Dry taper of Oxazepam

Hope this is the right board to post in.

 

I've been on 20 mg of Oxazepam for many years, at bedtime for insomnia. I was able to drop down to 17.5 mg last year but it was terrible. When I tried going down to 15 from 17.5 it was too much.

 

tl;dr I didn't know what I was doing and was breaking pills with my fingers.

 

Fast forward a year and I have a mg scale and I'm ready to really do this. My big question is should I drop my dose down once a month or do the every day taper method?

 

Right now I'm reducing by 1.25 mg (roughly 7% of my starting dose of 17.5 mg) every 30 days.

 

So like this: 16.25 mg for 30 days, then 15 mg for 30 days, then 13.75 mg for 30 days... etc.

 

Or should I be more day by day about it, reducing tiny amounts but still hitting 1.25 mg reduction per 30 days.

 

 

Also... any tips for taper off a very quick half-life benzo like Oxazepam? I don't have access to substitutions.

 

Thanks for all the help. <3

Dang I put this in the wrong board, can someone move it to http://www.benzobuddies.org/forum/index.php?board=56.0 ?

 

Thanks.

bluesie,

 

Your post can stay here because you're asking whether to dry taper or use titration. If you really want it moved, I can move it for you, but it's fine to remain here.

 

To get to your question. There really isn't a right or a wrong way to taper. It's what works for you. Some people prefer to dry cut and use a scale others prefer daily micro reductions. Often DMT's (daily micro tapering) is usually done to try and decrease symptoms. The reasoning is that doing these extremely small reductions might be easier on the brain than once-off bigger reductions (cut and hold). Another reason might be that it becomes too difficult to accurately shave and weigh your pills.  However, it doesn't mean you have to stick with the same taper method throughout your taper. I have tried many different methods throughout my taper. I think the most important thing is to keep a daily journal where you keep track of your symptoms. Let your symptoms guide your taper. Is there a method you feel comfortable with?

 

When it comes to short half-lifes, usually people either do a cross-over or they dose multiple times a day to avoid interdose withdrawal.

 

I hope this helps.

Thank you for the reply jelly baby! I totally agree with you and I'm really enjoying that philosophy of going at my own pace depending on my withdrawal symptoms that I see from the leadership here. Judging from how hard it was to go down 1.25 mg in one shot the last time, it took me about 4 weeks to start feeling like my head was screwed on straight again. Judging from that I'm going to switch over to a more gradual taper like the one below. It's still the 7 percent rate, but it will be spread out over the month. This will be my next 30 days:

 

0.107

0.107

0.106

0.106

0.106

0.106

0.105

0.105

0.105

0.104

0.104

0.104

0.104

0.103

0.103

0.103

0.103

0.102

0.102

0.102

0.101

0.101

0.101

0.101

0.1

0.1

0.1

0.1

0.099

0.099

 

Measured in grams it's the full weight of the pills given each 10 mg pill is 0.066 g. If I encounter any symptoms that really stop me from my day to day obligations I'll reassess or hold for a bit longer until I'm feeling ok enough to continue again.

 

Thanks again for your feedback and advice. 🙏

 

B

Your approach sounds very sensible to me. I was also having a hard time after I made a 6% cut from cut and hold and that's when I switched to micro tapering. It became easier after that. The only problem with micro tapering is it's difficult to determine your reduction percentage because cuts only materialize a lot later and they can catch up with you. If you keep this in mind and carefully monitor your symptoms you'll hopefully manage your taper. The moment you notice a strange symptom it would be best to hold.

 

Please keep us updated.

Ok I will be on the lookout for those build up withdrawal symptoms. Will keep you guys updated and thanks again!

Thank you for the reply jelly baby! I totally agree with you and I'm really enjoying that philosophy of going at my own pace depending on my withdrawal symptoms that I see from the leadership here. Judging from how hard it was to go down 1.25 mg in one shot the last time, it took me about 4 weeks to start feeling like my head was screwed on straight again. Judging from that I'm going to switch over to a more gradual taper like the one below. It's still the 7 percent rate, but it will be spread out over the month. This will be my next 30 days:

 

0.107

0.107

0.106

0.106

0.106

0.106

0.105

0.105

0.105

0.104

0.104

0.104

0.104

0.103

0.103

0.103

0.103

0.102

0.102

0.102

0.101

0.101

0.101

0.101

0.1

0.1

0.1

0.1

0.099

0.099

 

Measured in grams it's the full weight of the pills given each 10 mg pill is 0.066 g. If I encounter any symptoms that really stop me from my day to day obligations I'll reassess or hold for a bit longer until I'm feeling ok enough to continue again.

 

Thanks again for your feedback and advice. 🙏

 

B

Hello bluesie,

 

I hope that switching to a micro taper will help you with your symptoms going forward. One caveat, though, is that you may be tricked by the accuracy of your scale. Milligram precision scales do have a 0.001g reading/display, but the accuracy of the cheap ones you can order online is usually +/- 0.005g. You should be able to check the accuracy of your scale; it is normally indicated in the product information leaflet provided by the manufacturer (and/or online). The more accurate, but significantly more expensive, scales are usually laboratory grade scales.

 

It seems that oxazepam isn’t available in pills dosed at less than 10mg. This is unfortunate — if you switched to, say, a 2mg pill, you may end up removing more than 5mg pill weight at a time, so this would be a workaround for the limited accuracy of your scale. For diazepam, 2mg pills are usually available and make micro tapering easier.

 

Another option is a liquid taper. Ideally, you would be able to find a compounding pharmacy that could prepare a 1 mg/mL oxazepam suspension. Less ideally, you could crush a 10mg pill, add 10mL Ora-Plus, shake vigorously, and obtain a 1 mg/mL suspension. Much less ideally, you could replace the Ora-Plus with lukewarm homogenized whole milk or water (25-30C). I do not recommend doing this, because oxazepam may precipitate and the oxazepam particles will sink to the bottom quickly. Unless you dose as quickly as possible after shaking, your dosing may be off. Note, though, that many members have successfully tapered with a water or milk titration*. In all cases, except possibly for a water titration for the aforementioned reasons, you would be tapering by 0.1mg oxazepam every time you remove 0.1mL suspension (using a 1mL syringe).

 

If you would like a less potent suspension, you can double the amount of Ora-Plus, milk or water, i.e. use 20mL, to obtain a 0.5 mg/mL suspension. You would be tapering 0.05mg oxazepam by removing 0.1mL suspension in this case.

 

For now, you can follow the plan that you have laid out for the next 30 days and see if it works for you.

 

* Milk is a decent solvent for diazepam because it is the most lipophilic benzodiazepine, moreso than oxazepam. In theory, it should be an at least slightly better choice than water, but I have no evidence to substantiate this claim other than oxazepam is lipophilic.

Hello, bluesie.

 

Are you aware of this approach to dry microtapering?

 

Bob7’s Benzo Dry Taper Method 

 

It improves accuracy by increasing the weight of the substance being measured (in this case, pill powder mixed with microcrystalline cellulose). 

 

Although many members have dry tapered successfully using inexpensive milligram scales, others have chosen to invest in higher-end scales/balances.  Here is a starter list of reputable manufacturers I’ve seen mentioned here and elsewhere:

 

Sartorious

Ohaus

US Solid

Mettler Toledo

 

Hello, bluesie.

 

Are you aware of this approach to dry microtapering?

 

Bob7’s Benzo Dry Taper Method 

 

It improves accuracy by increasing the weight of the substance being measured (in this case, pill powder mixed with microcrystalline cellulose). 

 

Although many members have dry tapered successfully using inexpensive milligram scales, others have chosen to invest in higher-end scales/balances.  Here is a starter list of reputable manufacturers I’ve seen mentioned here and elsewhere:

 

Sartorious

Ohaus

US Solid

Mettler Toledo

bluesie, Bob7’s method is a very clever trick indeed. A good choice if you wish to proceed with your dry micro taper instead of being forced to switch to a liquid taper. (Personally, I would have followed it with my 5mg diazepam pills, but I am physically unable to do the preparation work so I am doing a liquid taper instead.)

Hey thank you both for the additional information really this is all new to me so thanks a lot.

 

Potatosaur, cool name btw. Yeah I'm definitely noticed this with my scale it's very cheap, I have two cheap scales. One seems to be more accurate but still fluctuates while I'm weighing things plus minus 3 mg. I tried to just get sort of in between the fluctuation if it's fluctuating a lot I'll just take the average of the fluctuation as the pill weight. I have avoided using liquid because, not that I don't think I can do it, it's just really seems overly complicated for what I'm trying to do. Even though I know it's benefits. I experienced a huge stability going from breaking pills with my fingers to weighing pill fragments with the cheap scale. Enough stability that I think I can do that moving forward but if not then I like the method libertas posted.

 

My worry though with the cellulose method is that I've heard the scales don't weigh powder very well I don't know if that's true. I saw a video on YouTube where they were trying to weigh the pill versus the powder and they said that the powder was very difficult to register on the scale, but I don't think they were using cellulose they were just trying to weigh the pill itself. And maybe that doesn't weigh enough so I would need to add more cellulose. But this is a really cool method I think that I may do this eventually when I'm getting down to the last couple milligrams of oxazepam and it's virtually like taking pill crumbs.

 

Also I like the method of using a spoon and a bowl to crush the pills, because using a mortar and pestle I was afraid that the pill powder would get like stuck in all the pores stone.

 

Thanks again,

B

I understand that you want to continue with a dry taper. By all means, if you have found that this method is better for you, you should proceed with it going forward.

 

I am absolutely not sure of the hypothesis I am about to propose, but weighing powder directly on the scale may lead to inaccurate weighing due to static electricity. Here is what the pinned thread on how to use a scale for a dry taper says:

 

If you're measuring a powder, as opposed to granules or small cut-up pieces, there can be effects from static electricity. These become much more significant as the weights get lower. You can try to not to generate any static e- by not rubbing any non-conductors. We used the "cling-be-gone" thingies you put in the dryer in my lab--no kidding! Gently rub the weighing surfaces; don't use the ones that have powder. The also make zero-stat ion guns.

http://www.benzobuddies.org/forum/index.php?topic=233546.0

 

However, with Bob7’s dry taper method, the cellulose and the crushed tablet both go inside a capsule — neither comes directly in contact with the scale itself —. This should mitigate the problem.

 

Another issue though, just looking at Bob7’s example spreadsheet, is that the reductions in total capsule weight (e.g. 0.4g on day 1, 0.397g on day 2) still fall within the tolerance of the scale. Ideally, you should find capsules as large as possible — it would be ideal if they could contain, say, 1 gram total (cellulose + crushed tablet).

 

Since you have brought up crushing tablets with a spoon in a bowl, a second issue may be that the resulting mixture is inhomogeneous. Even if the tablets are crushed as finely as possible, they may not be spread evenly throughout the cellulose. This is cause for concern in theory, but whether that is the case in practice, I do not know. It would be up to you to try it and see if it works well for you.

Ugh... I'm facing the reality that doing a pure dry taper is not going to work. I tried doing it last night and I weighed it once I weighed twice I weighed the whole pill container three times and every time it was different numbers I got so frustrated I just gave up. Looking at my scale it is plus minus 5 mg tolerance, and I'm trying to step down by 1 mg per week, as potatosaur pointed out. So yeah it looks like I don't really have a choice I need to either do the cellulose or the liquid titration

 

Strictly from a standpoint of saving money, because honestly that's my biggest concern right now, which might be cheaper? I could just get an oral syringe and some whole milk. Looking at the Microcrystalline Cellulose, is pretty expensive on Amazon. Maybe y'all know a better source (I'm in Canada).

 

Thanks for the help here.

B

I'm looking at syringes, 1ml or 3ml look like good choices. 1ml would give me about 1mg per line marker, 3ml would give me about 2.2mg per line marker. Assuming one pill is 66mg full weight. But 1ml seems pretty difficult to work with. I would need to crush several pills at a time to get a large enough quality of liquid to handle that concentration level.

Ok no worries explaining, I think I found a good method with this video series

 

I'll post details later but basically 60mg of pills into 600ml milk then ration out 7 days of drinks for the week. Should be enough liquid to get really fine detail with the dose. And I'll take the missing 10mg per day as pill form.

In the words of Ron Burgundy... "Milk was a bad choice."

 

It seems that particles of the pill are now floating at the top and sticking to the sides... I can't tell if they are bits of filler, or the actual Benzo itself. Even at room temp they are still there. Anyone seen something like this before? I didn't crush the pills before, I just let them dissolve in the liquid. Think I should try to crush them up next time?

 

Gonna keep it in the fridge until I get some confirmation on this.

 

Bluesie

 

I really commend you for your efforts. I'm not at all familiar with milk titration. Hopefully Libertas will share her wisdom.  Just popped in to say I wish you all the best and please don't give up. Once you get the hang of it  I'm sure it will be much easier.

Thanks jelly baby. Do you think this would be good for the dry mixture method?

 

Allergy Research Group - Cellulose Powder 250 gms by Allergy Research Group https://a.co/d/idfEqob

 

I'm sorry you had difficulty with using milk, I've heard such good things about it.  This method used in this video seems to work well. 

Thanks Pamster. That's actually the video I learned from haha. So I took my liquid dose last night, and besides a very fast on set, it felt pretty much the same as my dry taper dose... So I think I did it right. Will continue with this method. Reducing the same amount as my dry taper, but now with much more control over the dose (0.1mg active Oxazepam per 1ml of liquid). Removing 1ml every 2 to 3 days. I'll try to keep it up for a month and will update as needed.

I'm glad it worked better last night but please remember that what you're using is a suspension so its important to shake it up before ingesting, then if possible putting more liquid in so you can fully ingest the remaining particles.  Also, it couldn't hurt to crush the pill before adding it, might as well do all you can to get it to disperse. 

 

 

Hello, bluesie.  Good for you for giving milk another try.  I’ve included a link to a paper that discusses the use of mllk as a lipid excipient for the oral delivery of lipophilic poorly water soluble drugs, such as oxazepam.

 

Do you plan to hold at your current dose for a week or so to give your body time to adjust to the new dosage form?  Are you keeping a daily taper journal? 

 

Re: your questions about tablet disintegration and the particles you’re seeing in the liquid ….

 

Tablets from different manufacturers ‘behave’ differently when  liquid is added to them.  Some tablets disintegrate/disperse quickly, whereas others take longer.

 

To help ‘jump start’ the tablet disintegration/dispersion process, some individuals add a little water to cover the tablet then let the tablet/water mixture sit for a period of time (say 5 - 15 minutes).  If the tablet still hasn’t dispersed, you could also try using a glass rod (or a similar smooth, non-reactive implement) to gently break the tablet into evenly sized particles.  Then you would add the milk. 

 

If you try the above, I suggest you use distilled or purified water (depending on where you live, tap water may contain chemicals that have the potential to interact with the excipients in the tablet). Be sure to record the amount of water you use — you will need to decrease the volume of milk by that amount.  For example,  if you use 2mL of water to disperse the tablet, you would decrease the amount of milk you add by 2mL.

 

I also suggest you rinse the glass rod with the milk as you add the milk to your mixing container.  That way, any particles of drug/excipient adhering to the glass rod will be included in your liquid.

 

fyi You may still see particles in your milk. Please do not discount them!  They may contain the API (Active Pharmaceutical Ingredient) and/or excipients that affect the bioavailability and pharmacokinetic profile of the API.  (This is why it’s important to shake your liquid to disperse the particles as evenly as possible and measure your reduction/dose quickly before the particles settle out suspension.)

 

Link:

 

Salim M, Eason T, Boyd BJ. Opportunities for milk and milk-related systems as 'new' low-cost excipient drug delivery materials. Adv Drug Deliv Rev. 2022 Apr;183:114139. Accessed online at: https://www.sciencedirect.com/science/article/pii/S0169409X22000291

 

 

 

Thanks Libertas. That's actually the video I learned from!

 

Ya it looks like just letting the pills dissolve long enough in liquid helps. I'm doing two rotating batches of 400ml milk in 500ml mason jars. Seems to work well and give me enough time to make a new jar a heard of time. Just for other people I wanted to lay out exactly my plan in case someone else wants to use the method.

 

 

So because I'm dumb and wanted to just make things simple so I made a solution of 1:10, medication to milk. So for ever 0.1mg there is 1ml of milk. Same thing as saying 1mg for every 10ml of milk.

 

My batches are always 1 10mg tablet for every 100ml of milk. So a batch of 400ml of milk would have 4 10mg pills in it.

 

I use a 50ml syringe to measure the milk and use a clean mason jar, mix everything together. I let it sit in the fridge and shake it every day. After 3 days it should be well dissolved. I always have 2 batches going at the same time so I don't get caught off guard without a well dissolved batch.

 

Then I use a 20ml syringe to pull off what I need from the large batch. Make sure to swirl up the milk in the jar before each pull to make sure it's evenly mixed. For me I'm at around 55ml per night, that is 5.5mg. I put the 55ml into a little cup and drink it, then put water into the cup to rinse and drink that too. I also take a 10mg pill straight too so that brings me up to my dose of 15.5mg currently.

 

The math for my ml/per night reduction rate was a bit of trial and error. But I found that a reduction of 1.25mg per month (about 7.8%) was enough for me to live and function (with supplements, meditation, yoga, breathing, etc.) And I only dose once per day so that makes everything a bit easier for my case.

 

So 1.25mg divided up into 31 days would be 0.04mg. Take that 0.04mg reduction per day rate and multiply it by 10 (since I have a 1:10 ratio) and it's about 0.4ml per day. So every day I would reduce by about 0.4 ml. But on a spread sheet it would look more like this:

 

Day Oxazepam (mg) milk (ml)

1 6 60

2 5.9583 59.5

3 5.9167 59.1

4 5.875 58.7

5 5.8333 58.3

6 5.7917 57.9

7 5.75 57.5

8 5.7083 57.0

9 5.6667 56.6

10 5.625 56.2

11 5.5833 55.8

12 5.5417 55.4

13 5.5 55

14 5.4583 54.5

15 5.4167 54.1

16 5.375 53.7

17 5.3333 53.3

18 5.2917 52.9

19 5.25 52.5

20 5.2083 52.0

21 5.1667 51.6

22 5.125 51.2

23 5.0833 50.8

24 5.0417 50.4

25 5 50

26 4.9583 49.5

27 4.9167 49.1

28 4.875 48.7

29 4.8333 48.3

30 4.7917 47.9

31 4.75 47.5

 

At the start of the month I'm at 6mg and at the end of the month I'm at 4.75mg, a reduction of 1.25mg. Of course this is just a table but you should go at your own pace and hold when needed. But the basic is 0.4ml reduction per day.

 

This is the site I used to make all the in between numbers on my table https://benzo.alwaysdata.net/titration/titrationForm.php

 

Hope that helps anyone.

So I've been soaking up the advice on here. and after coming across a few key pieces of info and hitting a wall in my linear taper, I've decided to hold for a week, at minimum, and I'm going to avoid all supplements for a while. Only using them for extreme situations. But I will stop all supplements for at least a week.

 

Apparently taking certain supplements that can agitate Gaba receptors or mimic Gaba can give a rebound effect, which I didn't know. I was using them heavily for the inter-dose withdrawals, but will stop now.

 

That combined with the linear taper, I think it was a bit much for me. I have some relief knowing I'll hold for a bit. Gonna start my taper again after a week, and maybe try a hold one day, taper one day approach.

 

Here is more about supplements back firing: https://www.benzowarrior.com/may-cause-setbacks

 

EDIT: I would like to say that I have dropped down by 2.2mg since April so I'm proud of my progress.

Congratulations on your progress! I think you're doing the right thing by listening to your symptoms and taking a break. Hoping you'll see some improvements soon!