Question about compounded Klonopin

Hi guys,

 

So my husband is currently experiencing a break from akathisia (although anxiety and tolerance withdrawal are still so terrible)and we are trying to figure out what best way for him to start going down... The transition from K to V kicked off 2 cycles of akathisia so perhaps direct taper may be the best option.. I have read several threads where different members not only support the option but have been successful doing it that way.

 

We thought about compounding in order to make measuring easier and avoid variations because of issues with titration (he is SO sensitive to any changes because of the damage to his nervous system, so predictability is our friend).

 

We have some questions that I wonder if anyone can help us with:

 

1. Are there members that have experience using this method as opposed to titration?

2. If so, what was the suspension/ compounding liquid that was used? (trying to see if it's always the same and if it's relevant to the outcome)

 

Regardless of what method you chose for your withdrawal journey, is there a time that you start feeling better? I realize that it varies, but is there a time that you start noticing ... something positive?  Does it have to be at 50%... more than that?

 

Thank you all for any feedback...

I've moved your post to the titration board because the method you're describing is titration and using a professionally compounded liquid is in my opinion the next best thing to the use of a pharmaceutical solution.  You're just about guaranteed to have the proper ingredients in the proper amounts using a proper process making your taper that much smoother.  You'll want to speak with your compounding pharmacy to get the details about their process and you absolutely have the right to do so.

 

We have a member who has been using this method with great success so hopefully they'll stop by with their experience.  I don't have personal experience so I'll let others provide that.

Thank you so very much @Pamster!  And sorry for posting in the wrong place and thank you for fixing that.

 

Trying to even get started has been such a nightmare... and he HAS to. Right now it's either going up or down... and going up- even if someone chooses to go up, because it's necessary for them- means it's a matter of time before going down. I think that although the prospect of the withdrawal is scary for anyone who has educated themselves about benzos, STARTING is such a big step for the psych.. The success stories are amazing motivation.. Thank you.

Hats off to you for helping your husband, feelberlin! 

 

Yes, we have members who have used a compounded clonazepam suspension to taper.  I am one of them; Healing64 is another. I’ve encountered at least a dozen others in my travels around the forum. (We also have members who are tapering other benzodiazepines using compounded suspensions and solutions.)

 

Members typically do not share the formulations their compounding pharmacists use, but I’ve included a link to one below.  It’s important to note that this particular formulation has been potency- and stability-tested.

 

0.1mg/ml clonazepam oral suspension from Nationwide Children’s Hospital:

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

 

Hello feelberlin!

 

I'm sorry to hear your husband has been struggling so much. I think he's so lucky to have your help! And I agree that it sounds like accuracy and repeat-ability are going to be key in dosage adjustments, and pharmacy compounding is ideal for this.

 

1. Titration just means an adjustment in dosage. On the BB forum it seems to refer to dosage reduction methods that have a high degree of accuracy.

 

2. My pharmacist compounded liquid clonazepam is 0.125mg/ml, it's made with 30% ethanol, water and pure clonazepam powder. I chose 0.125mg/ml because this means 1ml = 1/4 of my 0.5mg tablets.

 

I'm doing a liquid/tablet hybrid, so I use mostly tablets and tablet pieces for my doses, and I only take one very small liquid dose that I can very accurately reduce with a 1ml syringe. I describe liquid/tablet dosing in my 'Klonopin Taper Tools & Techniques' progress log, linked in my signature; one of the benefits of using tablets with liquid is that if the liquid isn't tolerated well for some reason, the tablets can sometimes keep things from getting too screwy.

 

Liquid/tablet tapering helped me immensely when I was trialing liquids as the first two tries went very poorly. I did not tolerate MCT oil suspensions, especially a proprietary blend of lipids and such, and I haven't even bothered with some of the more complex "OraPlus" type suspensions. Ethanol in high enough concentrations creates a solution (dissolved clonazepam) and preserves the medicine at the same time. I take such a small liquid dose, because I also use tablets, that I take less than 0.33ml of ethanol per day; 1/20th of a teaspoon or thereabouts.

 

There are other options for dissolving or suspending clonazepam; hopefully your pharmacist will have some safe and tolerable options for your husband.

We're here if you need more help! 

Hi guys,

 

I did some homework based on your suggestions and have located a highly rated pharmacy in the area. They have experience with Xanax - and it actually was for someone who was tapering. They were very nice and provided me the name of the psychiatrist with whom they had worked before as a reference. My husband currently has a benzo-friendly psychiatrist so we are not looking to change things, but it is a relief to know that more psychiatrists are catching on...

 

My husband has been considering something and I wonder what your thoughts may be on it:

 

Instead of doing a 1:1 or 1:5 solution he is considering 1:20. This will allow cuts that would be equivalent to diazepam cutting.

 

Some of you may have read my posts about just how horrible his response to the crossover (K to V) was... it actually triggered two episodes of akathisia that landed him in the ER..

 

Do you think that there is a downside to the 1:20 proposition? The harm caused to his nervous system because of the benzos has made his neurochemistry so sensitive to changes (and it was pretty bad before). If he can start tapering slowly, then we can figure out how much he can cut without it becoming debilitating.

 

I'm trying not to be overprotective, because that will hinder him... but I want to do whatever I can to support him and help him through this.

 

Thank you for the guidance and thoughts..

 

You guys have my gratitude for being there :smitten:

Hey feelberlin,

I'm glad you found a compounding pharmacy you like!

 

I'm not certain what you mean by 1:1, etc. Are you talking about 1mg/1ml solutions and 1mg/5ml, etc? If so, 1:20, 1mg/20ml creates a 0.05mg/ml solution. This isn't necessarily the easiest way to dose because you'll need somewhat large volumes of the liquid medicine. I think you mean it's like diazepam in that 1mg of clonazepam is divided into 20 parts (like the 20mg equivalency of diazepam)? However the half-life of clonazepam remains the same, and the equivalency charts are just suggestions, so this 1:20 really doesn't provide much of an analogue in my opinion.

 

EDIT: The degrees to which you can reduce depends both on the dilution of the liquid AND on the accuracy of your measuring equipment. Typically pharmacies give out 1ml syringes with 100 gradations (maybe something to inquire about); this allows 1ml to be divided pretty closely into 100 parts. For example, a 0.1mg solution (1:10 by your numbers), can be reduced by 1ml syringe in intervals as small as 0.001mg of clonazepam.

 

At a 0.1mg/ml solution (1:10), to take your husbands full dose of clonazepam as liquid would require 8.75ml per day. This requires about 275ml per month containing 27.5mg of clonazepam. To dose 8.75ml you'd require a 10ml syringe and the 1ml syringe described above; the 10ml would be to draw 8ml and the 1ml would be to draw the decimal (which is where you reductions would be happening).

 

If you use 1:20 or a 0.05mg/ml solution, double the above numbers for dosage and monthly volume. It's a little more of a handful drawing 17+ml from a 550ml supply, and possibly twice as expensive, but yes, you could reduce with a 1ml syringe by an even smaller degree of EDIT: 0.0005mg. This might be the best dilution for you; I cannot say. It would be far more affordable if combined with insurance-covered tablets.

 

I wrote a tutorial on how to use this popular liquid DMT schedule creation website:

http://www.benzobuddies.org/forum/index.php?topic=254653.5#post_generator

 

This form takes any variety of liquid, any potency, and also can schedule a liquid/tablet hybrid, minimizing the risks of switching entirely to liquid. I found doing a DMT to be the gentlest way for me to reduce my dosage; it's comfortable in many ways perhaps more than diazepam. I also have a post on the benefits and methodology of a clonazepam DMT as a part of that same thread linked above (if you scroll to the very top there is a table of contents).

 

I am really celebrate your efforts to support your husband through this arduous journey. That you're striving to balance protection without hindering him I think is very admirable and brave. Please keep letting us know any way we can help.

Slownsteady, great job on the tutorial of the benzo.alwaysdata website. This helps others who do not understand what I consider a good tool to use during one’s taper. It does all the math and calculations for you.

Slownsteady, great job on the tutorial of the benzo.alwaysdata website. This helps others who do not understand what I consider a good tool to use during one’s taper. It does all the math and calculations for you.

 

Thanks! I appreciate your feedback.

@[Sl...] :smitten:

 

Yes, you are correct about what I meant with the 1:20. It is quite a bit of liquid... The idea was to translate the k-taper to the closest thing to a v-taper. My husband did try to transition as I said and that went horribly- horribly- wrong. He was given the liquid diazepam and I have to say that other than the terrible flavor, the suspension made measuring SO much easier.

 

So the thought was, what if you can just repeat the experiment with compounded k and decrease minuscule amounts to find the most that he can tolerate cutting without risking another episode of akathisia?

 

When that happens I HAVE to take off from work... it's impossible not to, but employers don't quite understand the urgency. I am trying to switch to something fully remote so that I can be there for support while he's actually tapering. It's not only for him... it's selfish as well. I want to be there.

 

On a side note, when using a liquid suspension, is there improvement during the taper? If so, how far along do you need to be to start experiencing it?

 

I know that answers may vary, but do wonder if there is some common ground when using compounding.

 

Thank you again. You guys not only help with your suggestions, but also ground me. Loved ones care, but the priorities of the person coming off are what matters... we need to find ways to support THOSE goals... not impose our own... You help me do that as well as I possibly can...

Hello feelberlin,

I'm glad I could be some help to you and your husband!

 

I understand what you're trying to do now, and while the degree to which you can accurately reduce the medicine is very important, the other half of emulating a diazepam taper is the size and frequency with which you take reductions.

 

What I think you're asking to create is called a daily micro taper (DMT); it can be done dry or wet, with tablets/powder and a scale or with a liquid form (and optionally combined with tablets). Nothing about a daily micro taper is specific to liquid tapering, and there are no special tapering benefits to liquid other than that it can be very easily and accurately measured and dosed.

 

There are however additional risks to liquid medicines, and this may explain why your husband had a difficult time transitioning to liquid diazepam; liquid medicines are made with a wide variety of ingredients. I trialed two compounded clonazepam formulas, both of which made me very sick, before trying a third alcohol and water based formula I made at home that luckily worked for me; this was a long and very stressful month and a half. I now have the same basic formula compounded by a pharmacist, and it works perfectly. I am lucky that in all three of my liquid medicine trials I was dosing mostly with tablets so the liquids had a minimal effect on me; even then, the two incompatible liquids caused severe and debilitating symptoms.

 

I don't mean to put you off of liquids, but only to help you put your husbands sensitivities in perspective. He may actually tolerate diazepam tablets well, if you haven't tried those already. I would have suggested a gradual step-wise crossover to diazepam tablets first, then after stabilizing, trialing liquid forms again as a very gradual, step-wise crossover from tablets. Some people can't tolerate the commercial liquid diazepam, and I think they really don't need it if they have a decent pill splitter and small enough tablets.

 

A DMT essentially takes a medicine with a moderate half-life, like clonazepam, and gives it a seemingly longer half-life and thus a smoother taper. The way it does this is by taking a 14-day cut-and-hold reduction that would be reduced all at once with diazepam, and breaking it instead into 14 reductions, each taken one day at a time. Cumulatively the bi-weekly reduction totals are the same, but neurologically it's as though the clonazepam reduction was being gradually eliminated over two weeks instead of over the typical 5-9 days (per it's ~35 hour half-life). In my experience, this can have a HUGE impact on reducing symptoms.

 

Using a DMT has significantly improved my clonazepam taper. My symptoms are minimal, as long as I stick to a reasonable rate of reduction. For me currently this is 6%/14 days, or 0.43%/day. The DMT taper generator is how I schedule my reductions, and it's very easy to follow.

 

I'm happy to answer questions or offer suggestions, on any way you two want to move forward.

I know you'll find an option that works well for you.

@[sl...]

 

First of all,  , just  :smitten: Thank you for the advice and the outline based on your experience. I took it and run with it. My husband's psychiatrist is willing to work with the compounding pharmacy and the pharmacists at the compounding pharmacy appear to have some appreciation about the horrors of benzo withdrawal.

 

I had read that some compounding pharmacies expect a decrease in dosage when compounding benzos. Considering the sensitivity that my husband has demonstrated, control of his hold times was a huge concern that I can report has been addressed and I have received assurances that the pharmacy will only fill the prescriptions they receive, exactly as they receive them.

 

I would like to ask for some more information, if you are comfortable sharing... Do you recall what the compounding combinations that did not work for you were? Can you detail the one with alcohol that you can up with? This will be the next round of discussions. The hope is to get the compounding done in July and see how that works.

 

Thank you again... This is taking a while but I hope that we are getting our ducks in a row...

@slownsteady

 

First of all,  , just  :smitten: Thank you for the advice and the outline based on your experience. I took it and run with it. My husband's psychiatrist is willing to work with the compounding pharmacy and the pharmacists at the compounding pharmacy appear to have some appreciation about the horrors of benzo withdrawal.

 

I had read that some compounding pharmacies expect a decrease in dosage when compounding benzos. Considering the sensitivity that my husband has demonstrated, control of his hold times was a huge concern that I can report has been addressed and I have received assurances that the pharmacy will only fill the prescriptions they receive, exactly as they receive them.

 

I would like to ask for some more information, if you are comfortable sharing... Do you recall what the compounding combinations that did not work for you were? Can you detail the one with alcohol that you can up with? This will be the next round of discussions. The hope is to get the compounding done in July and see how that works.

 

Thank you again... This is taking a while but I hope that we are getting our ducks in a row...

 

I'm glad that I have been some help to you and your husband. I had not heard of pharmacists changing the compounding formula from the one prescribed; that's scary. I'm glad to have been reassured your husband will receive his prescription accurately.

 

I tried two pharmacy compounded liquids that didn't work for me. I avoided the Ora-Plus type suspensions entirely; too many ingredients. Instead I tried an MCT-oil based proprietary suspending vehicle that was MCT-oil, various lipids, and a bitter blocker; this was used to suspend pure clonazepam powder at 0.125mg/ml. The bitter blocker seemed to cause a severe inflammatory response in my body with regular use; it took six miserable days to deduce this was the culprit of my immediate state of extreme exhaustion, pain and fatigue after dosing, which lasted about 10 hours each day and got progressively worse until I quit the liquid doses.

 

The second attempt was an MCT-oil-only suspension of pure clonazepam powder, again at 0.125mg/ml. This attempt revealed that the oil suspended clonazepam wasn't having a noticeable medical effect on me; I had removed a 1/4 tablet (representing 7.7% of my daily dose) and replaced it with the liquid. I was titrating slowly down on the liquid, but feeling all the symptoms of a hard 7.7% cut-and-hold; it was as if the liquid wasn't even in the equation.

 

The compounded formula I use now is very similar to one I can make with tablets at home. My pharmacist uses 200 proof ethanol and pure clonazepam powder at 0.125mg/ml, and then dilutes this to 30% ethanol by volume. The resulting liquid is clear as day, giving a visual verification of total dissolution of the clonazepam. I buy 35ml every month or so, and the cost is $35 with shipping. If your in ME, MA, NH or FL, I can recommend a very good pharmacy.

 

To dissolve more clonazepam into solution, for example, if trying to do a 1mg/ml formula, this should require a higher percent ethanol; it has been shown that a maximum of 0.2mg/ml can be dissolved in 30% ethanol. It has been shown that a maximum of 1.6mg/ml can be dissolved in a 50% ethanol solution. I mention this to illustrate that the % ethanol dictates the amount of clonazepam that can be reliably dissolved per ml of solution.

 

I sent my compounding pharmacist the following research report:

Solubility of Lamotrigine, Diazepam, and Clonazepam in Ethanol + Water Mixtures at 298.15 K. Journal of Chemical and Engineering Data, 2008, Washington D.C.: American Chemical Society, pp. 1107-1109. Accessed online at:

https://digital.library.unt.edu/ark:/67531/metadc674044/m2/1/high_res_d/Acree%20Pub-479.pdf

 

This report shows maximum saturation levels for ethanol + water mixtures of pure clonazepam, and suggests that 30% ethanol is adequate for my 0.125mg/ml solution. It's not easy to read, but your pharmacist will know how to convert the mol/L data into mg/ml.

 

By using a liquid/tablet hybrid DMT, I take 1ml or less of my compounded liquid per day. This makes the compounding very affordable, minimizes the amount of ethanol I consume to at-most 0.3ml/day, and I also only dose liquid once per day which is convenient because cut tablets are far easier to store and dose on the go or during times when I'm half-asleep.

 

I'm glad those little ducks are lining up for you, no doubt as a result of very hard work on your part! I'm certain you won't regret this amount of careful preparation.

 

Did you have a chance to explore the DMT generator form that I linked to several post ago?

Let me know if you have other questions.