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What if YOU build yourself your own taper plan?


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Hi,

 

When I went though the posts in this forum, I realized that many asked for a taper plan. As I have been through this step in the past, I wonder if there is a simple way for the patients, who chose to go Liquid Taper, to prepare by themselves their own taper plan with just basic multiplication/division skill.

 

The method I'm going to expose here is (reduction) percent-driven. For instance you decide as first tentative for a reduction of 10% every 14 days. With that decision, you will find here your daily dose. After 1, 2 weeks following unbearable withdrawal symptoms, you decide to switch to 6% every 14 days. Again you will find here the new dose. This new reduction finally gives good result and you decide to stick to it until the end of the taper exercise. Why percent-driven? Because I understand our organism feels more comfortable when the cut is in terms of fixed percent reduction from the previous dose rather than with a fixed amount to reduce.

 

I will abstain from discussing in this post the solvents to use nor the solution concentration (E.g: 0.1 mg/ml or 0.01 mg/ml). Many posts in here already addressed these points and replied by highly knowledgeable buddies from whom I've learnt a lot.

 

So here the first questions to yourself:

- What are your current daily doses?

- How fast do you think to taper? (Recommendations: Reduce the daily dose by somewhere between 5% and 10% every 10-14 days)

- How many mg are your tablets?

 

                                      Reduction (%)

            5         6         7         8         9         10

        10 0.9950 0.9940 0.9930 0.9920 0.9910 0.9900

        11 0.9955 0.9945 0.9936 0.9927 0.9918 0.9909

Days 12 0.9958 0.9950 0.9942 0.9933 0.9925 0.9917

        13 0.9962 0.9954 0.9946 0.9938 0.9931 0.9923

        14 0.9964 0.9957 0.9950 0.9943 0.9936 0.9929

 

                    Fig.1 Taper ratio

 

(Using formula (100-Reduction Percent/Days)/100)

 

From the combination of your desired reduction percent and days, get the daily taper ratio from table (Fig.1).

To get the today dose (mg), multiply the dose of yesterday (mg) to your taper ratio.

To get the today volume to draw up (ml), divide the dose in mg by the solution concentration (E.g: 0.01 mg/ml)

 

Example:

- Klonopin 1mg/day

- Reduction 10% every 14 days

- Solution concentration: 0.01 mg/ml (1 mg tablet dissolved in 100 ml liquid)

 

Based on the reference table, the daily taper ratio will be 0.9929.

 

In mg

Day 0: 1.000  mg

Day 1: 0.9929 mg (=1.0000 mg * 0.9929)

Day 2: 0.9858 mg (=0.9929 mg * 0.9929)

Day 3: 0.9787 mg (=0.9858 mg * 0.9929)

...

(You can combine tablets with solution. E.g: Day 2: 0.5 mg tablet + 0.4858 mg)

 

In ml

Day 0: 100  ml

Day 1: 99.29 ml (=0.9929 mg/0.01) ; 0.01 is the solution concentration in mg/ml.

Day 2: 98.58 ml (=0.9858 mg/0.01)

Day 3: 97.87 ml (=0.9787 mg/0.01)

...

(When combine tablets with solution. E.g: Day 2: 0.5 mg tablet + 48.58 ml)

 

After 13 days when the daily dose was at 0.9110 mg, you find that you need to lower the reduction pace to 6% every 14 days. Based on the same reference table, the daily taper ratio will be now 0.9957.

 

In mg

Day 13: 0.9110 mg

Day 14: 0.9071 mg (=0.9110 mg * 0.9957)

Day 15: 0.9032 mg (=0.9071 mg * 0.9957)

Day 16: 0.8994 mg (=0.9032 mg * 0.9957)

...

 

In ml

Day 13: 91.10 ml

Day 14: 90.71 ml (=0.9071 mg/0.01)

Day 15: 90.32 ml (=0.9032 mg/0.01)

Day 16: 89.94 ml (=0.8994 mg/0.01)

...

(Same rules apply to combine tablets with solution.)

 

This calculation requires you to keep track of the dose you took the day before. If you do not use a spreadsheet to prepare the complete taper plan then use an agenda or notepad to write down the daily progress. Should you forget one or two days, it will not be the end of the world as the difference between doses is not high. In this case, resume from your last known dose.

 

Hope it helps.

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Its all greek to me and I am completely lost by your post.  I keep things simple.  I just withdraw a small amount daily building on that amount until I reach the 100 mls of solution and I am done.  No math....no confusion.  I guess I am just a simple person but whatever works for each person is the way they should do their taper.  Oh and by the way.... my taper is about 10 percent monthly and congrats on your successful taper!  You give me encouragement and hope!!  :thumbsup::smitten:
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Hi RaquelRocks :hug:

 

"Why make things simple when one can make them complicated?" :laugh: . I happened to listen to that statement several times in my working years and now I have the chance to use it again. By trying to be simple, I made things worse!

 

Let me plant a seed of doubt in your mind with your reduction dose of 10 percent monthly. This 10% certainly refers to an initial dose of 2mg of benzo for instance (this is only an example!). So every day that passes you drop a fixed amount of 0.007mg (0.2 mg/30 days). But guess what? When by reducing months after months you arrive to your daily dose of 1mg then 0.007mg is no longer 10%/month! It's actually 20%/month and will be 40%/month when you are at 0.5mg/day!

 

One thing is to feel comfortable (psychological?) with the taper dose, another is how actually our body physically reacts when increasingly the dose changes from 10% to 40% or more.

 

If I spread more confusion in your mind, then I apologize. Just ignore my reply in that case.

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Hi RaquelRocks :hug:

 

"Why make things simple when one can make them complicated?" :laugh: .

 

Here's the cliffnotes version of How to Build Your Own Taper Plan:

 

Choose a taper rate/time frame.  Ex:  10% per 14 days

 

Multiply the rate X your dose.  Ex: 10mg X 10% = 1mg

 

Divide by the time.  Ex: 1mg/14 days = .07mg daily reduction

 

Subtract .07mg from your dose each day.

 

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Hi Builder,

 

Subtract .07mg from your dose each day

 

In the calculation I tried to expose there is no such thing as fixed amount to subtract from the dose each day ;) . The only element that is fixed in this calculation is the reduction rate (Ex: 10% per 14 days) to apply to the daily dose. As the daily dose decreases day after day, the reduction that is proportional to the daily dose decreases too.

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Hi Builder,

 

Subtract .07mg from your dose each day

 

In the calculation I tried to expose there is no such thing as fixed amount to subtract from the dose each day ;) . The only element that is fixed in this calculation is the reduction rate (Ex: 10% per 14 days) to apply to the daily dose. As the daily dose decreases day after day, the reduction that is proportional to the daily dose decreases too.

 

When doing a daily taper, the "fixed" reduction concept works just fine.  A daily taper, like any taper, does need to be symptom based.  And with a daily taper, any sxs will emerge gradually, and you can respond with a change in taper rate when needed.  So in short, a fixed cut rate works, until it doesn't.  Then you change it.

 

And as a practical matter, everybody can grasp

Subtract .07mg from your dose each day
, but only a tiny percentage of folks on BB will grasp your lengthy essay.  Most of the folks that I help start the  conversation with "...I can't do the math".  So the guiding principle really needs to be KISS.

 

Don't misunderstand.  I'm actually very  impressed by your detailed presentation, and kudos to you for the time and effort. And from a theoretical point of view, a constant % reduction would be the ideal, but it definitely is NOT required.  And so it seems to me the simplest, most straight forward approach is one that will work for most folk.  (Plus, a constant percentage taper goes to infinity, it never reaches zero.  :) )

 

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Hi Builder,

 

Thanks for your remarks. I enjoy having someone to discuss about things not many people find interesting enough to spend time for :D

 

When I first started to prepare my liquid taper plan time ago in a spreadsheet, I was intrigued to find discrepancy between my daily doses and the ones in the global view per blocks of 14 days. I realised that after 14 days or 28 days my daily dose differs from the same one in the global view after 1 or 2 periods of 14 days. Not very much but they are not the same as they are supposed to be. Then I found out why.

 

While in the daily calculation the reduction daily decreases because of the decreasing daily dose, in the global view a same and unchanged reduction is applied to each single day of the block of 14 days. When I fixed the error I saw that my so longed Jump Day has been pushed to about 3 periods of 14 days later. I concluded that there are real impacts on patients should we use one method or another.

 

With the fixed reduction, easy for most people to understand and adopt the taper is faster at the cost of potential arising rough withdrawal symptoms. To address them you will certainly have to adapt the reduction one or more times during the entire taper process.

 

With a fixed reduction percentage, the taper is absolutely a nightmare (for me!) to explain and for others to understand, let alone to adopt! The good point is that when a taper ratio is found with acceptable withdrawal symptoms then the same can be used all along the taper exercise, be it months or years. And very likely with same acceptable withdrawal symptoms.

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Hi!

 

To give a graphic example in support of my position: A corn bag transported on a man's back! :laugh:

 

A 150-pound corn bag is transported by a 20 year old worker on his back.

 

With fixed reduction dose, the 150-pound is the weight the worker put on his back when he is 20. When he is 40 it is still 150-pound. When he is 70 the same 150-pound bag carried on his back crashes the old man to the ground. At that time based on his broken teeth, they start to give him 80-pound bags to carry.

 

With fixed reduction percent: At 20 the young man carries 150-pound bag. At 40, the bag for him to carry is 120-pound. At 70 the bag to carry is 80-pound.

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When I was a little girl my father asked me the the question of what was the heavier,  "a ton of lead or a ton of feathers?"  I'm still trying to work it out.    :)

 

Dee  :smitten:

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When I was a little girl my father asked me the the question of what was the heavier,  "a ton of lead or a ton of feathers?"  I'm still trying to work it out.    :)

 

Dee  :smitten:

They both weigh the same, a ton is a ton regardless of what the material is :)

 

Love Nova xxx  :smitten: :smitten: :smitten:

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I built my liquid micro-taper plan on a reduction of 10% every 30 days. Therefore my first month’s cut was 1/10. At the beginning of the second 30 days I decided to continue the fixed dose reduction so the I was reducing 1/9. I carried  this into the third period reducing 1/8 or equivalently 12.5% which still within the 5-10% every 10-14 days. I am now in my 4th 30 day period reducing 1/7. Every 30 days I decide whether to to reset the original 10% reduction. So far the sxs vary day to day from fine to nasty (same as during my long hold before beginning the micro-taper). Also, while the percentage of the prior day’s dose is increasing, the mg reduction as a percentage of the fluid in my synapses and blood is steady. The percentage cuts are under my control. My taper is driven by symptoms and calculated using math rather than driven by math. Each person must be comfortable with their taper plan. I am glad you are comfortable with your plan. If I continue the fixed dose reduction I will be cutting 1/6 or 16 2/3% (still in the recommended BB range) in the next period. At the end of that period I will have reduced my original dose at the beginning of my micro-taper by 50%. If I continue to taper (instead of jumping; see signature) I may decide to reduce the fixed cut back to 10%. I will decide what to do based on how I am feeling.
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Hi peter2017 :smitten:

 

During my multiple simulations with spreadsheets, I found that the difference in doses between the fixed reduction method and the fixed percent method, insignificant at the beginning, tends to further deepen when the initial dose dropped to half or a quarter. So if there is a risk to feel withdrawal symptoms with no intermediate rectification then it must be towards the second half or final part. Besides that, your initial taper ratio of 5% every 14 days is the slowest suggested by this BB (Reduce the daily dose by somewhere between 5% and 10% every 10-14 days). Before you go out of range (by keeping an unchanged reduction), provided it means anything, it will take some time perhaps.

 

I'm fine that you selected months ago the fixed reduction approach combined with symptoms-driven adjustments. Should you at that time have an alternative solution to go, in this case the fixed percent method where the reduction dose decreases day after day, would you be open to consider it or you just drop it because too difficult to understand and apply?

 

namo tassa bhagavato arahato samma sambuddhassa

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Tried to quote you Jim Hawke but your post re my justification  :)seems to have disappeared, and there I was thinking that everything went on into infinity.  :laugh:  Don't know what happened.  :o

 

I guess I wanted to thank, and reply to Nova  :smitten:because I've met many adult people who would be scratching their heads over the feather/lead question and I could easily have been one.  Thanks Nova  :smitten:

 

I don't know how I'm going to taper.  Currently I'm sitting on 2mg Valium after reinstating from cold jump 23 days ago. 

 

I also jumped off Cymbalta and Lexapro at the same time, after less than 2 weeks use.  Thought it would be OK but it wasn't  :crazy: 

 

Think I'm still feeling the effects of jumping from all three.  Antidepressants really mess with my head. I developed Serotonin Syndrome a number of years back with collision of two a/d's and had seizure.  Doctor's  :idiot:

 

 

I'm still feeling unwell, unstable, somewhat manic and shaky (and some) and am too afraid to cut.  Sitting on 2mg Valium but no anti depressants.  Maybe I should just hold? 

 

I'm between the devil and the deep blue sea. 

 

Hope you are travelling well Jim Hawke. 

 

Dee  :smitten:

 

 

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Hi peter2017 :smitten:

 

During my multiple simulations with spreadsheets, I found that the difference in doses between the fixed reduction method and the fixed percent method, insignificant at the beginning, tends to further deepen when the initial dose dropped to half or a quarter. So if there is a risk to feel withdrawal symptoms with no intermediate rectification then it must be towards the second half or final part. Besides that, your initial taper ratio of 5% every 14 days is the slowest suggested by this BB (Reduce the daily dose by somewhere between 5% and 10% every 10-14 days). Before you go out of range (by keeping an unchanged reduction), provided it means anything, it will take some time perhaps.

 

I'm fine that you selected months ago the fixed reduction approach combined with symptoms-driven adjustments. Should you at that time have an alternative solution to go, in this case the fixed percent method where the reduction dose decreases day after day, would you be open to consider it or you just drop it because too difficult to understand and apply?

 

namo tassa bhagavato arahato samma sambuddhassa

Hi Jim,

 

I developed a workbook about a year ago that I use to calculate and track my taper and estimate the accumulated un-metabolized diazepam+active metabolites. The formulas can easily be adjusted for a daily of other periodic reset of the daily cut to account for the drop in the prior daily dose.

 

I have not changed my daily 3 1/3 microgram cut (0.1 mg every 30 days) for 92 days because I am tolerating it well (mostly, LOL) and don't think that reducing the daily cut would reduce my w/d symptoms. I am focused on getting to my jump point "on schedule". The highest percentage I will reach in my schedule is 16 2/3% over the 30 day period ending on April 6th. If I extend my taper an extra 30 days to reach to 0.40 mg before I jump, then I would be cutting at a rate of 20% during the last period. After that it would go to 25%, 33 1/3%, 50%, and 100% based on my current fixed daily cut. 

 

Of course, I don't want to be miserable so I will reduce my daily cuts if my symptoms spike. Some days symptoms feel like they may be getting out of hand but then, with a little patience, the next day there may be few or no symptoms. In my experience it is important to take difficult stretches in stride.

 

No matter how many times you adjust your daily cut your last one will be 100%! The question is how long do you need to take to get there in order to feel reasonably stable during the process.

 

Best wishes with your taper. It is generous of you to share your experience with BB. Each person's taper is an ongoing science project with theory and experience constantly intersecting!

 

By the way, if you look at the Ashton Manual you will see that her withdrawal schedules have fixed dose reductions for many consecutive periods. For example, Schedule 2 for diazepam reduces by 1 mg per period for stages 13 through 26 going from 14 mg to 1 mg then jump. I don't necessarily view the Ashton's manual as the last word on tapering but she had a pretty good run.

 

Best wishes,

 

Peter

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Hi deadwoodgone :hug:

 

In your case it is not just the 'traditional' combination between AD and Benzo, it's something different! A quick search on Internet shows the combined use of Lexapro (escitalopram) and Cymbalta (duloxetine) can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death..

 

Luckily I also understood that you've stopped to take these ADs after 2 weeks use. The little that I've learnt told me that when you are using an AD or Benzo for a short period of time, between 2 and 3 weeks, than the dependency has not rooted deep yet and withdrawal symptoms would remain mild during taper. In your shoes, I would keep waiting until the waves pass or stabilize a little bit. A couple of weeks perhaps? Only then I will start the 2mg Valium taper.

 

For the Valium taper, how long have you been using it before the cold jump 23 days ago? If it's about months or years then the taper should be slow to minimize withdrawal symptoms. I you wish then I can provide you with a tentative planning to use as a reference. In that case thanks to let me know:

- How fast do you think to taper? (Recommendations: Reduce the daily dose by somewhere between 5% and 10% every 10-14 days)

- How many mg are your tablets?

Hope you stabilize, smoothly heal and be back soon the person you were before ADs and benzo stepped in with their havoc. :smitten:

 

 

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With all due respect! Congrats on your taper and re-birth! Thanks for the teaching session...I don't get it but hey that is my bad... I've never been very analytical just creative! :thumbsup::smitten:
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Hi peter2017,

 

Thanks for sharing your valuable experience.

 

When months ago I first read in Ashton manual something like this (Schedule 2):

...

Stage 10 (1-2 weeks) diazepam 10mg diazepam 10mg 20mg

Stage 11 (1-2 weeks) diazepam  8mg diazepam 10mg 18mg

...

my immediate conclusion was that a fixed dose/period (Ex: 2mg/1-2 weeks) is the way to go. This is when I started my first spreadsheet that finally led to 'errors' because of fixed reduction dose, despite the fact that it was limited to just 14 days period.

 

When I later visited the Liquid Taper forum I learnt that this approach is called Cut & Hold. You cut and use the same dose during the whole period until the next cut.  Compared to the daily cut, the jump is understandably more abrupt, more prone to symptoms.

 

But perhaps the above point has little to do with our discussion on fixed reduction vs fixed reduction percent ??? where in both cases reduction is carried out on a daily basis. In the first case the reduction dose remains fixed until symptoms occur. Then it needs to be adjusted. In the second case, the reduction dose decreases proportionally to the decreasing daily dose. Seamlessly until the end.

 

No matter how many times you adjust your daily cut your last one will be 100%

In the fixed reduction percent calculation, the daily cut is proportional to the daily dose and it will remain so until the end when the daily dose reaches the jump dose (E.g 0.025 mg/day for Clonazepam). Then it will be 0/0 :laugh:.

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Hi RaquelRocks :hug:

 

I've never been very analytical just creative!

I wish I had just a small percent :D of your creativity! I sincerely admire and love creative people :smitten:. With them I learn to see the world not just under one angle!

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Hi RaquelRocks :hug:

 

I've never been very analytical just creative!

I wish I had just a small percent :D of your creativity! I sincerely admire and love creative people :smitten:. With them I learn to see the world not just under one angle!

 

Thank you kind sir. I appreciate the compliment. And without analytical people we would be literally in the dark.... I highly admire you as well! Cheers!  :thumbsup:

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Thank you Jim Hawke and I think that's exactly what happened to me. 

 

I think I did get SS and am still recovering.  The doctor did not advise a washout period at all.  :idiot:  I rang Poisons Information and was told that I'd copped a dose of too much Serotonin but would be OK.  I am still not right and it has been most terrible.

 

I was introduced to Valium as a result of developing SS a number of years back, oh man, why me?  Why not me?  :)with collision of Mirtazapine and Lexapro, and don't even think I was all that depressed.  Naive, and followed doctor's advice. 

 

Been using Valium ever since, say 5 years, with regular 2mg dose 2 years and intermittant 5 mgs (from friend) the entire 5 years.  Messy I know, but life's circumstance had me believe I could find relief in these horrible pills. 

 

Thank you for offering to help me Jim Hawke because I am so confused about what to do.  Even thought about updosing the Valium because I feel so rotten but don't want to take backward steps. 

 

Again, many thanks

Dee  :smitten:

 

 

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Hi deadwoodgone :hug:

 

I will use the 2mg Valium tablets for the tentative taper plan. As you are still under ADs influence, I would go slow with the most conservative recommended reduction ratio that is 5% every 14 days. I would not be very keen to go slower as full recovery cannot begin until you have got off your tablets completely. Once you've begun your taper, by listening to your body you will decide on your own if the reduction is too much or not enough. This will give you the final speed that will accompany you until the end of the taper exercise. The idea is to reach the comfort level where you don't even think about taking your dose.

 

Here is the global view of the taper plan. And here is the daily view for your daily dose. Download them to your computer and enlarge them for better view. The green column is the volume to draw up with 10ml, 5ml, 1ml syringes. The solution has been prepared by dissolving 5 tablets of 2mg each in 20 ml of Vodka and filled with 80ml of water. It gives 100ml solution at 0.1 mg/ml.

 

For space reason, the daily plan covers only 120 days while you need 14 months to complete the taper. If you wish to know how to proceed after that period by yourself, let me know.

 

Come back if questions!

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Thank you so much Jim Hawke and apologies for late response, I had trouble relocating your thread my memory is still off kilter, and finished up having to ask Magrita at HelpDesk. I am about to go now and view your taper regime for which again, I thank you so.  Let's see if I can work it all out. 

 

Funny, my former husband is a physicist but none of it seemed to rub off on me.  :(

 

Went to outpatient Addiction Clinic today just to see what they might do and say and as suspected after explaining all including the a/d's, he said I would be fine to jump cold as 2mgs was zip in the scheme of things.  No, that's not going to work for me, and I am not the generic patient.  Oh well.

 

To your plan....

 

Thanks Jim Hawke

Dee

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Hi deadwoodgone :smitten:

 

I thought my figures must have made everybody run for their life! Apparently not all of them do :D

 

In case you want to combine solution and tablets to avoid drinking just solution then you can too. Example: you split your 2mg tablet in 2 halves of 1mg each. When it comes to take 12.12 ml (period 10, month 5 in this example) you can replace 10 ml with that half-tablet and drink just 2.12 ml in solution. In this way your batch of solution will last more days. This is the example in figures.

 

Let me know if it's unclear.

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