Personal milk titration plan

I have been taking .75mg clonazepam twice a day with breakfast and dinner for about three weeks. Was on .5mg twice a day for approximately year and a half, but switched to .75 twice a day at doctor's advice which was serious mistake. Within last week starting switch to valium by substituting 5mg valium for .25mg of the clonazepam with both doses.  Having problems with the change to valium however in form of dizziness, headaches and worst of all increased nausea - was prescribed the clonazepam in first place to help with chronic idiopathic nausea but now need to get off the clonazepam as it too was making nausea worse although not as bad as before partial transition to valium.  Just happen to have an appointment with my prescribing doctor this Friday, April 10 and would like to be able to discuss a milk titration plan based on starting point of most recent dose of .75mg of clonazepam twice daily.  I wasn't aware of milk titration as possibility previously and advantages of transition to valium seemed obvious, but thinking now milk titration may be best for me given problems with switch to valium, especially spike in nausea which has made it impossible to eat without daily use of prescription nausea meds which I have previously needed only very infrequently.  One other point I should mention is that from 2011 to 2012 I was taking .25mg clonazepam twice a day for just over a year for anxiety related to gastric emptying problem following gall bladder surgery.  Tapered off that small dose by simply taking half of one dose first week, half of both doses second week, single half dose third week and stopped completely 4th week with no problems.  Don't know how that impacts my current situation but thought you should know.  Anything else I need to do to get personal titration schedule.  Thanks.

 

I guess I'm confused as to which drug you will taper - V or K.  But whole milk works for both.

Sorry if I wasn't clear.  Because the transition from clonazepam to valium is not going well for me, I want to go back to the daily total of 1.5mg of clonazepam divided into two equal doses that I was taking before I began trying the transition dose combining both drugs.  I would then use the liquid titration approach starting with the 1.5mg of clonazepam.  What I need to know is how to get a personal titration plan I can share with my doctor at my upcoming appointment on April 10.  I'm brand new to the site and I'm not sure I'm putting my request for a titration plan in the right place.  If not and you know what I need to do make that request please let me know.  Thanks.

The way it works is you just post for comment like you are doing and people will respond.  Then just keep conversing and asking questions until you have a plan.

 

I can tell you what I might do were I in your shoes.  I'd probably liquify .5mg K at a time with whole milk and take the rest as dry pill.  I'd get a 1ml and a 10ml syringe and a few good sealing jars and take .75mg AM and PM.  I'd first dose with milk for a week or two to get used to it, then begin cutting .0015mg K per day as a starting point.

Hey oldlawyer and welcome!

 

I agree with SG, good advice there.  I am currently titrating off of clonazepam and things are going good so far.  I have reduced 16% in 16 days and the symptoms are very manageable for me so far.  I was given librium to substitute for the clonazepam but i haven't switched because the titration is going good.

 

stay strong!

sharkey

Thanks for the replies, but I've got a couple of questions.  First, are you suggesting liquefy only one of the two .5mg K pills I take daily to start with or both?  Second, either way, do you recommend taking the .25mg in pill form until both liquefied versions of .5mg pills have been completely reduced to zero?  Next,  with respect to your comments and the video I watched it appears that once you start reducing your dosage you stick to the same amount of the reduction every day until you have a negative reaction.  For example, you might reduce by .0015mg of K daily for a week or weeks.  Since the remaining dose is constantly going down, that means the percentage of reduction gets bigger every day, albeit at quite a small rate to begin with.  Have I got that right?  Finally, how does dosing with milk affect the bodies reaction to the K?  Since initially it will be exactly the same dose of the same med it seems like there should not be any reaction, but that's obviously that's not always the case.  Mainly just curious about this.  When I changed to liquid Zoloft from the pills because of the slow taper I had to make, I didn't notice any change in how the drug affected me but then I wasn't adding another substance altogether like milk to the mix.  Thanks again.  I am so looking forward to starting the dose reduction.  I've gotten free syringes from my pharmacist and ordered a good quality 100 ml graduated cylinder.  Thanks again.  The doctors here haven't got a clue about how to get off these drugs even though they have no problem prescribing them.  Fortunately mine is willing to learn.

Thanks for the replies, but I've got a couple of questions.  First, are you suggesting liquefy only one of the two .5mg K pills I take daily to start with or both?  Second, either way, do you recommend taking the .25mg in pill form until both liquefied versions of .5mg pills have been completely reduced to zero?  Next,  with respect to your comments and the video I watched it appears that once you start reducing your dosage you stick to the same amount of the reduction every day until you have a negative reaction.  For example, you might reduce by .0015mg of K daily for a week or weeks.  Since the remaining dose is constantly going down, that means the percentage of reduction gets bigger every day, albeit at quite a small rate to begin with.  Have I got that right?  Finally, how does dosing with milk affect the bodies reaction to the K?  Since initially it will be exactly the same dose of the same med it seems like there should not be any reaction, but that's obviously that's not always the case.  Mainly just curious about this.  When I changed to liquid Zoloft from the pills because of the slow taper I had to make, I didn't notice any change in how the drug affected me but then I wasn't adding another substance altogether like milk to the mix.  Thanks again.  I am so looking forward to starting the dose reduction.  I've gotten free syringes from my pharmacist and ordered a good quality 100 ml graduated cylinder.  Thanks again.  The doctors here haven't got a clue about how to get off these drugs even though they have no problem prescribing them.  Fortunately mine is willing to learn.

 

I'll try to hit your questions...

 

You can do it either way.  You can liquify the entire dose or just one pill at a time.  What pills do you have?

 

Yes, reduce the liquid to zero before beginning another pill.

 

Right, reduce the same amount each day until you have a negative reaction (symptom increase).  Percentage does not mean much when tapering daily.  Start slow and search up the ladder for the right cut size.

 

The milk is just a carrier for the drug.  It does not affect anything.

Thanks SG, I think I'm almost there.  I use one .5mg K with one-half .5mg pill to get the .75mg that I take twice each day.  I think I need to keep the am & pm doses proportional so I would liquefy both the .5mg pills and take liquid with the one-half .5mg pill in the morning and evening until I have reduced the liquid to zero at which point I would liquefy the half pills and finish the job.  Since I would be converting both .5mg pills to liquid would I still drop at .0015mg a day?  Also my undergraduate degree was in history and I made my living as a lawyer so whatever math skills I once had are pretty much lost in the mists of time and the cognitive fog created by all the meds I've been on for four years.  So, what's the formula for reducing my 100 ml of 1mg K milk by .0015mg of K?  When I tapered from the Zoloft I used the liquid but I dropped a specific percentage of the existing dose every few weeks, so if I was on 10mg and dropping at 10% I went to 9mg at the next drop, 8.1mg at the next drop and so on. The liquid was 20mg per milliliter so it was pretty straight forward, even for the math impaired like me. Is it just a simple ratio of .0015mg k over 1mg k is equal to x ml of milk over 100ml of milk?  Solving that gives me a drop of .15ml per day.  Is that right?

Not much math is required don't worry.  Just divide the pill size by the amount of milk and that number is the amount of K contained in each ml.

 

It sounds like you have three .5mg pills and you dose twice a day.  I'm going to suggest you liquify one .5mg pill in 50ml whole milk.  This makes the same .01mg/ml solution.  But your math is right on target.  To get a .0015mg cut reduce by .15ml each day.  Split what is remaining in half for your two doses.  This will keep things nice and even as you drop.

 

But before you start cutting give it a while to adjust to the liquid.  Also, it goes without saying but be sure to hold as needed.  That goes without saying, but people sometimes think daily cutting means you MUST cut every day, which is not the case.

Thanks.  As soon as my 100ml cylinder arrives I'll be ready to go.  I really appreciate your time in helping me get this all straight in my head.

Sorry SG, but one more question/realization.  At the rate of a drop of only .0015mg per day or one tenth of one percent of the starting dose, even if I never have to hold it will take 1,000 days to get to zero mg of K, which is over 2 and a half years.  Am I doing this right or am I missing something? I don't know what dose he started from, but Sharkey talked about dropping 16% in 16 days. To get 16% in 16 days I'd have to be dropping at .015mg a day, not .0015m, which I take it would be much too high.  I knew going slowly is important but I guess I never realized how slow it would be.  I'll be pushing 68 when I'm finished, but it is what it is.  Thanks again for your help and oh, how I hate these drugs.  Wish more doctors thought about the end game when they think about prescribing them, but I guess everybody on this site shares those sentiments. 

OL, Your body will determine the rate.  You heal as fast as you heal and the way you taper does not really affect that.

 

The rate I proposed is just a starting point to jump in and have initial success and get your bearings.  It's slow enough to pretty much guarantee that.  Try it for two weeks, then if all is good, nudge it up to .002mg.  Test two weeks.  Nudge to .0025mg.  Test.  Nudge to .003mg. Test.  And so on until you find a rate that brings on symptoms.  This way you can methodically and safely search for your optimal rate.

 

It's likely that you will be able to taper much faster than .0015mg, but some people are down near there and I don't think it is a good idea to jump in high.

Got it.  Thanks.

While waiting for my 100ml cylinder to begin milk titration I tried the advice of my new psychiatrist and dropped from 1.5mg K to 1.25mg in one step by cutting one pill in half.  Since I was dosing twice daily I got two .125mg tablets & took one with each remaining .5mg tablet.  This was April 11, 2105 through April 26. First week was unpleasant, mainly with GI symptoms of increased nausea & diarrhea, but after first week things calmed down & by April 27 symptoms essentially the same as they were before I dropped with nausea being the main problem.  I had noticed since summer of 2014 that nausea would increase each afternoon until after my evening dose.  At that time took am dose with breakfast around 7:30 and pm dose between 6 and 7, whenever we had dinner.  Problem started in later afternoon around 5 but then gradually got earlier & earlier.  Didn't realize this was my body telling me it had reached tolerance point & wanted more of the drug.  Some days better though & at that time didn't understand why.  Had been given 10mg valium suppositories for chronic pelvic pain following bowel movements.  Sometimes it hurt and sometimes it didn't so I took the suppositories as needed.  Had I kept accurate records I'm sure I would find that the days my pm nausea failed to materialize were the days I used a suppository and therefore had 2 different benzos in my system simultaneously, with the long half-life of the valium extending its benefit for more than one day.  I had thought that only small amount of the valium getting to the brain and prescribing MD didn't know one way or other.  By chance had appointment with MD treating my restless legs & he said large amount of the valium from suppository getting to brain.  After learning this in early February of 2015 weaned myself off the suppositories with little difficulty because I had taken them only intermittently. Had a couple of weeks of dizziness and anxiety & that was it. 

 

Problem was, this completely unmasked my K tolerance problems and afternoon nausea became early afternoon & evening nausea of increasing magnitude.  Was then I finally had my aha moment & realized I needed to get off the K right now.  Had known that it needed to be done but was tapering slowly off Zoloft & didn't think it wise to do both together.  Once off Zoloft in June of 2014 still experienced some nausea, which I attributed to lingering effects of Zoloft, but which my well have been effects of K tolerance.  Nausea essentially gone by September of 2014.  In retrospect that's when I should have started K taper, but was still some nausea which I, probably incorrectly, attributed to the lingering effects of Zoloft.  Tried to switch from K to valium starting March 25, 2015 using online table.  Unfortunately experienced dizziness, increasing nausea and restless leg symptoms and difficulty urinating.  Was told by restless leg MD I had not experienced these symptoms with the valium suppositories because of blood vessel near rectum that goes straight to brain bypassing liver, gut & kidneys.  So went back to just K to use milk titration on remaining 1.25mg after getting advice from other member and finally began milk taper April 27 by converting one pill to liquid and taking half the liquid, half remaining pill and one .125mg pill twice daily.  Problem was that afternoon and evening nausea continued to worsen to point I had to start taking Rx nausea meds to be able to sleep at night.  Seems I had gotten to point that effect of the K just not great enough after long time on dose to carry over the 12 hours between doses.  (Had gone to strict 12 hour interval during the two weeks following my one-time drop of .25mg. but didn't help.)  Continued reduction of dose from .15ml to .3ml of k milk only seemed to make nausea worse, so held at drop of .3ml for 3 days with nausea getting worse requiring nausea meds every day and night and starting to lose weight. 

 

At that point decided to go all in.  Liquified all pills and divided into 3 equal doses starting May 1, holding steady at .3ml reduction for time being.  My thinking being that although 1 third dose smaller by taking every 8 hours rather than every 12 I would maintain a higher average concentration of k in my system and avoid the afternoon through evening bouts of terrible nausea. As of today, May 3 seems to be working to some extent.  Am dizzy in am with odd sensation in lower legs, both tolerable and seem to get better as day goes on. More importantly, nausea is better although not gone.  So, what's the question?

 

My question is whether I am one of those people who would be better off taking the fast taper my psychiatrist recommends, suffering a period of bad but diminishing symptoms with each drop or sticking with the slow tape.  At this point, I am still experiencing unpleasant nausea every day. Not at the level it was before switching to 3 does per day but its still there and does affect my eating.  So any votes for rolling the dice on the fast taper? I know it's not recommended by benzobuddies, but it does work for some people and I really don't know if I can do an indefinite period of being nauseous every day, especially since the  nausea seems to worsen with each taper.  I can deal with dizziness, headaches and anxiety.  They won't kill me.  But if I get too nauseous to eat properly for long periods and lose weight that is clearly not a viable option.  I'm beginning to feel like damned if I do and damned if I don't. Help! 

I don't recommend a fast taper.  The fact that you were able to influence the nausea by simply dosing more frequently shows you may be able to control it.  Why not try four a day and see if that helps more.

I'm with SG. I went that route last year under the guidance of an addictionologist/psychiatrist and did OK until the end and then all hell broke loose.And I don't even know if my taper would be classified as being fast,he didn't think so. I did .125 reductions with 3 week holds. When I reached my last .25mg  I started having a couple sleepless nights a week,which led to a few sleepless nights in a row per week . I pushed though to zero and wasn't sleeping hardly at all. I was benzo-free and sleeping about 8-10 hrs. a week for nearly 3 months (and still working) until I finally went over a week straight with no sleep at all and just disintegrated;then ended up hospitalized for Christmas.Sounds impossible but it is true,I still don't know how that was even humanly possible. I guess the silver lining was that I was able to reinstate at less than half my original dose,which has enabled me to do a slow titration down from there. So far,so good.

 

TH

Thanks to both of you.  I think I just needed the encouragement to stay the course.  I am just so incredibly desperate to be off this drug, but I know desperate actions will only lead to the sort of problems TH described.  I managed to stick it out for 18 months on my Zoloft taper so I guess I can handle this one too as long as I can keep the nausea in check.  I'll stick with my current rate of taper of .4ml a day which I seem to be handling well, and if that holds true for a couple of weeks I'll try increasing it a bit.  The morning dizziness I experienced the first few days of switching to 3 doses has disappeared already after only 4 days.  I have no trouble falling asleep with the new regimen but can't fall back asleep after my usual 5am trip to the bathroom.  That happened when I switched back to K after my failed attempt to convert to Valium so I'm hoping sleep will return to normal as well.  If the nausea flares up or sleep problems continue I'll try SG's suggestion to try four doses a day.  Thanks again.  The place I live is too small for a support group and it gets a bit lonesome dealing with this on my own, so I really do appreciate your comments.  My family & friends really don't understand what this is like and I'm glad they don't and although my GI doctor who originally prescribed the K is completely supportive about taking the slow approach, it would be nice to live in a place where I could talk regularly with people who have or are going through this.  Can't wait until I can start counting the days I've been benzo free!  OL

Hey OL,

 

Sounds like you are settling in to the taper nicely;that's great news. I'm happy for you. If you decide to start increasing your cut rate just be sure to give yourself a good two weeks to get acclimated to it. It seems that after I increase my cut rate, the symptoms get pretty intense between days 8-10. When I'm just about ready to turn back they seem to subside.

 

Good luck with it,

TH

Thanks, TH that's good to know.  So far my symptoms are mainly gastrointestinal, i.e. nausea.  No jitters, anxiety or the like.  As was true with my Zoloft taper, I have to find the line between tapering too slowly which causes nausea and tapering too fast which does the same.  My brain itself seems a bit more forgiving about the tapering process.  It's my gut that gets unhappy with me.  Right now the nausea is gone first thing in the morning because I've had nothing to eat for 12 hours or so and no dose of the K for 8 hours.  The nausea sets in again after about two hours of dosing and remains at a fairly steady level through the day.  It's bearable but looking forward to getting to the point where I've cut enough to reduce it significantly & then eliminate it altogether.  Thanks again. ol

One more for go slow. Many options to deal with the GI issues. I would be asking my doctor for Zofran or Kytril - used to eliminate nausea from patient on Chemo. Amazing drugs.

 

You will be benzo free !