Considering microtaper

Oregon Katz, can you explain further the DLMT taper you did from 1mg Valium?  Reducing by .01mg.  I am currently at 16mg Valium, crossed over from 1.5mg Xanax over 6 months. 

Before I was just reducing my evening dose of Valium and keeping the morning dose of Xanax the same (per my pdoc) that didn't work.  I got to 2.4mg Valium in the evening and my symptoms caught up to me. Once I got below 3mg of Valium, it was very difficult.  I was thinking perhaps I would start this DLMT at 3mg?  It may take a while, but I am in no rush, just want to be free. 

I have changed my plan several times and realized there is no plan while tapering.

I have all liquid Valium right now and for the rest of my taper- the manufacture liquid 5mg/5ml, so I will be easy for me to do the smaller doses once I get further down in dose.

Right now, my goal is to taper 1mg every 2 weeks until I get to 3mg morning and 3mg evening.  Then I may need to reconsider this plan as it's to great of a cut every 2 weeks.  I was able to do it before with the night dose until I got lower then 3mg.  That seems to be my body's limit. 

Sorry for my many questions:  Did you just take .01mg less every day?  were there some days you held?  or did you just keep going?

Thanks in advance!

Edit: Split posts to create new thread, changed title.

When I had tapered down to 1 mg of valium doing cut and hold, I made up my own "witches brew" (note: it's far better to get liquid valium from your pharmacy) that consisted of 1 mg of valium, 1 ml of vodka, and 99 ml of water. I made this up daily. So, on day one of my liquid taper, I used my small syringe to suck up and throw away 1 ml of this mixture. I drank the rest. Day 2 I made up another mixture, threw away 2 mls . . . and so on to zero. There were several bumps along the way where the cuts caught up with me and I had to hold, but basically it was uneventful. I had had a terrible time with my taper from 15 mgs using cut and hold. This saved my bacon.

I don't see why a DLMT wouldn't work at 3 mgs of valium, using the pharma liquid. You could make up 300 ml of valium and water and throw away whatever you want.

My witches brew worked for me, but only because I made it up daily, I think. Valium in pill form is *supposed* to be soluble in alcohol, but just to be sure, I stirred like hell before I sucked up the amount to throw away. (I didn't use liquid valium as I couldn't stand the taste  )

Hope this helps.

Katz

Thank you so much for your explanation!!  I really appreciate it! I have major benzo brain and am horrible at Math! 

Since I have the liquid Valium from the pharmacy (it does taste nasty), can I just do .01mg less every day instead of making up a 300ml solution?  Will that work the same?

So sorry for these questions- my brain is just not working like I would like it to- you know?

Hello, cooper5.

Oregonkatz asked me to stop by to see if I can lend a helping hand.

Am I understanding correctly that you plan to use the commercial 1mg/mL oral diazepam solution to taper — no tablets, just the solution?

How did the pharmacist dispense the medication?  Did s/he put it in a bottle fitted with an adapter cap or press-in syringe adapter? 

Did s/he provide you with an oral syringe to measure the liquid?  If so, what is the capacity of the syringe and how many graduations does it have?

What taper rate do you want to try? 

Lastly, just to double check … is this your current daily dosing schedule:

10mg Valium morning, 6mg Valium evening

Libertas- Thank you so much for stopping by to help me!

Am I understanding correctly that you plan to use the commercial 1mg/mL oral diazepam solution to taper — no tablets, just the solution?

Correct  I have the 5mg/5ml commercial solution, but my understanding is this is the same as above- correct?

How did the pharmacist dispense the medication?  Did s/he put it in a bottle fitted with an adapter cap or press-in syringe adapter?

It's a 500mL bottle with an adapter cap I bought to fit- Yes, press in syringe adapter.

Did s/he provide you with an oral syringe to measure the liquid?  If so, what is the capacity of the syringe and how many graduations does it have?

I bought my own on amazon, I use the 3ml capacity one right now, but also have a 1ml capacity one which has 50 graduations.

What taper rate do you want to try? 

I am currently tapering 1mg every 2 weeks until I get to 3mg morning and 3mg evening.  Then I would like to  combine to just evening- that would equal 6mg evening.  Then when get to 3mg evening, doing the DLMT OR Possibly before based on symptoms.  This taper has not been predictable, so It's hard to say.

Lastly, just to double check … is this your current daily dosing schedule:

10mg Valium morning, 6mg Valium evening

Correct My Pdoc would just like to keep me on liquid, so there is no transition and I can taper at the rate I need to.  He is the BEST.

Again- Thank you sooooooooo much for your help!!!  I really appreciate you and this team.

You are most welcome, cooper5.

Yes - 5mg/5mL is the same as 1mg/1mL.  The drug manufacturers use ‘5 mg per 5 mL’ on the drug labels so I do as well to avoid confusion when communicating with prescribers and pharmacists.

The initial taper plan you’ve described reduces your dose by a fixed amount (i.e. 1mg every two weeks).  This is fine but please be aware that there is a potential ‘gotcha’ with this approach — that is, your taper rate will increase over time.

For example, reducing your total daily dose from 16mg to 15mg is a 6.25% reduction.  However, reducing your dose from 7mg to 6mg will be a 14.29% reduction — more than double your initial taper rate.

When using a fixed amount reduction approach, it’s very important to keep track of your taper rate as well as your withdrawal symptoms and functionality.  An increase in symptoms and/or a decrease in a functionality are signals that you may have reached your personal ‘speed limit’ in terms of taper rate.  If this occurs, you will need to adjust your taper plan accordingly so you do not exceed your ‘speed limit’ moving forward.

If you have not already done so, I strongly encourage you to set up and start keeping a daily taper journal (see details below). I have also included a link to a calculator you can use to calculate your taper rate (i.e. the percent change between two doses).

In light of the above, there’s no way to predict when or even if switching to a daily liquid microtaper (DLMT) will be needed. It all depends on how you respond to your initial taper plan.

If you do decide a DLMT is called for we can talk about how to proceed at that time.  The good news is that you are in an excellent position to implement this approach if needed. 

Using the commercially manufactured oral solution in conjunction with a good quality, appropriately calibrated oral syringe (i.e., a 1mL syringe with marks every 0.01mL) will allow you to measure doses in the range of 0.01mg (or 10 micrograms).  Individuals who discover they need to make even smaller reductions (e.g., 0.001mg or 1 microgram) report success with diluting the commercial oral solution with water  (preferably distilled or purified) to make a do-it-yourself liquid with a lower concentration.

FYI You will not need to use the shake/measure/discard approach oregonkatz used. She was making and using a do-it-yourself liquid with unknown properties so was taking appropriate steps to mitigate risk.  In contrast, you are using a commercially manufactured oral solution with known properties so can be reasonably confident that your doses will be accurate and precise using a measure/ingest approach.  Moreover, your oral solution has a proven shelf life of at least 90 days after opening.

PS Your idea of evening up your two daily doses in a sound one. Have you considered decreasing your morning dose first from 10mg to 6mg to accomplish this sooner rather than later?

Setting Up and Using a Taper Journal

 

Examples of data to collect include:

 

- The date

- Time(s) and amounts(s) of drug ingested

- Daily rating of your withdrawal symptoms (0 = no symptoms; 10 = intolerable symptoms)

- Daily rating of your functionality (0 = able to perform all essential daily tasks; 10 = unable to perform any essential daily tasks)

 

If you are a visual learner, you may find it helpful to graph the daily ratings of symptoms and functionality. Doing this will enable you to see trends/patterns in the data.

 

Review the data in your taper journal on a regular basis and adjust your taper rate and/or interval if needed.

Link:

Percentage Change Calculator

https://www.calculatorsoup.com/calculators/algebra/percent-change-calculator.php

Libertas,

Thank you for all of that super helpful info!  I would like to keep my taper rate at 10% every 2 weeks If I can handle that.  I didn't explain I am tapering the morning dose of 10mg first to get to 6mg like the evening dose. 

So on August 15th, I will drop to 9mg Valium in the morning and keep the 6mg in the evening.  I love that calculator!! Thank you so much for sending to me!  I am going to now calculate each taper to be a 10% cut every 2 weeks and see how that goes.

My ultimate goal is to get to 3mg morning, 3mg evening for 2 weeks, then combine 6mg to just evening and taper from there.  I may have to slow things down by then, but that's OK.  I was looking into the DLMT for options as I want this to be a successful taper and want to go as slow as my brain can handle and be functional.  I am not looking to be miserable.  I know I am going to have symptoms, but that's OK and I am prepared for that.  I just need to remain functional. 

Yes, I do keep a journal via and excel spreadsheet my husband made for me!  LOL  It has my taper rates, dates notes, etc. 

Thank you so much again for your insight and for looking at my taper!  I could never do this successfully without this board.

Thank you again!!!!

I’m glad I was able to help, cooper5.

I’ve included links below to a 1mL oral syringe by BAXA that has marks every 0.01mL as well as a 5mL syringe with marks every 0.2mL.  (Per forum guidelines, live links to commercial sites are not allowed so just copy and paste the URLs into your web browser.)

fwiw I personally use Medisca’s PreciseDose oral syringes. BD (formerly Becton-Dickenson) is also a good quality brand.

BAXA ExactaMed Oral Liquid Medication Syringe 1cc/1mL

Graduated in 0.01mL

[nobbc]https://www.amazon.com/dp/B01628CDEE?ref_=cm_sw_r_ud_dp_DNSM4XS6REG31GNMEXWW[/nobbc]

BAXA ExactaMed Oral Liquid Medication Syringe 5cc/5mL

Graduated in 0.2mL

[nobbc]https://www.amazon.com/dp/B01DS6KQ5Q?ref_=cm_sw_r_ud_dp_JSN8C51WDJM4SSP6BCV3[/nobbc]

Perfect!!!  Thank you so much!  My syringes are good, but sometimes hard to read.  I really appreciate the links for these- HUGE HELP!

I can't thank you enough for your time!