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I have been holding at 10mg valium for almost 3 weeks now.  I travelled for a week during that time and also consolidated my dose to once daily in the evening (was following Ashton recommendation reducing the am dose and 8mg evening prior) as I was planning to cut to 9.5mg at night only next using a 5mg tab, half a 5mg tab, and a 2mg tab at night.  This was the only way to take the same tab within 24hrs (the half of the 5mg pill) which is important to me as I don't believe the active ingredient to be evenly distributed and taking one full tab within 24 hrs of each other made me feel most comfortable. 

 

Long story short, my worst symptom (insomnia) has seemed to become more unpredictable since the 2nd cut and hold with more near sleepless nights and up and downs instead of the more predictable 1-3 hours decent sleep, followed by 1-3 hours choppy light vivid dream sleep I seemed to stabilize at after the long hold.  I handled the two .5mg cut and holds down to 10mg but feel I need to change gears while at a nice round number of 10mg to hopefully maintain function and each .5mg cut down now is going to equate to 5% or greater cuts and holds.  As badly as I want off this medicine, I know I need to be able to function as best I can to work and for family.  It is so hard.  I did have 2 of my better nights of sleep in last couple weeks after a few nights of terrible sleep (a 6hr straight sleep and a 4.5hr straight sleep) which helps me remember that my brain does know how to sleep when needed.

 

I had appointment with psychiatrist who is handling my deprescribing this morning, and I suggested trying four 2 mg tabs and reducing the remaining 2mg with .02mg daily cuts via compounded liquid.  This would be a 6% reduction the first month and if I handled ok, I could just continue the daily .02mg cuts.  He said he would call and inquire.  I just feel I need to start a micro taper sooner rather than later so I don't continue to shock my already shocked system with each cut and hold of .5mg and fear of being more unstable or having to hold for long periods of time.  I have 2 other medications to taper at some point as well.

 

Oh, he also continues to want me to try 500mg Depakote at night which I have refused to this point.  Any advice and/or personal experience would be so greatly appreciated.  I feel I am at an extremely critical point in terms of how to proceed from 10mg.

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Are you aware Valium comes from the manufacturer in liquid form?  I think you're wise to recognize you need to adjust your taper, this is what we have to do in this grand experiment.  Using your symptoms to guide your decision making is exactly what you should be doing, and I'm glad to know your doctor is listening.

 

Do you suffer with epilepsy, bi-polar disorder, or migraines, is this why your doctor wants to prescribe Depakote?  I've not heard any positive stories about it for benzodiazepine withdrawal and adding another drug of questionable efficacy seems pointless leading to more polydrugging when you start chasing the new symptoms caused by it.

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Sorry for the long post and thank you very much for the reply, Pamster.  I am aware of the manufacturer’s liquid and that sounds like a viable option.  I assume I can use a combo starting with four 2mg pills and dilute 2mg of the manufacturer’s liquid with distilled water?  I know this is an unknown suspension, but would feel most comfortable with a combo of pills and liquid and proceeding with daily cuts off the liquid.  I just don’t know how to do that yet.

 

In regards to the Depakote, I have no past psychiatric issues.  I now have some anxiety and situational depression (who wouldn’t) but love my life and family outside of my current predicament. I am still functional, just exhausted yet wired all day. Very weird feeling. The medicines I am on were prescribed for muscle issues, and then I made the tough decision to add the 7.5mg mirtazpaine to help with sleep.  It is slightly working I believe, but I am not sleeping great but have to come to grips with this. My psychiatrist seems more concerned with my lack of sleep than I so I should probably not speak with him to the extent of my hours of sleep. He believes the Depakote will help me sleep and easy to wean off which I kindly disagree with him every time.

 

 

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You have a wonderful grasp of your situation, yes, a combination of liquid and tablets is the perfect way to go about this and your understanding that you'd be making a suspension out of your liquid solution is refreshing.

 

I love that you're kindly letting your doctor know you don't wish to add more drugs and from what I've seen here, Mirtazapine seems to be less harmful out of the adjunct drugs members have been using.

 

 

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Thank you so much Pamster for the kind words and reassurance.  It truly does make me, and other people, more confident in the direction they are headed when selfless people like yourself, with much witness and experience, give positive guidance like you do.

 

Is there anyone that is active on the forum currently tapering Valium with pills and diluted manufacturer’s liquid combo (or in the past successfully) that would be kind enough and willing to assist me getting started?  I understand the suspension aspect like we discussed, but I believe we have to trust a lot of assumptions in this process including even if our tablets are manufactured truly accurate with active ingredient etc..  I will just have to commit to believing my suspension will be accurate enough for a more stable taper and hopefully someone can chime in with personal experience going this route.

 

Also, my psychiatrist is willing to prescribe the pills and liquid which is good news.  I assume I need the 5mg/5ml solution (instead of the 5mg/ml solution)?

 

Thank you so very much in advance.

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Hello, Faith Hope Love.

 

Pamster asked me to stop by.

 

That’s great news that your psychiatrist is willing to prescribe a combination of tablets and liquid.  We have another member whose prescriber and pharmacist have told him this is not possible (as you’ve discovered, it is; indeed we have many members who have used this approach over the years).

 

You are correct that you will want to use the 5mg/5mL (1mg/1mL) oral solution instead of the concentrate. If your prescriber is willing (and your pharmacist can stock it), I suggest you ask him to specify the one manufactured by Hikma - see link below.

 

Am I understanding correctly that your current total daily dose of diazepam is 10mg?

 

What is your daily dosing schedule?  How many milligrams of drug do you take at what times?

 

What strength tablets are you currently using? 10mg? 5mg? 2mg?  What is the manufacturer of your tablets?  (If you need to switch to a lower strength tablet, it’s preferable to stay with the same manufacturer.)

 

Link:

DailyMed - DIAZEPAM solution - Hikma

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e85abed-1a8b-4762-a31f-f2c7f196b8af

 

 

 

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Hi, Libertas.  Let me start by thanking you and Pamster so much for what you (and others) do here to selflessly serve.  Very special people that the world needs more of.

 

I agree that it is great news assuming that you also agree with Pamster that my thinking is clear, and that this is a very reasonable way to micro taper going forward in my particular situation.  He has even agreed to switch to a private, locally owned, pharmacy so we can get the Hikma solution you recommended.  This is assuming the pharmacy agrees and can stock it, but I am going to believe they will.  I didn't ask you why this manufacturer, but trust you and believe I know why.

 

Yes my current dose is now down to 10mg of diazepam.  I have been holding here for 3 weeks today.  I travelled out of state for a week in this time period and also have switched my dosing from 2mg (9am) and 8mg (9pm) to all 10mg at 9pm.  My thought here was I was going to cut to 9.5mg next using a 5mg tab, half a 5mg tab, and 2mg tab and it was going to be all at night so I would be taking a full tab within 24 hours.  Obviously, I am now changing gears to hopefully get ahead of these cut and holds and establish a more comfortable and subtle withdrawal (taper). 

 

So, yes 10mg dose.  All at 9pm.  Poor sleep is my worst symptom which affects everything, but I am still functioning, and sleep seems to be settling down again at the moment.  I am currently taking five 2mg MFG IVAX Teva 3925 tablets at 9pm.  I also have some leftover 5mg tabs from my original prescription (same manufacturer) from Sep. of last year that I used during my 2 week hold at 10.5mg. 

 

Again, thank you for helping me...from the bottom of my heart.  Let me know if you need any other information.

 

 

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You are most welcome, Faith Hope Love.  It’s a pleasure working with a member who is approaching their taper in such a thoughtful manner.  Pamster and I are indeed in agreement that your thinking is clear and your approach is reasonable. 

 

I also agree with you that adding Depakote into the mix would not be a good idea at this time.  Although there have been a few studies about its use as an adjunctive medication during benzodiazepine withdrawal, the quality of the research is low.  (I do wonder, however, if the mirtazapine is helping or perhaps harming you in terms of side effects or an adverse reaction - what do you think?)

 

Now that we know your psychiatrist is willing to prescribe the manufacturer’s liquid, here’s a taper plan for your consideration:

 

Stage 1: Take 8mg in tablet form + 2mg (2mL) in liquid form, taper liquid to 0 as tolerable

Stage 2: Take 6mg in tablet form + 2mg (2mL) in liquid form, taper liquid to 0 as tolerable

Stage 3: Take 4mg in tablet form + 2mg (2mL) in liquid form, taper liquid to 0 as tolerable

Stage 4: Take 2mg in tablet form + 2mg (2mL) in liquid form, taper liquid to 0 as tolerable

Stage 5: Take 2mg (2mL) in liquid form, taper liquid to 0 as tolerable

 

The above plan gives you the flexibility to adjust your taper amount and taper interval as needed (i.e. in accordance with the tolerability of your withdrawal symptoms and your desired level of functionality).

 

For Stage 1, you would not need to dilute the liquid.  You could just use a 1mL oral syringe with graduation marks every 0.01mL or 0.02mL. You would need 60mL of the manufacturer’s liquid per month for the above plan.  (Another advantage of starting with the undiluted liquid is that you won’t have to mention dilution to either your prescriber or pharmacist — some healthcare professionals have concerns about such do-it-yourself drug manipulations.)

 

As for next steps, I suggest you have a conversation with your pharmacist of choice to ascertain if s/he is comfortable with your plan and willing to help you implement it.  Topics to discuss include:

 

- Can the pharmacy stock and dispense the required amount of the liquid for the duration of your taper?  The liquid is supplied in 400mL containers from the manufacturer so it’s possible the pharmacist may be more comfortable with dispensing a larger amount per month, especially if you will be the only patient using the liquid.  You could increase the amount used per month by adjusting the above plan to start with 6mg in pill form and 4mL in liquid form for a total of 120mL a month.

- Can the pharmacist run a ‘test case’ to find out if your insurance will pay for both the tablets and the liquid?  Some insurance providers will only pay for both if the prescription is written for split dosing (e.g. 2 times a day a day instead of 1).

- Will the pharmacy be able to dispense the liquid in a bottle with a press-in bottle adapter?

- Will the pharmacy provide you with a supply of supply of 1mL oral syringes? Medisca and BD are two high quality manufacturers used by compounding pharmacists.

- Can the pharmacy stock and dispense the 2mg Teva tablets for the duration of your taper?  Explain that you are sensitive to changes in manufacturers.

 

PS The reason I suggested Hikma is twofold.  First, it is the original formulation that has been used by the most members.  The formulation was first developed by a company called Roxanne which was then purchased by West-Ward which was then purchased by Hikma.  Second, Hikma is a large, stable pharmaceutical company with expertise in manufacturing liquid formulations of benzodiazepines (in addition to liquid diazepam, its product portfolio includes liquid formulations for alprazolam and lorazepam).  However, if Hikma is not a possibility, we also have members who used the liquid from Lannett.  The third manufacturer - Chartwell - is relatively new to the market.

 

Edit: corrected typo

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Thanks, Libertas.

 

I have been taking 7.5mg mirtazapine since January (3 months).  I swapped the trazodone for mirt in hopes of gaining more sleep.  I tapered the 100mg Trazodone (3 months use) easily and quickly it seemed and added the Mirt.  I don't know if the Mirt is helping or hurting honestly at this point now.  I have much less, or basically no sleepless nights now.  I've stopped looking at clock at night, but I seem to be sleeping ok currently.  Early awakening (prob after 4-5 hours of decent sleep) then some very light toss sleep until the house is up, but I feel unwell/exhausted especially in the morning hours.  I don't know if the Mirt is helping slightly or my CNS has just been slowly stabilizing underneath the Mirt.  I wish I wasn't on it obviously, but don't know what side effects or adverse reactions I would be looking for.  I am not gaining weight which I know is a common side effect.  I also don't know if I should try getting off the baclofen and/or the mirtazapine first, but my desire is to be med free.

 

Thank you for laying out the stages.  I know it was just typo, however stage 2 would be 6mg tablet and 2mg (ml) liquid.  I know we want to get off these medications as quickly, yet safely as possible. 

 

I assume I would start by using 8mg tablet and 2ml liquid and hold for a certain length of time?

 

I was thinking of reducing by .02mg(ml) per day to start.  So day 1, 8mg tablet and 1.98ml liquid.  Day 2, 8mg tablet and 1.96ml liquid etc...  This would be a 6% decrease in the first month.  If I handled it well, I would just continue at .02ml reduction per day until I felt worse/different and re-evaluate. 

 

Is this route possible without diluting all the way down?  I have already mentioned diluting the solution with psychiatrist and he is agreeable and now feel at the point of "whatever" with me, which I guess is good thing.  I have not spoken to the new pharmacy yet.

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Thanks for catching that typo —  I should refrain from posting until after I’ve had my morning allotment of coffee. :laugh:

 

It may well be that you are doing AOK with the mirtazapine.  I just got the sense that it might not be providing the desired therapeutic effect (i.e. improved sleep). You can look up side effects and adverse reactions for mirtazapine online (e.g. use the official FDA drug label at DailyMed for adverse reactions and drugs.com for side effects).

 

Please be careful with the baclofen.  It binds to GABA-B receptors.

 

Yes, you would want to hold your dose constant for a while after you make the switch from all tablets to a combination of tablets and liquid.  This will give you the opportunity to observe how you react to the liquid.  As to how long to hold - do you have a sense of your withdrawal pattern?  That is, about how many days does it typically take for your withdrawal symptoms to emerge, peak, and then return to baseline?

 

Yes, you can begin with a 0.02mg reduction per day to begin.  However, please be aware that one of the downsides of daily microtapering is that those seemingly tiny reductions can accumulate until a tipping point is reached and symptoms shift from tolerable to intolerable.  This is especially true in the case of benzodiazepines with a long half-life such as diazepam.  One way to avoid this issue is to build holds into your taper plan.  For example, make daily reductions for X number of days, then hold for Y days.

 

Another gotcha with fixed amount (linear) daily microtapering is that the percent reduction increases over time.  You’ll want to keep an eye on your monthly taper rate so you don’t exceed your personal ‘speed limit’ (maximum monthly taper rate).

 

Regrettably, there’s no way to know at this point if you will be able to use the undiluted liquid for your entire taper.  It all depends on what reduction amounts you can tolerate as you proceed with your taper.  Here’s a video that explains why smaller reductions may be necessary at lower doses:

 

Should I do a Hyperbolic Taper? What you need to know

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No problem, I get it.  I actually re-introduced 2 cups of coffee in the morning again about a month ago and didn't notice any correlation with my sleep.  Oddly enough, I try and eat as healthy as possible, but have had cake at a birthday party one evening and other moderate amount of "sweets" some other evenings and slept relatively good and have drank only water, smoothie, grilled chicken and vegetables all day and slept very poorly.

 

I don't notice much difference since taking the Mirt so don't believe I am having any side effects or adverse reactions, however, you are correct in that it did not provide the desired therapeutic effect I was hoping.  My sleep has been getting better since on it, but I have no way of saying the Mirt is the reason as I have also held for almost 4 months and only dropped 1mg of valium in 5 months. I have had way less sleepless, or near sleepless, nights since on it.  I slept fairly well last night again.  Either way, I don't know how I would discontinue mirt at this point being on it for 3 months.

 

I agree regarding baclofen.  I have dropped to 40mg a day for 2 weeks once and didn't notice tremendous change but it may be more difficult now, and I know once you get to lower numbers it can even be harder.  This is the main reason I want to discontinue these medicines as safely as possible, and I have become overwhelmed by the thought of how I am going to get off these 3 medicines, function, and be there for my family whom I love deeply.  Fear entered my life in a strong way, but I am dealing with it better now.  I just have a good/busy life with work and young family, and I want to be able to enjoy it and not be a burden.  If I had a set plan going forward I felt comfortable with I'm sure that would help.  I really need help and advice.

 

I understand the lower you go, the higher the percentage etc.. and symptom based.  I just need help getting started and hoping someone can help and affirm that I am proceeding prudently.  I didn't notice any change from 11mg to 10.5mg.  10.5mg to 10mg, I travelled out of state with wife, 6 year old and newborn a week after that reduction, so that could have played a part in why I slept worse in that stretch and felt more despair.  After 3 weeks now holding, I am back to baseline (or maybe better now home etc..).

 

I just am thinking I should be safer rather than aggressive under my circumstances.  I'm sure I could try another cut to 9.5mg as well, I just don't know if that is the correct decision.

 

Assuming I can reduce .02ml a day... Can I do this without diluting?  Even if I had to hold or eventually reduce by .01ml a day that would be progress.  Any thoughts and feedback so greatly appreciated.

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Are you familiar with the Shewhart Cycle? It’s an iterative method for the continuous improvement of processes.  The steps in the cycle are Plan Do Check Adjust or PDCA.

 

You have developed a well-conceived and reasonable draft taper plan.  Your next step is to implement the first stage of your plan, check to see how it works for you, and then make any necessary adjustments.  From then on it’s rinse and repeat … Plan Do Check Adjust.

 

For the Check phase of the cycle, I strongly encourage you to keep and refer to a daily taper journal.  It can be as simple as the date, your dose, and two global ratings — one for your symptoms and one for your functionality level (e.g. 0 = no withdrawal symptoms, able to complete all essential daily tasks; 10 = intolerable symptoms, unable to complete any essential daily tasks). 

 

Tapers are experiments in which you are both the principal investigator and the subject.  My sense is you are in a good position to begin the experiment.

 

 

 

 

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Thank you for your words.

 

I’m assuming this means put the baclofen and the mirtazapine on the shelf, and proceed with trying to reduce the diazepam via .02ml increments and track my progress.

 

If so, do I do this via 1ml syringe and not dilute the solution?  Just draw 1.98ml and squirt into mouth?  I’m sorry for being trouble.  Just respect your opinion and don’t have anyone I trust to help me make decisions…

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You’re welcome.  You aren’t being ‘trouble’ … you’re asking great questions plus it’s clear you’ve invested considerable time and effort to understanding your situation and deciding how you wish to proceed.

 

If neither the baclofen nor the mirtazapine is causing you issues, then it makes sense to just keep them as is.  (If you’re familiar with the scientific method, you are aware that one should only change 1 variable at a time when conducting experiments.)

 

Per our discussion upthread, you’d want to begin by taking four of your 2mg tablets and ingesting 2mL of the liquid.  If all goes well with that, your next step would be to take four of the 2mg tablets but only ingest 1.98mL of the liquid. 

 

To do this using a 1mL syringe, you would draw up 1mL of the liquid and squirt it into your mouth; then you would draw up 0.98 of the liquid and squirt it into your mouth.  After that, you would rinse the syringe a couple of times with distilled water … some people drink the rinse water, some don’t.  What’s important is to follow the same procedure each time you dose.  (It’s also important to ask your pharmacist to include an appropriately sized, press-in adapter cap for your medicine bottle; these make using an oral syringe much easier plus avoid the problem of wasting medicine by having to pour it it into another container before drawing up the dose.)

 

If you haven’t used an oral syringe to measure medicine before, I’ve included a video below. You can also ask your pharmacist to give you a lesson.

 

I’ll close with a tip for using syringes — putting a piece of clear tape over the markings on the barrel will prevent the markings from wearing off.

 

Link:

Giving Medications Safely at Home: Using the Right Liquid Oral Syringe and Giving the Correct Amount

Dana-Farber Cancer Institute

 

(The video indicates that a 3mL syringe should be used to measure doses between 1 to 3mL;  however, it’s also ok to use a 1mL syringe … again, what matters is consistency in procedure.)

 

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Thank you so much, Libertas!  I am picking up 120ml of the Hikma 5mg/5ml solution today (along with the press in bottle adapter and the 1ml oral syringes).  Insurance is covering the solution, and I am using a pharmacy coupon at the previous/same larger chain pharmacy for my Teva 2mg tablets which almost gets the price down to copay with insurance.  To say that these people are intrigued with my situation, and requests, would be a gross understatement.

 

It's hard to say if the baclofen and mirtazapine are causing issues, but if so I doubt they are causing as many issues as the diazepam.  Certainly wish I was on neither, but as you mentioned changing only 1 variable at a time is the best route and the diazepam is already in motion.  I know the baclofen comes in liquid as well, so when the time comes I can send the psychiatrist and pharmacist into another tail spin.

 

I have been holding 4 weeks today at 10mg in tablet form.  I will switch tonight to 8mg tablet form and 2mg/ml oral solution.  I will do this for at least a week and hopefully nothing changes much for me.  If not, I plan to start reducing at .02mg/ml per day.  Even if I have to hold and/or reduce by .01mg/ml per day at some point, it sounds like there is a good chance I won't have to alter the solution during my taper.

 

Again, thank you so much for your help!

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This is an edited post.  I should have edited the above post to include this information.

 

I just picked up prescription.  The pharmacist gave me 3ml, 1ml, and .5ml oral syringes.  They are Baxter ExactaMed oral syringes.  These people already think I’ve lost it (they arguably could be correct) so I could not muster up the courage to question the quality of manufacturer of the oral syringes.  I assume these oral syringes can be trusted? Again, thank you so much for taking time to answer questions and help ensure I start this experiment on the right foot.

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Hello Faith Hope Love.  I’m glad to see your sense of humor is intact.  This will serve you well as you proceed with your taper. 

 

Congratulations on obtaining the liquid as well as scoring not one, not two, but three oral syringes. Baxter ExactaMed is a quality manufacturer so you are good to go on that front. 

 

I’ll keep my syringes (and fingers) crossed tonight that all goes well for you. Please do keep us updated as to your experiment.

 

 

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Thank you, Libertas!  Just wanted to give an update. 

 

I proceeded confidently for 3 evenings at 8mg tablets, and 2mg/ml liquid.  Nothing seemed to change, and I slept relatively well all 3 evenings.  It tastes like the poison I figured it would. 

 

Last night I felt confident and decided I would begin tapering so I am currently at 9.98mg of diazepam and plan to reduce again this evening to 9.96mg.  Life is very busy with work, a 6 year old boy that is into everything and a 2 month old baby girl.  Thank you so much for assisting me in getting started with this route.  I truly feel it is the best way forward for me to be able to function to the best of my ability while still getting off the diazepam.  I plan to factor in some regular holds throughout this journey.  I will be watching my monthly percentages as well and know I will need to slow down to .01mg/ml with more frequent holds most likely down the road. 

 

I hope all is well with you and your family.  You are a blessing to many people.  I am off to coach my son's tball game this afternoon.  Faith it 'til I make it!  ;)

 

PS - One last question....since my liquid is a true solution do I need to shake bottle before ingesting?  It seems to create a bunch of little air bubbles that I wait to settle for a minute or so.

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Good to hear from you, Faith Hope Love.  I’ve been hoping you would stop by with an update.  I’m delighted all is going well with the pharma liquid and taper.

 

Re: your question about shaking the liquid before you measure your dose …

 

You are correct.  The pharma-grade diazepam oral liquid is indeed a ‘true’ solution (i.e. each and every milliliter contains exactly the same amount of drug).  Consequently, it does not require shaking before use.

 

If you reach a point in your experiment (taper) where your symptom and functionality data indicate that smaller reductions in dose are needed than can be achieved with your pharma liquid, we can talk about diluting it with water to achieve a lower concentration. We can also talk about how to minimize the risks associated with manipulating (modifying) a commercial dosage form.  Let me hasten to add that many members have tapered successfully by diluting their pharma liquids. 

 

Regrettably, you are not alone in reporting that the taste of the pharma liquid is less than wonderful.  You may adjust to it. Or, if not, you could measure your dose, dispense it in a glass of water, then drink the water.  (If you go this route, I suggest you then rinse the drinking glass a couple of times with water and drink the rinse water — this will ensure that all of the drug gets into your GI system instead of remaining on the surface of the glass.)

 

I’m sure your life is quite busy with two young children. In addition to your sense of humor and your faith, this will also work to your advantage.  Why?  Because it will keep you engaged with life instead of isolating yourself from it. Please do keep an eye on your taper rate and interval and adjust them as needed to maintain your functionality.

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Thank you, Libertas.  I'm glad I was able to post a positive update to this thread.

 

As bad as it tastes, I will (for now) continue to just shoot the solution directly into my mouth from the oral syringe.  The awful taste is most likely the least of my problems.  I then draw up filtered drinking water (from a glass I bring to bed) 2-3 times into the oral syringe and drink that as well. 

 

I am not overly concerned with manipulating my pharma liquid and would certainly be willing to if it becomes needed.  I also really appreciate your constant willingness to be available to help me and others.  However, I do feel if I don't need to dilute/modify the solution that has become available to me, that just brings one less variable into the equation for the time being.  I will remain optimistic that I can at least handle a .01mg/ml cut of diazepam.  Hopefully my thinking is sound in this regard.

 

I completely agree with you regarding staying engaged with life.  I have to keep working and being a husband and father.  At this point, I am learning to not let the fear run this show....slowly.  Emotions/feelings are important but they do not need to be the lead car.  Again, thank you so much for getting me started on this particular experiment (taper) that I am highly confident and optimistic about!

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Hello again, Faith Hope Love.

 

Your thinking is sound about not switching to a diluted liquid unless it is necessary.  Like you, I’m a proponent of ‘If it ain’t broke, don’t fix it.’

 

I’ve been cleaning up Notes on my iPad today and came across one you might find interesting.  It’s from a no-longer-active member of ours (Maugham1) who completed a successful taper using the undiluted, pharma liquid.  He was an MD with a PhD in pharmacology so I paid attention to what he had to say.

 

His take was that it was not necessary to microtaper diazepam (as in, make reductions in the range of 1 microgram or 0.001mg).  What he did deem important was making ‘small enough’ reductions in dose on a ‘gradual enough’ schedule to keep withdrawal symptoms tolerable and maintain high functionality (he ran a medical research lab at a large university plus was up for tenure so had to stay sharp). 

 

I’ve included tapering data from his signature below.  It looks like he may not have recorded all of his reduction dates (at the beginning, he was tapering at about 0.1mg every 14 days), but it will give you a general sense of his taper trajectory.

 

Working with you is a pleasure.  You’re on the right track with your taper and I have every confidence you will be successful!

 

Libertas

 

2019

1/4/19 V 7.5 mg (see Note)

1/23 7.0

2/15 6.6

3/04 6.4

3/11 6.3

3/18 6.2

3/30 6.1

4/10 6.0

4/19 5.9

4/27 5.8

5/5  5.7

6/1  5.3

6/27 5.0

7/29 4.6

8/23 4.3

10/15 4.0

11/27 3.7

12/24 3.5

2020

03/03 3.0

04/06 2.7

06/02 2.3

07/26 1.9

9/17 1.6

10/4 1.3

12/24 1

2021

3/7 0.7

4/10 0.4

7/28 0

 

Note: He crossed over from 0.375mg of clonazepam to 7.5mg of diazepam.  If memory serves, he found the diazepam sedating and felt his crossover amount might have been on the high side; hence the larger reductions at the beginning.

 

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Hi, Libertas! 

 

I use a variation of your phrase often.... "If it ain't broke, don't break it." 

 

You are absolutely correct.  I do find your 'Note' interesting and greatly appreciate you sharing it with me!  I already had the diazepam taper schedules saved from the members builder and openroad.  This will be a great 3rd, and final, addition to my 'successful example tapers' for diazepam (IMHO).  I greatly appreciate these members posting their taper milestones, dates and hope for other members like myself.

 

I feel I am about done "searching" on here for now, as I have a plan that I am confident will see me through.  I am currently planning to reduce at .02mg/day, .01mg/day or .00mg/day for the duration of my taper based on my symptoms and striving to maintain as high a degree of daily 'function' as I am able (while still moving towards diazepam 0mg).  I am currently at 9.92mg diazepam.  I remembered I had some leftover 5mg Teva tablets so I have been using a 5mg tablet, two 2mg Teva tablets and drawing the remaining (.98mg/ml, .96mg/ml, .94mg/ml etc...) via the 1ml oral syringe.  I am planning a smaller reduction and/or a hold soon.  I will run out of the 5mg tablets in the near future but figured it would be good time to use them up just in case my body needed time to adjust to the liquid and/or had/have a bad reaction to it.  So far so good.  :thumbsup:

 

I also greatly appreciate you, as I wouldn't be at this point and feel confident in my current plan/taper/experiment going forward without you.  I am also grateful for Pamster for responding to me first and 'introducing' us!

 

Sorry for the abundance of gratitude oozing out of this post, but at least it is genuine and positive.  To each their own, but I personally do not believe in coincidences and am certainly glad you happened to be cleaning up the notes on your iPad the other day.  If you happen to come across anything else you may think I find interesting/helpful and have time and/or think of me, please do pass it along! 

 

You and Pamster have over 50,000 combined selfless posts to hurt, lost, confused, searching and suffering individuals.  The world needs more Pamsters and Libertas.  The personal text "seek and ye shall find" on your profile is sage advice.  The author of my faith uses it in Matthew 7:7-8.  I respect all people of faith (whether they realize they possess it or not) and those with different "higher powers".  The only approach I have found that does not work is to be one's own "higher power."

 

FHL

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What a lovely, thoughtful post, Faith Hope Love.  Many of our members are in such dire straights they do not have the capacity to express gratitude toward others.  Consequently, offering support in this community can get a bit discouraging at times.  Posts like yours lift us up and carry us forward.  Thank you so much!
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Greetings, Faith Hope Love.  I hope this finds you and your family in good health and spirits. I came across another post from Maugham1 (the MD/pharmacologist) you might find of interest:

 

As a pharmacologist, I would like to point out that percentages are the most important in the therapeutic range. The reason is that that's how receptors work. That's why drug dose-effect relationships are expressed on a semilogarithmic plot.

 

Here is an example of such a semilogarithmic curve for diazepam: https://www.alomone.com/p/diazepam/D-215?cn-reloaded=1.

 

However, once you reach a low enough dose, which is well below the therapeutic dose, the curve becomes less steep and you can go faster (or you will feel the cuts less). The taper becomes harder when you are on the steep part of the slope. That's also the reason why it's usually easier to taper in the beginning at high doses where the curve is not yet as steep.

 

To learn more about the hyperbolic relationship between drug dose and receptor occupancy and the implications this might have for dose reductions:

 

Should I do a Hyperbolic Taper? What You Need to Know

 

 

Edit: Corrected link

 

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Hi, Libertas!

 

Thanks for reaching out and thinking about me.  I am hanging in there.  I am nearing two weeks into the new (and hopefully final) experiment and everything seems to be going well.  I am currently at 9.86mg diazepam (reducing at .02mg/ml per day so far) and sleeping fairly well with a more consistent pattern (possibly even slowly improving).  I don't feel very good and always a degree of fatigue/exhausted but it could certainly be worse.  It is a very busy season of life, and I am very blessed with an amazing wife, 6 year old son and 2 month old baby girl.  They give me every reason in the world to live above my circumstances.

 

Hopefully everything continues to settle and possibly even keep improving (if I go slow enough)!  I am very active, go to the gym 3-4 days a week, and coach tee ball for my son.  The hardest part is staying up with my daily "work".  I am a "business guy" and investor.  Most of my daily responsibilities however are running operations for a residential development and construction company that I am also a part owner of.  This has always been a very stressful job to say the least.  A lot of pressure to perform and stay on top of things.

 

I appreciate you sharing the post from Maugham1.  I believe the youtube link was Dr. Josef Witt-Doerring explaining liquid tapers, however, you did post the link of his regarding hyperbolic tapers upthread that I did watch. 

 

The drug dose and receptor occupancy relationship is an interesting and important one.  I would assume everyone is different in this regard as some people are able to get off easily (or fairly easily) with minimal to no symptoms?  The binding and disengagement differs from person to person? Also, what about the people group that have been previously severely “injured” and still have to taper? I obviously had a severe injury when I went from 15mg diazepam to 2.5mg diazepam in 3 weeks.  “Injury” seems to be more appropriate than “withdrawal” as when I reinstated, it did not alleviate my symptoms.  The injury was done.  I will never know what would have happened if I jumped instead of reinstated.  It was a horrific time getting "stable" and holding dose (and hope) since this injury in September 2022.

 

In essence, your quote from Maugham1 upthread I believe to be the best "broken down lay person" approach to get off any psychotropic drug for most people and especially those that have been "injured": "making ‘small enough’ reductions in dose on a ‘gradual enough’ schedule to keep withdrawal symptoms tolerable and maintain high functionality".  I will be watching my monthly percentages, tracking my progress, adjusting to reduce by .01mg/ml per day more the lower I get, and factor in some holds to gather as much data as I can as I progress towards 0mg diazepam.  I will be using the 3 member schedules I have for reference, but will listen to my body most importantly.  Functionality is certainly more important than getting off of diazepam quickly and recklessly (for me personally). 

 

Thank you so much again for helping me.  It will never be forgotten.  I will keep you posted on my progress!  You are always too busy helping other people, but I hope everything is well with you and your family. 

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