Titration instructions! Deprecated: please read the new sticky titration thread

Hi,

 

The following method is suitable for most people. If you are beginning titration with some fraction of tablets (two-and-a-half tablets per day, for example), please ask us to make the calculation for you, as that situation requires an extra instruction. This method also assumes that your tablets are all of the same dosage (size).

 

We will be soon updating this method to cover the above compilations.

 

Please feedback with your comments. It would be useful to know what is unclear before we start adding to the method.

 

Thanks.

 

---

 

Introduction

 

At BenzoBuddies, all we mean by 'titration' is the making of a liquid from benzodiazepine tablets. Please note: if your benzos come in capsule form, you will need to check with your doctor or pharmacist that the contents are safe to ingest in a liquid form - capsules can contain ingredients that can cause irritation or burning. Titration from your benzodiazepine tablets is perfectly safe though!

 

Titration allows us to make much smaller cuts than we can achieve by splitting our pills and is far more accurate, resulting in a much better controlled and smoother withdrawal. Because the reductions with titration are so much smaller, you should be able to make cuts more frequently - usually every day! This means that that your taper will probably take no more time than it would by the pill-splitting route. In fact, because it should be less traumatic, it might even result in a faster withdrawal!

 

 

Preparations for Titrating Benzodiazepines

 

When deciding at what rate we should be titrating off our benzo, we should first look to our own history. If we have made cuts to our dose in the past, first make an assessment of which cuts were successful, and which caused us problems. How severely a cut will affect us seems to be closely related to how much of a cut we make to our dose in terms of percentage. Cutting 3mg from a 30mg dose of Valium (a 10% cut) is probably manageable by most people, but a 3mg reduction from a dose of 10mg (a 30% cut) would cause most of us to experience severe withdrawal symptoms - 1mg cut from 10mg would probably be a more sensible. However, we vary enormously in our reactions to tapering off benzodiazepines. What is manageable by one person may cause intolerable withdrawal effects in another: this is why we recommend that you look to your own history. Assess the successful cuts and covert them to a percentage for comparison. If you have no cutting history to speak of, we then recommend an initial cutting rate of 10% every 14 days. If you have tried cutting in the past, but always experienced problems, then 5% every 14 days might be more appropriate. Joining the BenzoBuddies forum will help you determine what the appropriate taper rate is for you.

 

You will also need to know (or estimate as best as you are able) how long you required to recover from your previous cuts before you felt ready to tackle a new cut. We are trying to arrive at a daily titration rate that is equivalent to your earlier (successful) pill-splitting cuts. This is at the heart of the method.

 

 

The Titration Calculation

 

The calculation is based upon titrating just one of your daily tablets. The resultant liquid (once you have disposed of your daily reduction) will have your other tablets added to the benzo-milk solution. Please read the Basic Method that follows the calculation, it will explain this more fully.

 

All you need to determine before the calculation is the following:

 

days = The number of days spanned by your successful cut before you felt able to make a new cut.

 

tablets = The number of tablets you now take per day. They must be of the same dose (size).

 

rate = The reference rate of your successful cut converted from a percentage to the decimal equivalent: 10%=0.1; 12.5%=0.125; 5%=0.05; etc. (How to convert a percentage to a decimal, or determine the figure from the number of pills cut or split, is explained in endnote b.)

 

All you need do is plug-in your figures that correspond with the above into the following equation:

 

(days/tablets)/rate = volume

 

In most cases, the above is the only calculation you will need to make. If you would like a member of the Team to make the calculation, or if your dosing situation is more complicated than the basic method, please join the BenzoBuddies forum.

 

volume = The amount of titrated liquid you will be preparing.

 

volume will indicate the amount of titrated benzodiazepine you will need to make up. If the volume is more than 100ml - please refer to endnote c.

 

This basic method assumes that you are taking a whole number of tablets per day (not two-and-a-half tablets per day, for example). If this in not the case, then please join the forum and allow us to make the calculation for you.

 

It also assumes that the tablets you use each day are of the same dosage (you are not mixing tablets sizes to achieve a particular dose).

 

 

Preparing the Benzodiazepine-Milk Liquid

 

The Basic Method - Usually, all that is needed!

 

You will need:

 

• A 100ml graduated cylinder marked at 1ml intervals
  
• A supply of little covered jars
  
• A 10ml syringe marked at .2ml intervals (optional)
  
• A stirring rod (a butter knife will substitute)
  
• A daily supply of homogenised milk
  

 

You will be titrating one tablet at a time. When you have finished titrating with one tablet from your daily dose, you will start titration of your next tablet, with fresh calculations.

 

[*]Crush one of your tablets in a jar with the back of a spoon.[br][br]

[*]Add a little HOMOGENIZED milk (the amount is not important, but it MUST be homogenized), and swirl it around to dissolve the benzo. Let this sit for a few minutes to be sure the benzo is completely dissolved, then swirl around again.[br][br]

[*]Add this mixture to the 100ml cylinder.[br][br]

[*]Add a little more milk to the jar, stir, and again empty into the cylinder. This is to make sure all of the benzo gets transferred to the cylinder.[br][br]

[*]Add more milk to the cylinder to bring the amount up to volume(ml). Mix well with either a stirring rod or a butter knife.[br][br]

[*]Throw out 1ml of the benzo liquid on the first day. Dispose of an additional 1ml of the benzo liquid every day. Continue to do this until you are disposing of all the liquid. At this stage you will need to make the calculation afresh with your remaining tablets to determine a new volume of liquid - this is important![br][br]

[*]Crush the remaining part of your daily dose in another little jar with the back of a spoon. Add a little of the remaining liquid from the cylinder and swirl it around to dissolve the powdered benzo (read endnote a. if the amount left in the cylinder is not enough to do this). Add this solution back to the cylinder and mix well. Again take a little of the cylinder solution and add it to the jar, swirling the liquid around to pick up any remaining benzo. Return the solution to the cylinder. Mix well.[br][br]

[*]Divide the liquid up into two or three equal (or more) parts to take during the day. You can keep the doses in little covered jars in the fridge.[br][br]

[*]When you are done, be sure to rinse everything (cylinder and syringes) thoroughly since milk is perishable.

 

 

Endnotes - minor complications

 

[*]If you do not have enough milk left in the cylinder to pour into the jar to collect the rest of your benzo powder, simply add some more milk. Since we have already disposed of the benzo required for this day's titration, all we are doing is making the liquid more milky. You will still divide the total volume up into two or three (or more) doses for the day, as usual.[br][br]

[*]To convert your percentage figure to a decimal equivalent, simply divide the percentage figure by 100. You can do this simply by moving the decimal point two places to the left. Therefore, 9% becomes 0.09; 16.7% becomes 0.167; etc. If you are not working from a percentage, you can very easily arrive at this figure from your history by dividing the amount cut by the total uncut dose. For example, 2mg cut from 20mg would be 2/20 = 0.1; 3mg cut from 25mg would 3/25 = 0.12; etc.[br][br]

[*]If the volume is more than 100ml, you will need to divide this by the lowest possible whole number so that the volume equals less than 100ml. This is so that the liquid will fit your 100ml cylinder. We will refer to this number as 'period' and is the number of days taken between each new cut. Mostly, however, the volume will be less than 100ml without any additional division. In which case, you will make daily cuts instead.

 

period = The number of days between each new cut.

 

 

 

Options & Tips

 

• After step 5, if your solution in the cylinder(volume) measures 50 ml or less, double the amount by adding more milk and then cut twice as much (i.e., cut 2ml for each 1ml). If the amount measures 33ml or less, triple the amount by adding more milk and then cut three times as much (i.e., cut 3ml for each 1ml). This will make cutting and measuring the amounts for individual doses easier, and increase accuracy.[br][br]
  
• After step 7, before you divide up your solution into equal parts, add a little extra milk to the cylinder to make the amount nicely divisible by 2 or 3 (or however many doses you take a day). For example, if you have 29 ml of solution and wish to divide it into three doses, you could add an extra 1 ml of milk to the cylinder to bring the solution up to 30 ml, which is easily divisible by 3. Mix well after adding the extra milk.[br][br]
  
• To fine-tune the amount of milk you add to the cylinder, to bring it up to exactly the volume desired, simply draw some milk into the syringe and slowly add to the cylinder until you reach the specified amount.[br][br]
  
• To fine-tune the amount of benzo solution you are cutting for the day, pour the liquid into a fresh jar until left with a little less in the cylinder than you need. Simply draw some of the liquid from the jar into your syringe and slowly add to the cylinder until you reach the specified amount.[br][br]
  
• To measure out your dose if you are cutting a very large amount (for example, if you are throwing out 66ml of a 69ml solution) it would be easier to measure 3ml (with your syringe), consider this your dose for the day, and dispose of the remaining 66ml from the cylinder.
  

 

I am further simplifying these instructions before I add the complications to cover less usual situations, and adding a few corrections and (hopefully) some better explanations.

 

Where's my feedback peeps?!

 

---

 

Introduction

 

At BenzoBuddies, all we mean by 'titration' is the making of a liquid from benzodiazepine tablets. Please note: if your benzos come in capsule form, you will need to check with your doctor or pharmacist that the contents are safe to ingest in a liquid form - capsules can contain ingredients that can cause irritation or burning. Titration from your benzodiazepine tablets is perfectly safe though!

 

 

Preparations for Titrating Benzodiazepines

 

When deciding the rate of your taper, it is best to first look to your own taper history. By using your past successful cuts as the basis of your titration schedule, you are better assured of creating a schedule that suits your particular needs. If you have not yet tried tapering off your benzos, we then suggest a taper rate of 10% of your present dose over a two-week period as a good starting point. It is best to start your taper relatively conservatively - you can always increase the rate of your taper later.

 

If your past attempts at tapering off benzos were unsuccessful, especially if you experienced problems with even the smallest of cuts, then a taper rate of 5% over two weeks might be more advisable.

 

Once you are have determined what appears to be a sensible taper rate for you, then simply apply the figures to our simple formula.

 

 

The Titration Calculation

 

The calculation is based upon titrating just one of your daily tablets. You will remove 1ml of the volume of liquid on day 1, and an additional 1ml each new day until you finished titrating off this tablet. At this stage you will make fresh calculations, and taper off the next tablet.

 

Before making the calculation, you will need to determine the following:

 

days = The number of days spanned by your successful cut before you felt able to make a new cut.

 

tablets = The number of tablets you now take per day. The tablets must be of the same dose (size).

 

rate = The rate of your past successful cut (or the rate the you have determined is suitable for you) converted from a percentage to a decimal equivalent: 10%=0.1; 12.5%=0.125; 5%=0.05; etc. (How to convert a percentage to a decimal, or determine the figure from the number of pills cut or split, is explained in endnote b.)

 

All you need do is plug-in your figures that correspond with the above into the following equation:

 

(days/tablets)/rate = volume

 

In most cases, the above is the only calculation you will need to make. If you would like a member of the Team to make the calculation, or if your dosing situation is more complicated than the basic method, please join the BenzoBuddies forum.

 

volume = The amount of titrated liquid you will be preparing.

 

volume will indicate the amount of titrated benzodiazepine you will need to make up. If the volume is more than 100ml - please refer to endnote c.

 

The above assumes that you are not taking a fraction of a tablet of your daily dose (not two-and-a-half tablets per day, for example). If this in not the case, then please join the forum and allow us to make the calculation for you.

 

It also assumes that the tablets you use each day are of the same dosage (you are not mixing tablets sizes to achieve a particular dose). Again, join the forum and we will make the calculation for you.

 

Preparing the Benzodiazepine-Milk Liquid

 

The Basic Method - Usually, all that is needed!

 

You will need:

 

• A 100ml graduated cylinder marked at 1ml intervals
  
• A supply of little covered jars
  
• A 10ml syringe marked at .2ml intervals (optional)
  
• A stirring rod (a butter knife will substitute)
  
• A daily supply of homogenised milk
  

 

You will be titrating one tablet at a time. When you have finished titrating with one tablet from your daily dose, you will start titration of your next tablet, with fresh calculations.

 

[*]Crush one of your tablets in a jar with the back of a spoon.[br][br]

[*]Add a little HOMOGENIZED milk (the amount is not important, but it MUST be homogenized), and swirl it around to dissolve the benzo. Let this sit for a few minutes to be sure the benzo is completely dissolved, then swirl around again.[br][br]

[*]Add this mixture to the 100ml cylinder.[br][br]

[*]Add a little more milk to the jar, stir, and again empty into the cylinder. This is to make sure all of the benzo gets transferred to the cylinder.[br][br]

[*]Add more milk to the cylinder to bring the amount up to volume(ml). Mix well with either a stirring rod or a butter knife.[br][br]

[*]Throw out 1ml of the benzo liquid on the first day. Dispose of an additional 1ml of the benzo liquid every day. Continue to do this until you are disposing of all the liquid. At this stage you will need to make the calculation afresh with your remaining tablets to determine a new volume of liquid - this is important![br][br]

[*]Crush the remaining part of your daily dose in another little jar with the back of a spoon. Add a little of the remaining liquid from the cylinder and swirl it around to dissolve the powdered benzo (read endnote a. if the amount left in the cylinder is not enough to do this). Add this solution back to the cylinder and mix well. Again take a little of the cylinder solution and add it to the jar, swirling the liquid around to pick up any remaining benzo. Return the solution to the cylinder. Mix well.[br][br]

[*]Divide the liquid up into two or three equal (or more) parts to take during the day. You can keep the doses in little covered jars in the fridge.[br][br]

[*]When you are done, be sure to rinse everything (cylinder and syringes) thoroughly since milk is perishable.

 

 

Endnotes - minor complications

 

[*]If you do not have enough milk left in the cylinder to pour into the jar to collect the rest of your benzo powder, simply add some more milk. Since we have already disposed of the benzo required for this day's reduction, all we are doing is making the liquid more milky. You will still divide the total volume up into two or three (or more) doses for the day, as usual.[br][br]

[*]To convert your percentage figure to a decimal equivalent, simply divide the percentage figure by 100. You can do this simply by moving the decimal point two places to the left. Therefore, 9% becomes 0.09; 16.7% becomes 0.167; etc. If you are not working from a percentage, you can very easily arrive at this figure from your history by dividing the amount cut by the total uncut dose. For example, 2mg cut from 20mg would be 2/20 = 0.1; 3mg cut from 25mg would 3/25 = 0.12; etc.[br][br]

[*]If the volume is more than 100ml, you will need to divide this by the lowest possible whole number so that the volume equals less than 100ml. This is so that the liquid will fit your 100ml cylinder. We will instead spread make the cuts less frequently to compensate. We will refer to this number as the 'period' and is the number of days taken between each new cut. Mostly, however, the volume will be less than 100ml without any additional division. In which case, you will instead make daily cuts.

 

period = The number of days between each new cut.

 

 

 

Options & Tips

 

• After step 5, if your solution in the cylinder(volume) measures 50 ml or less, double the amount by adding more milk and then cut twice as much (i.e., cut 2ml for each 1ml). If the amount measures 33ml or less, triple the amount by adding more milk and then cut three times as much (i.e., cut 3ml for each 1ml). This will make cutting and measuring the amounts for individual doses easier, and increase accuracy.[br][br]
  
• After step 7, before you divide up your solution into equal parts, add a little extra milk to the cylinder to make the amount nicely divisible by 2 or 3 (or however many doses you take a day). For example, if you have 29 ml of solution and wish to divide it into three doses, you could add an extra 1 ml of milk to the cylinder to bring the solution up to 30 ml, which is easily divisible by 3. Mix well after adding the extra milk.[br][br]
  
• To fine-tune the amount of milk you add to the cylinder, to bring it up to exactly the volume desired, simply draw some milk into the syringe and slowly add to the cylinder until you reach the specified amount.[br][br]
  
• To fine-tune the amount of benzo solution you are cutting for the day, pour the liquid into a fresh jar until left with a little less in the cylinder than you need. Simply draw some of the liquid from the jar into your syringe and slowly add to the cylinder until you reach the specified amount.[br][br]
  
• To measure out your dose if you are cutting a very large amount (for example, if you are throwing out 66ml of a 69ml solution) it would be easier to measure 3ml (with your syringe), consider this your dose for the day, and dispose of the remaining 66ml from the cylinder.
  

 

 

Thank you Colin for spelling out this complicated process.  I think I'm starting to understand it more.

 

I do have some concerns about titration.  I take my dose (22mg Valium ) at night before bed.  I have had insomnia for a few years and that's the reason I was prescribed benzos in the first place.  Insomnia is also my worst w/d symptoms too now that I am tapering.

 

I'm afraid that if I titrate that I won't sleep at night at all.  I was wondering if titration is really worth trying since Valium has such a long half life anyway.  What do you think?

 

Thanks,

Maggie

I agree with you about Valium, at your dose at least. You should be able to manage cuts of 0.5mg, and from 22mgs, that's a little over 2%. OK, you won't be making cuts like that every day (more like every few days), but for the vast majority cuts of that size should cause no problems. However, you may find that titration is valuable for you too as your dose decreases, and cuts account for a larger proportion of your daily dose. Play it by ear; you will know if you need to use titration.

Thank you for all the helpful information.  Until reading your last post, I really didn't consider cutting my dose right now by 0.5 every couple days.  I was doing the 10 % or so cut every two weeks, following what I read by Dr. Ashton.  I now plan to do the 0.5 mg cut and see how that works.  Looks like I do have some time to really understand the titration method until I get lower on my doses.

 

Thanks...once again   You are Superman in my book! You do such a great job and give so much to this website.  You and the moderators are helping so many of us.

 

Maggie

I have things to add to the method I've outlined above. I just wanted to include the most important stuff for now. The difference between the method we are developing, and usual benzo titration, is that we aren't titrating the benzo to a standard strength. Mostly people make a liquid benzo and then determin and deduct (or use) the appropriate amount to make up their daily dose. Instead we offer a method that instructs you to always remove 1ml from the prepared benzo-liquid. If we need the taper to be more gentle, then we simply increase the initial volume of the liquid so that each 1ml removed counts for a smaller percentage (fraction) of the total volume. What we have done is develop a system that is effectively fine pill-splitting using a formula that can relate these cuts to earlier cuts. The method allows us to make an equivalent daily cut to a 10% every 10 days, or whatever amount and period. You will end up with, for example, 22ml and you will remove 1ml each day. We have effectively split the pill into 22 pieces.

Hi,

I am new to this post so I'm not sure if I am doing this right but I noticed that you did a direct taper from Klonopin.  Can you tell me the dose you were on and for how long and how your taper schedule was set up?  I don't think I can do the titration method and will have to taper directly from the pills.  Also....is it normal to have withdrawal symptoms with each cut you make?  How do you know what is normal symptoms and when you need to slow down or are going too fast?  Thanks, Pebbles

Hi Pebbles,

 

Welcome to BenzoBuddies.

 

I took the liberty of removing the very long quote the end of you post above as it didn't really add anything (maybe you clicked 'quote' instead of 'reply' by mistake).

 

Anyway, to answer your question - I followed no particular schedule. I was totally ignorant of how I should manage my taper and only began to look into benzos after I had completed my withdrawal because of some protracted withdrawal symptoms. My withdrawal was very much by the seat-of-my-pants.

 

The titration technique is really a direct taper since you will not be substituting for another benzo - but yes, it is less straightforward. You can certainly taper off by making small cuts to your pills, and for many that is enough. It is important to keep the cuts small (prefereably no more than about 10% of your overall dose), but this becomes increasingly difficult to achieve as our dose is reduced. If you are on one pill a day, it is pretty much impossible to to make 10% reduction, or even a 12.5% reduction (one-eighth of one pill), especially using small pills such as Klonopin. This is an even bigger problem if that one pill needs to be splread over the day into two, three, or even more doses. This is where the titration technique comes in useful! Many will be able to taper off without it, but it is there if needed.

 

I should also point out, whatever method you use, small frequent cuts are better tolerated than larger less frequent cuts. Using a titration method would probably be of some benefit to all, but maybe overkill for many too. Since you are not very enthusiastic about it, then yes, try tapering off by standard pill-splitting, but know at the same time that, if need be, there are options available if you have problems.

 

You can probably expect some withdrawal symptoms with each cut, but as I have already mentioned, small cuts are likely to cause less symptoms. Many report that they can taper as quickly (or even faster) using titration and with fewer withdrawal symptoms. Tapering by pill-splitting tends create a shock to the system (and induces withdrawal symptoms), you then recover, and then make a new cut. The cuts with titration reduce this shock, and you instead follow a slow gradual decline - the chances are that you would experience less withdrawal symptoms.

 

Take care.

it is official - at this time i am too stupid to titrate.

 

i have take 2 (1) mg of adavan per night for anxiety, fibromyalgia and insomnia.

 

so i cut down to 1.34 mg and it seemed to work

 

so would it work to maybe wait maybe 14 days or 30 days and go down another 1/4

 

perhaps when i am feeling clever and alert i read this again.

 

i assume we are not suppose to talk about teas or l-tryptolin on here?

Hi Silver,

 

You can talk about pretty much what you wish at this forum. It would be better to post it to the most suitable board though: http://www.benzobuddies.org/forum/general-health-and-wellbeing/0/

 

If later you wish to try titration, we will work through it with you. I will also try to simplify the instructions; they do need work!