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Diazepam Titration


[Mr...]

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Hi everyone,

 

I was wondering how do I go about doing a liquid taper of Valium (I am using 5mg tablet, and my doc says she doesn't have the 2mg version of it); honestly I have no other option but head this direction supposing I were to do a 5-10% reduction every fortnight. I know the de-prescribing guidance advises that we reconstitute the tablet into liquid form in a syringe, but I was just wondering whether this has worked for other sufferers like me (will water just deactivate the components of Valium, and how long can I store it)?

 

MM

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Are you located in the US?

 

If so, would your doctor be willing to prescribe the commercially manufactured, 5mg/5mL (1mg/1mL) oral solution of diazepam?  I’ve included a link to the official FDA drug label from one of the manufacturers of below.  Many of our members have used this oral solution to taper diazepam; some use it ‘as is’ whereas others dilute it further with water (this lowers the concentration of the liquid to enable smaller reductions in dose).

 

If your doctor is not willing to do this, have you considered finding a new ‘benzodiazepine cooperative’ prescriber, ideally in the area where you will be moving?  I’ve included a link below to helpful information from the Benzodiazepine Information Coalition on how to find such a prescriber.

 

Link:

DailyMed - DIAZEPAM solution

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e85abed-1a8b-4762-a31f-f2c7f196b8af

 

Benzodiazepine Cooperative Providers - Benzodiazepine Information Coalition

https://www.benzoinfo.com/doctors/

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Hi Libertas,

 

Thanks for getting back to me. Unfortunately I am not from the US. My doctor doesn't have access to Valium syrup. I was wondering how else I could titrate my 5mg tablet? Could I just crush and weigh it instead? I wanted to reconstitute them with water, but I don't think that's a good idea. I am on 1.875mg, but it is so difficult to survive the smallest dose reduction. I also keep wondering if all these symptoms are due to Valium or is it just me. It's really stressing me out.

 

MM

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You’re welcome, MrMeaner.

 

That’s unfortunate you do not have access to a commercially manufactured oral diazepam solution where you live (it’s the preferred choice in terms of safety, effectiveness, and accuracy of dosing).  However, if this is not an option, we also have members who have obtained diazepam liquids from a compounding pharmacy.  Is this an option?  Or, are Tapering Strips an option (see link below)?

 

If not, we have members who have made ‘do-it-yourself’ (DIY) liquids using regular diazepam tablets along with other other ingredients such as a commercial suspending vehicle (see link below); whole-fat, homogenized milk; and just plain water.  We also have members who have experimented with the use of co-solvents (e.g. ethanol, propylene glycol, glycerine plus water).

 

Regrettably, per our Titration: FAQs, these DIY liquids have not been professionally analyzed so we do not know their properties.  For example, we do not know how much of the Active Pharmaceutical Ingredient (API) is contained in a given amount of the liquid or its bioavailability.  We also do know the effects of the other ingredients in the tablets — or any added ingredients  — on the efficacy, safety, stability, and assay potency of the liquid.

 

The bottom line is that some individuals are able to taper using DIY liquids whereas others are not.  The only way to know is to try.  For example, to make 50mL of a DIY liquid with a concentration of 0.1mg/mL, you could disperse a 5mg tablet in 50mL of a commercial suspending vehicle, whole-fat homogenized milk, or water.

 

Links:

Tapering strip | Responsibly reducing your medicine intake

https://www.taperingstrip.com/

 

Basics of Compounding: Vehicles for Compounded Oral Liquid Medications: A Review (2018)

https://fisherpub.sjfc.edu/cgi/viewcontent.cgi?article=1189&context=pharmacy_facpub

 

Edit: Added links

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Hi MM

 

I think if you posted a question on the withdrawal support board asking if anyone else has ever wondered how in the world their symptoms could possibly be all related to benzodiazepines, you’d be inundated with replies. There is no part of the body that cannot be affected by benzodiazepine withdrawal. Many people worry there must be something else wrong with them and therefore go to the trouble of having every test and scan under the sun done, only to find that every one of them comes back completely clear. Symptoms of benzodiazepine withdrawal mimic nearly every illness and disease you could possibly imagine, and the potential for pain and suffering is beyond comprehension to anyone other than those who have actually been through it.

 

I think you may find the information in the link below very interesting.

 

What’s happening inside your brain

 

In regard to your taper options… consider the information Libertas has kindly provided, and just let us know what you’re thinking, and then we’ll go from there  :thumbsup:

 

 

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Hi WS,

 

I suppose for now, the only way for me is to keep myself busy. As for titration, let's go with the DIY method, it is worth a shot.

 

MM

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Hi MM

 

If you’ve decided to give the DIY method a shot, you should make sure to hold your equivalent liquid suspension dose for a week or so to give your body time to adjust to the different delivery method. Members sometimes find the initial switch to liquid can feel like a reduction in dose, so hold that dose until you feel stabile enough to start the taper.  :thumbsup:

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Hi MM

 

If you’ve decided to give the DIY method a shot, you should make sure to hold your equivalent liquid suspension dose for a week or so to give your body time to adjust to the different delivery method. Members sometimes find the initial switch to liquid can feel like a reduction in dose, so hold that dose until you feel stabile enough to start the taper.  :thumbsup:

 

In addition, you should definitely wait until you stabilise on the 1.875mg solid form dose before you switch to the liquid.

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Hi WS and everyone,

 

Just an update. Looks like for the past few days (after maintaining a dose of 1.875mg of Diazepam), I am beginning to feel more functional than before. Sleep is getting better and I am able to tolerate noise better (though I don't like it at all). Who would have thought such a small dose could make a big difference. However, I don't think I'm out of the woods yet, I still feel that anxiety feeling in the background, waiting to pounce on me anytime. But at least it is now more manageable.

 

MM

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Hi WS and everyone,

 

Just an update. Looks like for the past few days (after maintaining a dose of 1.875mg of Diazepam), I am beginning to feel more functional than before. Sleep is getting better and I am able to tolerate noise better (though I don't like it at all). Who would have thought such a small dose could make a big difference. However, I don't think I'm out of the woods yet, I still feel that anxiety feeling in the background, waiting to pounce on me anytime. But at least it is now more manageable.

 

Rabin

 

Hi MM

 

We’ll, that’s very good news you are beginning to stabilise, so just allow some more time to pass to stabilise further. Good signs!

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