Jump to content

Part 2: How fast and what size steps for clonazepam taper


[...]

Recommended Posts

I should've listened and now I need help to know about updosing.  In May, SG57 responded to my request for advise  about my plan to taper from .25 mg clonazepam where I had been holding.

 

If you don't know where to start and you want to cut every other day.  I probably would not begin at .003125mg every other day.  That's 18.8% a month...pretty aggressive.  .002mg or even .0015mg might be better.  You could do the same rate and get a bit more advantage by breaking that cut up into daily cuts if you wanted.

 

Right, the smaller steps will be fine since the cuts are so small.  If you feel symptoms coming on, just hold.  You'll get a feel for it by doing it.

 

I didn't listen!  As I had planned, I began my taper at .00625 alternating 4 days and 6 days (slightly less agressive than .003125 every 2 days) with no problems until I got to .225/day.

 

 

5-21 Drop %Drop Daily

5-22 0.00000 0.00% 0.2500

5-23 0.00625 2.50% 0.2438

5-24 0.00000 0.00% 0.2438

5-25 0.00000 0.00% 0.2438

5-26 0.00000 0.00% 0.2438

5-27 0.00625 2.56% 0.2375

5-28 0.00000 0.00% 0.2375

5-29 0.00000 0.00% 0.2375

5-30 0.00000 0.00% 0.2375

5-31 0.00000 0.00% 0.2375

6-01 0.00000 0.00% 0.2375

6-02 0.00625 2.63% 0.23125

6-03 0.00000 0.00% 0.23125

6-04 0.00000 0.00% 0.23125

6-05 0.00000 0.00% 0.23125

6-06 0.00625 2.70% 0.225

 

That's about 11% in 15 days. Everything seemed okay until 4 days into holding at 0.225, when I started to get symptoms, so I stopped dropping.  I am still holding 2 weeks later and the symptoms have taken a turn for the worse.

 

My question now is about updosing. Is there a technique or rule of thumb? Should I go up? How high, to 0.2375? All the way to .25? Or should I try to stay here at 0.225.

 

Of course, once I get this under control, I will proceed more slowly as SG57 originally recommended.  His suggestion would have been faster than my larger drops with the 2 week or longer hold added on, or worse, an updose and start all over!

 

Thanks.

 

Link to comment
Share on other sites

Hi, You're learning the way I learned...the hard way.  Most of us do.

 

You need to get it under control and the sooner the better.  It can be tricky to get out of the weeds once you are in.  Updosing does not always work and it depends on how bad your symptoms are and how long ago you felt well.  There are many strategies.  A common one is to go back to the last dose you felt good on and hold there.  Or you could try creeping back up a little at a time until you feel good.  Or, like you said, you could go back and start over.  Again, it does not always work.  Sorry this happened to you.

Link to comment
Share on other sites

When you say it doesn't always work, what does that mean.  Is there no next step?

 

I have been jittery, jumpy, unable to sit down, pacing etc. for long periods of time during the last few days.  I was used to this happening, but not so relentless.

 

Thanks for being there.

Link to comment
Share on other sites

I just wanted to be sure you're aware that you could updose and not get relief.  Or only get a little relief.  The sooner you do it the more likely it is to work.  It sounds like you are pretty uncomfortable so it might make sense to give it a try.  Up to you.
Link to comment
Share on other sites

I know it depends on each person and other factors, but are we talking days or weeks of not updosing before it isn't helpful and I should just stick it out.  Does the fact that the problem showed up 4 days after the dose change pertain?
Link to comment
Share on other sites

It seems very unpredictable to me and I do not have a handle on it.  The sooner the better is about all I can say.  Some people can go weeks and still have it be effective, others can't.  It has not been too long in your case.  I like your chances.  If it were me I'd do it.
Link to comment
Share on other sites

I'm trying to decide what to do.  2 other questions, please.

 

1.  Does the fact that it took many days after the change in dose for the symptoms to appear mean anything?  In other words, I'm not reacting to what I ingest, but to my stored level dissipating over time.  Do you know if this is relevant in any way?

 

2.  I  saw your link to the glutamate hypothesis in the current "Hitting a wall" thread.  I did not understand the link, but while looking around the thread I saw a reference, and perhaps disagreement, to the idea that older people have more severe symptoms.  Are you aware of this.  I am 71 and I am concerned about my chances of succeeding at this withdrawal.  I think I can, but that is partly because the Ashton manual gives examples of older people succeeding.

 

thanks

Link to comment
Share on other sites

I'm trying to decide what to do.  2 other questions, please.

 

1.  Does the fact that it took many days after the change in dose for the symptoms to appear mean anything?  In other words, I'm not reacting to what I ingest, but to my stored level dissipating over time.  Do you know if this is relevant in any way?

 

2.  I  saw your link to the glutamate hypothesis in the current "Hitting a wall" thread.  I did not understand the link, but while looking around the thread I saw a reference, and perhaps disagreement, to the idea that older people have more severe symptoms.  Are you aware of this.  I am 71 and I am concerned about my chances of succeeding at this withdrawal.  I think I can, but that is partly because the Ashton manual gives examples of older people succeeding.

 

thanks

 

Some people react right away and others over a week out. I became insomniatic practically overnight after a tiny cut. Was getting plenty of sleep up until then.

 

On average, younger people heal faster but not always. And regardless of your age, YOU CAN DO THIS!!!

Link to comment
Share on other sites

I'm trying to decide what to do.  2 other questions, please.

 

1.  Does the fact that it took many days after the change in dose for the symptoms to appear mean anything?  In other words, I'm not reacting to what I ingest, but to my stored level dissipating over time.  Do you know if this is relevant in any way?

 

2.  I  saw your link to the glutamate hypothesis in the current "Hitting a wall" thread.  I did not understand the link, but while looking around the thread I saw a reference, and perhaps disagreement, to the idea that older people have more severe symptoms.  Are you aware of this.  I am 71 and I am concerned about my chances of succeeding at this withdrawal.  I think I can, but that is partly because the Ashton manual gives examples of older people succeeding.

 

thanks

 

I don't think age means you can't do it.  In general it may mean you have to go slower, but we all taper by symptoms anyway.

 

Symptoms have lag times.  It is normal for them to appear days after a cut.  The amount of time varies from person to person.  The benzo you are taking also affects it.

Link to comment
Share on other sites

Thanks.

 

I was up most of the night, I have brain fog, and I don't know how to decide.  If you look at the chart in opening message, you would add another 15 days or so of .225 to get a realistic visual of the taper since .25.

 

Do you think I should go back to .2375 or all the way to .25.  Does it really matter in the big scheme of things.  In terms of doing it quickly, will I ruin my chance of going all the way back if I go halfway first.  If I go all the way to .25, do I establish it as a difficult place to descend from.  Please tell me the ramifications of these choices.  I don't know how to decide.  I'm feeling nuts and like screaming.

Link to comment
Share on other sites

Updosing can be tricky and like I said, I don't have a good feel for it.  If you felt good on .2375mg you could give that a try.  That is commonly tried - going back to the last dose you felt good at.
Link to comment
Share on other sites

SG57, Thank you very much.  I am grateful for this site and your help.

 

I made my next batch for .2375 and I'll post feedback when I have some.

Link to comment
Share on other sites

  • 2 weeks later...

After trying .2375 for just a day, went up to .25 and have been holding. I've had some windows, but no relief.  Insomnia last night and today is particularly difficult

 

Is there any point to going up to .26 or .27?  Would this get around the "glultamate issue?

 

You say it takes a long time. (Quoted from #19 -Hitting a wall at 0.046mg K. What to do next?)

 

" . . .we can be short of benzo to a certain point until there is just too much 'excitement' of the neuron, at which point a chain of events occur which result in bad and long-lasting symptoms on the glutamate side of things. . . .  I worry bigger step cuts might leave us too short and do a little glutamate damage with each cut until enough GABA receptors are restored to quiet it back down."

 

How long does it take for the "bad and long-lasting symptoms" to improve?  You mention "several years" in your case.  And, again, would going up to .26 or .27 make any difference?

 

thanks

Link to comment
Share on other sites

I don't know if going higher will help.  The result of an updose is hard to predict.

 

I can only tell you what I think the nature of symptoms are.  There is benzo shortage symptoms caused by the lack of GABA receptors and then there are glutamate symptoms caused by being too short of benzo for too long.  The GABA type seem to respond well to dose, but the glutamate do not seem to.  They can last - and my belief is these are the ones that take so long to go away.  For example, when someone is done tapering yet they have symptoms for months or years later.  Or when someone updoses and only gets partial relief or no relief.  The glutamate hypothesis explains why there are time limits on reinstatement and updosing.  It is logical and fits with what we observe so I am swayed to believe it, but again it is just my opinion of what is going on.

Link to comment
Share on other sites

What is "reinstatement"?

 

That's when you are off the drug completely for a while and then go back on.  When someone CTs, the sooner they reinstate the more chance there is of success...time is involved.

Link to comment
Share on other sites

The last time I updosed (4/21), it took 2 weeks or more before I started to feel better. Its only been a week so far.

 

I created this text for a signature yesterday, but it is way too many characters. I will edit it down - I have a new doctor, BTW

 

4-6 .5 mg ativan per MONTH for 15 years for sleep. No problem. 

 

2/2/16 - 2/9 1.25 mg Ativan

In light conversation about TV ad, Doc said, Would you like to try zoloft? Had bad reaction and, at doc's suggestion, took between 1.25 and 1.5 ativan per day for a week to alleviate reaction. Dropped zoloft

 

2/10/16 - 2/22 .75mg clonazepam

Doc's assistant saw me and said try paxil instead of zoloft and switched ativan to clonazepam as needed. Bad reaction to paxil also. Dropped paxil. Took .75 mg K for for 2 weeks.

 

 

2/23/16 drop from .75 to .625 clonazepam

2/24/16  drop to 0.375 and hold 4 days

2/28/16  drop to .3125

2/29/16  drop to .25 and hold 4 days

3/4/16  drop to .1875 for 2 days

3/6/16  up to .25

3/9/16  drop back to .1875 for 2 days

3/11/16  no record for 2 days

3/12  up dose to .356 - begin water titration

3/14 to 4/17 tapered .356 to .225 in steps of about .014

4/18    up dose to .2375 for 4 days

4/21    up dose to .25 on advise of new counselor to hold there for a month

5/19    switch from water taper to vodka. much easier to do.

5/23 to 6/6 tapered .25 to .225 in steps of .00625 alternating hold at 4 or 6 days

6/12    Begin not doing well. 6/14 horrible

6/22    Updose to .2375

6/23    Updose to .25

 

Do you see anything that might have caused glutamate symptoms?  My initial exposure was 3 weeks including the Ativan.

 

Thanks

Link to comment
Share on other sites

Well, between 2/23 and 3/6 you dropped from .75mg to ~.25mg and you've been around that dose ever since.  That's a big drop in a short time.
Link to comment
Share on other sites

[09...]
Hi,  I just wanted to add that it takes me 4 days to feel the full effects of a dosage cut .  So I always wait at least a week between dosage reductions.  I try to avoid up dosing, but if necessary it will probably take a few days to re stabilize.    best to you 
Link to comment
Share on other sites

Thanks, SG.  Should I stay where I am or consider going back to .75 and start  my taper there. Or something in-between?

 

Do you have a feeling for which would be faster?  If I feel decent after another week or so here, I hate to go all the way up.  On the other hand, if I taper at the .0015 you originally suggested, this will take a year anyway.

 

As you said, I've been holding for 4 months at .25.  And before I began this last taper, I was feeling pretty good.

 

thanks for your help

Link to comment
Share on other sites

Also, forgot to mention.  I barely remember the initial 3 weeks of Benzo use, except that I was never very comfortable.  In other words, I am not sure I would feel good at .75, but I don't really know.
Link to comment
Share on other sites

Thanks, SG.  Should I stay where I am or consider going back to .75 and start  my taper there. Or something in-between?

 

Do you have a feeling for which would be faster?  If I feel decent after another week or so here, I hate to go all the way up.  On the other hand, if I taper at the .0015 you originally suggested, this will take a year anyway.

 

As you said, I've been holding for 4 months at .25.  And before I began this last taper, I was feeling pretty good.

 

thanks for your help

 

So you felt good at this dose fairly recently?  That's a good sign.  It sounds like you are at a dose you felt good at.  Maybe just sit tight and wait?

Link to comment
Share on other sites

After updosing from .225, I have been holding .25 mg clonazepam for 12 days.  getting slightly better, but I've been in the neighborhood of .25 for 5 months and my new doctor (she's great) doesn't like that I'm not progressing and my symptoms are often debilitating, though I also have windows.  Wants me to try something else.  She agreed to the move to valium according to the Ashton method, which converts my .25 K to 5 mg valium.

 

So I have asked for help with the substitution in a new thread on the Substitution Taper Plans Forum. The topic is ".25K to Valium"

Link to comment
Share on other sites

×
×
  • Create New...