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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Janelle on May 25, 2003, at 20:47:15
Hi all -- I have had yet another series of horrendous mood swings in my bout with BiPolar2. I discovered that for some odd reason, Buspar HELPS me (my pdoc wanted to reduce the number of meds I'm on, started by taking me off Buspar, it was a disaster so I'm back on it and feeling somewhat better) -- the next med he wants to remove is Klonopin, which I have been on for like 10 years and I could swear after the first year or so, I became habituated to it and it has NOT worked one iota for me. Case in point: in the hospital about a year ago I couldn't sleep (chronic insomnia at the time) so they gave me like 8 mg of Klonopin - NOTHING. I was WIDE AWAKE and the nurses let me watch a video at 2:30 in the morning! When I told this to the pdoc the next day he was astonished and said if he had been given that dose of Klonopin, he'd have been on the floor konked out!
Anyway, with the Klonopin, I'm currently taking 1mg in the am (breakfast time) and 1 mg in the pm (bedtime) -- I will be seeing my pdoc fairly soon, but I cannot stand taking this stuff which does not help me. When I went off Buspar recently, then crashed, Klonopin did NOTHING to ease the anxiety I had, which was HIGH.
I want to start tapering off Klonopin ASAP, and if anyone has a reasonable idea for a taper schedule (I know it's a benzo, but the least addictive of them, but I've been on it a long time) I would appreciate it if you would present it to me under here. Thanks.
Posted by Squiggles on May 25, 2003, at 21:03:51
In reply to HELP! Need TAPER schedule for KLONOPIN asap!, posted by Janelle on May 25, 2003, at 20:47:15
Hi Janelle,
I imagine that after the very emphatic
and litigious efforts of the benzo.org
group, the doctors and/or pharmacists may
now be more aware of the difficulty of
getting off Klonopin. At least I hope so.
I am always talking about myself and it
is probably tiresome, so i will not tell you
just how surprisingly difficult it was for me.I tried cutting 1.0 over a year and a half or
two by cutting the pills in tiny bits - it did
not work for some reason (maybe other than
the drug). *But* I will tell you that the
benzo group following Ashton and Ray Nimmo's
advice, insisted that it cannot be done with
ease, unless a substitute benzo is provided
to smooth out the dense nature of Klonopin --
Valium being the most advised. If you
subscribe there you may find schedules as
the site is devoted to benzo withdrawal and
coping with benzo addiction.I would be very curious to hear more
suggestions here, from people who know
meds.Squiggles
Posted by BekkaH on May 25, 2003, at 22:13:33
In reply to HELP! Need TAPER schedule for KLONOPIN asap!, posted by Janelle on May 25, 2003, at 20:47:15
Hi Janelle,
I don't know about Klonopin in particular, but I've read that when tapering off of psychotropic drugs in general, it is best to reduce the drug by NOT MORE THAN 10 percent per week. When you get down to the last week or so, it helps to stretch that last interval out even farther. Ask your doctor whether Klonopin comes in liquid form. I find it's easier to take minute amounts of a medicine when they are in liquid form. You can buy one of those medicine droppers. I bought a 1.0 milliliter oral syringe when I tapered off a medication. I think it was made by a company called "Ezy Dose."
Posted by Squiggles on May 25, 2003, at 22:55:54
In reply to Need TAPER schedule for KLONOPIN - Janelle, posted by BekkaH on May 25, 2003, at 22:13:33
Here is a reliable source of information
for withdrawal strategy from benzodiazepines:The Merck Manual:
http://www.merck.com/pubs/mmanual/section15/chapter195/195d.htm
Squiggles
Posted by Willow on May 25, 2003, at 23:03:38
In reply to HELP! Need TAPER schedule for KLONOPIN asap!, posted by Janelle on May 25, 2003, at 20:47:15
My psychiatrist on last visit informed me that I would experience bad effects whenever I change something drastically. She said when it is time for me to come off a medication, including clonazepam, to take regular dose one day ~ second day take half the regular dose ~ next day back to regular dose and then be on the half doseage for a week and keep repeating. Let us know how you manage to cope with leaving this med behind. Right now I'm not at that stage, but she had mentioned cutting it out in several months.
Regarding your insomnia during hospital "visit," I think once we reach the point you were at what would normally bring a grown man down doesn't work, because it isn't a normal situation. The last time I was in that position I swear the drugs made me worse, what helped was a nurse massaging my lower back until I fell asleep. It wasn't a peaceful sleep according to roommates but it was sleep.
BEST WISHES
Whispering Willow
Posted by Janelle on May 26, 2003, at 1:06:45
In reply to Re: HELP! Need TAPER schedule for KLONOPIN asap! » Janelle, posted by Squiggles on May 25, 2003, at 21:03:51
Thanks for the info, folks! Believe it or not, I was SUCCESSFULLY tapered OFF d@mn Klonopin almost a year ago, then was forced (long story) to switch pdocs and got a WITCH who put me right back on it at TWICE THE DOSE. Was too weak and out of it to fight her. Believe it or not, at that time it was NOT HARD to get off 1mg/day. But now I've been on frigging 2mg/day for almost a year. Well, my current pdoc has been a doll up to now, so he had better have a taper schedule for me or else ... LOL! Seriously, I will take myself off this med in small increments and suffer the consequences if he won't help me. Sorry, but I had to vent. I WANT OFF THIS USELESS (for me, anyway) MED!!!
Posted by Snoozy on May 26, 2003, at 1:52:02
In reply to I am DISCOURAGED but DETERMINED !!, posted by Janelle on May 26, 2003, at 1:06:45
Hi Janelle -
I hear you on the withdrawl. I've had some pretty messed up pdoc situations, but I don't think it ever screwed up my meds.
I was nervous when I was tapering off Xanax - I'd seen some of those tv newsmagazine pieces that were, shall we say, alarmist? I went really slowly and was surprised it wasn't bad.
I hope if you have any negatives from withdrawl, they're more than made up for in gaining some alertness. I'm rooting for you!
> Thanks for the info, folks! Believe it or not, I was SUCCESSFULLY tapered OFF d@mn Klonopin almost a year ago, then was forced (long story) to switch pdocs and got a WITCH who put me right back on it at TWICE THE DOSE. Was too weak and out of it to fight her. Believe it or not, at that time it was NOT HARD to get off 1mg/day. But now I've been on frigging 2mg/day for almost a year. Well, my current pdoc has been a doll up to now, so he had better have a taper schedule for me or else ... LOL! Seriously, I will take myself off this med in small increments and suffer the consequences if he won't help me. Sorry, but I had to vent. I WANT OFF THIS USELESS (for me, anyway) MED!!!
Posted by cubbybear on May 26, 2003, at 8:33:37
In reply to Need TAPER schedule for KLONOPIN - Janelle, posted by BekkaH on May 25, 2003, at 22:13:33
> I don't know about Klonopin in particular, but I've read that when tapering off of psychotropic drugs in general, it is best to reduce the drug by NOT MORE THAN 10 percent per week. When you get down to the last week or so, it helps to stretch that last interval out even farther.
Hey, this is very scary to me. I'm in the process of tapering down-- presently at 2.5 mg. and decreasing by only .125 mg. per wk. Now when I get down to .5 mg, let's say, if you're advised to decrease by no more than 10%, that would mean I'd have to remove .05 mg from the pill, am I right? How in the world do you cut off something so small, even with a pill cutter? It sounds like we're dealing with just crumbs here. Somebody please explain.
Posted by Squiggles on May 26, 2003, at 8:40:06
In reply to Re: Need TAPER schedule for KLONOPIN - Janelle » BekkaH, posted by cubbybear on May 26, 2003, at 8:33:37
When i first tried to withdraw from Klonopin,
my doctor told me that if i went to a pharmacist
i would be able to get a liquid preparation.
I know someone from the benzo group who tried
that successfully. There are, as the Merck states
the factors of dose and time taken.The reason I did not go to a pharmacist to get
a liquid preparation as my dr. suggested, was
that i was very uncomfortable with stories of
dropping the stuff on the floor, etc. or
miscalculating.I used a calculator my husband devised (the
Chunk-0-meter) but we removed it from the group
as even this very cautious decremental schecule
led to disastrous results IN MY CASE. I don't
wish to speak for everyone and as i said the
factor of how long you have been taking the drug
is very important.Squiggles
Posted by stjames on May 26, 2003, at 13:38:44
In reply to HELP! Need TAPER schedule for KLONOPIN asap!, posted by Janelle on May 25, 2003, at 20:47:15
-- the next med he wants to remove is Klonopin, which I have been on for like 10 years and I could swear after the first year or so,
What does your doc suggest for a taper schedule ?
Posted by Janelle on May 26, 2003, at 15:04:24
In reply to Re: HELP! Need TAPER schedule for KLONOPIN asap!, posted by stjames on May 26, 2003, at 13:38:44
I was trying to see if anyone here had any direct experience with tapering off Klonopin before I see him (in about 10 days).
He had said something in last appointment about going from 1mg am to .5 mg am and doing the same reduction at pm (1mg to .5 mg) but I don't know how long I'd do that for and the if I'd have to cut the 1mg pill in half again to get it down to .25 mg. Or maybe he'd give me a prescription for .5 mg and I could more easily cut that into .25mg, but something tells me he will have me go from 1.0 mg twice a day to .5 mg twice a day for who knows how long, to stopping the am dose for awhile, then stopping the pm dose, and being off this cr@p for good. He is NOT into microdosing for tapering and I honestly do not think I will have a problem with what I've mentioned here because the hosptial pdoc had me do something similar when I tapered off 1mg/day. She had me on .5 mg/day for awhile then took me off completely and I had no withdrawal problems at that time.
It's the fact that I'm on double the dose I had been on that kinda scares me.
Posted by BekkaH on May 26, 2003, at 19:48:30
In reply to Re: Need TAPER schedule for KLONOPIN - Janelle » BekkaH, posted by cubbybear on May 26, 2003, at 8:33:37
Hi Cubbybear,
The "not more than 10% per week" is not written in stone. It is just a suggestion to make the process of withdrawal a little easier. If the medicine is decreased in nearly imperceptible increments, the withdrawal will be less painful.
Some people have no trouble tapering faster, while others may rebound or have other complications if they taper too fast. Also, remember that you should not discontinue benzodiazapines too quickly. I know about the difficulty of having crumbs from trying to cut medicines. That's why I suggested getting a liquid form of Klonopin, if it is available.
Posted by cubbybear on May 27, 2003, at 1:13:01
In reply to TAPER schedule for KLONOPIN - cubbybear, posted by BekkaH on May 26, 2003, at 19:48:30
> Hi Cubbybear,
>
> The "not more than 10% per week" is not written in stone. It is just a suggestion to make the process of withdrawal a little easier. If the medicine is decreased in nearly imperceptible increments, the withdrawal will be less painful.
> Some people have no trouble tapering faster, while others may rebound or have other complications if they taper too fast. Also, remember that you should not discontinue benzodiazapines too quickly. I know about the difficulty of having crumbs from trying to cut medicines. That's why I suggested getting a liquid form of Klonopin, if it is available.thanks for your info, Bekka, I don't know ig the Klonopin is available in liquid form here; I live in Thailand (plan to return to the U.S. hopefully within the next few months). I somehow doubt if it is.
Posted by judy1 on May 27, 2003, at 13:18:28
In reply to HELP! Need TAPER schedule for KLONOPIN asap!, posted by Janelle on May 25, 2003, at 20:47:15
I've tapered off klonopin many times (pregnancy, etc.) and what worked for me was the 10% taper (like Bekka said), giving my body a few days-week to get used to it before moving on. once I was in the low doses- .125mg or .25mg (coming down from 6mg/day)- I stopped. I had some anxiety and insomnia, but nothing horrendous, and would increase my support from my therapist. hope this helped-judy
Posted by brianw68 on May 28, 2003, at 10:04:12
In reply to HELP! Need TAPER schedule for KLONOPIN asap!, posted by Janelle on May 25, 2003, at 20:47:15
Hi all:
Background: I Started on Klonopin back in December, quickly ramped up to 2.5 mg/day (1 mg in the AM, 1.5 mg in the PM). In February, I began to become tolerant to the effects. At the beginning of April, I began taking Buspar, and have ramped up to 60 mg/day. Two weeks ago, Ibegan my Klonopin taper.
My doctor's view on Klonopin tapering... the slower, the better. I had asked him about a taper schedule of 0.5 mg/week. He said for the first week, removing 0.5 mg (1 pill) would probably be okay, but after that, he wanted me to go in 0.25 mg (half-pill) increments, and with each decrease, stretch out the time in between a little bit. The idea was to make the taper a curve rather than linear, if that makes sense.
First: - eliminated 0.5 mg from PM dose. Experienced 1 or 2 nights of sleep disturbance, but o.w. OK.
Eight days later: eliminated 0.25 mg from AM dose. No problems.
Next step: in two or three days, will eliminate 0.25 mg from PM dose.
Will continue to alternate eliminating half-pills from AM and PM doses, with intervals in between going something like 10 days, 15 days, 20 days, etc. When I get down to my last 0.5 mg/day, I may even taper that down with quarter-pill doses.
All I can say is, so far so good. I believe the Buspar is helping to mitigate the rebound anxiety. Also, I run, which helps tremendously; I do as much of that as my bodily fatigue will allow.
Good luck!
Brian
Posted by cubbybear on May 28, 2003, at 11:47:48
In reply to Re: HELP! Need TAPER schedule for KLONOPIN asap!, posted by brianw68 on May 28, 2003, at 10:04:12
>
> My doctor's view on Klonopin tapering... the slower, the better. I had asked him about a taper schedule of 0.5 mg/week. He said for the first week, removing 0.5 mg (1 pill) would probably be okay, but after that, he wanted me to go in 0.25 mg (half-pill) increments, and with each decrease, stretch out the time in between a little bit. The idea was to make the taper a curve rather than linear, if that makes sense.
>
> First: - eliminated 0.5 mg from PM dose. Experienced 1 or 2 nights of sleep disturbance, but o.w. OK.
>
> Eight days later: eliminated 0.25 mg from AM dose. No problems.
>
> Next step: in two or three days, will eliminate 0.25 mg from PM dose.
>
> Will continue to alternate eliminating half-pills from AM and PM doses, with intervals in between going something like 10 days, 15 days, 20 days, etc. When I get down to my last 0.5 mg/day, I may even taper that down with quarter-pill doses.Brian--this sounds pretty good --it seems that different people have their own or their pdoc's special formula for the process. I'm presently at 2.5 mg.; yet instead of stretching out the time intervals, as you're doing, I've decided to taper at the rate of .125 mg once a week (using a pill cutter.) If I run into problems, I'll backpedal and stay on the previous dose longer.. I don't care if this takes months to complete--I just don't want to encounter any more withdrawal anxiety and insomnia. It's a real bummer! Good luck to you too.
>
>
Posted by Tony P on May 30, 2003, at 8:20:40
In reply to Re: HELP! Need TAPER schedule for KLONOPIN asap!, posted by brianw68 on May 28, 2003, at 10:04:12
I have tapered from klonopin, Ativan & others, using two quite different regimes prescribed by Drs., plus the homegrown hit-or-miss system "I'll only Take it if I Need it" (also known as the bad method).
Nearly everybody suggests switching to Valium for the tapering;
a) for the smoothest ride
b) because Valium is available in smaller dose tablets than most others.
c) it's cheaper than most.
Both Valium & Klonopin have long half-lives so b) is the important issue here. I've copied a table of generally-agreed equivalent doses (YMMV!) at the end of this post; there are several on the web.1) (suggested by my MD) Using Valium 10 or 5 mg tablets, drop the dose by 5 mg every 2 weeks, or even 2.5 mg every 2 weeks. You could switch to 2 mg tablets toward the end and even split those for the smoothest drop-off.
2) (used by an in-patient treatment centre):
Start with valium 5 or 10 mg (q.s.) 4 times a day, decrease Valium dose by 5 mg every 4-5 days; when down to 20 mg/day start dropping one dose every 5 days, finishing with just the bedtime dose, then stop after 5 days. Much faster - in a safe environment with 24-hr nursing & counselling available. I found it pretty painless during the actual detox, esp. having already tapered down to 2mg Ativan, but in the next 3 months still lived with a high level of anxiety - hard to say how much was continuing withdrawal symptoms and how much other aspects of treatment process!Tony P
------------------------------------
*Equivalent doses of benzodiazepines
------------------------------------
Xanax (alprazolam) 0.5
Librium (chlordiazepoxide) 25
Valium (diazepam) 10
Ativan (lorazepam) 1
Mogadon (nitrazepam) 10
Serenid (oxazepam) 20
Normison (temazepam) 20
Halcion (triazolam) 0.5
------------------------------------
Note: these equivalents are approximate and adjustment to individual requirements may be necessary.
------------------------------------
*Quote from The Ashton Manual • Professor Ashton's Main Page • www.benzo.org.uk
Posted by Squiggles on May 30, 2003, at 8:36:08
In reply to Re: HELP! Need TAPER schedule for KLONOPIN asap!, posted by Tony P on May 30, 2003, at 8:20:40
Thanks for this Tony. The Valium substitution
carries more weight coming from more than one solitary
voice. Infact, my dr. agreed i could do that
after the seizure/stroke thingy i had, but
i am too medically jaded and have taken the
K for 15 or 17 yrs., to try another experiment.I think others who have been on it less time
will have better luck.Squiggles
Posted by Squiggles on May 30, 2003, at 9:54:06
In reply to Re: HELP! Need TAPER schedule for KLONOPIN asap! » Tony P, posted by Squiggles on May 30, 2003, at 8:36:08
What about Dr. Bob's theory of
the subdural epileptoid syndrome?
The two theories clash, n'est pas?Just wondering, because some researchers
have proposed that bipolar is a species
of epilepsy (e.g. the Poppoulos au pair);
i don't know anything about epilepsy except
that it's horrible - i witnessed a case when
i was a child. Also, i have read that anti-convulsants
like Klonopin (Rivotril) are given to beepers
for that reason.It looks like it's still controversial and not
settled.Squiggles
This is the end of the thread.
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