Please Help.

Hi, I have been tapering for nine months and have been pretty happy with the way it's gone, despite the fact that it's difficult. My old psychiatrist retired and I have a new one. He's an older man in his 70's. He seems like a decent doctor but he contradicts himself a lot and I don't entirely trust any doctors. He says that at this point in my taper I should either switch to Klonopin for the last part or do a micro-taper.

 

I have been very resistant to go on Klonopin because of the horror stories I've seen on here. I also just don't have the brain power to do a micro taper. My husband says he will help but I was hoping to keep going as I have been.

 

I have gotten my dose down to .75 and he says that I won't be able to go much farther before I hit a wall. He thinks I am suffering needlessly. I think this is just what I have to go through. Am I over thinking this? Can anyone advise me about micro tapering? I just can't wrap my head around it.

 

Has anyone switched from Xanax to Klonopin? That seems crazy to me. He says I will get less inter-dose withdrawal symptoms on it and thinks it's a better choice than Xanax. Any suggestions would be helpful. I'm freaking out. I feel like I've come so far only to be told it can't be finished on my terms. 

Bumping this, hoping someone has some insight.

From Dr. Stuart Shipko's book Xanax Withdrawal:

For a person on Xanax 0.5 mg three times a day a typical suggested tapering involves cuts usually at intervals of 2 to 3 weeks, but sometimes at much larger intervals.  The time interval between cuts is different in each patient and what is most important is that the tapering not be done too fast.

Below are sample tapering schedules, however, there is no such thing as a specific schedule that must be followed, and this is a general idea of how tapering might proceed.

Starting schedule:  0.50 mg 0.50 mg 0.50 mg

Cut number one:  0.50 mg 0.25mg 0.50 mg

Cut number two:  0.25 mg 0.25 mg 0.50 mg

Stretch number one:  stretch the middle dose until it drops off at the night dose at which time the patient will be taking: 0.25 mg in the AM and 0.50mg in the PM.

Cut number three:  0.25mg 0.25 mg

Cut number four:  0.125 mg 0.25 mg

Cut number five:  0.125 mg 0.125 mg

Stretch number two:  stretch the AM dose towards the PM dose until the AM dose is dropped.

Week eight:  none, with .0625 mg (1/4 of a .25 mg pill) every few days as needed.

Another typical tapering schedule for the less sensitive patient might be:

Week one:  0.50 mg twice daily

Week two:  0.25 mg in AM, 0.5 mg in PM

Week three:  0.25 mg twice daily

Week four:  0.25 mg daily

Week five:  none

These are only suggested tapering schedules and are not intended to be specific instructions on how to taper.  Each patient needs to adjust the tapering according to their own tolerance; there is no one way to do it.  Some people taper the last 1.5 mg by .125 mg increments, and some by .25 mg increments and some by 0.625 mg increments.  Some patients find that stretching the time between dosages more useful than continued dosage cuts, while some find that it is easier to just cut the dosage down over time.  Some patients require frequent extra dosages of Xanax and some patients require few or none.  Some patients require a month between cuts and some patients only two weeks.  The process is highly variable from individual to individual.

Hey there. I sympathise with your doctor's viewpoint but not sure I'd want to change if I was managing as things are. Also, I'd prefer switching to an equivalent dose in diazepam rather than clonazepam because it is less potent and has a longer half life, which are both theoretical advantages for tapering. I suspect your doctor would probably be unwilling to prescribe diazepam, most likely for some bureaucratic reason, but figured I would make that point.

 

Like many things withdrawal related, it could go either way. It's fairly common for the adjustment to be tricky no matter what benzos you swap to/from. They are all benzos but they're not exactly the same... the amount of time it's going to take for your body to get used to the substitution is an unknown and this gives a lot of scope for complications. It would be unusual to take more than a few weeks to stabilise after substituting but I have seen some individuals here who fell into difficulties for much longer.

 

I think if I were you, I'd keep this in mind for if things start to go more wrong in the future. For now, I would stick with what sounds to be a winning formula on the whole. Perhaps you could tell your doc that you're not dismissing the idea but maybe try to get to 0.5mg and if it is starting to become less manageable, perhaps look at substituting at that point. Whenever you do substitute, if you go that route, you want to be as stable as possible before making the change. Don't substitute when you're in a bad state of withdrawal, if you can help it.

It seems like you have done a great job so far on your taper.  You have also identified what works for you in terms of cut and hold.  For that reason, I would be tempted to keep doing what is working, until it doesn't work anymore.

 

I get what you are saying about not trusting doctors....I feel the same.  It's important for doctors to listen to what is working for us, and to support us in that goal as best they can.

 

I worry about switching to another benzo if you are doing ok right now.  It seems to introduce more unknowns....how will your brain respond to klonopin?  What will the transition period be like?  And lastly:  why not diazepam?  It seems to be the gold standard of cross-taper plans, so I'm not sure why your doc is recommending K instead.

 

It sounds like this doctor is predicting you will hit a wall and is outlining his/her plan.  It just doesn't make sense that you would change something that is working for you right now.  None of us are going to get out of this without some amount of suffering.  The question is: are you managing the suffering ok?  One step at a time.  A plan B if/when you need it is probably a good idea.

Keep us posted.

I agree with Diaz. Switching to Valium should smooth out your symptoms and make tapering more tolerable. You might want to go on the Micro Tapering thread and ask how they do it. There are many different techniques. I like my liquid taper because it's so easy. All you need is a 1 ml syringe and a 100 ml graduated cylinder. You could PM me if you like and I'll be glad to tell you how I do it

From Dr. Stuart Shipko's book Xanax Withdrawal:

For a person on Xanax 0.5 mg three times a day a typical suggested tapering involves cuts usually at intervals of 2 to 3 weeks, but sometimes at much larger intervals.  The time interval between cuts is different in each patient and what is most important is that the tapering not be done too fast.

Below are sample tapering schedules, however, there is no such thing as a specific schedule that must be followed, and this is a general idea of how tapering might proceed.

Starting schedule:  0.50 mg 0.50 mg 0.50 mg

Cut number one:  0.50 mg 0.25mg 0.50 mg

Cut number two:  0.25 mg 0.25 mg 0.50 mg

Stretch number one:  stretch the middle dose until it drops off at the night dose at which time the patient will be taking: 0.25 mg in the AM and 0.50mg in the PM.

Cut number three:  0.25mg 0.25 mg

Cut number four:  0.125 mg 0.25 mg

Cut number five:  0.125 mg 0.125 mg

Stretch number two:  stretch the AM dose towards the PM dose until the AM dose is dropped.

Week eight:  none, with .0625 mg (1/4 of a .25 mg pill) every few days as needed.

Another typical tapering schedule for the less sensitive patient might be:

Week one:  0.50 mg twice daily

Week two:  0.25 mg in AM, 0.5 mg in PM

Week three:  0.25 mg twice daily

Week four:  0.25 mg daily

Week five:  none

These are only suggested tapering schedules and are not intended to be specific instructions on how to taper.  Each patient needs to adjust the tapering according to their own tolerance; there is no one way to do it.  Some people taper the last 1.5 mg by .125 mg increments, and some by .25 mg increments and some by 0.625 mg increments.  Some patients find that stretching the time between dosages more useful than continued dosage cuts, while some find that it is easier to just cut the dosage down over time.  Some patients require frequent extra dosages of Xanax and some patients require few or none.  Some patients require a month between cuts and some patients only two weeks.  The process is highly variable from individual to individual.

Thanks for sharing this!

Hey there. I sympathise with your doctor's viewpoint but not sure I'd want to change if I was managing as things are. Also, I'd prefer switching to an equivalent dose in diazepam rather than clonazepam because it is less potent and has a longer half life, which are both theoretical advantages for tapering. I suspect your doctor would probably be unwilling to prescribe diazepam, most likely for some bureaucratic reason, but figured I would make that point.

 

Like many things withdrawal related, it could go either way. It's fairly common for the adjustment to be tricky no matter what benzos you swap to/from. They are all benzos but they're not exactly the same... the amount of time it's going to take for your body to get used to the substitution is an unknown and this gives a lot of scope for complications. It would be unusual to take more than a few weeks to stabilise after substituting but I have seen some individuals here who fell into difficulties for much longer.

 

I think if I were you, I'd keep this in mind for if things start to go more wrong in the future. For now, I would stick with what sounds to be a winning formula on the whole. Perhaps you could tell your doc that you're not dismissing the idea but maybe try to get to 0.5mg and if it is starting to become less manageable, perhaps look at substituting at that point. Whenever you do substitute, if you go that route, you want to be as stable as possible before making the change. Don't substitute when you're in a bad state of withdrawal, if you can help it.

Thanks so much, this is all really helpful. I can't switch to valium because I have a reaction to it but I think I'm going to switch to a liquid xanax closer to the end. Thanks for your input. It's very helpful!

It seems like you have done a great job so far on your taper.  You have also identified what works for you in terms of cut and hold.  For that reason, I would be tempted to keep doing what is working, until it doesn't work anymore.

 

I get what you are saying about not trusting doctors....I feel the same.  It's important for doctors to listen to what is working for us, and to support us in that goal as best they can.

 

I worry about switching to another benzo if you are doing ok right now.  It seems to introduce more unknowns....how will your brain respond to klonopin?  What will the transition period be like?  And lastly:  why not diazepam?  It seems to be the gold standard of cross-taper plans, so I'm not sure why your doc is recommending K instead.

 

It sounds like this doctor is predicting you will hit a wall and is outlining his/her plan.  It just doesn't make sense that you would change something that is working for you right now.  None of us are going to get out of this without some amount of suffering.  The question is: are you managing the suffering ok?  One step at a time.  A plan B if/when you need it is probably a good idea.

Keep us posted.

Thanks, very well said. I can't tolerate valium but honestly, I would like to keep going as I am and if it gets too difficult, I'll switch to a liquid xanax. He seems to like klonipin but I really don't think it's a good idea at all. I'm going to get my husband to go in with me next time to help me clarify that and to get all the info on how to do the liquid taper.

I agree with Diaz. Switching to Valium should smooth out your symptoms and make tapering more tolerable. You might want to go on the Micro Tapering thread and ask how they do it. There are many different techniques. I like my liquid taper because it's so easy. All you need is a 1 ml syringe and a 100 ml graduated cylinder. You could PM me if you like and I'll be glad to tell you how I do it

[/quote

I wish I could. I can't tolerate valium at all but I'm so far along that hopefully I can switch to liquid xanax for the last part. I will look at the micro tapering thread!

I agree with Diaz. Switching to Valium should smooth out your symptoms and make tapering more tolerable. You might want to go on the Micro Tapering thread and ask how they do it. There are many different techniques. I like my liquid taper because it's so easy. All you need is a 1 ml syringe and a 100 ml graduated cylinder. You could PM me if you like and I'll be glad to tell you how I do it

[/quote

I wish I could. I can't tolerate valium at all but I'm so far along that hopefully I can switch to liquid xanax for the last part. I will look at the micro tapering thread!

 

That's a good alternative but I'm wondering if you can do a daily micro taper with liquid xanax because of it's short half life and the problem with interdose WD idk.

I agree with Diaz. Switching to Valium should smooth out your symptoms and make tapering more tolerable. You might want to go on the Micro Tapering thread and ask how they do it. There are many different techniques. I like my liquid taper because it's so easy. All you need is a 1 ml syringe and a 100 ml graduated cylinder. You could PM me if you like and I'll be glad to tell you how I do it

[/quote

I wish I could. I can't tolerate valium at all but I'm so far along that hopefully I can switch to liquid xanax for the last part. I will look at the micro tapering thread!

 

That's a good alternative but I'm wondering if you can do a daily micro taper with liquid xanax because of it's short half life and the problem with interdose WD idk.

The doctor seems to think I can but I’m not sure either. I just hope I’m far enough along in my taper that it will be okay.

I'm glad you found my advice helpful 

 

Xanax is difficult to taper directly and this is the issue your doctor was trying to address. It's not impossible though and I have even seen examples of people trying to substitute and then going back to the original benzo to complete their taper. This is why I think it's best to keep going if you're managing as you are. I believe that your doctor has helped you come to the right choice in the end with the liquid Xanax, which ought to make measuring small reductions easier. You're really lucky to have a doctor that seems to know what they are talking about.

 

I don't know if I'm mixing you up with another member but I seem to remember you're taking several doses per day? If that's not you and you're only taking the Xanax is one or two doses per day, taking three doses per day may help level symptoms out. More than 3 doses isn't going to hurt too much but is probably unnecessary.

I'm glad you found my advice helpful 

 

Xanax is difficult to taper directly and this is the issue your doctor was trying to address. It's not impossible though and I have even seen examples of people trying to substitute and then going back to the original benzo to complete their taper. This is why I think it's best to keep going if you're managing as you are. I believe that your doctor has helped you come to the right choice in the end with the liquid Xanax, which ought to make measuring small reductions easier. You're really lucky to have a doctor that seems to know what they are talking about.

 

I don't know if I'm mixing you up with another member but I seem to remember you're taking several doses per day? If that's not you and you're only taking the Xanax is one or two doses per day, taking three doses per day may help level symptoms out. More than 3 doses isn't going to hurt too much but is probably unnecessary.

Thanks, I think I'm going to try to start the liquid in a month or two when I see him again. Yes, I take 4 doses a day. I always spaced it out like that and he said to keep it like that to avoid interdose withdrawals.  The thing is though, I've had at least a little of that for years. I get shaky and anxious between doses. I just assume it's going to be like that until I'm off of The drug. I have trouble understating the difference between interdose withdrawals and just plain old withdrawal which we all must go through when getting off these drugs. I'm also not sure where the term tolerance fits in. What is your opinion? Thanks for being so helpful to us all on here!

You're totally right to expect some minimum amount of symptoms until you're clear of benzos and in all likelihood for some time afterwards. It is unrealistic to think there's a way to withdraw without potential for complication and symptoms. Substituting clonazepam does not offer that possibility.

 

Say you dosed once a day, it would be easy to recognise interdose withdrawal if symptoms built in number and intensity over the course of the day and until the next dose is due, followed by relief after taking the dose followed by the same pattern. Tolerance has to do with feeling symptoms just by staying at the same dose. I experienced tolerance withdrawals when I was on 10mg diazepam for a couple of years, before my circumstances allowed me to taper. They're not really withdrawals, to be honest. That's a misnomer.

 

Your doctor's hypothesis is that although you space your dose out into 4 intervals, some of your symptoms are due to the dose wearing off long before you take the next. If that were true and you're also lucky enough to not have too many problems switching, then in theory you should find it easier to do so. I'm not sure I agree with your doctor, though. I think you would report to feel a lot worse because interdose withdrawal seems to cause sensitization of the nervous system to a greater degree than what you are describing. I don't rule out that it will happen to you in the future though, which is why I suggest to keep an open mind.

This is a website which lists what drugs are available in liquid form for your information, I don't see a liquid Xanax so I guess you're looking at making your own home brew?

 

https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm

Are you in the US?  If so, a 1 mg/mL oral concentrate of alprazolam is available from Hikma Pharmaceuticals.

 

Diaz, I'm glad you brought up the point that tolerance is not really WD. From what I understand, tolerance is when your receptors have downregulated to the point where the benzo is no longer having a therapeutic effect and glutamate is unchecked. WD is when the body is reacting to the decrease of something it's become physically and mentally dependent on. I think it gets confusing because we can experience tolerance and WDs at the same time.

Are you in the US?  If so, a 1 mg/mL oral concentrate of alprazolam is available from Hikma Pharmaceuticals.

 

Oh my, I need to add this information to my list, thanks so much Libertas! 

Diaz, I'm glad you brought up the point that tolerance is not really WD. From what I understand, tolerance is when your receptors have downregulated to the point where the benzo is no longer having a therapeutic effect and glutamate is unchecked. WD is when the body is reacting to the decrease of something it's become physically and mentally dependent on. I think it gets confusing because we can experience tolerance and WDs at the same time.

 

This makes sense. I feel withdrawal symptoms  quite severely for a few days when I cut my dose and then it usually gets better over the weeks.

SSR, I agree with your approach.  Keep doing what your doing until you can’t any longer.  I plan to micro taper with a liquid if I have trouble.  The thought of switching to another Benzo and having additional side effects is not worth it, in my opinion.  Your doing great so far!!

SSR, I agree with your approach.  Keep doing what your doing until you can’t any longer.  I plan to micro taper with a liquid if I have trouble.  The thought of switching to another Benzo and having additional side effects is not worth it, in my opinion.  Your doing great so far!!

 

Thanks, I really agree. I just don't want to try something else only to have new unexpected complications. I think in this case a known devil is better.

Diaz, I'm glad you brought up the point that tolerance is not really WD. From what I understand, tolerance is when your receptors have downregulated to the point where the benzo is no longer having a therapeutic effect and glutamate is unchecked. WD is when the body is reacting to the decrease of something it's become physically and mentally dependent on. I think it gets confusing because we can experience tolerance and WDs at the same time.

I take 2.5 mgs of diazepam 3 times daily. I start feeling WD about an hour every time I take it. Should I switch to taking it all once a day? I’m only 1 month into this nightmare. I’ve been on this since 9-11-20. Today I haven’t taken my afternoon dose and I don’t feel all shaky. Still messed up though. Anybody, please?

Have you always been dosing three times per day?  If so, I would try to continue with that.

Diaz, I'm glad you brought up the point that tolerance is not really WD. From what I understand, tolerance is when your receptors have downregulated to the point where the benzo is no longer having a therapeutic effect and glutamate is unchecked. WD is when the body is reacting to the decrease of something it's become physically and mentally dependent on. I think it gets confusing because we can experience tolerance and WDs at the same time.

I take 2.5 mgs of diazepam 3 times daily. I start feeling WD about an hour every time I take it. Should I switch to taking it all once a day? I’m only 1 month into this nightmare. I’ve been on this since 9-11-20. Today I haven’t taken my afternoon dose and I don’t feel all shaky. Still messed up though. Anybody, please?

 

Has it been like this since your CO from lorazepam? IDK it could be your body's still trying to adjust to Valium or a paradoxical reaction.