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Valium Crossover Substitution Taper


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Hi friends -

 

I’m on .25 klonopin and .5 Ativan.  I failed my klonopin liquid titration, going at 10% every two weeks, after getting to half the dose & holding.  Tried my best, but went into major withdrawals. 

 

What suggestions would you have to convert the .25 klonopin into a Valium substitution taper?  I’m on a dose below how the Ashton manual suggests crossing over, so don’t know how to do the math.

 

I’d also like the same information for how to crossover to Valium from .5 Ativan.

 

For both, I’d like to do the 3x a day crossover until I’m fully on Valium.  And then hopefully just take Valium one time a day at night.

 

Thank you for your help 🙏🏻

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Am I understanding correctly that you reduced your Klonopin/clonazepam dose by 50% in just a little over 3 months?  That would be a taper rate of almost 17% a month. Have you considered trying to taper the clonazepam again using a slower taper rate?

 

I also wonder if you have considered tapering the Ativan/lorazepam first given that it has a shorter half-life than clonazepam?

 

Addendum:

 

Pamster has asked another member an important question that applies to you as well: Is your prescriber willing to prescribe Valium/diazepam? (Not all prescribers are, especially those in the US.)

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I tapered the klonopin at what I thought was a 10% taper every 2 weeks.  Maybe the spreadsheet was wrong.

 

I haven’t tried tapering the Ativan because I thought klonopin would be easier to do first since it has a longer half life.

 

I am not certain if my prescriber will go for a Valium crossover.  Especially after the klonopin disaster.

 

I’m still trying to recover from the withdrawals.  I’m not sure how long that is going to take. 

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You mention Klonopin liquid titration, can you elaborate on that, did you have this compounded at a pharmacy or did you make your own, if so what method did you use?  Do you have a copy of your taper schedule you could share with us, if Libertas is correct in her observation that you may have tapered at a rate far above what you thought, it would help us to see this.

 

Also, I agree with Libertas's suggestions to taper the Ativan first if you can't find a doctor to prescribe Valium. 

 

Lets keep talking so we can work this out.

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I used benzo.always data.net to figure out the taper plan.  To make the solution, I smashed 10 tablets of 0.25 dissolving klonopin in 5 ml of PG to 20 ml H2O to make 25 ml solution.  Then I withdrew the dose for that day.  For example, my first dose was 2.48 ml for a total dose of 0.2482.

 

I’m pretty sure I tapered at the 10% rate every 2 weeks.  When I got to 0.125 mg klonopin, I held with the lowest dose tablet that is dissolvable.  So, yes, between Sept 25 & Dec 3, I was at a 50% cut on klonopin.

 

I did not recognize my symptoms as withdrawal symptoms until it was too late & I ended up in the ER with my heart hurting.  I have a benign heart issue where my heart pounds all the time.  I noticed I had started losing my appetite.  In December, Jan, Feb, I held at 0.125 starting Dec. 3).  Then in Feb, I started “shaking like a drug addict”, not knowing if I was real or where I was, not sleeping at all, constant chest pain, jaw hurting/teeth grinding & my jaws snapping shut like an alligator.

 

Although klonopin was reinstated about 2 weeks ago at original 0.25 mg, I am not back to prior taper baseline.  It is scaring me.  I am still basically eating nothing, & I’m really not one to exaggerate.  My frontal lobe aches.  I still can’t think clearly.  My heart still hurts off & on, but is cleared by the cardiologist.  The other bizarre withdrawal symptoms subsided when my primary care doctor told me to reinstate the gummy.  I started a 5 mg THC cannabis gummy 4 days before I began the taper.  I’m hind sight, I think it masked the withdrawal symptoms.  So when I started tapering the gummy in January, I got hit full force

 

I’m open to any insight or expertise.  I do not know how to get out of the mess I’m in.  My body has to calm down some before I can try again & I need to be able to eat.

 

Curious why the recommendation would be to taper Ativan first.  I thought it has a faster half life & would be more difficult.

 

I do not know if my doctor will go for Valium taper.  I want the information for the crossover to at least present to her.  She seems to be of the camp that staying on the same med & tapering it is best, but I’m just hoping for something that might be easier on my body because of the longer half life, but realize things are rarely that simple.

 

I will add my poly drug mess into my signature.  I’m certain now that an estrogen patch is what kicked all this off with panic attacks…& then meds just kept being added instead of me listening to my intuition (& not the doctor) and ripping off the patch.

 

Thanks for listening.  Usually I’m not as wordy & more to the point, but I’m panicking & terrified.  I’m a single mom to a beautiful 15 year old & am emotionally unavailable to her.

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Okie I’m sorry for your predicament I’ve never seen or have experience with a 2 benzo to one crossover before but I can take a stab at it based on the Ashton manual

I don’t know know if it’s best to do one crossover at a time or both at the same time

Let me do some searches and see if anyone else has done this

Libertas is very savy you can pm him and ask him if he’s seen this before

Joeb

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I would love any help I can get, Joeb.  It would be so appreciated.  I don’t know if I need to look at 2 separate crossover taper plans, like klonopin to Valium & then Ativan to Valium and do them separately…or if they could be combined. 
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Joeb:  Thank you for offering to help OkieYogi by searching for members who have completed a two-benzos-to-one crossover. Your kindness and generosity toward other members is much appreciated.

 

OkieYogi:  I am so sorry you are suffering but we will do our best to help you get back on steadier footing.  You have already made a major step forward by sharing more of your history with us.  The more we know, the better equipped we are to offer suggestions and assist with connecting you to relevant resources. 

 

It’s time for me to call it a night, so I must close for now.  However, I promise I will get back to you tomorrow.

 

In the interim, please know you are doing the right thing — giving your body time to process and adjust to the changes its been through. 

 

Have you found any coping/calming techniques that work for you? For example, belly breathing has always worked amazingly well for me and is easy to learn/do.  Here’s a video I found helpful when I was learning it:

 

How to Breathe - Breathe2Relax

 

Dr. Weil’s 4-7-8 breathing technique also works well:

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I just want to say that I appreciate you.  I appreciate those of you who open their hearts & arms to help those of us who are scared.  It’s hard for me to express how much it means to me, but I want you to know how appreciated you are.  Thank you for your kindness, your gentleness, your guidance & your time.
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I can answer one of your questions until Libertas returns with her wisdom.

 

You asked why taper Ativan first. It's precisely for the reasons you mentioned. It has a shorter half-life and due to potential interdose withdrawal it's more difficult to taper. The rationale is while you're tapering Ativan you’ll still have Klonopin in your system to counteract the short half-life. Klonopin is also much more potent so theoretically it should help make tapering Ativan easier if you taper the Ativan first. I hope I make sense.

 

I'm sorry you're in this mess. I am a mom too and know how difficult it is to do this and be present for your kids. Just know that everything will be okay.

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Hello again, OkieYogi.

 

Thank you for your kind words of appreciation. 

 

jelly baby has done an excellent job of explaining the rationale for tapering a short-acting benzodiazepine such as Ativan/lorazepam before a longer-acting benzodiazepine such as Klonopin/clonazepam.

 

Indeed, this causes me to wonder if you have considered substituting Klonopin for the Ativan and then doing a gradual, symptom-based taper from the Klonopin?

 

It would also be helpful if you could tell us more about how you ended up on two benzodiazepines.  Are you getting them from the same prescriber?  (If you are, I would be surprised if the same prescriber would be willing to prescribe a third benzodiazepine — Valium — to do a crossover.)

 

 

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Libertas: 

Two different prescribers originally prescribed the benzos.  In Oct. 2020, I sought out a psychiatrist to help me get off them.  I was in such a state of extreme anxiety/panic that she had me take them every day until I stabilized.  I still haven’t stabilized, so in Sept 2021, I figured if I had anxiety even while taking them, that I might as well start somewhere & start getting off of them.

 

I have wondered if I could be switched from Ativan over to Klonopin so I’m just on one benzo.

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Thank you for the additional information, OkieYogi. 

 

Am I understanding correctly that the psychiatrist you sought out to help you with discontinuation is now prescribing both the Ativan and the Klonopin?

 

If so, then my guess is she would be more receptive to replacing the Ativan with Klonopin and then tapering from Klonopin versus doing two crossovers to a third benzodiazepine (e.g., from Ativan to Valium and then Klonopin to Valium).

 

Is this something you’d like to consider?  If so, we can suggest a plan (or plans) on how this might be accomplished.

 

Would you be open to the idea of using a professionally formulated, stability-tested compounded clonazepam oral suspension to taper instead of the homebrew liquid you made with the clonazepam ODTs, propylene glycol, and water?  We suspect there are issues with the ‘recipe’ you used.

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Yes, Libertas, the psychiatrist I sought out is now prescribing both.

 

I’m hoping she will be open to my switching Ativan to klonopin.  One less drug would be nice even though they’d be comparable strength.  I’d totally be interested in that.

 

I am open to compounding.  I’d asked her about that initially & really didn’t feel like I got much interest from her.  She didn’t really have any solid advice or guidance on tapering, hence my home brew.  I wasn’t sure what else to do.

 

I don’t know if she’ll let me do anything until I restabilize some.  I’m not sure why I’m not restabilizing.  I really hope I get an appetite back soon & my heart/chest stops hurting (cleared by cardiologist.  Not actual heart issue).

 

I appreciate you 🙏🏻

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I'm pleased to see you open to crossing your Ativan dose to Clonazepam but I wanted to give you this cool little tool for determining the correct dose to cross to so you and your doctor can be on the same page for what you're going to need. https://clincalc.com/Benzodiazepine/

 

Also I feel it's an excellent idea to pursue compounded Clonazepam, I know Libertas has been using one and as you can see, she's very high functioning. 

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Your CNS has been through a shock. It may take a while for things to settle down so please try to be patient (I know this is easier said than done).  Are you keeping a daily journal of your symptoms and level of functioning?  If not, I encourage you to do so.  Keeping a journal will allow you to see patterns and trends that can be easily missed in the absence of a written record of some sort.

 

That’s great that you are open to compounding.  It sounds like your psychiatrist may not have much experience with it.  My prescriber didn’t either but was willing to learn so I volunteered to find out what we would need to do, including finding a reputable compounding pharmacist with the expertise and equipment required to prepare the compound. I can share the process I used if you are interested.

 

If you have not already done so, I encourage you to explore the calculator Pamster shared with you and consider sharing it with your prescriber at an appropriate moment.  The information in the ‘About this Calculator’ section can be quite helpful to both prescribers and patients.

 

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I do keep record of the symptoms as they’re a bit hard to figure out.

 

Question, when you crossover to Valium, you have to do a step-wise cross.  If I went from 0.5 Ativan & moved that to the equivalent klonopin dose of .25, do you have to do it step-wise as well?  Or just one day switch from Ativan to a new Klonopin dose of 0.5?

 

I would love any compounding information you have.  There are 2 compounding pharmacies in town that probably have the capabilities.

 

I’m assuming I need to wait until my CNS hopefully calms down some before attempting to taper again?  You would have thought I’d cold turkeyed it, the way my body reacted to the reduction.

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Good for you for keeping a record of your symptoms.  Do you also track your functionality?  If you are not already doing so, you might want to assign daily ratings to both your symptoms and your functionality. For example, on a scale of 0-10, how tolerable were your symptoms for that day?  On a scale of 0-10, how functional were you on that day?  Graphing such daily ratings would allow you to see patterns and trends.

 

In your case, my inclination would be to adopt a conservative approach to a lorazepam to clonazepam crossover.  What is the dosage of the lorazepam tablets you are taking?  0.5mg?  If so, one possible approach would be to split the tablet in half to get a dose of 0.25mg.  Then you could do a two stage crossover as follows:

 

Stage 1

0.25 clonazepam ODT + 0.125 clonazepam ODT + 0.25mg lorazepam

 

Hold at the above doses for 10-14 days to give the clonazepam sufficient time to reach steady state.  You may experience an uptick in withdrawal symptoms over the first week as the lorazepam is eliminated from your body.

 

Pay close attention to how you react to the above change to gauge: (1) if the substituted dose of clonazepam is too much, too little, or about right (e.g. some individuals discover that the Ashton equivalent is higher than they need to achieve the desired therapeutic effect) and (2) how you react to the change.

 

If your symptoms stabilize (i.e. stop changing, become tolerable) after Stage 1, you could proceed to Stage 2.

 

Stage 2

0.25mg clonazepam ODT + 0.125 clonazepam ODT + 0.125mg clonazepam ODT

 

Needless to say, you would be wise to discuss all of the above with a pharmacist who understands the pharmacokinetics of benzodiazepines.

 

That’s excellent news that you have not one but two compounding pharmacies in your town.  Do they specialize in compounding or are they ‘regular’ pharmacies that do compounding ‘on the side’?  The former is preferable to the latter.  If the pharmacies specialize in compounding, a first step you could take is to find out (a) if they are accredited (e.g. PCAB) and (b) what professional associations they belong to (e.g. PCCA).  I will also work on a consolidated list of what to look for and questions to ask when vetting a compounding pharmacy.

 

Your assumption is correct.

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The compounding pharmacies are true compounding pharmacies.  I think one is a national chain, College Pharmacy.

 

I have 0.5 mg tablets of lorazepam.

 

Are you recommending taking them 3x a day?  With lorazepam being the evening dose in Stage 1?

 

Thank you for your help 🙏🏻

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You’re welcome!

 

Thank you for the confirm re: your tablet dosage.

 

No, I was not recommending you take them 3x a day.  I was just suggesting one way you could do the crossover using a combination of tablets.  My assumption was that you would take them at the same time you currently take your meds (i.e. at night).

 

Are you considering changing your dosing schedule?  If so, why?

 

I’ll check out College Pharmacy.

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I used benzo.always data.net to figure out the taper plan.  To make the solution, I smashed 10 tablets of 0.25 dissolving klonopin in 5 ml of PG to 20 ml H2O to make 25 ml solution.  Then I withdrew the dose for that day.  For example, my first dose was 2.48 ml for a total dose of 0.2482.

 

I’m pretty sure I tapered at the 10% rate every 2 weeks.  When I got to 0.125 mg klonopin, I held with the lowest dose tablet that is dissolvable.  So, yes, between Sept 25 & Dec 3, I was at a 50% cut on klonopin.

 

I did not recognize my symptoms as withdrawal symptoms until it was too late & I ended up in the ER with my heart hurting.  I have a benign heart issue where my heart pounds all the time.  I noticed I had started losing my appetite.  In December, Jan, Feb, I held at 0.125 starting Dec. 3).  Then in Feb, I started “shaking like a drug addict”, not knowing if I was real or where I was, not sleeping at all, constant chest pain, jaw hurting/teeth grinding & my jaws snapping shut like an alligator.

 

Although klonopin was reinstated about 2 weeks ago at original 0.25 mg, I am not back to prior taper baseline.  It is scaring me.  I am still basically eating nothing, & I’m really not one to exaggerate.  My frontal lobe aches.  I still can’t think clearly.  My heart still hurts off & on, but is cleared by the cardiologist.  The other bizarre withdrawal symptoms subsided when my primary care doctor told me to reinstate the gummy.  I started a 5 mg THC cannabis gummy 4 days before I began the taper.  I’m hind sight, I think it masked the withdrawal symptoms.  So when I started tapering the gummy in January, I got hit full force

 

I’m open to any insight or expertise.  I do not know how to get out of the mess I’m in.  My body has to calm down some before I can try again & I need to be able to eat.

 

Curious why the recommendation would be to taper Ativan first.  I thought it has a faster half life & would be more difficult.

 

I do not know if my doctor will go for Valium taper.  I want the information for the crossover to at least present to her.  She seems to be of the camp that staying on the same med & tapering it is best, but I’m just hoping for something that might be easier on my body because of the longer half life, but realize things are rarely that simple.

 

I will add my poly drug mess into my signature.  I’m certain now that an estrogen patch is what kicked all this off with panic attacks…& then meds just kept being added instead of me listening to my intuition (& not the doctor) and ripping off the patch.

 

Thanks for listening.  Usually I’m not as wordy & more to the point, but I’m panicking & terrified.  I’m a single mom to a beautiful 15 year old & am emotionally unavailable to her.

 

I am having a lot of the same issues as you and I've only cut from 1.25mg clonazepam to 1mg in three months, going slow but maybe to slow. I have suffered with eating disorders for years and after my second cut a month ago I can't eat anything and I'm getting very scared. Yesterday I only got 400 calories in me and so far today 100. I don't know if holding will help. I too just started to do a crossover to Valium but not sure about it.

Wishing us all the best.

If you have any tips on eating I'd love to hear them.

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Nanaquits:  I wish I had some great advice for you on eating.  For some reason, I have more luck late in the evenings getting food in me.  I do drink shakes & Ensure to try & get enough calories.

 

One shake I make has about 500 calories:

16 ounces of water or whatever you’d like

1/2 avocado

2 scoops chocolate Orgain protein powder

1 Tbsp chia seeds (soak overnight in 1/2 c water to make them more easily digestible)

1 Tbsp hemp seeds

1 Tbsp flax seed meal

1 tsp to Tbsp coconut oil

 

It at least gets some nutrition & fats into you.

 

Liberatas:  I intend to just dose at night.  I just wasn’t totally following why you had it listed as 3 separate doses.  Thanks for clarifying!

 

Your info on compounding pharmacies…stuff I never would have thought to ask.  Thanks!

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Nanaquits:  I wish I had some great advice for you on eating.  For some reason, I have more luck late in the evenings getting food in me.  I do drink shakes & Ensure to try & get enough calories.

 

One shake I make has about 500 calories:

16 ounces of water or whatever you’d like

1/2 avocado

2 scoops chocolate Orgain protein powder

1 Tbsp chia seeds (soak overnight in 1/2 c water to make them more easily digestible)

1 Tbsp hemp seeds

1 Tbsp flax seed meal

1 tsp to Tbsp coconut oil

 

It at least gets some nutrition & fats into you.

 

Liberatas:  I intend to just dose at night.  I just wasn’t totally following why you had it listed as 3 separate doses.  Thanks for clarifying!

 

Your info on compounding pharmacies…stuff I never would have thought to ask.  Thanks!

 

Thank you for the recipe!

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