Kindled on Clonazepam-switch to Valium maybe helpful?

HI-I have been trying to get off clonazepam for years now-I was down to about .165, tried tapering the rest too fast, had a monstrous crash, ended up going back up to .35 and have not bee the same since (2 years). Even trying to updose from where I am at makes me feel worse. I can barely make a tiny cut and feel like I have been hit by a freight train (I actually even held for a year and just could not get stable). I am thinking that maybe switching to Valium might help? Anyone have any thoughts on that, or am I just doomed from kindling? Thank you!!!

Hi ddjohn3,

I'm sorry to hear you've been unable to stabilize at .35mg clonazepam after holding for a year. I understand that you're considering a crossover to diazepam as a way to progress on your taper.

 

I generally don't suggest a short-to-long benzo cross for someone who is currently unstable. The lapse in blood serum levels that happen during crossover steps can make someone feel significantly worse. Furthermore a crossover to a new drug is a gamble as to whether or not the new drug is tolerated and some buddies have had major setbacks as a result of crossover attempts.

 

I can understand that you're looking for a way forward, and if you've exhausted every other option a cross might be worth the risks and challenges. But without knowing more about your situation, I suggest taking a hard look for any ongoing and optional causes of neurological instability in your life.

 

To start, I suggest taking an accurate and reliable dose of your medication at evenly spaced intervals so that you're not being dragged down by fluctuating blood serum levels.

 

How are you measuring your clonazepam doses?

How often are you dosing per day, and at what times?

 

I think these two variables are very common causes of instability when dosing benzos. I think other causes of ongoing instability might be stressful lifestyle choices (employment, relationships, etc), underdeveloped self-soothing skills, dietary or other sources of ongoing inflammation, and certain supplements.

 

Please let us know more when you get a chance.

You are far from doomed; you're in good company here. 

Hello, ddjohn3.  I’ve read about several members who were unable to stabilize on clonazepam, crossed to diazepam/Valium, and tapered successfully.  Momof7babes and Maugham1 come immediately to mind. 

Thank you slow and steady for your input....my first taper attempt was going pretty smooth at about 2-5% a month. I have always done a water titration, dosing at 4 times a day....got to .162, then had to switch brands (which was hard?), so held for 6 months, then tried a very rapid taper off the remainder and within a month went into ACUTE WD and after a month of agony the Dr. updosed me back to .375 and I held for a year. Since then I have had terrible vertigo and barely been functional. I started tapering again last Oct. at about 2% a month-I was doing ok (still ridiculously sick but it was clear I was not getting any better). The tiny cuts are brutal and the last month has been debilitating and I haven't even made a cut in last 30 days.  I am just at my wits end. I eat super healthy, have really good tools (meditation, counseling, yoga, motivational videos, etc.). I don't do any supplements (I have tried everything under the sun and I just can't tolerate anything). I agree that I am terrified to switch and make it worse. Updosing doesn't work at all-it's like I have a paradoxal effect so just feel trapped in this hellish purgatory. I am 62....any other ideas? I am seriously desperate :-(

Hi ddjohn3,

Thanks for telling us more about your situation. I'm glad to hear that you are exploring tools like meditation and yoga! I'm also relieved that you're not taking supplements; I also have had poor results with these kinds of products and I think they can unnecessarily complicate benzo recovery.

 

I wonder if your previous water titration was too inaccurate for your body, especially once you got to lower doses; if you were holding while dosing with a water suspension of deconstructed tablets, this inaccuracy could have impeded you're ability to recover and possibly even exacerbated your instability via kindling. I'm just speculating. I hope that your hold at 0.375mg was on tablets.

 

Did you see my two questions about your current dosing strategy? It doesn't seem like you answered them. They are:

 

How are you measuring your clonazepam doses?

How often are you dosing per day, and at what times?

thank you again for your reply slowandsteady. Yes-I held for a year on water titration-I have never gone back on pills.

Here is how I do my water mixture:

300 ml water with two .5 clonozepam pills-this creates a potency of .0033 per ml of water

I disperse 26 ml in each of 4 glass bottles (so actually I am now back up to .34 total dose per day). I take one bottle when I wake up usually around 8:00. I take 1/2 dose at 10:00, the rest at 11:00. Next is 1/2 dose at 2:00 and the other half at 3:00, then last one is 1/2 at 6:00 and the rest around 7:30. So it kind of looks like I dose 8 times a day, but it seems if I take the whole dose all at once (one bottles worth) it makes me super groggy.

I have only managed to cut .04 in the last year (can't tell you how depressing that is). About 6 weeks ago on my last tiny cut it hit hard. I thought maybe I was just in a wave, but I have gone downhill since....the dizziness is horrible and now I have terrible heart skips and palpitations, had a frightening head electric shock a couple days ago, spasms, etc....about 15 things off the withdrawal list, it's like being in acute for no reason I can discern.

should I tr switching back to pills? Try valium? I am in such bad shape I am afraid if I try and switch to valium it might just totally put me over the edge. As it is I am likely going to have to sell my business because I just cannot run it anymore (more sadness). I so appreciate any thoughts you have-it sucks to feel so alone and desperate and frozen in terms of not knowing what to do and afraid of making the wrong decision-especially since I feel like every decision I have made in the last 2 years has put me in this mess.

Hi ddjohn3,

My concern has been that by using an at-home water suspension of deconstructed tablets, you may not have been getting a consistent dosage of clonazepam from day to day. I was hoping that you had been holding on 0.375mg as tablets, since I think this is an easy dose to reliably produce using a pill splitter and 0.5mg tablets. But to hear that you held your dose for a year while using an at-home water suspension and during this time you were unable to stabilize, I am now fairly certain that your dosing method is one (if not the) primary cause of your ongoing instability.

 

From the research we have on clonazepam's solubility in water, it's evident that pure clonazepam is reluctant to dissolve in water, even given excess drug material, constant agitation for long periods (48+ hours) and a steady temperature. To combine clonazepam with water for a very brief period as in at-home water titration, and furthermore to be using tablets instead of pure clonazepam, I suspect that very little if any clonazepam is able to dissolve by this method.

 

Therefore, I am fairly certain that the result of an at-home daily water titration is almost entirely undissolved particles of clonazepam and tablet filler in water. This method requires the viscosity of water and vigorous agitation to create a suspension of these particles for dosing. However water is a very poor suspension vehicle; I expect you can easily see that the larger particles dropping out of suspension rather quickly even immediately after stirring and or shaking. Therefore using a water suspension of deconstructed tablets can require special preparation and handling, and even then I think that some people's nervous system cannot handle the inaccuracy inherent in this method.

 

If I was in your situation, as I understand it, here's what I would do next. First I would purchase an aluminum pill splitter from Amazon (I use the EqualSplit brand and

) or similar and learn how to reliably split my tablets into 1/4s. I would also ensure that I was being prescribed 0.5mg clonazepam tablets.

 

Second I would updose to 0.375mg/day, and take this as 3/4 of a 0.5mg tablet, probably as 1/4 tablet 3x per day, with doses 8 hrs apart. I would hold at this dosage and schedule for 2-4 weeks while keeping a daily tapering journal. I'd expect some good days and some bad days, but I'd be looking for a downward trend in withdrawal symptom intensity, which is an upward trend in neurological stability.

 

After gleaning what benefits I could from a steady dose of tablets, I'd have a choice for tapering; I could either trial a new tapering method such as a pharmacy compounded suspension or custom capsules (both of which would offer ease and reliability of dosing, but each have their complications), or I could return to using an at-home water suspension.

 

If I was going to return to a water suspension, I would include a few procedural steps that I didn't hear you mention...

 

First, I would not suspend my entire daily dosage. I would suspend and titrate only one of my doses until elimination, and my preference would be either the first or second dose of the day. I would take the other two doses as dry 1/4 tablets for reliability.

 

Second, I would start my water suspension by using a mortar and pestle and a little bit of water to very finely grind the 1/4 tablet that I'm titrating into a slurry before rinsing this and the mortar and pestle clean into my primary measuring vessel. Smaller particles will stay in suspension longer and thus dose more reliably.

 

Then I would dilute this slurry to my desired total volume, probably 250ml because that'd create easy math with a 0.0005mg/ml solution. Then I would vigorously stir or shake this volume, pull a discard amount with an appropriately sized oral syringe from the MIDDLE of the volume of liquid, and swallow the remainder. Lastly, I would rinse the measuring vessel with water and swallow this as well.

 

I am sorry that you've suffered so much. Water suspensions are notoriously inaccurate, and I think some people cannot tolerate them, whether due to their sensitivity or an ineffective technique. Because I think any future tapering steps would be dramatically improved for you by stabilizing now on clonazepam, I suggest a return to tablets and revision of your tapering method after your symptoms have improved. It is my opinion that if you try to take more reductions now or continue with your dosing method, things may only get more difficult.

 

Please let us know how we can help! Sorry for the long read. I hope it is helpful. 

Gosh-thank you SO much for all of that information! It makes a lot of sense and is actually something I have suspected. When I was on Sandoz brand it didn't seem to be an issue-everything bad started when I had to switch to first Klonopin brand, and then a few months later, Teva brand.....maybe Sandoz did better in water?

I am also going to talk to my Dr about switching to Valium-they come in nice 2mg pills so it is much easier to dry cut...I have an appt with her next week-I realize that is a gamble, but have been PMing another buddie that was having terrible problems with clonozepam and also just could not get stable, and even though she said the switch was tough, it made a huge difference.

Do you think I should go ahead and order a scale and the cutting device and start doing dry now or wait to see if she will switch me over to valium and then just start substituting the valium (slowly) in pill form? I swear anytime I make any kind of change it hits like a freight train. I will say I did try a day of dry about 2 weeks ago just to see (.375 cut into thirds and 1 dose 3x a day)....first it seemed like it was strong? And then the next day was horrible so I immediately went back to my water solution. thank you again for your help-I am really battling that sense of hopelessness :-(

BTW...I had to see a different Dr today for another issue and she told me the benzo withdrawals are all in my head and I am using it to avoid facing something. Probably don't need to tell you how I felt about that.

 

Hi ddjohn3,

I'm glad my post was helpful for you. Yeah, don't get me started on doctors in denial; at least you know what that doctor is worth...

 

Different tablet manufacturers use different tablet excipients and manufacturing processes, which is perhaps why some buddies report issues changing between generic tablet manufacturers. I don't think the manufacturers themselves can change the solubility of clonazepam in water, but some other factor may have made your dosage more reliable. I don't know. All water under the bridge now... 

 

I do not recommend getting a cheap milligram scale and starting with that learning curve at this time; inexpensive scales are also notoriously inaccurate and for sensitive individuals this inaccuracy may not be tolerable. As with water suspensions there are techniques that I think improve the usability and accuracy of a cheap scale, but these make dosage preparation more complicated.

 

As I said previously, I think any future tapering steps would be dramatically improved for you by stabilizing now on clonazepam; I suggest a return to tablets and revision of your tapering method AFTER your symptoms have improved. If you want to cross to diazepam, I suggest exploring this option after establishing as much stability as possible on your current drug.

 

I think an updose to 0.375mg and a hold of 2-4 weeks could work well towards this end, along with 3 evenly spaced daily doses (either 8hrs apart, or 7hrs apart with a 10hr sleep window), keeping a daily tapering journal, and dosing strictly with accurately split tablets.

 

Also stabilizing on 3x 0.125mg/dose of clonazepam could be a good setup for making a cross to diazepam; each clonazepam dose would be the Ashton-equivalent of 2.5mg of diazepam, an amount fairly easy to produce with 2mg tablets. You could do a three-step slow crossover using only split tablets for reliability of dosing.

 

But I will say, you might feel much better about clonazepam if you can stabilize on it. I'm sorry you haven't received better medical care; holding on a water suspension while unstable is just terribly risky IMO and I realize you must be pretty fed up with this medication by now.

 

For what it's worth I am extremely sensitive to clonazepam, I think probably like you are. I doubt I could do a water suspension for any length of time, and certainly not of my entire daily dose. But I can say that I have been tapering clonazepam for 10 months or so now, and it's been easier and easier. With a tolerable and reliable dosing method, IMO clonazepam is very much a medication that can be functionally tapered by sensitive individuals and I am grateful to be able to avoid the risks of trialing diazepam.

 

Of course this is your taper. I truly support however you want to proceed!

Let us know how we can help. 

Hi slowandsteady....I was able to get my doctor on board with updosing and switching to dry pills, so I got the pill slicer you recommended and started 1/4 pill 3x a day a few days ago. I am feeling really horrible-is that normal? I am assuming it is because my body was so used to the water titration for last 4 years at 4 doses a day? I have also heard sometimes you end up having paradoxal effects when updosoing? Of course I am mortified I am making myself worse (which right when I think it can't get worse it does). Your thoughts? Thank you!!!

Hi slowandsteady....I was able to get my doctor on board with updosing and switching to dry pills, so I got the pill slicer you recommended and started 1/4 pill 3x a day a few days ago. I am feeling really horrible-is that normal? I am assuming it is because my body was so used to the water titration for last 4 years at 4 doses a day? I have also heard sometimes you end up having paradoxal effects when updosoing? Of course I am mortified I am making myself worse (which right when I think it can't get worse it does). Your thoughts? Thank you!!!

 

Hi ddjohn3,

I'm glad that you were able to get your doctors support, and that you are back on dry tablets for reliable dosing.

 

I'm sorry you're feeling really horrible. Yes, paradoxical effects exist. I think that maybe changing from 8 doses per day to 3 doses per day is requiring some neurological adjustment. All my schedule changes have been followed by an adjustment period.

 

I suggest keeping notes and being as patient as you can be while you get to know your symptoms at this time. In my own taper, I've had many hard and confusing days but it's only been after a sufficient time (days, weeks, sometimes longer) that I've been able to deduce the factors involved (if ever...). With the uniqueness each taper, I know no other way to navigate these waters than by trial and discovery.

 

I suggest keeping your eye on the goal of neurological stability. I think that factors like steady dosing, accurate dosing, self-soothing skills, and time play a big part in stabilizing.

 

How long have you been at 0.375mg/day by dry tablets divided into 3 doses per day?

What does "really horrible" feel like?

 

Let us know how we can help. 

thank you for such a quick reply! It has only been 3 days. My dizziness is MUCH worse and I feel terribly groggy and drugged... can't think very straight or remember things. Body feels like it weighs 500 pounds, headache-buzzy feeling in my head.  I kind of feel like my body was used to a bunch of really small doses and it is not handling these 3 big doses all at once. Not sleeping well at all, either. Nightmares and waking up repeatedly :-(

The V crossover didnt work for me

thank you for such a quick reply! It has only been 3 days. My dizziness is MUCH worse and I feel terribly groggy and drugged... can't think very straight or remember things. Body feels like it weighs 500 pounds, headache-buzzy feeling in my head.  I kind of feel like my body was used to a bunch of really small doses and it is not handling these 3 big doses all at once. Not sleeping well at all, either. Nightmares and waking up repeatedly :-(

 

Hi ddjohn3,

Thank you for giving us more information about what you're going through.

 

I understand that even just 3 days of increased symptoms can be a very disconcerting experience; I've been there recently and it's hard for me when there's no clear answer or solution. But I don't think 3 days is long enough to deduce whether or not you're having a paradoxical reaction to clonazepam or just adjusting to your new dosing schedule; my guess is that it's a dosing schedule adjustment and this could take a week or more of gradually diminishing symptoms.

 

I am making this guess because the symptoms you describe sound to me like neurological instability. When I'm unstable I have very similar issues including extreme fatigue, headaches, difficulty thinking, nightmares and interrupted sleep. At my worst I feel severely mentally impaired, and have significant difficulty using the computer or making decisions; while I similarly feel "drugged", this is not caused for me by an excess of medication or a paradoxical reaction. I think this is caused by a fragile nervous system and making a change too quickly; I agree that it sounds like you were used to your eight small doses and may be overwhelmed by this dose schedule adjustment.

 

I'm sorry we weren't able to suggest to you a more gradual transition; I didn't expect that you would respond so strongly to a schedule change. It's possible to do a step-wise transition from your water suspension method to dry tablets, but I'm not sure this will help you at this point. I still think you're on the track to neurological stability by being on a more reliable dosing method and I think that you will get there if you can take care of yourself through this turbulence. 

 

My best suggestion now is trying give your body the highest quality care and encouragement that you have available. I think that anything you can do to calm down and give your body opportunities to be noticed and allowed to gently express itself will lead to relaxation and improved functionality. Calming breath-work, gentle music, art, creativity, or just sitting or lying down mindfully could help you to heal and soothe your nerves. I think that self-soothing is an extremely valuable skill to practice and there's no better time then when we're unstable.

 

I hope you'll keep us posted and give this a little more time to see if your body can find balance at your new dosage and schedule.

 

We're with you on this journey.