Cross tapering Clonazepam to Diazepam while in tolerance withdrawal.

After failing to directly taper from Clonazepam, I had decided to try the Ashton Manual to switch from Clonazepam to Diazepam. My psychiatrist never heard of it and wanted me to use gabapentin but I wanted to avoid another addiction. I seen a local doctor to help me with setting up the switch and plan with the Ashton manual, but he has very little experience with some aspects of it...like switching while in tolerance withdrawal. I have been in tolerance withdrawal for sometime without knowing it and had many tests done thinking it was so many other issues.

So I am going from .5mg of Clonazepam twice daily (1mg) to 10mg Diazepam twice daily (20mg) via a cross taper right now. What I was wondering about is if it is normal to feel worse during the cross taper and feel more withdrawal symptoms? I do not feel anything with the 5mg switch of diazepam during my evening switch so far. Should I increase my dose at the start to get out of tolerance first, and if so should that be done by adding more Clonazpam or Diazepam? My doctor said I might need to do that and to go ahead and add a low dose mid-day to stabilize if I feel like it, but I don't know which one would be best or if that would be the best time to add it.

Thank you for any help or suggestions. I don't want to mess anything up.

I'm not sure I understand your statement when you say you "do not feel anything", does this mean you don't feel tolerance symptoms or you don't feel like you've had less Clonazepam or do you mean you don't feel the effects of the Valium?

Also, how many days has it been since you added in the 5 mgs of Valium and how much of the Clonazepam did you decrease at that time?

It would be helpful if you created a signature showing us what you're doing, here a link to help you make one. Add your history/signature

Maybe complete your crossover via Ashton method before deciding if you want to up-dose.  The ratio used for the switch is a guideline - some people don't need as much (some need more).  So you may find you have adequate coverage without updosing.

fwiw - If you're in tolerance withdrawal and updose, you may feel better for a time, but as soon as you decrease your dose back to where it was, you'll be back into withdrawal.  There's probably no big problem with that, but you postpone your ultimate jump date.  I'd invite you to try to not updose if possible.

I'm not sure I understand your statement when you say you "do not feel anything", does this mean you don't feel tolerance symptoms or you don't feel like you've had less Clonazepam or do you mean you don't feel the effects of the Valium?

 

Also, how many days has it been since you added in the 5 mgs of Valium and how much of the Clonazepam did you decrease at that time?

 

It would be helpful if you created a signature showing us what you're doing, here a link to help you make one. Add your history/signature

Sorry about that. What I meant was that I don’t feel any sedation like most say they get when adding in Valium. I feel worse than I have while in clonzepam tolerance.

It has only been 3 days so far. I was just wondering if it was normal to feel worse during the cross taper since I hear of many saying they felt relieved, so wasn’t sure if that was a result while in tolerance. So far I am only on step one where I have substituted half the nightly dose with 5mg diazepam, so I am at .25mg clonazepam and 5mg diazepam.

I will try and do up a signature, thank you!

Maybe complete your crossover via Ashton method before deciding if you want to up-dose.  The ratio used for the switch is a guideline - some people don't need as much (some need more).  So you may find you have adequate coverage without updosing.

 

fwiw - If you're in tolerance withdrawal and updose, you may feel better for a time, but as soon as you decrease your dose back to where it was, you'll be back into withdrawal.  There's probably no big problem with that, but you postpone your ultimate jump date.  I'd invite you to try to not updose if possible.

Thanks. So far I am trying to complete according to the guide. I had read in the FAQs on the Ashton manual site that “During this period of dose substitution, sometimes cuts to your total dose are made, and other times, slight increases are made. If you experience extreme oversedation and no withdrawal symptoms, that is a sign that the equivalency dose is too high for you, and you may wish make a small cut in your total dose as you cross over. If, on the other hand, you begin to experience heightened withdrawal symptoms during cross-over, you may wish to make a small increase in your dose during cross-over. Because the proper equivalencies vary from person to person, the cross-over process can be a matter of trial and error. However, it is important to understand that the end result of switching to Valium should be that you are relatively stable after the switch is complete, meaning that you are experiencing either no withdrawal or very mild withdrawal symptoms.”

So because it says that it is important to be stable, I wasn’t sure. Right now I feel worse than when I was in clonzepam tolerance with nausea all day, headaches, panic attacks, and insomnia. It is still the beginning though. I understand an increase would add length. I figured that when it comes time to start reducing, wouldn’t it be better to do it from a stable dose than from a place of tolerance which would make starting withdrawals worse?

This is all so new to me, thanks!

It takes over a week for valium levels to approach equilibrium in your body following any change in dosage, so I'd again suggest you wait a bit before deciding on any changes in dosage.  Also, since you're replacing one benzo with a benzo with a longer half-life, there will be a brief drop in therapeutic coverage.  Basically, the klonopin levels drop faster than the valium levels increase.  The valium will catch up after a week or so.  Graphically, the gap in coverage looks like this.

http://enchantedskies.net/KtoV.jpg

There are strategies for mitigating that gap in coverage, but it gets more complicated.  Personally, I enjoy that kind of math, and I'm happy to go over it with you.  But few people want to go that direction.

Feeling stable doesn't necessarily mean feeling good.  It just means that you're not in agony and that your symptoms are not changing a lot from day to day.  You're likely to experience some level of insomnia, headaches, anxiety and nausea during your withdrawal.  You adjust the intensity of those feelings with the speed of your taper.  Only you can know what is an appropriate tapering speed since everybody's medical histories, pain thresholds and resiliencies are different.  I think that people should push themselves a bit, but not so much that you become bed bound. 

Badsocref, "that kind of math" you enjoy is of interest to me, as my partner is hoping to begin the switch from clonazepam to valium after he talks to his doctor later this month.  What can we do about that coverage gap in order to make his transition as smooth as possible?   

Badsocref, "that kind of math" you enjoy is of interest to me, as my partner is hoping to begin the switch from clonazepam to valium after he talks to his doctor later this month.  What can we do about that coverage gap in order to make his transition as smooth as possible? 

I'd need more info.  Current dose.  Current dosing schedule.  Proposed dose.  Proposed dosing schedule.  Usually, it simply takes a small increase in an early dose of the new (longer-lasting) benzo to bring levels up more rapidly.

fwiw - a lot of people simply taper klonopin.  Cross-overs are always a bit of a crapshoot.

Apologies to the Original Poster for temporarily hijacking this thread. 

Koko Lee: I see you are in the U.S.  Regrettably, an FDA-approved, prescription oral solution of clonazepam is not available in the U.S. so you won’t find a pharmacy that offers it.  Fortunately, there’s another option. You can obtain a prescription for a stability-tested compounded oral suspension of clonazepam.

Yeah, let's do this on another thread.  If I don't respond in a day, send me a pm with the link. 

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