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tapering questions.


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aloha everyone and thank you plecosaur and all who helped put the tapering sticky together.

i apologize that this is lengthy and will so greatly appreciate any input in the next two weeks before i see my DO.

background --  1-1/2 years ago, dangerous life circumstances triggered majorly debilitating Social Anxiety, GAD, PTSD, OCD, and some panic. (more recently i learned that i have seven family members [no further than uncles and first cousins] with OCD.)

for most of this time i've been basically on seven .5mg klonopins/day = 3.5 mg day (i metabolize quickly and stagger them because i really feel them wear off) plus a 5mg valium (and a melatonin) at bedtime to avoid nightmares and not obsess too much when i awaken. for the rarest scariest episodes i'd take a tiny xanax.

thankfully, through changes in circumstances and great therapies (EMDR, kenisiology and acupuncture) i'm feeling MUCH less of everything but the OCD, and working successfully with that, and am ready to taper. but i'm finding some conflicting information on the process.

first is about equivalencies. i keep seeing vastly differing charts, the differences are double or more. my DO doesn't trust the charts but is open-minded. if he allows me to increasingly substitute valium for klonopin (and then taper), what is the real equivalency between the two, or can it be measured? i'll appreciate personal as well as "scientific" accounts.

also, my DO, who has been great in the past, seems either confused on this or had a mental block (i know through the grapevine he had some bad personal problems last visit). he was saying that it's better to taper by going to shorter acting benzos.    this makes no sense to me or my PsyD. i know xanax would be bad for me on a daily basis (we even tried the XR but it lasted shorter and shorter, just like the regular ones.) i'd bring him the whole ashton manual but that feels like too much, and i'd print out posts here but that might look too "street" for him.

in summary, for anyone who's had the patience to read and understand this (thank you again!) i'm looking for 1. any official or informal equivalencies between klonopin and valium and/or 2. anything concise but "official" (besides the whole ashton manual) on switching to longer-acting benzos to taper and/or (this would be an incredible gift from someone with time to spare) a suggested taper schedule from my current dosages.

on the other hand my PsyD says i can always get a pill cutter and just take a little less each time. i am confused.

thank you good crazy people. love and wellness and aloha.

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The Ashton manual is the foremost method used for successful benzo tapering. If it's long, oh well. It supposedly works. I know when I was tapering ojj klonopin, I was on1.5mgper day(3pills) and my pdoc had me decrease dose by 1/2 apill every five days. I am also a fast metabolizer, and I ended up back onklonopin.

You sound like you are on a pretty high dose and need to take it slow. Slower is better. Youaren't in a race. But I would suggest sticking with the Ashton method. Try to push it with your pdoc. mel-who does not really know what the hell she's talking about!

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aloha again and thank you both.

i did refer to the tapering plan sticky in the first line of my post -- i am just confused about differing equivalency charts, that my dosage schedule is weird, and that my doc has a false impression (or had a brain lapse) about tapering from klonopin to xanax, yikes.

and my dosage is actually much lower than the sample above, not higher.

i don't think i'll bring him the entire manual but if concensus is that the ashton equivalency chart and method are the best we've got, i'll be firm in referring to it (and maybe bring a few pages.)

thank you for slowing me down, mel! i've been paralyzed by situations and conditions so long that it's easy to transfer that feeling to the meds, as the side effects have kept me from doing so much.

all input still welcome, thank you very much. i remain veru concerned about a safe and sane way out of this frequent feeding trap.

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hi again, perhaps my questions/concerns weren't clear, as i was misunderstood twice (i must be on drugs.)

i thought i'd bump this up because i am seeing my doc this week and would really appreciate more input if possible.

thank you and aloha.

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hi again, perhaps my questions/concerns weren't clear, as i was misunderstood twice (i must be on drugs.)

i thought i'd bump this up because i am seeing my doc this week and would really appreciate more input if possible.

thank you and aloha.

<{POST_SNAPBACK}>

I found this on dr-bob.org:

Benzodiazepine Equivalence Charts

    * Brought to you by George Davidson

    * Courtesy of Felicity Plunkett

Date: Sat, 29 Jul 1995 08:29:51 -0500

From: gsdavids@chardonnay.niagara.com (Dr. George S. Davidson MB BS FRCPC)

A while ago people were interested in relative doses of benzodiazepines. This is a table which I find useful. It is difficult to compare them on the same scale since they differ in their anxiolytic, sedative, and antipanic effects, but this table provides a rough comparison useful for managing benzodiazepine taper or withdrawal. Thus, oxazepam 15 mg is roughly similar to diazepam 5 mg.

From: Clinical Handbook of Psychotropic Drugs, 4th revised edition, Bezchlibnyk-Butler et al. editors (Clarke Insitute of Psychiatry, Toronto), Hogrefe & Huber.

------------------------------------------------------------------------------------

Benzodiazepine    Comparative    Time      Half-life

                              dose        to peak

                                                plasma

                                                  level

------------------------------------------------------------------------------------

Alprazolam                  .5        1 - 2    9 -  20

Bromazepam          3.0            .5 - 4    8 -  30

Chlordiazepoxide  25            1 - 4      24 - 100

Clonazepam                .25          1 - 4      19 -  60

Clorazepate          10          variable      1.3 - 120 * (unreliable absorption)

Diazepam              5          1 - 2      30 - 200 *

Estazolam              1              .5 -  .6  8 -  24

Flurazepam          15              .5 - 1      40 - 250 *

Halazepam              40          1 - 3      30 -  96 *

Ketazolam              7.5        3.2          30 - 200

Lorazepam                1          2 4        8 -  24

Nitrazepam        2.5            .5 - 7      15 -  48

Oxazepam            15          2 - 3    3 -  25 

Prazepam            10          2.5 - 6      30 - 100

Quazepam          7.5        1.5          39 - 120 *

Temazepam        10          2.5        3 -  25

Triazolam          .25          1 - 2    1.5 - 5

                                                        * metabolites

The other, even longer, equivalency chart was also posted by a doctor and has a column entitled, "Mg equivalent to 10 mg diazepam." It doesn't have official-looking bibliographical information, though.

I still haven't found an official-looking thing justifying long-acting benzos for tapering, though. Have you tried Entrez Pubmed?

Edited to add: Tried Pubmed, haven't found it yet.

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thank you, StrungOutOnLife. i think i'm getting a better understanding of these charts, and why my doc has doubts about their usefulness, and i don't know how he's gonna deal with my schedule but i sure hope his "taper with shorter acting benzos" comment wasn't what he really meant to say.

things are worse again and i'm probably not ready to taper.  BUT the theory is still feeling important to present to my doc, as the klonopins are acting shorter and lesser on me just like the old xanax had, and i'm concerned. i apologize that i'm dragging out this thread but i'm just sick and tired of basing my sanity around the efficacy of these pills. even if i'm not ready to taper, wouldn't i be better off with a longer-acting benzo??

at this point i'd most appreciate personal accounts from anyone who understands anything i'm experiencing or concerned about, and any further suggestions.

thank you all, aloha nui loa.

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Just my experience Freedom, but my pdoc did not want me on the Valium because of its long half-life. She preferred klonopin whose half life is still fairly long. I never had a problem starting or stopping the Valium I could cold-turkey it anytime and it never had any side effects/withdrawal problems.

I have been on and off klonopin several times. One time I did have to cold-turkey the klonopin and I had definite withdrawal problems (very shaky, couldn't eat anything without getting sick). I am back on klonopin now 2-3mg a day depending on the day. I also find that sometimes the klonopin poops out in the middle of the day despite its fairly long half-life. My pdoc doesn't really see this as possible due to its half-life but I do feel it wearing off and have to take it in divided doses. On bad days I bumped up to 3mg. I have GAD and PTSD, plus BP, and there are times when my anxiety or social anxiety are so bad that I will occasionally take 5-10mg of Valium as an add on to the klonopin. But I am very careful about taking the Valium. Altough I have not expereinced the problem, for may people Valium can become addciting.

Don't know if any of that helps. Just sharing a personal experience.

Erika

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Bless you, Erika.  sometimes it helps to just hear a similar experience. i couldn't cold-turkey the klonopin, i'm a basket case enough when it wears off after 4-5 hours. your pdoc seems to have the same philosophy as my DO, yet your experience seems to match with the ashton theory (on which my PsyD and my intuition agree). the klonopon roller coaster is making me crazy, as if i weren't anxious enough! i feel like a longer and steadier halflife with a gradually decreased dosage would be best.

i printed out the ashton stuff about why go to longer halflife before tapering and i hope my DO "gets" it.

i should mention that unresolved external stuff resurfaced and re-triggered me, which is why i'm not ready to taper, and still need all day "protection". i already had a car accident from being stressed, i still have nightmares, etc., so until i'm better on my own i need drugs.

sorry to rant and i thank you again for your sharing your experience.

i can't imagine valium being more addicting than xanax or klonopin but once again all input is welcome. i just wanna function best i can and get off this stuff as smoothly as possible when the time comes.

aloha.

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