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Tapering from temazepan


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Hi Carole,

 

What size are your tablets (how many mgs)? Splitting 30mg over four doses is 7.5mg/dose. Or did you mean to type that you take 20mg Tamezepam/day?

 

Totration is handy, but it may not be needed straight away. Do you know what are the smallest dose tablets available to you?

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Hi Colin,

 

I am taking 30 mg in a capsule form right now.  My schedule does not add up right.

Sorry, I miscalculated!  I was wondering if I could open my capsule and dissolve

in water an then measure out doses?  I could come up with a gradual reduction

by taking small does throughout the day.  I believe that these capsules come in

7.5 mg at lowest dose.

 

Thanks,

Carole

 

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No, don't split your capsules. The contents can sometimes cause burning in the throat - you need to talk to your pharmacist! If your doctor/pharmacist says it is OK to do this, or if they say you can spilt the capsules and repackage them, then this may well be a sound approach.

 

I've just checked, and Temazepam does appear to come in 7.5mg tablets at the smallest, but if you are using capsules, your pharmacist should be able to make these up to any strength you require.

 

What is your daily dosing regimen at the moment? Given that Temazepam has a pretty short half-life, 7.5mg four times a day would seem sensible.

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Hi Colin,

 

I am taking the full dose at bedtime, but have experienced withdrawals during the

day.  I think this is because I have reached tolerance.  Do these dissolve in water

very well?

 

Carole

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First, do not split the contents into water without the OK from your pharmacist. The contents of some capsules can still be caustic even if diluted in water.

 

I'm not surprised that you experience interdose withdrawals if you only take Temazepam once a day. Of course this is how benzos are often prescribed, but once we are hooked we are prone to experience withdrawal between doses if they are not taken regularly enough.

 

What I recommend is that you start to move part of your dose. So, assuming that you take four 7.5mg capsules/day, take the three at night, and move the one tablet to twelve hours later. Do this for a while, and once you feel comfortable with this, take just two at night, and the other two at eight hour intervals (so that you taking Temazepam three times/day). Again, once you have adjusted to this, then move to taking it four times/day - spreading the doses out as evenly as possible. Once you have gone through this process, then start a slow withdrawal. Does this make sense to you?

 

Also, be sure to talk to your doctor about your intention to quit.

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Colin,

 

Yes, this sounds like the way to go.  I will talk to my Psych and have him prescribe

7.5 mg and my intent to withdraw.  The schedule sounds good!  Thanks.

 

Carole

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[e8...]

Hi Carole,

You didn't ask me, but I'm sneaking in here because I began my benzo horror with temazepam and oxazepam, both in capsule form. The doctor said to  open the capsules and use less by half  for a week and then do it again.  That caused a disaster that couldn't be fixed. The powder wasn't the problem. The big reductions were the problem and the inaccuracy of estimating the amount of powder ensured failure.

 

A compounded dry capsule form could work.  A pharmacy may or may not be willing to do this. The dosage in each capsule will certainly have to be prescribed.

 

As for making a liquid and then measuring that, I wish that I had thought of it then, but I was unable to think at all. I now am in favor of a liquid, but a compounded liquid makes people feel the safest. If everyone refuses to help you, you can take over. For now, asking  for what you need is the best plan. A compounding pharmacy will do the liquid with a prescription. If what you need is available as a capsule, I'd go for it just as Colin suggested. You have options if that fails.

Jana

 

 

 

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Hi Jana,

 

I am so proud of you!  You give hope a courage to so many....your suffering was

not in vain.  Thank you for your plan for me.  I will ask for a liquid compound and

see if my PSYch will go along.  What amount do you think I should reduce to

begin my taper? 

 

Thanks,

Carol

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Hi Carole,

 

For now, I wouldn't worry about how much to cut by. If you decide to follow my suggestion about switching your dose over the full day instead of all in one go at night, this will probably take few weeks. How long depends upon how you feel. Only proceed to the next step when you feel you have adjusted to the previous reorganisation.

 

At first, I think you should be looking to loose about a third of one capsule, that is, one twelfth of your daily dose. We usually recommend that people should cut buy no more than about one tenth, but keep the maths simple - one third of one capsule is straightforward - simplicity is important too!

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[e8...]

Hi Carole,

Colin made a good point about making the change gradually. I was crossed from Ativan and Dalmane to temazepam and oxazepam one single dose. There was no time for adjustment.  This was the doctor's prescription. The pharmacy erred, and the oxazepam wasn't dispensed. I didn't  know that I was given three prescriptions but received only one. Also I didmn't tolerate these benzos anyway. This isn't exactly your situation, but acclimating our bodies is apparently a necessary process.

 

I would be surprised if  a psychiatrist would agree that a liquid is necessary though I like it for the ease of adjusting doses. If just a better capsule program is okayed, you'd still  do better. Maintaining close to consistent benzo blood levels is the key to managing tolerance as well as managing a taper.

 

I'm not experienced in tapering temazepam except as in the misguided medically prescribed attempt that I described. I did my liquid tapers with Xanax and then Valium. That doesn't mean that  a temazepam taper isn't possible. I'll have to look at the expected half life to get a better idea.

 

Temazepam doesn't have active metabolites. This means that it doesn't have the somewhat cushioning effect for interdose withdrawals that Valium has. It is apparently a metabolite of Valium.

 

Right now, since you appear to be entering tolerance, you need to find a dosing schedule that will ease the symptoms. What Colin described could do the trick. Then you could feel well enough to think about how you want to do your taper.

 

Psychiatrists tend to be rigid. That doesn't mean that you can't give your's a chance to be more reasonable. There will be ways around problems. Mine was to fire the doctors and do what I knew I needed to do, but you may very well do better with your psychiatrist.

 

I'll try to take a closer look at both temazepam and your doses. Hey, I'll meet you back here later.

Jana

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Hi Colin,

 

I will start by spreading my dose throughout the day like you suggested.  I will

get stable and than reduce one third of a capsule per day and see how that goes.

Thank you so much for your help!

 

Carole

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Hi Jana,

 

When I start to reduce my dosage, should I titrate in milk like you have recommended

for Mike to do?  Can I skip the vodka? Do I need to keep in refrigerator if I skip the

vodka?

 

Thank you for your help!

Carol

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[e8...]

Hi Carole,

You must keep everything in the fridge. The containers should be extremely clean.  Treat this as milk, a perishable food.

 

Colin has given us the probable half life of temazepam. The way to manage that is to divide your daily dose into many doses throughout the day.

 

My attempt to split capsules was a disaster though I made some complicated effort to be accurate. I didn't notice that the powder was particularly alkaline, but I'm not sure that I could have known. I was shaking too badly to do a good job. However if what you are doing is working for you, this is all that you need to know right now.

 

The Ashton Manual lists temazepam as a 20 if Valium is a 10. So you'd need twice the temazepam to equal the W/D managing effect of Valium. This makes your job easier in a way. Temazepam isn't one of the benzos as potent as Klonopin and Xanax.

 

Do you have the cooperation of your doctor? I had to do this alone, but there are advantages to keeping your doctor up to date.

 

When you have used your 4.5mg T dose for a week, it will be time to consider trying your taper.  If your doctor should agree to a compounded liquid, a lot of the work is done for you.

 

Are you currently taking any other prescriptions or OTC drugs? Any of these must be factored into the taper plan.

 

Having a helpfull pharmacist can be a great help. I used to call mine because he had up to date data for drugs and drug interactions as well as metabolizing effects. I had to drag the information out of him, but he did come through.

Jana

 

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The vodka is used to help preserve your milk. It's inevitable that the milk will not keep as long once you have been messing about with it, but if it's very fresh and you make sure to keep everything very clean, I'm sure that it will keep for a couple of days without the vodka. ;)
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Jana,

 

I am not taking any other drugs.  I am thinking about taking Dramamine for sleep

if necessary.  I will follow your suggestions and I feel very confident that I

can accomplish this.  I do not feel comfortable involving my psychiatrist as

i don not want to risk being forced into a quick taper.  I feel the support that

you and Colin have given far outweighs what a psych could do for me.  You are

both so helpful!

 

Thank you,

Carole

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[e8...]

Hi Carole,

As you know, I am not confident that a doctor will have the knowledge and experience to manage a taper. Here is an important distinction. A doctor who knows nothing about benzos can be valuable in watching your condition and vital signs.

 

You may need blood tests such as liver function to start. You absolutely must watch your blood pressure. This is a usual problem when tapering from Benzos. A high diastolic number can damage your heart. An M.D. can prescribe BP meds to keep this under control. It's nice to not use any other drugs. We can't always keep to that standard safely. Sometimes liver enzymes go out of whack. Blood work can determine a baseline and changes.

 

Using MD's for what they are trained to do is wise. Have a doctor watch your general condition. Don't expect too much benzo help.

 

If you should find yourself in a serious state, an ER will want to know your doctor's name. These emergency people tend to look for drug seeking behavior. You  would need to  have a doctor who knows you to provide the right information.

 

Of course my own conclusion is that if we take  great care to do this right, there will be no emergencies. In fact, my only emergencies occurred when I was under medical supervision. I took much greater care to manage my taper with a slow and even decline in benzo levels. Any increase in symptoms while titrating will be smaller and more manageable that symptoms from a "regular' cut.

 

We have it in our power to be very carefull and to use medical services to good advantage. In any case, it is we who are responsible for carrying out any taper. We must be informed and we must use care.

 

Though you may not want to preserve your benzo liquid with alcohol as in Vodka, rinsing your bottles and other benzo objects in something like Vodka can help to keep bacteria to a minmum. I ran my bottles through the dishwasher and then rinsed them in vodka and put them in the fridge to store them even when empty.

 

I know that psychiatrists don't tend to follow drug manufacturer's suggestions for monitoring patients. You may need to use a different doctor for this. I also agree that upsetting a psychiatrist is a bad idea.

 

I just holed up in the house with no more help for the other 10 months that I needed. I don't recommend that. Some of us are left with no other choice. Take Care.

Jana

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Hi Jana,

 

Thanks for all the info!  What is the concern regarding bacteria?  Has anyone

had a bad experience with bacteria forming in their dose?  I am so grateful for

all your good advice and help. 

Thank you Jana and Colin for the sacrifices that you are making to help others.

WE all love you both and pray that you will keep well and safe!  We need you!

 

Thanks,

Carole

 

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Hi Carole,

 

There is no particular concern with bacteria - it's just the same with anything we ingest. Unless we use sterilised equipment and food in laboratory conditions, there is always bacteria. Because you will be using kitchen equipment, there will be some small amount of tainting of the your benzo liquid. It just makes sense to keep things as clean as possible, and not keep things too long. The alcohol will help to keep bacteria growth down and you liquid fit for consumption for longer, that's all. So long as you keep things clean, refridgerated, and for just a day or two, then I imagine that not using alcohol makes little difference. It's just the same common sense you would apply to any food stuff. There is nothing particularly dangerous in the food stuff you are using.

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Hi everyone,

 

For my Temazepan withdrawal from 30 mg....

One empty 1 oz vanilla bottle

Open capsule drop in

Pour in half and half milk to full bottle

1 oz = 6 teaspoons= 30mg

Take 1 teaspoon 5 times a day = 30mg

I plan to start tapering once I feel better

 

What do you think?

Carole

 

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Opps!

 

I meant that 1 teaspoon = 5 mgs

So....I take 6 teaspoons x 5 = 30 mgs

I will spread throughout the day.... 7am, 10pm, 1pm, 3pm, 6pm, 9pm.

This should get an even distribution in my system.

May start reducing 1pm dose to 1/2 teaspoon = 2.5 mgs.

Thank you for your help!  You guys are the best!

Carole :thumbsup:

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Is 9PM last thing at night? I think that's when I'd take it. You may need to move the times of the other doses to compensate.
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[e8...]

Carole,

This may work well for now. The end result is that you get the total mgs of temazepam for sure and more evenly distributed.

 

When you start tapering, the measuring is more critical. At that point, using a measuring syringe and  ml container will be necessary. Teaspoons aren't accurate enough for that

 

The choice of benzos is your's. I am concerned that the half life of temazepam may not work well enough for you. If you find that to be true, you'll have to think about the long half life benzos, Klonopin and Valium.

 

Just keep this in the back of your mind as a backup plan. Right now, finding your stable condition is the most important.  You thought of your own plan, and that's great.  :thumbsup: Getting your own mind into the process helps in many ways. We're always here to help.

Jana

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