Taper help

Hello Bob7, got your message.  I am reading the BENZO BOOK written by Jack Hobson-Dupont right at the moment.  Paused and came over here for a Q%A.  That liquid taper he used sounds promising for a person like me who has to crunch and chew pills before ingesting. Could your spreadsheet formulas b adapted to a Valium 1mg liquid taper schedule?  Not sure why Dupont selected 60 days, he sounds extremely intelligent in the use of his words. I myself hold a Master's in computer science, but 20 years of Valium plus old age (near 70) have blunted my cognitive skills to an extent. 

 

To quote Mr. Dupont's book:

"I prepared to implement a plan I had devised for the final stage of tapering, a liquid dilution method. It was apparent that a reduction by too great a percentage of the previous dose caused the body to be in sudden want of its accustomed amount of benzodiazepine, resulting in distress. The distress often caused an increase in the number and severity of withdrawal symptoms, which itself was a form of distress.

 

As I had approached 1 mg in dosage, I began to feel each cut quite significantly, and usually spent five to seven days in some sort of reaction before I stabilized. That was because as the overall dosage got lower, the percentage of each cut to the total dosage increased. To avoid this ebect, I then decided to use a dilution method for getting from 1 mg diazepam down to 0 mg.

 

Reducing by decrements of 0.25 mg of Valium seemed initially quite small, but as the overall dose lowered, the percentage 0.25 mg

constitutes of the total dose increased exponentially. At a dose of 4mg, a cut of 0.25 mg represents 6.25%, a percentage small enough that it doesn’t take much for the body to adjust to it. At 2 mg, that same cut of 0.25 mg becomes a reduction of 12.5%. At 1 mg, it becomes fully 25% of the total dose. Had I continued to use 0.25 mg cuts, the final reductions from 1 mg down to 0 would have been 25%, then 33%, then 50%, and, finally, 100% of the total dose.

 

I decided that it would suit me better to use a continually variable reduction method, where the percentage of each cut actually

decreased—with the exception of the final dose, where stopping will always represent 100% of the previous amount. I was two months from completing the taper, so I calculated the entire quantity of diazepam I would consume over the course of those

sixty days. I then had my pharmacy compound that amount of diazepam and put it into a liquid suspension where 1 milliliter (ml) of liq-uid equaled the amount of diazepam in a 1 mg tablet. This liquid came in a bottle, and I also got a bottle of just the plain suspension medium, i.e., the liquid without any diazepam in it.

 

The way I took a dose was actually quite simple. Using an oral syringe (without a needle) I would remove from the medicine bottle 1ml. from the liquid containing diazepam and ingest it by mouth. Then I put 1 ml. of the plain suspension liquid (containing no diazepam) back in that bottle, so it constantly had the same total amount of liquid in it. In this way, the amount of diazepam was constantly being diluted. I was making a ‘cut’ with each and every dose I took. For example, the first day of taking the liquid, I ingested 1 mg of diazepam. On the second day, because I had diluted the mixture when I replaced the liquid in the bottle, the dose of one ml. only contained 0.9667 mg of diazepam. On the following day, one ml of liquid contained 0.9344 mg of diazepam, and so on.

 

The amount by which a decrease was made got smaller and smaller all the time, and each day’s ‘cut’ represented a continually smaller percentage of the previous dose. The final cut was the equivalent of a mere 1/5000th of a milligram of diazepam, to a final dose of 0.1353 mg of diazepam. The last dose from which someone ends their taper is called ‘jumping ob’ by people discontinuing Valium. I doubt anybody ever ‘jumped ob’ from a lower amount than 0.1353 mg. Perhaps I was being overly cautious by using this method, but I reasoned that it would be better for me to be too cautious than not cautious enough. I did note that after I switched to liquid dilution dosing, the more neurological symptoms such as fasciculations and Restless Leg Syndrome disappeared. Other symptoms persisted, but that was to be expected: even though this was a more gentle method of reducing the dosage, it was a reduction nonetheless, and my central nervous system was bound to react to it."

Jack Hobson-Dupont, The Benzo Book.

 

My inquiry is:

I am currently taking 20mg of Valium using 5mg pills. I have been using this poison for 20 years.  I have sent a message to my prescribing doctor to change the 5mg size to the 2mg for easier pill cutting for a 1mg dose size. That meant asking for 120 pills per month of 20mg to be changed for 300 of the 2mg size.  I can just imagine thee initial thoughts of those reading that script for THREE HUNDRED PILLS OF VALIUM. (I am already getting leery side looks from the pharmacy each refill.  Just that number of 300 pills might send them into a fit). 

 

I might be stuck trying to use the 5m size I have. I used a pill splitter this morning to cut the 5 into half, then try to cut that half into half. (5mg /2 = 2.5mg, then half again: 2.5mg/2 = 1.25mg, more or less depending upon the crumbs)

 

If I do need to retain the 5mg size pills, how would I equate Mt Dupont's titration formula from either the 2.5 or 1.25 (+/-) size down to zero, using the 'less than 10% dose reduction every 2 weeks' equation?  It is the BOLD highlighted paragraph I get lost in. The last final minuscule liquid tapering dose schedule. 

 

If I do not obtain help to change to the 2mg pill size, I will have to make do with the pill cutter.  I doubt the pharmacy would help making any liquid suspension on my behalf, so I would most likely be stuck using water or fruit drink to add the Valium powder, then shake it to mix - then hope the dose is correct.  I also plan to refrigerate the liquid mix, saves on the waste.

 

Question: what amount of milliliters of liquid is needed for a starting 2.5mg dose, or a 1.25mg dose? 

 

I get the 'remove 1mL, then replace it with an inert liquid to retain the full level' part.  What is the initial full level amount though?

 

This is not an immediate scenario as I just started my reduction from 20mg to 19mg (+/-) today. Will try to reduce 1mg every 2 weeks using the 5mg size and pill cutter - waiting for help from my MD for the 2mg size.

Easy to remember start date: EASTER 2023.

 

Thus far:  the major barriers in refills have been the pharmacy and the insurance company (medicare HMO).

 

(sorry for the 10 page manifesto)

 

Edit: Split thread and retitled.

 

oh boy, that is long.  I am stepping out for the day but will get back to this when I can.

Well Key West,

 

I think you are overthinking it.  Many of us Benzo users also have anxiety issues and we over do it on our tapers.

 

The best advice I can give you is to learn Non-Benzo ways to control your anxiety.  You will need these tools when you are off the benzos.

 

As for a taper method, you want to first try the simple approach.  I say this because again, if you have anxiety about your taper method, the anxiety will make your withdrawal symptoms worse.  Find a simple method and see if it works before doing anything too difficult.  I know you have advanced technical degrees but still, try to do the simple way first.

 

Consider this simple method:

 

Bob

Seen that video, plus others.  One problem that I have which Dupont didn't was obtain:

 

" I was two months from completing the taper, so I calculated the entire quantity of diazepam I would consume over the course of those sixty days. I then had my pharmacy compound that amount of diazepam and put it into a liquid suspension where 1 milliliter (ml) of liquid equaled the amount of diazepam in a 1 mg tablet."

 

I can only refill each 30 days - not 60 like Dupont, regardless of the pill size I need to use. I have 5mg's. I can pill cut those if required into 2.5mg give or take and liquid taper from there instead of the preferred 1mg.  The fact still remains that I only have 30 days of pills to work with at a time - not 60.  I'm looking at simple water - so a compounding pharmacy and liquid suspension is not a factor, not would it be covered by my medicare HMO. 

 

Not wanting to waste product and toss into the sink I still think Dupont's "take out then refill with same inert amount" approach is the most appropriate, using just 1 bottle of water and  pill.  Perhaps enough solution to last for 1 week at a time. (?)  The key to his little gem was remove 1mL of product, then replace with 1 mL of inert material- thus maintaining the same level in the container, but also diluting it in the process each day. 

 

Don't think storing Valium in a water jar in the fridge for more than 1 week at a time is wise from a sanity standpoint, plus it also helps me calculate a 1 week reduction dose schedule - should I be able to handle it, which is going to be about 1 year from now.

 

Here is where I could use help with the conflicting information of titration. The mg per mL formula.

 

Dupont is using his 1mg pill to 1milliter of liquid equation.  He stated a number of 60 days, so he  must have used a 60mL primary jar of suspension mixed with 60mg of his benzo?  Doesn't sound right.

 

Another Video source states the formula of pill to liquid to use is: 1mg pill per 10mL of liquid - which sound more reasonable.

For me using a 1mg pill for 7 days (1 week reduction time in fridge), that would be 70mg of pills placed into 70mL of water.

 

Sound about right?

 

Then using the Dupont style, syringe out 1mL and take, then replace with 1mL of water - thereby diluting the mix in the process.

 

My Medicare HMO is strange. Online they have a PDF formulary and a drug price checker tool.  The formulary states they over both 5mg/5mL and 5mg/mL doses, yet when I log into my account and input that into the price checker tool they have - the result is NOT COVERED in huge black lettering.  Just to show you what the insurance and pharmacy is doing , along with the newly 'must call in the valium refill each month' routine.  This is Florida - the land of the strange, and the pain pill mills hurt a lot of innocent people in need in the process.  Perhaps the next on the list is the benzo's. 

 

Then to overthink this even more (12 months out), I can always turn to using discount pharmacy coupons for payment - but what if my pharmacy doesn't carry the valium suspension product.  Onwards to other pharmacies to check - then my name changes to MUD for drug and pharmacy shopping. I do prefer to try to use the regular pharmacy oral suspension approach for the sake of accuracy.  Valium is cheap - (to buy), but the overall cost it takes  from people is HUGE.

 

Life was so much simpler with that huge mug of German Beer in my hand - nobody bothered me.

 

Sorry again Bob, long post.  I guess I am so used to composing 20-30 page research reports with citations in APA format and a Works Cited page from my years of school.

 

 

I do not see anything which alarms me - except for the length of your post.  I mean, I do not see any concerns with your tapering analysis.  I made the comment about the length of your posts because most people suffering from Benzos cannot process long posts.  You will get more help with shorter posts because more people will read and chime in.

 

Sorry about that. Short one. Looked at GoodRx for oral diazepam options and prices. 

 

They have both 5mg/5mL and 5mg/mL for 2,30,60,90,120, and custom amount settings.

 

If I am at 1mg dose per day, and the doctor only writes for 30 days scripts (controlled meds), which of the above would be best suited for me to start with?  I would be using the same container taking out a set mL amount per day and replacing it with water.

 

 

 

 

If you have a choice to either:

(1) 5mg/5mL (which is the same as 1mg/mL)

(2) 5mg/mL

 

you want to get number 1.  It will let you measure smaller amounts.

Have you considered using a combination of regular diazepam tablets and the 5mg/5mL oral diazepam solution to taper?  Many of our members have used this strategy successfully.  For example, if you are dosing 20mg once a day:

 

Stage 1: Take 15mg in tablet form + 5mL (5mg) in liquid form, taper the liquid portion to 0

Stage 2: Take 10mg in tablet form + 5mL (5mg) in liquid form, taper the liquid portion to 0

etc.

 

Some members use the manufacturer’s liquid ‘as is’ whereas some dilute it with distilled water to obtain a lower-concentration liquid (e.g. 0.1mg/mL).

 

I agree with Bob7 that shorter versus longer posts are more likely to garner input from members (many of whom do indeed have difficulty processing large amounts of text).  When requesting assistance with taper planning and adjustment, it is also helpful to add a signature to your profile.  Examples of helpful information to include:

 

- Current total daily dose and daily dosing schedule (how many milligrams of drug do you take a what times)

- Duration of use (e.g. days, weeks, months, years)

- Past use (have you taken and discontinued benzodiazepines before)

- Other medications and supplements you are taking, especially psychoactive medications such as antidepressants, Z-drugs, stimulants, antipsychotics

 

Here are the instructions:  Add your history/signature

 

Appreciate the feedback, but this is Florida. My MD, pharmacy and insurance will not cover 2 different scripts for valium. I have asked to change the 5 size to a 2mg size with no response. If my MD prescribes the liquid solution ultimately, I might have to use a discount pharmacy coupon to purchase it.  Then - the monthly 'fight' I go through at the pharmacy to refill valium. Just trying to get the 2mg size pill for now - will work on the liquid ratios later.

 

20 years of valium intake

started reduction Easter Sunday to 18mg - a 10% reduction.

currently at day - 3.

stopped both baclofen and tramadol.

the rest are just blood pressure and cholesterol medications.