Author Topic: Going from Dry Taper to Liquid titration  (Read 204 times)

[Buddie]

Going from Dry Taper to Liquid titration
« on: November 17, 2018, 01:34:18 am »
Hello,

Right now I dose twice a day .5 mg of Clonazepam for a total of 1 mg. When I change over to liquid taper, i was told it was better to dose 3 times in order to keep a level blood serum.

On the day I start to go from twice a day to three times a day, will I will go through withdrawal because my two doses are larger amounts than the three smaller doses. In other words, have any of you ever known if anyone went through withdrawal while switching from dry taper with only two doses to liquid taper of three doses but both only using 1 mg of Clonazepam.

Thank you for any help you can provide.

[...]

Lisa
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #1 on: November 17, 2018, 02:31:22 am »
You should not notice any withdrawal effects from splitting your daily dose into 3 instead of 2. Clonazepam half life and active window are long, so doses will overlap each other a little, anyway. If anything you may feel better. Some people (it seems to be a controversial subject) have issues switching to liquid, even without changing their dosing schedule. But not all, and seemingly not most. I would try not to be afraid of either change, but would recommend not making both changes at the same time. First split your doses into 3 with tablets, wait a while to prove to yourself there are no problems with this. Then switch to liquid. That way if for some reason you do have problems, it will be easier to ascertain why.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #2 on: November 17, 2018, 04:36:49 am »
Hello,

Right now I dose twice a day .5 mg of Clonazepam for a total of 1 mg. When I change over to liquid taper, i was told it was better to dose 3 times in order to keep a level blood serum.



Lisa

That's really not correct.  Because of its long half life, 2 doses/day will keep serum levels adequately level.  Many folks on K do fine on just 1x day dosing.

Going to 3X will not cause any problems, but it won't give you any advantage, either.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #3 on: November 17, 2018, 09:31:29 am »
Hello,

Right now I dose twice a day .5 mg of Clonazepam for a total of 1 mg. When I change over to liquid taper, i was told it was better to dose 3 times in order to keep a level blood serum.



Lisa

That's really not correct.  Because of its long half life, 2 doses/day will keep serum levels adequately level.  Many folks on K do fine on just 1x day dosing.

Going to 3X will not cause any problems, but it won't give you any advantage, either.

I really hate to rock the boat, but I feel like I have to speak up here. Being this definitive about something so subjective is misleading and may be harmful. While Lisa may not be having any trouble dosing twice daily, and thus may notice no change switching to three times daily, there are people who are dosing three times daily who may read this and think they are sure to do fine switching to twice or even once daily, which may or may not be true for them due to the many variables involved.

Half life actually ranges widely from person to person. The "average" half life of Clonazepam is given as a range of 18-30. This is not a complete range, but an average range, which means there are people who would experience measurable half life of shorter and longer duration than this, though less commonly. This means that there are people out there for whom the overall half life is only 12 hours, meaning the concentration of the drug in their body has dropped to 50% of peak concentration in 12 hours. If that person were to dose twice daily, they would be on a roller-coaster.

But let's not use an outlier as an example. Let's consider the middle of the average range. Let's say you are painfully beautifully average, and the drug's half life in your body is 24 hours. Well, what does that mean exactly? Well, to understand this, you must understand how the half life of a drug is determined, and you must know how many compartments are involved. Because Clonazepam is highly fat-soluble, three compartments are involved (blood cells, organ cells, and fat cells) and that is where this gets tricky.

To determine overall half life of a drug, half life of each compartment is tested individually, then those three numbers are averaged. The problem with this method when it comes to fat soluble drugs is that drug concentration in fat cells remains significant LONG after the drug has been essentially eliminated from the blood and organs, and because the drug remaining in the fat cells is released slowly, and primarily excreted without effect, that means that the overall half life number is skewed significantly, and is not representative of how long blood serum levels will remain "adequately" stable. Third compartment half life is often twice or three times as long as half life in blood and organs (which are typically very similar, for obvious reasons). Therefore, if your "overall" half life is 24 hours, your blood serum levels could be reaching 50% at 12, or even 8, hours!

The bottom line is that everyone is unique. For this reason, with few exceptions, people here recommend a symptom-based taper. For the same reason, I would recommend a symptom-based dosing schedule.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #4 on: November 17, 2018, 01:45:20 pm »
Hello,

Right now I dose twice a day .5 mg of Clonazepam for a total of 1 mg. When I change over to liquid taper, i was told it was better to dose 3 times in order to keep a level blood serum.



Lisa



That's really not correct.  Because of its long half life, 2 doses/day will keep serum levels adequately level.  Many folks on K do fine on just 1x day dosing.

Going to 3X will not cause any problems, but it won't give you any advantage, either.

It may be advantageous if one metabolizes of this class of medication quickly and is experiencing inter-dose withdrawals  :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #5 on: November 18, 2018, 10:24:11 pm »
Thank you [...] and [...] for your assistance. It sounds like Iím just going to have to see and go by my symptoms.

I am so sensitive to changing doses and also to changing meds which my pharmacy does often so Iím always afraid the try something different when it comes to this hell drug.

I Was told that many have been successful and feel better doing a 3x per day liquid titration with whole milk starting at 300 ml and removing 1 ml each day until youíre down to nothing.

Dry cutting clonazepam is getting difficult even with a gram scale because the pharmacies are constantly changing the brand of Clonazepam they carry.

Again, thank you for your help and good luck with your own tapers!

[...] :)


Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #6 on: November 19, 2018, 04:44:19 pm »
...
I am so sensitive to changing doses and also to changing meds which my pharmacy does often so Iím always afraid the try something different when it comes to this hell drug.

I Was told that many have been successful and feel better doing a 3x per day liquid titration with whole milk starting at 300 ml and removing 1 ml each day until youíre down to nothing.
...

Since you are sensitive to changes, it seems to me that you might want to begin by sticking with your current time schedule ... let your body adjust to the liquid titration before changing your dosing schedule.  If you find that you experience issues, then tinker with the doses. (Both the number of doses & the rate at which you reduce.)

You may find that you adjust to the liquid, (in two doses), without any issues - and if this is the case, then you won't have complicated your schedule by adding another into your daily routine.  (It's easy enough to add it in later on if you need to...)

Regardless of what you decide to do, good luck!
« Last Edit: November 19, 2018, 06:11:18 pm by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #7 on: November 19, 2018, 09:11:52 pm »
Hello,

Right now I dose twice a day .5 mg of Clonazepam for a total of 1 mg. When I change over to liquid taper, i was told it was better to dose 3 times in order to keep a level blood serum.



Lisa

That's really not correct.  Because of its long half life, 2 doses/day will keep serum levels adequately level.  Many folks on K do fine on just 1x day dosing.

Going to 3X will not cause any problems, but it won't give you any advantage, either.

I really hate to rock the boat, but I feel like I have to speak up here. Being this definitive about something so subjective is misleading and may be harmful. While Lisa may not be having any trouble dosing twice daily, and thus may notice no change switching to three times daily, there are people who are dosing three times daily who may read this and think they are sure to do fine switching to twice or even once daily, which may or may not be true for them due to the many variables involved.

Half life actually ranges widely from person to person. The "average" half life of Clonazepam is given as a range of 18-30. This is not a complete range, but an average range, which means there are people who would experience measurable half life of shorter and longer duration than this, though less commonly. This means that there are people out there for whom the overall half life is only 12 hours, meaning the concentration of the drug in their body has dropped to 50% of peak concentration in 12 hours. If that person were to dose twice daily, they would be on a roller-coaster.

But let's not use an outlier as an example. Let's consider the middle of the average range. Let's say you are painfully beautifully average, and the drug's half life in your body is 24 hours. Well, what does that mean exactly? Well, to understand this, you must understand how the half life of a drug is determined, and you must know how many compartments are involved. Because Clonazepam is highly fat-soluble, three compartments are involved (blood cells, organ cells, and fat cells) and that is where this gets tricky.

To determine overall half life of a drug, half life of each compartment is tested individually, then those three numbers are averaged. The problem with this method when it comes to fat soluble drugs is that drug concentration in fat cells remains significant LONG after the drug has been essentially eliminated from the blood and organs, and because the drug remaining in the fat cells is released slowly, and primarily excreted without effect, that means that the overall half life number is skewed significantly, and is not representative of how long blood serum levels will remain "adequately" stable. Third compartment half life is often twice or three times as long as half life in blood and organs (which are typically very similar, for obvious reasons). Therefore, if your "overall" half life is 24 hours, your blood serum levels could be reaching 50% at 12, or even 8, hours!

The bottom line is that everyone is unique. For this reason, with few exceptions, people here recommend a symptom-based taper. For the same reason, I would recommend a symptom-based dosing schedule.

It is true that the various compartments are important in drug distribution. The half-life data listed (18-30 hours, in some studies more) are based on blood levels. Since the blood will provide benzos to the brain and not fat tissue, it is irrelevant what happens to the benzos in fat.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Going from Dry Taper to Liquid titration
« Reply #8 on: November 20, 2018, 11:51:34 am »
Thank you [...]! I appreciate that advice as well. Good luck with your own taper! We can do this!
 :smitten:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.