Need help putting together a Klonopin titration schedule

Hello.  I am currently taking .375 mg in the AM (3/4 of a .5 mg tablet) and .5 mg at night.  I was taking .5 mg in the AM and PM but 9 days ago I cut my morning dosage by 25%.  I'm still feeling the effects of the cut and plan on staying at this level until I feel stable again.  Once I start tapering again I want to do the liquid titration method.  I have all the equipment I need because I tapered off of Prozac back at the beginning of the year using the same method.  Will someone please put together a schedule for me.  I want to try a medium to slow taper.  Thanks. 

BTW,  I do have a 100ml graduated cylinder with 1 ml markings.

It's good that you already have titration experience.  What did you have in mind as far as liquid and taper?

Thanks for the reply SG57.  I've read here on this board that whole milk is the best liquid to use.  I used water when I tapered from Prozac but I know that the two drugs are different and maybe Klonopin doesn't mix as well with water.  I will go with whatever you suggest.  Also, I've had a lot of anxiety in the past few months due to starting a new job so I don't want to do a fast taper.  I'm still trying to get over my 12.5% taper from nine days ago.  I'm hoping the worst is behind me but I just don't know how my body is going to react because this is all new to me.  I think my best approach will be to take it nice and slow.  I'll go with whatever you think is best.  Thanks for the help and support.

Whole milk is a very good choice.  How do you feel after that cut?  Are you functional?

I felt ok until day 7.  I started feeling a little more anxious with some body effects--slight shakiness and some anxiety that seemed to get worse in the afternoon and evening.  Day 8 was probably the worst.  Around lunchtime I felt some anxiety coming on and felt a little bit of unreality.  It felt like a panic attack was coming on but never did.  The strange thing is that since I've been on Klonopin I haven't had a full blown panic attack like I used to have occasionally when I got overstressed while taking Prozac and before Prozac.  There's been times when it felt like one was coming on but they haven't yet. By Day 9 I was feeling better and today, Day 10, I'm able to function at a decent level.

 

BTW, I experienced extreme anxiety and panic attacks for the first time when I was 15 yo.  It came as a result of bad trips on mushrooms (Psilocybin).  I had terrible experiences (twice) which included terror inducing hallucinations and panic.  Ever since then I've been prone to panic attacks when I get overly stressed.  When they do come on they feel like flashbacks without the hallucinations.  Don't know if that is TMI but I thought I'd include it as a reference.

 

 

Well, you're 9 days out from a 12.5% cut.  You seem to be handling it and recovering from it so your plan to sit tight might work fine.  I certainly wouldn't taper until the symptoms abate.  That was a big cut equivalent to 2.5mg Valium.  I don't like seeing people remove that much all at once.  It matters how we get to the goal and big step sizes can cause problems.

 

As for tapering, you don't really need the cylinder.  A 1ml and 10ml syringes will do the job.  And some well-sealed jars like jam jars or canning jars.

 

I assume you have two .5mg pills?  I'd probably dose one dry and one in milk.  I'd probably choose to use 50ml milk and put one .5mg pill into it to make a .01mg/ml concentration.  Each 1ml of milk will contain .01mg K.

 

I'd first dose without cutting to get used to it as the change alone can feel like a cut.  Each dose would be .25mg (half the dry pill) + 25ml K-milk.

 

When I was ready to cut I'd probably be comfortable removing .0015mg (.15ml) per day as a starting point to see how it goes for a few weeks before considering a bigger cut.  The idea is to start low and work up the ladder testing each rung for a few weeks until you find a cut that seems too much, then back off.

Thanks SG57.  Sounds like a good schedule.

Do you think I should start my liquid taper back at my original 1 mg (.5mg twice a day) or should I start at [1.0 mg - .125 mg = ] .875 mg per day which includes the 12.5% cut that I'm at currently.  If so, that would make my morning and evening dosages ~ .44 mg?  Also, should I keep my morning dosage and evening dosages the same?  The Ashton  Method (using diazepam) suggests cutting down to one dosage per day at night.  I don't know how well this would work with Klonopin since it has a shorter half-life than diazepam. Let me know  what you think.  Thanks.

 

Yes, keep the two doses the same.  That is important.

 

I'm not sure if you need to go back.  What I'm thinking is it's only been nine days so if you put it all back back you will likely feel good again quickly.  Then you can taper from that place and keep feeling good, so it is probably worth it.  I think I would go back if I were doing it.

SG57.

In your post, you said, "When I was ready to cut I'd probably be comfortable removing .0015mg (.15ml) per day as a starting point to see how it goes... "

 

Did you actually mean: removing .015mg (1.5ml) per day as a starting point. 

At the rate of .015mg (1.5ml) per day it would take 33.3 days to taper .5mg.

 

I'm still considering whether or not to go back to my full dose.  I don't feel too bad now but then again, I'd only be adding 9 days more days to my taper at that rate.  I'll probably have to slow down once I get below .5mg per day.  That's what I've been reading in some of the posts.

No, the decimal point is not off.  I meant .0015mg.  .015mg would be a massive daily cut for K.

 

It's important to realize two things...

 

1.  .0015mg is only a starting point

2.  Whatever your best cut is, high or low, you need to accept it and not exceed it

OK, then how would I taper by  .0015mg (.15ml) a day?  My graduated cylinder only has 1 ml markings.  Are you suggesting a taper of 1 ml of liquid every 7 days?  Maybe I'm not understanding the math.

Not 1ml every seven days.  .0015mg (.15ml) each day.  Don't remove the drug sooner than you need.  This works against you.  Let it stay in your body to cover symptoms.

 

If it were me I'd forget the cylinder.  I'd get a 1ml and a 10ml syringe and two jam jars (since you dose 2x a day).  That's it.  That's all you need.

 

Drop the .5mg pill into a jam jar, put in 50ml whole milk with the 10ml syringe (5 pulls).  Cap, mix, and allow time to dissolve, mixing now and then (doing this the night before is a good way).  Some pills need to be crushed first, but most don't.

 

When ready to cut, remove .0015mg (.15ml) with your 1ml syringe.  This is your dose for the day.  Next, split it into two jars by eyeballing them even.  Take each dose at dose time with your dry pill.

What I meant was 1ml total over a seven day period (.15ml daily  x 7 days = 1ml)

 

Please tell me how long it would take to reduce completely to zero using your suggested rate if I were to make no changes to it throughout the process.  Thanks.

Ah, okay.  Yes, the weekly amount would be about 1ml.

 

It would take 667 days or about 22 months if you never went higher.  But you likely will be able to go quite a bit higher.  .0015mg is just a starting point to get your bearings.  You can then methodically search for your best cut.

Hey SG57.

Thanks for being patient with me.  Sorry if I seem a little difficult but the idea of taking such a long time to taper is just so dang depressing.  :'( I've only been on this poison for a few months and the idea of staying on them for months longer really brings me down.    I guess I just suck it up and start my taper plan slow like you suggest and see how it goes.

 

BTW, I added another .0625 mg back to my morning dosage so my cut from the original .5mg twice daily is now  6.25%.  I think I'll stay here until I'm ready to start my taper.  I'll probably start after Christmas but I may start before that depending on how I feel.

 

Also, do you know anyone who has mixed liquid tapering with micro cut tapering using a gram scale?  There may be times when liquid tapering might be impractical for me and I'd like to have the option of doing micro cuts with a gram scale during those times; i.e, when travelling.

Yes, there are people using milligram scales.  The smallest cut you can make is about .003mg with a .5mg K pill, which is on the edge for daily tapering.  But I would not assume you would be able to switch back and forth without problems.  There seems to be a difference in how much gets into your body between liquid and dry pill delivery.

Hello SG57.  Just wanted to give you an update on my liquid titration taper progress.

 

Well, like a fool,    I didn't take your experienced advice on two main points:

 

1. When I switched to a liquid (milk) solution, rather than wait a week or two at my normal dosage, without tapering, I plunged right in and started my taper.  This was a mistake because I found out that a liquid solution dosage is absorbed differently, for whatever reasons,  than a dry dosage.  Some have suggested that even at the same dosage a liquid dosage  can feel like a cut and I definitely wasn't prepared for the w/d symptoms that it would cause.

 

2. Instead of starting my taper slowly, like at .0015 mg/day as you suggested I jumped right in at .0075 mg/day. 

Here's how it went:

 

12-29-14 - tossed 7 ml from my  .01mg/ml solution.  I had already dry cut tapered by 6.125%  down to .938 mg  from my original 1.0 mg /day dosage.  I did the .75 ml (.0075 mg) daily cut for three days until 12-31-14.  At this point I was starting to feel some w/d.  It wasn't the terrible shaking, trembly, panicky type of w/d but it was enough to make me slow down.

1/1/15 - Held at the previous day's dosage- .915 mg and felt better by the next day so I continued my taper at a slower pace.

1/2/15 - Restarted taper at .005 mg /day.  I did this for four days until 1-5-14.  By then the w/d had started coming back; not extreme but definitely unpleasant. 

1/6/15 - I have decided to hold at my current dosage until I feel better. Right now I'm at  .895 mg /day.  The last three days Jan.6,7,8 have been unpleasant but not unbearable.  Most of my symptoms have been emotional.  Either I'm feeling anxious or extremely depressed.  I'm glad I'm not having the near panic or depersonalization that I experienced early on when I tried to taper by 12.5% in my first run at tapering.

 

I'm realizing now that even though I haven't been on Klonopin for a very long time, withdrawal will still be a slow, tough experience.

 

How long do you think I should wait before I start tapering again.  I think my body might still be adjusting to the switch to a liquid solution/suspension.  I do believe that when I do start my taper again I will start slow (.0015 mg/day as you suggested) because slow progress is better than no progress. 

 

Hi Dave,  You are hardly the first to find out the hard way.  It can be difficult to grasp the mindset required for a proper taper.  It is what did me in.

 

You could hold where you are and wait it out, but it has not been long since the last dose you felt good at so I would put it back and hold there instead if it were me.  Probably not what you want to hear, but you have obviously tapered too fast - thankfully over a short stretch - and you still have the opportunity to go back and correct that.  I'd take it.  I don't think you will lose much if any time by doing this, yet you will feel better.

 

You might want to go to the New Years Day dose or go all the way back to .938mg.  The hold should be brief, then begin tapering at .0015mg and see how that goes for a few weeks before considering a slightly bigger cut.

Hi SG57. 

 

When you say that "...you have obviously tapered too fast - thankfully over a short stretch - and you still have the opportunity to go back and correct that.  I'd take it. "  What do you mean I still have the opportunity to go back and correct that?  Does that mean that if one waits too long after a cut then going back won't help?  How does that work?  I think I've seen similar posts that mention this.  Thanks.

Yes, there is a clock ticking.  If we wait too long we may get only partial or no relief.  I don't know why but something else is happening IMO.  Why doesn't updosing ALWAYS correct symptoms?

I updosed back up to .930 mg daily on 1-10-15 (from .895) after starting my taper too fast too soon on 12-29-14.  It's been 8 days since and I can't say I feel much better.  I've only had two decent days where I didn't have anxiety nagging away at me. I would have hoped that I would be feeling better by now.  I want to start my taper but don't really want to get ahead of myself.  Has anyone else had a hard time going from a dry dosage to a liquid taper?  How long did it take for you to adjust to a liquid solution? 

It's very common to feel a hit when switching from pills to liquid.  And I think you are smart to not taper until things settle down.

If you read in my signature you'll see that I was on Prozac and Celexa for 17 years and did a three month taper that finished in mid-January 2014.  I started experiencing severe anxiety in September 2014 (which was triggered by an new job which I was hardly qualified for) and it continued to get worse through November.  It was during this time that I began taking Klonopin regularly and I attributed by bad anxiety, shakes, trouble sleeping, tinnitus, etc.. to withdrawals from the Benzos when I didn't take them regularly. 

 

Well, I've been reading on survivingantidepressants.org that since I was on SSRIs for such a long time, my three month taper was much too fast.  Other folks there tell of similar experiences with protracted delayed w/d after stopping SSRIs c/t or too quickly.  SSRI w/d causes much of the same symptoms as benzo withdrawal.  I'm starting to think that my problem is SSRI withdrawal complicated by benzo dependency.  If this is the case then it changes everything.  Now I don't know if I should continue with my benzo withdrawal soon like I had planned.  I want to get off the benzos but they may actually be helping with my SSRI w/d.  At this point I don't know what do do.

 

SG57, do you know much about SSRI w/d syndrome?  Anyone here know much about it?  Things may not be as simple for me as I first thought.

 

SA takes a wider view and deals with all the psych meds and are in a better position to advise you than here, where all we deal with is benzos really.

 

But I'm puzzled how you could be free of the SSRI for eight months and feel okay yet still be in some kind of delayed withdrawal state.  If they are suggesting at SA that symptoms can be delayed for eight months I would not choose to believe them unless they can prove it.  I'm not saying it can't happen, I'm just saying there is way too much assuming and non-factual information on the forums that gets accepted as fact when in reality the people who run the forums and their experienced members know just as little as everyone else so it pays to be very skeptical.

 

From what I can see, all psych meds can produce long-term symptoms that are strikingly similar to benzos.  And the remedy seems to be the same - a long slow "symptom-based" taper with small cuts, always keeping yourself feeling good.  Symptom-based tapering with small cuts is the key I think.  If you are asking me I'd say go ahead and taper but never let it get out of hand.  Never.  If that means one, two, or even three years or more then that is what is required.  The brain is good at slow adjustment.