Tolerance

1.0 mg in the am (klonopin) and 1.5 in pm.  When I start tapering, whoud you combine the 1.0 am mg with the 1.5 pm or would you keep separate.

 

Also, this is my 3rd time weaning off klon of which I am very scared (it's a long story of which I regret.  Do you have any advice (1 st time weaned off .5 mg, 2nd tme 1.3 mg of klon and now the 2.5.  I'm not ready to start, but I'd like to be.

 

appreciate the reply.  hope you are doing well

 

Also what are your thoughts on liquid taperring expecially with a bunth of .5mg pills (5). 

 

Edit: Removed PM response

Hi Charlene,

 

Ok, I can help you here.

 

First, help me understand your situation.

 

Is anxiety one of your primary issues in life (the reason for starting Benzos in the first place)?

 

Is insomnia a factor?

 

What is the mg of your pill (e.g. 0.5mg?)

 

What are you current symptoms?

 

When was the last time you made any change to your dose?

 

Are you on or ever used other medication - like an antidepressant?

 

Hi Charlene,

 

Ok, I can help you here.

 

First, help me understand your situation.

 

Is anxiety one of your primary issues in life (the reason for starting Benzos in the first place)? Yes

 

Is insomnia a factor? Yes

 

What is the mg of your pill (e.g. 0.5mg?) .5 mg of which I take 1 mg in am and 1.5 in pm for a total of 2.5

 

What are you current symptoms? scared, anxiety, the fact that this will be the forth time

 

When was the last time you made any change to your dose?  I was at no does in 2020.  and almost done with cymbalta.  Now I'm back on everything do to a  health scare

 

Are you on or ever used other medication - like an antidepressant? zoloft, mirazapam.  Thank you

Hi Charlene,

 

Ok, I can help you here.

 

First, help me understand your situation.

 

Is anxiety one of your primary issues in life (the reason for starting Benzos in the first place)?

 

Is insomnia a factor?

 

What is the mg of your pill (e.g. 0.5mg?)

 

What are you current symptoms?

 

When was the last time you made any change to your dose?

 

Are you on or ever used other medication - like an antidepressant?

sorry this did not work .5mg for a total of 2.5 (1 in the a.m and 1.5 pm).  currenty symtopms...anxiety due to health scare, fear, crying alll the times..  Can't think I was on zoloft and mirazapam.  scared that I've already done this three times.  Thank you

Anxiety is huge and sleep is secondary. 

Sleep is probably ok because you take a large does at bed.

 

The good news - you do not have any painful symptoms yet. 

 

It seems odd you went from zero benzo in 2020 to 2.5mg a day.  Did a doctor say you needed 2.5 mg or is this your own decision? 

I was not on consectutively, but something does not seem right

Please update your signature with your current medications, I have no idea what you're asking or where you are in your journey, help us help you.

Please update your signature with your current medications, I have no idea what you're asking or where you are in your journey, help us help you.

.5,1.5 and 2 (2017, 2019 and 2022)

To answer your question regarding tolerance, here is a study you might want to look at.  It appears that it happens rather rapidly:

 

https://pubmed.ncbi.nlm.nih.gov/2908516/

 

thank you

Should you speed up weaning when in tolerance or do you stilll do the normal 10% weaning process?

 

Can tolerance cause nausea?

 

Thank you. Appreciate it if one of the monitators could reply

This will answer many of your questions. Deprescribing Guidelines

Should you speed up weaning when in tolerance or do you stilll do the normal 10% weaning process?

 

Can tolerance cause nausea?

Charlene,

You should listen to your body to make all decisions.

 

The only general information I give out is, if you are doing 5 to 10% reductions, then hold for at least 2 weeks or until your symptoms are tolerable, whichever is longer.

 

If you keep a daily journal of your dose and symptoms and life stress, it will help you clearly see what it means to have tolerable symptoms.

 

This will answer many of your questions. Deprescribing Guidelines

Are we talking about this section?  How does this differ from usual tapering?  Thank you!

3. Tapering Principles

● A symptom-based, patient-directed taper is the best approach.12,18-20

● Initiate with a small test reduction (≤5% of current dose). Allow the patient to lead subsequent

reduction amounts/intervals based on tolerability of withdrawal symptoms.

● Lived experience suggests ≤5%-10% reduction of the total dose monthly is best tolerated.

● Skipping doses, supplemental (“rescue”) doses, or up-dosing increase risk of kindling.41 Up-dosing may

be necessary in case of over-rapid reduction and severe symptomatology (e.g.,akathisia, suicidality).

● Hyperbolic (exponential) dose reductions are better tolerated than fixed reductions;42 i.e., dose

reductions should become smaller as the taper progresses.

● Complete discontinuation may take 12-18 months or longer.

● Nervous system hypersensitivity is common during withdrawal, and any foreign substance can have

adverse effects. Caution is advised with any new supplement or medication.23

This will answer many of your questions. Deprescribing Guidelines

Are we talking about this section?  How does this differ from usual tapering?  Thank you!

3. Tapering Principles

● A symptom-based, patient-directed taper is the best approach.12,18-20

● Initiate with a small test reduction (≤5% of current dose). Allow the patient to lead subsequent

reduction amounts/intervals based on tolerability of withdrawal symptoms.

● Lived experience suggests ≤5%-10% reduction of the total dose monthly is best tolerated.

● Skipping doses, supplemental (“rescue”) doses, or up-dosing increase risk of kindling.41 Up-dosing may

be necessary in case of over-rapid reduction and severe symptomatology (e.g.,akathisia, suicidality).

● Hyperbolic (exponential) dose reductions are better tolerated than fixed reductions;42 i.e., dose

reductions should become smaller as the taper progresses.

● Complete discontinuation may take 12-18 months or longer.

● Nervous system hypersensitivity is common during withdrawal, and any foreign substance can have

adverse effects. Caution is advised with any new supplement or medication.23

The Lived Experience suggests 5 - 10% reduction -- what does that mean?

Your signature indicates you've tapered in the past, how did you do it?

titration

 

Were you comfortable with this method, did you reduce every day or cut and hold?  I'm just wondering why you're not going with the method you used previously.

I'm not going thru the same method because I think I'm in tolerrance.  I wasn't in tolerance the last two times. 

I didn't realize that made a difference in how you taper.  What method are you planning to use?