Author Topic: Slow Klonapin taper advice  (Read 542 times)

[Buddie]

Re: Slow Klonapin taper advice
« Reply #10 on: April 17, 2022, 04:36:26 pm »
Hi [...],
No worries I really appreciate your support! I will be picking up the compounded clonazepam tomorrow as I still had  a few klonapin pills left to get me through the weekend.  The dosage will be 0.5mg/1ml. I went back up to taking almost .25 during the day( I shaved a tiny corner off) and continued with .25 at night and am feeling stable now. (Sleep and appetite are much improved and anxiety is at a minimum).  I am wondering also about the effects of liquid vs taking pill form. From the pharmacist it sounds like it will still have the same half life  etc but just wondering others experiences with that has been.
Thank you again for all of your help!
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: Slow Klonapin taper advice
« Reply #11 on: April 17, 2022, 09:42:22 pm »
Some members have noticed a difference when switching to liquid so please plan to hold your current dose to see how it's going to affect you, it can feel like an increase or a decrease or just different so if you can just observe for a few days that would be good.

When you pick up your prescription be sure to ask the pharmacist any questions you have and make sure you have the proper dispensing tools to withdraw the drug.  Here is some information to help you get an idea of what you might want to pick up.

Using an Adapter Cap | The Withdrawal Project
https://withdrawal.theinnercompass.org/taper/using-adapter-cap

Using Syringes | The Withdrawal Project
https://withdrawal.theinnercompass.org/taper/using-syringes

I don't have experience with this so I'm hoping another member will drop by to take a look at your dosage.
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: Slow Klonapin taper advice
« Reply #12 on: April 17, 2022, 10:56:32 pm »
Hello, [...].

[...] has given you excellent advice.  When you switch to the liquid, hold your dose constant at 0.25 BID for a week or so to discover how you will react to the change in dosage form. (If you have not already done so, I strongly encourage you to set up a daily taper journal to record your dose, symptoms, and functionality level).  Also, definitely ask your pharmacist to supply you with an adapter cap (aka press-in bottle adapter) as well as several 1mL oral syringes, preferably with 100 graduations. 

Other questions/topics you might want to address with your pharmacist include:

(1) What formulation was used to prepare your compounded liquid?  Has it been stability-tested? Is it a suspension or a solution?  What does it use as the drug source — regular tablets or the API (active pharmaceutical ingredient)?  If regular tablets, were they from the same manufacturer as the ones you are currently taking?  What other ingredients does the liquid contain?

(2) What is the concentration of the liquid?  In one post, you indicated it was 0.05mg/mL and in another you indicated it was 0.5mg/mL.

Clonazepam is a very potent benzodiazepine so the lower the concentration of the liquid, the better.

It will be challenging to make small enough reductions in dose if the liquid is 0.5mg/mL even if you are using a 1mL oral syringe with 100 graduations.  Having said that, let me hasten to add that you should be ok using the concentrated liquid for the transition phase of your taper (i.e. when you switch from a solid dosage form to liquid and hold your dose constant at 0.25mg BID) as well as for your first reduction(s). 

However, if it turns out that the concentration of the liquid is indeed 0.5mg/mL,  I suggest you ask the pharmacist if s/he can prepare a liquid with a lower concentration for your next batch.  See link below for a stability-tested formulation for a 0.1mg/mL oral clonazepam suspension.  You will need to ask your prescriber for a new prescription for this, but, happily for you, it sounds like you have a prescriber who is willing to work with you on a gradual, symptom-based taper.  If you feel your prescriber would benefit from additional information on this topic, I’ve included a link below that might be helpful.

(3) If you are uncertain about how to measure your 0.25mg BID doses using your compounded liquid, an adapter cap, and an oral syringe, ask your pharmacist for a lesson.

Links:

0.1mg/mL Clonazepam Oral Suspension from Nationwide Children’s Hospital
https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

Benzodiazepine Deprescribing Guidance Document (for prescribers)
https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf
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: Slow Klonapin taper advice
« Reply #13 on: April 18, 2022, 08:39:42 pm »
[...]:
Thank you for your ongoing support and advice.
Liberta:
Thank you so much for all of the information. I picked up the prescription and the official concentrations is 0.25mg/1ml so better than 0.5. I was supplied the adapter cap and syringe. They said they used klonapin tablets to make the suspension and they are by the same manufacturer of the tablets I was taking. They said they don’t do stability testing there but that they base it off of some researched back stability testing? It was hard to hear and I was feeling awkward with so many people around in line. So I will plan to take the 0.25 BID for the next few days to see how I respond to the liquid and then begin to taper. Do you think an10% decrease is too much to start out with? Like everyone I am just wanting to be off of this but I know that it’s a process…. Also wondering how you know when to begin the next taper? If no symptoms or just tolerable symptoms after 7-10 days is it okay to decrease? Do you wait until symptoms improve? Do they improve? Sorry so many questions I’m just feeling defeated and nervous about this whole thing.
Thank you 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]

Re: Slow Klonapin taper advice
« Reply #14 on: April 19, 2022, 12:58:59 am »
You are most welcome, [...].  No apologies needed for asking questions — that’s how we learn.  Also, please know you are not alone in feeling defeated and nervous.  Many if not most of our members feel that way from time to time.

I’m glad the concentration of your liquid is 0.25mg/mL rather than 0.5mg/mL.  It’s also encouraging that the pharmacy is using a formulation that has most likely been stability-tested.   Now onto your questions ….

Quote
Do you think a 10% decrease is too much to start out with?

When initiating a taper, I am a proponent of the “start low and go slow” approach. It is far easier to speed up a taper that is going well than it is to slow down and recover from a too-fast taper.

If had your history, I would probably start with a 5% trial reduction.  If that went well, I would bump it up to 10%. 

Quote
Also wondering how you know when to begin the next taper? If no symptoms or just tolerable symptoms after 7-10 days is it okay to decrease? Do you wait until symptoms improve? Do they improve?

The collective wisdom of this community is to let your symptoms guide both the amount and the timing of reductions.  Consequently, if you have not already done so, I strongly encourage you to set up and start keeping a daily taper journal.  It can be as simple as a table in which you record the date, time(s) and amount(s) of your doses, a rating of your symptoms (0 = no symptoms, 10 = intolerable symptoms), and a rating of your functionality (0 = unable to perform essential daily tasks, 10 = able to perform all essential daily tasks).

Most individuals will experience withdrawal symptoms during discontinuation.  The goal is to keep symptoms in the tolerable range by adjusting the taper rate as needed.

In the case of clonazepam, a common withdrawal pattern is the ‘3/10’.  It takes about 3 days for withdrawal symptoms to fully emerge and about 10 days for symptoms to stabilize (stabilize means ‘not changing and tolerable’ not ‘no symptoms’).  However, please be aware that your withdrawal pattern may well be different. Again, this is why it’s important to keep a daily taper journal.  Reviewing or graphing your daily symptom and functionality data will allow you to discover your unique pattern.

PS The liquid you are using is a suspension.  So please remember to shake it vigorously before measuring your dose. Also be sure to follow any storage instructions on the medicine bottle (e.g. protect from light, refrigerate).
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.