Jump to content

Fast (and Furious) or Smooth? Pick one!


[Ji...]

Recommended Posts

Hi buddies :hug:

 

Background

When back in Feb 2018 I laid down first ideas for the application "Benzodiazepine Daily Taper Plan", my objectives were two:

1. Assist buddies who hate maths and spreadsheets to prepare their own taper plan

2. Help minimize symptoms through a smooth reduction during the entire tapering exercise

 

When the first version of the app became available, feedbacks from buddies flowed in. Surprisingly I've been asked by many why the app did not have the function to reduce a fixed quantity like for instance 0.1 mg/14 days (vs 10%/14 days). With all evidence, the requested approach would be more 'natural', easier to understand, easier to remember, easier to execute for both titration users and tablet-splitters. When I made some research, I surprisingly realised that most of the community buddies, to not say 100% of them, are tapering by removing a fixed quantity of benzo each day. So although I hated and still hate what I did, I finally embedded this approach in the application.

 

Fast (and Furious)

I still clearly remember a post from a buddy. Instead of celebrating the milestone of 1/2 tapered off after many months, she suffered severe withdrawal symptoms that suddenly arose during the last few weeks. With DLMT (Daily Liquid Micro Taper) she has been reducing for months a fixed quantity of benzo per day. Everything seems under control when unsettling symptoms suddenly kicked in and caught her off guard. Incomprehension, doubts, anger, shouts and kicks followed: "But why? I have always followed a state-of-the-art DLMT and have always reduced a SAME amount every single day!".

 

Let's try to see what drove to that furious reaction! Let's take a simple example: taper Klonopin 1mg/day with reduction 10% every 14 days. At the start this is equivalent to a reduction of 0.1 mg/14 days. After the first 14 days, we have 0.9mg/day left to taper. By cutting the same 0.1 mg/14 days the percent of the cut is no longer 10%, it is now 11.11% (0.1/0.9*100) of the current dose. Every 14 days that passed this percent continues to increase although buddie has never changed the cut. When buddie arrives to half way with 0.5mg/day left to taper, the percent of the cut has become now 20% (0.1/0.5*100) of the current dose. It's a huge cut and symptoms are the way her body begs to have a break. I just cannot bear the idea of how the disaster is like when buddie arrived close to the end!

 

Comparing to the fixed percent approach, the fixed quantity approach offers the advantage to be faster. The taperer sees the target very close and it gives great motivation to grit the teeth and go ahead. It does not however take into account the associated disabilitating symptoms towards the end nor potential protracted symptoms that might result from a too fast taper.

 

Smooth

The other approach is the fixed percent approach. By using the above example, at the start the reduction quantity is the same 0.1 mg/14 days. After the first 14 days, we have 0.9mg/day left to taper. From this point the reduction is no longer 0.1 mg/14 days. It has become 0.09 mg/14 days (10% of 0.9mg). It decreases following the lower dose left to taper. The lower you go down the lesser you cut.

 

The fixed percent approach offers the advantage to be smoother from a symptoms perspective. If the percent suits at the beginning with symptoms that are manageable then buddie will likely continue to have manageable  symptoms until the end of the exercise. It is slower and requires more time to complete the entire taper.

 

With very few exceptions, for instance when buddies are on benzo for a very short time, I largely prefer this approach.

 

How to?

Due to the very large number of Fast (and Furious) buddies who want to taper fast, the app has been set with Fixed Quantity proposed by default. Once the daily doses are set, the app proposes a default reduction quantity (mg) equivalent to 5% of the daily total dose. The field is editable for buddies who wish to enter their own values. While manipulating the Quantity (mg) field, the Percent (%) field is protected and cannot be edited. When the resulting graph is a straight line, you know that you are in the Fast (and Furious) mode :laugh:.

 

Should buddies wish to use the Smooth fixed percent approach, the field Quantity (mg) must be cleared first. Once done, it will turn the Percent (%) field editable and ready to accept new values. When the resulting graph is a hyperbola curve, you know that you are in the Smooth mode :D.

 

Hope it helps.

Link to comment
Share on other sites

  • 2 weeks later...
×
×
  • Create New...