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Old 08-23-2009, 10:24 AM   #1
caira
 
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Need tips to prepare for Clonazepam taper

I've been waiting for almost 2 years post-Cymbalta to start the benzo taper. I was hoping that my anxiety and insomnia would be better by now.

I have been wondering whether a lot of it is rebound anxiety from taking Clonazepam for over 10 years. If Clonazepam is causing part of the problems anyway, then I know that the only way to improve my situation is to stop it. But after at least 3 failed attempts to withdraw years ago, I am still very afraid.

I work full-time and go to school. I cannot get into the shape that I was in when I tried to discontinue before.

My doctor was good about prescribing enough Cymbalta for that taper and pretty supportive of my decision; but when I've mentioned tapering Clonazepam, he hasn't been as enthusiastic. I would like to have a good plan in place before I approach him about it again.

I currently take 1mg at night and .5-1mg as needed (which I try to avoid doing).

I am so grateful for the advice that I received here about antidepressant withdrawal and tapering. I know that I would not have made it this far without the help that I got here.

Can anyone give me some advice on how to start the taper and how this process compares with an antidepressant taper?


1) Does the 10% of each last dose apply with benzos?

2) How long between drops? 3 weeks or more like with ADs?

3) Liquid or capsules?

4) If capsules: would having a compounded prescription for each drop in dose for each month be a good plan to start with?

5) What can I expect as far as insurance/flex spending account coverage for compounding?
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Old 08-23-2009, 02:54 PM   #2
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Re: Need tips to prepare for Clonazepam taper

I think the easiest way to get off Klonopin is by switching to Valium. It has a longer half-life so it leaves your body more gradually, and it is also available in 2 mg pills (.5 mg Klonopin = 10 mg Valium) which allows you to taper by cutting pills. So you would switch over to Valium gradually, and then taper by .5 mg about every 2 weeks. This is the Ashton method of benzo tapering and it worked well for me. Do a search for Dr. Heather Ashton and hopefully you will find her benzo tapering manual, which you should definitely read before starting your taper. Good luck and good job getting off Cymbalta!
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Old 08-23-2009, 09:27 PM   #3
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Re: Need tips to prepare for Clonazepam taper

There are also members here who have done tapers from benzos without having to resort to another benzo.

IMHO, I personally don't see the logic of adding another benzo to the mix while tapering...it just causes the person to taper from another drug.
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Old 08-23-2009, 09:29 PM   #4
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Re: Need tips to prepare for Clonazepam taper

Rachilina why are you tapering off both a benzo and Paxil at the same time? Just curious....the most common piece of advice I've read here is to taper the Paxil first then tackle the benzo later....
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Old 08-23-2009, 09:34 PM   #5
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Re: Need tips to prepare for Clonazepam taper

I'm working on a K taper and I switched to Valium about midway through, but it is by no means always appropriate and not everyone does okay with it...I had a very hard time with it but it seemed necessary. I had to go much much slower on the switch than is often recommended.

check out the Ashton manual...but know that all she recommends does not work for everyone. It's a very good beginning place though:

http://www.benzo.org.uk/manual/

Benzos can be very very hard to get off of...it's often necessary to do smaller than 10% cuts...I was able to do 10% at the beginning but now towards the end I'm doing much smaller cuts...

I have a page on my blog dedicated to benzo info...

check it out:

http://bipolarblast.wordpress.com/benzos/

how much K are you on?

good luck.
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Old 08-24-2009, 04:37 AM   #6
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Re: Need tips to prepare for Clonazepam taper

Amaya's Nana did this taper. You might like to click on some of her most recent posts where she talks of her taper. Good Luck!
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Old 08-24-2009, 08:23 AM   #7
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Re: Need tips to prepare for Clonazepam taper

I tapered off clonazepam by having it compounded into capsules. I went much faster than 10% every 3-4 weeks, but I didn't do it by choice; it's because my insurance didn't cover it. Other people here have had their compounded meds covered, though; you'll need to check your policy.

After 10 years, I can almost guarantee that the drug is contributing to more than relieving your insomnia and anxiety. (I reached tolerance in about a year, and by the time I'd been on it 18 months was having more adverse effects than benefits.) If you have the ability to compound and take it very slow, you may be pleasantly surprised that you actually feel better the lower in dose you go.
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Old 08-24-2009, 08:24 AM   #8
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Re: Need tips to prepare for Clonazepam taper

Quote:
Originally Posted by eileen View Post
Amaya's Nana did this taper. You might like to click on some of her most recent posts where she talks of her taper. Good Luck!
Eileen
She' still on the drug, I think.
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Old 08-24-2009, 10:32 AM   #9
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Re: Need tips to prepare for Clonazepam taper

Quote:
Originally Posted by paxilgirl View Post
Rachilina why are you tapering off both a benzo and Paxil at the same time? Just curious....the most common piece of advice I've read here is to taper the Paxil first then tackle the benzo later....
Every situation is different. In my case, I was only on the benzo for one month to deal with overwhelming Paxil withdrawal. Getting off Paxil is going to take years and I don't want to be on a benzo that whole time. Right now the Valium taper is a piece of cake; that might not be the case if I were on it for a few years.

It's true that the Valium crossover doesn't work for everyone and is certainly not the only way. What I like about it is that it allows you to control your own taper, which is harder if you're getting it compounded. You can decide, based on how you are feeling, that you'd better stay on the same dose another week or two, or that you can speed it up a bit, or make a smaller cut next time - no need to call your doctor every time you want to adjust your taper. And the longer half-life does make for a smoother taper. I tried tapering by cutting up my Klonopin pills but it was just not happening.

Best wishes Cairistiona whatever you decide.
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Old 08-24-2009, 10:45 AM   #10
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Re: Need tips to prepare for Clonazepam taper

Quote:
Originally Posted by Rachelina View Post
Every situation is different.

It's true that the Valium crossover doesn't work for everyone and is certainly not the only way.

What I like about it is that it allows you to control your own taper, which is harder if you're getting it compounded. You can decide, based on how you are feeling, that you'd better stay on the same dose another week or two, or that you can speed it up a bit, or make a smaller cut next time - no need to call your doctor every time you want to adjust your taper. And the longer half-life does make for a smoother taper. I tried tapering by cutting up my Klonopin pills but it was just not happening.

Best wishes Cairistiona whatever you decide.
Indeed to all of the above...

another GREAT thing about Valium, is if you're super sensitive, as I am, it comes in LIQUID...which means I can cut by as little as .05 mg...easily...actually I couldn't cut even smaller...right now I'm cutting at .05 mg and I'm still on 6.75 mg so it's a very very tiny fraction of a mg and there is no way in heck you can do that with Klonopin...
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Old 08-24-2009, 11:19 AM   #11
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Re: Need tips to prepare for Clonazepam taper

Thank you for all of your input. I really appreciate it.

Quote:
Originally Posted by GiannaK View Post
I'm working on a K taper and I switched to Valium about midway through, but it is by no means always appropriate and not everyone does okay with it...I had a very hard time with it but it seemed necessary.

how much K are you on?
The Valium crossover is something I am keeping in mind in case I get to a lower dose of Klonopin and things get worse. It also looks appealing because it is available in a liquid form. But I would like to at least attempt a slow taper from the Klonopin first.

I currently take 1mg at night.

Quote:
Originally Posted by texgirl View Post
After 10 years, I can almost guarantee that the drug is contributing to more than relieving your insomnia and anxiety. (I reached tolerance in about a year, and by the time I'd been on it 18 months was having more adverse effects than benefits.) If you have the ability to compound and take it very slow, you may be pleasantly surprised that you actually feel better the lower in dose you go.
I hope you're right! That would be so great. I have been wondering about this since I have been on it for so long. I feel like the only thing it is doing now is keeping me from going into withdrawal.


Quote:
Originally Posted by Rachelina View Post
Every situation is different. In my case, I was only on the benzo for one month to deal with overwhelming Paxil withdrawal. Getting off Paxil is going to take years and I don't want to be on a benzo that whole time. Right now the Valium taper is a piece of cake; that might not be the case if I were on it for a few years.
I can understand this. I can definitely see the appeal of the longer half-life and dosing options and how this could work for short-term use.

Unfortunately, I think I've been on too long and that I'm going to need to at least try to lower the Klonopin slowly before I think about switching.
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Old 08-24-2009, 11:21 AM   #12
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Re: Need tips to prepare for Clonazepam taper

Yes, it is great to see that option.

Quote:
Originally Posted by GiannaK View Post
Indeed to all of the above...

another GREAT thing about Valium, is if you're super sensitive, as I am, it comes in LIQUID...which means I can cut by as little as .05 mg...easily...actually I couldn't cut even smaller...right now I'm cutting at .05 mg and I'm still on 6.75 mg so it's a very very tiny fraction of a mg and there is no way in heck you can do that with Klonopin...
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Old 08-24-2009, 11:37 AM   #13
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Re: Need tips to prepare for Clonazepam taper

Cairistiona,
I think your reasoning is very good. I think if one can stay on the original "poison" it makes sense as you never know how you will react to a new drug...

It got seemingly impossible for me to continue on Klonopin...

Valium is still a major b-i-t-c-h but it's much easier to slow it way down...

I've known plenty of people to get off K without the switch though...so hopefully you will be one of those lucky ones.
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Old 08-24-2009, 03:28 PM   #14
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Re: Need tips to prepare for Clonazepam taper

I have the .5 Klonopins to help me wean,but how easy is the water titration?I see it mentioned on all the benzo wd websites as being effective.
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Old 08-24-2009, 03:37 PM   #15
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Re: Need tips to prepare for Clonazepam taper

I didn't like water titration...it wasn't precise enough for me...I'm very very sensitive to tapers...some people do fine with it though. I know lots of people who have used it.
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Old 08-25-2009, 04:32 AM   #16
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Re: Need tips to prepare for Clonazepam taper

If I could do it all over again I would of done the water titration.I was also on 1mg of kolonipin but I dry cut it and I had a hellish tapper followed by post acute withdrawal.Allot of people have a hard time with a crossover with valium.There are benzo forums like this one that you can go to. Good luck.
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Old 08-25-2009, 09:42 AM   #17
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Re: Need tips to prepare for Clonazepam taper

It sounds like a liquid compound would be easiest to control my dosage.


What mg to ml ratio should I ask for since I am already on 1mg?
I keep seeing "Clonazepam 1 mg/5ml oral suspension" on my web searches for compounded clonazepam.

Would that work with my taper?
My taper will be: .90, .81, .729, etc. (in milligrams)
And I'm using the Doseweights chart to convert it from 1mg to 5ml.

Substituting milliliters for grams on there, I am coming up with:
.90mg=4.5ml, .81mg=4.05ml, .729mg=3.645ml, etc.

Does that sound right?
I'm sorry for all of the questions!

I am very math challenged; but I am pretty comfortable with Excel charts.
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Old 08-25-2009, 10:58 AM   #18
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Re: Need tips to prepare for Clonazepam taper

Would this be better?

0.1mg/mL

It looks this would be ideal for cutting 10% at a time if the syringe was 10mL.
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Old 08-25-2009, 11:40 AM   #19
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Re: Need tips to prepare for Clonazepam taper

Cairostina - my doctor had the klonopin compounded into a liquid. I was on .5 mg a day for a little over 1 year when I started my taper. He compounded it to be 1 ml of liquid equaled .5 mg of the K. Tapering klonopin was physically difficult but emotionally it wasn't hard. The withdrawal was much more predictable than Paxil was for me. I'd drop, about three days later get withdrawal symptoms, and after about 3 days it would level off. I dropped no more than 10% of my current dose every three weeks or so. There were some drops I had to hold for a while. At the very end of my taper, I was prescribed a steroid for a serious sinus infection and it totally screwed me up. I had two more drops of K to go when that happened and I would've been off the crap. I suffered for several months trying to stabalize by updosing just a tad of the K to be able to function and ended up having to go all the way back up to .25 mg of K a day. I've been there for a little over a year. I just haven't had the heart to start tapering again until now. Next month, I will start water titration from the .25 and I'm hoping that I'll be able to do it without much problem.

My doctor refused to do the valium crossover for me.

I found great help and lots of knowledge at benzowithdrawal.com. Lots of nice people over there.
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Old 08-25-2009, 11:55 AM   #20
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Re: Need tips to prepare for Clonazepam taper

I did a liquid compound and it completely threw me for a loop...don't know why but I tried two different batches so I don't think it was an error in the recipe...i think somehow I simply absorbed the liquid differently...or maybe I was allergic to something in the compound...I don't know but it did not work out.

it's certainly worth a try. I was completely stumped as to why I reacted to it.
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Old 08-25-2009, 01:58 PM   #21
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Re: Need tips to prepare for Clonazepam taper

Quote:
Originally Posted by Amaya's Nana View Post
Cairostina - my doctor had the klonopin compounded into a liquid. I was on .5 mg a day for a little over 1 year when I started my taper. He compounded it to be 1 ml of liquid equaled .5 mg of the K. Tapering klonopin was physically difficult but emotionally it wasn't hard. The withdrawal was much more predictable than Paxil was for me. I'd drop, about three days later get withdrawal symptoms, and after about 3 days it would level off. I dropped no more than 10% of my current dose every three weeks or so. There were some drops I had to hold for a while. At the very end of my taper, I was prescribed a steroid for a serious sinus infection and it totally screwed me up. I had two more drops of K to go when that happened and I would've been off the crap. I suffered for several months trying to stabalize by updosing just a tad of the K to be able to function and ended up having to go all the way back up to .25 mg of K a day. I've been there for a little over a year. I just haven't had the heart to start tapering again until now. Next month, I will start water titration from the .25 and I'm hoping that I'll be able to do it without much problem.

My doctor refused to do the valium crossover for me.

I found great help and lots of knowledge at benzowithdrawal.com. Lots of nice people over there.
Thanks. That is very reassuring. The combo of emotional and physical problems with Cymbalta was overwhelming.

The info about the steroid is timely too, as I've had a lot of trouble with allergies and have been thinking about going that route. Now I know what to avoid. I'm sorry that you had so much trouble with this.

I will have to do more research on the water titration. I'm afraid of doing anything that I can really mess up.

Thanks for the link.



Quote:
Originally Posted by GiannaK View Post
I did a liquid compound and it completely threw me for a loop...don't know why but I tried two different batches so I don't think it was an error in the recipe...i think somehow I simply absorbed the liquid differently...or maybe I was allergic to something in the compound...I don't know but it did not work out.

it's certainly worth a try. I was completely stumped as to why I reacted to it.

I'll keep this in mind.

Since I've been conservative with my PRN doses, I do have some backup in case the liquid doesn't agree with me.
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Old 08-27-2009, 02:13 PM   #22
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Re: Need tips to prepare for Clonazepam taper

<Sigh>

I filled out an electronic appointment form giving the reason for my appointment and the # for the local compounding pharmacy.

I was specific about the 10% drops every 3-4 weeks.

Just now I got a call from my doctor's nurse.

She told me what they usually do -- fast taper with dry cutting.

I listened until she finished and told her that I had tried that before and had "very bad results" and this time I would like to go slowly.

She then said it was possible to make it slower and still work with the pills I have and come off in 2 months.

I then asked her if it would be possible to go even slower and compound the medication.

She said that she did speak to the people at the compound pharmacy and they said they could do it; but that's not usually how it's done.

I told her that I felt that I needed to go slowly since I have been on the med for over 10 years she said asked why I wanted to stop and I explained rebound anxiety and insomnia.

She said that since I've been on for so long I would need to be on *something*. I asked she what she meant.

She said that I would need to take *something* for the anxiety and insomnia even if I stopped Clonazepam.

I told her I was seeing a therapist for anxiety; but the taper was for the physical dependence issues.

She said that I would need to come in to discuss that.

Now I feel like I am being called in because I have become a problem and they need to talk me out of a slow taper.

So I will see the substitute doc next week since my doc won't be in on the day I am off work.

I thought I was prepared for this. I've got my spreadsheet ready and have thought very carefully about this and feel that I've received very good info here to prepare me for my taper.

It's dealing with the doc that has me rattled now. It's been 2 years since I've been challenged about my medical decisions and I'm out of practice.

I'm sorry for the rant; but I cannot talk to anyone else about this.

I know that I shouldn't be so upset; but I thought this kind of thing was over. I guess that's part of the reason I've delayed having this conversation with the doc.

Maybe it's just the nurse who has a problem with it and the doc won't give me a problem. But I'm not sure how to prepare for the worst.

Any ideas?
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Old 08-27-2009, 02:17 PM   #23
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Re: Need tips to prepare for Clonazepam taper

Quote:
Originally Posted by Cairistìona View Post
<Sigh>



Any ideas?
My only idea is to find a doc who will respect you and listen to you.

Hearing about docs like yours makes my blood boil. I'm very sorry you have to go through this.
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Old 08-27-2009, 02:47 PM   #24
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Re: Need tips to prepare for Clonazepam taper

Quote:
Originally Posted by GiannaK View Post
My only idea is to find a doc who will respect you and listen to you.

Hearing about docs like yours makes my blood boil. I'm very sorry you have to go through this.

Thanks Gianna.

I read this kind of thing on here a lot and it makes me so angry too -- esp. since I went through it with 2 different psychiatrists when I was trying to stop Cymbalta.

I was really hoping that I wouldn't have to go through it again or switch docs.

My doc (general practitioner) actually was good about supplying me with Cymbalta prescriptions and supporting me with my taper. He actually believed me about the weight gain, etc. (other docs did not).

He (and I think even this same nurse) seemed pleased when I started losing weight during or after that taper.

They seem to not be big fans of antidepressants, which worked in my favor.

Unfortunately, they don't seem as concerned with or knowledgable about benzos or benzo withdrawal. I think the nurse really thinks that she was reccomending a slow taper.

I really don't want to be told that I have to be on meds my entire life just because I have been on a benzo for 10 years.

I just wish they would give me a little credit for succeeding with the Cymbalta taper and being off for 2 years and just give me a chance to do the same thing with the benzo.

I wish there was a nice way to get this across to the doc. I'm afraid I am coming off as very unreasonable for wanting to go so slow.
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Old 08-27-2009, 02:56 PM   #25
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Re: Need tips to prepare for Clonazepam taper

Quote:
Originally Posted by Cairistìona View Post
I wish there was a nice way to get this across to the doc. I'm afraid I am coming off as very unreasonable for wanting to go so slow.
yes, I imagine that is what they think...but that is certainly THEIR problem and not yours.

I see much more tragedy among long term benzo users than I do among AD users...not that there aren't tragic stories to go all around...there are...but shear numbers of people living in hell? I see worse crap on the benzo boards...

god only knows what the real stats are given no one who is in a position to really take note and record and document is paying attention.

you stick to your guns and do what you need to do to take care of yourself.
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Drug free as of 2/09/10

recovery is slow
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