Thanks for -- "Create Your Own Taper Plan" by Jim Hawk

Just wanted to thank Jim Hawk on behalf of all BBs for this invaluable support during our benzo withdrawal, for taking the time and energy to design the "Create Your Own Taper Plan"! 

 

I've bookmarked the site/program:  http://bzo.spes-lavaux.ch/TaperPlan.htm (but I don't know how to make this link look all purty like our very own Bella Amis does, who I think helped out in the design?)

 

My mother's taper isn't there yet, but when we get to starting a DLMT, I sure will use your program.  Just tested it out with our current Xanax and Valium dosages, and it looked great (although it said our taper would take 4 years, yowza  )!

 

So thank you for putting so much work into it, for all of us! 

Hi delta1

 

Many thanks, you have lightened my day with your post!

 

The application would not be what it is today without the participation of several people. Moderator Bella Amis has been one of them. With requirements and enthusiasm she gives me motivation to always do better. She's has also adopted the application day 1 and by frequently using it becomes THE ambassador of it.

 

As for the long taper duration that could span over years, here are a few clarifications. In this BB you can see almost always reductions in terms of percent/period of days (E.g: 10%/14 days). Behind this term, actually there are two distinct approaches in tapering:

 

1. That 10%/14 days will be translated in mg/day based on the current dose you are taking. For instance if your current dose is 1 mg/day then 10% will be 0.1 mg. Divided by 14 days (=2 weeks), it gives 0.00714 mg/day. This fixed amount will be your daily reduction until the end, if no symptoms arise meanwhile. So this percentage is just applied for the first dose then ignored afterwards. This approach known as "fixed quantity reduction" is the most commonly seen in this BB. It is fast, easy to remember and to apply. There might be symptoms upcoming especially towards the end and might require you to reduce the dose or hold more time until you stabilize to pass to a lower dose.

 

2. The "fixed percent reduction" is where the ratio of 10%/14 days is applied throughout the entire taper exercise. The daily reduction is calculated with that ratio over the daily dose. That implies that the daily reduction diminishes every day because the daily dose is smaller each day. That implies too a very low reduction evolution, a longer taper duration but it will likely raise no symptoms. This method is definitely "gentler" from a symptoms viewpoint.

 

Many people asked what method should they use when they have not yet started to taper and therefore have no clue which method would best suit. The rule of thumb would be to reduce the daily dose by somewhere between 5% and 10% every 10-14 days. However, it is only intended as general guides. The rate of tapering should never be rigid but should be flexible and controlled by the patient, not the doctor. It must be in accordance with the patient's individual needs which are different in every case. But in parallele a full recovery cannot begin until you have got off your tablets completely. Taperers must therefore find for them the best trade-off between symptoms and a taper duration that must not go on forever.

 

For those cases, I would say to try first with "Fixed percent" starting with the most conservative 5%/14 days. If problem then hold more days until you stabilize. Then after 2, 3 weeks should symptoms persist, lower the ratio, 4%/14 days for instance. If no rough symptoms found, change the pace to 5%/10 days or 6%/14 days. Finally when things are OK you can try "Fixed quantity" to shorten the taper duration. Overall that's your body who must have the last words:  listen to it and adjust the reduction dose accordingly.

 

Again, thanks for your post. If questions please ask.

 

All the best!

Hi delta1

 

Many thanks, you have lightened my day with your post!

 

The application would not be what it is today without the participation of several people. Moderator Bella Amis has been one of them. With requirements and enthusiasm she gives me motivation to always do better. She's has also adopted the application day 1 and by frequently using it becomes THE ambassador of it.

 

As for the long taper duration that could span over years, here are a few clarifications. In this BB you can see almost always reductions in terms of percent/period of days (E.g: 10%/14 days). Behind this term, actually there are two distinct approaches in tapering:

 

1. That 10%/14 days will be translated in mg/day based on the current dose you are taking. For instance if your current dose is 1 mg/day then 10% will be 0.1 mg. Divided by 14 days (=2 weeks), it gives 0.00714 mg/day. This fixed amount will be your daily reduction until the end, if no symptoms arise meanwhile. So this percentage is just applied for the first dose then ignored afterwards. This approach known as "fixed quantity reduction" is the most commonly seen in this BB. It is fast, easy to remember and to apply. There might be symptoms upcoming especially towards the end and might require you to reduce the dose or hold more time until you stabilize to pass to a lower dose.

 

2. The "fixed percent reduction" is where the ratio of 10%/14 days is applied throughout the entire taper exercise. The daily reduction is calculated with that ratio over the daily dose. That implies that the daily reduction diminishes every day because the daily dose is smaller each day. That implies too a very low reduction evolution, a longer taper duration but it will likely raise no symptoms. This method is definitely "gentler" from a symptoms viewpoint.

 

Many people asked what method should they use when they have not yet started to taper and therefore have no clue which method would best suit. The rule of thumb would be to reduce the daily dose by somewhere between 5% and 10% every 10-14 days. However, it is only intended as general guides. The rate of tapering should never be rigid but should be flexible and controlled by the patient, not the doctor. It must be in accordance with the patient's individual needs which are different in every case. But in parallele a full recovery cannot begin until you have got off your tablets completely. Taperers must therefore find for them the best trade-off between symptoms and a taper duration that must not go on forever.

 

For those cases, I would say to try first with "Fixed percent" starting with the most conservative 5%/14 days. If problem then hold more days until you stabilize. Then after 2, 3 weeks should symptoms persist, lower the ratio, 4%/14 days for instance. If no rough symptoms found, change the pace to 5%/10 days or 6%/14 days. Finally when things are OK you can try "Fixed quantity" to shorten the taper duration. Overall that's your body who must have the last words:  listen to it and adjust the reduction dose accordingly.

 

Again, thanks for your post. If questions please ask.

 

All the best!

 

 

Thank you so much for the explanation!  I just tried it out, roughly, first with "Fixed Percent" then with "Fixed Quantity" and that is really fantastic! 

 

Like the way you guys designed the program, nice thinking went into it.  I really appreciate that, so I don't have to labor over every little detail of a taper plan. 

Wow, impressed and grateful to you, Bella Amis, and all who helped 

Jim, what if symptoms continue on indefinitely and we never stabilize?  I am told that this condition could mean we are in tolerance withdrawal and that there is nothing to do but to continue down.  I have never felt stable, but have always felt very sick as long as I can remember.  It only continually gets worse instead of improving.  The latest symptoms is super-super sensitive hyperacusis where I have to wear earplugs in because merely turning a page in a book sounds like glass shattering in my ear.  Even talking is extremely painful vibrations throughout my skull.  So, if things don't change and I have to continue down, would there be a special percentage that I would consider in order to avoid seizures/stroke, etc.?

I just went onto your link and saw that I need to know the weight of 10 pills.  So, I would need to purchase a scale.  Where would you suggest and what brand?  I want to be sure it is accurate and reliable.  Thanks.

 

Hi LynnM

 

...what if symptoms continue on indefinitely and we never stabilize?

Before starting, let me tell you that I'm really sorry to learn all these problems of yours  . I really wish they will fade away with time and you will find again health and joy of living.

 

I see back in June 2017 you used the crossover method to taper Clonazepam. If you don't mind I would like to better know a few more details:

1. What were the reasons behind the decision to taper Clonazepam (2016)?

2. How did you do to crossover small quantities from Clonazepam to Diazepam?

3. Could you please confirm that you tapered 12 mg of Diazepam in 3 months (June-Sep 2017)?

4. During this 3-month period, how were the symptoms compared to when you were under Clonazepam?

5. Between Sep and Nov 2017, before reinstate to 6.25 mg, were you with zero benzo?

6. Are you using 6.25 mg Diazepam nowadays?

 

would there be a special percentage that I would consider in order to avoid seizures/stroke, etc.?

Seizures/stroke generally arise when someone stopped abruptly his/her dose of benzo. The body then violently reacts to that sudden lack of GABA-like substance that regulates and "keeps quiet" our CNS like natural GABA and benzo would.

 

To avoid rough withdrawal symptoms, the general recommendations are to reduce the daily dose by somewhere between 5% and 10% every 10-14 days. That means it varies from the most conservative 5%/14 days to 10%/10 days. Most of buddies' reduction fall into that range. It does not exclude that you might need to go lower.

 

Hang in girl! You will heal!

 

Hi LynnM,

 

I just went onto your link and saw that I need to know the weight of 10 pills.  So, I would need to purchase a scale.  Where would you suggest and what brand?  I want to be sure it is accurate and reliable.  Thanks.

 

I see that you finished to the Direct Taper application . May I ask you why you selected this method amongst three? For information, the measure of 10 tablets was to try to determine the average weight of one tablet. Actually due to production process, no tablet weighs the same as another of the same batch.

 

For the gram scale, a number of buddies in here use a cheap, chinese production Galaxy-20 sold in Amazon for about USD 20.

 

The question is: do we need a lab device with finest precision for our taper? No, we do not!. If the scale consistently measures the same way between yesterday and today then that is enough since ONLY the difference between doses counts. I give an example. Yesterday I measured and took 0. 093 g dose. According to the lab scale it is far away from the real 0.097 g. Today I measure my new dose again with my cheap scale: 0.092 g. Compared to the lab scale's measure of 0.096 g, the difference between the 2 doses is very likely the same for both scales as both of them consistently do their job. But even if it is not, the dose difference between the 2 devices would be so insignificant that hardly your body will feel it.

 

While precision and accuracy are important for the taper exercise, it is not as important as a taper practice that consistently lowers dose after dose all along its course.

 

LynnM,

 

Jim, what if symptoms continue on indefinitely and we never stabilize?  I am told that this condition could mean we are in tolerance withdrawal and that there is nothing to do but to continue down.  I have never felt stable, but have always felt very sick as long as I can remember.  It only continually gets worse instead of improving.

 

Do you mean that on Ativan, Klonopin, and Valium, even when you were NOT tapering, you never felt stable? 

 

Or could your symptoms be from FAST tapers off these drugs? 

 

I'm curious about what Jim asked as well, especially the bolded questions, so what about those?

 

Trying to understand what's been going on with you 

 

Hi LynnM

 

...what if symptoms continue on indefinitely and we never stabilize?

Before starting, let me tell you that I'm really sorry to learn all these problems of yours  . I really wish they will fade away with time and you will find again health and joy of living.

 

I see back in June 2017 you used the crossover method to taper Clonazepam. If you don't mind I would like to better know a few more details:

1. What were the reasons behind the decision to taper Clonazepam (2016)?

2. How did you do to crossover small quantities from Clonazepam to Diazepam?

3. Could you please confirm that you tapered 12 mg of Diazepam in 3 months (June-Sep 2017)?

4. During this 3-month period, how were the symptoms compared to when you were under Clonazepam?

5. Between Sep and Nov 2017, before reinstate to 6.25 mg, were you with zero benzo?

6. Are you using 6.25 mg Diazepam nowadays?

 

would there be a special percentage that I would consider in order to avoid seizures/stroke, etc.?

Seizures/stroke generally arise when someone stopped abruptly his/her dose of benzo. The body then violently reacts to that sudden lack of GABA-like substance that regulates and "keeps quiet" our CNS like natural GABA and benzo would.

 

To avoid rough withdrawal symptoms, the general recommendations are to reduce the daily dose by somewhere between 5% and 10% every 10-14 days. That means it varies from the most conservative 5%/14 days to 10%/10 days. Most of buddies' reduction fall into that range. It does not exclude that you might need to go lower.

 

Hang in girl! You will heal!

Never felt stable.  Had opioid w/d from c/t powerful surgery meds that they never warned me about.  Long, sad story.  See related here: https://www.minnpost.com/community-voices/2017/12/opioid-addict-10-days-cautionary-experience    When I c/t from the meds, they never told me they were addictive or that I should taper them.  The fella in the article here was aware.  I was not.

 

Perhaps that's why the ativan they prescribed for my quote--anxiety disorder--during that unfortunate undiscovered opioid withdrawal, never worked and I tried to get off of too quickly---again!  I never took aspirin let alone all these powerful drugs I know nothing about and that the dr's NEVER warned me about.

 

Yes, symptoms are possible from too fast tapers.  I was not familiar with BB then.  I was just following dr's orders.

 

Here's the answers to Jim's questions.  Had been too ill to write earlier.  Still not very well.  But hope this helps you and others:

1.  Tapering off of K. because I learned too late that they were very addictive and bad for you.

2.  Did immediate c/o  from K. to V. per dr's orders

3.  Dr. said to drop 1 mg V. per week for 12 weeks.  Again, before I knew of BB.

4.  Symptoms during 12 week period--June 25-Sept 1--were:  No burning.  More tired.  Could sleep better.  A little more calm--knocked out feeling.

5.  Off V. Sept 1 and Mirtazepine Sept 15      Went 2-1/2 months to Mid Nov w/increasing burning, sleeplessness, horrible side effects, ACID whole body burning down to the bones!!! Bladder fail.

6.  No V. now.  Check signature

 

BIG FAILURE!!!  AM HIGHLY TOXIC FEELING AND UNABLE TO FUNCTION AT ALL.  A LOT OF EFFORT PUT INTO DOING THIS TO HELP YOU AND OTHERS.  NOT SURE I WILL MAKE IT.  PRAYING!

LynnM, from what I can understand, it sounds like you've been suffering a lot of withdrawal symptoms from going through different drugs and tapering fast from them, this cycle being repeated a few times.  And if your brain isn't calming down at all, it could be because after all that you've been through, the .25 Klonopin you're currently taking is too low a dose to give your system any relief, any room to settle down. 

 

I hope that Jim Hawk or others chime in here, but if I were you, I'd try updosing the K to find a dose where you start to calm down, maybe adding another .25mg to start and seeing what that does.  This would just get you to a more comfortable place, then you can assess how you should proceed.  Have you tried something like this? 

Hi LynnM 

 

Thank you for taking time and efforts to answer my several questions. They were not there for anything else but a support to understand what you are currently through, be able to put a finger on the problem and say "Hey LynnM I think your problem might be...".

 

For what I can see between Nov 2015 and Mar 2018, it has been an uninterrupted use and withdrawal of several drugs: narcotic for pain (Dilaudid?), Ativan, Klonopin, Mirtazepine, Valium, Klonopin again. I realized there might be 2 distinct aspects that marked this long odissey:

 

1. The benzodiazepines/anti-depressant taken are no longer effective after long months of regular use. They lost much of their efficacy because of the development of tolerance. When tolerance develops, "withdrawal" symptoms can appear even though you continue to take the drug. Thus the symptoms suffered by many long-term users are a mixture of adverse secondary effects of the drugs and "withdrawal" effects due to tolerance.

 

2. Kindling: here is an extract from Wikipedia "...Kindling due to substance withdrawal refers to the neurological condition which results from repeated withdrawal episodes from sedative–hypnotic drugs such as alcohol and benzodiazepines. Each withdrawal leads to more severe withdrawal symptoms than in previous episodes. Individuals who have had more withdrawal episodes are at an increased risk of very severe withdrawal symptoms, up to and including seizures..."

 

If they are true then they might partially explain why those destabilizing symptoms you are enduring.

 

What to do? The idea is to become comfortable and stable with your current dose before making any new cut. In your fragile state, for each cut you make the CNS's equilibrium has the potential to go out whack . You'll need to adjust to that dose until you feel comfortable and stable once again. Of course, this will feel like withdrawal, but it will eventually stabilize again. From there the cycle just continues until you've reduced your dosage enough to make the jump.

 

But what if it takes ages to stabilize? If the symptoms are really so severe that life is becoming a hell then you should not go on to suffer like that. After all, medications good or bad, are there to help alleviate sufferings. Klonopin or Valium, whatever you are taking, let's possibly updose until you feel comfortable. It will lengthen the dependency duration but it certainly won't kill you. Wait for one or two weeks or more for the body to get acquaintance to the dose and slowly taper from there.

 

What amount of the drug you should be cutting with each successive cut? The general rule of thumb to reduce the daily dose by somewhere between 5% and 10% every 10-14 days is a good point to start. Once you've begun your taper, you really need to decide on your own how much is too much or not enough. Your psych or any doc won't really be able to tell you what will work for you, either, primarily because we're all so different from one another. The key is to listen to your body and what it's trying to tell you. You'll know once you get there. The good news is that you'll eventually get beyond this and feeling good once again.

 

Clean diet (less glutamate, less aspartame, less carbohydrates...), avoidance of alcohol and caffeine, light exercise, distractions (music, walks, friends, animal refuges, volunteering ...) can only be beneficial.

 

Hang in LynnM! You will overcome this too and will be healthy again! It's just a matter of time.

 

Tried to updose, but got really bad!  So, backed down a bit and felt better--still bad, still not good, but not as bad as when updosing.  Wondering if the drugs are doing more harm than good.  Am under the impression that these drugs can turn on you and bite you WITH depression and anxiety.  If that's the case, then holding only keeps this going, right?

Hi LynnM 

 

Wondering if the drugs are doing more harm than good

Of course it does more harm, otherwise we have not struggled that much to get rid of them...

 

these drugs can turn on you and bite you WITH depression and anxiety

It is highly probable that tolerance symptoms from the use of the drug manifest themselves under the form of depression and anxiety. Because of that in a certain sense we might get the feeling the drugs are turning on us after the happy 'honeymoon' period.

 

holding only keeps this going, right?

Human organism after 5-7 millions years of evolution has built in it capabilities to repair itself. These capabilities allow the body to heal by itself things we can see like scars, cold, flu...and many more we do not know. However each individual is so different from each other due to so many factors including the personality, lifestyle, life experience, specific vulnerabilities, and the (perhaps genetically determined) speed of one's recovery systems. To cut it short it may stabilize but may take time.

 

What would be then our options since stay with benzo is not one? I can only see a very low reduction that may span years amongst ups and downs but that finally frees you from the benzo grip.

 

 

 

 

 

Hi JH 

 

I'd like to make sure I understand something in the Benzodiazepine Liquid Taper Help section:

 

Daily basis or Periodic basis reduction?

The reduction quantity might be applied at the daily basis with consequent decreasing daily dose or kept unchanged during the whole period of more days where the daily dose remains unchanged. Compared to the daily approach, the second method also known as "Cut and Hold" is more prone to symptoms.

 

Would you mind giving an example, with numbers, of what this is discussing? 

Even though I have not taken up on your "create your own..." YET, Jim Hawk, your tremendous effort and contribution to our lives has not escaped me. 

 

Dee x

 

*  Operative word "YET", Jim.  I might finish to not be the manicurist (emery board method) I once thought.  You are a good man. 

 

D. 

Following...

 

Hi JH 

 

I'd like to make sure I understand something in the Benzodiazepine Liquid Taper Help section:

 

Daily basis or Periodic basis reduction?

The reduction quantity might be applied at the daily basis with consequent decreasing daily dose or kept unchanged during the whole period of more days where the daily dose remains unchanged. Compared to the daily approach, the second method also known as "Cut and Hold" is more prone to symptoms.

 

Would you mind giving an example, with numbers, of what this is discussing?

 

Hi delta1

 

Example:

You are currently taking 1 mg of Klonopin per day. You decide to taper at 10% every 14 days. The reduction quantity per 14 days is 0.1 mg (=1 mg * 10%) . The reduction per day is therefore 0.00714 mg (=0.1 mg / 14 days).

 

Periodic basis reduction (Cut % Hold)

Day 1: 0.993 mg (=1 mg - 0.00714 mg)

Day 2: 0.993 mg

Day 3: 0.993 mg

...

Day 14: 0.993 mg

During this period of 14 days your daily dose remains unchanged (you hold for 14 days!).

 

After 14 days you have tapered off 10% of 1 mg. There remains 90% or 0.9 mg to taper. The same reduction pace (10%/14 days) is now applied to 0.9 mg. The reduction quantity per 14 days is 0.09 mg (=0.9 mg * 10%). The reduction per day is therefore the new 0.00643 mg (=0.09 mg / 14 days).

Day 15: 0.987 mg (= 0.993 mg - 0.00643 mg)

Day 16: 0.987 mg

Day 17: 0.987 mg

...

and so on.

 

The jump from 0.993 mg to 0.987 between day 14 and 15 (and between any block of 14 days) might be source of discomfort.

 

Daily basis reduction

Day 1 0.993 mg (=1 mg - 0.00714 mg)

Day 2 0.986 mg (=0.993 mg - 0.00714 mg)

Day 3 0.979 mg (=0.986 mg - 0.00714 mg)

Day 4 0.971 mg (=0.979 mg - 0.00714 mg)

Day 5 0.964 mg

Day 6 0.957 mg

Day 7 0.950 mg

Day 8 0.943 mg

Day 9 0.936 mg

Day 10 0.929 mg

Day 11 0.921 mg

Day 12 0.914 mg

Day 13 0.907 mg

Day 14 0.900 mg

Day 15 0.893 mg (=0.900 mg - 0.00714 mg)

Day 16 0.886 mg (=0.893 mg - 0.00714 mg)

Day 17 0.879 mg (=0.886 mg - 0.00714 mg)

...

With this approach every day a different and lower dose is taken.

 

Hope I answered your question.

 

 

As usual, JH, thorough and thoughtful, THANK YOU!

 

And ANOTHER THANK YOU, for putting together all that information in one place in the Help sections of your taper plans generator.  I finally had a chance to look at them, and it proved very helpful in understanding what's going on.  Really can't thank you enough for all the valuable work you do for BBs! 

JH,

 

For dissolving benzo in solvent, the "rule" is per 1mg benzo, use 2ml solvent if using 90 proof vodka. 

 

Let's say you're working with 0.25mg in tablet.  Would dissolving this in 0.5ml of that vodka work? 

 

Or is that too small in volume of liquid to dissolve anything? 

 

delta1

Hi delta1  ,

 

you're working with 0.25mg in tablet.  Would dissolving this in 0.5ml of that vodka work?

 

It would, provided the small vodka quantity is enough to cover the physical tablet. If not, the tablet must be first crushed to powder.

 

It is perhaps easier to dissolve more tablets at a time, for instance 10 x 0.25 mg in 5 ml of vodka or 20 x 0.25 mg in 10 ml of vodka. After the due amount of water is added to get the right concentration, the final solution must be kept in a closed jar to be used for more days (10-14 days).

 

Why is it whenever I try to use Jim Hawks formula, it tells me it will take me 950 days to get off .75 mgs Xanax at 5% reduction every 14 days?  What am I doing wrong??  Im begi nk g to think I should just let my.psych do the quick taper he's suggesting and get it over with. 

 

Can someone help me with this??

Hi delta1  ,

 

you're working with 0.25mg in tablet.  Would dissolving this in 0.5ml of that vodka work?

 

It would, provided the small vodka quantity is enough to cover the physical tablet. If not, the tablet must be first crushed to powder.

 

It is perhaps easier to dissolve more tablets at a time, for instance 10 x 0.25 mg in 5 ml of vodka or 20 x 0.25 mg in 10 ml of vodka. After the due amount of water is added to get the right concentration, the final solution must be kept in a closed jar to be used for more days (10-14 days).

 

 

Of course!  This is why I'm so grateful to be able to check in with you!  My "benzo caregiver brain" gets in my way constantly, so thank you very much for setting me straight, JH! 

Hi Ch33kyKK 

 

Because by filling in the percent field you were using the fixed percent reduction.

 

When you use the fixed quantity reduction like below, the duration will be shorter.

 

 

So .0375 reduction every 2 weeks should work just fine?  No need to crush or liquid pills then.  I already tried .0625 every 2 weeks and failed.  Went back up.  It was too much.  Jim, what if I want to liquid micro taper?  Can you show me.how.that looks?  My pills are .25 mg each, taken 3 x's a day.

Hi Ch33kyKK

 

Can you show me.how.that looks?

 

Take some time to have a look here. When everything is clear and no more questions needed, go here.

 

All the best!