New here. Need help with unusual taper!

[[Buddie]]

Hello all. I am new here and need help. I started taking Xanax at .75 mg per day in 2019 for anxiety due to some misdiagnosed health conditions. I started having panic attacks and my psychiatrist put me on the Xanax. I kept on .75 mg daily taken as .25 mg 3x daily until July 2022 when I had a massive panic attack and ended up in the emergency room for it. My psychiatrist then bumped me up to 1.5 mg daily and within a month I was up to 2.5 mg daily. I finally realized the vast majority of my issues are caused by the Xanax and I want off. I discussed switching to Valium with my psychiatrist and she was fully supportive so we attempted to do a partial transition as per Ashton manual, problem though. I can’t handle very high dose Valium apparently. It was far far too sedating for me at 10 mg plus 1.5 mg Xanax daily. So we made the decision to add in a low dose of Valium to help. My biggest fear is a seizure. I’m flat out terrified of having one and want more than anything to safely get off without having any issues. I am having horrible anxiety now while cutting but I am down to 1.75 mg daily plus 4 mg Valium to help. I take it as .5 mg Xanax 2x daily and .375 mg Xanax 2x daily. Adding in 1 mg Valium with each dose. The plan is to cut by .125 Xanax every 1-2 weeks while maintaining the 4 mg Valium. Then once I’m completely off the Xanax begin to taper the Valium. My question is does this sound safe?  Should I be concerned about a seizure doing this?  I just haven’t really read many other stories of mixing in Valium but not fully transitioning to it. I should add I have no other preexisting medical conditions, just the anxiety. When I started the Xanax I was misdiagnosed as having a heart condition I do not actually have. The misdiagnoses caused me panic. Then Covid just spiraled me out of control anxiety wise. Also I’m not taking any other meds, don’t tolerate SSRIs well at all as they seem to increase my anxiety. And no alcohol or any other meds taken aside from my daily supplements.  Any help would be greatly appreciated. Thanks!!

[[Buddie]]

Hello, [...].

Our current understanding is that the risk of seizures is highest for individuals who (1) are on high doses of a benzodiazepine and (2) stop taking it abruptly (i.e. cold turkey).  Seizure risk is low for individuals who are gradually tapering a benzodiazepine.  (As you probably know, another risk factor for seizures is heavy alcohol use or binge drinking on a regular basis.)

To help us help you, would you please let us know:

Is this the first time you have taken/discontinued a benzodiazepine or Z-drug?  Do you have a history of taking/discontinuing other psychotropic drugs (see link below for examples)?

What supplements are you currently taking on a daily basis?

Are you taking any other medications (either prescription or over-the-counter) on a daily basis?

In closing …

If you have not already done so, I encourage you to use one or more of the online drug interaction checkers to check for interactions among and between any substances you ingest on a daily basis.

Link:
Quick Reference to Psychotropic Medications
https://www.continuingedcourses.net/active/courses/images/course015-quickreference2014.pdf

[[Buddie]]

Thank you for the reply!  I am not currently taking any other psychiatric or any other meds for that that matter. The only thing I’ll take is an occasional ibuprofen or Tylenol for headache or muscle pain. No alcohol at all. The last time I had a drink was probably 3-4 years ago and even then was just an occasional glass of wine. Never been a fan of how alcohol makes me feel. I did take klonopin nearly 10 years ago for some generalized anxiety but I never ended up having any issues withdrawing. However I hadn’t taken it nearly as long as I’ve taken the Xanax now and if I remember correctly it was just .5 mg per day. But again, it’s been a while and as of now my memory isn’t that great. Supplement wise I drink a packet of EMERGEN-C every day so that’s B vitamins and Vitamin C and things like that. I also take 200 mg magnesium citrate gummies per day as I’ve found they help slightly with my anxiety. I will also drink a small cup of coffee per day which I’ve done for years and doesn’t seem to impact my anxiety. I am having symptoms however. Within a month of being moved from .75 mg to 1.5 of per day and then up to 2.5 mg I became housebound and nearly bed bound. Looking back I should’ve cut back down right then but I thought the symptoms were my anxiety. I now realize it was the Xanax. I am having stress hives and itching almost daily, bad dizziness, and at times hot/burning skin sensation. Also light and sound sensitivity can at times be an issue.  I will have bad panic attacks where I will have high heart rate and muscles shaky and tense for hours. But the majority of my panic now that my other health issues have been resolved revolve around getting off the benzos. So it is quite hard for me to tell if what I’m having is symptoms of withdrawal or simply increased anxiety due to my fear of having a problem during withdrawal. I just want more than anything to get off these meds safely and not die in the process. Seizures terrify me although I have not ever had one. And I’d like to keep it that way if at all possible. Anyway, hope that helps clarify!

[[Buddie]]

Thank you for sharing more of your medication history with us.

Can you give us a ballpark of how many months you took the clonazepam 10 years ago?  Also, how did you discontinue it?  Did you taper or cold turkey?  (Fyi per Ashton, 0.5mg clonazepam is equivalent to 10mg diazepam so it’s not a ‘small’ dose.  Clonazepam is a very potent benzodiazepine.)

The fact that you don’t drink alcohol is a plus and, as long as you are tolerating them, the supplements you are currently taking should be ok.  (Fyi it is not uncommon for members to experience issues with supplements and medications while tapering benzodiazepines as well as during the recovery period.  So please be cautious about adding new ones.)

Now that we have your complete mediation history, other members will be able to give you more targeted feedback on the taper plan you’re considering.

[[Buddie]]

I’ll definitely keep that in mind about the supplements and discontinue them if I start having any issues. Thank you!  I wasn’t aware of that. I guess that makes sense though. Especially the B vitamins since they give energy which may not be helpful during withdrawal. Never thought about that before. As far as the klonopin goes I believe I took it for around a year. I’d moved to a new city and was helping care for a sick family member and combined those things caused me some anxiety. As far as withdrawing I know the way I did it wouldn’t be recommended, and I wouldn’t do it again now know what I know now. But I cut from .5 to .25 mg for I believe a week or 2. After that I started taking the .25 every other day for a couple of weeks. Then every 3rd day for a couple of weeks. Then just stopped. I do recall being terrified of quitting back then but I never had a problem thank God.

[[Buddie]]

I’m glad you will pay attention to supplements and other meds (both Rx and OTC).  It looks like EMERGEN-C has a lot of ingredients in it, some of which have caused issues for some members (e.g. some of the B vitamins, caffeine).

To make it easier for other members to quickly get up to speed on your current situation and proposed plan, I’ve created a draft summary below for your review.

[...]’s Case History (draft)

- Rx’d 0.5mg Klonopin for anxiety in about 2003; took for approx one year; d/c via fast taper; no issues.
- Rx’d 0.75mg Xanax in 2019 for anxiety; increased to 2.5mg by summer 2022, 3 divided doses.
- Attempted Ashton crossover to valium; too sedating.
- Current total daily dose: 1.75mg Xanax (0.875mg 2x a day) plus 4mg diazepam.
- No other daily Rx or OTC medications; daily supplements include EMERGEN-C, 200 mg magnesium citrate.
- Proposed plan: reduce Xanax by 0.125mg every 1-2 weeks while maintaining 4mg Valium.  Then taper Valium.

Would you please make any needed revisions then add the above information to your signature? Here are the instructions: Add your history/signature

[[Buddie]]

Just added. Thanks so much!! 

[[Buddie]]

Well done!  Thank you for clarifying your daily doses.  Just to double check, is the following correct?

You are taking 4 divided doses a day as follows:

0.375mg Xanax + 1mg Valium
0.5mg Xanax + 1mg Valium
0.375mg Xanax + 1mg Valium
0.5mg Xanax + 1mg Valium

If so, it is a bit unusual.  Are you stable on this dosing pattern?  Stable means your symptoms are not changing in number or nature from day to day and are tolerable.

[[Buddie]]

Basically yeah that’s it. I’d say I’m stable-ish like that. I am having symptoms but the majority of it seems to come from my horrible anxiety over seizures. The general plan was to cut by .125 from each .5 dose until all doses are .375 Xanax and 1 mg Valium. Then from there start one by one cutting the .375 doses down to .25 until all are .25. And so on down from there. And fortunately my psychiatrist is very workable and mostly willing to prescribe in any way needed to help me slowly and safely taper down. She just hasn’t quite been the best about coming up with a schedule for me which I’m actually kind of thankful for since it allows me to be more in control of it. My biggest thing is making sure I’m cutting in a slow and safe enough way to prevent a seizure. But I’m not being forced off in any certain timeframe from my doctor. The worst symptoms I have are dizziness, anxiety with muscle tension and a bit of shakiness, some tinnitus but I have had that for years so it’s likely not the benzos for me, and near constant itchy red skin and stress hives. But, mentally all of this is just very hard for me. I stress myself out so much obsessing over the taper I think my fear of the taper and fear of seizures is harming me more than the taper itself. Symptom wise it doesn’t seem to make any difference which dose I take I feel about the same. Also, if I got to a point where the 4 mg Valium just wasn’t enough to keep cutting then I’d be willing to increase it so that I could cut the Xanax. But I’m really trying to just stick with the 4mg total as long as that’s enough to safely prevent a seizure.