Can high dose of Valium be micro tapered?

I’m at a wall with Valium right now. I have been at 45 mgs for over 2 months. I tried a 5 mg cut last week following Ashton protocol and by day 5 I couldn’t tolerate it. Went back to 45 mgs (today is day 6) and still not feeling stable. Obviously I have a lot to think about in the coming weeks since I see my pdoc in mid November. I’m half tempted to go to a different benzo but I don’t even know how to go about doing that, or if that’s an option, so for now I’m thinking hypothetically if I stay with Valium, is it possible to micro taper such a high dose? Most of the posts I see are people at much lower doses. How would I start? Liquid titration? Can it be done at this dose? I’m not going to even start yet until I feel more stabilized and wait a while but I’m just trying to get a feel for the option of a liquid micro taper. Anyone have any suggestions? Do I need a compounding pharmacy? Make it myself? Thanks in advance

Are you in the US or another country?

 

What is your daily dosing schedule? 15mg, 3 times a day?

 

What strength tablets do you have?  10mg? 5mg?

 

Would your prescriber be willing to prescribe:

 

- tablets in a different strength?

- an oral diazepam solution?

- a combination of tablets and the solution?

 

 

 

If you are in the US, they make a liquid Valium.  You can MT using the commercially manufactured liquid Valium.  I am not sure about starting at 45mg though.  I am sure someone much more experienced can help answer that question.

Perhaps 5mg is way to much of a cut for your body to handle.  Maybe try starting with a 1mg cut every 2 weeks.  Just a suggestion.  I switched to DMT as it's a much smoother process for me. 

I am holding right now as I am traveling this weekend and just went through a hurricane.  I need some time to get back to normal life- whatever that is!  Ha!

Are you in the US or another country?

 

What is your daily dosing schedule? 15mg, 3 times a day?

 

What strength tablets do you have?  10mg? 5mg?

 

Would your prescriber be willing to prescribe:

 

- tablets in a different strength?

- an oral diazepam solution?

- a combination of tablets and the solution?

 

I’m in the US. I have 10 mg tablets. I take 5 mg am, 10 mgs afternoon, 10 mgs evening and 20 mgs at night. My pdoc is open to prescribing whatever will help me. I was trying to go by the Ashton method but once I got to stage 12 I have hit a wall.  Maybe I should try direct cuts at first before trying to liquid taper? I don’t even feel like I can stay on Valium either, so I’m pretty lost right now to be honest.

Thank you for the additional information.  That’s great news that you have a supportive prescriber. 

 

One working hypothesis is that the 11.1% reduction in dose from 45mg to 40mg (Stage 11 to Stage 12) was too high for you.  Using a combination of tablet strengths (e.g. 10mg, 5mg, and 2mg whole or split to deliver doses of 5mg, 2.5mg, and 1mg) and/or a combination of tablets and liquid (see link below) will allow you to make smaller reductions in dose.

 

But before we delve into details …

 

How did you feel at Stage 11 (50mg total daily dose divided into doses of 10mg, 10mg, 10mg, 20mg)?  Were you able to stabilize at that dose?

 

Link:

DailyMed - DIAZEPAM solution (5mg/5mL or 1mg/1mL)

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

Thank you for the additional information.  That’s great news that you have a supportive prescriber. 

 

One working hypothesis is that the 11.1% reduction in dose from 45mg to 40mg (Stage 11 to Stage 12) was too high for you.  Using a combination of tablet strengths (e.g. 10mg, 5mg, and 2mg whole or split to deliver doses of 5mg, 2.5mg, and 1mg) and/or a combination of tablets and liquid (see link below) will allow you to make smaller reductions in dose.

 

But before we delve into details …

 

How did you feel at Stage 11 (50mg total daily dose divided into doses of 10mg, 10mg, 10mg, 20mg)?  Were you able to stabilize at that dose?

 

Link:

DailyMed - DIAZEPAM solution (5mg/5mL or 1mg/1mL)

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

 

Thanks for your help. Okay, I looked back at my notes, and as soon as I got to stage 11 which is when the last 0.25 of Xanax was gone, I struggled there for 5 weeks. 

You are most welcome.

 

Tip of the hat for recognizing the importance of keeping taper notes!

 

When did you make the reduction from 50mg to 45mg?  After you struggled for 5 weeks or before?

 

If you made the reduction after 5 weeks of struggling, we’re you still struggling at that point or had you stabilized?  In this community, we define stabilize as ‘symptoms are not changing in number or nature and are tolerable enough to make the next reduction.’

You are most welcome.

 

Tip of the hat for recognizing the importance of keeping taper notes!

 

When did you make the reduction from 50mg to 45mg?  After you struggled for 5 weeks or before?

 

If you made the reduction after 5 weeks of struggling, we’re you still struggling at that point or had you stabilized?  In this community, we define stabilize as ‘symptoms are not changing in number or nature and are tolerable enough to make the next reduction.’

 

I made the cut to 45 mg after 5 weeks. I was still kinda struggling but thought I had to keep going so went to stage 12, 45 mgs. I struggled at that for a good while and felt bad because I couldn’t seem to reduce my dose by the Ashton method. I didn’t think 5 mgs reduction would be so hard  .

Now I feel so sick and the dizziness and nausea and everything I felt when I was on Xanax and had to updose that. I almost feel paradoxical about an hour after I take the Valium, which is something I dealt with on the Xanax when I started my taper. I’m so confused

I’m sorry you felt pressured to keep moving forward with Ashton’s schedule. As she wrote in the introduction to this section: “Schedules such as these have worked on real people, but you may need to adapt them for your own needs.”

 

In your case, it sounds like you may have benefited from staying at Stage 11 for a while longer to give your body additional time to process the final two alprazolam reductions and to ensure the diazepam was acting smoothly.

I’m sorry you felt pressured to keep moving forward with Ashton’s schedule. As she wrote in the introduction to this section: “Schedules such as these have worked on real people, but you may need to adapt them for your own needs.”

 

In your case, it sounds like you may have benefited from staying at Stage 11 for a while longer to give your body additional time to process the final two alprazolam reductions and to ensure the diazepam was acting smoothly.

 

Thank you for your help. So, I can’t go back to that stage, and I’m not sure what to do now to be honest. 

If I were in your shoes, I would probably hold at the current dose (45mg) in hopes that I would stabilize.  I would also work on a taper plan to discuss with my prescriber at my next appointment. 

 

Re: developing a plan … if you have not already done so, I strongly encourage you to read the benzodiazepine deprescribing guidance document linked below.  You also might consider sharing this with your prescriber.

 

Questions to consider as you develop a plan include:

 

(1) Is your current daily dosing schedule working for you?  Or do you feel changes are needed in times or amounts? Generally speaking, it’s preferable to keep doses as even as possible. Also, generally speaking, most individuals only need to dose diazepam 1 or 2 times a day.  However, we have had members who dose 3+ times a day.

 

(2) What taper rate do you wish to try given that you’ve discovered 10% reductions in dose may be too much for you?

 

(3) What approach(es) do you wish to use to make ‘small enough’ reductions in dose? Given that you are starting at a relatively high dose, a combination of regular tablets and the FDA-approved 5mg/5mL (1mg/1mL) oral diazepam solution is worth consideration. 

 

(4) What plan will you present to your prescriber?  For example, if you decide on a daily dosing schedule of 15mg, three times a day, the first two phases of a taper using a combination of regular tablets and the 1mg/1mL oral diazepam solution might look like:

 

Phase1:

10mg tablet + 5mL (5mg) in liquid form (taper as tolerated to 0)

10mg tablet + 5mL in liquid form (taper to 0)

10mg tablet + 5mL in liquid form (taper to 0)

 

(An alternative to the above might be: 10mg tablet  + 2mg tablet  + 3mL in liquid form.)

 

Phase 2:

5mg tablet + 5mL in liquid form (taper as tolerated to 0)

5mg tablet + 5mL in liquid form (taper to 0)

5mg tablet + 5mL in liquid form (taper to 0)

 

Link:

Benzodiazepine Deprescribing Guidance Document (2022)

https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf

Libertas, thanks for the help. I will keep all of this saved to think about. I just can’t mentally answer it right now, I’m sorry. My brain is so jumbled. The problem is, I don’t know if I can stay on Valium. I feel miserable on it. I can’t seem to stabilize even though I went back up to 45 mg after I tried to lower.

Do you have any suggestions or information about switching from Valium to a different benzo? Your knowledge is very great on tapering and you are supportive without judgment which I appreciate. I’m not saying that I’m going to switch, but I’m still on the fence to be quite honest. I just feel deep down that Valium isn’t working for me. 

 

So, if I was to ask you for some advice on switching from Valium to something else, what would you say?

 

Hello again, ThroughAGlassDarkly.

 

I wish I could offer suggestions or information about switching from Valium to a different benzodiazepine, but, regrettably, I do not have personal experience with this and have not researched and read about members who do.

 

What I can offer is a suggestion that might make the decision-making process you’re facing a little easier. That is — consider making a pros-and-cons list about switching using the feedback you’ve received in response to your thread on the Withdrawal Support board (linked below) as well as your own research (e.g., Ashton’s reasons for a Valium taper linked below).

 

Links:

Pros-and-Cons - An Approach For Decision-making

https://thinkinsights.net/strategy/pros-and-cons-decision-making/

 

Switching to a different benzo questions?

http://www.benzobuddies.org/forum/index.php?topic=272584.msg3414464#msg3414464

 

Reasons for a diazepam (Valium) taper (Ashton, 2001)

https://benzo.org.uk/ashvtaper.htm