A complicated mess - need some answers/opinions

I tapered from Ativan this summer and have been an active board member until recently.  I was having trouble sleeping at the time of my taper but was getting enough to make do.  Over the last several months, though, my insomnia has developed into not being able to sleep on my own at all.  I want to get to my questions so won't go into all the details about what I've tried, etc. right now. Bottom line is that I had to start taking temazepam just to get a few hours and have been doing so for eight to ten weeks now.  At first I only took it every third day or so (after having been up for two or three days straight) but - the same old story - I have been taking 30mg a night now for about a month and have developed a tolerance as evidenced by reduced efficacy and some inter-dose s/x's in the late afternoon.

OK, so I thought maybe a switch to valium would be worth a shot because of its longer half life (reduce the inter-dose s/x's), because it is sedating and many report it as a better sleep aid than temazepam, and because I'm going to have to taper off some day and tapering from valium seemed easier than from the temazepam.  Unfortunately, for right now I still need a sleep aid so the taper will have to wait.  OK, now it gets messy so pay attention.

I contacted my doc (she answers email) and asked about a script for valium and explained the whole Ashton thing and sent her a copy of the manual.  Somewhat to my surprise she said "no problem" and called in a script.  Well, it turns out to be for 10mg which, according to Ashton, is only equal to 20mg of temazepam.  Remember I'm taking 30mg/night.  Also, I just got an email from her and she seems to have not grasped my explanation about a crossover because she said to just quit the temazepam and start taking 10mg of valium each night instead.  So ... I can perhaps clear things up with her when I see her in person later this month but for now I've used up my time and am not sure how to proceed with the valium.  I have enough to get started on the crossover but eventually I'd need 15mg/night to meet the equivalent of the 30mg of temazepam; remember the doc only gave me 10mg/night.  I thus have some questions:

1) Why does one have to make a gradual cross-over ?  Why not just do what my doc says and simply replace my benzo with valium ?  Since I have 10mg tablets I could cut some of them in half so that I could take the equivalent dose (i.e. 15mg of valium instead of 30 of temazepam).

2) If I make a crossover as per Ashton I'll be taking some of both benzos for a while.  However, if I can't get enough valium to completely switch over (which would be true if 10mg isn't sufficient to produce sleep) then I'd have to keep taking some of the temazepam to make up the shortage.  What would be the consequences of doing that ?  It seems to me that I'd still be better off since I would have replaced two thirds of the temazepam with a longer half-life drug.  Am I wrong ?

3) If I end up taking 2/3 valium and 1/3 temazepam for a while and eventually decide to start tapering, could I then just keep taking the 10mg valium and make my initial cuts from the temazepam portion ?  That would then eventually get me down to the 10mg of valium prescribed and I would then be completely crossed over.  Any reason this wouldn't be OK ?

Sorry this is so complicated but I want to try the valium, won't be able to renegotiate the dose right now, and want to make the best of the situation I find myself in regarding the meds I have available.

Thanks for your time and attention.  I haven't been posting lately because I'm a mental mess and most days I'm just can't handle it.  I do need answers to my questions, though, so I'll make myself check in to see what wisdom you have to offer.

John

John,

I'm so sorry you are having some difficulty right now.  I feel your pain, since your story about the 30mg Temazepam and tolerance was the same as my own.

My doc switched me to Librium from Temazepam directly with no crossover plan.  I don't think he even knows what a crossover plan is.

I didn't have this site at the time, or any benzo knowledge, but I didn't have a crossover problem. 

Later I switched directly to Diazepam from the Librium.  Don't get me wrong, all this time, I'm having typical w/d symptoms, but

I never felt like it was due to the crossover.  Obviously every person is different, and Ashton tries to account for that, but sometimes a little knowledge is just enough to make you more afraid.  You are doing the right thing, asking good questions, and coming to the place where many folks have

been thru this ordeal.  We will do it together and hopefully get it right.

I'm not experienced enough here to be able to answer all your good questions, but I want you to know that someone is listening and is there for you.

I'm sure that you will get some better answers from more experienced people at BB, but I am hoping that my information may be of some comfort to you.

-David

David, thanks for your quick reply and words of encouragement and support.  This forum is so good that way.  Boy, sounds like you got some bad advice.  Looking at your dosages, it seems that you were subjected to pretty extreme cuts several times:  30 to 15mg temazepam, then only 3mg of diazepam.  No wonder you're having symptoms !  I am curious about your nausea.  Do you think its from the valium or do you think its just part of withdrawing in general ?  I'm a little anxious about the valium thing because many have reported nausea and depression and I don't need either of those.

Good luck to you on your journey.

John

I tapered from Ativan this summer and have been an active board member until recently.  I was having trouble sleeping at the time of my taper but was getting enough to make do.  Over the last several months, though, my insomnia has developed into not being able to sleep on my own at all.  I want to get to my questions so won't go into all the details about what I've tried, etc. right now. Bottom line is that I had to start taking temazepam just to get a few hours and have been doing so for eight to ten weeks now.  At first I only took it every third day or so (after having been up for two or three days straight) but - the same old story - I have been taking 30mg a night now for about a month and have developed a tolerance as evidenced by reduced efficacy and some inter-dose s/x's in the late afternoon.

 

OK, so I thought maybe a switch to valium would be worth a shot because of its longer half life (reduce the inter-dose s/x's), because it is sedating and many report it as a better sleep aid than temazepam, and because I'm going to have to taper off some day and tapering from valium seemed easier than from the temazepam.  Unfortunately, for right now I still need a sleep aid so the taper will have to wait.  OK, now it gets messy so pay attention.

 

I contacted my doc (she answers email) and asked about a script for valium and explained the whole Ashton thing and sent her a copy of the manual.  Somewhat to my surprise she said "no problem" and called in a script.  Well, it turns out to be for 10mg which, according to Ashton, is only equal to 20mg of temazepam.  Remember I'm taking 30mg/night.  Also, I just got an email from her and she seems to have not grasped my explanation about a crossover because she said to just quit the temazepam and start taking 10mg of valium each night instead.  So ... I can perhaps clear things up with her when I see her in person later this month but for now I've used up my time and am not sure how to proceed with the valium.  I have enough to get started on the crossover but eventually I'd need 15mg/night to meet the equivalent of the 30mg of temazepam; remember the doc only gave me 10mg/night.  I thus have some questions:

 

 

1) Why does one have to make a gradual cross-over ?  Why not just do what my doc says and simply replace my benzo with valium ?  Since I have 10mg tablets I could cut some of them in half so that I could take the equivalent dose (i.e. 15mg of valium instead of 30 of temazepam).

 

2) If I make a crossover as per Ashton I'll be taking some of both benzos for a while.  However, if I can't get enough valium to completely switch over (which would be true if 10mg isn't sufficient to produce sleep) then I'd have to keep taking some of the temazepam to make up the shortage.  What would be the consequences of doing that ?  It seems to me that I'd still be better off since I would have replaced two thirds of the temazepam with a longer half-life drug.  Am I wrong ?

 

3) If I end up taking 2/3 valium and 1/3 temazepam for a while and eventually decide to start tapering, could I then just keep taking the 10mg valium and make my initial cuts from the temazepam portion ?  That would then eventually get me down to the 10mg of valium prescribed and I would then be completely crossed over.  Any reason this wouldn't be OK ?

 

Sorry this is so complicated but I want to try the valium, won't be able to renegotiate the dose right now, and want to make the best of the situation I find myself in regarding the meds I have available.

 

Thanks for your time and attention.  I haven't been posting lately because I'm a mental mess and most days I'm just can't handle it.  I do need answers to my questions, though, so I'll make myself check in to see what wisdom you have to offer.

 

John

 

Hey, John.

I surely don't have all the answers and am a little foggy tonight so I'll just pipe in with what came to mind about some of your questions.

About why do a slow crossover/substitution when switching from temazepam to diazepam, that would be because of the short half-life of the temp vs the long half-life of the diaz., I think.  As you stop taking the temp. and replacing a dose with diazepam, it takes a while for the diazepam to build up to full strength.  I believe Prof. Ashton  basically had her patients substitute something like a dose each week until the person was on all diazepam and then they started to taper.  I don't think there's anything "magic" about a about week, though.  Along those same lines, the Ashton equivalencies are just guidelines as well.  From what I understand, everyone metabolizes the different benzos differently so saying that 20mg temp. = 10 mg diazepam must be some kind of average.  I remember reading posts from members who did tried to cross over or subtitute the amount shown in the Ashton manual for their benzo and become overly-sedated. 

My doctor wouldn't cross me over to valium and believed I could taper .5mg every few days for a few weeks and be done.  She did agree to keep prescribing the lorazepam, though, so I ended up coming up with my own taper schedule which is abbreviated in my signature line.  I guess what I'm trying to say is you just have to do the best you can with what the doctor agrees to or keep trying to change her mind.

Good luck. 

remember, ashton almost never takes a cut more than 10% , often less.  she gives 1 to 2 weeks as a guideline at each step, and says may need to stabilize longer ("go sideways" which i've done, like 3 weeks.)  remember, too, that Ashton's equivalencies are double several other sources (see home page - top - withdrawal methods - substitution - equivalency table) .  so far, i have gone from 2.5 mg /day xanax to 12.5 mg/day valium, with tolerable symptoms and a muuuch more stable level, due to valiums much longer half life.  i am subbing and tapering xanax to valium.  due to similar doc problem, i slowly tapered as i subbed.

good luck.

Hi David

Just read your post and I'm sorry you're having a rough time of it.

Unfortunately the cross over to diazepam (valium) isn't always easy.  Don't want to go against what your dr says, but if you read further on the Ashton site you will find that it can sometimes be difficult to get the equivalent dose correct.  So if you do the crossover there could be a period of adjustment. 

Also just a suggestion - try not to link taking your benzos to allowing you to sleep.  I know they are sedatives, but if you think you can't sleep without taking a benzo, you probably won't sleep.  Unfortunately insomnia or broken sleep is part of withdrawal, it seems to be one of the most common s/x.  Try looking at your thought patterns and maybe looking at relaxation techniques or some other routine at nightime to help get you to sleep.

Hi John,

I'm far from an expert on substitution plans but I can tell you a couple things about my own experience of crossing from xanax to valium.

1) When I crossed I was taking 1mg of Xanax (.25 4 times/day).  My doctor prescribed 15mg of Valium and initially I did an immediate substitution.  The first night I didn't sleep at all, so I went back to the Ashton manually and realized that I was supposed to gradually switch each dose.  Once I did that I didn't have much trouble crossing.

2) When I finished crossing to 15mg of Valium I found it too sedating and quickly dropped to 10mg.  So for me the equivalency was closer to 1mg Xanax = 10mg Valium.

Your #3 question is basically what I did.  I substituted .25 xanax for 5mg of Valium and when I got to the last dose I just dropped the Xanax and then like I said quickly dropped one of the Valium doses so that I was down to 10 mg V.  Of course, this was my experience and your milleage may vary.

Since crossing to Valium I've experienced moderate depression that I didn't have using Xanax, but may have eventually developed anyway - who knows with benzos (btw, I never had depression pre-benzo use).  And in the past month I've been experience headaches and nausea, which in the last few days seem to be subsiding.  I started taking fish oil about a week ago, so maybe that's helping.  I'm currently at 1.75 mg of Valium and it seems like I'm feeling a bit better as I get lower, so I'm hoping this trend continues.

Anyway, I hope this helps and that you find an answer that works for you.

Take care,

RV

John,

I just reviewed the Ashton materials on crossover, and since it is so detailed, I have to think there must be a good reason why.

It's bound to be a good plan if you can get the meds in place.  Obviously everyone doesn't have them, or can't get them, or don't have the knowledge

of such good advice about crossovers. 

If you cannot get the meds, then the modified crossover plan you mentioned might be appropriate as a substitute. 

It's all about trying to be as "well" as possible, and avoid as many serious s/x's as possible.

I wish I could answer your questions accurately about the effects Diazepam has on me compared to other meds. 

Nausea was never a problem for me with any other med.  But having said that, I didn't have a problem with nausea when I first started on

Diazpm either, but at 1.5mg, it showed up, and I had to reinstate to 2mg.

I know that I can't seem to handle Diazpm in any liquid format.

I do have some depression, but it is only related to days that I feel bad s/x's, and it's not just general depression. 

I  get depressed like anyone else about feeling sick, and I remember being depressed about that even on the other meds.

All my experience with other meds was at higher doses, so I don't think it's too relevant to be able to compare very well.

With all info on why Diazpm is preferred, I don't really want to change over to something else, unless someone comes up

with something better, or I come to the point where it's completely intolerable. 

I am still hoping that you will get some better advice about your crossover questions, and that whatever decision

you make will be the right one.

Everyone at BB cares about you, and feels your pain, and wants you back on the road to healing.

-David