Harm Reduction Need help for a rapid but as safe as possible clonidine taper with some complications

[FnX]

Okay so I fucked up a little, I was supposed to see my psych doc to have my prescriptions refilled this month before I head back to school the next, but I thought he was on vacation in June instead of July. Long story short, most definitely running out of meds before I can see him again, I have an appointment but it's over 5 weeks later than I thought it would be.

It's going to be extremely unpleasant, but thank god I have a vacation as well for the most part of it. I'm rather concerned about the clonidine though, because I have been on it for almost a year, taking a steady 300ug every night except for the last few weeks when I've had to raise the dose to 450ug at night to actually fall asleep. We have 150ug pills here, so that's 2-3 pills a day, and I have only 14 left, totaling for 2.1mg if that's easier to picture. I was thinking of something the sort of dropping straight from 0.45mg to 0.3mg for 3 days (3 times 2), then down to 0.225mg for 2 days (2 times 1.5), leaving me at either 5 days on 0.15mg (5 times 1) or 3 days of 0.15mg and 4 days of 0.075mg (4 times 0.5). I'd rather leave the end of the taper slightly open so I can go according to how I feel at that point unless that puts me at risk. I don't mind unpleasantness in particular, but the rebound hypertension really worries me. I will also have to drop my clonazepam dosage from 1mg to 0,75mg right away and to 0.5mg after 3 or so weeks if I don't want to run out, which should be a gentle enough temporary taper down that no special advice is needed, but I believe this will also be a factor with the clonidine.

Other than that, tzolpidem (ambien) runs out in two weeks which I'm not really worried about, but if I wasn't tolerant to it already it could have been a relief. I'm also prescribed stimulants (amph) which I believe I have to drop for the time being because of their side-effects, ironically they're the only thing I wouldn't run out of early. Can this tilt the equation a little bit towards lower blood pressure, or am I going to run into something unpredictable physiologically? I don't drink or take any other drugs except for nicotine at a rather high dose (e-cig ~60-70mg/ml nicotine solution) perhaps 0.5ml a day, I have always preferred small but potent dosing not too many times a day for various reasons. I think I might have to put this habit on hold too, hopefully not stressing myself too much just from all the combined withdrawing.

I wouldn't do anything like this if I didn't have to, the girl who gave me the appointment on phone wasn't too helpful when I explained her the situation (except for what medications I'm taking, not sure if the customer service has access to that kind of information or if they even understand it) and asked if there's anything I can do besides wait. Doctors here have this weird attitude towards each other where they kind of either don't stick their noses in other doctors stuff at all or harrass them as much as they can with complaints etc if their treatment methods are against some personal belief what is proper treatment, and the public sector is somehow offended by the private sector (perhaps in part because all doctors are kind of forced to first serve publicly when they first graduate) so nobody else will have these scripts refilled I suppose. If there is a medical emergency the ER will of course treat me and in fact that is probably the only place where I can see a doctor without first waiting weeks to months. It will only be a quick patch-you-up-off-you-go thing though from what I have heard.

But yeah, this is completely my error regarding the doctors vacation. I had my last refill in january so we didn't talk about how the doctor was going to spend his summer vacation and I'm more used to dealing with the public sector where this isn't an issue, but I can't get a contact from there right now without waiting too long in line first.

Any input is welcome, like how to go about the day, nutrition etc. I'm 30 years old and high blood pressure isn't a specific risk factor for me.

 

[BigG]

That seems a lot of clonidine. I was also on it for about a year but the amount I was prescribed was 100mcg. 3 times per day (which is pretty much the maximum recommended dose here in the UK). It you're only talking it once a day (at night) then 300mcg seems excessive in one go. Do you not get dizzy spells from low blood pressure from taking that much when you stand up?

Personally I had no problem stopping it cold turkey other than maybe a little rebound high blood pressure but I definately think you could drastically reduce your dose and still be fine if you just intend to make what you have stretch out a bit further....

 

[FnX]

I used to be fine with 75mcg before stimulants became part of the equation. I know 450mcg is a lot, but I honestly don't get dizzy spells, I'm sure I would have if that was how I started though. I carefully balanced everything I was taking so that I had what I thought to just the right amount of medication. It was almost like a clockwork, alarm clock at 6am, take morning meds, sleep until 7am then wake up. Be at school 8:15 every day. Between 16-18, take the clonazepam (pretty much same dosage for years) according to how stressful the day was to prime myself for evening relaxation. At 20 o'clock take the clonidine and begin the rituals that prepare me to fall asleep, which for me translates to "don't touch the computer", watch tv instead for example, or anything passive really. Just participating in an engaging conversation could compromise the sleep, I've had to politely ask to stop a conversation many times because if it's 'too interesting' at such late hours, my brain is just naturally excitable like that if and only if the subject is of particular interest. By around 22, I would feel either ready to sleep or possibly ready to sleep, in the latter case I take a complimentary ambien but at this point I would almost always go to sleep, no matter what day of the week. Worked out to 7-8 hours of uninterrupted sleep.

Very rarely would this routine fail, it was imperative for my ability to function in the society, and actually lead to success that I have never encountered in my life before. Sadly, recently I have noticed (or perhaps admitted to myself) that the clonidine is unsustainable and I actually wanted to discuss with my doctor if there's something we can replace it with and do a bit less intense taper than what will happen now. It was a godsend for any residual stimulation in the evening, I only took the stimulant once per day at 6am, usually skipping weekends. I was thinking about tizanidine as a replacement, since it works in a similiar way as clonidine but doesn't have the same intensity of cardiovascular effects. My clonidine prescription states is 1-3 pills per day, but I figured that if the upper boundary eventually became minimum for the desired effect of falling asleep (I have suffered from terrible insomnia all my life) then it can't be sustainable, even if it took almost a year of incremental increases to reach this point. If I skip a dose, I get dizzy spells from high blood pressure accompanied with a thumping sensation in my head when I stand up. Never skipped two doses in row.

I hope you're right that it will be fine. At the very least it is encouraging in the sense that it reduces stress a bit. Being at the mercy of events you have no power over can brew a bit panic.

 

[BigG]

Yeah I think stopping the stimulants would be a bit help. Using onidine to kill stimulant induces anxiety and insomnia is a pretty round about way of doing things as it's not really meant for that and results in having to use the excessive doses you describe. I know stimulants are part of your routine but realistically you may have to rethink that....

Regarding the doctor situation - it's different over here in that you could simply call the surgery and be seen same day by any doctor who would sort out your script without any charge (i understand it's different in the US) but definately visit the ER if you feel you are in any form of danger due to having to stop any medication too quickly