withdraw from librium

[kthorse]

Hi, I am trying to wean off klonapin and was given Librium to withdraw from. Can I open the capsule to water taper? Or  should I divide the dose into gelatin capsules. I have 25 mg capsules .

I was on .75 mg of klonapin  Is it best to take the  librium dose once a day or divide it 2 3 times a day. My dr said go cold turkey off klonapin and take librium as needed. This is not working for me and my Dr want listen. I need help.
Thank you

[Roger Gould, M.D.]

YOu have already received a well thought through response from Ryan....

[RCA759I]

Hello,

Firstly, how is the Klonopin currently being dosed? One or twice daily? If you are taking the Klonopin only once daily, you will not have an adequate accumulation level of the drug in your plasma, and hence, it would be very difficult to discontinue. Klonopin works on the principles of steady-state and accumulation. The drug carries an average half-life of 36 hours, and accumulates from 1.5 to 3 times that of the steady-state plasma level within two weeks of repeated dosing. This steady-state level, along with the accumulation level prevent abrupt peaks and troughs in the plasma level, making the drug more tolerable to discontinue. Hence, breaking your 0.75 mg dosage into three equal dosages of 0.25 milligrams taken every eight hours would be more desirable.

The issue with Librium is its half-life variation compared to Klonopin. Klonopin carries a half-life of 36 hours, while the active metabolite of Librium (N-Desmethyldiazepam) carries a prolonged elimination half-life of 36-200 hours. Given that Librium's half-life is far greater than that of Klonopin, it will not instantaneously replace Klonopin. The Librium much first reach steady-state (a two-to-four week process), at which point it will replace Klonopin in full. Thus, if the Klonopin is replaced entirely with Librium, withdrawal symptoms will manifest for a limited length of time, until the Librium accumulates. Librium has to play "catch up", given the longer terminal half-life. For this reason, it would be prudent to gradually introduce the Librium, while simultaneously stepping out the Klonopin. This may be accomplished by dividing your Klonopin into three equivalent dosages of 0.25 mg each, substituting each with 5 mg of Librium (the equivalent dosage to 0.25 mg of Klonopin).

Example:

Week 1: Morning (0.25 mg Klonopin), Afternoon (5 mg Librium), Night (0.25 mg Klonopin)

Week 2: Morning (5 mg Librium), Afternoon (5 mg Librium), Night (0.25 mg Klonopin)

Week 3: Librium, 5 mg, t.i.d.

By gradually introducing the Librium and stepping out the Klonopin simultaneously, you  give the Librium an adequate period of time to accumulate. If necessary, the above schedule can be modified further by substituting 2.5 mg of Librium for every 0.125 mg of Klonopin. The plan should be individualized for your particular needs. Speak with your physician about such an option.

If you sucessfully tolerate Librium, it is typically very easy to discontinue, as it is essentially "self-tapering". Wait approximately one month before beginning a taper from Librium, as this will allow the active metabolite to accumulate in full. The accumulation level for Librium is 5-7 times that of the steady-state plasma level, which is quite large.

Taking the Librium as a single 25 mg dose, once daily, will not allow for adequate accumulation. It is the accumulation that you want to take advantage of, as this allows for a gradual decline in the blood plasma level. 5 mg, three-to-four times daily is ideal to accomplish this.

25 milligrams of Librium is equivalent in potency to 1 milligram of Klonopin. Never-the-less, the dosage should be tailored to your needs. Librium, in lower dosages, for example, is ineffective for panic - equivalent to Klonopin or not. Given the vast pharmacological differences among the Benzodiazepines, and their differing affinities for various GABA receptors, equivalency means little in the grand scheme of things. Therefore, the dosage should be tailored by your physician for maximal beneficial effect.

Best regards,

Ryan

[Roger Gould, M.D.]

You have already received a thoughtful and fact based answer to your question from Ryan...I don't have anything to add.

[kthorse]

Thank you,
Can you open the librium capsules to water taper ? or maybe divide the dose into gelatine capsules?

[kthorse]

I forgot to say thank you very much for your response. It explains everything except the above question.
I Usualy Take klonapin morning and lunch time. So for a week or 2  I will spread this out over 8 hours as you have written above. . I will do this for a week or two until stable as I am suffing withdrawal from being tolerant. Hopefully this will stop the up and downs.

Then I will slowly switch to Librium. I know Librium isnt for panic , but I figure I am going to get panic from with drawal anyways. I feel worse now than before I took any benzos. I am house bound and severly depressed suffer panic attacks daily.  I started to get them after my daughter passed. Now the meds dont work and the side effects are to much so I dont want to go up in dose.
Your information was wonderful and very helpful thank you so much
Kat

[RCA759I]

Kat,

How long have you been taking Klonopin? Generally with this drug, there is no appreciable loss of efficacy over the long-term. But certainly, if you feel that it is less effective or ineffective, tapering off gradually is better than increasing the dosage in my view. The APA reports that the effective dosage range for Klonopin ranges from 1-2 milligrams, and that dosages in excess of this have no additional beneficial effect. The manufacturer (Roche) suggests, from two clinical trials, that dosages in excess of 1 milligram are of no additional benefit, but rather associated with greater adverse effects.

Benzodiazepines are not soluble in water. They are lipophilic agents. Hence, you could not use water as a titration medium. You may however, consider speaking with a compounding pharmacist who could make customized doses for you. Another option would be to purchase a digital scale, measure the mass of the contents contained in one capsulet, and reduce this mass by 10%/week (or by whatever value or duration you see fit). Librium used to be available in tablet form, under the name Libritabs, but these have been discontinued. The Libritabs could be broken into quarters, but this isn't possible with the capsules.

I would rethink using Librium, and consider Valium instead. Valium is two and a half times the potency of Librium, and ten times less the potency of Klonopin. Each of your 0.25 mg doses of Klonopin could be very easily replaced with 2.5 milligrams of Valium. Like Librium, Valium carries a prolonged elimination half-life. The chief active metabolite for both is N-Desmethyldiazepam. Valium is more ideal than Librium for discontinuation purposes, as it is available in 2 milligram tablets - which may be broken down into quarters, each quarter representing 0.5 milligrams. This allows for far greater flexibility.

The lowest available dosage of Librium is 5 milligrams - approximately equivalent to 2 milligrams of Valium.

1 mg Klonopin = 10 mg Valium = 25 mg Librium

Speak with your doctor about implementing Valium in place of Librium, as you've not yet started on it. I can write you a transition schedule for Valium if you wish.

Best regards,

Ryan

[kthorse]

Ryan again thank you so much for the very detailed explaination. I have been on klonapin 2 years.  It will be another month before I see the Dr again. I did ask for valium or librium hoping to taper. He gave me the librium. I was suprised as I thought valium was the best to taper from. I am also on lamictal and trileptal and they both effect gaba so I think its too much for my brain. I hope to taper off lamictal also as I am severly depressed so its not working  either. whats the point of taking drugs that dont work. My dr also prescribed neurotin . I  took it a few times then read it also effects Gaba.  I cant think or concentrate or learn anything new . I have no memory and learn anything new.
I would love a transition squedule for valium. I would take it to the Dr and tell him that this is what I would like to do. I hope he listens as I have already ended up in the physc ward for severe depression. I know its from the meds and I cant seem to get off. the valium sounds like the way to go.
Your advise is wonderful . I appreciate the time you took to answer my question. Its very much appreciated.
Kat