What if...

Hi,

I'm finishing an application to assist buddies in establishing by themselves their own Taper plan. At this stage of development errors can occur and the best way to find and fix them is to let users test it. I shall welcome any feedback.

For a few weeks it will be hosted  on a friend's website. I'll remove it if buddies find it totally useless.

I reserve the right to make modifications whenever needed.

Here it is.

Hi,

 

I'm finishing an application to assist buddies in establishing by themselves their own Taper plan. At this stage of development errors can occur and the best way to find and fix them is to let users test it. I shall welcome any feedback.

 

For a few weeks it will be hosted  on a friend's website. I'll remove it if buddies find it totally useless.

 

I reserve the right to make modifications whenever needed.

 

Here it is.

Hey Jim Hawk!

This is very impressive Jim! 

This tool will be extremely valuable to our buddies. I can actually see you expanding this to crossover schedules, Dry cut schedules & gram scale schedules. This is ingenious. I can imagine it took some time to write the code for this. THANK-YOU so very much Jim Hawk! You rock! I will be testing this out & will be happy to give you feed back. I a very glad to see a program like this.

I did just try it out with a plan I just got done with for a buddie. It seems highly functional. I was wondering if it was at all possible to have the option of tapering from each individual dose the same amount instead of tapering from just one of say 3 doses? The reason I think this option would be advantageous is that when a person takes a particular dose at a particular time every day for many years the body seems to get accustom to this & many may  find it difficult to eliminate 1 dose especially if the benzo they are tapering is eliminated quickly and one is experiencing interdose withdrawal like Xanax. Just a thought...

Hey this is AWESOME! Thanks again, Jim Hawk 

Hi GreenCup,

...I plan on going down to .01mg of clonazepam...

While technically feasible, I'd rather you have a look here:

"...Getting off the last tablet: Stopping the last few milligrams is often viewed as particularly difficult. This is mainly due to fear of how you will cope without any drug at all. In fact, the final parting is surprisingly easy. People are usually delighted by the new sense of freedom gained. In any case the 1mg or 0.5mg diazepam per day which you are taking at the end of your schedule is having little effect apart from keeping the dependence going. Do not be tempted to spin out the withdrawal to a ridiculously slow rate towards the end (such as 0.25mg each month). Take the plunge when you reach 0.5mg daily; full recovery cannot begin until you have got off your tablets completely...." Ashton manual.

The quit dose for clonazepam used in the calculation is based on the corresponding value of 0.5mg diazepam.

Hi Bella Amis,

... tapering from each individual dose the same amount instead of tapering from just one of say 3 doses...

Could you please give an example with figures?

Hi Bella Amis,

 

... tapering from each individual dose the same amount instead of tapering from just one of say 3 doses...

 

Could you please give an example with figures?

Here you go Jim a 3 Dose Schedule

Hi Bella Amis,

I hope I correctly interpreted your chart. I wonder if it's not the same as when you put 0.283 in Dose 1,  0.283 in Dose 2 and 0.283 in Dose 3 (Start dose = .85mg) in the daily dose(s) of the application?

Hi Bella Amis,

 

I hope I correctly interpreted your chart. I wonder if it's not the same as when you put 0.283 in Dose 1,  0.283 in Dose 2 and 0.283 in Dose 3 (Start dose = .85mg) in the daily dose(s) of the application?

I tried this & it still reduces only from the first dose then after 7 days it reduces from 1st & 2nd dose.

Also when making  the entry into "tablet size"  (in this particular case Diazapam) Valium does not come in 1 mg tablet. So not sure how to get around this if person is using 2mg tablets for their solution. This may cause some confusion. When I typed in "1mg" the numbers came out right.

Hi Bella Amis,

reduces only from the first dose then after 7 days it reduces from 1st & 2nd dose

The quit dose for Valium been 0.5 mg/day, when the total daily dose goes lower than this value (0.4571 in our case) calculation stops as taper is considered as completed.

not sure how to get around this if person is using 2mg tablets for their solution

There's actually no constraint set in the application on the size of tablets. You can input whatever values. Try to type 2 in the field.

Could you please confirm that in our case the taper starts with a TINY start daily dose of 0.85mg (divided in 3 times) which is very SMALL (not even half a tablet!) and close to the quit dose of 0.5 mg.

Hi Bella Amis,

 

reduces only from the first dose then after 7 days it reduces from 1st & 2nd dose

 

The quit dose for Valium been 0.5 mg/day, when the total daily dose goes lower than this value (0.4571 in our case) calculation stops as taper is considered as completed.

 

not sure how to get around this if person is using 2mg tablets for their solution

 

There's actually no constraint set in the application on the size of tablets. You can input whatever values. Try to type 2 in the field.

 

Could you please confirm that in our case the taper starts with a TINY start daily dose of 0.85mg (divided in 3 times) which is very SMALL (not even half a tablet!) and close to the quit dose of 0.5 mg.

Hey there Jim-

That is a 10/4....very TINY start dose. This buddie started titration @ 1mg. She had completed 1 month of taper & I was trying to finish her schedule. I was using this particular schedule because I had just finished it today & was curious. I wanted to check out your new program.

I did try to type in "2mg Valium" which is what she is using to make her solution but then the output is not accurate to the actual taper.

Any how, when I get more time I will be trying out some of the other schedules I have made. This new program you have come up with should make it easy for buddies to make their own schedules with very little effort. I love it! 

Hi Bella Amis,

I just received a feedback by PM :

Tapering from 5 mg of diazepam to 0.5 mg in fixed cuts of 5/70=0.0714 mg seems like a very fast taper to me. I am tapering my last 1 mg in cuts of 0.003333 mg per day (about 1/20 of the cuts you describe) which now on day 108 is equivalent to about 15% every 30 days. I will be happy if I can maintain that reduction for the next 42 days when I plan to jump at 0.5 mg.

Do you think that the Ashton reduction speed for the last 5mg (in 10 weeks) is too agressive and we should let patients decide their own pace?

Hi Bella Amis,

 

I just received a feedback by PM :

Tapering from 5 mg of diazepam to 0.5 mg in fixed cuts of 5/70=0.0714 mg seems like a very fast taper to me. I am tapering my last 1 mg in cuts of 0.003333 mg per day (about 1/20 of the cuts you describe) which now on day 108 is equivalent to about 15% every 30 days. I will be happy if I can maintain that reduction for the next 42 days when I plan to jump at 0.5 mg.

for the calculation algorithm mentioned in the notes (... until the daily dose get down to the equivalent of 5mg Diazepam. Then it will be tapered off by daily removing a fixed reduction quantity during a period of 10 weeks (Ashton). The ratio being used from that moment on will be no longer the one requested by the patient but is set to 5mg/70 days with  fixed reduction quantity per day.

[Do you think that the Ashton reduction speed for the last 5mg (in 10 weeks) is too agressive and we should let patients decide their own pace?

Hi Jim Hawk-

I think if there was anyway possible to change the calculation algorithm to allow more flexibility the program would then be able to  adapt to virtually any taper. I personally used the Ashton aggressive taper. I went from 15mg tapering 1mg every month till my jump @.5mg. If I had to do it all over again I would do it differently. I think some may benefit from an aggressive taper. This may be short term users, or the ones who may not be genetically prone or super sensitive or severely symptomatic in withdrawal.  It really does vary individually. So more versatility would be AWESOME Jim!!! 

Hi Bella Amis and Peter2017,

I modified the code in accordance with your suggestions. Please try again and let me know how you feel. Thanks for your input.

Hi peter2017,

...but I do realize that it really doesn't matter...

Well it does matter! Actually when it comes to display the daily dose after for instance 14 days of 10% reduction over a starting dose of 40 mg then the formula is =40 *((100-10/14)/100)^14 for the first period. As this calculation will repeat for the second period but this time no longer based on the initial 40 mg but lower and so on...the resulting graph as you can see is then a curved line and not a straight line like in fixed reduction calculation.

http://farm5.staticflickr.com/4711/25556372757_76539be2b5_b.jpg

Hi Bella Amis and Peter2017,

 

I modified the code in accordance with your suggestions. Please try again and let me know how you feel. Thanks for your input.

Hi there Jim-

I just tried again. A couple of things I want to share. If I calculate a new 10% reduction amount every 14 days it takes approx. 98 days to reduce to .5mg (using the reference below.) When I plug these same numbers into your program it takes 72 days. Is the difference because the calculations in your program are staying at the same 10% instead of adjusting the percentage every 14 days?

Also I see that it is only reducing from one dose instead of all three doses evenly. Is it possible to get the program to reduce from each dose evenly so the taperer can dose X amount of thime through out their taper??

This function would be spot on if it were to reduce from every dose(when more than 1 dose)

http://i.imgur.com/rAdN5Ix.png

Like this:                                 

This plan starts @ .85mg V & reduces @ 10% every 14 days using a 1:10(1mg-10ml) solution                                             

              Am      Noon      Pm      Total          Ml                Mg              Total

            Dose    Dose      Dose    Dose    Reduction      Reduction        Dose

Day        ml        ml          ml        ml        Per Day        Per Day            mg

1)        2.81      2.81      2.81      8.43          .06              .006              .843

2)        2.79      2.79      2.79      8.37          .12              .012              .837

3)        2.77      2.79      2.79      8.31          .18              .018              .831

4)        2.75      2.75      2.75      8.25          .24              .024              .825

5)        2.73      2.73      2.73      8.19          .30              .030              .819

6)        2.71      2.71      2.71      8.13          .36              .036              .813

7)        2.69      2.69      2.69      8.07          .42              .042              .807

Hi Bella Amis,

your program are staying at the same 10% instead of adjusting the percentage every 14 days?

In the calculation with fixed reduction percentage, the same reduction ratio (10%/14 days for instance) is kept unchanged until the end.

To explain with an example the algorithm used (for a starting dose of 0.843 mg) :

A daily reduction quantity = DailyDose * (1 - (100-10/14)/100) is applied for the entire taper exercise, keeping in mind that the DailyDose varies every day. It started at 0.843 then becomes 0.8370 the first day then 0.8310 the second day...The daily reduction quantity lowers accordingly. I can see that the same figures appeared on your spreadsheet. I expect both calculations to end the same day. By any chance is your quit dose 0.5 mg as the one used in the calculation?

For the reduction distributed across doses, if you don't mind I would wait for feedback from other buddies before starting the modifications.

Hi peter2017,

 

...but I do realize that it really doesn't matter...

Well it does matter! Actually when it comes to display the daily dose after for instance 14 days of 10% reduction over a starting dose of 40 mg then the formula is =40 *((100-10/14)/100)^14 for the first period. As this calculation will repeat for the second period but this time no longer based on the initial 40 mg but lower and so on...the resulting graph as you can see is then a curved line and not a straight line like in fixed reduction calculation.

 

http://farm5.staticflickr.com/4711/25556372757_76539be2b5_b.jpg

Hi Jim,

I wasn't talking about a fixed reduction versus the percentage reduction. I was just pointing out that the formula ((100-10/14)/100)^14=0.9045 does not precisely reduce by 10% after 14 days. Instead you obtain a slightly lower reduction of 9.55%. If you use my formula ((1-.1))^(1/14))^14=0.9 you get an exact 10% reduction over a 14 day period. It does not really matter because the difference between your method and a true 10% reduction is trivial for the purposes of planning a taper schedule. The chart derived from tapering from 40 mg using a daily reduction factor of ((1-.1))^(1/14))^n for n =1 to 550 is shown below.

http://image.ibb.co/gXn48H/chart_1.png

What I am personally doing in my taper is a fixed reduction which is a straight line but that is not based on either my formula above or yours. I am tapering as 1 - 1/300 x n which is, of course, a linear equation in n and therefore graphs as a straight line

Hi peter2017,

Hat off!

Hi,

Following suggestions from Bella Amis, I implemented the reduction order feature. Thanks to let me know if it works.

Here it is.

Hi Jim!

This looks great!

This adjustment will make it easier for those who dose multiple times a day to figure out their dose amounts on their own.

Hey thanks for taking the time to create & write this program. It will prove to be in valuable to so many.

Hi Magnesi

it'll be very useful for many people, I'm sure!

Thanks! I hope it can save some time and pain for a few buddies.

Hi everybody 

Following suggestions from GreenCup and peter2017, I implemented these points in the application:

1. Rectify the calculation algorithm to be more precise when a fixed percent is required

2. Give the possibility to users to set their own quit dose

3. Include a disclaimer

In addition:

4. For those who might want to know what Liquid Taper is and how to start I also included a Help function.

As from a buddie's PM

It will be a huge help for many buddies for years to come

Here is the new version.