Temazapan to Diazapan.. Yay or nay?

Hello,

 

I'm just trying to figure out my taper plan. Ive been taking Temaxapan very irregularly for 4 weeks. Getting interdose withdrawals. Ive been given poor advice from Drs & specialists to "just stop taking it" so im trying to work out a plan so that i can function. I've read the Ashton manual & they suggest switching from Temazapan  to  Diazapan. Im about to stabilise my dose (5mg in the evening). But the equivalent dose would be quite low I believe (2mg). I was thinking of switching over and taking maybe 1mg morning & 1mg night and immediately  tapering. Although I'm reluctant to I produce another drug into my system. Does anyone have any experience  with this?

 

Have you ever taken benzos before the Temazepam you have taken sporadically over the past 4 weeks? For what reason was it prescribed?

 

I doubt it would make sense to substitute after only 4 weeks of irregular use. The people who need to switch to diazepam are long term users who can't function at all if they miss their dose. The fact that you're able to use irregularly, even though you have some interdose withdrawals, suggests that you're not at the same level of dependency.

 

It would be helpful if you could describe your symptoms in more detail as well as how much they are affecting you. It's difficult to give good advice without these details. Most people have to accept that they are going to be affected by some challenging withdrawal symptoms.

Thanks so much for your reply.

 

I have Generalised Anxiety Disorder which manifests mostly as health anxiety. Last year, I had some stress in my life and I had some real trouble sleeping so Temazapan was prescribed to take on an 'as needs basis'. I was very careful to only take it once or twice per week and had some long spaces in between doses. I took 10mg doses and I perhaps took ten doses in total over 3 months. I stopped taking it with no issues.

 

This year, around May/June my sleep issues returned and I had some leftover Temazapan in the cupboard so I started taking them again. I was careful to take only once or twice per week over around six weeks. I stopped taking them without giving it a second thought.

 

I went to a Psychiatrist and described my sleep problems. He gave a perscription for Valdoxan (which is a basically like a melatonin but very strong. Its classified as an antidepressent but its more targeted at helping sleep). It seemed to work well for the first week but in the second week I started getting severe anxiety and severe insomnia. At the time, I blamed the Valdoxan but in hindsight I think I may have been withdrawing from the Temazapan.

 

Stupidly, I asked my Psych to give me another script for Temazapan and I started taking it again. This time I needed 20mg and even that wasnt giving me a full nights sleep. While I was starting back on the Temazapan, I started having night time panic attacks. I would fall asleep and then half an hour later I would wake up in an extreme panic. I also had night sweats. I put this down to my anxiety (but I think these may have been withdrawals from the Temazapan usage back in June). My psych said I should take Mirtazapine so I tried this for two nights and also Valdoxan. During this week I was on Mirtazapine, Valdoxan, Cirtalopran, Temazapan so its hard to say which drug was causing symptoms but I was experiencing night time sweats, hypnic jerks, twitching.

 

Again, I was taking the Temazapan sporadically (thinking this was a avoid dependence). My usage has been all over the place, sometimes 20mg, sometimes 10mg and sometimes, four days in between doses.

 

I've been given so much conflicting information, and as I'm sleep deprived, my decision making ability is not at its best. I saw an addiction specialist who told me that I absolutely was not dependent on the drug. She gave me a 'taper' plan which basically saw me space my doses out taking 10mg ever second day and then every third day and then no more.

 

Last week I did exactly that. I took 10mg Monday night, Wednesday night and Saturday night. My only real symptom was severe anxiety and insomnia. I slept OK on the nights I took Temazapan and on the night after I slept equally as good. By the third night though, i have difficulty sleeping (it could be my anxiety about sleeping playing a part also).

 

This week I halved all of my tablets and dropped my dose to 5mg and I took 5mg Monday night and 5mg Wednesday night.

 

Last night I felt panicky at bed time, as I lay in bed my heart was racing. I didn't want to take a Temazapan, I was going to try to stop taking them all together and see what happens but I caved and took one. I woke up in the middle of the night covered in sweat. I also had a glass of red wine with dinner so i'm not sure if that was a contributing factor.

 

Overall, the past week my symptoms have been insomnia, anxiety, some increased anxiety at bed time (panicky) and last night some night sweats.

 

I did have insomnia before starting temazapan which is how I got here to begin with.

 

I am a mother to two young boys and I also need to work. I've taken 8 weeks off while I deal with all of this but I will need to go back as I need to earn an income.

 

 

 

 

If it were me, I would stay on what you are on and reduce your dose slowly by 5 to 10 percent every 10 days or so. I only cut my dose once a month but I'm on a different drug and I have been on it for a long time. I'm not sure you'd want to switch drugs since you've only used them for a short time? Either way, I would still recommend a slow steady taper.

I'm glad you posted all of that. It's possible that you're getting conflicting advice because people are trying to make suggestions without knowing these important details.

 

If I'm understanding you correctly, you have taken 30mg temazepam in a week and you're having interdose withdrawals that are moderately severe? By that, I mean bad enough to make you miserable and affect your functioning but not so bad that you're in complete agony. Does that sound fair?

 

I think you should convert to a daily dose of temazepam. No need to convert to diazepam unless you start having trouble. While you take 10mg, that is not currently daily. Based upon your body being dependent on a bit more than 30mg temazepam per week, 5mg per day is a good place to start and conveniently half of a 10mg tablet. Doing this will help to level out symptoms. You will probably continue to have symptoms but rather than big ups and downs, it should even things out so that you can function more normally.

 

I'd suggest taking 5mg per day for a week at first and then see how you feel. I would then come back to the forum and ask for advice on a tapering plan. If 5mg per day had you settled within a week, then it is probably a good idea to try and reduce quite quickly. If you're still agitated, it might be better to go slower and perhaps much slower. All the other meds make things more complicated. It's a lot for your body to take every time you start and stop a medication. There's way too much changing around and it's little wonder that you're a bit discombobulated!

Yes, you have pretty much summarised exactly where I'm at and your suggestion is along the lines of what I was thinking.

 

Over the past four weeks, my usage has been so all over the place as I try to figure out how I get off this stuff:

Week 1 - 60mgs across four days (panic attacks, severe anxiety - could have been withdrawals from taking it in June or could have been the antidepressent that I tried)

Week 2 - 40 mgs across two separate days (worst week, tried Mirtazapine, Valdoxan, anything to sleep, was having sweats, jerks - could have been the temaz, could have been the other stuff)

Week 3 - 70mgs across six days (still severe anxiety)

Week 4 - 30 mgs across three days (some insomnia, still anxious but starting to settle)

This week - 10mgs across two days (some insomnia, bit of anxiety, starting to settle)

 

You are correct that the interdose withdrawals are enough to make me miserable but i'm not in complete agony.

 

I agree, I think I should convert to a daily dose of temazapan and I think 5mg is a good place to start. I am loathe to take the pill as I actually hate it however I feel like I need to stabilise and level out my symptoms before I reduce. 

 

I found a compounding chemist and have arranged to make tablets in 1.25mg so that will make tapering easier.

 

Thank you again. It is really good to have another opinion on all of this as I am so clueless but trying to learn as much as I can in a sleep deprived, anxious state.

 

 

It's a really tough situation to give advice about. Your usage is in this grey area where you might be chemically dependent but it's not necessarily the case. What you may be treating is rebound anxiety which would gradually fade if you abstain from benzos or anything risky like alcohol. In that case, the best advice would be to do a rapid taper but not where you're skipping days. There may be some difficult symptoms but getting off the drug before you become dependent should be the first priority, if at all possible.

 

However, if you're chemically dependent, then trying a rapid taper could make things a lot worse. This is why I said take 5mg for a week to see where you are at. If you stabilise quickly, I think you should go ahead and reduce to 2.5mg per day for a week. This would be an insane reduction for someone who is chemically dependent but may be manageable for you. If it is not manageable, it'll be obvious, and then you can go back to 5mg and follow a gradual taper as gets widely recommended here. I have a hunch that you'll be alright since you missed days. After a week at 2.5mg, if you manage it and depending on your symptoms, you could either hold your dose, go back up to 5mg, make another large reduction or start making smaller reduction. If you can tolerate symptoms, quicker is better so you get out before you really become dependent. Don't torture yourself though. Severe symptoms indicate you're "one of us" and in that case, this will take a while.

That is incredibly helpful. Thank you for explaining it to me. One question is on my mind... Would I be at all better off to cut it off now & not take another pill and "run the gauntlet" just in case I'm not chemically dependent. Would reducing the dose & having another 2 weeks+ risk forming a chemical dependency if I don't already have one. If that makes sense.

 

I actually think it makes complete sense that it is rebound anxiety. Well.at least I think I had rebound anxiety and insomnia which pushed me back to the temazapan in the first place. It was soo severe! Worst anxiety I've ever experienced. Oh I really hope I have not become

That's a great question to ask. It's the dilemma that I was hinting at and why situations like yours can be tricky.

 

IMO, there is a compelling argument for never taking another temazepam pill, as long as the withdrawals are within a range you can tolerate. That's the part you have to judge. It sounds like you're able to go a few days without taking it which is a good sign. If you can keep going and you're managing to function (but not necessarily as well as you'd prefer) then it might be the best thing for you. I would say prepare to feel like this is here to stay, though. You're probably not going to get better in a matter of days, you'll probably see improvement over the next month or so but it might take a while longer to feel yourself. To be honest, it's not that easy to say how long and how intense it will be, but it's something to be aware of. It may be quite a journey whichever way you choose. It shouldn't be this way but it seems to be how it is.

Thanks so much @diaze-bam. You have provided some great insights & I'm really thankful for your help.

Hi @Diaz-e-bam,

 

I would really welcome your opinion on my next move. Your views are always so well articulated & balanced & I really appreciate them. I'm also speaking with a benzo withdrawal service (hotline) and they have given me some guidance but I get the impression the advice they give me (whilst it's very good) is quite textbook and not tailored to my situation.

 

I decided to stabilise on 2.5mg per night and it's been a week & my symptoms were very manageable (anxiety, a few twitches but nothing major, bit of insomnia but actually sleeping better than when I was on a much higher dose, cog fog, headache & unable to concentrate, restless/pacing). But I actually managed to be happy at times. I even laughed (genuinely) and smiled which hasn't happened much if ever over the past few months. I think it might be because I'm not getting the massive highs and lows of the higher dose.

 

I am a mum of 2 boys so I need to keep it together to care for them & I'm going back to work in 2 weeks.

 

I am highly motivated to get off the temepan as quickly as possible so I am thinking of doing the following:

 

Drop to 2mg for a week

Drop to 1.5mg for a week

Drop to 1.25 for a week

Drop to 1mg for a week

Drop to .75mg for a week

Drop to .5mg for a week

Drop to .25 for a week (possibly longer)

 

The other thing I am considering trying is a drop to 1.25mg daily. I've handled 50% drops over the last three weeks so maybe it will work & that would be 1 x 1.25mg capsule which would be easy to do (not requiring liquid titration).

 

The hotline advised to hold at 2.5mg for 2 weeks to allow my nervous system a chance to adapt. But there are a few making me want to go quicker:

1. The fact I haven't been on temaz continuously and I've only been on it 5 weeks (including reducing dose)

2. I have some pills from a compounding chemist (I have 86 left and they are 1.25mg each) I'd like to finish my taper without needing more.

3. I am highly motivated to get off as soon as possible

4. I've had some pretty significant reductions the last 3 weeks & I've been OK. Not comfortable  but OK.

 

Do you think my plan is too fast or too slow? Is there another way (daily reductions?). How and when will I know if I'm tapering too fast? Would I know within a week of making a reduction?

 

Thank you so much.

 

 

You've been getting great input from Diaz-e-BAM, it's tough to know what to do when you've only been on the drug for a short time.  I like your plan, it looks like you've decided to taper rather than quit cold turkey, perfectly understandable considering you have a family to care for and a job to return to.  '

 

Since Temazepam has a relatively short half life, I would imagine you'll be able to tell if you're going too fast with your weekly reduction plan and the only way to know if its going to work is to give it a shot.  Tapers are just one big experiment with you as the subject so you might as well give it a try.  Most members have to adjust their tapers as they proceed so be prepared for this and don't get discouraged.