Jr Buddie Seeking Support with Planning Taper

Hello,

 

I am just pulling out of an attempt to quickly taper (approx. 3 weeks) from Xanax, which was unsuccessful and resulted in severe GI withdrawal symptoms. The quick taper was suggested by my PCP due to the low dose (max .75mg daily) and sporadic and 'short-term' duration (approx. 3 months) of my recent use. But, alas, my sensitive system wasn't cooperative. I am starting my third day of reinstatement and trying to titrate to determine my baseline dosage for a slow, safe, and effective taper. Based on the dose that seemed to trigger my withdrawal symptoms during the initial taper and the dose that now seems to effectively reduce/remove the withdrawal symptoms, this baseline dose is likely .37 - .5mg daily. I currently have plenty of .25mg tabs of Xanax, but my PCP is supportive of prescribing whatever is needed to get me through this taper and detox. Please, I will be grateful for any guidance on how to structure my taper in the weeks ahead. Be safe. Be well. 

Hello JustHope,

 

You're wise to reinstate a the lowest possible dose in order to stabilize, I'm very glad to hear you're judging this by your symptoms.  This will help you as you taper, the best guide you have is your body and it's reactions to the reductions.

 

I'm sorry to hear your body became dependent so quickly but this is very common and when it comes to these drugs, no dose is small.  Can you tell us how many times you dose each day and it is your preference to taper from the Xanax or cross over to a longer acting benzo?

 

Pamster

Hello JustHope,

 

You're wise to reinstate a the lowest possible dose in order to stabilize, I'm very glad to hear you're judging this by your symptoms.  This will help you as you taper, the best guide you have is your body and it's reactions to the reductions.

 

I'm sorry to hear your body became dependent so quickly but this is very common and when it comes to these drugs, no dose is small.  Can you tell us how many times you dose each day and it is your preference to taper from the Xanax or cross over to a longer acting benzo?

 

Pamster

Hello JustHope,

 

You're wise to reinstate a the lowest possible dose in order to stabilize, I'm very glad to hear you're judging this by your symptoms.  This will help you as you taper, the best guide you have is your body and it's reactions to the reductions.

 

I'm sorry to hear your body became dependent so quickly but this is very common and when it comes to these drugs, no dose is small.  Can you tell us how many times you dose each day and it is your preference to taper from the Xanax or cross over to a longer acting benzo?

 

Pamster

 

 

Hello Pamster,

 

Thank you for your reply. I hope that I am replying in the proper format!

 

Prior to the initiation of my tapering adventures, I mostly dosed based on feel of need. With the tapering, however, I have tried to evenly space the doses. Right now I am taking .12mg (a half tab) of the Xanax every 4 hours. . . 9am, 1pm, 5pm, 9pm. Yesterday, my 9pm dose was just .06mg for a total daily dose of .42ish mg. In the 2.5 days of reinstatement of Xanax I have gone from pretty much a shut-down of the GI processing to being able to tolerate a light meal or two later in the day. I am tending to get a bit queasy during the hour after eating (clearly my stomach is still a bit touchy), but things have improved tremendously. I hope this answers your questions adequately. If not, just let me know. I appreciate your help. 

OOPs,

 

Forgot the issue of Xanax or crossover to Valium. . . I am open to whatever might seem best. Someone else in the forum suggested that crossover might not be necessary.

 

It appears as though the introduction of crossover doesn't happen until approximately midway through the tapering process. Are their signs of which approach might be best that one can watch for/monitor during the early stages of tapering?

Most members don't cross over to Valium as many prescribers aren't comfortable putting their patients on another benzo, as a result I've seen many taper from Xanax using the same method you are, lots of doses each day.  The only reason to cross over is if you can't go another day on a short acting benzo but if you're able to tolerate it, then as I said, you can be successful.

 

It looks as if you're already very good at cutting your pills, what is it you need from us, are you wondering how or by how much to make your first reduction?

 

 

Yes, please, how much should the first and subsequent reductions be? Also, for my baseline, stabalizing dose am I looking for what will leave me symptom free? Yesterday brought only very mild GI signs. Same for today, except nausea that started about and hour after my first and only light meal in the afternoon. I have taken my 3rd dose for the day and an hour after that dose feeling minor relief. Should I take my 4th planned dose of .12mg early or plan on adding an additional amount of xanax to my daily plan?

Stabilizing does not mean symptom free, you'll find this to be true when you start to taper.  It's your decision as to what you feel is the right dose for you, Professor Ashton suggests starting your taper from a stable place so let this be your guide. 

 

I hope you understand though, that this is an unpleasant process and there is not much hope of withdrawing symptom free and once off the drug, you're still going to have some healing to do.  I don't want to cause you distress, I want to prepare you for what lies ahead.

Thank  you. . . I just want to make sure that I am able to take in some nourishment and fluids.

 

This is brutal.

It is brutal, but you're right, you're going to need to eat and drink.  Too many people lose a lot of weight during this process so it's important to get as much nourishment in you that you can. 

 

What did you decide to do, are you going up a bit more in dose?

Hi JustHope

 

I will try to find a few answers to your different queries.

 

how much should the first and subsequent reductions be?

By using Xanax 0.25 mg tablets, currently you are taking every 4 hours:

- 9am 0.125mg

- 1pm 0.125mg

- 5pm 0.125mg

- 9pm 0.06mg

for a total of 0.435mg/day of alprazolam.

 

The general recommendations are to reduce between 5-10% every 10-14 days. By following these recommendations the lowest taper speed would be 5% over 14 days while the fastest taper speed would be 10% over 10 days. It is also recommended to start slow and gradually increase following the reactions from your body. If you want to see how a possible taper plan in your case might look like,  here it is. If you do, have a look at the ReadmeFirst for clarifications.

 

stabalizing dose am I looking for what will leave me symptom free?

Only few people taper with the chance to be symptoms free. Some lucky buddies might have mild and manageable symptoms but most of us do not have that chance. Usually it is the presence of unsettling symptoms that push buddie to taper. If you feel that your symptoms are manageable and it leaves you to live your life without been permanently nailed to bed unable to move a finger then I believe you can start to taper.

 

Should I take my 4th planned dose of .12mg early or plan on adding an additional amount of xanax to my daily plan?

If your symptoms are bearable and you can 'forget' about them by other distraction activities like yoga, walk, reading, ... then hold at the current dose and possibly avoid to updose. Your CNS will learn to adapt to the new situation of less benzo and you will gradually feel less discomfort. If you get a good 'attitude' this time, the same unsettling symptoms might come back during the real taper but now you have learnt how to deal with them.

 

Do your best to nourish yourself properly. Your CNS needs your support when you start the road towards freedom.

 

All the best.

Thank you to all for your feedback and input. I have two other serious health issues that need to be factored into my choices here.  So, based on these and lessons learned yesterday, I am trying a slightly shifted approach for my stabilizing baseline with a higher daily dose and increased frequency of dosing:

 

By using Xanax 0.25 mg tablets, I plan to take the following doses every 3 hours:

- 8am 0.125mg

- 11pm 0.125mg

- 2pm 0.125mg

- 5pm 0.125mg

- 8pm 0.06mg

for a total of 0.56mg/day of alprazolam.

 

Thank you for the conversion app. This should be very helpful, and I will explore its use shortly. My biggest concern regarding this step-down process is the unlikely chance of being able to really control the dose size using a pill cutter, but we work with what we have! Too bad I am retired and no longer have access to a lab.    I will definitely start with a slow taper and see how it goes.

Regarding the important management of symptoms and necessary/essential nourishment. I have recently phased out of a half-century career that, in part, involved not only using relaxation techniques, but helping others reduce the negative influences of stress on their bodies and psyches (fields: e.g., neurophysiology, psychophysiology, clinical psychology, neuropsychology). Lord knows, I am no stranger to the effects of stress, nor to the huge benefits of yoga, meditation, exercise, etc., and I have used these throughout my process of battling more recent deterioration in health and functioning. In fact, these challenges are what led me to try the benzo route as a short, temporary aid when the going was tougher than I could handle. This was not an easy adjustment for a person who normally forged through stressors and challenges without flinching. . . but I did adjust and have improved. It is frustrating to have to deal with this additional set-back, but I have accepted the reality and ready to start this battle and healing process. The symptoms that I have experienced due to this disruption of my natural brain and peripheral chemisty are a threat to more than my gut and comfort level. Hence, my caution and self-protective feelings as I restart the quest for freedom from benzo interference! I have much to live for and more that I want to do for others. Again, thank you to all of you for offering your perspectives. I am grateful to not have to do this alone and grateful to have the shared wisdom of those who have been there and done that. There is no more valuable support to have. 

Hi JustHope,

 

...being able to really control the dose size using a pill cutter...

Well your doubt is justified! You can't actually control the dose that is more accurate than a quart of a tablet by tablet splitting. You could rather easily split a 0.25 mg tablet to 4 quarters of 0.0625 mg each. But what if you need to go to further down to 1/8 = 0.03125 mg necessary for your taper? Actually a number of unaware buddies taper by tablet splitting. With this method you can taper at best a quarter of a tablet at a time. This taper method depends uniquely on the ability of the person to split a tablet to 4 equal parts but does not take into consideration the impact at the moment of the drastic cut to the organism that badly tolerates cut in the order of 25% (=1 over 4), 33% (=1 over 3), 50% (=1 over 2) when you cut one quarter after the other. Knowing that splitting the tablet to 8 or 16 parts is nearly impossible, tablet splitting is probably amongst the less indicated methods to taper benzo.

 

What to do then? Instead of doing tablet splitting taper where at best you can taper a quarter of a tablet at a time, consider to micro taper with either Dry cut or Liquid taper.

- For dry cut you will need a precision gram scale to weigh out the needed dose from a number of tablets previously reduced to powder.

- With liquid taper, it is preferable that you start with a doctor prescribed Rx Liquid. But if you don't have a Rx liquid, you can transform your tablets to liquid via a solvent (Eg: Vodka, PG, milk...) to be then diluted with water to make up the right volume. Another way is to get a compound solution directly prepared by your pharmacist. With liquid taper, you will draw up the needed dose by using a syringe. Liquid Taper is more accurate from a dose measuring viewpoint.

 

For both methods it is recommended to follow a taper schedule previously established based on the general recommendations to reduce between 5%-10% every 10-14 days. It is also recommended to taper on a daily basis to minimize withdrawal symptoms.

 

All the best.

Thank you, Jim Hawk,

 

I will check with my PCP first about the Rx liquid option. This sounds like a good approach if I can get the professional support for it.

 

Oh, and my weight loss so far in this new adventure is just under 15 pounds in 4 weeks. . . nice side benefit.