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Discouraged! Why is this last little bit of librium causing so much havoc?


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I'm trying to get off my last 5mg of librium and it is making dizzy, very unstable walking, nauseous and have head pressure.  I've been doing a water titration because it only comes in capsules. I open the capsules and put in water only.  Should I be trying to dissolve the librium powder with a couple ml of vodka first?  I was told early on that librium was water soluble, so no need to dissolve with alcohol.

 

I can't believe how bad this affecting me.  I've reduced just over 30% so far.  I was on 10mg back in 9/19 and doing fine before starting this benzo withdraw.  My PCP suggested that I should taper off it because as I age it could make me dizzy and may cause me to fall.  What a joke, I've never been so dizzy in my life, trying to get off this benzo!

 

Any suggestion please?

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Hello, Spartan.  I’m sorry you’ve hit a rough patch.  My understanding is the same as yours, chlordiazepoxide hydrochloride is water soluble.  Were you advised that (a) pure chlordiazepoxide hydrochloride is unstable in solution and (b) your homemade liquid may have characteristics of both a solution and a suspension due to the fact that the capsule you are using does not contain the pure active drug substance (ADS) alone but rather the ADS along with other ingredients?

 

Hats off and thank you for including your signature — this makes it so much easier for members such as myself to provide feedback!  Per your signature:

 

4/20 - 5mg

5/20 - 4mg (5mg to 4mg = a 20% reduction in a month)

6/20 - 3.5mg (4mg to 3.5mg = a 12.5% reduction in a month)

 

If I were in your shoes, I would consider: (1) holding for a bit to stabilize (stabilize means symptoms are not changing and are tolerable, not the absence of symptoms) and (2) decreasing my taper rate.

 

It is not uncommon for members to discover they need to decrease their taper rate when they get lower in dose.  Or, to phrase it another way, “Go slow as you get low.” 

 

PS Here is an online tool you can use to calculate your taper rate:

 

Percentage Change Calculator

https://www.calculatorsoup.com/calculators/algebra/percent-change-calculator.php

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Thanks Libertas for responding. 

 

The drug I'm on is Librax, prescribed by GI doctor 15 years ago for post surgical colon pain and Ibs.  Each capsule has 5mg of librium and 2.5mg of clidinium, which is  a anticholinergics/antispasmodics. 

 

I took it as prescribed and was told by my two former GI doctors that It was on a "baby dose".  I never up my dose and seemingly felt okay on it.  At this point I'm kind of regreting going off it.

 

Do you think that since Librax has two different drugs in one, that it may be causing some problems with the titration?

 

I recently held for 10 days and started up again.  Perhaps i should have gone longer.   

 

Did you use a compound pharmacy to prepare your meds?  I wondering if I should look into that since this Librax has two meds combined.

 

All the best

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You are most welcome, Spartan.  I wish I could help with your question about the clidinium in your Librax capsules. Regrettably, I am neither a compounding pharmacist nor a pharmaceutical scientist so cannot.

 

I missed that you were taking 10mg/5mg of chlordiazepine/clidinium back in 9/19 (fwiw per Ashton, 10mg of chlordiazepine is equivalent to 4mg of diazepam).  I’ve added it to your taper history as follows:

 

9/19 - 10mg chlordiazepine (doing fine)

4/20 - 5mg (10mg to 5mg = a 50% reduction in 7 months or about 7% a month)

5/20 - 4mg (5mg to 4mg = a 20% reduction in a month)

6/20 - 3.5mg (4mg to 3.5mg = a 12.5% reduction in a month)

 

Were your withdrawal symptoms tolerable at 5mg of chlordiazepoxide and 2.5mg of clidinium?  (I’m trying to get a sense of what your maximum taper rate might be moving forward.)

 

Yes, I use a compounding pharmacy. My compounding pharmacist and her team have been incredibly helpful and supportive.

 

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Hi Libertas,

 

Yes I was on two capsules of Librax (10mg of chlordiazepoxide/5mg clindinium) for 15 years.  Never had interdose withdraw or any ill feelings from it until I did a fairly rapid taper and jumped after 26days. 

 

I had read Ashton schedule for librium withdraw and understood you could cut 2.5mg every week or two.  I jumped off a couple days early at 2.5mg and hit the wall. 

 

I had checked with my PCP, current GI doctor and pharmacist.  All approved of my plan and obviously they had no idea.  The day after I had all the crazy symptoms.  I immediately reinstated on 2.5mg.  I continued to struggle for a week until I was able to see a chem. dependency doctor.  He put back on 5mg. 

 

All symptoms went away with the of exception of what they call floater/boater legs. That symptom also improved over several month, but didn't go away completely.  Since doing this water titration the floater/boater symptom has gotten much worse.  This is the most worrisome symptom and I pray to god It will go away eventually.

 

All the best

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I was on Librax for several years and quit taking them Jan 2020. I just opened the capsules and divided the powder the best I could over a period of 4 months. I kept reducing the amount at a rate that was suitable for myself until I was taking a very small amount per day, when I was down to less than 1/4 capsule per day I stopped. Wasn’t easy but it’s been about 6 months now and I’m doing ok.
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Hello again, Spartan.

 

I’m sorry you have the floater/boater symptom but glad you’ve discovered “The Dizziness Group: For those who are floating, boating, falling or flying.”  Member Lapis2 does a stellar job of facilitating that Support Group.

 

Your situation is challenging.  You’ve had one failed discontinuation due to a too rapid taper, followed by a reinstatement, albeit at a lower dose.  You’ve now hit a rough patch in your second discontinuation attempt.  Regrettably, there’s no way to know if this rough patch is due to a too rapid taper rate, the homemade liquid you are using, a combination thereof or something else.

 

The length of time you took Librax (15 years) coupled with your discontinuation history suggest the need for careful deliberation re: next steps. If you’ve already decided how to proceed, skip the following.  If not, here are some “brainstorming mode” options:

 

(1) If your symptoms are tolerable, hold both your current drug source (i.e. your homemade liquid) and your current dose (3.5mg) constant in hope you will stabilize.

 

(2) If your symptoms are tolerable, change your drug source (e.g. use Outdoors2020’s “dry” strategy, consult with a compounding pharmacist about options) while holding your current dose constant ... again, in hope you will stabilize.

 

(3) If your symptoms are not tolerable, updose and return to your original drug source (i.e. a full capsule of Librax) in hope you will stabilize. 

 

Needless to say, each of the above options has pros and cons and there are other options.

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Thanks Libertas for the suggestions,

 

As of today I'm done with this water titration.  I've been mucking around with this water thing for several months and hoping that I would have a smooth taper.  I never felt well the whole time and really think I was getting very little of the drug. 

 

Today I just cut the capsule in half, poured it in a spoon, put half of the other half in the spoon and washed it down with a glass of water.

So I took approx. 3.75mg of the Librax.

 

This is what I did back in Sept. 2019, however like I mentioned before I reduced 2.5mg every week per Ashton schedule.  Obviously that was to fast for me.  I will now hold for a couple months before making further reductions.

 

All the best 

 

 

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You are welcome, Spartan. Good for you for making a decision. Holding at your current dose, returning to a drug format that has worked for you in the past, and slowing your taper rate are sound strategies. On the outside chance you haven’t already read it, according to the drug information pamphlet for Librax at DailyMed, the active drug substance in your capsule (chlordiazepoxide hydrochloride) must be protected from light.
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Thanks Libertas, 

 

I would be remiss if I didn't ask you how your taper is going.  How long have you been tapering, what syptoms have you had and any idea when you want to step off?  Also it sounds like you are happy with your compounded drugs.  How much is withdrawn from the drug and over what period of time?

 

All the best

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Hello, Spartan.  After much reading and experimentation, I am currently implementing a pharmacologically informed, symptom-driven mini-taper.  This is just a fancy way of saying I make “small enough” reductions in dose on a schedule that is informed by the half-life of the benzodiazepine I take, how my body processes that benzodiazepine, and the pattern (waxing and waning) of my withdrawal symptoms. 

 

The stability-tested, compounded oral suspension of clonazepam has worked well for me. (Unfortunately, an FDA-approved oral solution of clonazepam is not available in the US.) I use it just like any other liquid medication.  I measure my dose using an oral syringe and then ingest it.

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Hi Spartan

Wanted to share I take Librium and reduce a micro amount daily by pouring the capsule out weighing the powder and then recapsule it. The system works well for me. Although I do a fairly slow rate of .025mg a day reduction.

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Hello Libertas,

 

It sounds like you have a good plan.  I hope you have a very smooth taper going forward.  Thanks again for all your suggestions and advise over the past few days!

 

All the best

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Thanks for responding Jlavogt,

 

As you can see I gave up on the water titration and went back to dry cutting too.  Since I just have to get off the last capsule, I just cut it in half, pour in spoon, pour half of the other half in the spoon, ingest it and wash it down with a glass of water.  I plan on holding for a couple months.  I might take up what you are doing from that point or drop to 2.5mg (half pill) and see how my body responds.

 

All the best 

 

 

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