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Switching from Clonazapam to Diazapam oral liquid Need help with mearurements


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My current dose of K is 0.037g using a scale, what would be the equivalent done in ml of the liquid Diazapam??

my dr said its 3ml, is that correct?

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There are a couple steps, and some missing information, to answer your question Needhelp101.

 

Libertas is asking what potency of tablet you've been tapering (i.e. are you prescribed 2mg, 1mg, 0.5mg, 0.25mg, or 0.125mg tablets?). We'll also need to know what the total weight of one of these whole tablets is (or ideally the total weight of ten tablets to get an average).

 

Could you provide these two pieces of information? Potency of tablet, and weight of a whole tablet?

 

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Great! So I understand you're taking 0.5mg tablets that, when whole, weigh 0.199g.

 

The mg of clonazepam in 0.037g of one of these 0.5mg tablets would be 0.0930mg of clonazepam. I did 0.037/0.199 = 0.1859, which is saying you're taking 18.59% of the 0.5mg tablet. 0.1859 * 0.5 = 0.0930, which is saying that 18.59% of your tablet is 0.093mg of clonazepam.

 

It seems like your current dose of clonazepam is 0.093mg.

 

There are 20mg of diazepam in 1mg of clonazepam, according to Ashton equivalents. So 0.093 * 20 = 1.86, which is saying that the equivalent diazepam dose would be 1.86mg.

 

How many mg/ml is your liquid diazepam?

This information should be printed clearly on the bottle or script.

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I'm not familiar with commercial diazepam solutions, but if I understand you correctly you have a solution of 1mg/1ml liquid diazepam. 5mg/5ml, or 10mg/10ml, etc, are all the same as 1mg/1ml.

 

To take an equivalent dose to your 0.093mg of clonazepam in this 1mg/1ml liquid diazepam form, you'd need to take 1.86ml. This 1.86ml will contain the 1.86mg of diazepam discussed earlier.

 

Your doctors suggestion of 3ml would be 3mg diazepam, or almost double your current clonazepam dose. I wonder why this was their recommendation...

 

As you probably know, crossovers between clonazepam and diazepam are not always successful; also crossing over to diazepam rapidly can be very difficult because I think it often takes a week or so for one of the primary metabolites to become effective (desmethyldiazepam).

 

I hope this information finally answers your original question, and if you have any more questions please don't hesitate to ask!  :thumbsup:

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yes so the dr told me to stop the K and just begin on the liquid diazepam, why do crossovers fail?

im going to call the office now and tell him about the dosage that i think its to high.

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There are too many reasons to list why crossovers fail, only that clonazepam to diazepam is notoriously difficult. Rapid crossovers to diazepam, are also notoriously difficult, in part for the metabolite issue mentioned and also other factors such as increased depression and possible DAO blocking. I really can't cite references (tried to find some in Ashton's Manual, but I wasn't successful); I just wanted to mention these are common issues I see around the forum.
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I spoke to the DR and he adjusted the dose to 2ml.

Wish me luck. Im stopping clonazapam to day and starting diazepam today.

 

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I have zippo experience with substitution but I have read enough to be concerned that if you stop your clonazepam suddenly, you may experience withdrawal symptoms from the clonazepam before the diazepam has built up to a sufficient level to “cover” them.

 

I hope someone with more experience with substitution will share their thoughts. 

 

In the meantime, here’s what Ashton has to say:

 

When making the switch it is important to do it gradually, replacing one dose at a time and at approximately weekly intervals and making allowance for the difference in potency.

 

For example, if you are taking lorazepam 1mg three times daily, first change the night dose to 10mg diazepam. (This can be done in two stages if necessary e.g. lorazepam 0.5mg (half a 1mg tablet) plus diazepam 5mg; then drop the lorazepam and go on to diazepam 10mg). A week or two later change one of the day-time doses, and two weeks later change the other day-time dose.

 

Suggested schedules and information on relative potencies and elimination half-life are available in the Manual: "Benzodiazepines: How they work and how to withdraw".

 

Source:

Reasons for a diazepam (Valium) taper

https://benzo.org.uk/ashvtaper.htm

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I agree with Libertas that there is likely to be a period of increased WD symptoms as you do this rapid crossover to diazepam. I appreciate the Ashton reference cited.

 

I suggest asking your doctor for at LEAST one transitional step, taking half your dose as diazepam and half as clonazepam for two weeks before switching entirely to diazepam. Ashton took her patients through a 3-4 week gradual step-wise crossover, as Libertas quoted, but usually they were at much higher benzo doses than you are.

 

If you can't change your doctor's mind or enact a slower crossover for other reasons, hang tight! I hope this doesn't scare you, but gets you prepared for an uncomfortable transition. If this is your best option, I support you in just getting through it. I hope the ends justify the means on this one.

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Would it be wise to split my 2ml dose for one in the am and one in pm so it's not such a shock to my system?
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Would it be wise to split my 2ml dose for one in the am and one in pm so it's not such a shock to my system?

 

That wouldn't address the rapidly declining clonazepam serum levels, and the delay for diazepam to become an active replacement. I think if you've been taking clonazepam once a day, then once a day with diazepam will be more than sufficient once it's become therapeutically active and equivalent to your previous clonazepam dose.

 

The minimal two-step crossover I was describing was half clonazepam, half diazepam for two weeks, then taking the full dose as diazepam; this and more gradual transitions are to give time for your body to adjust to the differences between the two benzos. Crossovers are a bit of a gamble in my opinion, and rapid crossovers even more so.

 

What do you think about asking your doctor to do at least a two-step crossover?

 

You could a two-step crossover at home if you have left over clonazepam. This would look like once a day taking 0.018g of one of your 0.5mg clonazepam tablets and a 1ml dose of diazepam, for two weeks.  And then you'd start taking the full 2ml dose of diazepam after that.

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Thank you for the information. I have alot of left over CLONAZAPAM so I think I will do that take 0.018g of the CLONAZAPAM and 1ml or diazapam for 2 weeks
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Great! There still may be some rough days, but I think the two-step crossover will be a big improvement over a sudden switch.

 

Hang in there Needhelp101! You've made so much progress.  :thumbsup:

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