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Jsince - may need to consider titration


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Hi Colin, my name is Jim and you can see from my post on the welcome page or from my signature I am working my way down from 2mg of Klonopin that I started taking about about 10 months ago after a ADR to Cipro. I started to taper off from in late April so I had 7 months total at the full dose. I have been doing .125mg dry cuts every 2 weeks and it wasn't going to bad, actually not bad at all, until the last cut a week ago yesterday from 1.125 to 1.0. With that one I had 3 - 4 days of a very upset/sick stomach, increased anxiety and really increased depression, that has kinda flattened out and I feel better now but not perfect. I'm vacillating between doing another .125 dry cut to see how it goes, maybe go to a .0625 dry cut or liquid titration. I would just as soon stick with dry cuts because I take it 3 times a day (for now) and transporting the liquid to work could become quite a pain but I really need to keep working so if titration is what will get me thru this then so be it.

 

So, with that said I would greatly appreciate your input with a titration schedule to consider and your opinion on what my next steps should be.

 

The answers to the initial questions are as follows:

 

Start date: Aug 4th

 

Dose: 1mg Klonopin

 

Tablet dose: .5mg

 

Number of tablets: 2 of the .5mg tablets total. I take .25 @ 8am, .25 at 2:30PM, .5 at night, usually about 9:30

 

 

Taper rate: not sure but let's say 1% per day, that maybe a bit aggressive using my last cut as a guideline but as mentioned the previous cuts went fine.

 

 

Cylinder details: don't have a cylinder yet, would appreciate your input & guidance, I will buy whatever is recommended.

 

Let me know what you think,

 

Jim

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Hi Jim,

 

This seems fine to me. I can draw up a schedule based upon your figures, and if you need the schedule adjusting later, this is not a problem.

 

As for a suitable cylinder: I recommend two 100ml cylinders, marked with 1ml increments, one glass (your primary cylinder that is easy to clean), and one plastic (as a backup, in case you break your glass cylinder). These are easily obtainable on the Net, and should not be expensive.

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Thanks for the reply Colin, will yiou post the schedule on this forum or send it to m email, not sure what the enxt step would be.

 

Jim

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Thanks for the reply Colin, will yiou post the schedule on this forum or send it to m email, not sure what the enxt step would be.

 

Jim

 

Colin will post the schedule here in this thread.  :thumbsup:

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Thanks Theresa, that's what I thought but wasn't sure.

 

Jim

 

PS, sorry about the spelling on the previous post, it's been a busy morning at work and I hit post before spell check, I'm not the greatest typer in the world as you can see.

 

Jim

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Hi Jim,

 

Here's the schedule based upon the figures you supplied: http://www.benzobuddies.org/spreadsheets/tt-jsince-2009-08-02.html.

 

Please add the following code to your signature (through your profile):

 

[url=http://www.benzobuddies.org/spreadsheets/tt-jsince-2009-08-02.html][u]My Titration Schedule[/u][/url].

 

Please print off your schedule now, in case you cannot access your schedule here for some reason.

 

Let us know if you have any questions.

 

Good luck.

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Thanks Colin, so I would just titrate 1 pill at a time, I am a bit confused on that. If it is just one pill at a time how do I divide up the other pill, I take it 3 times a day?

 

Sorry for the confisuion,

 

Jim

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Colin, I am also wondering about the % of reduction, I noticed on some other threads that you spoke about reducing by 2ml each day for a user of 1mg of Klonopin and that would be about 10 % and would take approx. 100 days to complete, kinda the same pace that I am on by doing the .125 reductions every 2 weeks.

 

Is there a reason that you are suggesting that I go with 1ml per day instead of 2ml?

 

Thanks

 

Jim

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Thanks Colin, so I would just titrate 1 pill at a time, I am a bit confused on that. If it is just one pill at a time how do I divide up the other pill, I take it 3 times a day?

 

Sorry for the confisuion,

 

Jim

 

Hi Jim,

 

Our titration system is based upon titrating just one tablet from your daily dose. All you need do to include the other pill is make up the 100ml of liquid, dispose of the liquid that is not required from the 100ml so that you left with your dose (98ml on the 4th Aug., for example), crush your second pill, and add it to the 98ml. The liquid now contains your whole dose for the day. When you get to the stage where you are drinking just a small amount of the 100ml, you go through same procedure, but after you have added your second crushed pill, just top up the liquid with extra milk so that you have enough liquid to easily divide into several smaller doses over the day.

 

Your schedule gradually reduces the size (or frequency) of you cuts over time. At a low dose (one 0.5mg pill per day in the schedule I drew up for you), the taper rate no longer grows any smaller so that the end of you taper plan is not drawn for too long. You are reducing your dose by just 1ml per day.

 

If you prefer, you could start off with 100ml, using a single pill, and reduce your dose by 2ml every day, and then continue at this rate all the way down, even when on a single pill per day. There is no real right or wrong about this. You should do what you feel is best for you, and be willing to adjust your plan according to how you react. 100 days (reducing your dose by 2ml all way down across two pills) is a perfectly reasonable plan for a dose 0f 1mg Klonopin per day. You may or may not find this taper rate too fast. The only way to know is to try it and see.

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Water titration is a piece of cake. I now consider myself a PRO with my OWN schedule. If I start feeling like crap..I just HOLD for a few days..or even back-up a few ML until I feel better..then hold there a few days..then proceed with the toss.  When I began this..of course had to complicate EVERYTHING.  I felt I wasnt capable, and that I should hire a nurse to mix it up for me. The process JUST MAKES SENSE and I believe the accuracy is far superior to any dry cut..plus...like I mentioned..it is SO easy to adjust as needed.

 

Good Luck..

 

Jeff

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Thanks Jeff, so if I read your signature line correctly you took the 1mg pill, put it in the 100ml beaker and removed 1ml a day on average. That is kinda what i was thinking I would do. Simple as that huh?

 

Jim

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  • 2 weeks later...

Colin, I am sorry to ask that you re-calculate my titration but if you don't mind. I have been making bi-weekly .125 cuts all the way from 2mg, now at .75 without a whole lot of difficulty, some problematic days after each reduction but then flattens out.

 

Even though I have not had any real problem w/ dry cutiing I think for the last .75 I really want to go with titration. It just sounds like a smoother way to go, esepcially when the dry cuts amonuts now start to far exceed the 10% bi-weekly reccomendation.

 

So, with that said, here is where I am at:

 

Start date: Aug 30th

 

Dose: .75mg Klonopin

 

Tablet dose: .5mg

 

Number of tablets: 1 1/2 of the .5mg tablets total. I take .25 @ 6:30am, .125 at 2:30PM, ..375 at 10PM

 

Taper rate: not sure but let's say 1% per day, that being said we would be looking at 75 days, is that correct?

 

Thanks in advance

 

 

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Colin/T2

 

Just wondering if it's this simple.

 

I have both a 100ml. I am at .75mg of Klonopin a day. Is a 10%/10 day taper as easy as crushing up the .5 & .25 tablets (1/2 of .5 tab) mixing it with 100ml liquid, pouring off .25 ml, starting at 75 ml and reducing at 1ml per day?

 

In other words it would take 75 days to get off as long as all goes well

 

that simple?

 

Jim

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Colin/T2

 

Just wondering if it's this simple.

 

I have both a 100ml. I am at .75mg of Klonopin a day. Is a 10%/10 day taper as easy as crushing up the .5 & .25 tablets (1/2 of .5 tab) mixing it with 100ml liquid, pouring off .25 ml, starting at 75 ml and reducing at 1ml per day?

 

In other words it would take 75 days to get off as long as all goes well

 

that simple?

 

Jim

 

You would want to crush up two .50mg pills and mix with 100ml of liquid and then remove the 25ml. Colin prefers using whole pills to insure accuracy. If you want, you could just titrate .50mg in 50ml of liquid and continue taking the .25mg in pill form especially if you have limited pills to work with and don't want to waste using two pills.

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Hi T2,

 

I guess my math was a little off last night, my plan would have had me a lot lower than the .75mg/ml starting point I was looking for.

 

I have plenty of pills so that isn't a problem.

 

So does that sound like a reasonable plan, crush 2 of the .5's, add it to a 100ml, take out .25  and start reducing at 1ml a day? Is that a 10% reduction over 10 days? what am I missing. It seemed that when I received a spreadsheet from Colin awhile ago when I was at 1 mg the taper plan was going to take quite a bit longer, is 75 days reasonable for a .75mg daily dosage? at my current rate of dry cutting .125 every 14 days that would take me 12 weeks (3 months), with this titration plan I'm looking at a little over 2 months, is that still cool?

 

Thanks and sorry that I'm being a little dense.

 

Jim

 

 

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Hi T2,

 

I guess my math was a little off last night, my plan would have had me a lot lower than the .75mg/ml starting point I was looking for.

 

I have plenty of pills so that isn't a problem.

 

So does that sound like a reasonable plan, crush 2 of the .5's, add it to a 100ml, take out .25  and start reducing at 1ml a day? Is that a 10% reduction over 10 days? what am I missing. It seemed that when I received a spreadsheet from Colin awhile ago when I was at 1 mg the taper plan was going to take quite a bit longer, is 75 days reasonable for a .75mg daily dosage? at my current rate of dry cutting .125 every 14 days that would take me 12 weeks (3 months), with this titration plan I'm looking at a little over 2 months, is that still cool?

 

Thanks and sorry that I'm being a little dense.

 

Jim

 

 

 

Well, if my math is correct..... two .50mg pills is 1.00mg in 100ml of liquid. By cutting 1ml per day that would equate to 1% a day in 100 days equaling 100%. If you titrate 1ml per day as stated, then it would be a little faster than your current rate by dry cutting but as you know the cuts are spread out instead of cutting a lot at once. Most people cut at a rate of 10% every 10 days as the norm so it is still cool. If you start becoming symptomatic, you can always stop and hold or even make smaller cuts.

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so since I am at .75mg, I would put both tablets (.5mg each for total of 1mg) in the 100ml, remove 25ml to get me to my current dose of .75mg and start from there, correct?

 

Thanks again,

 

Jim

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Hi Jim,

 

75 days to withdraw from 0.75mg Klonopin seems like a reasonable aim to me. As you outlined, add two 0.5mg tablets to 100ml of liquid, and start from a dose of 75ml to equal your present dose of 0.75mg Klonopin. If you ever feel it becoming too much, then stabilise your dose for a week or two, and then continue by cutting 1ml two out of every three days, or every other day. It is highly unlikely that you need to withdraw at a rate any slower than by 1ml every other day.

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There really is no need for a spreadsheet when withdrawing by a regular amount like this. Just keep a pad with your equipment to note down dates and dose. It is easy to forget your previous day's dose when your dose is changing daily.
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Colin, sorry to be a pain but I have a question and then need some clarification.

 

First, the question. I has been suggested by another member that I consider going from a 3 doses per day to 2 doses per day to make titration a little easier to work around during the work day. Is that recommended? I currently take my doses at 6am, 2pm, and 10pm. If I were to switch to a 2 per day, I assume I have to keep them about 12 hours apart and since I have been having sleep issues does a 7am, 7pm plan make sense, or should it be more like a 10am to 10pm which then has me bring in the solution to work again.

 

Then the clarification question. The spreadsheet that you put together for me about a month ago (link in above text) was for the 1mg total I was on. At the time, you suggested titrating one .5 pill at a time in 100ml of water and the total duration of the program for the 1mg would have been about 6 months.

 

Now I am at .75mg but you are suggesting putting both .5 tablets into 100ml and pouring off 25ml and then reducing by 1ml per day for a 75 day titration schedule.

 

Just confused by the math as to why the 1mg titration was going to take me 180 days while the new plan for .75mg will only take 75 days. Was the first schedule slower than a 1ml per day reduction, is the new plan faster?

 

Basically I want to try stay within the suggest 10%/10 day guideline.

 

Thanks again and sorry to be a somewhat dense pest,

 

Jim

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From your dose of 0.75mg, a linear taper (I mean a taper rate than no longer diminishes as your dose is reduced) is fine, and, actually, sensible. I think starting such a taper from 1mg Klonopin would be reasonable, so at this rate, it would take 100 days to withdraw from 1mg (a reasonable aim). So, a taper rate of about 10% every ten days (if I understand your "10/10" correctly), would equate to 100 days for 1mg, and 75 days from a dose 0.75mg. If I was drawing up a formal schedule, with a taper rate of 1% per day (about 10% every 10 days), and the linear taper kicked in at 1mg or 0.75mg, then the last 100 or 75 days would look exactly the same as the taper you are planning.

 

The reason why a formal titration schedule based upon 1% per day might have taken longer is that it depends upon when the linear taper kicks in (choosing the starting dose of the linear taper is something of a judgement call). If you started at 1mg, and the taper rate was still related to your dose at the time (non-linear), down to a dose of 0.5mg (for example), then the amount being cut is still growing smaller as you progress from 1mg down to 0.5mg (the amount being cut grows smaller all the time, lengthening the taper). Further, in this example, when you get down to 0.5mg, a 1% per day taper rate will account for a rate of just half the amount that you were cutting at 1mg. You would start the linear part of your taper from 0.5mg, and cutting 1% per day would result in you taking 100 days to quit the final 0.5mg. I hope this is clear. :-\

 

You might try switching to taking your Klonopin twice a day - it may, or may not go well for you. An alternative would be to use water for your liquid (keep the liquid well agitated when making measurements or pouring out individual doses), and pour your midday dose into a small plastic or glass container to take with you to work.

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Thanks Colin, and it does make sense for the most part.

 

Just to confirm, with a non-linear plan it's 1% daily of the amount being taken, so obviously 1% of .5 is a smaller amount than 1% of 1.0.

 

Linear is just that, each day the same amount come out so as the amount gets lower the % of reduction gets higher.

 

The net result is that you think I would be OK with a straight linear reduction of 1% of the total amount per day even though as we get lower the overall reduction is a much higher overall % reduction? You say at .75 that a linear reduction is sensible, why is that?

 

Just don't want to be confused as I start this, also do want to make things drag on but also don't want to get overly aggressive, as a single parent I have to maintain my job, even if it means staying on the K.

 

Thanks,

 

Jim

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Hi,

 

Yes, you've understood what I was trying to get across. At some stage, the taper rate must become more linear, otherwise we'd be just reducing our dose, and never actually quitting. The thing to realise is that when on a substantial dose, it is the benzodiazepine that plays the dominant part in how GABA receptors operate. At a low dose, the benzodiazepine plays a much smaller part. This means that at high dose, it is sensible to make cuts relative to your dose at the time. But, because the benzodiazepine is less important at a low dose, cuts have a much smaller effect upon our GABA functioning. So long as you have followed a sensible taper plan (a taper plan that does not race ahead of your capacity to recover), then moving to a linear taper is right and proper. This is forced upon us when utilising pill-splitting, but really only happens at a tiny dose when titrating. Some people, when titrating, (understandably) feel they must make smaller and smaller (or less and less frequent) cuts, even at very low doses - this is a mistake. This would make the taper ridiculously and needlessly long.

 

Having said all this, you should treat any plan as an outline of your path to becoming benzo-free. A plan can be great for driving us forward, but do not stick to it rigidly if you begin to experience problems. You should control your taper, do not let your taper plan control  you! Proceed according to how you react.

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