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Slow Klonapin taper advice


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Hello,

I am attempting to taper off of klonapin. My most recent decrease was from .25 in the day and .25 at night to .125 during the day and .25 at night. This was too much for me initially I had some mild anxiety that was completely manageable but then at day 6 started having insomnia and lost about two nights of sleep. Needless to say I feel that I need to up my dose again to either .25 for the day time dose or .1825. I see that recommmendations are for 5-10% decreases every couple weeks but don’t know I could possible cut the .5mg pill in that small of increments. Would love any advice you all have. I will be consulting with my physiatrist as well but I do know from reading others experiences that drs tend to try to wean us much quicker that tolerated by many. Thank you

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Hi Nmh85, me again.  ;)

 

Just need a bit more information, will your doctor support a slow taper schedule, in other words will he supply you with enough to accomplish it?  Also, have you experienced any other symptoms besides the anxiety and insomnia?  It would also be good to put your medication information into your signature, and please include the fact that you went on for post partum.  This helps members help you because they can see at a glance what has been happening.  Here are the instructions but if you have problems you can put the information here and a team member can take care of it for you. Add your history/signature 

 

I'm going to give you a couple of links with some information but don't get overwhelmed because then I'll most likely ask another member to help you since I don't have taper experience but I'm really good at asking a lot of questions.  :laugh:

 

Titration FAQ's

 

 

Bob7 Benzo Dry Taper Method 

 

 

 

 

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Hi Pamster,

Okay I updated my signature. Thanks! My doctor has been pretty supportive so far in supporting me through a slower taper. I am waiting to hear back from her but she’s off for a long weeekend so likely won’t hear back from her until next week but I am hopeful that she will be supportive in slowing further based on my experience with her so far. And yes I have had other symptoms other than anxiety and insomnia like shakiness, I find myself clenching my jaw a lot, and overall restlessness. Also increased heart rate.

I reached out to a local compounding pharmacy and sounds like they have small doses of klonapin in a liquid suspension so if my doctor is on board that’s what I would hope to be able to do.

 

Thank you for all of your help!

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Your signature looks great, thank you.  I think compounding your Klonopin sounds like an excellent idea, many of our members will dilute it so they can make even smaller reductions so if you decide to go that route, let us help you figure that part out, okay? 

 

Also, do you plan to go back up in dose a bit before your doctor gets back to hopefully relieve your insomnia?

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If you can get your klonopin in liquid format it will probably be the most convenient way to taper in my experience.
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Pamster:

Okay that sounds good. Really hoping she is onboard for this! And thank you for offering all this support it’s so relieving to know I’m not the onlyoone out there experiencing this. And yes I’m thinking in the mean time I should increase my dose I’m just not sure if I should got back to .25 for daytime dose (from .125) or if I should try to get to .1875 with some creating cutting of the pill.

 

Jelly baby:

Thank you for your input. Have you experienced any withdrawal symptoms throughout your taper?

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Tapering is a challenging process so it would probably be a good idea to educate yourself as much as you can about what to expect because the more we know, the less we fear and fear is a huge symptom for us.  You're likely to face many of the same symptoms you've dealt with so far but we hope that by tapering you can remain well enough to take care of your baby. 

 

As for what dose to go up to, we tell members to find a dose they're stable on but this doesn't mean feeling good, it means being able to take care of your daily tasks.  So when deciding what dose you want to take, you might want to consider our definition of stable and understand that feeling good is something you'll know when you're off the drug and recovered from your use.  And full disclosure, even after you're off the drug you'll most likely still experience symptoms until you recover. 

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Yes I've had symptoms the whole time.  It's very seldom that people who end up here don't have symptoms at all. My symptoms have been manageable and I have been functional. It's certainly not easy but I'm coping and managing life and I definitely have it easier than a lot of people here.
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Yes thank you for that. I do know I need to prepare to continue to have symptoms. I just would like them to be more tolerable if possible and I don’t expect to get 8 hours of sleep but I’d love if I could continue getting 4-5 hours. I don’t know if that’s a realistic expectation or not but my goal is to remain as functional as possible while getting off of this.  Its hard when withdrawal symptoms are the same as the symptoms that printers  starting the medication.. is it even possible to discern whether it’s due to the withdrawal or that that’s your baseline anxiety symptoms  your experiencing? All of this came on so sudden for me I went from sleeping one night  to not sleeping (even when baby was sleeping)  and having severe anxiety the next. It felt like such an acute experience that I have no idea what my baseline is at this point.

 

I did just speak to my doctor and she is open to having the klonapin compounded and allowing me to taper by 5-10% every 2 weeks or so. So that is great news. The klonapin comes in 0.05mg doses per 1ml. Is it best to start with a 5% reduction? And do you always wait the full two weeks or if your feeling “stable” after one week is it okay  to decrease sooner? I understand this is a slow process and these are powerful medications but  I guess since I’ve been on the klonapin now for about two months (began tapering from 1.25mg at 4 weeks in) it seems wild to have to decrease it over such a long period of time she also recommended I go back to .25 BID for now to stabilize before I start tapering. How long do you recommend I hold on that does until starting to taper?

Thank you again

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Hi Nmh85, I'm sorry I left you hanging, have you picked up the compounded prescription yet, I'd like to get another member in here to help answer a couple of your questions but wanted to make sure you still need answers.
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Hi Pamster,

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!

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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.

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Hello, Nmh85.

 

Pamster 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

 

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Pamster:

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

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You are most welcome, Nmh85.  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 ….

 

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%. 

 

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).

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