Posted by Ame Sans Vie on August 22, 2003, at 11:19:47
In reply to Re: Lou's reply to cubbybear's post -BZDWD » Lou Pilder, posted by cubbybear on August 21, 2003, at 9:24:15
I'm certainly glad to read that you know better than to go cold turkey off of a benzodiazepine. The mild discomfort of a proper tapering schedule is nothing compared to the possibility of convulsions and death from discontinuing at such a "high" dose of Klonopin (I know it's a fairly low dose by many standards, but not when you consider that's it's roughly equivalent to 30mg Valium or 3mg Xanax). Other than the way you're doing it, the *ONLY* safe way to discontinue is to substitute it with a long half-life benzo or barbiturate. No ifs, ands, or buts about it. If someone recommended to you in person that you quit a benzodiazepine cold-turkey like that and you were to die because of it, I'm pretty sure that person could be prosecuted for practicing medicine without a license. The same would most likely hold true for internet advice -- familiar with the "Ripper" story? The kid who OD'd live on his webcam on methadone, propranolol, clonazepam, mushrooms, and pot while the other kids in the IRC chat egged him on? Well last I heard, the family is following through with prosecution. Same principle.
Anyway, I'd do one of three things if I were you:
1. Keep decreasing the dose in the manner you currently are, and add on 500mg niacinamide four times a day (or 1500mg extended-release niacinamide twice daily), anywhere from 1-100mcg melatonin before bed (whatever works best), and take a powerful herbal preparation as necessary (i.e. valerian root, passion flower, kava kava, California poppy -- preferably in liquid form).
2. Substitute phenobarbital for the clonazepam during the withdrawal. The procedure normally goes like this: For the first week, a dose of phenobarbital equivalent to the dose of the benzodiazepine you're taking is given divided into four equal doses daily -- 1.5mg of clonazepam is equivalent to 90mg phenobarbital. So, you'd start with 22.5mg four times daily (qid) for the first week. The second week, decrease the dose by 5% -- thus, 85.5mg phenobarbital, divided into 21.375mg qid. Third week, you'd decrease another 5% -- 20.25mg qid. Fourth week, 19.125mg qid; fifth week, 18mg qid; sixth week, 16.875mg qid; seventh week, 15.75mg qid; eighth week, 14.625mg qid; ninth week, 13.5mg qid; tenth week, 12.375mg qid; eleventh week, 11.25mg qid; twelfth week, 10.125mg qid; thirteenth week, 9mg qid; fourteenth week, 7.875mg qid; fifteenth week, 6.75mg qid; sixteenth, 5.625mg qid; seventeenth week, 4.5mg qid; eighteenth week, 3.375mg qid; nineteenth week, 3.25mg qid; twentieth week, 2.125mg qid; twenty-first week, 1mg qid. This last small amount would most likely be withdrawn at a rate of 0.125mg every week or two, depending on your personal comfort level. So obviously, because such large doses are needed for phenobarbital as compared to clonazepam, each decrease in dose is extremely small and should cause no discomfort whatsoever -- each 5% decrease is 1.125mg of phenobarbital, which is equivalent to less than 1/50 mg of clonazepam. Of course, phenobarbital in capsule or tablet form only comes in 8, 15, 16, 30, 32, 60, 65 and 100mg sizes, so for accurate dosage measurements, an elixer can be used. Elixers are available that contain either 15 or 20mg of phenobarbital per 5ml, allowing for exact dosing.
3. Substitute Valium (diazepam) or Tranxene (clorazepate) for clonazepam -- preferably Tranxene, whose half-life is about twice as long as Valium's. 60mg clorazepate or 30mg diazepam is equivalent to 1.5mg clonazepam. The tapering schedule would be basically the same as for phenobarbital, except that diazepam would be spread out in five doses over the course of the day instead of four. In the case of clorazepate:
Week 1: 15mg qid
Week 2: 14.25mg qid
Week 3: 13.5mg qid
Week 4: 12.75mg qid
Week 5: 12mg qid
Week 6: 11.25mg qid
Week 7: 10.5mg qid
Week 8: 9.75mg qid
Week 9: 9mg qid
Week 10: 8.25mg qid
Week 11: 7.5mg qid
Week 12: 6.75mg qid
Week 13: 6mg qid
Week 14: 5.25mg qid
Week 15: 4.5mg qid
Week 16: 3.75mg qid
Week 17: 3mg qid
Week 18: 2.25mg qid
Week 19: 1.5mg qidThe last 1.5mg would be decreased by 0.25mg each week or two. And once again, an elixer should be used -- though I believe you'd have to have one specially made at a compounding pharmacy.
The phenobarbital/switching benzos options seem the most promising, though whatever you decide, I wish you luck!
poster:Ame Sans Vie
thread:252411
URL: http://www.dr-bob.org/babble/20030818/msgs/253091.html