Clonazepam taper

Hi Everyone,

Been reading the ashton manual.  My boyfriend has been at .15 clonazepam twice a day.  Seems like people have mixed feelings about crossing over to valium.  Do people ever advise switching to 3 dosages a day of clonazepam for a smoother taper? (.10 3xday) Thank you!

Hello Maile,

It really depends on how your boyfriend is doing as to whether it's worth the hassle of splitting up his dose. The "active duration" of clonazepam is 10-12 hours, so twice a day is fine unless he's having problems towards the end of his doses; if he was having problems that felt like interdose withdrawal, then MAYBE it's worth doing what I'm doing and dosing roughly every 8 hours. The goal is just even serum levels, not numbers of doses, so they have to be spaced pretty well to get that effect. And at very low doses, like he's at, it's almost not worth the hassle.

A crossover to diazepam, especially from clonazepam, is pretty iffy at best, to my knowledge (says similar in the Ashton manual). I would try to stick with K unless there are bigger issues.

How is he dosing? Parts of tablets? 0.15mg isn't a tablet size or fraction of a tablet that I can think of off the top of my head, so is he already using a scale or doing some liquid titration?

Thank you for the reply!

Yes we have a scale so we weigh out crumbs.  A full tablet is around .170 grams so he is down to .050 grams a day (.025 twice a day) If that sounds correct...  It is difficult to weigh and sometimes I worry about the accuracy which is also something I could use some advice about. He is very sensitive.  He still feels the dose a bit and usually falls asleep for a few hours afterward.  Sometimes those last couple hours before the next dose do get hard.  He's been holding at this dose for awhile now though, since January.  It's a very hard situation.  He is very depressed and having severe agoraphobia.  He hasn't left the bedroom since February...  So although he isn't having acute withdrawal symptoms, it doesn't seem like he's stable enough to keep reducing.  So as far as helping him to get stable.... time? ...And then just grasping at straws for anything we are doing that could be aggravating his nervous system and slowing down his healing.  Would dividing the daily dose in thirds feel like a cut to him?   

Lots of good questions... Thank you for telling me more about your situation.

Yes, moving doses around in the day can be destabilizing. I am this sensitive; I move my doses by 15-30 minutes per day when I need to change my schedule. Ideally I do this when I'm not cutting because it can be upsetting to my nervous system.

People have mixed opinions about cheap mg scale accuracy; it's certainly something I worry about and there are two common solutions that I know of:

1) mix crushed pills with a filler, like micro crystaline cellulose, this bulks the volume so you're not working at the mg level (more like the 10 mg or so I think, but still getting that ultra low dose you need), see https://benzodrytapermath.com/ There is a spreadsheet on there, but you have to get a little familiar with the math.

2) make a liquid clonazepam. This is my preferred method; liquid can be really precise to dose and is easy to make and measure once you understand solvency issues and have some basic liquid measuring equipment. I'm still writing my instructions on how to make liquid clonazepam from tablets; it will be in the link in my signature with 'Tools & Techniques' hopefully in a few days.

But the biggest issue I hear from your recent post is that your boyfriend has been holding since January, and not leaving the bedroom since Feb. That's making me wonder what his journey has been like, and why he isn't recovering. These sound like withdrawal symptoms, so I'm curious if the taper has been rushed, or if this is an underlying condition that needs more of a psycho-therapeutic support. Benzo recovery is only half tapering; the other half is learning the life skills to live without the tranquilizer.

If you don't mind me asking...

What dose was he on initially, how long has he been on benzos, and at what rate did he taper? If you have dates with specific doses that's best, but whatever you've got would really help me get a better picture of your situation. Also, is this his first time on benzos, first time tapering, or have there been other benzos, tapers, or related history?

We can definitely make your dosing easier by considering an easier method than dry weighing the pills, if you're interested. But before that I'd like to get a sense for why he's not stable; stable is a relative term, I hear you that he's not acutely miserable, but if he can be more functional, less depressed, less anxious, then I suggest we reach for that before taking away any more of this medicine. In some situations an updose actually gets someone where they need to be to begin tapering; holding out at too low of a dose can lead to cascading failures (poor eating, lack of exercise, etc) that makes recovery harder and harder.

Not to worry you! He's so lucky to have your support.

Let me know what you can!

Thank you so much slownsteady,

Yes I can tell you a little more about the situation.  It's really hard.

So in August 2020 his dog died in a traumatic way that triggered a PTSD response and then about 3 weeks later he went into catatonia and stopped eating, drinking, speaking.  He eventually went to the emergency room and was hospitalized for a week and was given 3mg of Ativan a day and 100mg Sertraline (anti-depressant). (He had never taken medications before) It brought him out of catatonia.  I picked him up from the hospital and he was pretty drugged.  His home prescription was 2mg clonazepam/day.  He was on the full dose of Ativan/Clonazepam for exactly one month before he started tapering.  He started tapering too fast, following his psychiatrists directions... I will write out the dates here:

10/10 - 1.5

10/17 - 1 (this is where we really messed up and for 10 days he was just taking it at night and no morning pill.  Reall really bad

10/27 - Split the 1mg between morning and night - hold for awhile stabilizes a little and starts tapering off sertraline.

11/21 - Off Sertraline

Scale taper: These are weights based on 1mg =.170 grams

11-23 - .062/.084

11-29 - .062/.062

12-2 - .052/.052

12-6 - .040/.040

12-8 - .035/.035

12-12 - .030/.030

1-5 - .015/.030

1-12 - .015/.025

2-13 - Starts to go into catatonia again but still able to drink smoothies and water

2-23 - Comes out of catatonia after I add an extra .010 to his morning smoothie

Tell him a few days later...

Agrees to stay at .025/.025

He is very very resistant to going up but also resistant to everything in this moment.

I know this is complicated, and the catatonia makes it really scary.  I am working with his psychiatrist a bit but my boyfriend is so resistant to taking anything that they offer at this point.  Trying to help him heal and feel better and also avoid catatonia and hospitalization... Though will make that happen if it needs to.  The only thing they do for catatonia if I brought him back to the hospital though is more benzos or ECT.  So if he does need to go up I feel better about doing it at home so they don't over do it at the hospital. 

Hi Malie - So glad to have you here and so good of you to be an advocate for your boyfriend.

Slownsteady is already giving excellent advice and asking all the right questions. I am always learning from him too.

I went through his weaning schedule and his cuts were very large and very close together.  Even when he had 24 days between Dec and January that cut was at 25 % and then another cut followed.  It is my strong belief his poor central nervous system is just fried.  Slowandsteady mentioned “updosing” and there is a lot of controversy around this, and this is a very personal decision.  However, given the extremely large back to back cuts and not really anytime in between to allow for recovery time, if it were me, and knowing what I know now and if it were loved one of mine, I would updose to a stabilizing dose, and just start over and go very slowly.  I want to be clear: I am not giving medical advice.  I am just going off of what I have learned here on the BB forums and reading what others have gone through and those who have had to updose, because they went to quickly and crashed.  The they went on to do a slower and more successful taper, and many are still in the process.

Just something to think about.  The rule of thumb is about 5-10% cuts about every two weeks, and for many that is even too fast.  If you go back and calculate his step downs, they are way above that and with in days of each other. 

We are here for you.  I hope you find the answers you are seeking and he gets the relief he is seeking soon 

Marie

Thank you Marie!

I agree that that might be the thing to do.... He has suffered so much.  I know he hates to feel like it was all in vein but I guess the goal is progressing forward in the best way we can and being able to see improvements... 

With up-dosing, do you go up gradually like you tapered off?  Or maybe go back to the point where the crash started to happen? 

I really really appreciate all of the support and advice everyone!  It's scary and heart-breaking sometimes.  I wish I had signed up here earlier but hopefully I am on the road to figuring it out a bit... 

Thank you Marie!

 

I agree that that might be the thing to do.... He has suffered so much.  I know he hates to feel like it was all in vein but I guess the goal is progressing forward in the best way we can and being able to see improvements... 

 

With up-dosing, do you go up gradually like you tapered off?  Or maybe go back to the point where the crash started to happen? 

 

I really really appreciate all of the support and advice everyone!  It's scary and heart-breaking sometimes.  I wish I had signed up here earlier but hopefully I am on the road to figuring it out a bit...

Where did he feel stable last?  And when I went into the hospital after my c/t...I did not updose right away, even though it had only been a few days...I took a few days to get to the dose I was at when I c/t.  Then my doctor switched me to Klonopin 1.25mg and I held for a while before I started my taper. 

I’m not an expert on updosing, so I don’t really know what to say.  I just know I have seen people ask where the last place the person was stable or comfortable/functioning at....and then I guess I would go up slowly to that point and then I would hold probably for a couple months before beginning to taper again. Then do a slow and steady taper, and maybe consider c/o to Valium as per The Ashton Manual.  Just some thoughts.

Definitely talk this over with your doctor.  Hopefully his doctor is understanding and benzo wise too. 

Marie

He would say he's never felt good the whole time.  The whole thing has been awful, I think that's why he wanted to get off  so fast. 

I would say that mid November to mid December he was the most functional and experiencing what I think you call a paradoxical effect, extra talkative, lots of projects...  His motto at the time was "Gotta keep moving"...he had turned into one of those guys  ...  He started to go downhill again when he had another traumatic experience again on December 9th.  At that point he was at .035 and right in the middle of some big and frequent cuts...  I hate for him to go all the way back up to 1mg/day....

Thank you again for sharing more details! This paints a much clearer picture, and I think that we can help you both get to a better place, and soon. And it hasn't all been in vain! But the body leads the recovery; there's nothing gained by outpacing it's healing capacity.

Yes, as Marie and yourself are saying, the taper was rushed. I advocate a patient-led, symptom-based taper, and I don't know of ANY doctors who can lead this kind of process. The reason for this approach is that the nature of benzo recovery is individual, and depends on so many personal factors, both physical and psychological.

Ideally, the taperer is able to maintain a decent level of functionality throughout the entire taper (eating, gently exercising, sleeping), and adjusts their rate according to this goal. It won't always been comfortable, but these basic functions are sort of a threshold; when I can't eat, or I can't gently exercise, or I'm not sleeping, usually this means my nervous system can't keep up with the reductions and further cuts will only increase the overload of repairs going on and increase my misery. These physical functionality indicators are what I caution buddies to keep an eye on. The psychological issues, anxiety, depression, etc, are all difficult but with carefully tapering these will wax and wane, and are often more indicative of skill-building requirements (i.e. therapy, self-awareness, and emotional maturity; the grieving process is a skill!).

I definitely recommend an updose, but I do not think you'll need to go back to 1mg. It's very fortunate that that his usage has been short-term and he doesn't have a previous benzo history. This is ideal for recovery. From your previous posts it sounds like December was where he was the most stable and I'd aim for an updose in that range of 0.030 to 0.035mg of pill weight (I think that's 0.176 to 0.206mg K?).

The goal I suggest right now is that functionality I mentioned earlier. Around the forum this is also called "stability" or "stabilizing". I'd like to see him be able to have an appetite, go for a daily walk of ANY duration, and sleep well at night. This is the best we can often hope for during hard times in a taper, and these will pay dividends if sustained daily.

How long it takes to stabilize at 0.176 to 0.206mg of K, twice per day, will really depend on many internal and external factors and may be slow to realize; but you'll know it when it happens. For me, when I updosed after an absurdly rapid taper (doctors orders!), I was functioning better within days.

I wouldn't be surprised if it takes a week or two weeks in your case, but don't despair if it's a little longer. All that's happening is his nervous system is catching up to the back-log of repairs that were generated by your previous reductions. Once the catch up is complete, functionality, as described above, will be resumed. After that, a recommended 5-10% of current dose/14 day reduction should keep him coming back to full functionality within those two weeks, and this should be your indication that it's again safe to take another reduction.

Please try to accept the long-term nature of benzo recovery; the WD symptoms are all signs of a body getting backed up on repairs, and so many buddies get caught in cascading failures when they hurriedly reduce to "just be done with it". You sound very intelligent, and two heads are definitely better than one when it comes to this! Together the two of you have so much going for you; you'll see this as you read around the forum.

The last part of all this is if you're going to be holding, it's nice to have an easy dose regime. Twice a day 12 hours apart should be sufficient, so that keeps doses to a minimum. But weighing dry pills on a cheap scale is no fun, in my experience. Can you get 0.25mg tablets? If you doses 3/4 of a 0.25mg tablet twice a day, that's 0.188mg, and just a matter of cutting with a pill cutter. Easy peasy!

The pill cutter I recommend is the aluminum kind. Nothing with a razor blade in it has ever worked for more than two or three pills for me. Here's splitter I use and it's AMAZING for clonazepam tablets ([nobbc]https://www.amazon.com/EqualSplit-Splitter-Crafted-Medical-Aluminum/dp/B07MH6XTL7[/nobbc] ...just cut-and-paste the link...) but anything like that with aluminum blades will work. Assuming you have flat round tablets, stand the pill on-end between the blades (if you have a 1/2 score mark, it will tuck into one blade nicely) close the shield and squeeze; ignore the included instructions that say to lay the pills flat, that doesn't work for me. To get 1/4s, lay one half cut-side-down between the blades and eyeball the middle, close the shield and squeeze. You'll get the hang of it.

Can you get 0.25mg tablets? Do you have a cooperative doctor? I'd suggest keeping them in the dark generally about your taper; maybe just say he's down to half his 1mg dose but he still needs it regularly, and you'd like smaller pills. If so, what do you think about going back up to 0.188mg and holding until he can get functionality back?

I think the second best option, if changing tablet size is a problem, would be to to go back to 0.25mg twice per day; this again is easy pill cutting with 0.5mg tablets (which I'm just assuming you have, but please correct me if I'm wrong). In the end, functionality is SO much more important than staying as low as possible right now. At even 0.25mg 2x day I think you'll lock in stability at half your starting dose, and finally get a chance to move forward.

I believe in you two! 

Slownsteady-  That was excellent! 

Like he says, you two together can do this!  I hope you will find the right solution and soon 

Marie

Oh my gosh, thank you so much for the amazing and detailed reply!

And the encouragement!  I'm reading these to him too of course, plus other inspiring or interesting things I find around here...

So partially it's just a matter of convincing him to go up too... Even when he was literally catatonic I couldn't get him to take more and had to put it in his smoothie.... But I think the discussion is a key part of it... and being as informed as possible even though you never know how one's body is going to react. 

So sleeping and eating seem to be ok lately...  He just recently actually switched all of a sudden from sleeping during the day to night time again.  First time in 6 weeks or so.  So besides the depression and anxiety(which are really bad), really the thing is the fear it seems.... fear of going outside where he could get some movement, and fear of going up or down with the benzos...  I really have no idea if this is a benzo symptom? Or he's still in mild catatonia: frozen in fear. Or maybe the two factors compounded?  He thinks that if he goes up, he will just sleep more and still be too scared to go outside.  Definitely I think more therapies are needed to process the traumas. 

So much goes on in my head all day trying to figure this out, how to create true healing, physically and emotionally, without having a lot of wiggle room.  This is something probably everyone is dealing with I guess.  How dose one heal all the other things while the withdrawal symptoms are taking all the energy?  I will keep presenting him with information and inspiration, and keep praying 

Thank you guys oh so much... I'll see what happens in these next few days.

First I want to say, Marie, your support on this thread has been fantastic; thank you for carrying this conversation along. Because you kept asking great questions it has made my posts so much easier!!

Maile, I'm glad that we could be helpful. The sleeping and eating situation sounds really promising. Patience is everything; you are really brave to be going through this with your boyfriend. My wife read your post and could relate with your struggle in many ways.

I went through a traumatizing and prolonged medical THC overdose last summer, and it took me a LONG time to get out of our tiny apartment. I was so terrified of everything, and not on anything like a benzo at that time.

I'm really hopeful hearing that you're considering therapies. I think the benzo taper is not going to solve much on it's own, except maybe reduce short term neurological damage and keep his feeling center open.

In my humble experience, acute traumas that have such profound impacts on us are caused by the re-emergence of developmental traumas that were hidden from our consciousness by a psychological magic trick sometimes called "dissociated parts". These are parts of ourselves that survived traumatic events, and weren't able to coalesce into a unified consciousness as we mature; instead denial and disconnection can keep these parts feeling very distant and immature. Reuniting with dissociated parts, by triggering circumstances (or in my case mind-altering psychiatric medicine), can be extremely overwhelming.

In my own recovery, it's been very important for me to begin framing the emotional traits of the emerging dissociated parts as both highly intelligent and deserving of both understanding and care. In your situation, I'm suggesting this perspective shift on the part of your boyfriend, but it helps if you can join in this awareness. Dissociated parts, to my knowledge, are formed when we need survival strategies in unsafe and unsupported situations, usually as children; these parts are literally trying to save our lives at times when outside circumstances require us to focus on psychological defense instead of development. Because of this, celebrating, honoring, including, respecting, and ultimately joining together with these seemingly alien thoughts and feelings, is what has been required for my stages of growth and healing.

I suggest doing trauma-informed psychotherapy, ideally with a therapist who has a proven methodology and is willing to work to achieve meaningful goals in session AND between sessions. But I hear you about feeling overwhelmed with just the benzo withdrawal! So that's why I have been suggesting updosing and stabilizing. The benzo can be a useful crutch as you transition to more effective therapies, but ONLY, I believe, if the dosage is sufficient for him to remain fully functional. Not necessarily feeling calm and content, not by a long shot, but at least exercising gently in addition to eating and sleeping.

Please keep us posted!