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Questions for those with titrating experience...one odd one....


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Hi all -

 

Hubby and I did a dry run (well, I guess it was a "wet" run) last night on titration.  He put my bedtime dosage of Klonopin (.5 mg) in 150 ml of water.  I have some questions:

 

- The medicine seemed to get "picked up" a lot faster by my body from already being dissolved.  It was most unpleasant.  Anyone else notice this?  Does it keep happening that way?

 

- The odd thing: my nose started running like crazy about 25 minutes after I took the dose, which has never happened when I've taken it in pill form.

 

- And a more long-term question: when you're titrating, how do you decide when you need to slow down?  With dry cuts it seems pretty easy to say "Aha, that was the problem."  When you're titrating, is it dangerously easy to get "ahead of yourself"?

 

I'm thinking of starting with a conservative rate - 8% or so over 14 days. 

 

I have been holding at 1 mg for 12 days, and while today I've had agitation from the choppy night of sleep I got, the last few days have generally been an improvement over the previous week.  I wish to heavens I could just knock this 1 mg out in a month like I did the first one, but I don't think my body or mind can take that kind of stress again.  The fast cutting was going fine for a long time, until then it suddenly really wasn't.

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Hi all -

 

Hubby and I did a dry run (well, I guess it was a "wet" run) last night on titration.  He put my bedtime dosage of Klonopin (.5 mg) in 150 ml of water.  I have some questions:

 

- The medicine seemed to get "picked up" a lot faster by my body from already being dissolved.  It was most unpleasant.  Anyone else notice this?  Does it keep happening that way?

 

Hi, I don't think anyone else has reported this, but I guess it does make sense. It takes time for the casing to be dissolved in the stomach (but this is removed when the pill is ground down), and the small granules are bound to be more easily dissolved and absorbed through the stomach. I suggest that easy solution is to simply sip the liquid over a period of about an hour. ;)

 

- The odd thing: my nose started running like crazy about 25 minutes after I took the dose, which has never happened when I've taken it in pill form.

 

I don't know about this. maybe it is an effect or maybe it is just coincidence. If is an effect, then drinking the liquid slowly, as outlined above, should take care of this.

 

- And a more long-term question: when you're titrating, how do you decide when you need to slow down?  With dry cuts it seems pretty easy to say "Aha, that was the problem."  When you're titrating, is it dangerously easy to get "ahead of yourself"?

 

I understand your concern, but just as with pill-splitting, if you feel that the taper is too fast, simply suspend making further cuts. If you are using one of our titration schedules, and new one can be compiled to start from from any stage of titration, and with a new titration rate.

 

I'm thinking of starting with a conservative rate - 8% or so over 14 days.

 

This is reasonable. A taper plan can always be modified with an increased taper rate too if you later feel that that 8% over 14 days is needlessly pessimistic.

 

I have been holding at 1 mg for 12 days, and while today I've had agitation from the choppy night of sleep I got, the last few days have generally been an improvement over the previous week.  I wish to heavens I could just knock this 1 mg out in a month like I did the first one, but I don't think my body or mind can take that kind of stress again.  The fast cutting was going fine for a long time, until then it suddenly really wasn't.

 

Just let me know if and when you would like to me to complie a titration schedule for you.

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Thanks for the answers, Colin.  That certainly gives me some things to think about.

 

One of my doses is a middle-of-the-night one, which makes sipping problematic.  I might have to combine the doses.  Any advice on doing that?  How long to take, how to proceed?  I'm sure that's here somewhere, but I can't seem to find it now.

 

Right now I'm taking one at about 9:30 p.m. and the second when I wake up between 12:30 and 2 a.m.  Do you think the varied times could be making things harder for me?  That middle-of-the-night dose is certainly the one I'd like to get rid of first.

 

I can't take the stuff in the morning after waking up - no matter how little, it zombifies me. 

 

Even though I've been holding for 13 days at 1 mg, the stuff still doesn't agree with me.  As when I arrived here, I still feel best furthest away from my dosages.  While my general level of anxiety/agitation has decreased from when I was at 2 mg, the mornings are still bad, and I still have times where it's a 10 out of 10 - suicidal thoughts, hopelessness, all sorts of awful stuff.  Wish I'd never gotten near the stuff.

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Hi,

 

You should not need to take Clonazepam this often, as it has a fairly long half-life. If I was you, I'd take one dose last thing at night, and the next dose first thing in the morning (about 8 hours later). I'd take a third dose in the middle of my day (about another 8 hours later). The three doses should be of roughly equal size. You might find that by not taking the extra dose in the middle of the night, you feel less sedated by the morning dose. Also, it will help to take it after breakfast. If you still cannot stand this, then you might split your dose in to just two parts over the day, but this means bigger doses, so I think it likely you will feel more sedated.

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The actual prescription is for once a day, at bedtime, but unfortunately I got in the habit of taking more when I woke up back when I started taking it.  I think I will just have to work on whittling down that middle-of-the-night dose and get to the point that I'm only taking it at bedtime.  I really can't tolerate it during the day.  Well, I can't tolerate it at any point, clearly, and it's messing with my sleep architecture.

 

Is your thinking that taking it an even 8 hours apart, three times a day, would even out blood levels and minimize w/d symptoms?  Because as stated, my anxiety/agitation symptoms are worst in the morning (when there's the most of it in my system) and improve as the day goes on.  I'm afraid if I took it evenly three times a day I'd never get out from under the anxiety and agitation.  What's your thought?

 

Thanks again for the help, Colin.  I really appreciate it.

 

 

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My understanding is that your blood levels will peak within an hour of taking your pills. You blood levels will then fall until your next dose. Perhaps, by making a liquid from your pills, peak blood levels will occur even sooner. So, in the morning, your levels will have dropped, so heightened anxiety may result. Of course, some people suffer with morning anxiety anyway. So, I think, in your situation, there is a lot to be said for trying out a more even regimen over the day. Though, I didn't take benzos for anxiety, so you might wait for some feeback from others first.
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Hmm.  I'm not sure I see where you're going here.  While pickup might be faster, I wouldn't think that titration would change the drug's half-life after absorption.  Am I misunderstanding?

 

Yeah, I wasn't prescribed this for anxiety either - it was for "excitatory neurotoxicity" - but obviously the drug causes anxiety in me.

 

I tried taking some in the daytime a few times when I was at 2 mg, shifting it out of the night dosage to during the day - I tried .25 at breakfast and afternoon and then .125 at breakfast and afternoon, and then .125 at breakfast, and I couldn't deal with even .125 mg.  I couldn't function at all.

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Hi,

 

I probably wasn't very clear - my phrasing wasn't great.

 

If all of the dose is absorbed very quickly, then there will be a greater peak, and because the dose is not being gradually absorbed, there is not the trickle into the bloodstream of benzo if it was instead absorbed slowly. I think the peak might be noticeably different if the absobsion rate is much increased, but the corresponding drop in blood levels before the next dose will be marginal. You are correct, the half-life is not affected, but there will be a small increase in between peak bloodlevels, and a small decrease immediately before the next dose (compared to the pill being absorbed more slowly). And the fact the peak is greater, means that blood levels have further to drop too (if they are to achieve the a similar low to when the benzo is absorbed more slowly). The low in bloodlevels before the next dose must be only minutely less than they would be anyway.

 

You should do what works best for you. It might take little while to adjust to any changes. Did you try gradually drinking your liquid, so that it is absorbed more slowly?

 

Don't worry about the 'lows', because, as I said, this effect must be tiny. You might experience noticeable peak levels though, with a quick absorbsion of benzo.

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Hi Colin -

 

Did my first titration cut last night on the middle of the night dose - 1 a.m.  I never got around to doing a "sipping slowly" experiment.  Just haven't had a good day for it. Since this was the middle of the nigt, I did have to drink it all at once, of course, but I did have some yogurt with it hoping to slow absorption. 

 

Didn't notice my nose running, but I did wake up with a *massive* headache at 6:30 this morning.  Yikes.  Maybe my body will get used to the different delivery in time?  Maybe it'll diminish as the dosage is smaller?  I had to take 975 mg of acetaminophen/paracetemol to knock the pain down.  I hope I don't have to do that every morning.

 

If I did want to shift that dose out of the middle of the night to split doses during the day, how would I go about that?  Gradually, like with everything else?

 

Continued thanks for your assistance.

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