Titration Taper: Where to Start? HELP!!!

I definitely know that I need to do a slow, liquid titration process. I'm just totally confused as to how to create a schedule. I've watched some YouTube videos, and they're not entirely clear to me. This was posted by Colin, and I thought that by writing to him, I could get help with a schedule. Please advise, as I don't want to screw this up.....

 

The number of tablets (or fractions of tablets) you take per day, and the dose of those tablets. This is especially important if your daily dose comprises of tablets of differing strengths. As a double check, we also ask that you provide us with your daily dose in mg. If you are unsure of the dose, we will work through this with you.

The rate at which you want to taper. We can help you with this on the forum if you are not sure. We can easily alter the taper rate if you later decide it is too fast or too slow.

The volume of the cylinder you will be using, preferably 100 ml.

The increments (graduations) of your cylinder or other measuring equipment. Kitchen equipment tends to be rather inaccurate though. For example, if you have a 100ml cylinder, and it is marked at 5ml intervals, we can provide a titration table based upon 5ml increments, or (if you feel comfortable with estimating a measurement by eye), you might decide that you would like to use 2.5ml increments. The more parts into which the volume of liquid can be divided, the smoother the titration! Accuracy is important too though; keep measurements by eye to a reasonable level. Dividing 5ml into five 1ml parts by eye would not be sensible.

Can you get klonopin in liquid form from your pharmacy or will you be preparing your own liquid formulation?  If the latter, do you have any sensitivities to milk or small amounts of alcohol??

Hello! Thanks so much for your reply. There's a gal who does YouTube videos about her liquid titration process. She includes a spreadsheet that calculates how much liquid to use based on how much of the med you're dissolving and how much to take each day. It lets you know what percentage you're going down each day. That was first thing that finally made me go, "Aha!" I do like the idea of a pharmacy creating a formulation-- at least for starters.

 

Just curious-- why is milk or alcohol necessary if I do my own liquid titration? The gal in the YouTube videos uses distilled water. Just wondering if there is any advantage to using milk or alcohol? I'd rather use alcohol, quite honestly. Thanks for chiming in.

The choice of liquid depends on the drug that you're tapering.  Klonopin isn't soluble in water, so one must use whole milk (the fat helps to dissolve the drug) or alcohol (the drug is soluble in distilled alcohols like vodka or my favorite - single malt scotch whiskey).  Water can be used, but it's much trickier since you have to suspend the insoluble medicine then withdraw an amount then drink the rest before it starts to settle.

 

The amounts and volumes are easy to calculate.  One just needs to know where they are starting, and how one wants to do the taper.  For a liquid titration, you'll need some sort of measuring device like a graduated cylinder.  100 mls is a good size if you do a milk titration.  You'll want something much smaller if you do an alcohol titration - something like a 5 ml cylinder.  All are inexpensive and available from ebay or amazon.  Finally, you'll want an eye-dropper so that you can remove small amounts of liquid easily.

 

If you can obtain a liquid formulation from a pharmacy, you'll still need a way to accurately measure the medicine, so you'll still need a graduated cylinder.  The size will depend on your dose and the formulation that you can obtain.  You can buy small sets of grad cylinders containing a variety of sizes for something like $20.

Thanks, badsocref. I'm sort of baffled, as the YouTube videos I've watched (and this lady has chronicled EVERY step of her journey with like 35 videos) got off of klonopin using distilled water. She's never described any sort of difficulty with the process.

 

Actually, I take that back-- she was using the generic of klonopin, clonazepam. Could that be making the difference? I have to admit it does seem like it would be much easier to use water. Well, milk wouldn't be so bad. But I may be sensitive to dairy, so I'm not really sure. I could do alcohol. In the spreadsheet that I filled out, it was really simple. I was given the exact amount of how much to drink vs. throw out. The pill was dissolved in 250ml of distilled water. I'm not even sure how one would remedy that if using alcohol.

 

Does crushing the medication help? I was so excited to find this lady's videos and spreadsheet. Actually the spread sheet she uses is from benzosupport.org It's an informational site and actually lists Benzo Buddies as the site to join for support. So I'm confused now...help! LOL!

Hi Briggy,

 

I used the water titration method to taper from clonazepam.  If you click on the link in my signature it will take you to my experience.  There you will find another link that will take you to the exact method I used including an Excel spreadsheet that you can download to handle all of the calculations.

I shall defer to Ben at this point.

Thanks, badsocref. I'm sort of baffled, as the YouTube videos I've watched (and this lady has chronicled EVERY step of her journey with like 35 videos) got off of klonopin using distilled water. She's never described any sort of difficulty with the process.

 

Actually, I take that back-- she was using the generic of klonopin, clonazepam. Could that be making the difference? I have to admit it does seem like it would be much easier to use water. Well, milk wouldn't be so bad. But I may be sensitive to dairy, so I'm not really sure. I could do alcohol. In the spreadsheet that I filled out, it was really simple. I was given the exact amount of how much to drink vs. throw out. The pill was dissolved in 250ml of distilled water. I'm not even sure how one would remedy that if using alcohol.

 

Does crushing the medication help? I was so excited to find this lady's videos and spreadsheet. Actually the spread sheet she uses is from benzosupport.org It's an informational site and actually lists Benzo Buddies as the site to join for support. So I'm confused now...help! LOL!

  Yes, some folks successfully do liquid tapers with water.  And many are not successful.  I tried water taper 3 times, each attempt ended in failure.

 

Although some make the method work, it is a FACT of physical chemistry that most benzos (including klonopin/clonazepam) are NOT water soluble. 

 

If you simply start with 1-2ml of vodka before adding the water, from there the procedure is exactly  the same as water titration.  And you know for sure the benzo is in solution.

 

Ben, I will definitely check out your link regarding your water taper.

 

As for the vodka/alcohol method-- So if it says to use 250mL of water (per the information on benzosupport.org) then how much vodka/alcohol do I use? You mentioned 1-2mg. Did you mean 1-2 ml? Please advise, as it is disheartening to think that water alone could cause potential failures. Thanks!

Ben, I will definitely check out your link regarding your water taper.

 

As for the vodka/alcohol method-- So if it says to use 250mL of water (per the information on benzosupport.org) then how much vodka/alcohol do I use? You mentioned 1-2mg. Did you mean 1-2 ml? Please advise, as it is disheartening to think that water alone could cause potential failures. Thanks!

  Yes, I meant "1-2ML" of vodka.  (I'll fix it!)

 

I don't  know the details of the procedure you are referring to, but if start with 2ml of vodka and add 248 ml water, you have the 250ml.

I'm guessing that the solubility of klonopin in 0.4% alcohol is pretty low - basically the same as the solubility in water.  I'm guessing that the drug dissolves pretty well in the (2 mls of) vodka, then forms a very fine suspension when diluted with 250 ml of water.  The particle size is probably sufficiently small to make it appear as a solution.  The finer particles probably also help to keep the suspension stable for a little longer than if you were to simply try to create a suspension directly from a tablet/pill.  I think that one would still want to work fairly quickly with the liquid preparation, and that it would not store well.  But if it stays suspended long enough to do what you need to do, that's great.

Actually, the process is 1) dissolve the benzo in alcohol (80 proof is 40% alcohol) then 2) dilute that solute with water.  Once it is dissolved in the alcohol, it can be made into a dilute aqueous solution.  Here's some data from another BB:

 

I've generated a chart of benzo solubility from data found online.  Thought it would be useful so I am sharing it here.

 

http://i9.photobucket.com/albums/a54/Seth_Ghiorse/Benzosolubility_zps599343c1.jpg

 

I'd appreciate any input on this.  I converted the solubility units to mg/ml so they would be easier for us to relate to so if anyone can check the numbers that would be great.  This seems like reliable data to me.  A couple of things are eye-opening, at least to me...

 

- Librium, contrary to popular belief, is not much more soluble in water than other benzos.

- they all do poorly at the low proof end.

- no matter the benzo, the peaks all occur near ~85-90% alcohol, not 100%.

- Clonazepam dissolves quite well - up to 6mg in a single ml.

 

Another thing I found interesting is that, on a Valium-equivalent basis, the best-dissolving is lorazepam followed by clonazepam.  Valium and Librium, although they do well also, are a distant third and fourth.

 

I wanted to include Xanax in this, but I searched and searched and was unable to come up with any Xanax data.  If anybody knows of any please let me know.

 

A lot of people are using alcohol to help dissolve their benzos.  I think this will be useful to them.  As far as online data goes, these researchers seem to be about it.  We are lucky to have access to their work.  If anyone knows of other sources for benzo solubility, please let me know.  I hope some people find this useful.

 

Thoughts?

 

 

Sources:

Abolghasem Jouyban *#, Javad Shokri †, Mohammad Barzegar-Jalali †, Davoud Hassanzadeh ‡, William E. Acree , Jr.§, Taravat Ghafourian Δ and Ali Nokhodchi Δ, Solubility of Chlordiazepoxide, Diazepam, and Lorazepam in Ethanol + Water Mixtures at 303.2 K, J. Chem. Eng. Data, 2009, 54 (7), pp 2142–2145, April 22, 2009.

 

Ali Shayanfar †, Mohammad A. A. Fakhree §, William E. Acree , Jr.∥ and Abolghasem Jouyban *‡, Solubility of Lamotrigine, Diazepam, and Clonazepam in Ethanol + Water Mixtures at 298.15 K, J. Chem. Eng. Data, 2009, 54 (3), pp 1107–1109, December 22, 2008

Thanks, everybody! Builder, interesting diagram there. So I'll lay out the first part of the plan, and if any of you can help me fill in the gaps, that would be great.

 

1. My current dose is 2.5mg/day of clonazepam

2. If I want to go down 10% in a month, I can achieve this by doing approximately .33% drops every day.

3. Thus, I would take one of my .25mg pills, dilute it in 250mL of water and then pull out the recommended amount based on the spread sheet.

 

For example: On my first taper day, I would toss 32ml of the solution and drink 218 of it. The next day, I'd toss 40 and drink 210. And so on, and so forth.

 

This is where I'm getting tripped up in using alcohol: So let's say I dissolve the clonazepam in 2 mL of Vodka. Do I shake it up like crazy? How long do I wait for it to dissolve? Once it's dissolved, do I then add 250mL of water? Or do I only add 248mL of water?

 

Math is hard. Thanks for everyone's help!!!

Sorry! Forgot to mention that I would take 2.25mg dry and dissolve the remaining .25 of my dose. Also if up to 6mg of clonazepam can be diluted in 1ml of alcohol and I'm doing .25mg, then how much alcohol do I need. Is it bad to use too much alcohol? I mean, if I use 1ml, will I be okay?

 

Does anyone know if Collin still checks these boards? I'd love to get his input. But thanks to all of you who have chimed in. Very helpful and appreciated.

The data in the chart shows that benzos are essentially insoluble in anything less than 20% alcohol (.2 = 20%).  Highest solubility is in the 80-90% range.

Thanks, everybody! Builder, interesting diagram there. So I'll lay out the first part of the plan, and if any of you can help me fill in the gaps, that would be great.

 

1. My current dose is 2.5mg/day of clonazepam

2. If I want to go down 10% in a month, I can achieve this by doing approximately .33% drops every day.

3. Thus, I would take one of my .25mg pills, dilute it in 250mL of water and then pull out the recommended amount based on the spread sheet.

 

For example: On my first taper day, I would toss 32ml of the solution and drink 218 of it. The next day, I'd toss 40 and drink 210. And so on, and so forth.

 

This is where I'm getting tripped up in using alcohol: So let's say I dissolve the clonazepam in 2 mL of Vodka. Do I shake it up like crazy? How long do I wait for it to dissolve? Once it's dissolved, do I then add 250mL of water? Or do I only add 248mL of water?

 

Math is hard. Thanks for everyone's help!!!

 

 

1)  Only a tiny percentage of your tablet is actually benzo.  A 2mg tablet might weight 150 mg, so 148 mg is "other ingredients".  Some of these ingredients will probably be insoluble.  If your tablets breaks down readily (as most seem to do) then the K will be quickly released and go into solution.  (There will likely be some insolubles remaining...don't worry about them)  Your K will probably dissolve on its own, but some swishing/agitation is a good idea.

 

2) If you want 250ml of solution, and start with 2 ml alcohol, then just add 248ml water.  But 2ml would be less than a 1% variation, so honestly it really wouldn't matter.

 

3)  Within reason, the more vodka/alcohol just increases the solubility.  I would stay with the .25mg-1ml ratio to insure dissolution, and just to avoid complicating the process.

The data in the chart shows that benzos are essentially insoluble in anything less than 20% alcohol (.2 = 20%).  Highest solubility is in the 80-90% range.

 

Hi Bad.  Yes, very close to insoluble but not insoluble.  Here are the actual values for Jouyban's study.

 

The following table shows the solubility of the various benzos in ethanol/water mixtures from 0% (i.e., plain water) to 100% ethanol.  Key: V=Valium; A=Ativan; Lib=Librium; K=Klonopin; X=Xanax.

 

Units = mg/ml

% Alc.  V          A        Lib      K          X

0        0.04    0.05    0.11    0.03    0.04

10      0.11    0.11    0.19    0.04 

20      0.21    0.23    0.29    0.08

30      0.57    0.77    0.80    0.20

40      1.90    3.51    2.89    0.60

50      4.76    4.19    7.48    1.43

60    11.17    8.04    12.48    2.64

70    21.31  13.09    22.89    4.22

80    28.67  17.33    31.81    5.65

90    38.36    6.64    31.72    6.18

100  26.07  10.89    19.46    5.11

 

Sources:

Abolghasem Jouyban *#, Javad Shokri †, Mohammad Barzegar-Jalali †, Davoud Hassanzadeh ‡, William E. Acree , Jr.§, Taravat Ghafourian Δ and Ali Nokhodchi Δ, Solubility of Chlordiazepoxide, Diazepam, and Lorazepam in Ethanol + Water Mixtures at 303.2 K, J. Chem. Eng. Data, 2009, 54 (7), pp 2142–2145, April 22, 2009.

 

Ali Shayanfar †, Mohammad A. A. Fakhree §, William E. Acree , Jr.∥ and Abolghasem Jouyban *‡, Solubility of Lamotrigine, Diazepam, and Clonazepam in Ethanol + Water Mixtures at 298.15 K, J. Chem. Eng. Data, 2009, 54 (3), pp 1107–1109, December 22, 2008

 

 

Once in solution in alcohol, it can be diluted with water and the solubility quickly goes to the water value, which is .03mg/ml or 3mg/100ml for K.  So 100ml water can keep up to 3mg K dissolved.  I think it is important to use a lot of water to create a margin for error.

 

Your comment about forming a fine suspension was interesting.  I wonder if that happens and that it might be so fine that it remains suspended extremely well?  If this happened, do you think we would see it?  Would the water turn cloudy?  We are certainly near the edge and walking a fine line between a solution and a suspension.  The numbers and our anecdotal observations seem to indicate it remains dissolved.

I have to agree with builder and SG that the safest way to make a liquid is to dissolve the tablet in a small amount of alcohol and then dilute with water. That way you have a solution, which means the benzo will stay evenly distributed in the liquid and not settle to the bottom if stored properly (room temp is safe).

 

If you crush and mix with water you have a suspension, which starts fairly evenly distributed but, over time, the benzo will settle to the bottom. How fast? I don't know. Suspensions can be done and many people have tapered successfully using a suspension. You just have to shake like crazy and measure quickly while the particles of benzo are all still evenly distributed in the water.

 

More people seem to be using a method of dissolving first in alcohol and then diluting with water, or dissolving directly in full-fat milk. Alcohol and fat will dissolve most benzos. I'm not talking about dissolving the fillers and binders in the tablet. They may settle out of any liquid. And they are nothing to worry about.

 

Thanks for posting the numbers.  The graph didn't show enough detail for low alcohol content. 

 

These numbers would (almost) suggest that one could directly dissolve up to 3 mg of klonopin in 100 mls of water without even going through alcohol.  But I'm guessing that it might take a little time and effort to do so.  Probably much faster and more efficient to begin in alcohol, then dilute with water. 

I'm not sure how it could ever be tested, but I have thought the same thing.  If these benzos were left in a good amount of water overnight or for 24 hours with a few shakes, would they dissolve?  It would be a great to be able to make a solution from just water...what could be simpler.

It's probably testable using an HPLC, but I haven't had any 'k' pills around my house for well over 2.5 years (for which I'm very grateful).

It's probably testable using an HPLC, but I haven't had any 'k' pills around my house for well over 2.5 years (for which I'm very grateful).

 

On a tangent, I just noticed in your signature that you took gabapentin for sleep. Do you still take it? Did you have to taper it? I would like to take only gabapentin for sleep but I'm afraid if I don't alternate it with something the sleep effect will wear off. The Seroquel is awful, though, because of my restless leg syndrome. Really irritates it and I wake up feeling awful and feel awful most of the day. Not so with the gabapentin, which is actually treatment for RLS.

Thanks to all of you who have weighed in. I really appreciate it. So just to make sure I'm clear based on all the charts and graphs, 1ml of vodka should be fine to dissolve the pill in before adding water? Vodka is 40% alcohol....I can handle that.

 

Now I just have to figure out the supplies I need. I know I need a beaker that's 500mL. And in the videos I watched, the gal used a jar to put the mixture into. And a syringe. Is that about it? And the vodka.

 

I was able to get down from 4mg to 2mg doing dry cuts. I did this over 10 months. I had to go back up because the manufacturer ran out of brand klonopin last year and for me at least, clonazepam is weaker, so I went up to 2.5. When I tried to dry cut down to 2.25, I had problems. I'm not sure why since I got down to 2mg.

 

But now the question....for those of you who have done dry cuts and liquid titration, how has it been for you to go down about .33% per day compared to the dry cuts? My goal is to go down 10% a month. I want to minimize any side effects, obviously. Ha!

 

Is there anything I'm missing?

On a tangent, I just noticed in your signature that you took gabapentin for sleep. Do you still take it? Did you have to taper it? I would like to take only gabapentin for sleep but I'm afraid if I don't alternate it with something the sleep effect will wear off. The Seroquel is awful, though, because of my restless leg syndrome. Really irritates it and I wake up feeling awful and feel awful most of the day. Not so with the gabapentin, which is actually treatment for RLS.

 

I stopped taking gabapentin three months after I c/t'd Ativan.  I was doing well enough at three months that I wanted to see how I would do without it.  I was only taking 300 mg, so I simply stopped taking it.  I had a lousy week of sleep after I dropped gabapentin, but otherwise had few (if any) withdrawal hassles.  Folks who take higher doses should taper (on and off).  It was relaxing and extended my sleep, but it did not put me to sleep.

On a tangent, I just noticed in your signature that you took gabapentin for sleep. Do you still take it? Did you have to taper it? I would like to take only gabapentin for sleep but I'm afraid if I don't alternate it with something the sleep effect will wear off. The Seroquel is awful, though, because of my restless leg syndrome. Really irritates it and I wake up feeling awful and feel awful most of the day. Not so with the gabapentin, which is actually treatment for RLS.

 

I stopped taking gabapentin three months after I c/t'd Ativan.  I was doing well enough at three months that I wanted to see how I would do without it.  I was only taking 300 mg, so I simply stopped taking it.  I had a lousy week of sleep after I dropped gabapentin, but otherwise had few (if any) withdrawal hassles.  Folks who take higher doses should taper (on and off).  It was relaxing and extended my sleep, but it did not put me to sleep.

 

That's interesting. Thanks for sharing.