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Road Warrior, Now Retired. Temazepam (15mg) Micro Tapering Help


[Tx...]

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The only way that I could navigate my career of international and domestic travel was to take 15mg of Temazepam nightly.  This allowed my body to break through weekly time zone changes for sleep.  I am thankful for this forum because I thought I would be alone in trying to figure out how to figure this out.  To be honest, I am somewhat drinking from that proverbial fire hose and looking for options.  I do not wish to just go 'cold turkey' as a previous primary care doctor had suggested. 

 

I would like to begin a micro tapering regiment from Temazepam.  I have read the  Heather Ashton guide about long term Benzodiazepine use and migrating to a longer acting benzodiazepine such as Diazepam (Valium).  Would you recommend that this be my first step? (Or) Should I start cutting my Temazepam capsules and begin dry tapering with a scale and begin a liquid titration conversion?

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I would try to taper from the Temazepam, most members will stick with the drug they know unless it proves too difficult to do.  What method appeals to you more, using a scale or making a liquid?

 

I'm going to ask a member who has a good knowledge of tapering methods to drop by, hopefully we'll provide some good options for you.

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You are VERY lucky because temazapam is the lowest potency benzo. (50% lower than Valium) PLEASE DO NOT SUBSTITUTE WITH VALIUM.  I made that choice 6 years ago and I’m still tapering. Valium is a beast of a drug. There is a water titration called a suspension. You mix water with temazapam and micro taper daily. There are members who did this successfully. One name “Meowie” comes to mind. Not doing this, was the biggest mistake of my life.
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Thank you for your replies.  I appreciate the response not to switch to Valium.  Instead, I met with a very helpful Compounding pharmacist yesterday.  He suggested that I cut the Temazepam capsules using a scale and use Glycerin has my diluting solution at generally a 1mg:1ml ratio.
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Sorry I am late to the post.

I agree.  Do not cross over until you have exhausted the simplest of tapers with your current benzo.

Here is a simple option for you.

 

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The missing info in the video is how much water to use.  This equals total taper days.  Some people use 300 ml which equals 300 days.  (At 1 ml per day).
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Thank you for your replies.  I appreciate the response not to switch to Valium.  Instead, I met with a very helpful Compounding pharmacist yesterday.  He suggested that I cut the Temazepam capsules using a scale and use Glycerin has my diluting solution at generally a 1mg:1ml ratio.

 

Tip of the hat for reaching out to a compounding pharmacist for advice.  Can you tell us a bit more about the instructions he gave you?  What’s puzzling me is how a scale would be used.  Was he suggesting that you weigh the contents of your capsule to achieve a certain amount, then add glycerin, then dilute the resulting capsule power/glycerin mixture with water? 

 

Please be aware that there are more unknowns than knowns about do-it-yourself (DIY) liquids made with regular tablets or (in your case) capsules as the source of the Active Pharmaceutical Ingredient (API).  For example, we do not know if mixing the contents of a temazepam capsule with a solvent such as glycerin or water fully and completely dissolves all of the API in the capsule. We also do not know what happens to the API when DIY liquids are diluted with additional water.

 

My observation is that members who find success with DIY liquids tend to regard their liquids as suspensions with an unknown stability (‘shelf-life’) — not solutions with a known stability.  Commonly used practices include making smaller rather than larger batches, shaking the DIY liquid well before using it, and measuring the target dose/reduction as quickly as possible before visible/invisible particles of API/excipient settle out of suspension.

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Thank you for the replies and apologize for the late reply.  Libertas -The Compounding Specialist gave me the following directions via email:

 

"It would probably be good to add 5ml of water to the 150mg of powder to hydrate it well before adding glycerin (145ml) to total 150ml.  That could make it mix more evenly without “flecks” in the suspension.  Just be sure to shake well before using each time."

 

We were assuming I would dry cut 10 capsules at 15mg (each) for a total of 150mg.  Rather than using a straight 1:1 ration, he suggested that I reserve 5 ml of glycerin and use water instead to bring the total concentrate to 150ml.  He gave me a couple of syringes.  One to dilute the concentrate and the other to draw from the 150 ml nightly.  My assumption is that if I begin tapering 2% per week that I would take 14.7 ml, 14.4 ml etc.  Make sense?

 

Bob7 - Perhaps I am overthinking this and just follow the instructions that the Youtuber gave?  Simply dissolve one tablet per day in 300ml of water.  Use a syringe to taper weekly.

 

Again, I appreciate all that are replying.  I think I can do this.

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Tip of the hat for getting those directions, Tx17340.  Yes, you can do this.  We just want to make sure you are fully aware of the knowns/unknowns, risks/benefits of making and using do-it-yourself (DIY) liquids so you can make an informed decision about how you wish to proceed. 

 

For example, generally speaking, it’s preferable to keep as much of your dose in unmodified form as long as possible.

 

What is your current dose?  15mg a night?  30mg a night?  Other? 

 

Also, if you are comfortable sharing this information, it would be helpful to know the manufacturer of the temazepam capsules you are using.

 

Fyi The video Bob7 shared with you will not produce a solution but rather a suspension.  Although it’s easy to miss, ‘Benzo Brains’ makes this point at the beginning of the video. 

 

Why is this important?  If a solution has been properly and professionally formulated and prepared, one can assume that each milliliter of the solution will contain exactly the same amount of the Active Pharmaceutical Ingredient (API).  One cannot make this assumption with respect to a suspension, especially not a DIY suspension made with regular tablets/capsules as the API source.

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Libertas - thanks for your patience.  I had to Google the difference between 'suspension' and 'solution' since I did not understand.  So the YouTube video that Bob7 forwarded was the woman making a suspension (as you noted).  You are advocating for the creation of solution that could be more stable and provide a precise tapering liquid.  I am prepared to purchase a micro scale to ensure that the Temazepam powder added to glycerin is exact. 

 

To answer your question, I am taking 15mg nightly for sleep only.  The manufacturer Amneal Pharmaceuticals.  Thank you.

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You are welcome, Tx17340. Now it’s my turn to thank you for letting me know you were not aware of the difference between a solution and a suspension.  I will endeavor to do a better job of explaining this important distinction in future posts.

 

You are correct that the likelihood of obtaining an accurate and precise dose (see note below for another vocabulary lesson ;)) is higher when using an oral solution. HOWEVER, many members have been able to taper successfully using suspensions prepared by a compounding pharmacist as well as do-it-yourself (DIY) suspensions made with regular tablets or capsules.

 

Given that your compounding pharmacist stressed the importance of shaking the DIY liquid, my guess is he considers it to be a suspension not a solution. Just to double check … am I understanding correctly that he suggested you use the contents of your regular Amneal capsules as the source of the Active Pharmaceutical Ingredient (API)?  Or, was he offering to supply you with the API itself (i.e. the pure drug powder)?

 

The good news is that a speciality pharmacy in the UK has developed a formulation for a temazepam oral solution. See link below.  I wonder if your compounding pharmacist would be willing to make it for you?  Another option would be to ask if he has the equipment and know-how to prepare a stability-tested formulation for a temazepam oral suspension.

 

Thank you for letting me know the manufacturer of the capsules you are using. According to DailyMed, Amneal makes a lower dose capsule — 7.5mg.  Would your prescriber be willing to prescribe these?  This would allow you to begin your taper by taking 7.5mg of your current 15mg dose in a known, unmodified form while tapering the other 7.5mg.

 

Note:

 

Accuracy is how close a measurement is to the true value. An example is how close an arrow gets to the bull's-eye of a target.

 

Precision is how consistent results are when measurements are repeated. An example is how close a second arrow is to the first one (regardless of whether either is near the bull’s-eye).

 

In the case of liquid titration, using a commercially manufactured oral solution in conjunction with a properly calibrated measuring device of the appropriate capacity has the highest likelihood of delivering doses that are both accurate and precise.

 

Link:

 

Temazepam 10mg/5ml Oral Solution

https://www.medicines.org.uk/emc/product/9479/smpc

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Hello again, Tx17340.  To give you a sense of how complex a liquid formulation of a drug can be, here is a list of the ingredients in the 10mg/5mL oral temazepam solution I mentioned in my previous post:

 

Temazepam API

Ethanol

Propylene glycol

Trometamol

Citric acid monohydrate

Liquid sorbitol (non-crystallising)

Purified water

Peppermint oil

Patent Blue V

Caramel

Glycerol

 

It’s interesting that it includes multiple solvents (e.g. ethanol, propylene glycol, purified water).

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  • 3 weeks later...
I stopped procrastinating and started using the glycerin suspension the night before last.  I mixed five gel capsules of Temazepam (15mg/each) into 75 ml of glycerin solution.  I just completed the second night. I never thought about it, but gel capsules take approximately 30 minutes to release the power.  The suspension liquid works almost immediately.  I have found that I am waking up more frequently after about five to six hours than previously.  Perhaps it's because it is anxiety because I am finally moving forward?  I am trying to eliminate afternoon naps.  I will give this a go at full strength and then begin tapering early next week.  Perhaps I should go directly to the 7.5 mg Temazepam capsules, but will try reducing to that point with the liquid first. 
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Thank you for the update.  I don’t have experience with using capsules to make a do-it-yourself (DIY) liquid but, based on what I’ve read here, my sense is that many members open up the capsules and dump the contents into whatever liquid(s) they are using (as opposed to placing the entire capsule in the liquid).

 

It is not uncommon for members to report that their DIY liquids have a different onset of action, duration of action, and/or ‘potency’ compared to their regular, unmodified dosage form (in your case capsules).

 

Strategies to address this include:

 

(1) Hold your dose constant while giving your body time to adjust to the new dosage form.

 

(2) Use a combination of the unmodified dosage form (in your case 7.5mg capsules) and the DIY liquid as long as possible.

 

(3) Experiment with titrating your dose upwards slightly to see if that helps.

 

 

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