Jump to content

Tapering off of .75mg/day Clonazepam


[Ch...]

Recommended Posts

Hi,

 

For the past 12 years, I have taken Klonopin on and off, with plenty of stretches during which I didn't take it at all.

 

I aim to be off of all substances that form dependence. In the past few years, I have successfully come off, respectively, Remeron, Depakote, Baclofen, and Zoloft. My last Zoloft dose was 12/31/2019, and now all that's left to go is .75mg Klonopin.

 

After stretches of taking ~.5mg every other day, or every three days, or as "needed," I started taking Klonopin daily in March 2019 at 1mg. In July, I went from 1mg day to .75/mg day by cutting tablets over the course of 2.5 weeks with only minor difficulties.

 

I've have days on which I took extra (1mg in a day), but I'm glad to say I haven't cheated on my Klonopin dose in 1.5 months, staying at a steady .75mg/day. I take .25 upon waking, .25 at noon, and .25 at 5pm.

 

What's a good way I can taper off? I'm thinking of getting a liquid solution from my specialty compounding pharmacy and replacing my evening dose with it, so .25 tab, .25 tab, .25 liquid. Then I'd lower the evening liquid dose by .05mg, holding each drop for... 10 days? 14? Once I'm off of that and taking .5mg/day, I'd replace the afternoon dose with liquid, and so on.

 

I have hypothyroidism and minor HPA dysregulation. Both began before daily Klonopin use and before all withdrawals, but I'm sure chronic benzo use is making it worse.

 

I have diagnoses of GAD, depression, and OCD, though my symptoms have been improving with disciplined personal work as well as ketamine infusions.

 

I take very good care of myself... Paleo diet, meditation, breathwork, bodywork, yoga, walking, chiropractic, good sleep hygiene, and most recently, ketamine infusions. I am even typing this message from an Epsom salt bath! I take Xyzal (anti-histamine) and NP Thyroid. I supplement minimally - just Magnesium Glycinate and ginger. I've tried Black Seed Oil, which allegedly can help repair GABA receptors, but don't seem to have a good reaction to it. I believe I'm sensitive to cholinergics.

 

Does my taper plan sound reasonable? Again, I was able to go from 1mg to .75mg with only mild acute symptoms, but that was over half a year ago.

 

I'm meeting my functional medicine doc in two weeks and can start after I get the liquid... Please let me know anything else I should consider!

 

Thank you, everybody, for your attention and any advice you may give.

Link to comment
Share on other sites

Hello Chzlime,

 

You've done so well getting off a plethora of drugs. Now it's time to tackle the klonopin.

 

 

What's a good way I can taper off? I'm thinking of getting a liquid solution from my specialty compounding pharmacy and replacing my evening dose with it, so .25 tab, .25 tab, .25 liquid. Then I'd lower the evening liquid dose by .05mg, holding each drop for... 10 days? 14? Once I'm off of that and taking .5mg/day, I'd replace the afternoon dose with liquid, and so on.

 

I think this is a very good plan. Using compounded formula created by a pharmacy is the best way to assure the quality of the product.  Using both tablets and liquid at the start is also a good idea.

 

I believe some people dilute the compounded K with a liquid, let me check on that.

 

How long you hold depends on how you feel, let your body be your guide. I would say at least 10 days between cuts.

 

pianogirl

Link to comment
Share on other sites

Thank you!

 

I think I would get a .5mg/mL solution with a 1mL dropper... So I can take .5mL and drop by .1mL each time :)

Link to comment
Share on other sites

Thank you!

 

I think I would get a .5mg/mL solution with a 1mL dropper... So I can take .5mL and drop by .1mL each time :)

 

I was told by someone who knows more about this than me, I didn't do a liquid taper, that  there is a stability-tested formulation for clonazepam at a 0.1mg/mL. That is, if you are in the USA.

Link to comment
Share on other sites

Greetings, Chziime!

 

If I were you, I would use a lower concentration liquid to taper the 0.25mg.  Are you in the U.S.?  There are several stability-tested formulations for a 0.1mg/mL suspension of clonazepam.  I’ll include a link to one of them below my signature.

 

Although a dropper would work, a 1mL oral syringe with 100 graduations would be preferable. It would allow you to make reductions as small as 1/100th of 0.1mg or 0.001mg.  Your compounding pharmacist should be willing to provide you with several of these as well as a push-in adapter cap for the bottle containing your suspension.  The adapter cap makes it easy to draw the suspension from the bottle into the syringe.

 

You also might want to consider asking your prescriber for lower strength tablets from which to taper instead of splitting a 1mg pill (which, correct me if I’m wrong) does not have functional score lines for quartering.  In the US, clonazepam is available in 0.125mg and 0.25mg orally disintegrating tablets.

 

Again, if you are in the US, check with your compounding pharmacist about the specific language your prescriber should include on the prescription.  Insurance is more likely to cover compounding if certain language is used (in a nutshell, the prescriber needs to make it clear that you need both a different format and a different strength of drug than one that is commercially available.)

 

Sending all best wishes your way for a successful taper .... Libertas

 

Clonazepam Oral Suspension, 0.1mg/mL

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

 

 

Link to comment
Share on other sites

Oh, yes, I'm in the US. What is the .1mg/mL suspension? That would be a lot of liquid per dose.

 

It comes down to the other ingredients in the solution... I can also ask my compound pharmacy for day, a .25mg/mL (or less) solution.

 

I don't want to get the .125mg tablets because that is still more than I'd prefer to lower each time. As much as I'd love to go that quickly and lower by 16%! It worked last year, but might not work this year...

 

EDIT - I didn't see your whole message, thanks for the link! Yes, I meant syringe, not dropper :)

 

And I currently take .5mg tablets, which can easily be split in two to create .25mg.

Link to comment
Share on other sites

I wasn’t suggesting that you reduce by 0.125mg.  Your opening post indicated that you wanted to use a combination of tablets and liquids.  Shifting to lower strength tablets in combination with liquid would allow you to do this.  Make sense?

 

2.5mL of liquid (which is how much of a 0.1mg/mL suspension you would take to get a dose of 0.25mg) is a very small amount of liquid.  It might help you to get a 1mL (or, in your case, you could start with a 3mL) oral syringe and measure out 2.5mL to see how much this is.

Link to comment
Share on other sites

Yes, right. .125mg tabs for when I get to lower doses. Thanks :)

 

I used liquid suspensions for both Remeron (compounded) and Zoloft (prescription). It's not a lot of liquid, but in the latter case, it contained ethanol, which wasn't pleasant, even mixed with water. I'll have to look up that .1mg/mL though... Can I get it at any pharmacy? Or does it have to be specialty? That link seems to be instructions to produce it.

Link to comment
Share on other sites

Hi Chzlime

 

I take prescribed liquid compound clonazepam.  I’m at .125 mgs which is 1 ml of the syringe.  It’s compound def in something that looks like jelly water.  I’ve had no problem with this compound.  I went directly from pill to liquid.  Because in Canada there is no .125 pill, so pill splits became inaccurate and tedious.  So I recommend a liquid compound for accurate dosing.  I will taper by going down 1 ml per cut.  Because I cannot follow the math of all the other taper plans.  1 ml in this way is 10 % cut.  That would be about .08 mgs dose.  .125 to .08.  I think?  I’m asking the pharmacist today.  I hope to be off this med soon, but I tend to hold a month between cuts, and previous cuts were much bigger.  Your plan sounds good!  I’m interested in your recovery and please keep posting!!

Link to comment
Share on other sites

Hello again.

 

Here is the plan I had in mind when I suggested the 0.125mg ODTs.  There are two advantages to this.  First,  it would allow you to keep taking your clonazepam three times a day (which is a good thing b/c this maintains a steady concentration of the drug in your system).  Second, it would allow you to make reductions evenly across doses (reducing and eliminating one entire dose at a time can cause issues).

 

0.125mg ODT + 1.25mL of a 0.1mg/mL suspension = 0.25mg

0.125mg ODT + 1.25mL of a 0.1mg/mL suspension = 0.25mg

0.125mg ODT + 1.25mL of a 0.1mg/mL suspension = 0.25mg

 

Thank you for clarifying that you would use an oral syringe not a dropper.  That’s good. Droppers are not as accurate as syringes for measurement.

 

Thank you also for clarifying that you are using 0.5mg tablets.  Your opening post seemed to indicate you were using 1mg.  Just checking ... is this the method you are using each day?

 

(1) Get two 0.5mg tablets.

(2) Split the two tablets in half.

(3) Take 3 of the half-tablets at designated times.

 

What to you do with the 4th half-tablet?  Take it for your first dose the next day?

 

That’s great you have experience with using liquid suspensions! The stability-tested formulations for the clonazepam suspensions do not contain ethanol.  Instead they use a suspending vehicle (OraPlus/OraSweet or OraBlend).  The taste is not great but it’s such a small amount of liquid it’s tolerable.  You can have a glass of water ready to wash it down quickly.  Indeed, as you probably already know, it’s good practice to (1) rinse the syringe out at least three times after you have used it to measure the suspension and (2) drink the rinse water each time.

 

I’m not sure what you mean by specialty.  Do you mean a pharmacy that specializes in compounding?  If so, that would be a good idea if you have access to one.  Pharmacies that specialize in compounding have more/better equipment/facilities and — even more important — more expertise/experience with compounding than general purpose pharmacies.  They are also more likely to be accredited (which is something you should look for as well).  A reputable, accredited compounding pharmacy will have access to databases of stability-tested formulations.  In addition to the one I shared earlier, the USP also has a compounding monograph for a 0.1mg/mL clonazepam suspension:

 

Compounded Preparations Monographs (CPMs) | USP

https://www.usp.org/compounding/compounded-preparation-monographs

Link to comment
Share on other sites

Oh, so that involves taking the liquid solution 3 times a day. I don't know if I would feel comfortable doing that? Especially on days I work (I work freelance, video), it might not be realistic. I don't mean to sound contrarian, and I do take this very seriously as you might tell. I just know that I wouldn't feel comfortable with that.

 

Actually, it wasn't until recently that I split the doses into 3. For the past years, I would take .25 in the morning, then .5 whenever I felt I needed it :) Not great, but... I never have trouble sleeping, at least.

 

Is that really what you recommend? Would it be that difficult to lower one of the 3 doses at a time, that is, the evening dose to start? Isn't that how Ashton lays it out?

 

I normally am not perfectly diligent with splitting the .5mg tablets in half and saving it for a later dose. I often just put it back in the bottle, and I'm aware of the difficulties that could cause with a taper. Perhaps I could use .25mg ODT for the taper, so I get exact doses with tablets? Or if I only use liquid for the evening dose, I can just split a .5mg in half in the morning and save the other half for the noon dose.

 

I will call my specialty pharmacy (https://www.cfspharmacy.pharmacy/ -- it's close to me in New Jersey, I used them for my Remeron) next week to see which methods they commonly use for Clonazepam. I want to have a plan laid out before I see my physician on the 24th.

 

Thank you very much!!

Link to comment
Share on other sites

Oops I did the math wrong there in my post above.  Or a typo.  I meant to say .125 is indeed 1 ml liquid compound.  I’ll go down .1 each cut.  So 1 ml to .9 ml.  Etc.  I may go faster.  But Not!! 1 ml.  That would be too much.  Sorry if this caused any confusion. 
Link to comment
Share on other sites

  • 4 weeks later...

Oh boy.

 

So I'm on Day 11 of .70mg Clonazepam, down from .75mg, and sleeping the past couple nights was very difficult. Withdrawal hit me on Day 9, when I started feeling chest pain, increased heart rate, and body pain.

 

Is it generally a better idea to keep the same drops (.05mg) and hold for longer, say 2-3 weeks total instead of my original 10 days, or to decrease in smaller drops (.025mg) and hold for shorter? What's a good way to move forward according to symptoms?

Link to comment
Share on other sites

I'm sorry things are rough now,  this is not an easy process.

 

I think that I would decrease the amount and hold as long as necessary to find a little stability before reducing again. One week is a pretty short interim between cuts.

Link to comment
Share on other sites

Yeah... thank you. Do you mean, for example, to hold on .70mg until I feel a bit more stable, then to lower to .675mg and see how I do with the smaller decrease?
Link to comment
Share on other sites

Yeah... thank you. Do you mean, for example, to hold on .70mg until I feel a bit more stable, then to lower to .675mg and see how I do with the smaller decrease?

 

Yes, that is a good idea.  You may not be symptom free, I never was, but a decrease in the intensity would tell me it's OK to make another reduction.

Link to comment
Share on other sites

  • 1 month later...

Hey, I have a question about symptoms. First, here's my taper schedule...

 

4/4 - Down to .70mg (from .75)

4/19 - Down to .675mg

4/30 - Down to .65mg

5/15 - Down to .625mg

 

Symptom-wise, outside of some strong anxiety and insomnia 10 days after the first drop, it's been manageable. However, I've had some strong stomach pains that I've never had before. They started around 4/22.

 

It feels like stabbing, intermittent pains in my upper abdomen. It doesn't feel like any gut issues I've had in the past. It comes on with stress, physical exercise of all sorts, and most commonly and strongly, in the middle of the night while sleeping. My functional medicine doctor, to be cautious, had me rule out stones (ultrasound), ulcers (bloodwork), and H. Pylori (breath test).

 

My diet has been constant this whole time, so I believe it's neurological, related to benzodiazepine withdrawal and emotional stress.

 

Ginger, simethicone, Advil, and prescription Bentyl (which I only tried once) don't really help. It's manageable during the day, but when it wakes me up at 2-3am and keeps me up for over an hour, I'm not sure what to do besides wait it out and at least manage my nighttime routines well without getting discouraged.

 

Does anyone have any tips for how to at least treat the symptoms while my body regulates? I heard of "benzo belly..." Is it common to get such strong symptoms this early on?

 

Thank you so much for any help!!

Link to comment
Share on other sites

  • 2 months later...

Okay!!! So as of a few days ago, I am down to .50mg  :)  Starting the taper down from .75mg in early April, lowering by .025mg every 7-10 days. At first I had those awful gut symptoms, but now it's just manageable waves of anxiety and some eye twitching, as well as periodically interrupted sleep. Ketamine infusions have been great for the depression/anxiety of withdrawal, but they don't seem to last like they used to, as there is a consistent low grade clonazepam withdrawal.

 

I take .25mg tablet (.5mg cut in half) in the morning and .25mg tablet (other half) in the evening. I'm thinking to get down to 0mg, I'd go this route. Please let me know if this sounds like a reasonable plan.

 

-Start lowering morning dose to .125mg Oral Disintegrating Tablet + compounded liquid for the remaining .125mg. Take .25mg tablet at night (saving the other .25mg and taking it the following evening).

-Eventually, I'll be down to .125mg ODT in the morning and .25mg tablet at night.

-At this point, I would start lowering the evening dose in that same way, until eventually I take .125mg ODT both in the morning and evening.

-From there, I would use compounded liquid to lower the morning dose to 0, and then after all that, the evening dose to 0.

 

Anything I should keep in mind while doing this? Thank you!!

Link to comment
Share on other sites

×
×
  • Create New...