Author Topic: Trying to get off 4mg/day of Klonopin - starting with .125mg drops - need help  (Read 1708 times)

[Buddie]

I need help and support tapering off and getting off Klonopin.

I take 4mg per day, 2 in the morning and 2 in the evening.

I have been taking these for about 12 years, gradually going from .5 at the beginning to where I am now.

I am starting to have problems with even this dose and really cannot go higher.

I see the Ashton manual has 1.5 and 3 mg tables from K to V - can anyone help with making a table for 4mg K to V? Twice a day?

Thanks!
« Last Edit: December 27, 2021, 03:43:41 am by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Trying to get off 4mg/day of Klonopin by switching to Valium
« Reply #1 on: December 25, 2021, 08:02:00 pm »
Hi [...],
Yes, we can help you. Before spending too much time evaluating and planning a crossover, are you sure this is your best option?

I understand that you're experiencing some problems on your clonazepam dosage, but I don't imagine that the Ashton-equivalent of diazepam (80mg/day) would be without it's own high dosage risks and side-effects. Furthermore crossing to diazepam is a drug trial; it's not universally tolerated and while it can support taperers at lower doses or shorter-acting benzos, I'm doubtful that the rewards outweigh the risks in the case of your current drug and dosage.

In my opinion, I think it would be much easier to begin your recovery with direct tapering your clonazepam. If you can be prescribed 0.5mg tablets, you could reduce your dosage by 0.125mg intervals (1/4 tablet) which start at about 3% total daily dose per reduction and go up to about 6% per reduction once you've reduced to 2mg/day; I think 3-6% is a great range in which to start tapering.

These 0.125mg reductions can be cut from 0.5mg tablets with a good tablet splitter (I like the aluminum ones; I have the EqualSplit brand from Amazon), and the relatively long half-life of clonazepam can make this a well-tolerated option for many taperers. I would suggest holding for 2 weeks at each 0.125mg reduction, or longer if you're still experiencing new symptoms or symptom intensity, before taking another cut.

If your problems include interdose withdrawal, again, I think this could be resolved while direct tapering clonazepam, in this case simply by spreading out your doses over the day. For comparison, when I was at 2mg/day clonazepam I needed to dose 4x per day to eliminate interdose withdrawal; now that I am below 1mg/day, I only need to dose 2x per day.

So are you certain that the gamble of a crossover to diazepam at your current dosage is your next step? Or would you like to consider tapering clonazepam first, and keep a diazepam crossover on the table for later in your recovery?
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Trying to get off 4mg/day of Klonopin by switching to Valium
« Reply #2 on: December 26, 2021, 03:53:53 am »
Thank you so much for your long and thoughtful response!

I was contemplating this because once it gets down into the lower dosages - the .125 mg becomes such a big percentage of the total drop. But maybe that is something to think about down the road?

I think I may take your suggestion and request .5mg tabs and get a better pill cutter (1/4 seems tough because only half the pill is scored). I will check the cutter you mentioned. Does it make sense to cut .125 at night starting, wait 2 weeks and then do .125 at night? Which would put me at 3.75mg after a month?

Seems like a good pace? I will consider perhaps somehow working a dose into the middle of the day if I have intra-dose issues, not sure how to split things if it is 3x/day.

So for now:
Starting 2mg morning/2mg night

Week 1: Drop to 1.875 morning/2 mg night
Week 3 : 1.875 morning/1.875 night
Week 5: 1.75 morning/1.75 night
Week 7: 1.625 morning/1.75 night
Week 9: 1.625 morning/1.625 night
Week 11: 1.5 morning/1.625 night
Week 13: 1.5 morning/1.5 night

…and so forth - is there a point for instance where it becomes more
Feasible to switch (like if even .125 is too much)?

Thank so much!!!
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Trying to get off 4mg/day of Klonopin by switching to Valium
« Reply #3 on: December 26, 2021, 01:12:12 pm »
Hi [...],
Thanks for considering my suggestions. You have lots of good questions!

The forum often suggests 5-10% per 2 weeks as a starting range for reductions. This is because this range is generally well-tolerated, but because everyone is different there is no expectation that this will work best for everyone.

Quote
Tolerable tapers can be as small as 10% or less per month, and some patients can reduce by 10% or more per week.
https://benzoreform.org/wp-content/uploads/2020/11/Pamphlet-3-BZRA-Discontinuation-1-Getting-Started-v1.2.pdf

I suggest the 0.125mg reductions because I think it's better to start slow and speed up than the other way around, and 0.125mg is the smallest reduction that I think can be reliably cut from the 0.5mg clonazepam tablets.

Here's how I split 1/4s of clonazepam...
https://www.youtube.com/watch?v=-5EdUiBGKxI

I agree with your approach to alternate between your AM and PM doses for each reduction, so as to keep your two doses as similar as possible. I think you may have made some typos in your schedule outline, but I get the idea.

As for when 0.125mg/2-weeks is "too much", this will be something you'll need to find out for yourself through experience. I suggest starting a daily tapering journal with at a minimum the date, your dose, any withdrawal symptoms and their severity. I suggest considering this information to determine both when to take another reduction and when 0.125mg/2-weeks is too much. Everyone is different, and I think getting to know our own neurological stability is extremely important for making effective tapering decisions.

I also like to set personal functionality goals, since my taper isn't just about eliminating symptoms; it's about being high-functioning and enjoying my life while tapering. My functionality goals include basics like adequate sleep (8+ hours), appetite and body-weight, gentle exercise, car travel, and socializing. I reassess my taper rate whenever I'm not consistently meeting my functionality goals; sometimes it's a dosage scheduling problem, or a taper rate problem, other times I just need to hold a little more than usual to get my feet back under me. Life has plenty of other stressors that can impact our recovery.

I suggest that while you're taking 0.125mg reductions, to keep in my mind what % each cut is. To get the %, just divide the reduction amount by your total daily dose. Ex. 0.125mg/4mg = 0.03125, which is 3.125%. Once you find 0.125mg reductions feeling too difficult, I suggest noting that percent based on your then current daily total, hold to recover, and look for another tapering option that will let you take reductions below that percent going forward. This might be a good time to consider a crossover to diazepam, or you might look into other clonazepam titration options like custom compounding.

For now though, I think you should be able to make significant progress with pill splitting alone. IME higher doses are much easier to titrate; I think you might be able to get to 2mg/day or so before needing a new approach.

I also suggest learning self-soothing skills, via whatever opportunities are available to you. IME many buddies do not take this part of tapering seriously enough, to their detriment. Being dependent on a sedative suggests a lack of self-soothing skills; we all need these skills to better tolerate the taper itself and to live well without these drugs in the future. Going over this would make this post too long, but I'd regret not mentioning it; the forum has lots of good resources and suggestions from other buddies about skill-building. :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Trying to get off 4mg/day of Klonopin by switching to Valium
« Reply #4 on: December 26, 2021, 06:06:15 pm »
Thank you for staying with me on this - much appreciated!

I am going to call and request .5mg clonazepam tabs as soon as I can with my psychiatrist, and discuss the withdrawal. He had already suggested dropping the dose a bit due to
"cognitive impairment" as we age. But his initial suggestion was to try taking .5mg out of my 2 least stressful days of the week, and see if I tolerate it. Really strange, I even asked about "peaks and valleys" but he did not seem to concerned (maybe because of my high dose).

I also will get the pill splitter you mentioned - it looks great, and your video was very good.

Also of note, I take 10mg of citalopram (have been for a long time), I do not plan on reducing or discontinuing that one at all - but wonder if that will "help" in any way versus someone who does not take this?

I like your ideas about journaling and keeping a holistic view (like what is going on in your life, and what your limitations are) - I read your journey bio, amazing - congrats on the progress you have made.

Once I start the withdrawal - should I just post in the direct forum instead of substitution forum? Or can this be moved over?

Thanks again!



Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

I currently have a lot of anxiety due to tolerance to my current dose - and cannot go higher.

Wondering if I just start tapering ASAP to stabilize?

Going to try to taper .125mg every 2 weeks until I cannot tolerate it if it
Comes to that, and then possibly substitute Valium.

[...] has helped a lot here, and other thoughts?

Thanks in advance!
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Trying to get off 4mg/day of Klonopin by switching to Valium
« Reply #6 on: December 27, 2021, 02:12:14 pm »
Thank you for staying with me on this - much appreciated!

I am going to call and request .5mg clonazepam tabs as soon as I can with my psychiatrist, and discuss the withdrawal. He had already suggested dropping the dose a bit due to
"cognitive impairment" as we age. But his initial suggestion was to try taking .5mg out of my 2 least stressful days of the week, and see if I tolerate it. Really strange, I even asked about "peaks and valleys" but he did not seem to concerned (maybe because of my high dose).

I also will get the pill splitter you mentioned - it looks great, and your video was very good.

Also of note, I take 10mg of citalopram (have been for a long time), I do not plan on reducing or discontinuing that one at all - but wonder if that will "help" in any way versus someone who does not take this?

I like your ideas about journaling and keeping a holistic view (like what is going on in your life, and what your limitations are) - I read your journey bio, amazing - congrats on the progress you have made.

Once I start the withdrawal - should I just post in the direct forum instead of substitution forum? Or can this be moved over?

Thanks again!

Hi again [...],
Your psychiatrist's suggested two-day 12.5% dosage drop concerns me; I don't see this being an effective test of anything, nor supportive of your need for neurological stability. Given that you are experiencing tolerance at such high doses, I agree with some sort of reduction strategy beginning as soon as possible, but IME the nervous system responds far better to slow consistent dosage changes than to erratic and temporary ones.

Many buddies find working with their psychiatrist to navigate benzo withdrawal is ineffective if not disastrous. IME doctor-led tapers are often rushed, formulaic, and have low success rates. If you doctor will support you in leading your own taper then that's wonderful. If not, some buddies have chosen to keep their doctor in the dark about their at-home tapering; this is medical non-compliance, but I'd personally choose secrecy over a tortuously rushed taper.

I'm glad the video was helpful for you! I'm a terrible videographer but it saves me so much typing. I think you'll like that splitter if you use it in the way I demonstrated.

I can't say whether citalopram will be any help to you while tapering, but I do suggest leaving the dosage where it is while you're tapering your benzo. Tapering one psyche drug at a time is usually the most effective strategy, in my opinion.

Regarding using the forum, I think it's best to start threads in separate areas of the forum based on your specific needs. A buddie blog or progress log are ways to keep a record or a conversation going (blog is better IMO) about your ongoing journey to recovery. The tapering boards are places to ask for feedback on tapering plan specifics; the tapering threads are divided into Direct (tablet splitting), Substitution (switching between benzos) and Titration (which the forum uses to mean reduction methods more accurate than tablet splitting). And the Withdrawal Support board is a place to share or ask for advice about coping with general symptomatic issues during withdrawal, although there are symptom specific boards as well. There are many many other boards with specific topics (Other Medications, etc); I suggest looking around the main page of the forum to get familiar.

So IMO don't be afraid to start a new topic on the relevant board when you have an issue or question or concern. But if you want to keep us posted regularly about your progress, I suggest starting a Buddie Blog.

Lastly, seeing your new post, my opinion is that tapering sooner rather than later is the best way to treat ongoing tolerance, especially at high doses. I hope others will chime in with their experience and opinions.

We're here for you. :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

That was my take as well - dropping it for 2 days that much, and then raising it back up for a few weeks to "see how I do" didn't seem to make a lot of sense to me.

He actually just filled my request for .5mg tablets - so I am going to pick those up later today. Though pill splitter is on order and will not come until tomorrow. So I will probably start the taper down later in the week.

Once started I will create a new topic in direct taper, or buddy blog as you suggested to track progress.

Appreciate the advice as always!
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

He actually just filled my request for .5mg tablets - so I am going to pick those up later today. Though pill splitter is on order and will not come until tomorrow. So I will probably start the taper down later in the week.

That sounds great! Also it looks like [...] moved this thread to Direct Tapering, so if you want to post direct tapering questions here in the future you can do that. :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

He actually just filled my request for .5mg tablets - so I am going to pick those up later today. Though pill splitter is on order and will not come until tomorrow. So I will probably start the taper down later in the week.

That sounds great! Also it looks like [...] moved this thread to Direct Tapering, so if you want to post direct tapering questions here in the future you can do that. :thumbsup:

Yes I moved this thread on request from [...].

[...] if you're in tolerance it's unlikely your symptoms will "stabilize" or get better. In my opinion your current symptoms will likely serve as your baseline.

When in tolerance there's essentially only 2 options either increase the dose or start tapering. And I think you've chosen the better one of the two.

You can start a new topic any time you want. In fact if you feel this one is redundant and you have gathered all the information you want you could start a new topic. Or sometimes members want to keep the information in one place.

If you start giving updates on how you feel that is generally better for either a Progress Log or Buddie Blog. But in Progress Logs members cannot reply to you.

I think you have a solid plan to get started. Something I've learned through my journey is not to get precious over a tapering plan but to be flexible and prepared to change at any time. If my body doesn't like the plan then I adjust it. You've got this! :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.