Titration off of 1 mg of Ativan, is my math right?

My pill size is .5mg. I currently take 1mg at night. I was wanting to taper at a 10% rate for a week at a time. The math I have on this is, 10% of 1mg = .1. This is divided by 7, which equals the amount I delete per day is 1.4 mls, out of a 100ml container filled to the 100ml mark. Did I do the math right?

Can I crush both pills and put them in the 100ml at the same time? Or do I crush one first, mix in the milk, then crush the other, and add milk and mix?

Thanks

Hi Dan,

A 10% cut (0.1 in decimal terms);

This to be carried out over 7 days;

You take 2 tablets.

OK, yes, it is possible to use both tablets, but it involves changing the maths - it is best for all if we stick to one system!

(days/tablets)/rate = volume

(7/2)/0.1 = volume of milk

3.5/0.1 = Volume of milk

35ml = volume of milk.

So:

You crush one of your tablets and you bring this up to 35ml as per the the instructions (thoroughly mixing, etc.);

You discard 1ml from the benzo-milk solution;

You crush your second tablet and add that to solution (again, thoroughly mix);

This is now your total dose for the whole day. Divide it up into however many doses you require for the day.

On day two, you would remove 2ml instead of 1ml; day three would 3ml, etc. etc.

Once you have gotten down to just the one tablet, it would be a very good idea to reassess, and make a new calculation. Because you are using 1 tablet, the maths changes. This is because as our dose lowers, each similar sized cut will account for a larger and larger amount of our total dose. A similar rate of withdrawal fed into the formula with those new figures suggests that you  would start with 70ml of milk when you are down to 1 tablet. However, how you fair with titration of your first tablet will obviously influence what you decide would be a reasonable rate of withdrawal for you and the numbers from the formula.

Colin,

Thanks very much for the explanation.

I have had two rough patches with doctors having me reduce way to fast. I am just now recovering from the last one. Needless to say, I want to avoid these withdrawal problems as much as possible.

I would like to hear more success stories about slow titration. Where do I find those?

Thanks again

If you use the search function, with keyword 'titration' and member 'jana', you should come up some results. We've not been long using our titration method, but Jana (previously a moderator of BenzoBuddies) used to help people. Unfortunately Jan has left, and much of her help with Titration was off the forum, but there should still be some posts about.

There a few members using titration now - I guess I need to round them up make them use the titration board more! We could also do with encouraging all members to use standard words in their signatures so that we all better understand where everyone is at, and their method of withdrawal. If you have trouble finding threads, let me know and I'll have look for you.

Hi Colin,

Yes, I would like to read what Jana has to say about titration tapers. If you can point me to the posts, I would appreciate it.

My wife who is a nurse, calculated the mg dosage for each of my tapers. It was quite interesting to see it. Unfortuneatly I did not understand how she did the math. But in essence, my mg concentrations get progressively smaller in each taper. For instance, I get to half of my regular dosage at 17 tapers, but then it takes 70 tapers to get rid of the remaining half (right now I am at 1mg Ativan). We used the formula you provided in the previous post. I will probaly start my taper this coming week. Wish me luck.

Dan

Hi Dan,

My maths showed that you would be using 35ml for the first of the two pills - that's 35 steps! The same over all rate on the second pill does indeed work out at 70ml (70 steps).

The reason why we should re-access every-so-often (and doing it with every new pill being titrated is convenient) is that the regular sized cut accounts far a larger-and-larger percentage cut from our total dose. A 0.1mg cut from 2mg is a 5% cut; a 0.1mg cut from 1mg is a 10% cut; a 0.1mg cur from 0.5mg is 20% cut; etc. etc.

Dan, if you like I have an excel spreadsheet that does all the calculations for you. All you have to do is fill in what you benzo your tapering from, the dose and the amount of water/milk you'll be using. It goes as far as telling you exactly when your taper will be complete. If your interested PM me your email address.

Dave

Colin,

Currently I take two .5 mg of Ativan at night. With the calculation you provided, yes I would have a volume of 35 mls. According to my wife, at cut 17, my concentration has now reached .5 mg. It is at this point I switch to the new calculation and the number of cuts is 70, with each succeeding cut much less concentrated than the next.

The math I worked out is this; 1mg/35cuts = .0286mg taken out of my body/cut. At 17 cuts, (17 X .0286) = .5 mg is now my concentration, or I am now at a .5mg dosage. Your instructions: "Once you have gotten down to just the one tablet, it would be a very good idea to reassess, and make a new calculation." At 17 I am now at a one .5mg tablet dosage.

At cut 34, the concentration is .0286mg. If I cut down to the entire 35, I would have titrated down to 0 mg in my body. That is the same as a straight line cut.

At cut 17, I can now use the second calculation for the remaining .5 mg that I need to get rid of.

Dave, BTW my email address is dan@valuecreationpartners.com. I would like to see the spreadsheet.

Please let me know your thoughts.

Hi Dan,

I know see where the confusion comes from. You crush one pill, and you add that to the milk. You then remove the amount for that day (initially 1ml and an additional 1ml per day), you then add the other crushed pill. You see - you are only reducing the first pill each day. After 35 days you done done away with all of the first pill and you just take the the whole of the second pill (well, for one day). From then on you will be reducing this second pill - does that make sense?

You will be disposing of 1ml each and every day right down to zero, but it's only the fist pill that you are reducing! Please read the instruction on the titration page. I guess I need to work on them some more.

Colin,

I get it if you do not add the second pill to the milk. You are titrating one pill at a time. You take the first pill and put it in the milk, take out 1 ml. Then just take the other pill. When the 35 ml is gone you have titrated down to one pill, then you recalculate for the second pill. I thought you were putting both pills in the same 35 ml.

Dan

Hi Dan,

That's almost it, but not quite. You can do exactly what you explained above, or, you could add the remaining (crushed) benzo(s) to the milk (after you've made you daily reduction) so that you can then easily divide whole daily dose into several doses. This is easier and more accurate than trying to divide that remaining pill into however many doses you take over a day.

So, we crush one pill and add it to the milk. We remove the amount applicable for that day of our taper. We then add the remaining crushed tablets.

We have reduced the dose of the first tablet only! We are titrating one tablet at time, but it is useful (for most people) to then add the remaining (crushed) tablets to easily divide their daily dose.

Hi Colin,

I think I finally got it. The last 35ml/taper with have .0143 of the first .5 tablet and all of the second .5 mg tablet. When that is done we calculate the next taper, which is 70 ml. So we go twice as slow as the first taper. Is that because the last part of the taper is usually tougher?

Because I tried to cut my dose in half in one day (from my doctors suggestion), the resulting agony has got me gun shy. Since I have only been on the Ativan for a short time, I thought my taper might go faster that what has been outlined. But I would rather error on the conservative side since the pain was so high. With the calculation above I cut my dose in half at 35 days versus 1 day. What a difference.

Thanks for keeping with me to explain this approach. I look forward to the taper with both optimism and caution.

Dan

Hi Dan, that's it.

I should explain though, the reason we recalculate with each new tablet is that as our overall dose decreases, the absolute amount we taper by should reduce. I think I explained before, if we deduct 0.1mg from 2mg, that's a 5% reduction; it deduct 0.1mg from 1mg, that's a 10% reduction. Reducing buy a set amount results in us making larger-and-larger reductions to our dose in percentage terms! So, it is important to recalculate every so often.

If you are taking 2 tablets, and you remove one thirty-fifth from one tablet (one seventieth from the total), that's a reduction of of 1.42% from your total dose. When you get to the last 1ml from the first of the two tablets, you are, in effect, reducing your dose by one thirty-six from your total dose. That's a reduction of 2.78% on the day. This effect always happens, with whatever method is used, so we must reductions based upon our present dose, not the dose we used to take.

If you want to account of the above effect further, you might find that you can make a double reduction every other day for the first third of the tapered tablet, make a reduction each day for the middle third, and then make a reduction only every other day for the last third. At some stage I will write something up about this. However, the effect is minor when taking a larger number of tablets, and in any case, we should tailoring the taper according to how react. That can mean taking a break from further cuts, or indeed, making larger or more regular cuts. There is no standard rate at which we can all taper.

right now i am comfortable at 1.5 for first month - then i will try 1.1/4 - so the reduction will be less great - then i think i might be ready for titration.

i think if i do it over a month - my have more time to adjust - but i will know - if i am freaked for four days then i will need to titrate sooner.

something like 1. 1/8th - it is easy for me to work in 1/4 increments and 1.5 increments - i may get away with 1.1/4 - have to see if not time to break out syringe and milk.

right now even tho .5 reduction is a lot i am handling it

didn't sleep last night but sleep most of yesterday and sleep well night before last.  this on and off thing is not unusal for me.  as long as i am not wired all is well.