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How did you get ahold of phenobarbital? For the vast majority of benzo tapers in the Western world people are given diazepam (Valium) or chlordiazepoxide (Librium) to taper with. Although, phenobarbital, butalbital, and a couple of other barbs are still prescribed in North America. Here are a few links for greater information and light reading:
https://www.epilepsy.com/medications/phenobarbital
https://www.sciencedirect.com/topics/chemistry/phenobarbital
https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=phenobarbital&page=2&pagesize=20 [medication labels/inserts]
The reality of phenobarbital is that it is the oldest anticonvulsant still in use today. There's quite a bit of history surrounding the drug as well. Thus, a tremendous amount of research has been compiled over the last 100 years. Specific to your needs, we need to consider the drug's incredibly long duration of action (4 to 48 hours) and extremely long half-life (50 to 120 hours).
Tablets range in dosage from 15mg to 100mg, which is unlike most barbiturates. Currently, tablets range from 15mg to 64.8mg with varying dosage schedules dependent upon disorder and age. Previously, more popular barbs were typically available in 50mg and 100mg dosages.
Since you have lowered your dosage to 10mg per day, is this one single dosage or two dosage split up during the day?
>For the last 6 weeks, I've been on phenobarbital.
Did you order these online or is this medically supervised at all?
>I've never really experienced withdrawal, but I'm scared.
Mishandling a barb/benzo taper can have serious consequences such as seizure and even death.
Here is an abstract and citation on tapering phenobarbital versus clonazepam (I cannot find the full text. Maybe Google Scholar has it.):
Sullivan, M., Toshima, M., Lynn, P., & Roy-Byrne, P. (1993). Phenobarbital versus clonazepam for sedative-hypnotic taper in chronic pain patients: A pilot study. Annals of Clinical Psychiatry, 5(2), 123–128. https://0-doi-org.libus.csd.mu.edu/10.3109/10401239309148974
ABSTRACT: Conducted a randomized, double-blind controlled trial comparing phenobarbital and clonazepam for the purpose of sedative-hypnotic taper in 11 inpatients (mean age 46 yrs) with chronic, nonmalignant pain. Baseline dose of phenobarbital and clonazepam was maintained for 2 days and then tapered by 10% per day. Over the 1st wk of taper, differences in mean and maximum Beck Anxiety Scale scores and Benzodiazepine Withdrawal Scale (BWS) scores were insignificant. However, when Scale 1 (hypochondriasis), Scale 3 (hysteria), and Scale 8 (schizophrenia) of the MMPI were taken as covariates, differences on the BWS increased only to a trend level for mean scores and to a significant level for maximum scores. Findings support the superiority of benzodiazepines (i.e., clonazepam) over barbiturates (phenobarbital) for sedative-hypnotic taper for symptoms of withdrawal but not of recurrent or rebound anxiety. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
>Any ideas on weaning off?
Tapering guide for phenobarbital: http://www.taperingstrip.org/wp-content/uploads/2017/07/PHNB_bestel_GB.pdf
Equivalency chart 1: https://www.ncbi.nlm.nih.gov/books/NBK64116/table/A85649/
Equivalency chart 2: https://physicians.utah.edu/echo/pdfs/sedative-hypnotic-equivalency-chart.pdf
>I have clonazepam and diazepam that I could take super short term
10mg diazepam = 30mg phenobarbital
So, 10mg phenobarbital = 3.33mg diazepam. You could stabilize on 3.33mg diazepam and then taper down by 10% per week until you are completely off the drug. However, you mentioned only having a small amount of clonazepam and diazepam. Diazepam will be a much better drug to taper with since lower dosages are possible to achieve by taking a half or quarter tablet. You could also make a volumetric solution in order to more precisely titrate the dosage. For your own sake I would strongly recommend seeking medical care if you run out of barbs/benzos. Avoid tapering with clonazepam if you can --- it's an extremely potent benzo and quite difficult to taper from and with. Diazepam is superior for tapering.
The good news is that 10mg phenobarbital (and 3.33mg diazepam) are quite a low dosage. You might be able to take a dosage every other day and decrease by 10% per week until you feel comfortable going 2-3 days before administering another dose due to the… Comment too long. Click here to view the full text. |
