Going from Clonazapam to Diazepam for Sleep

I'm currently on 4 doses of clonazapam. I'm in the middle of my first 6.3% cut, so the total dose is 1.875mg/day but only the 8am dose has been cut; the other 3 doses are 0.5mg each.

 

I'm on 4 doses because when I took 3xday (8am, 2pm, 8pm), I woke up like clockwork around 2am, every single night for a month. That was WITHOUT tapering. Basically I get inter-dose withdrawal beginning at around 5-6 hours after each dose, almost every dose, since I started 3 months ago. So I rotated my doses around to keep my daily the same, and get a fourth dose at 2am.

 

Waking up at 2am is very disruptive to my sleep. If I'm sleeping well, it's hard to do; and if I'm not sleeping well, such as in withdrawal, it means I'm really not likely to get much more sleep that night. Usually from 2am onward is 1-2hour chunks of nightmares and tossing. 

 

I noticed the Ashton Manual substitution schedule for clonazapam to diazepam starts with transitioning the PM dose to diazepam over about a month. I'm thinking an appropriate diazepam dose might carry me through the night on an 8pm dose alone. I'm going to discuss this with my psyche NP on Tuesday, but I'd really appreciate anyone's opinion on the value of this experiment.

 

One upside I see to trying this is I'll know if I can tolerate diazepam, and if I do than I can do a gradual substitution and direct taper from diazepam. The down side seems to be a delay in my taper schedule, and a possible adverse reaction to the diazepam, either from symptoms or not getting the right equivalent dose.

 

Can anyone tell me if my sleep situation warrants this experiment?

 

How would I go about moving a 0.5mg K 8pm dose and a 0.5mg K 2am dose to a single 8pm diazepam dose? Ashton Manual is written for a 3-dose/day patient, and I'm not there.

 

1. Could I basically remove a half or quarter of the 2am dose, and add the equivalent in diazepam to the 8pm? Wait a week or two, and repeat? Eventually phasing out the 2am K, then, ideally phasing out the 8pm K with equivalent diazepam.

 

2. Or could I just drop the 2am dose at once and take the "equivalent" in diazepam with the 8pm K, all in one night? I guess that'd be 10mg diazepam added to the 0.5mg clonazapam at 8pm. Seems risky...

 

3. Last option is to just struggle with the 2am doses until I'm lower on my clonazapam taper, and then try a switch.

 

My head gets all muddled trying to plan for a steady serum level, and minimize the discrepancy in equivalencies.

Thank you anyone who can help!

Very curious what answers you get.  I am on Ativan 4 doses a day and am up at 3am every morning.  When I get up I am wired with something (cortisol or adrenaline or something else) I can’t lie in bed.  I have to get up and move around.  I was considering a crossover to clonazepam but not sure now.  My issue is I get hypnic jerks when I try to nap so I can never get caught up on sleep.  I haven’t started to taper yet either.  I don’t see how you can taper without sleep.

Do you just have a feeling that you can’t sleep, or are you wired and there is no way you are falling back to sleep - a very uncomfortable feeling.  Sometimes my morning dose of Ativan doesn’t take it away completely.  I’ve been wondering if Valium being more uniform in you blood would take care of this.

Ugh, I hate it when I see members have to wake up to take their dose, sleep is too precious to disrupt but I understand you do what you have to do.

 

It sounds like you're a good candidate for switching to Diazepam, I'll be interested to hear if your Dr is agreeable.  Diazepam takes awhile to build up in your blood so the crossover you're looking at may be a bit bumpy at first.

 

What time do you go to bed?

Thanks for your reply Pamster. I go to bed around 8-9pm; I'm desperate for those Zzz and I've taken 0.5mg melatonin at 8pm for eight months now so I usually get a good send off to sleep. But, especially in WD, 1:30am I wake up.

 

I'm nervous about the crossover bumps; I have a sensitive gut and I'm not clear on what side effects to expect. Are there some posts you'd recommend me reading? Ashton also warns about a clonazapam to diazapam crossover being uniquely difficult, but besides the GABA receptor interactions I don't remember her saying what patients struggled with.

 

Thanks!

Thanks for your reply Pamster. I go to bed around 8-9pm; I'm desperate for those Zzz and I've taken 0.5mg melatonin at 8pm for eight months now so I usually get a good send off to sleep. But, especially in WD, 1:30am I wake up.

 

I'm nervous about the crossover bumps; I have a sensitive gut and I'm not clear on what side effects to expect. Are there some posts you'd recommend me reading? Ashton also warns about a clonazapam to diazapam crossover being uniquely difficult, but besides the GABA receptor interactions I don't remember her saying what patients struggled with.

 

Thanks!

 

 

Clonazapam is potent, diazepam less so. So some struggle with that. Even though calculaters for equivalency say 16 mg diazepam for 1 mg clonazepam, Ashton switches patients to 20 mg diazepam, to help with that crossover. I crossed over without issues, and actually felt better on the diazepam. I don't miss the clonazepam. You can taper directly off of clonazepam, like diazepam, it has a long half life. But unlike diazepam, it doesn't come in smaller dose pills. Some get a liquid formula from a compounding pharmacy and use that. BB is full of helpful people that can help you either dry taper or liquid taper directly off clonazepam. There are ones who will give you instructions on making your own liquid if you can't get a liquid from a compounding pharmacy. There are math wizards who will help you create a taper spread sheet. If you want to dry taper, you can purchase a scale to weigh  your dose, and members who will help you with weighing your doses. So if Valium crossover isn't working for you, or you are having trepidations about switching, just taper directly from clonazepam. 

So grateful to BenzoLottie for chiming in with first hand experience! 

 

As for side effects, what I've heard the most from members who crossover is sedation and depression, some will go back to their original benzo but for those who stick it out, I hear the side effects go away.

 

If you decide to make the switch let us know and we'll figure out that nighttime dose.

Slow and steady, 

Did you and your doc make a decision about the crossover?

Thank you BenzoLottie and Pamster for your feedback!

 

I discussed the crossover with my psyche NP yesterday and he thought it was too early to make that adjustment. He was confused why I would have inter-dose withdrawal at all with clonazapam; I guess he's in the boat that thinks a medications half-life is synonymous with its active duration; he thought that my history of doses should be layered over each other and very smooth acting. All I know is that I woke up at 2am like clockwork for the first time in my life on this medication and for over a month, and when I'm in WD I wake up at 1:30am usually, which SEEMS like inter-dose withdrawal.

 

He made the remark that the 2am dose is likely just "psychological"; these are psyche meds, aren't they?

 

My psyche NP is only advising. I meet with my new PCP Monday next week; he was open to the switch last time we spoke. Originally, I was going to taper down to 1mg clonazapam or lower before attempting any substitution. I think I'll take the psyche NP advice and take another ~6% cut of clonazapam on Friday and put diazepam on the back-burner. I will discuss a future crossover with my PCP though; I have many months of uncharted waters ahead. Liquid diazepam is also more easy to come by than clonazapam.

 

Thank you everyone. I'll try to find and update this if I do decide to crossover.

You could bookmark this thread, that way you'll be able to come back to it and update it. If you post anything new elsewhere, you can just click on your name, and on the left you will see a link you can click for all the posts you made. I found that out on my own, so I could find something I posted.

 

Hope all goes well with new PCP. NP's are usually more sympathetic, I go to a Psychiatric NP, and she's been great. Too bad yours isn't helpful.