New and Improved Wet/Dry Taper

When I tried to post improvements (well, OK, changes) to my taper I got a big red flag that said [roughtly], "nobody's posted here in 120 days - start a new thread, Buddie". So, New and Improved. The changes are at the top, the dosing examples in the table and the new pill cutting addition. I've also added a very brief synopsis of the central method ideas. I copied the main taper method from the old thread ("End of Taper") , which was last revised in October of 2013 into the post, so the old thread can be deleted.

New and Improved!!

I have noticed that my 0.5 mg Ativan tabs cut in half very nicely, such that 1 out of 2 tries will give me halves within +/- 5%. They fit right “into the pocket” of the cheap plastic pill cutter that Kaiser gives out. I’m going to take advantage of this in the following way.

My dose is 4.00 mg/day. That’s 8 0.5 mg tabs or 16 0.25 mg half tablets. If I take 3 half tabs at each of my 4 daily dosings, I only have to make up for the missing half tab with the diminishing amount of make up solution. The make up solution “makes up” for the missing solid amount at each dose. It contains less Ativan each day; that’s how the cut is done. The advantage of only having to make up for half a tab, as opposed to the full tab I used to do, is that I only have to prepare and drink half as much alcoholic solution (tincture, if you will) of Ativan. I can use more dilute solutions, which are easier to handle and more accurately measured when you get down to small volumes. And I’m not that crazy about alcohol. 2.5 mL 4Xday is about half a standard drink.

Here’s what it might look like, starting from 3.975 mg/day (the closest cut to 4.000): [note: 3 X 1/2 = 3/2]

8:00am            2:00pm 8:00am        2:00pm          2:00am or hs

3 X ½ + 2.49 mL      3/2 + 2.50 mL 3/2 + 2.50mL      3/2 + 2.50mL 

3 X ½ + 2.48 mL      3 X ½ + 2.48 mL    3/2 + 2.48mL  3/2 + 2.48mL

3 X ½ + 2.46 mL      3 X ½ + 2.46 mL 3 X ½ + 2.46mL  3/2 +2.46mL

3 X ½ + 2.45 mL       (You can fill in the blanks from here)

3 X ½ + 2.44 mL

I did the best I could with the table. Hard getting good alignment after the post!

hs = hora somni = hour of sleep = bedtime. The idea is that you don’t set an alarm for your 2:00am dose. If something wakes you up, have it ready by the bedside, take it, and go back to sleep. Otherwise, take it when you wake up, don’t compromise your sleep. Or stay up ‘till 2, or change the times to suit you, as long as they’re every 6 hours apart.

The volumes in the table (2.492 mL, etc.) are given for a 0.1 mg/mL solution of Ativan in 75% ethanol. Dissolving 2 mg of Ativan in 20 mL ethanol gives a solution of this concentration. Round off the volumes and measure to the nearest 0.01 mL with a pipette or syringe. The cut rate is 0.009375 mg/day, what I would call moderate. I plan to increase it and see what happens, since I’m stable and minimally symptomatic (tip o’ the hat to Bart).

The only thing that changes from day to day is the volume of make up solution (prepare about 4 days worth in advance, refrigerate); it decreases by the amount of your cut. All the preparation details are given in the full method, which is linked at the bottom of my signature line, which will take you right here:

A Wet/Dry Taper (condensed version)                            [October, 2013]

Intro:

In revising my current taper method I was struck by how it might have particular interest for friends who are getting near the end of their taper and can no longer measure doses accurately by dry cutting. Although I’ve been using this method since near the beginning of my taper, I started it because even with my jeweler’s balance I couldn’t get the accuracy I wanted for daily reductions with dry cutting alone. I realized that by measuring a very small amount of the dose in liquid form, I could continue the taper all the way to zero by micro-controlling the cut. I would not have to jump at all! From what I can gather, it’s precisely at the end of the taper that measurement becomes critical and a small dosage change can have an unexpectedly large effect. After getting an “I never said that” from a certified addictionologist who had promised me a Rx for liquid Ativan 3 weeks earlier, I decided that 30 years of bench chemistry shouldn’t go to waste and I’d just make my own Ativan solution.

This method allows anyone (except for Klonopin users) to accurately measure as small a dose of benzo as they’d care to. (Unlike other benzos, Klonopin isn’t soluble in alcohol, but necessity is the grandmother of invention. Plenty of people are tapering from Klonopin successfully.) I'd like to add that this method was designed for people who are or want to be tapering with very small and frequent reductions and people who need to take a smaller dose than they can weigh accurately. The problems I and others face do not imply that dry cutting is a dead end or badly flawed. Obviously, many people use it successfully. I see it more as a question of choice. "Wet cutting" can provide an alternative.

The Method

The basic idea of this taper is to take most of the daily dose as uncut pills and use a small, carefully measured amount of lorazepam in solution to make the reduction in your daily dose. One 0.5 mg tablet is omitted from the daily dose and replaced by the equivalent amount of lorazepam in solution minus the daily cut.  This liquid (the ‘makeup solution’) is taken over the course of the day. To reiterate, the makeup solution is what you take in addition to your pills to bring your daily dose up to a little less than it was yesterday. The makeup solution, divided into multiple doses, can be taken at whatever times of the day work best for you. I started out taking them along with my solid doses, then discovered that I could get a smoother serum level (fewer inter-dose symptoms) if I spread the doses out more.

Here is a step-by-step description of the four calculations required to do this taper. They are also the four columns of the spreadsheet I use to automate the math.

1. Today’s dose in mg. This is yesterday’s dose minus the daily cut amount. I’m currently cutting by 0.0125 mg/day. Yesterday’s dose was 4.80 mg, so today’s is 4.80 – 0.0125 = 4.7875 mg.

2. Today’s make up amount in mg. This is the difference between what you’ll take in solid form and in liquid form (the “makeup solution”). 4.8 mg/day of lorazepam is nine 0.5 mg tablets [= 4.5 mg] + 0.3 mg additional. Today’s dose (from #1) is 4.7875 mg. So, 4.5 mg is taken as solid tablets and the liquid portion (make up dose) is 4.7875 mg (total) – 4.5 mg (solid) = 0.288 mg (in solution). This is the daily make up amount, how much you need to take in solution  in addition to the tablets to bring your daily dose up to the full amount.

3. Today’s makeup solution volume in mL. We have it in mg [from #2], we need it in mL. This (the volume of the makeup solution) depends on its concentration—how many mg are in each mL. This concentration is a number that you decide on, based on things like what volumes you can measure accurately with the equipment you have. For now, let’s say the concentration is going to be 0.066 mg/mL. To get the volume in mL, you just divide the make up amount in mg from #2 by the concentration you chose in mg/mL. 0.288 mg / 0.066 mg/mL = 4.363 mL. This is the total daily makeup solution amount.

4. Today’s individual doses. Divide the total makeup volume from #3 by your number of doses per day. I dose 3X per day, so 4.363 mL / 3 = 1.454 mL. This is the volume of one individual dose of makeup solution, to be taken during that day. It is what I remove from the bottle in the refrigerator with the pipette (or syringe), dilute in apple juice, and swallow. I take the liquid make up doses when they seem like they’ll do the most good, as opposed to the much larger solid doses which are taken on a fixed schedule..

Let’s look at the calculations in a tabular form, like a spread sheet:

    column A              column B                column C              column D

(4.80-0.0125)      (4.788 – 4.50)        (0.288 / 0.066)          (4.363 / 3)                                   

    4.788 mg            0.288 mg                4.363 mg                1.454 mL

You cut your dose by simply measuring a little less make up solution each day. Your total daily dose = the # of tablets + the volume of makeup solution. The # of tablets stays the same for a while, the volume of makeup solution changes a little bit every day. The whole point is that you can measure lorazepam much more accurately in solution than you can with any dry technique. I have not done it, but I believe this method could easily be adapted for cutting less often than once/day.

Solubility:

Alcohol’s concentration in water is expressed as either proof or %. The proof number equals twice the %, so 80 proof whisky is 40% alcohol. I’ll use the proof number. Lorazepam is soluble in ethyl alcohol, with maximum solubility at about 160 proof and reduced solubility at higher and lower concentrations. Don’t go below 120 proof. I use 151 proof Everclear, which is purely alcohol and water. 151 proof rum would probably work in a pinch, but I would prefer not to have smelly, unknown compounds in my solvent, if possible. Vodka would be a better substitute, if you can find it at 140 proof. Anyway, 1 mL of 151 proof alcohol will dissolve 18 mg of lorazepam—Jordan Journal of Pharmaceutical Sciences, Volume 5, No. 2, 2012. That’s plenty soluble! Propylene glycol is also used commercially to prepare oral Ativan solutions, for those who cannot tolerate alcohol. Bear in mind that a typical dose of alcohol in this method is 2 mL, equal to 1/10 of a standard drink.

Solution preparation and use:

I’m pretty picky as to equipment, but you don’t have to be...use what you have, be creative. With some exceptions, it can all be found in your kitchen. I’ll use my own taper figures for the example. Carefully measure 15 mL of 151 proof alcohol into a 25 mL clean brown glass bottle. This bottle should have a sturdy, airtight cap with (ideally) a silicon or Teflon sealing ring. Check this ring now and then for cracks or deterioration. Place two 0.5 mg lorazepam tablets in the bottle, close tightly and shake gently for 30 sec. Let stand at room temp. with occasional shaking for 5 min. Open the bottle and crush the tablets gently with the round end of a glass stirring rod. Stir and crush some more. Shake and examine to see that all the pills are now powder. Keep at room temperature for 1 hour with occasional shaking (this is important), then refrigerate. Solution concentration in this example is 2 X 0.5 mg / 15 mL = 0.0667 mg/mL.

So, now that you’ve gone through all this work to get the correctly calculated, accurately measured makeup dose, what do you do with it? I take it out of the ‘fridge, warm the bottle in my hands for a couple of minutes with shaking, and draw the solution into the pipette immediately. I adjust the liquid in the pipette to the correct level, remove my finger (or squeeze the red rubber bulb of the ‘pipette friend’), the solution flows into a glass containing about 20 mL of water or apple juice, and down the hatch.

Storage: I prepare enough make up solution to last 3-4 days, kept in the refrigerator. Once in solution, it’s not that stable. Keep all lorazepam solutions at 40 deg. F. Do not freeze. Protect from light by wrapping in foil. I discard solutions after 3-4 days, although that may be a bit conservative. Remember, it’s in a 75% alcohol solution at 40 deg F. in the dark for good reasons. Lorazepam, like most drugs, is much less stable in solution than as a dry solid. Water decomposes it. Heat and light accelerate this process. Once you put it into dilute water solution at room temperature for drinking, use within ½ hour max. If you have to transport it, do not dilute until time of use and pack it in an ice chest.

It seems to me that right about here is where I may have lost those hardy souls who persevered through all the math. Into a bunch of ‘stuff’ about measuring. Let’s simplify that by kicking it right to the curb (the “Notes” section): anyone who’s actually going to be using Mohr pipettes doesn’t need me to tell them how or why.

The real question is how much accuracy do you need? A common figure I see for the plastic syringes most people use is +/- 5%. I have no basis for an opinion as to whether that’s ‘good enough’ or not. Anecdotal evidence would suggest that it is good enough for many. My intuitive take is that +/- 5% probably is OK, if your physical technique is solid and you keep good records (you do keep records, right?). Near the end of the taper, when you’re measuring much smaller amounts, +/- 5% might not do it.

**************************************************************

Opinions and loose thoughts:

Measuring:

People use a variety of liquids in tapering, generally in order to put solid drugs into solution for accurate measuring. Water and milk are the probably the most common. Lorazepam is not soluble in water, and I do not know if it is soluble in milk. I would guess that the fat globules in milk help to keep the lorazepam particles in suspension. I prefer to work with solutions, as I am familiar with their properties but know very little about handling suspensions. The main difference is that solutions are homogenous by their nature, while suspensions are not, though they can be made so. In a homogeneous solution, every mL contains the same amount of drug as every other mL. This is a prerequisite for accurate measurement.

I recommend buying good quality lab glassware, if you’ll be using it for a few months. You can use a plastic syringe and it’ll work for a while. Or you could spend ~$50 and get pipettes and so on from Amazon. Learn how to use them from a book or the net. I think there are decent videos on You Tube. Disposable syringes aren’t well made and may soon become unreliable. However, not everyone can afford $50. So, many people use ½ cc syringes (diabetes syringes, not the TB) which are also marked in 100ths of a mL for small volumes. They read better than the 1mL TB syringes, which also do work, and they’re cheap. Clean off the lubricant on the plunger and barrel with alcohol or soap and water before you use it for the first time. Rinse off the soap very thoroughly. Soap films can stay on your equipment forever, which is why I prefer alcohol. Lab equipment is one area where you won’t save money by purchasing the cheap stuff

In measuring your daily makeup doses, it really doesn’t matter if you foul one up. Think about it. Your cut is ~15 micrograms. If you took 50% more, would you even notice it? If you took 100% less, you just had a hold day and will be back to work tomorrow. An error would likely have to be in the same direction for several days running to make any noticeable difference. What matters isn’t how accurate a single measurement is, it’s more in using the same technique, the same equipment, and the same “head” every day. OTOH, the makeup solution itself needs to be measured very carefully indeed, as any mistake here will propagate into all doses from that batch. That’s why I use a volumetric flask—they only measure one amount, but they measure it real accurately.

I chose my starting cut rate by converting a Valium rate from someone whose taper started well and had a similar drug history to mine. I’d also heard that ~0.3%/day was a reasonable starting point. 0.3% of 6 mg/day = 0.018 mg/d, which turned out to be a little fast for me. A week’s hold and restart at 0.0125 seemed much better. One refinement, which I have found unnecessary so far, would be to use less than the smallest tab for the makeup solution by cutting a tab and weighing the fragment with a jeweler’s balance.

The cited paper examines lorazepam’s solubility in alcohol, propylene glycol (PG) and various surfactants. PG is used commercially to prepare pharmaceutical solutions for oral use, as is alcohol. PG could probably be used in place of alcohol here, with some method modifications. I prefer to use alcohol.

A book worth knowing: Handbook of Solubility Data for Pharmaceuticals

            Abolghasem Jouyban, CRC Press 2009

            Print ISBN: 978-1-4398-0485-8

« Last Edit: October 04, 2013, 04:19:54 am by aweigh »

hi aweigh. im using vodka to dissolve valium tablets and then add water for my daily micro taper. i am using vodka which happens to be only 50 proof. you said above that there is maximum solubility at 160 proof and do not go lower than 120 proof. does this mean my valium does not fully dissolve in the 50 proof vodka?

thanks,

SF

Siggy:

That data is for lorazepam, not diazepam. However, diazepam is quite soluble in alcohol, so you're probably OK. If you add water after dissolving the tabs, the Valium will come out of solution, which is OK as long as you're going to drink it, not measure it.

My guess is that 100 proof vodka will probably dissolve Valium tabs, but 151 proof Everclear is available in all 50 states (try BevMo). I use that. Order it online if you live far from a large liquor outlet.

Aweigh

 

If you add water after dissolving the tabs, the Valium will come out of solution, which is OK as long as you're going to drink it, not measure it.

 

you mean its okay to do a daily titration using vodka-water solution? what method are you using right now for your daily taper?

SF:

No, I didn't mean that. It would depend a lot on the proof of the vodka, and I've never used vodka so I can't speak about it. I use the method that's linked at the end of my sig line and posted right here, which I've adapted/created from a number of sources and which most people find unnecessarily complicated.

Aweigh

Hi,

I’ve broken my wrist. Big hurts, no typing for a while. At least I don’t have to take bd for the pain.

I love all of you,,,

Aweigh

hi aweigh. im using vodka to dissolve valium tablets and then add water for my daily micro taper. i am using vodka which happens to be only 50 proof. you said above that there is maximum solubility at 160 proof and do not go lower than 120 proof. does this mean my valium does not fully dissolve in the 50 proof vodka?

 

thanks,

SF

1 ml of alcohol will dissolve 41 mg of valium.  So if your using a 50 proof liquor (25% alcohol), 1 ml of that would dissolve 41mg x .25 = 10.25 mg valium.