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Need help with Clonazepam titration


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I'm new to the boards and have found searching through posts to be very helpful.

 

I'm in need of some help with my titration.

 

I've been taking Clonazepam twice daily for a little over ten years. I was taking SSRIs as well and successfully cleaned myself of them in 2003. I left Clonazepam till last because I heard it was the hardest. In 2004, I went from 3 mg to 1.5 mg and hit a wall. I stopped there because I needed surgery and couldn't handle that and withdrawal at the same time.

 

I finally worked up the courage to start tapering again in Sept 2007. I have a psychiatrist who is willing to work with me on going as slowly as needed (even though he never uses the word "withdrawal'). He regularly calls in my prescription for liquid Clonazepam at a compounding pharmacy. I could never understand the instructions on how to do it myself and feared making myself worse, so I left it up to them.

 

I've been adjusting my schedule according to how I feel, but have followed the doses exactly as my doctor wrote them out. In the beginning, I tapered from 1.5 mg to 1.4 mg in two weeks. In another two weeks, I went down to 1.3. And so on, until I began experiencing severe withdrawal symptoms that interfered with my life. Then I started drawing out the cuts to every three weeks.

 

In February, I hit a snag that I haven't seemed to recover from. My doc had me taking it twice a day, but then my day dose eventually equaled zero, with my night dose being 0.6 mg. My body didn't like daytime without the drug and I had a very difficult time. I decided to give myself a day dose of 0.1 mg and a night dose of 0.5 mg to total the current 0.6 mg. I allowed myself three weeks after that and began to feel better until this weekend. I haven't done anything different, but I feel like I'm back at square one with many, many side effects and generally feeling helllish.

 

Is there something wrong with my schedule? Am I making too much of a cut each time? I don't know if my doctor truly understands withdrawal, so maybe this isn't the best way for me to taper. And the brain fog I have from w/d is making it even harder for me to figure out if I'm doing the right thing or not. I know withdrawal is terrible, but I can't imagine feeling this bad for another 6 months or so. The depression/cognitive issues are severe and the physical symptoms are leaving me couchbound on some days. I know I'm pretty unpleasant to live with. I live with Fibromyalgia, so this on top of that is almost too much.

 

There has to be a way to make this a little easier.

 

Thank you so much for any help.

 

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Hi Adie

Welcome  :)

I've read your post.. Im a bit lost as to what your dose is now, and what your last cut was. From what to what?

With Klon (Clonazepam), It would help If you dose more then just at bedtime. Its best to get in 3 equal doses 8hrs apart. I dose 6am 2pm 10pm...

It looks like youve made alot of progress  :) Adie...this for sure isnt easy. You will have with/drawl symptoms. Possibly your last cut was too big? If you can post your previous level and what you cut to ( present level).

Have you read Benzo Guide on withdrawing from benzo's , Klon,  It goes into detail about the withdrawl process.. 5-10% cuts every week to 2 weeks are recommended.

T/C

Sk

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Hi Adie:

 

Welcome to BenzoBuddies.  You've made enormous progress already.  Congratulations.  Your taper sounds good to me but I don't want to comment on it, and will leave that to others.

 

I did pick up on you suffering from fibro.  I was on clonzepam for 10 years also, and suffered from fibro symtoms for years.  When I finally got off the clonazepam a lot of it went away.  I just wanted to let you know that and encourage you. 

 

Colin does most of the taper schedules for us so he will get back to you about your taper.

 

best to you

juleswife

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I just wanted to drop in and say hi and welcome! You;ve done amazing so far! Colin will be by soon to help you out.

Amanda  :smitten:

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Hi Adie,

 

Welcome to BenzoBuddies.

 

You have already identified the problem - the lack of a dose during the day. Clonazepam has a medium-long half-life, so is not really suited to being taken just once-a-day. Most people take it two or three times a day. I would think because you faired well taking just twice-a-day, then this is often as you need take it now. You have described the benefit gained from switching 0.1mg from your evening dose to the daytime - I suppose that you are wondering if you should do the same again with another 0.1mg? Well, it makes total sense to me, especially as you experienced some relief when you did this last time. I would expect that because you have been in this routine for some time, part of the lift in symptoms is down to time (you have adjusted somewhat to this skewed regimen) - I hope I've explained this well enough! This means that you might experience relief a lot sooner than three weeks with this switch. All you can do is try and see what happens. If I was in your shoes, this is exactly what I would do.

 

Take care, and good luck.

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Thank you all so much for the kind words and help. I often forget that I actually have made progress. It's so easy to get stuck on focusing on the lack of progress! I needed those kind words.  :)

 

I'm sorry if I was confusing when I mentioned my current dose. All these numbers and brain fog can make your mind swirl.

 

I'm currently taking 0.6mg (0.1 day, 0.5 night). My last taper was 0.0 mg day and 0.6 mg night, but I quickly realized I needed two doses. So four weeks ago, I switched it to my current dose of 0.1 mg day and 0.5 mg night. I've been hesitant to make another cut because I haven't felt stable. I'll have some tolerable days, than not. Though that could just be the nature of the beast.

 

If I follow what I've been doing, my next cut will bring my current night dose of 0.5mg to 0.4mg (added with the 0.1mg in daytime to equal 0.5mg total). Does this seem right? I admit, I'm not the best at math on a good day, so trying to figure out percents of doses so small is difficult for me. I feel like the smaller doses I reach, the more sensitive I am to the changes. So maybe I should be making cuts even smaller than going from 0.6mg to 0.5mg?

 

Thanks so much.

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Hi,

 

I meant that you should move an additional 0.1mg from your evening dose to your day time dose, so that daily regimen consists of 0.2mg + 04mg. Once stabilised, you might then move 0.3mg + 0.3mg. After this, you would begin to reduce your dose, in at least a week (and two or more weeks if required) between each of these steps (the change in daily regimen, and the proceeding cuts).

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Could you water down the liquid so that your overall taper rate remains the same, or even slower, but you'd be tapering a teeny bit every day or two? You asked for a way to make this easier, and I found that tapering very tiny amounts every other day reduced the duration, intensity and number of symptoms quite dramatically.

 

For example, let's say you're tapering 0.1 mg every 10 days. Could you mix the liquid 1 part to 9 parts water and taper 0.02 every 2 days?

 

In my experience that would make the symptoms much more tolerable. :thumbsup:

 

Tony

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Colin, that's a great idea with adding more to the day dose. I hadn't thought of that. That might really help me stabilize. I often wonder as I take the 0.1 mg if it's enough to get me through the day. I'll try that for awhile and see how I feel.

 

Tony, that's another good idea. Would diluting a compounded medication be a problem? I'm wary of messing with their mix because I'm not exactly sure how they mixed it.

I wonder it it would help if I just tapered 0.02 mg every two days without diluting it?

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Hi Adie,

 

I'm unsure of exactly what Tony is suggesting, but I wouldn't water-down the contents of your medicine bottle. This will potentially introduce contaminants which would would taint the contents. However, you might be to play around with an amount of liquid that equates to just a day or two of your dose. Maybe the next time you have prescription, it could be made up to more dilute solution, so that you can make smaller cuts?

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Colin,

I did what you suggested by shifting the doses to get more in the daytime (0.2mg day, 0.4mg night) and I think it's helping. It's only been two days, but I do feel some relief. Hopefully it isn't a placebo effect!

 

Thank you so much. I wouldn't have thought of that on my own.

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So far, so good. It's amazing what shifting just that little amount can do. I'm trying to decide if I should next spread it to 0.3mg and 0.3mg or keep it as is and just taper down from there.

 

Thank you so much for checking on me. I appreciate that. :)

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wow, i'm happy for you Adie  :thumbsup:! Glad you are feelin better with the different cuts throughout the day. Maybe i should try that.

 

K

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So far, so good. It's amazing what shifting just that little amount can do. I'm trying to decide if I should next spread it to 0.3mg and 0.3mg or keep it as is and just taper down from there.

 

Thank you so much for checking on me. I appreciate that. :)

 

Although an even dose over the day is generally the way to go, if you feel very much improved with this latest change, maybe there is not a lot to be gained by switching to two does of 0.3mg + 0.3mg per day. Once stabilised with your present regimen, make a 0.1mg cut to your nighttime dose. Your cut after that would be another 0.1mg to your nighttime dose. Once at 0.2mg twice per day, you would probably do better to cut your daytime dose first and alternate this cut with a cut to your nighttime dose, reducing both doses in a stepwise manner.

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Colin,

I hope you don't think I am being an idiot in preparation for my titrate that you are going to help me with. But I have only been taking .5mg of Klonopin at different times....sometimes in the am, sometimes at noon and then sometimes at night ( just one dose) To get ready for this titrate should I start splitting my dose in two intervals,or at this point would it not matter since I am going to start when the cylinder gets here UPS. Should I just leave it alone.

 

You stated somewhere in this post that Klonopin should be taken in intervals which I never did. It seemed to work

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I took it once daily and had no problems. It's mostly a matter of what works for you. Klonopin has a relatively long half-life so once a day should be fine IMHO.  :thumbsup:
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I'd recommend that you try taking it at least twice a day. Yes, it does have an averagely-long half-life, but most people seem to benefit from taking more than once-a-day. Tony is right though, it is a matter of what ever works best for you.
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  • 1 month later...

Well, I'm back to this thread asking for help.

 

I did manage to even out my day and night doses to 0.3mg each, totalling 0.6 in early May. Then I tapered to 0.55 on May 19. I felt stable, so I tapered to 0.50 a week later. It's been one week and I feel terrible. I thought making a smaller cut would ease some of the nasty symptoms. I would normally have jumped from 0.6 to 0.5, but it seems I'm having more problems the closer I get to being off Clonazepam completely, so I did the .55 jump in between. It didn't really help.

 

The stuff I'm experiencing is interfering with my life in a big way. The aches and pains are tremendous (I have Fibromyalgia on top of this), the depression is very severe and my cognitive skills are failing me. I get really nauseated when I take my night dose and it makes me very drowsy (not a side effect I usually feel from the drug). My social anxiety and irritability are off the charts.

 

I don't know why I'm having such trouble. Are the cuts too big? Am I going to quick? Too slow? And the million dollar question, is there a way to make this easier? I feel like I've been going so slowly and that this will never end. I just want off of this stuff. I'm so close, but I don't feel like I can keep doing this. I'm emotionally worn down and my body is wrecked.

 

I started tapering in September.

 

Here's what I've done so far:

 

9-10-07: 1.4mg                   

 

9-29-07: 1.3mg       

 

10-13-07: 1.2mg   

 

10-25-07: 1.1mg     

 

11-28-07: 1.0mg     

 

12-15-07: 0.9mg   

 

1-9-08: 0.8mg         

 

1-30-08: 0.7mg     

 

2-29-08: 0.6mg       

 

3-17-08: 0.6mg      (switched doses to even out AM/PM doses)

 

4-24-08: 0.6mg      (switched doses again)

 

5-3-08: 0.6mg      (and a third time, to equal 0.3mg each dose)

 

5-19-08: 0.55mg        (0.3 day/0.25 night)

 

5-26-08: 0.50mg        (0.3 day/0.2 night)

 

I use a compounding pharmacy for my Clonazepam and I use a mg syringe for my cuts. I've been reading about people doing water titration at home. Should I look into doing it myself now that I'm on 0.5 and could get the tablets?

 

I'll do anything to make this easier and get off of this faster.

 

Any help with cuts and scheduling would be so appreciated. Thank you.

 

 

 

 

 

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Its hard to know for sure what's happening. This is often the case when withdrawing.

 

You have recently made quite big changes to your regimen, what with splitting your dose into two parts and tapering too. Maybe you just need a little more time before continuing with your taper. You could try holding off making any more changes for a week or two and see what happens.

 

Sometimes, people hit rough patches in the withdrawal, and for no apparent reason. If you do stabilise your dose for a while, and notice no improvement, then this what is happening. If you establish this to be the case, then I think there is is no option but to continue with a sensible taper. These patches are usually limited in timescale, and you may well feel better quite soon -so long as you continue with a sensible taper plan, that is.

 

Sorry I cannot be exact about this. I can reassure you though, there is nothing unusual in what you are experiencing. Benzo withdrawal is often rather unpredictable.

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Adieblue,

 

It sounds to me like you are doing everything right. Sometimes people just begin having a more difficult time at the lower doses. Its as if your body becomes hypersensitive to it, and just wants off. The fact that you seem to have a bad reaction after you dose, points to that.

Since you are already using a liquid suspension from a compounding pharmacy, there really is no reason to switch to home titration. There is though, a very small chance you are sensitive to the liquid that they use to mix it in, but since you have been ok up til now, this is unlikely.

You could consider speeding up just a tad, but that is something you have to decide. Not sure if this is what's going on, but sometimes when people begin to develop paradox or sensitivity issues, this is an option.

Then again, this may just be a "bad" cut. Everyone experiences good and bad cuts. There is no explanation to it. Your next cut could be a piece of cake.

You are almost done, and it will get better with time, so hang in there and keep moving. You are healing.  

 

didn't see your post there Colin, sorry.  :laugh:

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Hi Adie,

 

I was diagnosed with Fibromyalgia 20 years ago so I think I know what you are going through.  People with Fibro are much more sensitive to everything to begin with - we are already hypersensitive to many things including medicines. We have to deal with so many strange symptoms crowding our day that to add withdrwal symptoms seems unbearable.  I have felt this many times during my withdrwal.

 

I started to withdraw 11/06.  I was doing it alone.  My DR. told me it wasn't withdrawal, it was fibromyalgia,  I stopped seeing him.  I didn't come upon Ahston's manual 1/08, so I wasn't validated until then.  I had already made mistakes on my journey, I went up in my dosage - it has been like starting all over again.

 

But from what I read you are doing everything right.  If I could go back in time I would have worked with a compounding pharmicist as you have.  I would encourage you not to do it too fast.  And don't be hard on yourself.  I know this is difficult especially when you have a family.

 

I am looking forward tobetter days off Klonopin.  I know already that some of the symptoms I thought were fromFibro was really the Klonopin.

 

What other meds were you on for Fibro?  Amitriptilene?

 

I say this for all of us... just imagine what it will be like for all of us when we get this albatros from around our necks!!  Skys the limit!

 

Clair

 

 

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Thank you guys so much for your replies.

 

Something I've noticed is about an hour before time for my night dose, I get extremely anxious and jittery. The compulsive thoughts race and I'm "wired". I take my night dose and about a half hour later, I'm calmer, but I experience extreme nausea and drowsiness. I'm not sure what to make of this because it seems like my body is craving the drug, yet not liking when it receives it. I don't feel this way with my day dose. Any thoughts why this might be? Does this sound like my body just needs to continue with a sensible taper more or that maybe I should be off it?

 

My psychiatrist mentioned switching to something else to help with the taper, but that was when I first started in Sept. I'm incredibly hesitant to do it because I don't want trouble getting off of two things. However, if it makes it easier, I might consider it. I really don't know what I should do.

 

Right now, I feel like I'm crawling out of my skin and the depression and suicidal thoughts are pretty intense. I keep hoping for that window of good moments to find me.

 

Clair676, thank you so much for telling me about what you're going through. I often think I can't juggle these two things. It's too much sometimes.

 

I've been having terrible troubles with my hip, back and knee and even saw two physical therapists for them last month. They couldn't figure out how to help me and it's not typical fibro pain. I only recently made the possible connection to withdrawal.

 

I haven't been on any meds for fibro specifically. I was offered Amitriptilene and Lyrica, but declined them due to the stories I've heard about withdrawal from those. Even if they might help my pain, I really don't want to go through this kind of thing ever again. When I'm done, I'm done. No sense visiting hell twice!

 

Thank Colin and eljay. I was trying to do this alone, but I realize that having support is the only way to do this.

 

 

 

 

 

 

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