Help for my daughter

This is a message I sent to Jim asking for help with my daughter. I am very concerned for her wellbeing right now. I appreciate anyone who can offer their thoughts and help.

Hi Jim, you don’t know me but I ran across you and saw how you have helped others with titration. Jim Ihave been on BBS since 2012 and have been so thankful for all the help I have received on this forum. I have made many friends who have been with me through some dark hours. Without going into my story which at the moment is not what I am coming to you for. If you would like to know anything about me I have a blog and a progress log on this forum.

 

I am coming to you out of desperation for my daughter. My daughters name is Becky and she is 30 years old. She was a dental assistant for 10 years and then decided she wanted to be a therapist and help people through trauma. She will graduate with her masters in May 2019 so she is very close. She has been taking .05 Lorazepam for 5 years or more sporadically. She is going through 40 Lorazepam before her month is up and has been extremely sick. I believe she has hit tolerance. Her doctor isn’t to willing to up her dose but I think if we can talk to him we might be able to convince him to, just to get her through school.

 

I know nothing about titration and I am worse at math. I have tried to understand it but I feel lost. She made another appointment with him for next Tuesday. I hope we can convince him to up her dose to 1 mg to stabilize her and hope she will do ok until May and then use titration to get her off. Could you please give me your advice and please help me with this. It breaks my heart to realize that she will have to endure the suffering from these drugs. I have done it and I know how bad it is. Thank you for your help."

Thank you so much!

Jackie :smitten:

Hi jackie brown

Please accept my solidarity with Becky . Like many buddies in here she will heal. It's just a matter of time.

She has been taking .05 Lorazepam for 5 years

0.05 mg is tiny and is actually the jump dose suggested by Aston's manual for Lorazepam when someone arrives to the cross line of the taper. Can it be 0.5 mg instead?

She is going through 40 Lorazepam before her month is up

This is such a high daily dose! Could it be 4 mg instead or perhaps something else?

I hope we can convince him to up her dose to 1 mg to stabilize her

What is her CURRENT dose(s)? How many times a day? When was the last time she modified her dose(s)? What if after up-dose to 1 mg she doesn't stabilize?

hope she will do ok until May and then use titration to get her off

She doesn't need to wait until symptoms-free to start taper. She likely can start to taper as soon as she is functional with symptoms that are manageable.

I know nothing about titration and I am worse at math. I have tried to understand it but I feel lost.

I will try to provide you with a schedule that doesn't require any math ability. The only thing you will be asked is to learn to read the divisions of a syringe. When you know how, you will be able to draw up the right quantity without any need for calculation.

An here some basics about Liquid Taper through Questions & Answers.

1. Why do we taper with liquid?

We taper with liquid because with this method we can reduce very small quantity of drug at a time. The same quantity CANNOT be reduced by just splitting tablet to quarters or eighths. By reducing tiny quantity of benzo each time, we give a good chance to our CNS (Central Nervous System) to adapt itself to the change with symptoms that remain manageable. When we do tablet splitting, every time we cut by removing a quarter, it's a BIG CUT and results in a huge shock to our CNS. Withdrawal symptoms that kick in are a sign that your cut was too large and you need to slow down.

2. How does Liquid Taper work?

You need first to have your benzo solution. Then with a syringe you draw up every day the needed dose(s). Exactly the same way you would do with any liquid Rx prescribed by a doctor like cough syrup.

3. Benzo solution? What is it? Where can I find it?

Benzo solution is a liquid that contains benzo. Instead of taking benzo under the form of tablets, you will drink the benzo solution. You can find benzo solution by your pharmacist or you can prepare it by yourself.

4. How does the pharmacist do or how do I prepare the benzo solution by myself?

There are 2 ways to prepare a benzo solution:

- a suspended solution

- a dissolved solution

With suspended solution, benzo powder will be mixed up in a special liquid having a certain viscosity. This viscosity will enable benzo particles to remain suspended and well distributed in the solution when stirred. Typical suspension agents are ORA-Sweet®, ORA-Plus® and can be found in pharmacies. Benzo powder will remain powder in the solution as it will not be dissolved.

We have dissolved solution when benzo is uniformly distributed within the solution. Dissolved solution can be obtained by using benzo liquid Rx or tablets. It is greatly preferred when possible to use liquid Rx as it is directly and efficiently mixable with water. When we have only tablets then we need a solvent to first dissolve tablets. Once the tablets are dissolved, we will add water in a precise proportion to get the correct solution

5. Why shall I use a solvent? Isn't water OK?

Most benzos are NOT soluble in water. Water is a POOR benzo solvent and a POOR benzo suspension agent. By using water, high are the risks that benzo particles will be pulled down to the bottom of the recipient by their own weight. By drawing up the solution one may finish to get some benzo or no benzo in his dose. In no way he will get precise dose. Accuracy is a big looser in this.

6. What solvents can I use? And how much of it?

In many pharma formulas for benzo liquid Rx, we can mainly find alcohol (ethanol) or a combination of Polyethylene Glycol and Propylene Glycol. Besides that, as benzo tends to combine with or dissolve in lipids or fats (lipophilic) many buddies use fatty milk to dissolve benzo. The disadvantage of milk is that it can not be preserved for more than 1 or 2 days.

We can also find in pharma formulas 1 mg of benzo dissolved in 1 ml of PURE ethanol. Knowing that the commercial Vodka contains 40% of alcohol, the other 60% being water, it is recommended to use 2 ml of Vodka to dissolve 1 mg of benzo. Alcohol-dissolved solution can be preserved for 10 days with no problem.

7. How much water to add to the alcohol-dissolved benzo?

The volume of water to add must be PRECISE and must take into consideration some parameters:

- To facilitate the calculation, it is suggested to add water in the quantity that the final solution will contain 0.1 mg of benzo in 1 ml (milliliter) of solution. This quantity must take into account the existing volume of alcohol used to dissolve the drug. Exemple: 1 mg of Diazepam --> 2 ml of Vodka to dissolve + 8 ml of water will make a 10 ml final solution of 0.1 mg/ml concentration.

- When fatty milk is used, no alcohol nor water is needed and the milk quantity to use must produce a 0.1 mg/ml solution. Exemple: 1 mg of Diazepam --> 10 ml of fatty milk will make a 10 ml final solution of 0.1 mg/ml concentration.

8. Where shall I keep my solution?

The solution is best kept in a clean, closed jar at room temperature not exposed to sun light. Refrigeration is not required although it does not harm.

9. I see in Youtube that solution is discarded during taper?

The prepared solution is a medication in all aspects. Like with any liquid medication in bottle sold in pharmacy, take the needed volume and let unused solution in bottle for next uses. Do not discard anything unless it is perished milk.

10.Which tools do I need?

- Syringes in 2 sizes:

  - 10 ml with 50 divisions

  - 1 ml with 100 divisions. To use when drawing up small doses for better accuracy.

- A graduated cylinder (100 ml), useful but not required. Syringes and cylinder can be found in pharmacies or on Amazon/Ebay for a few dollars.

- A glass storage jar with a lid. Re-purposed jelly, salad dressing, pickle/olive etc... will be fine.

- Solvent in needed quantity (Ex; Vodka)

11. How much solution shall I draw up each time?

Use this online planner http://benzo.alwaysdata.net/ . Fill in your information and submit. You will obtain a schedule with the doses that need to be taken every day.

12. How much solution shall I prepare each time?

It would be useful to prepare solution enough for 7-10 days.

13. I can see solid particles floating on the surface or at the bottom of my solution. What are they?

Via the solvent, the totality of benzo ingredient is dissolved in the solution. Some solid particles can remain at the bottom but they are just excipients (coating, disintegrator, filler, binder, colorant...) and don't require special attention.

All this seems to be over complicated but it is NOT. Once you have your first question, things will clear up.

Please come back with your first questions.

Thank you Jim.

0.5 is probably right. 1/2 of 1 mg sorry about that

He prescribes her 40 0.5 pills a month

She has always just taken as needed but now is needing more

I don’t think she will be able to taper and finish school. The depression and anxiety is through the roof. I will do whatever it takes to learn how to read the thermometer and to help her with titration. I’m a little slow because my brain isn’t working as well either but I will give it my best. After reading all of this I can see that I will need some help. I looked at the liquid taper plan but do not know the pill weight yet so will have to weigh. I have a Gemini scale. I don’t really know how to fill out the liquid solution, really I feel lost right now. Sorry, I’m willing to learn though.

Thank you, Jackie

Hi jackie brown

1/2 of 1 mg

Yes, it is 0.5 mg and that is fine.

He prescribes her 40 0.5 pills a month

Fine

She has always just taken as needed but now is needing more

Evidence suggests that benzodiazepines are no longer effective after a few weeks or months of regular use. They lose much of their efficacy because of the development of tolerance. When tolerance develops, withdrawal symptoms can appear even though the user continues to take the drug as prescribed. Thus the symptoms suffered by many long-term users of benzodiazepines are a mixture of side effects of the drugs and withdrawal effects due to tolerance where the organism craves for more drug.

I’m a little slow because my brain isn’t working as well either but I will give it my best.

You will see that it is easier than most of us can imagine. I can see your first points are leading you in the right path. You don't have to justify your difficulties. While under benzo I personally was completely unable to fix even a smallest problem. I've got easily lost in a glass water. So I can understand you.

I’m willing to learn though.

I'll try where I can to drive you step-by-step. Don't hesitate to ask. I don't mind.

Could you please ask Becky how many doses a day does she take the med? The question will help to ensure she is not having the so called inter-dose withdrawal. This can be quite possible when one takes just one dose of Lorazepam that has a rather short elimination half-life of 10-12 hours.

If you go for Liquid Taper then you don't need the Gemini scale useful in case of Direct taper. Here is an example of how to generate a Liquid Taper schedule based on an hypothetical 2 doses of 0.25 mg /day.

(click on the picture to enlarge)

And here is the resulting schedule:

Thank you Jim, I will ask her tomorrow how she is dosing because I am planning on seeing her then. I do know she took one yesterday morning and another at 12 because she had a meeting and was pretty amped up. I think that is how she does it very inconsistent. I need to go pick up my dog that just got spayed today. I’ll look over everything tonight and write down any questions for you. Thank you for helping me.

Jackie  :smitten:

Hi Jim! I talked with my daughter and she just takes the Lorazepam as she needs them. For example like I said yesterday she took a 0.5 in the morning and took another 0.5 at noon. Some days she will take 3, 0.5 or sometimes she takes none. She hasn’t taken any since Thursday and is functioning ok just a little edgy and sadness. I might add that she takes Wellbutrin also.

Jackie :smitten:

Hi jackie brown

The fact that in the space of 6 years Becky is taking Lorazepam as needed with the quantity of drug irregularly varying between 0 and 1.5 mg and with no-drug periods up to 3 or more days push me to think her CNS has been submitted to frequent mini stops/restarts of benzo. This can create a special neurological condition which results from repeated withdrawal episodes. Each withdrawal appears to lead to more severe withdrawal symptoms than in previous episodes. Old dose that used to work won't work anymore and it's more and more difficult to taper as time goes by.

What to do? Would Becky accept to start to take regularly say 2 x 0.5 mg or 2 x 0.25 mg a day, see which of these two raises less symptoms, stabilize with it and finally taper from there? If she wishes she can keep on taking Wellbutrin as it seems that it helps.

Hi Jim and thank you. Becky has told me that she usually needs to take at least 2 0.5 to get any relief. So she is going in again to ask for 1 mg from her doctor on Tuesday. As I said before he has not wanted to give that to her but this time she is asking that he would give it to her with the plan to taper off in May after she finishes school. Should she take a consistent dose of 0.5 twice a day until May and then taper from that and if so how would that look? Also should she still ask for the 0.5 pills versus the 1 mg pills?

Jackie :smitten:

Hi jackie brown

Should she take a consistent dose of 0.5 twice a day until May

Yes. Provided she feels comfortable with too.

and then taper from that and if so how would that look?

I would prefer she starts to taper when she stabilises regardless of when. The reason is that the longer we wait the higher is the risk that same dose would become no longer effective due to tolerance. If her taper is slow and gentle then no special unsettling symptoms are expected

should she still ask for the 0.5 pills versus the 1 mg pills?

Both will work. In my case I had the possibility to have both 0.5 mg and 2 mg tablets. Since there are more 2 mg tablets in a bottle, I chose the 2 mg tablet and split it to quarters for each use. They crumbled but the amount of excipients in the tablets is 4 times less. If doctor is OK, I'd go for 1 mg tablet that I will split in 2.

Ok thank you Jim. Let’s wait and see what the doctor does. I’ve been looking over all the titration threads andI ain’t going to lie, I feel lost about how much vodka, how much water, how to read the syringe and what size syringe to use, basically all of it. You have helped a lot of people. How is your withdrawal going?

Jackie

Hi jackie brown

How is your withdrawal going?

I took my last benzo dose some 13 months ago. Apart from eye floaters in both eyes, I feel good with no other symptoms. I'm functional in all my activities, 5 miles hiking every other day included. I really enjoy this moment.

Your Becky will too. Don't worry too much about the formula for liquid taper. If needed ask Becky to have a look. I don't mind to answer your/her questions.

Hi Jim, sounds like you have been doing well. 5 mile hikes, that’s really good for you. I can’t even take my dogs for a walk because it’s raining like crazy here for a week now. What are eye floaters? Thank you for your kind words about Becky. She went to see her doctor today and he will not raise her dose so he will only give her 40 0.5 pills a month. He did ask her if she would want to try Prozac along with her Wellbutrin. She told him she didn’t really want to take it because of getting acclimated to it takes a bit and she is dealing with a lot right now but she wanted me to ask you your thoughts. Thank you for the time you are giving Becky and I.

Jackie  :smitten:

Hi jackie brown

ask you your thoughts.

Here they are: http://www.benzobuddies.org/forum/index.php?topic=211033.0

Jim I cannot agree with you more. I’m going to tell her this and I pray she trust what I’m saying. I don’t want to see her struggle with more drugs. I think she is concerned that the 40 Lorazepam won’t last and she is just trying to get through school. I get it but I really don’t want her to go down the polydrugging road. When I had to go back on the benzo due to becoming so ill and dropping 70 pounds in a very short amount of time my doctor also gave me Mirtezapine 3.75 mg a night so now at some point I get to look forward to coming off of it. This is not what I want for her. By the way her doctor is also my doctor. I think he didn’t up her Benzo because they are starting to crack down on benzodiazepines in our area so in some ways I’m glad but yet now concerned about any taper for her.

:smitten:

Hi Jim, I have been looking over everything you posted me and I am completely lost on this titration tapering. I also don’t have a clue what dose she would be tapering from since her doctor refuses to give her more then 40  0.5 mg pills a month. I really do feel helpless and not sure how to go forward. I want to thank you though for all your help. I’ll try to figure this out as we go. These drugs are a nightmare and not good for anyone.

Thank you again

Jackie  :smitten:

Hi jackie brown

I really do feel helpless and not sure how to go forward

Is there anything you think I can do for Becky?

I’m not sure Jim. I feel confused about the titration. Even the syringe reading. Not sure about her pill dose either. I’m looking at my Gemini scale also but even with that I need to learn what I’m doing. I need to understand how to do all of this. If I don’t know the dose she will be coming off from I can’t even do a formula to even try to learn this. But let’s say she will be coming off from 0.5 Lorazepam once a day. How do I figure this up? How do you know how much water,Vodka etc.. to put in?

:smitten:Jackie

Hi jackie brown

If I don’t know the dose she will be coming off from I can’t even do a formula to even try to learn this.

Agreed

let’s say she will be coming off from 0.5 Lorazepam once a day. How do I figure this up? How do you know how much water,Vodka etc.. to put in?

Solution for 1 day:

1 tablet of 0.5 mg Lorazepam + 1 ml Vodka + 4 ml water = 5 ml of solution, 0.1 mg/ml

Solution for 10 day:

10 tablet of 0.5 mg Lorazepam + 10 ml Vodka + 40 ml water = 50 ml of solution, 0.1 mg/ml

How much to draw up each day?

See blue column.

Thank you Jim, I just screenshot it and will study it. What if I decided to use my gram scale for her? I am thinking I might have to do that for my Mirtezapine.

:smitten:

Hi jackie brown

What if I decided to use my gram scale for her?

You will need to weigh 10 tablets and let me have the value. Before using the scale, tare it to be as consistent as possible.

Ok Jim, I can’t convey to you enough how much your help has meant to me. I will look over everything, pull out my titration cylinder and stuff and do some pretend rounds. I will write down any questions. I’m also going to play with my scale on some old pills. I’ll get back to you with questions and decide after that. You are a wonderful person to take the time to help others that can barely think half the time.

Thank you!

Jackie  :smitten: