lex1989: escitalopram / Cipralex and clonazepam / Rivotril / Klonopin

[Greatful]

@lex1989  I am so sorry that you are going through such a rough time.....Take a deep breathe and know that you will stabilize again....I don't think adding another benzo is a good idea.

Reminded yourself that your CNS is in a up roar and there is no quick fixes.   You have the ability to make it through this.....Get out of your mind.  This is were meditation is so helpful.....It certainly does not take the pain away but it helps you not get so wrapped up in the thoughts and mind....I know what terror is and it is horrible.  Everything that is going on  is a chemical issue and not you.

This is what Baylissa says in her book Recovery and Renewal.

 "Chemical" feel. Many of the people I have supported say they can tell the difference and with withdrawal-related symptoms feel 

"chemical" or organic caused by the imbalance created by the drug.  They describe the "chemical feel as more of a strange physical feeling which involves adrenaline rushes, shakiness, agitation, lethargy etc. accompanied by the most intense organic fear/anxiety or depression with no apparent link.  They usually describe it as being "off the charts" and nothing like they use to feel before withdrawal.

 

Hang in there lex, you've got this

[lex1989]

1 hour ago, Frogie said:

@lex1989

 

I think with all that is going on, in my opinion I would just stop moving the Clonazepam and just move the full dose to the evening, instead if moving by an hour every night.

 

You could also try upping it in the evening to the original dose and then add the .10 in the morning.

 

At least you have realized that you have made a mistake and are willing to stop and hold. That is the main thing to do at this point.

 

Let me know how you want to proceed.

 

Hang in there.

 

 

 

 

 

At this point I had 0.10 mg at 6 PM and 0.20 at 00. Doing horrible.

 

As in the state I am, I wanted to go 0.5mg overall (that I had originally till September , from where I did a fast taper to 0.3).

 

0.4 mg at 00 and move directly 0.10 at like 12 AM, shall I proceed like this ? I really don't care now that I prolonged my future taper from Clonazepam, as long as something helps.

 

What do you think ?

 

I did more than one mistake, I was very foolish and stupid. Now I feel I'm dyeing.

[Frogie]

@lex1989

 

I would go ahead and proceed with the .5 mg and see how that helps.

 

Hopefully that will help.

 

 

[lex1989]

4 hours ago, Greatful said:

@lex1989  I am so sorry that you are going through such a rough time.....Take a deep breathe and know that you will stabilize again....I don't think adding another benzo is a good idea.

Reminded yourself that your CNS is in a up roar and there is no quick fixes.   You have the ability to make it through this.....Get out of your mind.  This is were meditation is so helpful.....It certainly does not take the pain away but it helps you not get so wrapped up in the thoughts and mind....I know what terror is and it is horrible.  Everything that is going on  is a chemical issue and not you.

This is what Baylissa says in her book Recovery and Renewal.

 "Chemical" feel. Many of the people I have supported say they can tell the difference and with withdrawal-related symptoms feel 

"chemical" or organic caused by the imbalance created by the drug.  They describe the "chemical feel as more of a strange physical feeling which involves adrenaline rushes, shakiness, agitation, lethargy etc. accompanied by the most intense organic fear/anxiety or depression with no apparent link.  They usually describe it as being "off the charts" and nothing like they use to feel before withdrawal.

 

Hang in there lex, you've got this

 

Thank you so much for the kind words Greatful, unfortunately meditation does not work for me or I don't know how to meditate.

As long as the symptoms are mild / moderate and I have some windows at least in the evening I can accept it and not put any stress on top of it. 

But as the symptoms are very horrid (like a 9, from a scale 1 to 10) I cannot accept it anymore, I tried, it's almost 2 weeks and it's not getting better at all.

 

I know it's chemical, but the pain it's still ours. I believe that we can accept this and hold to stabilize and keep going as long as the pain it's not 24/7 and also very powerful, you can't endure that, it's impossible, at least for me.

 

I'm looking up on https://baylissa.com/, it seems it has some useful information.

[lex1989]

4 hours ago, benesh said:

https://www.meetup.com/global-psychmed-support-network/
 

@lex1989

 

I found this on meetup. 
 

This tapering from Lexapro is such a challenge. 
 

Hope these help you.

I am a believer in Jesus and wish I could find a sg with that worldview. 
Until then I pray, cling and trust one day freedom will occur.

Thanks for the link Benesh, membership pending :).

[Greatful]

@lex1989   I hear you about the pain at that level is horrendous and so hard to go through.

Plus no break makes it even unbearably  hard.  It's crazy how this can be so inhumane......

 

This is your doctor speaking, lol   it's not the drug that is doing this to you, you must be unmasking a new underline illness 😒

 

You will get through this Lex.  We are all here for you.😊

[Greatful]

 Hey @lex1989

Another member sent these to me.  I hope they can encourage you to get through this.

There are days when you may know mostly darkness

- your  mind, body and soul are surrounded by fear. It is difficult to

believe on those days that there can be any light in your

space. These are the days that you must dig deep to find the

strength that will help you to see the fears for what they are

and still emerge with hope in your spirit. There is no easy

explanation for the process that you have to encounter. But

you must believe that even though you do not understand

how everything is working, your healing is taking place.

As frustrating as this is for you, know that you will see the

light of your healing over time. Waiting for something is

never easy, but sometimes, that is all you can do. Wait. And

believe in your body's ability to surprise with wonderful, ever

present healing. The darkness will not be there forever, so

please hold on.

Know that it is normal for you to experience the darkness

and anxiety. But try not to allow this to overshadow the

strength you have inside. Focus on your healing. You won't

have all the answers you are searching for, but that does not

mean  your healing is not happening. Hold on. You have

more strength than you believe. You have more courage than

you give yourself credit for. Never give up on your ability to

hope, to cope and to heal. Keep holding on. Keep going.

 

 

When withdrawal anxiety is high and I am in 'fight' or 'flight'

or 'freeze' mode, it is difficult for me to be grounded and to

maintain perspective. I lose sight of the fact that this

experience is temporary and that it is leading me to my long-

awaited recovery. I am consumed with what is happening

and it can make me seem self-absorbed and uninterested in

my loved ones.

This is understandable, as I spend all my time and energy

managing the bizarre symptoms, breathing through the pain,

and holding on for dear life. I miss important moments in

the lives of those around me and I also overlook just how

courageous and persevering I have been and continue to be.

So today, I acknowledge my strength and I accept that while

I may spend much of my time consumed with coping, this

does not mean that I am self-centered or selfish. I am just

hypervigilant in the context of being constantly aware of my

symptoms, and of my environment, always looking for

perceived threats. I know that I will revert to normal when

this is over.

am compassionate and gentle with myself, in the

meantime, knowing

that no matter how intense and

overwhelming my symptoms are, I will cope well. I trust that

eventually I will begin to notice improvements and when the

timing is right for me, this challenge will end with my

recovery.

 

 

 

 

 

 

 

 

[lex1989]

The updose to 0.4 mg before sleep did not work, I almost haven t slept at all. 
 

Is there a posibility that when I split the dose from 0.3mg before bed to increase the tolerance of the Clonazepam? And now it’s giving and adverse reaction / paradoxal reaction?

 

I took a 3mg pill (at 10am) of Bromazepam to calm myself a bit, because I was feeling that I would die.

 

I am thinking that Clonazepam, as due to the fact it has a longer half time and also built tolerance for myself, will take some days for the body to get used to the new dose.

This is the same what happened when I split the dose, taking 0.15mg from what my body was original used (~7 months) to take before bed, it did not reached to me immediatly, but after a few days.

 

I am thinking to increase the dosage to 0.2 mid day and 0.5 before bed and give it a couple of days to see how it is going. Also in the state that ai am I think I will need at least 1mg overall to stabilize, but would increase gradually to 1mg if necesarry. And take 1 x 3mg of Bromazepam as needed a couple of days until this hopefully will work.

 

Also tought to bridge Clonazepam to Diazepam or Bromazepam, as I am not dependent on that, but if the first ideea would work I would incline more to that.

 

@Frogie please give me your input about this. Thank you very much.

[Frogie]

@lex1989

 

You could try the .2 mg during the day and .5 mg before bed. 

 

But you have gone up and down and done split doses on all your medications, that your body is saying enough is enough.

 

Have you tried melatonin? That helps a lot of members. Melatonin

 

I don't like to suggest switches at all, but if this doesn't work, you may want to switch to diazepam. It has a longer 1/2 life and you may do better on it.

[lex1989]

6 hours ago, Frogie said:

@lex1989

 

You could try the .2 mg during the day and .5 mg before bed. 

 

But you have gone up and down and done split doses on all your medications, that your body is saying enough is enough.

 

Have you tried melatonin? That helps a lot of members. Melatonin

 

I don't like to suggest switches at all, but if this doesn't work, you may want to switch to diazepam. It has a longer 1/2 life and you may do better on it.

I've tried melatonin, I can fall asleep, but cannot maintain the sleep, the "claw" in my chest accompanied with terror just keeps me awake.

 

Ok Frogie, bare with me, this is important :

 

1. Ok so, I've asked some "3rd parties" and so on about the powder I made, there is a possibility that crushing tablets to powder and store them for a couple of time somewhere it may loose potency, it's related to the active ingredient and other substances that keep it tight or something, I don't have all the info.

 

I crushed my tablets in December and kept it in a jar since then, also then was the time when I switch from solid pill to powder. That is 3 months ago, enough for the powder to loose some of it's potency, theoretically. 

I think it's also related to the manufacturers, as here in Eastern Europe we have Rivotril for Clonazepam, it does not look the same as Klonopin and it's a possibility to have a different outcome when you crush it as powder and store it for couple of months for further use.

 

Do we have something on SA that can relate to this things ? I am trying to find something more relevant until then, like proof.

 

If any of these is true, then it means starting from December I took less and less overall Clonazepam, due to loosing it's potency, while splitting the dose I kindled my CNS even further.

 

I gave my fiancée, my mother and my step father 0.5 Clonazepam, none of them have ever took this kind of medicine or be dependent on it or anything. My fiancée and step father had almost no reaction whatsoever, not even a small calm, dizzy, sleepy or pretty much any symptom. I assume everyone is different, but that is why I gave to 3 different people to see any reaction and they did not had any. My mother will take it tomorrow and if she does not have any reaction, specially after a tired day of work, then this theory of losing potency might be true.

 

 

2. If I somehow got in complete tolerance with Clonazepam, doing this split, adding to this thing then I assume there is no other choice that bridging to another benzo, isn't it ? I need to get off of Lexapro first. And now it felt like I almost CT the Clonazepam.

I've heard one can develop complete tolerance on a benzo, not even increasing the dosage might help.

 

 

So for my own conclusion, I will increase even further the Clonazepam. 0.2mg mid-day and 0.5mg before sleep, to check if there will be any improvement, If no improvements are followed that means any of the above situation can be true.

 

Tomorrow I will go to the doctor that gives me pills to get off of them and ask for Clonazepam and Diazepam.

What should I do next in your opinion ?

Go for solid Clonazepam same dosages or do the bridging to Diazepam ?

 

It's a hard one, I know.

 

 

[Frogie]

@lex1989

 

1 hour ago, lex1989 said:

I crushed my tablets in December and kept it in a jar since then, also then was the time when I switch from solid pill to powder. That is 3 months ago, enough for the powder to loose some of it's potency, theoretically. 

I think it's also related to the manufacturers, as here in Eastern Europe we have Rivotril for Clonazepam, it does not look the same as Klonopin and it's a possibility to have a different outcome when you crush it as powder and store it for couple of months for further use.

From what I have read (off SA), the powder will keep its potency for approximately 12 months as long as it's stored in a closed jar and out of heat/humidity. So theoretically I think you are ok with the powder.

 

1 hour ago, lex1989 said:

I gave my fiancée, my mother and my step father 0.5 Clonazepam, none of them have ever took this kind of medicine or be dependent on it or anything. My fiancée and step father had almost no reaction whatsoever, not even a small calm, dizzy, sleepy or pretty much any symptom. I assume everyone is different, but that is why I gave to 3 different people to see any reaction and they did not had any. My mother will take it tomorrow and if she does not have any reaction, specially after a tired day of work, then this theory of losing potency might be true.

Everyone is different with every medication. I can tell you first hand I was on 40 mg of Valium for 20+ years, and there was not one time I felt tired on it at all. I felt calm and relieved, but not tired. But Valium could knock you out. 

 

1 hour ago, lex1989 said:

I've heard one can develop complete tolerance on a benzo, not even increasing the dosage might help.

That statement is very true and correct. If you go into tolerance, it will no longer help you.

 

1 hour ago, lex1989 said:

I will increase even further the Clonazepam. 0.2mg mid-day and 0.5mg before sleep, to check if there will be any improvement, If no improvements are followed that means any of the above situation can be true.

So, if I am correct, you are taking 0.7 mg of Clonazepam? 

 

1 hour ago, lex1989 said:

Tomorrow I will go to the doctor that gives me pills to get off of them and ask for Clonazepam and Diazepam.

What should I do next in your opinion ?

Go for solid Clonazepam same dosages or do the bridging to Diazepam ?

You could switch to Diazepam. Just realize it is much stronger than Clonazepam and you will need to cross over, not just stop taking Clonazepam and start taking Diazepam. The equivalency of Diazepam is 10 mg to every 0.5 mg of Clonazepam, so you would need approximately 12 mg of Diazepam.

 

To make the switch you would:

3/4 Clonazepam and 1/4 Diazepam for one week

1/2 Clonazepam and 1/2 Diazepam for one week

1/4 Clonazepam and 3/4 Diazepam for one week

Then all Diazepam.

 

That way you can have the dr give you the correct dosage for each one to cross over.

 

[lex1989]

On 2/20/2022 at 9:49 PM, Greatful said:

 Hey @lex1989

Another member sent these to me.  I hope they can encourage you to get through this.

There are days when you may know mostly darkness

- your  mind, body and soul are surrounded by fear. It is difficult to

believe on those days that there can be any light in your

space. These are the days that you must dig deep to find the

strength that will help you to see the fears for what they are

and still emerge with hope in your spirit. There is no easy

explanation for the process that you have to encounter. But

you must believe that even though you do not understand

how everything is working, your healing is taking place.

As frustrating as this is for you, know that you will see the

light of your healing over time. Waiting for something is

never easy, but sometimes, that is all you can do. Wait. And

believe in your body's ability to surprise with wonderful, ever

present healing. The darkness will not be there forever, so

please hold on.

Know that it is normal for you to experience the darkness

and anxiety. But try not to allow this to overshadow the

strength you have inside. Focus on your healing. You won't

have all the answers you are searching for, but that does not

mean  your healing is not happening. Hold on. You have

more strength than you believe. You have more courage than

you give yourself credit for. Never give up on your ability to

hope, to cope and to heal. Keep holding on. Keep going.

 

 

When withdrawal anxiety is high and I am in 'fight' or 'flight'

or 'freeze' mode, it is difficult for me to be grounded and to

maintain perspective. I lose sight of the fact that this

experience is temporary and that it is leading me to my long-

awaited recovery. I am consumed with what is happening

and it can make me seem self-absorbed and uninterested in

my loved ones.

This is understandable, as I spend all my time and energy

managing the bizarre symptoms, breathing through the pain,

and holding on for dear life. I miss important moments in

the lives of those around me and I also overlook just how

courageous and persevering I have been and continue to be.

So today, I acknowledge my strength and I accept that while

I may spend much of my time consumed with coping, this

does not mean that I am self-centered or selfish. I am just

hypervigilant in the context of being constantly aware of my

symptoms, and of my environment, always looking for

perceived threats. I know that I will revert to normal when

this is over.

am compassionate and gentle with myself, in the

meantime, knowing

that no matter how intense and

overwhelming my symptoms are, I will cope well. I trust that

eventually I will begin to notice improvements and when the

timing is right for me, this challenge will end with my

recovery.

 

 

 

 

 

 

 

 

Thank you for the kind words Greatful >:D<

[lex1989]

On 2/21/2022 at 11:23 PM, Frogie said:

@lex1989

 

From what I have read (off SA), the powder will keep its potency for approximately 12 months as long as it's stored in a closed jar and out of heat/humidity. So theoretically I think you are ok with the powder.

 

Ok, I guess there are no problems there, powder should be fine. Then it goes to the almost complete tolerance issue

 

On 2/21/2022 at 11:23 PM, Frogie said:

That statement is very true and correct. If you go into tolerance, it will no longer help you.

 

So, if I am correct, you are taking 0.7 mg of Clonazepam? 

I have read articles about it, indeed it can happen, after a couple of time (different for everyone) , the benzo has no more anxiolytic proprieties, no matter how much you increase the dose.

 

I definitely reached that point, that it's certain. I have increased to 0.75 yesterday, the only thing I could actually observe is having even an adverse reaction to it when taken the 0.2 mg dose mid day, very high anxiety. This being said I cannot stabilize.

 

As I almost tripled my initial dose ( x 2.5) I would assume a benzo that would still have anxiolytic proprieties would make some difference, for me it was so tiny that almost did not matter.

Somehow when I split the 0.3 dose things have taken very sideways related to this.

 

As I know there are 2 options here :

1. Start to tapper the benzo, as it's impossible to stabilize in this situation, that is what you usually do in this situations.

2. Switch to another benzo, as I need to get of Lexapro first.

 

I would incline to second one, as I need to remain functional, to keep my job. If I would to taper Clonazepam I could not sleep, function, etc.

I know the SA "policy" is to taper the most activating drug first, as long as the other drugs don't create an adverse reaction, now I would see the Clonazepam doing that, but Lexapro has an adr as well from me. I am again between a rock and a hard place.

[lex1989]

On 2/21/2022 at 11:23 PM, Frogie said:

You could switch to Diazepam. Just realize it is much stronger than Clonazepam and you will need to cross over, not just stop taking Clonazepam and start taking Diazepam. The equivalency of Diazepam is 10 mg to every 0.5 mg of Clonazepam, so you would need approximately 12 mg of Diazepam.

 

To make the switch you would:

3/4 Clonazepam and 1/4 Diazepam for one week

1/2 Clonazepam and 1/2 Diazepam for one week

1/4 Clonazepam and 3/4 Diazepam for one week

Then all Diazepam.

 

That way you can have the dr give you the correct dosage for each one to cross over.

 

 

I got myself the diazepam, but I began to study a bit. 

Diazepam it's broken down by the same enzyme I am an ultra-fast metabolizer. CYP2C19, the same one as for Lexapro. I would add Diazepam and have a possible adverse reaction to this as well as for Lexapro.

 

There is no guarantee, but definitely the gene sight test specifies that being an ultra-fast metabolizer to any enzyme would imply a possible adverse reaction.

 

CYP2C19

UM : Ultrarapid metabolizer: Risk of decreased serum levels. Possible adverse events
associated with increased active metabolites
􀂇 A dose adjustment or alternate therapy may be considered

 

Be advised that there may be
altered exposure to
medications metabolized by
CYP2C19

 

Maybe @DataGuy can interfere a little here and help us.

 

@Frogie Now back to the switch. I would assume I would need a switch to a different benzo.

I cannot find Bromazepam, which enzymes are metabolized by it, or whatever medication is referring to. 

Google / Wiki just mentions that Bromazepam works similar to Valium (Diazepam).

[Frogie]

@lex1989

 

On 2/23/2022 at 12:32 PM, lex1989 said:

I got myself the diazepam, but I began to study a bit. 

Diazepam it's broken down by the same enzyme I am an ultra-fast metabolizer. CYP2C19, the same one as for Lexapro. I would add Diazepam and have a possible adverse reaction to this as well as for Lexapro.

 

There is no guarantee, but definitely the gene sight test specifies that being an ultra-fast metabolizer to any enzyme would imply a possible adverse reaction.

No, there is no guarantee, unfortunately. But Diazepam has a 1/2 life of up to 200 hours in your sytem where the Clonazepam has a 1/2 life of up to 50 hours. So I think you have a better chance with the Diazepam than you have with the Oh, I did find some information on the Bromazepam. According to Wiki it is metabolized in the liver CP450. I'm not an expert with the ultrafast metabolizer either. Anyone could have an adverse reaction to anything. 

 

We could certainly ask @DataGuyfor his input on this. I'm sure he would be happy to help.

 

I found on Wiki that Bromazepam was metabolized by the CP450 in the liver, if that helps you any.

 

 

Edited February 25, 2022 by Frogie

[Frogie]

@lex1989

 

2 hours ago, lex1989 said:

As I know there are 2 options here :

1. Start to tapper the benzo, as it's impossible to stabilize in this situation, that is what you usually do in this situations.

2. Switch to another benzo, as I need to get of Lexapro first.

If you want to switch to diazepam as it has a longer 1/2 life, you could try that first. As we always want you to taper the accelerator before the brake, if possible. You can try and see how you do.

 

2 hours ago, lex1989 said:

I am again between a rock and a hard place.

I know you are and I really feel for you.  And we will work with you with what is best for you. 

 

You aren't alone here. There are a lot of members and mods pulling for you. I think you know that😊

[lex1989]

15 hours ago, Frogie said:

@lex1989

 

No, there is no guarantee, unfortunately. But Diazepam has a 1/2 life of up to 200 hours in your sytem where the Clonazepam has a 1/2 life of up to 50 hours. So I think you have a better chance with the Diazepam than you have with the Oh, I did find some information on the Bromazepam. According to Wiki it is metabolized in the liver by Clonazepam. I'm not an expert with the ultrafast metabolizer either. Anyone could have an adverse reaction to anything. 

 

We could certainly ask @DataGuyfor his input on this. I'm sure he would be happy to help.

 

I found on Wiki that Bromazepam was metabolized by the CP450 in the liver, if that helps you any.

 

 

CP450 it's the super family containing all other sub families, unfortunately I did not find a proper information about Bromazepam either, related to which enzyme it's working with.

 

https://en.wikipedia.org/wiki/Cytochrome_P450

 

I found that Alprazolam (Xanax) it's metabolized by CYP3A4/5, where I have normal / good absorption. Theoretically it would work better according to the genesight test. But I know it's hard to wean of Xanax..

 

https://drive.google.com/file/d/1avgJBvZCqNZOVOr8fQ0VkwEgqAixEq1D/view?usp=sharing

 

Diazepam it's absorbed by CYP2C19, CYP3A4/5 and UGT2B15.

I am an ultrafast metabolizer of CYP2C19 (adverse reaction) and Diazepam has such a long half life, that means theoretically it could still work ? 

CYP3A4/5, which I am a normal / good metabolizer.

UGT2B15 I am an intermediate metabolizer (decreased activity).

 

Lexapro is as well metabolized by CYP2C19, I don't know if there may or not be an interaction with diazepam in this situation, theoretically it could.

 

@DataGuy Maybe could you help us a little here ?

 

 

Is there a possibility to make the bridge now to Xanax and afterwards I tapper off of Lexapro, if the Xanax taper would be to hard to bridge again to Diazepam ? Makes sense ?

 

 

 

[lex1989]

14 hours ago, Frogie said:

@lex1989

 

If you want to switch to diazepam as it has a longer 1/2 life, you could try that first. As we always want you to taper the accelerator before the brake, if possible. You can try and see how you do.

 

I know you are and I really feel for you.  And we will work with you with what is best for you. 

 

You aren't alone here. There are a lot of members and mods pulling for you. I think you know that😊

 

Yes I know that weaning of Lexapro would be the best, as weaning of Clonazepam would probably cripple me and bedridden me, while I could not stabilize. That is why I could not stabilize this past 2-3 weeks, complete tolerance to it, the split on it had made the impact.

 

Thank you very much for the support, I hope I can stabilize soon and get off slowly and see the light again :(.

[DataGuy]

1 hour ago, lex1989 said:

Lexapro is as well metabolized by CYP2C19, I don't know if there may or not be an interaction with diazepam in this situation, theoretically it could.

 

@DataGuy Maybe could you help us a little here ?

 

 

Is there a possibility to make the bridge now to Xanax and afterwards I tapper off of Lexapro, if the Xanax taper would be to hard to bridge again to Diazepam ? Makes sense ?

 

 

I'm sorry, @lex1989, I haven't been following. Have been busy with a move, which will hopefully be completed soon. Do you think you could summarize the evidence for why you need to switch benzos? I'm pretty tight for time. BTW, regardless of CYP activity, I would never recommend a switch the Xanax. 

[lex1989]

24 minutes ago, DataGuy said:

 

I'm sorry, @lex1989, I haven't been following. Have been busy with a move, which will hopefully be completed soon. Do you think you could summarize the evidence for why you need to switch benzos? I'm pretty tight for time. BTW, regardless of CYP activity, I would never recommend a switch the Xanax. 

 

Short summarize, I need to make a bridge from Clonazepam, I hit complete tolerance with it and the WD is awful and can't stabilize. While cannot tapper from it as I need to get off of Lexapro first.

 

That's why I need to switch to other benzo.

 

I pointed out my genesight test regarding the enzymes I metabolize and how.

Pointing as well diazepam enzymes I metabolize : 

 

1 hour ago, lex1989 said:

https://drive.google.com/file/d/1avgJBvZCqNZOVOr8fQ0VkwEgqAixEq1D/view?usp=sharing

 

Diazepam it's absorbed by CYP2C19, CYP3A4/5 and UGT2B15.

I am an ultrafast metabolizer of CYP2C19 (adverse reaction) and Diazepam has such a long half life, that means theoretically it could still work ? 

CYP3A4/5, which I am a normal / good metabolizer.

UGT2B15 I am an intermediate metabolizer (decreased activity).

 

Lexapro is as well metabolized by CYP2C19, I don't know if there may or not be an interaction with diazepam in this situation, theoretically it could.

Why do you not recommend a switch with Xanax ?

 

I just want to be sure which benzo to make the bridge with, while minimizing the potential risks.

[lex1989]

By the way, tried a dose of Diazepam today (10 mg) and I am very very dizzy from it, can't see very well either, dunno if this is normal. The relief it's there, I cannot lie, but the dizziness it's very high.

[Frogie]

@lex1989

 

Here are some of the side effects of Diazepam:

 

• drowsiness
• dizziness
• tiredness
• muscle weakness
• headache
• dry mouth
• nausea
• constipation
• confusion
• difficulty urinating
• frequent urination
• changes in sex drive or ability

[lex1989]

30 minutes ago, Frogie said:

@lex1989

 

Here are some of the side effects of Diazepam:

 

• drowsiness
• dizziness
• tiredness
• muscle weakness
• headache
• dry mouth
• nausea
• constipation
• confusion
• difficulty urinating
• frequent urination
• changes in sex drive or ability

This are the side effects of pretty much all benzos isn't it ? 

[Frogie]

@lex1989

 

Yeah most benzos have a lot of the same side effects unfortunately.

[DataGuy]

18 hours ago, lex1989 said:

 

Short summarize, I need to make a bridge from Clonazepam, I hit complete tolerance with it and the WD is awful and can't stabilize. While cannot tapper from it as I need to get off of Lexapro first.

 

That's why I need to switch to other benzo.

 

I pointed out my genesight test regarding the enzymes I metabolize and how.

Pointing as well diazepam enzymes I metabolize : 

 

Why do you not recommend a switch with Xanax ?

 

I just want to be sure which benzo to make the bridge with, while minimizing the potential risks.

 

 

Hi @lex1989,

 

IMO Xanax is the worst benzo. It is very powerful and has a short half-life. Many people cannot taper from it at all and end up needing to switch. You can read about the potential severity of Xanax wd here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/?report=classic

 

So you feel you need to change to another benzo because you have become tolerant to clonazepam? I think it's important that you have a very strong case to make a switch like that, because there is little evidence it could provide a benefit. A few important points:

 

1) Tolerance is an adaptive phenomenon of the nervous system. If you switched to another benzo, this would not really change the level of tolerance you have developed, but it would put your through a wd from the clonazepam, since all benzos work slightly differently, and the benzo you switch to will likely have a slightly different receptor profile than clonazepam. It could very well destabilize you further while hindering your progress in tapering. 

 

2) Your gene sight test does not indicate you necessarily have a problem with metabolizing clonazepam. While you have hyperactivity at one enzyme that metabolizes clonazepam, you have low activity at another. It's possible these balance each other out. 

 

3) Switching benzos may not solve your problem. (If I understand correctly, the problem is that you can't stabilize?) Sounds like your reaction to diazepam is even worse. Maybe the problem is more neurological, rather than metabolic? Did you take the diazepam in addition to your regular doses of clonazepam and lexapro?

 

Can you describe your symptoms of instability, when they started, and how they have progressed over time?

[lex1989]

2 hours ago, DataGuy said:

 

 

Hi @lex1989,

 

IMO Xanax is the worst benzo. It is very powerful and has a short half-life. Many people cannot taper from it at all and end up needing to switch. You can read about the potential severity of Xanax wd here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/?report=classic

I herd that Klonopin (Clonazepam) is the worst one. Maybe this is just speculative. Does not really matter at this point. I will read the topic from the link.

2 hours ago, DataGuy said:

So you feel you need to change to another benzo because you have become tolerant to clonazepam? I think it's important that you have a very strong case to make a switch like that, because there is little evidence it could provide a benefit. A few important points:

 

The strong case is that, after I split the 0.3 dose to x 2 times a day (0.15), from being kind of stable and ok to becoming not just very unstable, but beeing absolutelly horrible. Jumping from a 4 to a 9 (10 is horrible / dead).

I stood 2 weeks like that and nothing has changed, on some days had become even more worse.

Last week I updosed to 0.5 before bed and 0.2 mid day ( 0.3 to 0.7).

Considering the huge updose, I saw very little or no progress whatsoever.

Been discussing this with many people and the conclusion is complete tolerance with Clonazepam, while spliting the dose made it probably worse and triggered or kindled, I am not sure.

While beeing in complete tolerance with it, you cannot stabilize, while you are in awfull WD.

 

2 hours ago, DataGuy said:

 

1) Tolerance is an adaptive phenomenon of the nervous system. If you switched to another benzo, this would not really change the level of tolerance you have developed, but it would put your through a wd from the clonazepam, since all benzos work slightly differently, and the benzo you switch to will likely have a slightly different receptor profile than clonazepam. It could very well destabilize you further while hindering your progress in tapering. 

 

2) Your gene sight test does not indicate you necessarily have a problem with metabolizing clonazepam. While you have hyperactivity at one enzyme that metabolizes clonazepam, you have low activity at another. It's possible these balance each other out. 

 

3) Switching benzos may not solve your problem. (If I understand correctly, the problem is that you can't stabilize?) Sounds like your reaction to diazepam is even worse. Maybe the problem is more neurological, rather than metabolic? Did you take the diazepam in addition to your regular doses of clonazepam and lexapro?

1) as far as I know when one becomes completely tolerant to a benzo, it can try a switch to a new one that might work. Seen and heard many people doing this.

Don t get me wrong, this is the last thing I wanted to do in my tapering, to bring one more drug in my system. But if it’s the only way, what can I do?

 

2) Diazepam is the one with hyperactivity to cyp2c19, not Clonazepam. Clonazepam it’s metabolized like Alprazolam, with cyp3a4/5 (which I metabolize normal)

 

3)what more neurological means? Diazepam indeed had me very dizzy, but the relief of it, was clear, I also slept better last night while taking it at 3 PM (lasted more than 12 hours I assume).

Yes, I did take it while my normal doses of Clonazepam and Lexapro. I did just took it to do a “test” how I will react to it.

 

2 hours ago, DataGuy said:

 

Can you describe your symptoms of instability, when they started, and how they have progressed over time?

Insomnia. Waking with huge “claw” and / or heat in my chest accompanied by feeling of terror.

Feeling of dread / terror during the day, almost all day.

No windows.

Non-functional.

 

Do you have insight about Bromazepam, I tested it one day and did not have these huge dizzines as for Diazepam, but I can only see it s metabolized by the super family CT450 and it s like a brother to Valium / Diazepam.

 

One more thing, after taking Diazepam yesterday at 3PM, today I can say I feel much better then my usual horrible 3 weeks I had, if this info helps with something.

[Frogie]

@lex1989

 

I received this from Shep. I'm posting it here for your review and so we have it on your page:

 

"Benzo Tolerance withdrawal" during tapering - does it exist?

[DataGuy]

46 minutes ago, lex1989 said:

 

The strong case is that, after I split the 0.3 dose to x 2 times a day (0.15), from being kind of stable and ok to becoming not just very unstable, but beeing absolutelly horrible. Jumping from a 4 to a 9 (10 is horrible / dead).

I stood 2 weeks like that and nothing has changed, on some days had become even more worse.

Last week I updosed to 0.5 before bed and 0.2 mid day ( 0.3 to 0.7).

Considering the huge updose, I saw very little or no progress whatsoever.

Been discussing this with many people and the conclusion is complete tolerance with Clonazepam, while spliting the dose made it probably worse and triggered or kindled, I am not sure.

While beeing in complete tolerance with it, you cannot stabilize, while you are in awfull WD.

 

 

 

Ok. It is possible you are having wd from Clonazepam due to overly rapid metabolism. However, if this were the case, updosing and dose splitting would solve the problem. The reason I asked when these symptoms started and how they have changed over time was to try and assess whether they are from withdrawal or an adverse reaction. Did the symptoms start 3 weeks ago, or before that?

 

Updosing when experiencing benzodiazepine withdrawal does not always work, especially if it is something that has been going on a long time. Your reaction to the diazepam would seem to indicate your nervous system has been sensitized. If you take another dose of diazepam, I would recommend a much lower dose to start off. You should try to avoid feeling any dizziness or excess sedation. 

 

Your gene testing actually indicates you would have more of a problem with diazepam than clonazepam, due to slower metabolism. 

 

Is your entire drug history in your profile? Had you taken any medications previous to 2021? 

[lex1989]

1 hour ago, DataGuy said:

Ok. It is possible you are having wd from Clonazepam due to overly rapid metabolism.

 

I am ultra-fast metabolizer for CYP2C19 which implies Diazepam and Lexapro. Clonazepam is metabolized through cyp3a4/5 where I am a normal metabolizer. 

 

2 hours ago, DataGuy said:

However, if this were the case, updosing and dose splitting would solve the problem. 

How would up dosing help ? I did up dose from 0.3 to 0.7 and still doing bad. 

 

2 hours ago, DataGuy said:

The reason I asked when these symptoms started and how they have changed over time was to try and assess whether they are from withdrawal or an adverse reaction. Did the symptoms start 3 weeks ago, or before that?

 

I've done many changes this past 6 weeks, but I've recovered well and fast.

All of these horrible symptoms have right started after I finished the split of 0.3 Clonazepam, all hell broke loose after that. And that was about almost 3 weeks ago.

 

2 hours ago, DataGuy said:

Updosing when experiencing benzodiazepine withdrawal does not always work, especially if it is something that has been going on a long time. Your reaction to the diazepam would seem to indicate your nervous system has been sensitized. If you take another dose of diazepam, I would recommend a much lower dose to start off. You should try to avoid feeling any dizziness or excess sedation. 

 

As far as I know 10 mg Diazepam it's equivalent of 0.5 Clonazepam, it's not a big dose all around.

Shall I test for tomorrow mid day again a 5 or 7.5 mg dose of Diazepam ?

 

2 hours ago, DataGuy said:

Your gene testing actually indicates you would have more of a problem with diazepam than clonazepam, due to slower metabolism. 

 

Yes, that is true, actually the 3 genes are 1 ultra fast, 1 average / slow, 1 normal, for Diazepam.

 

2 hours ago, DataGuy said:

Is your entire drug history in your profile? Had you taken any medications previous to 2021? 

 

Yes. I've been given just for 2-3 weeks some psychiatrics meds (no idea what), 17 years ago when I had some panicky attack's during sleep. So kind of "clean" in history of these meds.

 

[Frogie]

@lex1989

 

As @DataGuy suggested, I would try 1/2 the dose of Diazepam, so 5 mg today and see what symptoms you get.

 

Keep me posted please.

Edited February 25, 2022 by Frogie

[Altostrata]

I'm not following what's going on here. I see a lot of speculation about tolerance, metabolization, etc.

 

If you've been keeping clonazepam powder since December, it is possible it might the active ingredient might deteriorate from heat, light, or moisture. Unfortunately, it's also possible your prescription was filled or partly filled with counterfeit pills.

 

The way to test this is to get new clonazepam and see how the equivalent dosing affects you.

[Altostrata]

I'm not following what's going on here. No benzo is the worst benzo. The shorter-acting ones are more likely to cause interdose withdrawal.

 

On 2/25/2022 at 8:09 AM, lex1989 said:

All of these horrible symptoms have right started after I finished the split of 0.3 Clonazepam, all hell broke loose after that. And that was about almost 3 weeks ago.

 

What happened about a month ago, before this split dosing, that might have affected your symptom pattern?

 

On 1/6/2022 at 6:16 AM, lex1989 said:

3) I've made a mistake 3 days ago and at 23 I took Escitalopram pill instead of Clonazepam, then I realized and took the Clonazepam as well. But as doing this mistake I did not want to take Escitalopram the following day again at 13, I am not sure if I should have or not, never happened before.

But doing this mistake I had a different kind of symptom schedule: the next day without Escitalopram was much better in the first part of the day, while in the second part, including noon and night was worse (it seemed like a CT for those couple of hours), maybe this is relevant.

I need I think a couple of days to stabilize after this mistake, as it seems it gotten be dr and dp very fast while doing this dosage skip, while usually I don't have dr and dp.

 

4) I've done a test, related to my daily symptoms, as I was in holiday in the past 3 weeks, I have put myself much later to sleep

 

Did you miss any other doses of anything or take them off-schedule, maybe during your holiday?

 

If you've been keeping crushed clonazepam in a jar since December, it might have lost potency from exposure to heat, light, or moisture. It's also possible that some of your prescription was filled with counterfeit pills.

 

I would not assume a biological cause for "all hell breaking loose" and switch to diazepam according. Why not test with a new prescription of clonazepam, make sure the pharmacy gives you a reliable brand?

[lex1989]

12 minutes ago, Altostrata said:

Did you miss any other doses of anything or take them off-schedule, maybe during your holiday?

 

I mistakenly took 1 Escitalopram instead of the Clonazepam dose and the following day I did not took the Escitalopram because of that. But that was 5 weeks ago almost.

 

Did not miss any Clonazepam dose tough.

 

12 minutes ago, Altostrata said:

If you've been keeping crushed clonazepam in a jar since December, it might have lost potency from exposure to heat, light, or moisture. It's also possible that some of your prescription was filled with counterfeit pills.

 

It's like this:

 

- new tablets, at that point, that now are 3 months old as powder

- scrapped tablets 5 months old, that I used to tapper before powder, while cutting them

- first 2 months kept it in a closed Jar (actually the jar that solid pills came with) in a drawer in my bedside. I would assume there was no heat and moisture.

- last 6 weeks I kept it on the Kitchen table and used / open it pretty often to weight the powder and so on.

 

 

Regarding counterfeit pills, I have no clue, I bought them with prescription every time from the pharmacy.

But here in Romania the brand name of Clonazepam it's Rivotril, not Klonopin. Maybe there is a slightly difference in the active ingredient and considering the above things I was taken an inconsistent dose of Clonazepam. 

And after I split the dose, boom...

 

45 minutes ago, Altostrata said:

I would not assume a biological cause for "all hell breaking loose" and switch to diazepam according. Why not test with a new prescription of clonazepam, make sure the pharmacy gives you a reliable brand?

 

I was thinking actually the exact thing. To go and get new pills and crush them and use them fresh every time. Instead of use more than 3 months old powder. 

 

It may that the powder can become sensible and have less potency, while I am not sure of this, still the above statements might be true.

 

Found this as well : https://pubmed.ncbi.nlm.nih.gov/25325120/

[Altostrata]

The drugs work together. If you accidentally make a mistake with one, you might find the other doesn't work as expected.

 

Please don't crush a huge batch at once, the powder would be more vulnerable to deterioration than the tablets.

[lex1989]

13 hours ago, Altostrata said:

The drugs work together. If you accidentally make a mistake with one, you might find the other doesn't work as expected.

 

Please don't crush a huge batch at once, the powder would be more vulnerable to deterioration than the tablets.

 

I will have new prescription hopefully tomorrow and always make fresh powder this time for maybe next few days only, while keeping solid pills intact.

 

Will see how it goes.

[lex1989]

On 2/21/2022 at 11:23 PM, Frogie said:

To make the switch you would:

3/4 Clonazepam and 1/4 Diazepam for one week

1/2 Clonazepam and 1/2 Diazepam for one week

1/4 Clonazepam and 3/4 Diazepam for one week

Then all Diazepam.

 

Let's make the switch. I would go for 5 days instead of 7.

How shall I handle / adjust the doses for switch? 

 

I am on 0.2 mg Clonazepam at 1 PM and 0.5 mg Clonazepam at 10 PM. Total 0.7 mg / day => 14mg Diazepam.

I would prefer to round this up to not have to split / make powder for a time beeing on Diazepam. That means 1 full pill of 10 mg and 1 x 1/2 10 mg pill.

 

First 5 days : 0.525 mg Clonazepam  and 3.5 Diazepam. (75 - 25 )

Second 5 days : 0.35 mg Clonazepam and 7 Diazepam. (50 - 50 )

Third 5 days : 0.175 mg Clonazepam and 10.5 Diazepam. (25 - 75)

Last 5 days : Full 15mg Diazepam. 5 mg at 1PM and 10 mg at 10 PM. (0 - 100)

 

I am right ? I would go with this.

 

I will keep the diazepam as full solid pills.

 

Note: Today I tried again 10 mg of diazepam for testing and the dizziness is still there, but at least it works relief wise.

I am not sure if it will wear off in time as my body will get used to it or not, but this is happening for 10 mg, not 5 mg.

So I assume taking it at 10 PM before sleep would be fine as I get to sleep anyway and the 5mg at 2 PM (after 1 hour of Lexapro) will be fine as well as for half a dose the dizziness is small. 

 

After this change and stabilization I would continue to taper Lexapro with a 0.08 (the lowest I can scale it) each 4,5 or 6 days. No matter what.

It gives me and adr and stabilization it's not possible, no matter how much I hold. All the talking, recommendation and so on has put me in this conclusion.

 

I need to s*** it up and make a fast micro taper to Lexapro and hope for the best.

Then will consider slowly getting off of Diazepam.