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i need a plan


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I need help developing a titration plan.  I am on .5mg klonopin.  i take half tablet in morning and half in the afternoon.  i want off the stuff because i think i'm developing a tolerance.  I'm also on 15 mg of remeron before bed for insomnia - been on it for 17 plus years.  i've been on the klonopin for 10 + months.  I'm scared because I have two small kids and a mortgage so I need to keep working through the whole process.  I keep reading over the posts and am a little confused - don't want to mess this up. 
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forgot to mention that I was on 11+ months of antibiotics for chronic lyme disease.  I think lyme can cause anxiety.  been off the antibiotics for 10 months.  not sure if the Lyme is gone for sure - there is no way to know for sure because the antibodies stay in your system for a long time.  I've been having a lot of dizziness lately.  Don't know if it is the lyme disease or if it is the klonopin/anxiety...
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I'm confused if you wanted to also taper the remeron?  If so you might want to check out survivingantidepressants.org and you might want to consider tapering that drug first, but they can advise you.

 

As for the .5mg K, if it were me I'd liquify it in 50ml full fat whole milk.  Give yourself some time to adjust, then begin cutting by removing maybe .15ml each day and see how it goes.

 

How many times a day do you dose?

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i don't want to get off remeron right now.  I want to attack the benzo first.  Is there a reason why you say to get off the remeron first?
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Yes, over on SA they explain a rationale for doing the AD before the benzo.  I'd say the most important thing is to not do them together, although there is a person over on SA who makes a good argument why she is tapering all her psych meds together.  She's bringing like four or five down together and feeling okay.
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Note that remeron is an atypical AD. 

 

Personally, I stopped remeron before I started my , but many BBs have found remeron to be very helpful during benzo WD.

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I have never felt the need for remeron.  It helped with my sleep and that is why I take it.  I do however feel the "need" for klonopin.  my body gets tense/tight, and sometimes i feel like there is a lump in my throat (kinda like what you feel like if your are afraid of public speaking and you have to give a speech) when it is close to my next dose.

Is it possible that the remeron has permanently "rewired" my brain since I have been on it so long and I will need it for the rest of my life?  Getting off the remeron scares me more than the klonopin because of the length of time I have been on it.  I asked my doc about it and he said he didn't know if I am permanently "damaged" but said why get off of it if you are functioning ok on it.  I wish I could just feel normal again - not needing these drugs anymore - not to have to worry whether I have klonopin in my pocket where ever i go.  I hate this part of my life.  I haven't felt normal since my first panic attack in 1998 - I don't know if it is because of my anxiety disorder or the drugs.  I've taken months of behavioral therapy but always felt i needed the drugs.  my therapist said my first panic attack turned on the anxiety switch and once turned on, it's on for life - that i would have to cope with the anxiety for the rest of my life.  talk about a depressing thought.

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The therapist sounds like a quack speaking with authority about something he really knows nothing about.

 

But on the remeron, I don't think it is permanent at all.  As near as I can tell all psych drugs cause the same type of problem as benzos and the remedy for all is the same - a slow taper.  If you go over to SA I think the picture will become clear to you.  They taper all pysch drugs there.  There is even a thread devoted to tapering remeron.

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SG57,  can you give me a general plan?  How much should i cut at first.  How long between each cut?  etc.  I'm currently on .5mg (.25mg twice daily.  would you cut one dose for example the morning dose and then the next cut would be to the afternoon dose?  How long do you think it will take me to jump?  I have all the equipment now to start (syringes, etc).  I got advice on the SA site about what to do with the remeron.  will be attacking the benzo first because the remeron helps me sleep.  after free of the benzo then will start on the remeron...
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SG57,  can you give me a general plan?  How much should i cut at first.  How long between each cut?  etc.  I'm currently on .5mg (.25mg twice daily.  would you cut one dose for example the morning dose and then the next cut would be to the afternoon dose?  How long do you think it will take me to jump?  I have all the equipment now to start (syringes, etc).  I got advice on the SA site about what to do with the remeron.  will be attacking the benzo first because the remeron helps me sleep.  after free of the benzo then will start on the remeron...

 

See reply #2 in this thread.  At your dose I'd begin by cutting .0015mg daily and see how it goes.  I'd take the cut from the daily batch then split what remains 50/50 into your two doses and I'd dose 12 hours apart.  I don't recommend jumping.  I'd taper all the way to zero.  There really is no predicting how long it will take.  It could be just five or six months, or it could take a couple of years.

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i dose when I get up at 6:30 am then I dose again at 12:15ish - this gets me through work - i work at a correctional facility which can be stressful at times.  I'm generally ok for the night with a little bit of a "need" around bedtime but that's when I take the 15mg of remeron which takes care of me for the night (usually…sometimes it takes me a while to fall asleep).  Is this dosing ok?  also, if I begin to feel withdrawal, do i just space the decrease further apart or do I adjust the amount of decrease?
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Well, if it were me I'd dose half at 6:30am then half at 6:30pm, but if what you are doing right now is working for you then that is the most important thing.

 

On the withdrawal, you hold as needed for as long as needed.  But with the right cut this should not happen much.  You can find a cut that you recover from within a day, so you always feel good.

 

From what I see the K milk will last many days.

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do you cut the same .0015mg each time or do you cut a percentage?  If using the percentage, the cut would get smaller and smaller as your dose decreases, right?
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Percentages become pretty meaningless with this way of cutting.  Just keep cutting that constant amount until it gets used up, then lower it.
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SG57 - first let me thank you for all of your advice.  I really appreciate it.  What do you mean when you say when used up then lower it?
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You're welcome for the advice.  I hope some of it is helpful.

 

What I meant was you just keep using the same cut every day and keep riding it until it starts to cause symptoms.  For example, you might find you need to keep holding to keep symptoms down.  When that happens you probably need to go to a smaller sized cut.  Then ride that cut the same way.

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It's a good idea to know which enzymes metabolize your benzo and to then check any foods or meds you ingest as these can speed or slow the benzo metabolism by affecting these enzymes.

 

Here it shows that omeprazole induces 1A2 and inhibits 2C8, 2C19, and 3A4...

 

http://www.edhayes.com/CYP450-4.html

 

K is metabolized by 3A4 so, yes, omeprazole slows your K clearance.  As long as you don't stop the omeprazole this may not be a bad thing as it is like the K half life is increased, which is a help to tapering.

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i haven't started the tapering yet.  waiting to see my doc first to run it by him.  I think i am in tolerance withdrawal.  i feel most "normal" for a few hours after each dose, but the majority of the day i don't feel well.  dizzy and anxious for good parts of the day.  I was wondering if i could dissolve in milk and split my does from my current twice a day to like 3 or 4 times a day at the same total amount per day before starting the taper.  is this ok or will it make tapering harder/more complicated?
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Oh yes, it sounds like splitting your dose more might help you.  When the dose is a cure for symptoms it is sign of interdose withdrawal and the best way to combat that is to split the dose up more.  But you need to be aware that when the switch from pills to liquid is made it is often felt as symptoms.  It is common for people to feel it.
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You're on .5mg K a day, right?  So you liquify the entire pill in say 50ml whole milk and from there it is a piece of cake.  Since your entire dose is liquified you can take your cut out from the total dose then split what is remaining into three equal doses.  Just line up three containers on a counter and eyeball them even.  Be sure to rinse and drink to get all the K-milk.

 

If you wanted/needed four a day just split into four containers instead of three.  A liquid drug is very useful when it comes to splitting.

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  • 3 weeks later...
SG57,  because of where i work, i can't keep the milk cold.  So I take my first dose at home at 6:45am and then my second dose at work at noon.  Can I freeze the milk solution so it stays unspoiled until noon?  or do I go with a ora plus solution?  or maybe the vodka method - but this method scares me because alcohol make me sick (my doc told me that my liver doesn't process alcohol correctly).  I can drink maybe a half glass of wine before my face gets red and it's harder for me to breathe.  Maybe the vodka amount is so small that I really don't have anything to be afraid of.  Your help or any one else's opinion would be greatly appreciated.  Have a doc appt soon and will be starting my taper soon.  also, can i do milk on weekends and ora plus/vodka during work week?
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