Crossing over from A to K

I’m sorry I post so much, I’m just very confused. I emailed an admin on another group who gave me a schedule that I do not understand. I am trying to cross over from 1mg A 4 x a day to K 1mg three times a day. I was told this is an updose, and basically to only take 0.5k three times a day. I may have messed up because I didn’t know what to do. I took 1mg k last night and this morning I took 0.5 k and 1mg A. I am really feeling it now. I think this was too much. I’m wondering if anyone would be willing to share their email address so I could send the schedule and hopefully have someone make sense of it. I am totally lost right now. My psych wants me to go from 1mg A 4 x daily to 1mg K three times a day and use the A as needed. I don’t think he knows what he is doing and had said this. I don’t want to cause any more damage, or put myself in a situation that is more difficult. Any help is appreciated! Thanks.

Sorry, but no email addresses (that's against forum policies).  You can post what you've been doing here.  Since you're looking for tapering information, we have to do this on the main boards (not in a PM).

 

Going from 4 x 1 mg of Ativan to 3 x 1 mg of klonopin is a pretty big increase in benzo dosage (roughly a 50% increase).

 

If you instead moved from 4 x 1 mg Ativan to 2 x 1 mg klonopin, it would be a similar benzo dose.  Perhaps your p-doc is trying to increase your dose.  Was the 4 x 1 mg of Ativan not working sufficiently for you???

 

If you want to do the 3 x 1 mg switch, I think all you have to do is stop taking Ativan four times a day and begin taking the klonopin three times a day.  Since it's a big up-dose there won't be any lapse in coverage.

 

If you decide to do the 2 x 1 mg switch instead, I'm happy to run some numbers and suggest a crossover strategy where you won't feel any coverage lapses. 

Thank you. I wasn’t sure if that was allowed, just thought I’d ask. Yes I would like some help with a crossover please. I’m finding the K is pretty strong, unless this is the wd. I’m not sure which. I made the mistake  of taking 1mg A + 0.5 K this morning and I don’t like the way I feel at all. I’m just waiting for it to pass. I did not have any direction at that point so I thought I’d try that. Bad idea. If you could help that would be great. Thank you!

Thank you. I wasn’t sure if that was allowed, just thought I’d ask. Yes I would like some help with a crossover please. I’m finding the K is pretty strong, unless this is the wd. I’m not sure which. I made the mistake  of taking 1mg A + 0.5 K this morning and I don’t like the way I feel at all. I’m just waiting for it to pass. I did not have any direction at that point so I thought I’d try that. Bad idea. If you could help that would be great. Thank you!

 

I need to know your current dosing schedule (times, amounts).  I'll show you the dose curve for a 4 x 1 A -> 2 x 1 K crossover and suggest a way to make the transition as smooth as possible.  But I need your dosing/timing info first.

I haven’t figured that out yet as today is the first day. I took 0.5mg k and 1mg A at 6:30am didn’t feel well an hour later. Almost like a high feeling. Then at 1pm I took 0.5mg k. I was taking a 2mg at 05:30, then 1mg at around 1pm and 1mg at bedtime. My psych told me to take 2mg A if needed so I was doing that in the morning. As I said I just started today, so I don’t have a schedule yet. Sorry if that makes it difficult.

What WAS your dosing schedule before today?

I was taking A 1mg 4 x a day. I took 2mg at around 5:30 am and 1mg around noon, and then 1mg at bedtime. I was only on it about 3 weeks. Before that I was taking x three times a day 1.5 mg in the morning, 1.5 mg around noon, 1mg at bedtime. It was very sporadic near the end as I was in tolerance withdrawal for a long time so sometimes I would take more because they didn’t work very well anymore and my anxiety was not controlled anymore, and to be 100% honest I would get very low on my prescription and have to ration near the end of my months supply.

I was taking A 1mg 4 x a day. I took 2mg at around 5:30 am and 1mg around noon, and then 1mg at bedtime. I was only on it about 3 weeks. Before that I was taking x three times a day 1.5 mg in the morning, 1.5 mg around noon, 1mg at bedtime. It was very sporadic near the end as I was in tolerance withdrawal for a long time so sometimes I would take more because they didn’t work very well anymore and my anxiety was not controlled anymore, and to be 100% honest I would get very low on my prescription and have to ration near the end of my months supply.

 

Help me here.  Both of those schedules are for 3 times a day. 

 

It's obvious that you have a lot of anxiety going on.  What (other than taking these pills) are you doing to deal with it??  It's clear that the meds aren't sufficient to control your anxiety anymore.  The choice is either to continue to increase your dose or learn to live without the drugs.  We're not really here to foster the former choice.  The latter will require that you develop some effective coping strategies to deal with your anxiety instead of looking to a benzo for relief.  A good therapist is often more help in these cases than a prescription-writing p-doc.

 

As for the crossover/eventual taper...  I think you need to get somewhat stable (and on a routine dosing schedule) before crossing over or beginning a taper.  Whatever is fueling this anxiety needs to be identified and calmed.  A withdrawal taper usually brings additional anxiety.  You are going to need to learn to deal with that additional anxiety if it's your intention to wean off of these drugs.  So before the taper begins (and the anxiety gets worse), I think you should try to get stable where you are and develop some good non-drug coping skills that will help you move forward.

I definitely want to get off of them, that’s why I’m here. They are not doing me any favours and I think the anxiety was not just anxiety, but the result of intradose withdrawal. Yes I do need to learn coping strategies, and am working with a counsellor doing cbt along with other things. Your response was a little harsh, and I think you misunderstood me, or maybe I wasn’t clear. My goal is to first stabilize somewhat because I am not able to function right now, and then start tapering because I don’t want to be on this medication for much longer, because I now know that it causing me to decline cognitively. I’m trying to ask for help here because I really don’t know what I’m doing. I have taken half the dose prescribed since I don’t want to go up to the dose my doctor wants me to. I’m really hurting right now, and very sensitive, and confused with what to do, and it doesn’t help to get a response like that. I tried to be honest, and I now regret it. This is the only place that I feel can offer advice on how to do this, and if I can’t even get advice without judgement here I’ll be totally lost, and even more hopeless. Please understand that my goal is to get off of them safely, and properly.  I hope that is clear. I just want to know the best way to do this without causing any further damage, or suffering.

I'm sorry if I sounded harsh.  I tend to write in a rather terse manner.  It's efficient albeit blunt at times.

 

I agree that you need to get stable first.  You can try to do that with the 4 x 1 mg Ativan you're currently on or you can switch over to 3 x 1 mg of klonopin.  The latter might bring you more relief since it's a 50% up-dose, but you'll have further to go to taper off of it.  I understand and appreciate that you've been trying to use the minimum amount of drug. 

 

I'm still happy to help you with a transition to 2 x 1 mg of klonopin if that's the direction you want to go, but I need your current dosing schedule (I thought you mentioned 4 doses - perhaps I'm misinterpreting 4 x 1 mg???), and I need for that schedule to be somewhat consistent (at least for a few days).  Else, I don't know how to run the numbers in my spreadsheet.

 

When you begin your taper, you're very likely to experience many of the same symptoms you are currently experiencing.  You can adjust the taper rate to try to keep those symptoms to a tolerable level, but developing effective coping skills will be really important.  That's why I mentioned them.

 

So choice A is to stay on 4 mg/day Ativan and try to stabilize

Choice B is to cross to 3 mg/day klonopin (50% updose so you can simply stop taking the Ativan and start taking the klonopin)

Choice C is to cross to 2 mg/day klonopin and try to stabilize (Similar effective dose to 4 mg Ativan.  I'll help you with a cross-over plan)

 

Again - it is not my intention to upset anybody.  I'm sorry for whatever grief I may have caused you.

At first I was trying 0.5 K at 0530, 0.5 at 1, and 1mg at bedtime. I then tried 0.75 K at 0530, 0.75 at 1pm and 1mg at bedtime yesterday, but the symptoms are still unbearable. I know I needed to give it more time, but I was on the verge of totally giving up. Today I will try 1mg at 0530, 0.75 at 1pm and 1mg at bedtime. I’m not happy about up dosing at all, but I just couldn’t handle it anymore. It’s been 3-4 weeks of debilitating symptoms. I have ditched the A completely and will stick to K. K is much stronger than I expected, and I don’t know if this is a good plan but I am trying to listen to my body, and just get to a more stable place, because for about 3-4 weeks i have been almost completely non functional. The 4 x 1mg was the A. That is off the table now. It wasn’t helping, and I was declining big time. I don’t think A agreed with me, or maybe it was just that it was a big cut, I’m not sure. I did not find that my anxiety was bad on A it was just a feeling of uneasiness between doses, and nausea and vomiting with severe head pressure which I still have, And many other symptoms. I understand that is normal in withdrawal, but very distressing. I was afraid that I was vomiting so often that I would become dehydrated and need medical intervention soon. Let me know what you think of my plan, and if you think it’s wise to do it this way. My plan is to stabilize for a few weeks and then start tapering by 5-10% every 2-4 weeks. I will be asking for help on how to do this when I am ready. I don’t know how to calculate, or do A 5-10% reduction, but I’ll deal with that when it’s time. I appreciate your help, and I hope this makes sense for you to do whatever you need to on your spreadsheet.

Sounds like you've already started doing the 3 x 1 mg of klonopin dosing.  It will take a few days to fully build up in your system.  I hope you get to a more stable place soon.