New to BenzoBuddies, ready to tackle fine points of micro tapering

Hello everyone from Flowergirls88.  Long timer here, and some reading of forums.  See abbreviated history below.  Particularly resonate with some of you here, but as I said I've just started and don't want to spend too much time distracting myself with less than positive info. 

Slownsteady I followed your recommendation to get the Equadose pill splitter so that I can do one quarter tabs of 0.5 mg of Clonazepam.  Right now I'm doing 1.75mg pretty comfortably for about 10 days along with the 15mg Mirtazapine I chose with my psych NP to start again, see history.

  Basically slownsteady can you tell me the best way to dissolve the quarter tab for the 1ml syringes I ordered from Amazon with 100 marks or titrations per 1ml.  They just sent me 4 syringes.  Is that enough to handle the one ml of diluted quarter tab?  How much do I put in the syringe or syringes to take over the coming nights.  I just use Clonazepam for sleep.  A big issue for me as I went 11 nights without sleep in my early 50s and was hospitalized, (self check in claiming suicidal danger to myself to get admitted, at that point I wasn't suicidal I just wanted off that train).

  Thanks so much for any help you can offer.  All the best for all of us  Flowergirls888

 

Hey Flowergirls88,

Thanks for making a tapering thread!

 

I'm glad you have an aluminum pill splitter and are feeling comfortable at 1.75mg clonazepam for the last 10 days. I'm guessing from your signature that you went from 1.875mg to 1.75mg; this is a 6.6% reduction. Your next 1/4 pill reduction will be 7.1%, and the following is 7.7%, then 8.3%.

 

I found doing 1/4 pill reductions was a good way for me to initially gauge my comfortable rate of reduction. It can be a little rocky; my withdrawal symptoms peaked between days 5-7, and generally resolved with full recovery by day 10-14. But I didn't enjoy cut-and-holds past 7.7%/14 days, and now I'm doing a liquid/tablet DMT very comfortably at 6%/14 days. If things go smoothly, I'll probably speed up to 7%, but I'm prioritizing functionality.

 

I suggest keeping things simple and doing 1/4 0.5mg tablet reductions per 14 days until you start to notice problems. Keep in mind, these cut-and-holds will peak in symptom severity and then your nervous system will recover; so I suggest expecting some kind of disturbances between days 3-10 of your cut, hang tight at your current dose, and you will very likely see a return to normal by the end of 14 days. If you're not feeling back to normal at 14 days, such as sleeping, eating, and gentle exercise, I suggest holding your current dose until you've fully recovered.

 

When this rollercoaster begins to feel too much or you're needing to hold your dose longer than 14 days to regain full functionality, that's when I'd say it's time for more precise tapering. Keeping a journal of the date, dosage, and withdrawal symptoms can come in really handy later for switching tapering methods or communicating with doctors.

 

No harm in thinking things through in advance! A DMT really improved my clonazepam tapering symptoms.

 

A 1ml syringe isn't going to do anything by itself; it's a measuring tool for a liquid form of medicine. To make a liquid form requires a few other tools and ingredients or a compounding pharmacist (and they usually give you the same 1ml syringes with your order).

 

Have you taken a look at this instructional? This is how I schedule my DMT, and it is possible to do a clonazepam DMT with either a scale (dry) or a liquid (wet).

 

Scales are fussy or expensive, or both. Liquids are risky. Using a liquid/tablet hybrid (taking most of your dose as tablets and only liquid for 1/4 tablet) minimizes the risk of trialing a liquid formula, but it can still be uncomfortable until you find a liquid formula that your body tolerates. I had about six weeks of trialing liquids, two very unsuccessful pharmacy compounds, and then I finally succeeded with the alcohol and water based liquid that I describe in my tapering notes (link in signature).

 

It sounds like you're interested in using a liquid; did you read through my notes on formulating liquid clonazepam? Do you have a compounding pharmacist who would be willing to make you a solution of clonazepam?

 

I would suggest seeking a compounding pharmacist first, if possible, to make a 0.125mg/ml solution of pure clonazepam in 30% ethanol. I buy mine in 35ml batches that last about a month and a half currently, and cost me around $35. With this liquid, your 1ml syringe, your regular supply of 0.5mg tablets, and use of the custom DMT schedule generator, I'd hope you'd be able to start a liquid/tablet hybrid of your own with relative ease.

 

If you can't find a compounding pharmacist, or they don't offer a form of the medicine that you can tolerate (not all pharmacists or liquid formulas are created equal), then I suggest either a daily liquid discard method or the way I make my homemade liquid clonazepam with alcohol, water, and tablets.

 

This may be a lot to digest at once! It sounds like you're in a really good place with your direct taper cut-and-holds presently, and now seems like a great time to be planning ahead for how you want to take more accurate reductions in the future. You may even be inclined to go with a dry taper! I think there are many paths to a successful taper, all depending on you and your needs.

 

Let me know how I can help! 

Just read this slownsteady, so many grateful blessings to you for all this info and good wishes.  I will be digesting this over the next week at least but your tips and experience really help.  I'll keep a lookout for those rough spots you speak about.  I am doing a calendared

recording of what i'm taking and a few notes on what's happening of significance that day.  My plan, as I'm retired, thank god, is to keep fairly active, walking usually 2plus miles a day or more, gardening, hobby of quilting, RESTING!!!!,  and doing pretty good at food and diet.  Dropped the coffee I had restarted in the last two weeks from my finally being able to stop it last year.  It dehydrates me among other things.

Dropped the wine as well.

I hope this 73 year old brain can grow some more gaba receptors!

I had a down day during the last week that was pretty sad but then the next day I made a decision to look at foggy yucky head spaces as the being the drug talking and thus it wasn't truly me.  I like things mostly quiet, being with people is good for a bit but not long, other than my husband. 

 

Well thanks again, I'll be studying your reply and sending you good thoughts wherever you are.  Flowergirls88

Flowergirls88, I feel joyful hearing how you're seeing and responding to this situation.

 

It sounds like you have the resources, self-awareness, and temperament to do this tapering business with success. Your patient progress in exploring tapering options is a very good sign; please consider using continued patience as a functionality standard for your taper. Rushing tends to beget more rushing in benzo tapering, and can lead to poor decision making and debilitating results.

 

I celebrate your decisions to reduce stimulants like coffee, and to eliminate alcohol. This will only make things easier through what may, at times, be a difficult transition.

 

I love your emphasis on gentle exercise, hobbies and rest! Three powerful healers, and they're already in your corner.

 

Please take your time responding, and when you're ready to discuss further details of tapering or to give updates on your progress you can post more here. I've got email notifications turned on so I'll see your posts.

 

Also other buddies I'm sure are reading this and there is a wealth of information here at the forum; many experiences and many suggestions. I hope you get to enjoy a diversity of opinions and support.

We're here for you. Here's to GABA receptors! 

Hello again,

I am now equipped to start the daily liquid micro tapering process.  I have glass beakers, in 100ml, 50ml, 25ml and 5ml.  All are marked per

1ml measure, except 5 ml is a 0.5ml measure.  Also two long droppers, and two cleaning brushes. 

 

I have about 6 to 8 oz of Vodka 40% alcohol, 180 proof.  I'm thinking of starting with a 7% taper over 12 days and have computed this out and calendared it over the next 6 months and then will fill in the rest.  I'm pretty sure things will have to be adjusted as daily life goes on.

 

I have the equadose pill splitter and 0.5mg Clonazepam tabs, currently at 1.625 mg at night for sleep.  Also started Mirtazipine 3 weeks ago so I'm reasoning this will offer some help with sleeping for at least awhile.

 

Wondering if you can help get me started.  I remember reading that I dissolve a certain number of tabs in the 50 ml beaker that is 30%filled with the vodka, and the rest is distilled or filtered water.

 

Looking to start the DLMT in about a week or two.

Thanks so very much! Flowergirls88

Hello again,

I am now equipped to start the daily liquid micro tapering process.  I have glass beakers, in 100ml, 50ml, 25ml and 5ml.  All are marked per

1ml measure, except 5 ml is a 0.5ml measure.  Also two long droppers, and two cleaning brushes. 

 

I have about 6 to 8 oz of Vodka 40% alcohol, 180 proof.  I'm thinking of starting with a 7% taper over 12 days and have computed this out and calendared it over the next 6 months and then will fill in the rest.  I'm pretty sure things will have to be adjusted as daily life goes on.

 

I have the equadose pill splitter and 0.5mg Clonazepam tabs, currently at 1.625 mg at night for sleep.  Also started Mirtazipine 3 weeks ago so I'm reasoning this will offer some help with sleeping for at least awhile.

 

Wondering if you can help get me started.  I remember reading that I dissolve a certain number of tabs in the 50 ml beaker that is 30%filled with the vodka, and the rest is distilled or filtered water.

 

Looking to start the DLMT in about a week or two.

Thanks so very much! Flowergirls88

 

Hello Flowergirls88,

It sounds like you're well equipped! FYI 40% ethanol vodka is 80 proof, not 180 proof.

 

My current-use taper notes are still where they were earlier, and linked again in my signature below. I may have also added a new post since we last spoke; it's instructions on how to use the online DMT taper schedule generator that I use...

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

 

Do you have questions that aren't explained in my taper notes?

I'm happy to help if I can.

Hi slownsteady, Yes I think I've got it.  I used the form for a 5% reduction over 14 days and it looks good for what I've agreed to with my Nurse Practitioner.  I may have said too much when I mentioned the liquid taper.  Her body language and verbal response was not favorable.

She is prescribing the 0.125 dispensable tablet for a monthly taper of 0.125.  As I've already been through that with this last cut, it wasn't pleasant for about 7 days, I'm feeling pretty level now, but I do get fatigued.  I don't want to go through that every month, when I could be tapering gradually to accomplish the same thing.  She has me finishing in July next year and this chart shows 234 days so that is less, but hopefully there is wiggle room if I need it.

 

I plan to start the end of this week so will be setting it up a couple days prior to dissolve tablets.  The chart says to use 50 ml quantity to start so I assume this is ok? I only take at bedtime.  I'll get back to you later in the week to ask any process questions, unless you have something more now.  Thanks again

Hi slownsteady, Yes I think I've got it.  I used the form for a 5% reduction over 14 days and it looks good for what I've agreed to with my Nurse Practitioner.  I may have said too much when I mentioned the liquid taper.  Her body language and verbal response was not favorable.

She is prescribing the 0.125 dispensable tablet for a monthly taper of 0.125.  As I've already been through that with this last cut, it wasn't pleasant for about 7 days, I'm feeling pretty level now, but I do get fatigued.  I don't want to go through that every month, when I could be tapering gradually to accomplish the same thing.  She has me finishing in July next year and this chart shows 234 days so that is less, but hopefully there is wiggle room if I need it.

 

I plan to start the end of this week so will be setting it up a couple days prior to dissolve tablets.  The chart says to use 50 ml quantity to start so I assume this is ok? I only take at bedtime.  I'll get back to you later in the week to ask any process questions, unless you have something more now.  Thanks again

 

Hello Flowergirls88,

My taper notes describe a liquid/tablet hybrid taper with a 0.125mg/ml liquid formula that I use to replace 1/4 tablet of my dose(s) at a time and then DMT the liquid until it's gone; rinse and repeat. The DMT generator I linked to earlier does all the math for the approach I'm doing, telling me both the ml of liquid and the parts of tablets to take each day. Not what you have to do, but just what I thought you've been referring to.

 

I'm curious what you're thinking of making 50ml of. Would you mind telling me more about the liquid taper method you plan to use? Is it a daily liquid discard method?

 

Maybe more importantly, 5%/14 days from 1.75mg/day would take 1160 days to complete. I'm not sure how you arrived at 234 days to complete a taper with this percent reduction rate. Even a linear taper of 0.125mg/month takes 387 days, and I think that's a tapering schedule with a high chance of severe withdrawal symptoms, especially for a long-term user.

 

Percent-based reductions, like 5%/14 days, means 5% is reduced from the current dose every 14 days; as a result that 5% quantity gets smaller and smaller, and this is an important part of slow tapering in my experience. This is also an ideal taper rate in my mind for taperers that want to remain fully functional and have a long history of benzo use.

 

A way that I've been thinking about percent-based tapering is that 5%/14 days takes about 6 months to cut the original dosage in half. Continuing at 5%/14 days takes another 6 months to cut this new dose in half. This pattern of 6 months to reduce by half repeats until the taperer gets to a jumping dose.

 

i.e. at 5%/14 days, 1.75mg becomes 0.88mg in 6 months, then 0.88mg becomes 0.44mg 6 months later, and 0.44mg becomes 0.22mg 6 months after that, and so on. A suggested jumping dose for clonazepam is 0.025mg which means  this process of reducing at 5%/14 days takes about seven 6-month periods, which is around three and a half years.

 

For comparison a 10%/14 day reduction schedule, the upper limit of what's generally recommended around the forum, takes 565 days. Still nowhere close to your NP's deadline, and quite possibly an overwhelming and unsustainable experience, especially towards the later half of your taper.

 

If I was a long term benzo user, I would never ask my doctor to taper my medicine; instead I'd be collecting my script as normal and do my tapering at home at 5%/14 days, expecting for a slow and highly functional 3+ year tapering experience.

 

I'm a short-term user and I'm only tapering at 6%/14 days, after trialing 7-9% over several months, with many debilitating symptoms and set-backs. I tried a doctor-led taper once, and it risked my life, led me to the ER, and to change doctors. My new doctor specifically agreed to let me lead my taper; if he ever changes his mind, I'll change doctors within the week. I'm that serious about the dangers involved in being rushed through the tapering process. Some benzo-wise doctors like Gail Dawson suggest even slower taper rates; on her site she suggests clients go 2-5% per MONTH...

https://www.integratedmentalhealth.org/benzodiazepine-withdrawal/

 

From what I've learned around the forum, the most successful taperers seem to keep their prescribing doctor in the dark, or else the doctor supports a patient-led taper. While I am totally in support of doctors, and they are an important part of this process (namely prescribing), I just haven't heard any good stories of doctor-led tapers, unless the doctor is a benzo expert and when they are, they seem to universally support patient-led tapers. A doctor-led taper is a big red flag for me that the doctor is not benzo-wise and not a strong support system for tapering.

 

I hope this is useful for you; I'm sorry to rain on your parade.

How can we help?

Oh shoot, I was afraid this was going to be wrong calculations on my part, especially when I get more down the line.  Thanks for letting me know.  I will have to look at this again and seek additional help. Back to square one on the figuring.  I'll try to digest more tomorrow 

I see how my computations didn't work.  Also am reaching out to a couple medical professionals.  I don't seem to be able to input the chart data without going every 14 days at 5% starting 6/20/21 and then on 15th day entering that number and having the chart recalculate for the next 14 days and then recalculating with the 15th day number at the 5% etc etc.

 

At this point I'll be faced with finding a willing professional to go along with what will be at least a 3 year taper plan, which I have feelers out for now, including the one slownsteady referenced in Colorado, she says she doesn't prescribe so it seems most of the information I need is provided here.  Day to day

 

I see how my computations didn't work.  Also am reaching out to a couple medical professionals.  I don't seem to be able to input the chart data without going every 14 days at 5% starting 6/20/21 and then on 15th day entering that number and having the chart recalculate for the next 14 days and then recalculating with the 15th day number at the 5% etc etc.

 

At this point I'll be faced with finding a willing professional to go along with what will be at least a 3 year taper plan, which I have feelers out for now, including the one slownsteady referenced in Colorado, she says she doesn't prescribe so it seems most of the information I need is provided here.  Day to day

 

I felt bad giving you all that information at once. I'm glad to hear you're reaching out for a more supportive medical provider!

 

Could you tell me more about how you're charting your taper schedule? Are you using the online DMT form that I suggested, or are you making a spreadsheet on the computer?

 

You may want to find a provider willing to write you scripts both for tablets and for liquid compounding. Compounding is by far the safest way to get liquid clonazepam, in my opinion. In my taper notes is the recipe I used originally for making liquid from tablets, and it does work. Now I have the same formula made by a pharmacist with pure clonazepam and 30% ethanol; it's clear as day, very easy to dose, and only costs me about $25/month because I combine with tablets.

 

Finding a flexible compounding pharmacist can be a bit of an egg hunt; I contacted three that would only mix me a proprietary Ora-Plus type suspension at 0.1mg/ml before my new doctor recommended a really good pharmacist out of state. She has been a gem. I know you're in California, but if other buddies are in Maine, New Hampshire, Massachusetts or Florida, Classic Compounding (link) is the best!

 

You can do this Flowergirls88!

I'm so glad you're taking the time to plan and get set up for success. 

I hope you don't mind us continuing this conversation in-thread, Flowergirls88. 

 

slownsteady, I just called our local small town compounding pharmacy and he said they would do the liquid alcohol/water solution!  also I am going to get a call soon from the psych nurse practitioner that my daughter wanted me see, but the insomnia was overboard before I could get in, so hopefully!!!!! good progress here

Flowergirls88

 

This is such wonderful news. My compounding pharmacist uses pure clonazepam powder, pure ethanol (200 proof), and distilled water to make my 30% ethanol, 0.125mg/ml solution; I buy 35ml at a time, and the cost with shipping is $35 (for comparison).

 

This 0.125mg/ml is a very useful solution strength, I'm finding, for doing a liquid/tablet hybrid taper with 0.5mg clonazepam tablets. The DMT generator I linked to earlier (also in my taper notes, in my signature), will make a custom tapering schedule using this liquid and tablets.

 

Let me know if you need help getting that schedule generator to work!

 

Also, could you remind me, do you have an aluminum pill splitter?

This is the one I use: [nobbc]https://www.amazon.com/gp/product/B07MH6XTL7[/nobbc]

It's called the EqualSplit.

 

This is a 5-minute instructional video on how to cut perfect 1/2 and 1/4 clonazepam tablets with the splitter linked above...

 

Keep us posted and please ask any questions.

You're making great progress. 

Hello Flowergirls88.  Slownsteady has shared important information about his compounded liquid clonazepam.  That is, his compounding pharmacist is using the pure active drug substance (also referred to as the Active Pharmaceutical Ingredient or bulk substance) as the drug source NOT regular tablets (also referred to as “commercial drug product”).  You might want to double-check with your compounding pharmacist about this. For more information:

 

Compounding with Commercial Drug Products Can Cause Errors

https://compoundingtoday.com/Newsletter/Science_and_Tech_1205.cfm

Thank you Libertas, this is good to know.  Seems that tablets and bulk do not correlate necessarily.

slownsteady,

I do have the equadose pill splitter, it's the blue one on amazon that looks just like the equasplit, only it cost me $10 more dollars.  They seem identical to me. 

 

I am still confused on how you get the reverse extended J curve on your micro taper doses.  Do you edit the started dose, say 1.625 daily, or every 14 days.  I can't seem to get anything like a j curve?  It's under your "Prepared" where I lose you.  Everything else and the order in which to enter I am doing exactly as you say.  Can you clarify that last step more.  I think that's the problem.

Thanks so much

slownsteady,

I do have the equadose pill splitter, it's the blue one on amazon that looks just like the equasplit, only it cost me $10 more dollars.  They seem identical to me. 

 

I am still confused on how you get the reverse extended J curve on your micro taper doses.  Do you edit the started dose, say 1.625 daily, or every 14 days.  I can't seem to get anything like a j curve?  It's under your "Prepared" where I lose you.  Everything else and the order in which to enter I am doing exactly as you say.  Can you clarify that last step more.  I think that's the problem.

Thanks so much

 

Great; so you have a good aluminum pill splitter!

 

Are you using the DMT schedule generator at: http://benzo.alwaysdata.net/titration/titrationForm.php ?

 

I'm a little confused about your post; the word "Prepared" doesn't seem to show up in my instructional on how to use that form or anywhere in my tapering notes. The inverse exponential curve, ski-slope or "reverse extended J" is the result of a percent-reduction. This is created in the "Planned Reduction" section of the generator form.

 

The steps to do a percent reduction is to delete the information in the "Quantity" field, then insert the desired percent reduction in the "Percent" field that then becomes white and available for entry. In my case I put in "6" for 6%, and then in the field immediately below called "Every" I put in "14", for 6%/14 days.

 

My instructional should be fairly comprehensive and list other details, like the glitch. It may take a bit of trial and error until you see what is being shown in the instructional images, but it can be done!

 

Let me know if this helps. I'll keep working with you until you get it! 

Hi,

haven't posted for awhile, still trying to get my NP on board to micro taper at 5% every 14 days.  I did manage to get slownsteady's titration schedule to work for me and have been talking to my local compounding pharmacist.  He is calling today to see if they can do an oil taper and any other info their people higher up might have.  Still stuck at 1.625 K.  Had to try and fail at one dose of lamictal, caused insomnia, despite benzos.  Just is hard to persuade psych nurse that I want to LOWER not increase.

 

Will have to wait and see, but should have some direction over next few days.

Hello Flowergirls88.

 

Good for you for reaching out to a reputable compounding pharmacy for information and support. Compounding pharmacists can be valuable allies in the benzodiazepine discontinuation process. 

 

In an ideal world, your compounding pharmacist will find a potency- and stability-tested formulation for an oral solution of clonazepam that uses the pure active drug substance (aka API or active pharmaceutical ingredient) as the drug source (as opposed to regular tablets).

 

In terms of formulations that use “oil” (medium chain triglycerides), Rosemont Pharmaceuticals in the UK manufactures a 0.5mg/5mL oral solution of clonazepam that may be of interest.

 

Your pharmacist might also want to check out the formulation for a 2.5 mg/ ml oral solution developed by a group of Iraqi pharmacists.

 

There also is a potency- and stability-tested formulation for a 0.1mg/mL oral suspension of clonazepam.  (This formulation uses regular tablets as the drug source but you could ask the compounding pharmacist if using the pure active drug substance might be an option.)

 

See links below.

 

Clonazepam Rosemont 0.5mg/5ml Oral Solution

https://emc-prod-wa.azurewebsites.net/emc/product/6021/smpc

 

Iraqi Pharmaceutical Formula for Clonazepam Oral Drop 2.5 mg/ ml to Treat Seizure Epilepsy in Infants and Children with its Stability Study

https://www.iasj.net/iasj?func=fulltext&aId=114176

or http://jmracpc.uobaghdad.edu.iq/index.php/IJMRCP/article/view/79/71

 

0.1mg/mL Clonazepam Oral Suspension

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