Ashton c/o from 6mg X to V for those age 65+

On 7 Jan 2019, I started the Ashton Schedule 1 (which fit my predicament exactly): "Withdrawing from high-dose (6mg) alprazolam daily with diazepam substitution". I was desperate to stop my spiralling Xanax dependence ASAP.  It was getting worse and I was getting scared.

As you can see in my signature area below, I've been able to reduce my Xanax from 6mg to 3.5mg in about 4 weeks, which was amazing and extremely encouraging to me! (I do realize it's going to be a LOT slower from now on.)

I started the program with the full recommended doses of alprazolam and diazepam, but after a few days, I soon developed overwhelming sedation that kept me in a coma-like sleep for up to 12 or more hours a day.   Surprisingly though, I could wake up with coffee and function pretty well after these "comas". Others here had been right - the sedative effect of Valium does seem to gradually decrease with usage...but a few days ago I also decreased the Valium itself, apparently decreasing it way too much, considering the misery of my symptoms today. Is this the Valium lag I've seen mentioned here?

My current Xanax dosing (1g - 1g - 1.5g) and my “total diazepam equivalent” (85mg - down from 120mg!), would put me around Stage 7 on Schedule 1 now. However, I haven't stopped the evening 1.5mg of Xanax because it quickly relieves w/d symptoms that  keep me awake - and I have significantly reduced my Valium intake to just 15mg a day (5g - 5g - 5g) versus the 50mg called for in the Ashton Schedule.

I made this drastic reduction because I got more and more worried (Like a good BB member, I do anxiety very well!) that the recommended daily Valium doses were getting extremely high (50mg a day from Stages 5 through 12! That’s an 8- to 16-week time period!). Given my initial coma-like response, I began to feel I needed to reduce the Valium, afraid I would stop breathing in the middle of the night. My worries were amplified when I saw that my insurance company had put a "prior explanation from physician required" block on all diazepam coverage for those age 65+ (but not on K. or X.!), and I had to find out why!

I kept reading experts saying that the older one gets, the more poorly one metabolizes and gets rid of the long-term Valium, which can accumulate to dangerous levels in the body - unlike Xanax, which is in and out in a relative flash. I repeatedly saw that those over 65 like myself should take only half the "regular maximum adult dose of 10mg" or 5mg. But at 15mg, I'm already taking triple the half-dose generally recommended by most sources.

This finally popped out at me: Ashton Manual, Chapter 1: Adverse Effects of Benzodiazepines: Adverse Effects in the Elderly:  “Older people are more sensitive than younger people to the central nervous system depressant effects of benzodiazepines….For these reasons, it is generally advised that, if benzodiazepines are used in the elderly, dosage should be half that recommended for adults.”

At 3.5 Xanax and 15mg Valium taken through the day, I have been able to fall asleep just fine for the past few days and even wake up at a decent 7 AM. But last night, 3 or 4 hours after going to bed, I woke up with my typical “first-wave” w/d symptoms:  Wet cold feet, burning eyes, rising BP, and growing anxiety. 1mg X. and 5mg V. put me back to sleep within the hour. (Apparently, Valium lag from the earlier larger doses had finally run out on me.)

And then I woke up at 6 AM or so. So I'm not sleeping for 12 hours plus anymore, at least. But honestly, I’m not feeling very rested, either.

I seriously wonder how concerned I should be about this accumulation of Valium as a 67 year old. I'm still trying to figure out how to handle it safely in my taper. How will I know if I reach levels that are too high? 

Dr. Ashton herself is not quite clear about this:

Ashton Manual, Chapter 2: The Withdrawal: Part 2: "With relatively short-acting benzodiazepines such as alprazolam (Xanax) and lorazepam (Ativan)...it is not possible to achieve a smooth decline in blood and tissue concentrations. These drugs are eliminated fairly rapidly with the result that concentrations fluctuate with peaks and troughs between each dose....For people withdrawing from these potent, short-acting drugs it is advisable switch to a long-acting, slowly metabolized benzodiazepine such as diazepam....The switch-over process needs to be carried out gradually....”

Then in Part 4: "Methods of benzodiazepine withdrawal in older people are similar to those recommended above for younger adults. A slow tapering regimen, in my experience, is easily tolerated, even by people in their 80s who have taken benzodiazepines for 20 or more years. The schedule may include the use of liquid preparations if available and judicious stepwise substitution with diazepam (Valium) if necessary.(??) There is, of course, a great deal of variation in the age at which individuals become "older" - perhaps 65-70 years would fit the definition in most cases."

I would welcome any advice or experiences of other older benzo users who have had success (or struggle) with a cross-over to Valium.

Thanks in advance. Your fellow victim of benzos,

Ailuron

I am no expert, but I am trying to switch over from Xanax to Valium as well. I would hold for a while to see how you react to the Valium for awhile longer. I am told its effects can take awhile to show up, and indeed some of its effects took about a week before catching up to me. The general advice seems to be to crossover completely from Xanax to Valium relatively quickly, and from what I know this  seems to come from Ashton. I had originally wanted to crossover relatively quickly to 12.5 mg of Valium But after getting a sense of how sedating Valium can be I have chosen to stay with the mixed dosing a bit longer and crossover nearer to 5 mg Valium.

Not sure if that helps

Thanks, Matt!

Your message has indeed been helpful to me and I'm sure to others who juggle with the difficult transition between these two very different benzos. The Ashton schedule for this c/o is not for everyone.

I myself have also decided to hold to a mixed dosing for a while until I get over the strongly sedative (and unpredicatably delayed) effects of Valium. I too wanted to transition from Xanax to Valium quickly and commence a regular tapering off, but I didn't realize how very different dealing with Valium can be, nor how sensitive I am to it (being over 65). Xanax to Valium is perhaps the most extreme change of benzos and not a simple transition to make.

But here's to our success. We can do it!

Ailuron