough that it no longer received any significant effect from the Klon, and that's why you're unable to stabilize.

 

You can try stopping your taper for a while, as Colin mentioned, and see if that makes a difference. Cutting a quarter of a tablet of Klon every week is an extremely rapid taper, so that's probably contributing to the symptoms. I know one member here who stopped his taper for six weeks because terrible symptoms hit him all at once. Since you are getting increased symptoms when you make a cut, the Klon is doing *something*. If you want, you could reverse your last cut, since you've been there presumably less than a week, and hold there to see if things improve before continuing.

 

I really don't think there's anything wrong with you other than w/d. Not everyone stabilizes between cuts. For some people, the taper is difficult the whole way. Everyone's body is different. I worked part-time during my taper, but that was difficult to do. I can't imagine how anyone could work full-time during it. But everyone experiences w/d a little bit differently.

 

Therese

Ashton says 1mg of Clonipin equals 20mg of Valium as does 1mg of Xanax equal 20mg of Valium as far as establishing equality in withdrawal treatment, just to let you know I personnaly didn't use the exact equivallancy in my taper so it proves we are all a bit different.

Good luck

Bobers

Pebbles,

Unfortunately, we're all very different when we're in w/d, and there's just no way to tell what the rest of your taper will be like. Even a "normal" taper is craziness. I hadn't heard of having such a quick tolerance as you do, but if that's how your body works, that's how it works. So I'm sorry, but I can't hazard a guess as to how long your symptoms will persist.

The advantage to having liquid Klon made up at a pharm is simply one of convenience. You don't have to do as much measuring and mixing. I think one of our members had liquid Klon made up at a solution of 1 mg : 20 ml.

Therese