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Tapering using a compound pharmacy


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Hello,

Has anyone completely tapered using a compound pharmacy? I’d like to if I can. It’s seems daunting to try to figure out how to do it on my own tho if it’ll make it easier to taper I’ll try.

I’m currently at .125 Klonopin am & .125 K in the evening. Last drop was 4 weeks ago still feeling shudders and excessive anxiety so probably staying here for a while.

 

8/1/20 -K .25 am & .25pm

11/17/20- K .125 am & .25 pm

12/1/20- K- .125 am & .125 pm

 

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Do you have one near you, has your Dr indicated he's willing to write the script?  We'll be happy to help you with the percentages and you'll probably find the pharmacist will be eager to help you understand what you need to do. 

 

For us to help you we'll just need to know the formulation for the liquid you're getting from the compounding pharmacist (is it stability-tested, what are the ingredients, and most important ... what is the concentration).

 

I'm glad to hear you're holding your current dose for now, it's so important to listen to your body's signals. 

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Hi,

Thanks for your response. I spoke to the compound pharmacist and she recommended doing a really low strength capsule so that I can lower by 25% each time I’m ready to lower. My psychiatrist said he’d write the script and talk to her about my dosage at the time I’m ready to lower from where I’m at now. Any thoughts?

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Okay, so a capsule, what would the strength be in mgs?  I'm concerned about that percentage, 25% is way too fast, we recommend only reducing by 5-10% to avoid crippling symptoms.  Since you've already experienced discomfort after reducing your dose by 33% on your last cut I was hoping you'd get the full benefit of a compounding pharmacy allowing you to do this slowly.

 

Depending on the dose of the capsule you could open it and weigh your dose on a jewelers scale to reduce your dose by less than 25%.  Of course then, why would you need to go to the expense of using a pharmacy when you could do this in your home with regular tablets?

 

I guess I'm confused, hopefully someone will stop by to help me understand how this will work.  :-[

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Hello, Angel123.  Have you considered using a compounded liquid instead of capsules to complete your taper?  Making adjustments in your taper amount and/or interval is easier with liquid.  I’ve read about a few members who have used compounded capsules successfully, but most used liquid.

 

If you are in the US, there is a USP-compliant, stability-tested formulation for a 0.1mg/mL compounded oral suspension of clonazepam.  Finding a compounding pharmacist who knows about this formulation (or other stability-tested formulations) and has the expertise and equipment to prepare it properly requires due diligence on your part, but it’s time well-spent.  A compounding pharmacist can be a valuable source of information and support to individuals who are discontinuing their benzodiazepine.

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The pharmacist should be able to make any dose desired.  So you can do 10% reductions, which will likely be easier on you than 25% reductions.
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Good for you, Angel123.  Please let us know what you learn. I’ve included a link below to a stability-tested formulation for a 0.1mg/mL oral suspension of clonazepam.  USP (United States Pharmacopeia) also has a formulation.  There may be others — different compounding pharmacies have access to different formulation databases. Stability-tested formulations are preferable.

 

Clonazepam, 0.1mg/mL Oral Suspension (see note)

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

 

Note: The 0.1mg/mL concentration works well for tapering a potent benzodiazepine such as clonazepam. Using a 1mL oral syringe with 100 graduation marks, you can measure as little as 0.01mL of the suspension or 0.001mg of clonazepam at a time.

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Hi,

I spoke to my pharmacist today and thankfully, yes, she can formulate with 10% reductions along the way.(lower if needed) She can do capsule or liquid though she recommended capsule as she thought the absorption may be easier as I'm taking disintegrating tablets now. I speak to my psychiatrist tomorrow so hopefully he'll go along and call in the script as I want it to be when my body is ready for me to lower.  Typically when tapering by 10% is a reduction approximately 2 weeks or so? I understand it'll ultimately depend on how I'm feeling along the way. Thank you.

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I'm so relieved, hopefully your Dr will go along with this.  I don't know enough about absorption to know which would be better for you but your question about how long to hold, you answered your own question, let your body be your guide.  ;)
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Thank you for the update, Angel123.

 

You might want to read though past posts from member nolongeranxiousbut.  She tapered clonazepam using compounded capsules and shared tips on how she made her dose adjustments as easy as possible for her prescriber and pharmacist to fulfill.

 

Re: your question about what reduction interval to use ...

 

Clonazepam is a potent benzodiazepine with a relatively long half-life. This means it can take a while for withdrawal symptoms to emerge and then stabilize. According to the sources I’ve consulted, a ballpark range for clonazepam to achieve steady state after a dose change is 4.58 to 13.75 days depending on how the individual metabolizes the drug (as well as other factors).

 

To discover what reduction interval works for you, you will need to conduct a “n of 1” (single-subject) experiment with you serving as the subject.  If you have not already done so, might I strongly encourage you to create and maintain a taper journal?  It can be as simple as a notebook where you record the date, the amount(s) and time(s) of your dose(s) as well as your withdrawal symptoms.  If you wish to take a deeper dive into taper journals and why they are key to successful tapering, here are two resources:

 

Why is it Valuable to Closely Track Withdrawal Symptoms?

https://withdrawal.theinnercompass.org/taper/why-it-valuable-closely-track-withdrawal-symptoms

 

What Symptoms and Experiences Should be Tracked in a Taper Journal?

https://withdrawal.theinnercompass.org/taper/what-symptoms-and-experiences-should-be-tracked-taper-journal

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Assuming that your doc goes along with the compounded capsules plan, I'd suggest that your first 'batch' be the same strength as the pills you are currently using.  Your pharmacist is correct that there could be an effect since you've been letting the pills dissolve in your mouth.  Capsules may feel like a slight reduction (same for liquid, fwiw).
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Thank you. I was thinking about that too. Just keep at this dose with the capsules for a bit.

Would I put nolongeranxiousbut into the search box to find her posts? I’m interested in reading what she had to say about her taper.

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There is a tab just about in the top center of your window that says Members, it's right next to your Logout tab.  If you'll click on that and choose search for members you'll find the member.  When you open that you'll see you'll see Show Posts, this will show you every post that was made.
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Hi,

My doc agreed and called in a script for the dose I’m currently taking to be made in the capsule form that the compound pharmacist uses. After about two weeks I’ll then start the 10% lower dose and continue on as necessary.

One thing the compound Pharmacist recommended is that on my first dose tonight, take my current dissolvable (.125) a couple hours before I take the new capsule (.125) at my regular scheduled time in the evening. (Called it loading) She said it can help with the transition as the capsules metabolize slower. (Was very specific that only the first dose) Then take my capsule in the morning at my scheduled time. If I have tremors tomorrow during the day that are stronger than I’ve had before she said I can then take half a dissolvable and for my evening only take the capsule. She explained that she wants to make this transition as easy as possible and assured me that taking both tonight would not be too much that it’s only for the initial dose. She said everyone transitions differently and I may not have any issue in between doses tomorrow but just in case, the small amount (half) of dissolvable can help but only if needed.

Any thoughts?

Thank you.

 

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Interesting approach, I've heard about loading before but only with Valium because it takes quite awhile to build up in your system.  It sounds like she's worked with others tapering from benzo's, perhaps this is where she got her information, in which case it's nice to see someone in the field learning from their patients.

 

Just for educational purposes, how long do you typically have to wait to feel the effects of your dose, if I remember my experience it seems like Klonopin comes on fairly fast.  I wonder if it would be a better idea to take your new capsule first and then if you run into unpleasant symptoms you could take your dissolvable?

 

I'm not suggesting you listen to me over your pharmacist, I'm just trying to understand her approach.  Whatever you decide, I'm sure these one or two extra doses won't be a big deal in the long run.

 

 

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I appreciate the quick response  :) She did say if I felt more comfortable that I can take the capsule then in the middle of the night take half a tab if I wake with bad tremors. She thinks just the first dose to get me through the transition to take the tab then a couple hours later take my new capsule may make it more comfortable of a change not knowing how my body will react. Either way I’m nervous but will keep moving in the direction needed to get me free.
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I feel you're working with a professional who has experience and is taking your comfort and your symptoms seriously, she's a real find.  Tapering is one big experiment with you as the subject but you have the advantage of working with someone who is taking the guesswork of cutting and measuring out of your equation, I agree with Libertas, you're in good hands.

 

Try not to worry, this can have a negative effect on you, this is just another step in your taper and you'll do great.  I hope you'll let us know how it goes, with every post we learn more so we can help others.

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The transition from dissolving .125 mg tabs to .125capsules went ok thankfully. I plan on lowering 10% in a week and a half (after my daughters birthday) My question is how low will I go before stopping? I know it’ll  take a while and I have to see how I feel as I go along but I’m hoping to have an idea of a goal. Thanks!
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Did you take the extra dose like your pharmacist suggested?

 

Many Clonazepam users will taper to .05, some go all the way to zero, its totally up to you and how you feel as you taper. 

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I did. I took half of .125 dissolving tablet 2 hours before my regular dose time then the capsule at my regular time. Now I’m on just the capsules.

Thanks for the guidance.

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[fb...]
I'd suggest going to at least 0.050 mg, then basing my decision on recent reductions.  For example, if 0.060 to 0.050 was rough, then continue tapering.  If easy, consider a jump.
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  • 2 weeks later...

Hello, I lowered my dose 10% on Monday. My hope/plan is to lower 10% about every two weeks or so depending on how I feel. My question is should I lower if my symptoms are just tolerable/manageable or wait until even less (feeling better) if that’s even an option? I don’t expect to feel well until completely weaned.

Also, how soon after a drop in dosage do withdrawal symptoms show up then dissipate? I’m assuming it’s different for everyone but is there an approximate guideline? I plan on keeping a journal as I drop.  Thank you.

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Most Klonopin users say symptoms appear around day 3 and start to dissipate around days 7-10.  Deciding to make another reduction is typically decided by symptoms which are tolerable, this is how we define stable, you're not feeling great but you can function.  I'm glad you're going to keep a journal, this is a valuable tool for helping you gauge your taper to help you make decisions going forward.

 

A word of caution, once off the drug completely there is still healing to be done, I don't want you to be blindsided by what comes next.  Your brain has a lot of repair work to do while tapering and after the drug has been eliminated so it's good to prepare yourself.  My intent is not to scare but prepare.

 

Four Phases of Withdrawal-Where Are You?

 

What’s happening inside your brain

 

 

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