LotusRising: Buspar, Ativan

[LotusRising]

@FrogieI like the final daily dose amount decrease of 3.49% What would it look like if we changed only the 1300/1700 doses. I’m sorry, struggling with the math right now. 

[LotusRising]

I’d also like to get that 1700 dose a bit smaller. It’s usually as the day goes on that everything gets worse. 

[Frogie]

You are no trouble at all! Don't think that for a minute.

 

If you did this decrease, it would be 1.655% total from .2175 to .2139

0500  0.055

0900  0.050

1300  0.048

1700  0.0609

 

If you did this decrease, it would be 1.51% total from .2175 to .2142

0500  0.055

0900  0.050

1300   0.048

1700   0.0612

Edited November 24, 2021 by Frogie

[LotusRising]

@Frogie

 

Ok, this is the best I think I can do with the 1mL syringe that I have.

 

I believe it's a 3.4% decrease

 

0500      0.055

0900      0.05

1300       0.045

1700        0.055

 

equivalent to .205mg/day

 

Sound reasonable?

[Frogie]

@MedRN

 

That sounds reasonable other than going down to 0.055 from 0.0625 at 1700. That's a huge decrease.  But you could try it and see how you do😊 it's an overall decrease of 5.747%, but from 0.0625 to 0.055 is a 12% decrease.

Edited November 24, 2021 by Frogie

[LotusRising]

@Frogie Ok, would 0.06mg be better for 1700 then?

[Frogie]

@MedRN

I think that would be more reasonable. It would only be a 4% decrease. Is that ok with you? It would be an overall decrease of 3.44%. That sounds very reasonable and hopefully it will help.

Edited November 24, 2021 by Frogie

[LotusRising]

Yes, sounds worth trying for sure. I would just like some relief. Thank you @Frogiefor all your time in this today. I’m feeling frazzled with lack of sleep. I wonder in future if the brass monkey way might work for me in the future. I need to do more reading on this one.  I seem to stabilize and then quickly go into paradoxical reactions with my decreases. 
 

thanks again and I will post my notes tomorrow. 

[Frogie]

You're very welcome. I didn't mind helping you at all. I hope it brings you a little relief. Once you are stable, the Brassmonkey Slide is easier on your system because you aren't tapering 10% all at once. You taper 2.5% a week with a 2 week hold. 

[Frogie]

@MedRN

 

Just wanted to check in on you.

[LotusRising]

Hi @Frogie Just dealing with the extreme tightness in my upper body muscles and waiting on my 1700 dose to peak, to see what it brings about. 

[Frogie]

Hopefully it will start to subside.

 

Sleep well😊

[LotusRising]

Thank you @Frogie  you as well. 

[LotusRising]

@Frogie @Altostrata 

 

I slept  Woke with some anxiety, knowing I made a reduction, but so thankful for some sleep. Thanks again for all your help yesterday @frogie. You were a lifesaver on a very tough day for me.

 

Here are my notes for Nov 24 Day 1 of reduction 3.4%

 

0500                 clonaz 0.055mg

0500-0730.      still feeling restless, agitated, energized

0800                 tinnitus 1-2/10

0900                 clonaz 0.05mg

                          still restlessness - eased up a bit after a bath

                          burning to scalp/neck

0945                 feels like adrenaline increasing, stomach area very tightened up

1020                  feeling worse, tightness all over body

                          yawning, but still feeling energized

1130                   passing panic

1230                   chest extremely tight 5-6/10

1300                   clonaz 0.045mg

1415                    tightness gone

1515                    tightness still gone, when I close my eyes I feel dizzy, can't sleep

1630                   tightness starting to chest, moving to neck for about an hour

1700                   clonaz 0.060mg

1800                  neck released, but tightness moving into torso 3-4/10

1900                  moving to chest, neck, diaphragm area

2015                 in bed after bath, some brief chest anxiety - anticipating sleep

2330-0250     fell asleep and woke briefly, back to sleep

0500                woke with pit of stomach anxiety 1/10                                     

[Frogie]

@MedRN

 

I'm so glad you were able to sleep. It's truly a wonderful feeling.

 

Hopefully this decrease will help. Just like you said, you may have some situational anxiety just knowing what's going on, but I sure hope we got your body to settle some now.

 

I'm here to help when you need it. May be off today because it's Thanksgiving here in the US, but you enjoy your day!

 

Take care,

Frogie xx

[LotusRising]

@Frogie @Altostrata

 

Looks as though I'm back to no sleep. Lots of muscle tightening and can't release them. Hardly getting a break. I seem to be really sensitive to any kind of change in dosage. I have no idea what my body is trying to say anymore. Did we go too slow, or too fast in the reductions? Adrenaline surges and tightness seem to be coming like clockwork with when the medication peaks. I'm having trouble getting muscle relief even with baths and massage.

 

Day 2 Nov 25 3.4% reduction

 

0500                  clonaz 0.055mg

                           pit of stomach anxiety 2/10, tinnitus 2/10

0700-0830.       anxiety to 2-3/10, breathing

                           nerves twitching/tightening in arms

0900                  clonaz 0.05mg

                           pulling tension in upper arms

0930                  tightening into chest 1-2/10

1200                   chest tightening and moving into arms

1300                   clonaz 0.045mg

1400                   chest tightening again, blurry vision, restless

1600-1630         neck tightening and moving into diaphragm

1700                   clonaz 0.06mg

1945                   tinnitus1/10

2000                   chest/arms tightening 3-4/10

2115                    bath, massage, into bed

2215                    nerves twitching in arms and chest, starting to tighten, tinnitus 2/10, anxiety 2/10

2330                   surge of adrenaline, anxiety 6-7/10, tinniitus 2/10

0030                   adrenaline surge and tinnitus continues

0200                   surge seems to have stopped

0230                   tinnitus 2/10

0300                   extreme muscle tightness 6/10, dizziness when eyes closed

                            startling when eyes are close and falling asleep.

 

[Frogie]

@MedRN

 

I think at this point you need to hold. You have been up and down so much your body doesn't know what to do.

 

Unfortunately, just do a lots of self care, fresh air, no TV or computer a couple hours before bed, you could try a little melatonin again and see what might happen. Don't take more than 0.3 mg. That is the sweet spot for about everyone I've read.

 

I know it's hard not sleeping, I'm lucky if I get 3-4 hours a couple nights a week. It certainly wears on you.

 

Take care,

Frogie xx

[Altostrata]

How is your symptom pattern different before and after you take the 5 a.m. dose? We need to see your symptom pattern before and after each dose.

 

I'm with @Frogie, we're not getting anywhere fine-tuning your dosing according to symptoms. Your holding for a while to get to a baseline symptom pattern is necessary for a clearer picture.

[LotusRising]

@Altostrata yes I understand. I am reacting to all doses currently. I am in a permanent state of tightness and adrenaline surges. It builds in intensity/severity throughout the day. I have had 2 15-30min windows without symptoms so far today. 

[LotusRising]

@Altostrata @Frogie pretty consistently tightening in chest/torso within one hour of taking my dose and then going into adrenaline surge following that. This has happened all day yesterday and today. I had a brief reprieve when we changed my dosing on Nov 24, when we lowered it. 
 

Extremely tight before my 500 am dose today. When I close my eyes, I am dizzy, I’m assuming from all the adrenaline. My biggest dose is at night, which is likely not helping matters. I know you’d like me to hold, but wondering if the 1700 dose is too high. 

[LotusRising]

@Altostrata @Frogie I am a pretty strong person, but feel like I am barely tolerating my symptoms. I am getting in the bath multiple times a day and having someone massage me, and still getting very little relief. 

[Frogie]

@MedRN

 

I hate to see you lower more within just a couple of days. 

 

Can you try to hold a couple more days and see what happens?

Edited November 26, 2021 by Frogie

[LotusRising]

@Frogie I totally understand what you’re saying and the importance of holding. But I have been extremely uncomfortable yesterday and today. When the tension is unrelieved, it is concerning and I wonder about taking this next dose as it is. 

[LotusRising]

@Frogie I don’t know if I can hold for a couple more days. My muscles are so tight I can barely walk and it gets progressively worse throughout the day with more intense surges and tightness. 

[Frogie]

@MedRN

 

You could try a tiny, tiny decrease if you feel it's absolutely necessary

[LotusRising]

@Frogie if I can hold out tonight, is 3 days worth of notes enough to see a symptom pattern? I’m really struggling to make a decision here, but I’m very uncomfortable. It is not even the insomnia that bothers me, it’s the intense amount of tension around my torso and chest and the inability to release it. 

And what would a tiny decrease be?

[Altostrata]

@Frogie could be that clonazepam is simply too strong. MedRN perhaps should consider replacing it with diazepam once a day.

 

This is what you were thinking only on Wednesday:

 

On 11/24/2021 at 12:11 PM, MedRN said:

@Frogie

 

Ok, this is the best I think I can do with the 1mL syringe that I have.

 

I believe it's a 3.4% decrease

 

0500      0.055

0900      0.05

1300       0.045

1700        0.055

 

equivalent to .205mg/day

 

....

 

Personally, I would have liked to see you taking 0.05mg for each dose, to lessen chances of a mistake. 

 

The 4 doses build up in your drug plasma level throughout the day. It could be the 5 p.m. dose is too high, but the others could be too high as well.

 

I never understood why 4 doses within 12 hours and zero in the other 12 hours. This has the effect of front-loading the clonazepam plasma level with the elevation in the curve skewed after 5 p.m.

 

Going by your symptom pattern, you have a plasma blood level curve markedly skewed after 5 p.m., when what we want is a level curve. If paradoxical reactions are occurring all along, this is a formula for no sleep.

 

Then it would decline overnight to the nadir prior to your 5 p.m. dose. Then the question is, do you get withdrawal symptoms overnight? These would be most marked PRIOR to your 5 a.m. dose.

 

This is all the information I have about what happens overnight:

9 hours ago, MedRN said:

1700                   clonaz 0.06mg

1945                   tinnitus1/10

2000                   chest/arms tightening 3-4/10

2115                    bath, massage, into bed

2215                    nerves twitching in arms and chest, starting to tighten, tinnitus 2/10, anxiety 2/10

2330                   surge of adrenaline, anxiety 6-7/10, tinniitus 2/10

0030                   adrenaline surge and tinnitus continues

0200                   surge seems to have stopped

0230                   tinnitus 2/10

0300                   extreme muscle tightness 6/10, dizziness when eyes closed

                            startling when eyes are close and falling asleep.

 

Clonazepam peak plasma within 1 to 4 hours. It appears the peak of your drug plasma level occurred about 2300 hours, 6 hours after you take the dose. (This would not be out of bounds for peak plasma, which is an average.)

 

About 2300, hours you also start to get a peak in paradoxical reaction. At about 0200, drug plasma level starts to decline, the intensity of the paradoxical reaction declines with it.

 

It appears on the downslope at 0300, the paradoxical reaction relaxes enough to allow you to get a little sleep.

 

Since you don't report anything significant happening at 0430, I do not see a pattern of withdrawal overnight. You still have enough clonazepam in you to continue a paradoxical reaction. 

 

It appears to me that you are overdosing within the 12 daytime hours, with paradoxical reactions, this continues predictably until the drug blood plasma level decreases a little 5 hours after your last dose, when some of the dosage load is metabolized -- but you are still overdosed.

 

Then you start the cycle over again at 5 a.m. 

 

Since you don't have withdrawal symptoms prior to your 5 a.m. dose, I am not getting how you can have almost an continuous paradoxical reaction from your 4 clonazepam doses AND interdose withdrawal if you reduce any of the daytime doses. It simply does not compute.

 

We know you are not getting underlying Effexor, mirtazapine, or Buspar withdrawal symptoms during the day because your symptoms get worse AFTER  each clonazepam dose.

 

Are you sure you it is not a tendency to anxiety generating symptoms after you reduce a dose?

 

Your current dosing is sort of messy, so this is what I would like to see: Make all 4 doses 0.05mg. Let it settle over a week. You'll probably still have paradoxical reactions, hopefully at lesser intensity, because 2.0mg clonazepam within 12 hours is still too much for you.

 

You will need to cope with the symptoms, which you're already doing, and get your anxiety about dose changes in hand. You are behaving as though you are psychologically dependent on clonazepam. Please stop this. 2+mg clonazepam per day is not your security blanket.

 

Then, after a week, I would like to see you reduce both of the 1300 and 1700 doses by 0.01mg every 4 days. You will need to keep daily notes every day, including overnight (but you don't need to wake up to do this).

 

At some point, the paradoxical reactions should ease. That is where you would stop reducing the dosage to reassess.

 

[Frogie]

@Altostrata

 

I think diazepam would be a lot easier and less toxic, in my opinion. And she could take it just a couple times a day with such a long 1/2 life. 

[Altostrata]

10 minutes ago, Frogie said:

@Altostrata

 

I think diazepam would be a lot easier and less toxic, in my opinion. And she could take it just a couple times a day with such a long 1/2 life. 

 

I agree. She'd have to gradually replace the clonazepam.

[LotusRising]

10 minutes ago, Altostrata said:

Then the question is, do you get withdrawal symptoms overnight?

@Altostrata @Frogie No, I don't have any withdrawal symptoms overnight.

 

10 minutes ago, Altostrata said:

Are you sure you it is not a tendency to anxiety generating symptoms after you reduce a dose?

No, I don't believe so. When I reduce my dose, I'm anticipating a decrease in symptoms. I want this drug out of my body. I don't feel like I'm psychologically dependent on it. If anything I have a tendency to want to reduce, but am concerned about reducing too quickly.

 

15 minutes ago, Altostrata said:

Make all 4 doses 0.05mg. Let it settle over a week.

Shall I start this tomorrow? I agree, the different dosages don't make sense to me either. 

[LotusRising]

53 minutes ago, Frogie said:

You could try a tiny, tiny decrease if you feel it's absolutely necessary

@Frogie I left my dose as is, as per your suggestion.

[Altostrata]

2 minutes ago, MedRN said:

Shall I start this tomorrow? I agree, the different dosages don't make sense to me either. 

 

Yes, but you need to manage your anxiety when you make dosage changes and you still get symptoms. As Frogie and I discussed, could be diazepam would be better for you.

[LotusRising]

21 minutes ago, Altostrata said:

@Frogie

 

Ok, this is the best I think I can do with the 1mL syringe that I have.

 

I believe it's a 3.4% decrease

 

0500      0.055

0900      0.05

1300       0.045

1700        0.055

 

equivalent to .205mg/day

@Altostrata Yes, this is what I wanted to do on Wednesday. I believe @Frogie thought that the drop in 1700 dose from .0625 to .055mg might be too much. Frogie, please correct me if I'm wrong, but that was my interpretation.

[LotusRising]

3 minutes ago, Altostrata said:

As Frogie and I discussed, could be diazepam would be better for you.

I already switched from lorazepam to clonazepam, so I'm not sure on this, but I can speak to my psychiatrist.

[Altostrata]

@Frogie has been alarmed that you have been reporting symptoms as those of withdrawal. But all I can see in your symptom pattern is paradoxical reactions.

 

As I explained in time-consuming detail, I cannot see how you would get both paradoxical symptoms from your dosing and withdrawal symptoms from reducing your overall daily dose, unless the withdrawal symptoms are generated by your anxiety. You are showing a lot of anxiety in your posting pattern.

 

2 minutes ago, MedRN said:

I already switched from lorazepam to clonazepam, so I'm not sure on this, but I can speak to my psychiatrist.

 

Have you not already told your psychiatrist your clonazepam prescription isn't helping?

[LotusRising]

4 minutes ago, Altostrata said:

@Frogie has been alarmed that you have been reporting symptoms as those of withdrawal. But all I can see in your symptom pattern is paradoxical reactions.

I'm sorry, I was clearly using the wrong choice of words. It has been my interpretation all along that I have been getting paradoxical reactions. You are the one that pointed this out. This is why I wanted to decrease my dosages on Wednesday. This is all pretty new to me. And yes, I did speak to my psychiatrist about having paradoxical reactions, but she of course, does not believe this to be true. She only wanted to add more medications, to which I declined.