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New titration method and procedure - update


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Hi,

 

I've been promising a new titration method, and it is coming along. I hoped to have a prototype completed today, but it looks like it will be tomorrow sometime. It is coming along. There is some pretty complicated maths and logic involved, but it is getting there. I'm trying to make it as flexible as possible, and that adds complications - it should be worth the effort though. This should result in individual plans - watch this space. ;)

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Hi everyone,

 

I've completed the first version of the new titration method and tables. We can now easily create tables for anyone using any titration method. It will work with any scale you use too - you do not have to use 100ml cylinders marked at 1ml intervals (though we still recommend them).

 

Here's and example. Be sure to scroll down for the actual table, not just the titration details outlines at the top.

 

http://www.benzobuddies.org/spreadsheets/titration-test-page-1.html

 

The 'Table Range' function is not yet implemented - it will allow for easy alterations if someone is part way through a tablet when beginning titration, or anticipate needing to adjust their taper rate at a later stage. This function will come later; few people need it anyway. I can always cobble together a get-around in the meantime.

 

The titrated dose is recalculated every day, and the dose will be the best possible fit according to the scale you use. The 'Absolute Cuts' indicate when the titration rate should no longer be calculated in relation to your actual dose on that day, but will be a regular cut (non-diminishing taper rate). This is important, otherwise you would never actually taper off completely, but rather just be taking less and less. The default will be for this to kick in at 1 tablet (of the smallest dose tablet available in your benzo), but can be adjusted if you use larger dose tablets, or are needing a very gentle taper schedule, for examples.

 

Unlike the old method, the same volume is created each day, and the amount to be consumed is indicated in the table. The date of each change in dose is also indicated.

 

I'll supply full details and explanations tomorrow. You will all have have your own tables. ;)

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Hi,

 

I've not managed to get back to this today. I know that I've mentioned the new titration method to a number of members: if you post your details here, I'll post a titration schedule for you.

 

I'll need:

 

A start date;

 

The number of tablets you take (the dose of the tablets and your total dose for a double check);

 

Your proposed taper rate (1% per day is probably about average, post your past experiences with cuts if you need some feedback from others);

 

The total volume your will be using (and units) and the scale (the marked increments);

 

Forget about the 'Table Range' for now - this feature is not yet implemented;

 

When your 'Absolute cuts' will start - @ 1 tablet is probably about right for most people, so log as you are using the smallest dose tablet available in your particular benzo.

 

 

Remember, this is new, so we will have to work through few issues around explanations etc. The biggest differences between this and the old method is that you can use any volume container and scale you like (according to what you have available or can obtain); you will always make up the same volume (this makes things less complicated); you will just consume less of the titrated liquid with progression of titration of each tablets; there are no calculations to make; and the table will provide you full details of how much and when.

 

You should also print off your table, and add comments with each cut. This will help if you need to make changes to your schedule.

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Hi Colin,

Can you help me with this new titration method?

Here 's the info, with a few questions for you along the way.

 

Start Date: Sept. 29, 2007;

 

The Number of tablets: 3 (.5mg each, total 1.5 a day);

 

Proposed taper rate: Not sure... I think 1% daily is too much for me. I was going to try 2.5 or 3% over 2 weeks;

 

Total Volume: You tell me, please. I have a 100 ml graduated cylinder with 1 ml divisions;

 

When your 'Absolute cuts' will start: Should it be at 1 tablet? I really don't understand this part. The smallest dose of klonopin is .125 mg but it is a wafer that should not be cut.

 

Colin, please keep in mind that I've been on this for 14 years, have tolerance w/d, so I want to go real easy and slow. I have a highly sensitive system.

 

I thank you so much for doing this for me and others. As I have said before, you are an angel...

 

Tanya

 

 

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Hi Tanya,

 

Your container is ideal.

 

We generally advise that people make cuts in relation to their present dose. So, if you start of at 40mg of Valium (the smallest tablet available is 2mg), and you decided upon cuts of about 10% every week, your first cut would be from 40mg to 36mg. After being at 36mg for a week, a 10% cut would work out as 3.6mg (awkward number) so you would probably just cut by 3mg to 33mg. The next cut of 3.3mg would round to 3mg, so you are now at 30mg. This would continue something like this: 27mg; 25mg; 22.5mg; 20mg; 18mg; 16.5mg; 15mg; 14mg; 13mg; 12mg; 11mg; 10mg; 9mg; 8.5mg; 8mg; 7.5mg; 7mg; 6.5mg; 6mg; 5.5mg; 5mg; 4.5mg; 4mg; 3.5mg; 3mg; 2.5mg; 2mg; 1.5mg; 1mg; 0.5mg; 0mg.

 

The cut from 10mg to 9mg is a 10% drop in dose, but from then on the cuts account for larger-and-larger percentages of the dose at the time. However, 0.5mg cuts are probably the smallest practical cuts that can be managed by pill-splitting, so that's the way it must be. Fortunately, at low doses, we do not not need to be making cuts in percentage terms (where the actual size of the cut diminishes with each new cut), but the amount cut can be constant; in this case 0.5mg from 9mg downwards. We are no longer making cuts in percentage terms, but rather making cuts in absolute terms - set reductions. Where we can start to comfortably make absolute cuts to our dose will vary with the individual though.

 

Because titration allows for much finer reductions in dose, we could carry on making cuts - in percentage terms - to much lower doses. It is good to have this option, but if taken too far, it unnecessarily extends the taper at lower doses, potentially by a very long way. For averagely quick to slightly slower tapers, I think that absolute cuts can start from about 1 tablet (so long as it is the smallest dose available in that particular benzo). If someone is following a very slow taper (such as you are proposing), then I suggest that they might start making absolute cuts at 0.5 tablets. I'll provide you with a table based upon this figure (half a tablet), and another table with absolute cuts starting at 1 tablet just for comparison. You will see that where the absolute cuts start makes a huge difference to the length of the taper at the lower end. If you really need a taper rate of 3% every 14 days, then I think you may well need the extra time. Remember though, you can review your taper schedule at any time; I especially recommend this when coming up to the end of titration of one tablet, as it makes the recalculations (if needed) easier for me to carry out. At some stage I will have formula that will do this automatically for you, no matter where you might be during your taper when you need a recalculation.

 

I'll post up your table on a new thread (on this board) in a few minutes.

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Hi there Colin

 

My start date is the 28th of September

 

Dose of tablets : 3x 5mg tablets a day = 15mg a day

 

Proposed Rate...I don't know, what i do know is that it has to be very a very slow taper.

 

I have the syringe marked in increments of .01,.02,.03 etc. The cylinder and can get whatever i need.

 

The "Absolute Cut" will start on the 28th of September with 1 x 5mg Valium pill, i take a generic and they don't come in a lower dosage that 5mg.

 

Thanks for all the effort, time, hard work and dedication into making a wrong into a right. I am sure all of us will use Tanya's words....you are an angel.

 

Peace

Dena

 

 

 

 

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Hi Dena,

 

You've stated the increments on the syringe, but I also need to know how much the syringe holds.

 

You've done very well with your recent enforced taper, halving of your dose in just a few weeks. I think it would be wise for you to allow yourself a little more time to make sure that you have fully adjusted to your present dose. Once you are ready, maybe a taper rate of 1% per day would be a good starting point. This is a pretty average taper rate. Given that you have done so well recently, I'm not at all convined you need to follow a particularly slow taper rate. What titration will offer, is the ability for you to make a very smooth withdrawal, even at an average taper rate.

 

I need to explain the 'absolute cuts' thing better. We always recommend that people make cuts is relation to their dose. A cut of 5mg from a dose of 50mg Valium might be reasonable, but a 5mg cut from a dose of 10mg of Valium is not reasonable. As our dose decreases, the taper rate should decrease. The new method does this automatically. The rate is recalculated every day, and the nearest suitable dose is displayed. However, at low doses, there is no point in the taper rate decreasing anymore, otherwise we would just be taperring more and more slowly, and never actually quit. So, at some point, the taper rate should just stay steady. It should be remembered that at 1 tablet per day, of any benzo (so long as it the smallest available dose, and the taper rate is not too quick), we will probably not need its taper rate to slow any further. If someone disaggrees with my rather arbitory '1 tablet' figure, it can be changed - this taper plan is designed to be as flexible as possible. However, you are using 5mg instead of 2mg tablets of Valium. This means that your absolute cuts should kick in at 0.4 of a tablet (that's 2mg of a 5mg tablet). The formula has a bug in it which I will fix soon. For now, I'll leave it at the default for absolute cuts to kick in at 1 tablet, simply because that will not break the formula. This makes no difference to your figures until you have tapered down to 1 tablet per day, so is of no immediate concern. I will have provided an updated table for you long before then.

 

Anyway, all I need to know is the size of the syringe, for you to confirm the taper rate (or for you to discuss it further), and for you to confirm the start date. If you are wooried about the 1% per day rate I suggested, the what about 10% over 14 days. Most people can manage that even if they are pill-splitting. The evidence suggests that an equivalent cut made of many smaller cuts is better toilerated than the single lager cut.

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