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taper plan confusion


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Hi everyone,

 

I’m in the US in rural America and there aren’t any compounding pharmacies I can find. I cut 25% from 1.0 Clonazepam 2 months ago and it was rough. I then cut another quarter tablet which isn’t scored so it is far from exact. Also local pharmacy can’t guarantee the pill is uniform throughout.

 

I find the liquid tapering discussions a bit confusing and I’m not sure generic Clonazepam can dissolve in water or milk consistently? The lowest dose of Clonazepam is .125 and it is a single use dose that comes in foil and dissolves on the tongue.

 

My psychiatrist says go ahead and reduce dose using the .5 pills I have as I feel ready and to take my time? She of corse thinks staying on would be just fine!

 

I take the 2 doses of .25 each at bedtime and about 12 hours later in the morning and another quarter pill cut so not really accurate in the late afternoon so I can manage to eat = .625.  I’m barely hanging on since my symptoms are pretty fierce lots of everything everyone has described so am definitely in interdose withdrawal mode and very uncomfortable. Not functioning well.

 

My only thought is to ask my GP to switch me to equivalent Valium per Ashton manual as I taper down from .625. Or just go on in this somewhat ruthless manner regarding symptoms using the stair step approach on the Clonazepam and try to taper with the dissolving doses which will be pretty inexact too.

 

Thanks for input my fellow buddies! I have great empathy for the suffering that goes with this process!

 

PS I’m a petite 69 yr old grandma with a very sensitive nervous system but had a great 40 year career and appeared healthy after surviving breast ca in 2019. Lots of exercise and in good shape and then 2020 hit and Clonazepam use is threatening my life and all I hold dear. Started using it 24 years ago but for most of that only .25 per night. Wish I had never gone up on the dose in last 2 years!

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I'm not sure crossing over to Valium at this point is what you should do, do you know if your Dr would be willing? 

 

Your pharmacist is correct, once a pill has been cut at the score line there's no guarantee the medication is evenly distributed.  Have we talked about you getting a jewelers scale so you could crush and weigh your dose?

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Thanks Pamster,

 

I don’t get how weighing the dose works in terms of consistency in what is being tapered? And I don’t know how to get or how to use the jeweler scale either so any help appreciated!

 

If I crush a full pill and put it on the scale, how do I consistently remove .1 for example? 

 

Thanks for the advice!

 

Storm

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I've read here you can get a scale from Amazon for about 25.00 USD and here is a link to a video of how to use a scale.  We have many members who can help you with this process if you decide to go with it.  Let us know what you're thinking, we'll help you figure this out.

 

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Thanks Pamster,

 

I watched the video and find it intimidating in terms of the complex process and not seeing how it gets around the fact that the med is not consistently distributed within the tablet since you could be shaving off the actual med or only the filler.  Does this make sense?

 

Any other experience from BBs who tapered K is appreciated!

 

I Agee with Benzo Information Coalition that safe tapering dosages are not generally available in the US.

 

Is milk suspension a better way?

 

Not there by a long shot but need an exit strategy!

 

Thanks again, I know you’re trying hard to help. ::)

 

Storm S

 

 

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Hi Storm,

 

Pamster asked me to talk to you.

 

I am a great believer in crushing the benzo and measuring the dose with a scale.  I am an engineer so math is my second language and I can guide you through the process effectively.

 

HOWEVER, I do believe liquid tapers using alcohol to dissolve the benzo to be a little bit more generally accepted.  I only recommended crushing into a dry powder and using a scale if:

    (1) You do not want any alcohol (even the small drops using to dissolve the benzo)

    (2) You do not want to mess with liquids each day

 

So question 1.  Do you want to do a liquid taper using alcohol (milk and water do not dissolve benzos) OR do you want to do a dry taper with a scale?

 

Just to give you more info, here is a good scale you would buy if you go the dry approach: 

 

[nobbc]https://www.amazon.com/Smart-Weigh-Precision-Milligram-Calibration/dp/B011J88S8M/ref=sr_1_1?ie=UTF8&qid=1541012152&sr=8-1&keywords=Smart+Weigh+Premium+High+Precision+Digital+Milligram+Scale+with+Case%2C+Tweezers%2C+Calibration+Weights+and+Three+Weighing+Pans%2C+50+x+0.001g[/nobbc]

 

Bob

 

Edit: Deactivated commercial link.

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One thing I should mention, I don't have taper experience but I've read that whole milk can be used to dissolve the drugs as mentioned here:  Titration FAQ's

 

However, I'm a fan of Bob7's method since he's helped so many achieve freedom. 

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Hello, Storm survivor.  Clonazepam is challenging to taper because of its high potency and relatively limited options for making “small enough” reductions in dose (at least in the US).  Unlike diazepam, lorazepam, and alprazolam, an FDA-approved oral solution of clonazepam is not available and the lowest available dry dose format is 0.125mg orally disintegrating tablets (ODTs). 

 

Have you considered the “grind tablet into powder and weigh powder” method (see Resources below for links to a video and instructions)?  This would address the potential risk you identified for the “shave and weigh” method (i.e. the active pharmaceutical ingredient in tablets may not be evenly distributed).

 

If you are interested in pursuing the “do it yourself” liquid approach, whole fat, homogenized milk has been used by many individuals over the years to successfully discontinue clonazepam.  The theory behind this method is that clonazepam is lipid soluble. Consequently, clonazepam molecules have an “affinity” for the fat molecules in the milk. Because the fat molecule are in suspension with the water in the milk (if the milk is homogenized), the clonazepam molecules are distributed evenly throughout the milk.  So one might characterize a clonazepam/milk liquid as a hybrid (part solution, part suspension).

 

Here’s an example of how one individual prepared and used a homebrew clonazepam/milk mixture to taper:

 

 

In contrast to milk which has been in use since this forum began, the “do it yourself” vodka/water and propylene glycol/water liquids are relative newcomers to the scene. Individuals who are discontinuing clonazepam should also be aware there may be issues with the one-size-fits-all-benzos “recipe” for using vodka or propylene glycol with clonazepam. (Clonazepam has a different, more challenging solubility profile than other commonly prescribed benzodiazepines such as diazepam and lorazepam.)

 

Resources

 

Grind tablets into powder and weigh video:

 

Using a digital scale to weigh powder method instructions:

https://withdrawal.theinnercompass.org/taper/step-18-essential-skills

(Select “Skills checklist for using a digital scale to weigh powder from a crushed immediate-release tablet or poured-out powder or beads from a capsule”)

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Storm,

 

I hope we are not overwhelming you with options.

 

The milk vs alcohol vs water is a source of great debate. 

    -Mixing with milk gives you a suspension (like blueberries in a cupcake - even distribution but not dissolved)

    -Mixing with alcohol gives you a solution (like sugar in water, completely dissolved)

    -Mixing with water does a poor job of either but is more handy.

 

In the end, people are successful with all methods - even with water - see this video

 

It comes down to this.  If you will not take any alcohol, use milk.  If you are allergic to milk, try water.  If you don't want to mess with liquids, use a dry taper with a scale.

 

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Actually we do not know for a fact that mixing clonazepam embedded in regular tablets with off-the-shelf vodka gives a solution because, to our knowledge, homebrew liquids have not been professionally analyzed.  Also, vodka (40% alcohol) is mostly water.  Clonazepam has extremely low solubility in water and is only slightly soluble in pharmaceutical-grade ethanol (95% alcohol).
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Thank you Libertas,

 

As you show so intelligently, the science is not complete, and so the debate happens.

 

I know people who are passionate about one or the other (milk or alcohol).

 

I don't a have horse in this race. 

 

Storm - I will add another comment in a moment.

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Storm,

 

Let me know if you want to learn more about doing a dry taper with a scale. 

 

In general, for folks like you with decades of benzo use, I recommend a two step approach. 

 

You first see how far you can get using a pill splitter from Walmart or Amazon and a scale to back it up.  Your benzo half-life is long enough and the current dose is large enough so that you do not need to worry if the pill splitter isn't perfect.  You may get a little more one day and a little less the next but over a 24 hour period, you will be fine unless you are very sensitive to changes.  More likely, you worry about these small differences and the anxiety triggers symptoms, not the small differences in day to day intake.  Anxiety is a powerful trigger to symptoms.

 

When you get really low on your benzo (almost done with the taper), you can move to a fine tuning method (see my signature for a link).  Don't let that link scare you.  You only need the fine tune method if you are very sensitive and need ultra slow reductions near the end of your taper.  Many people get all the way to zero benzo with just a cheap pill splitter and a scale to check the weight.

 

Bob

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Thanks Bob, Libertas and Pamster!

 

Yes these approaches are a bit overwhelming and especially with benzo brain and constant tinnitus and stomach issues along with mental symptoms. I used to use excel spreadsheets but let my prescription lapse since retired. I was quite good at math at one point but that seems to have lapsed as well with benzo brain and symptoms so I need the simplest approach possible.

 

The milk process seems easiest though I get the limitations. I would be somewhat concerned about losing some of the med in the process and would have to keep current prescription so my doctor would not know I’m discarding medication and that sounds a bit difficult if she starts to prescribe the .125 dose and expects me to get off from that.

 

Perhaps I can ask for help with a spreadsheet later or one of you could send me one I could use? I have a long way to go to get to .125 Clonazepam and as bad as I feel now not sure when that might be. Though sometimes I am tempted to rush it!

 

It’s really hard. I feel my mental health has severely deteriorated but that is a subject for a different thread.

 

Still can’t quite believe a year ago I was seemingly quite functional flying to see grandchildren and helping with our large family plus leading a full life at home with husband and dog. Then life went south and much of friends and family not in the know because of COVID isolation. They can’t understand why I can’t just quit the med and be done with it and move on and truly no med should be this hard or even life threatening to get off as you well know! I’m feeling various symptoms of actual withdrawal every day even at .625 which is way more than I took just at night for many years. Last 2 months dropping from 1.0 to .625 pretty fast and rough through dry cut estimates on the quarter pill. I marvel at what others go through on this site!

Thanks again all of you!

God bless, Storm

 

PS How was it for you Bob and Libertas? Did it get really bad after taper? I know Pam’s remarkable success story. Forgive me if I missed that part, guys! Poor memory!

 

Thanks again,

Storm

 

 

 

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Hi Storm,

 

I have not written a success story yet.  I had a stroke a few year before the benzo withdrawal so I am not going to write a success story until I know if the remaining symptoms are due to benzo or stroke.

 

However, what might be better for you, is I kept a weekly journal, during my taper and after my taper.  See the links in my signature.

 

You and I have a similar story.  I took Klonopin (or clonazepam) for over 10 years, around 0.25 to 0.5 mg at night to help sleep.  It was wonderful until all at once, about 13 years into using it, it stopped working and I got tolerance withdrawal.

 

Also like you, I tapered too fast at first and paid for it with bad symptoms.

 

If you want to do the milk taper, you will need to find someone with experience.

 

If you want to do the dry taper, then step one is to buy the scale, weight 10 of your pills, and give me that weight so I can determine your average weight per pill.  Then I will make you an easy to follow table with any taper rate you desire.

 

Bob

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