What do you think about this 5mg Valium tapering plan?

[[Buddie]]

First of all, some context:

- I live in Eastern Europe and in my country there are no benzo wise doctors or any helplines to guide me trough this.
- the only available Valium pills are 10mg, the leaflet inside states you shouldn't break up the pill for lower doses (they don't explain why, but probably the benzo is not evenly distributed)
-  there are no compounding pharmacies to prepare me reduced doses
-  it's my second taper, after spending five years protracted; the first one was a disaster, I surely do hope someone can guide me through this so I don't end up making stupid mistakes again 

Taking this into consideration,  I have decided to make my own milk preparation, by dissolving 10mg  diazepam into 100ml milk. I know this is not ideal, but I don't see what other options I have. I have also tried dissolving in alcohol but that gave me a paradoxical reaction, seems I cannot tolerate alcohol at all. So far I have used this method to take 5mg diazepam once per day for the last month, and the symptoms seem to have stabilized.

Going forward, I plan on doing a symptom-based taper, making for the moment conservative cuts of 5% once per two weeks, or maybe micro taper, and holding as needed. I am starting today to reduce my dose from 5mg to 4.75mg.

How does this plan sound to you, is this a good course of action?

[[Buddie]]

I would say that going slow, like 5% every 2 weeks or so, is a good starting plan.

[[Buddie]]

Hello, [...].

Let me begin by thanking you for presenting your case and medication histories in a concise and easy-to-follow manner.  This makes it so much easier for members to respond!  (I also appreciate the way you followed our guidelines regarding the use of PM; instead of asking me for tapering feedback in a PM, you used PM to give me a heads-up about your post and invited me to respond on the open forum. Well done!)

Your decision to make a do-it-yourself (DIY) liquid using regular diazepam tablets and whole fat, homogenized milk is a sound one.  Many members have used this approach over the years. 

According to extensive research conducted by one of our members (see link below), diazepam has a ‘best case’ solubility of 0.37mg/mL in whole fat, homogenized milk (see link below). According to another member who has a background in pharmaceutical science, the minimum standard for ‘sink conditions’ is a factor of 3-5 (see link below).  So, divide 0.37 by 3 or 5 and you have a ‘working’ (realistic) solubility closer to 0.12 - 0.7mg of diazepam per 1mL of milk.  The DIY liquid you are making has a concentration of 0.1mg per 1mL (10mg/100mL) so it is within this range.

Given your history, you might consider making a smaller trial reduction of 2.5% instead of 5%.  If that goes well, you could increase to 5%.  Please be aware that diazepam has a long half-life, so it may take longer than 2 weeks for the effects of a dose change to fully manifest and stabilize — it depends on how you metabolize the drug as well as other factors (e.g. other medications you are taking).  For example, according to the drug interaction checker linked below, the metabolism of progesterone can be increased when combined with diazepam.

Links:

Potatosaur’s post: http://www.benzobuddies.org/forum/index.php?topic=267260.msg3372864#msg3372864

Nogoldchain’s post: http://www.benzobuddies.org/forum/index.php?topic=267260.msg3372213#msg3372213

Drug Interaction Checker | DrugBank Online
https://go.drugbank.com/drug-interaction-checker

Edit: corrected typo

[[Buddie]]

Hi guys, and thank you both for taking the time to respond! 

[...], I am humbled by your words of appreciation and overwhelmed with gratitude for such a thoughtful response. I always appreciate it when somebody has a scientific reasoning, backed by links and citations. Progesterone is indeed influenced by the Valium, it even states so in the leaflet (thanks for checking, nevertheless). I have to deal with irregular bleeding since reinstating because of this. I might have to increase the progesterone dose a bit, but I don't want to change too many things at once. For the moment, I will start by following your advice, and attempt a 2,5% reduction. Will see later about the rest.

I am wondering, what your profession is, just out of curiosity. If you don't mind sharing on the forums, of course.
 

[[Buddie]]

You are most welcome, [...].  It’s always a pleasure to encounter a fellow member who appreciates the value of adopting an evidence-based approach to benzodiazepine discontinuation.  Case in point — tip of the hat for recognizing that changing multiple variables at the same time is not a good idea during taper trials.  For example, I encourage you to hold your dose constant at 5mg for at least a week or perhaps longer after you change your dosage form from tablets to liquid to evaluate how you respond to the change.  If all goes well, then you can make your first trial reduction.

I also encourage you to start keeping a daily taper log.  Doing so will provide you with valuable data about your withdrawal pattern (i.e., how many days does it take for withdrawal symptoms to emerge, peak, and stabilize); it will also give you a sense of what percent reduction you can tolerate (e.g. 2.5%, 5%, 10%).  Examples of data to record and review on a regular basis include:

- The date
- Time(s) and amounts(s) of drug ingested
- Daily global rating of your withdrawal symptoms (e.g., 0 = no symptoms; 10 = intolerable symptoms)
- Daily global rating of your functionality (e.g., 0 = able to perform all essential daily tasks; 10 = unable to perform any essential daily tasks)
- A brief note about anything that might have had an impact on your taper that day (e.g. stressful event; health issue; change in medications or supplements)

[[Buddie]]

Hi [...], thank you for coming back and giving me more advice. That shows you are meaning well and willing to be helpful. I appreciate that.

Regarding the homogenized milk concoction, I've been on it since reinstating, because the diazepam leaflet states not to break up the tablets (see my post above). So no need to hold 5mg longer.

I also keep this daily log that you suggest and a weekly log on my blog, I'm trying my best to improve my chances with this beast. I know from the first time around that I need to be super careful, and still, I might not succeed in spite of my best efforts.

I do however have a couple of questions though if you got time to spare. I have been feeling pretty dreadful yesterday even before your advised 2,5% cut. I went out for some grocery shopping and that seemed too much for my poor brain. The overstimulation caused made me to feel very dizzy, started shaking and had a horrible headache. I couldn't relax even after taking my evening Valium, my mind was racing and I was feeling agitated. I finally calmed down enough around 3 a.m. to fall asleep. I don't feel well today either.

And yet, I went out last week and did the same, without that much distress. I am wondering if this means that I've hit tolerance, since I've been holding at 5mg for 4 weeks. I'm one of those short time users, the first time around (2017) I've hit tolerance in about two months. I am not one of those people that that can be on benzos for years and years without impunity.

So when you recommend that it may take longer than 2 weeks for the effects of a dose change to fully manifest and stabilize, do you mean I should stay on the lowered -2,5% dose longer than two weeks? Cause I am now afraid of holding more than 3 weeks. 

Finally, one more question, do people that develop tolerance fast, are considered slow or fast metabolizers?

[[Buddie]]

The only way to know how long you should stay at a given dose is via experimentation.  That’s why keeping. a daily log is so important.  You might find it helpful to graph your global ratings of symptoms and functionality over time.  This will give you a visual representation of your unique withdrawal pattern.

I’ll defer to other members to answer your questions about tolerance.

[[Buddie]]

Thank you, [...]. I will continue to take the lowered dose and wait for somebody to respond.