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Titration schedule needed for triazolam after being floxed


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Hi there! I'm so grateful this group exists!! I cried when Pamster said you all could help me taper off triazolam after being floxed by cipro.

 

I have been on triazolam for 15 years for insomnia (with two breaks trying other things). I take half of a .25mg most nights (occasionally but rarely a whole pill). In 2015, I was given cipro for a basic UT infection. The combination of triazolam and cipro has caused significant brain and body damage for me, as indicated in this article: https://www.benzoinfo.com/2017/10/12/hidden-dangers-of-fluoroquinolone-antibiotics-in-the-benzodiazepine-dependent-population/. All my bodily and brain systems have been impacted (endocrine/thyroid/hormones, heart palpitations, extreme anxiety, muscle twitching, worsening insomnia, fatigue & exhaustion, severe tinnitus, digestive/c diff, sensitivity to light and loud noise, and so many other problems).

 

How would I titrate down .1275mg of triazolam? My pill is a football shape at .25mg that I almost always break in half. I think a formula for a liquid titration would be best.

 

I agree with Pamster that I need to go slow given my history of being floxed.

 

And because of these health issues, I need to sleep, so a recommendation for a natural sleep herb or supplement would be helpful. Melatonin doesn't work for me. Thank you all so much!!!

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Hi There WonderWoman22, 

 

I am so sorry you have been floxed by cipro.  What a terrible thing to happen. 

 

There are  few options when it comes to tapering.  You can break your pill down to smaller pieces, or use a jeweler's scale to weigh the pill so you can break it down even smaller, or you can make a liquid out of the pill and use milk or a small bit of alcohol or some pg, and use that to taper.

 

Whichever way you choose, the idea it to make tiny changes in the amount of benzo that you take when you make a cut, so as to minimize the awful withdrawal effects.  I tapered my benzo down using a liquid taper as that allowed me to make very tiny cuts, but I have heard that is also possible using a jeweler's scale as well.  Poke around the boards and see which one you want to do. 

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Hi There WonderWoman22, 

 

I am so sorry you have been floxed by cipro.  What a terrible thing to happen. 

 

There are  few options when it comes to tapering.  You can break your pill down to smaller pieces, or use a jeweler's scale to weigh the pill so you can break it down even smaller, or you can make a liquid out of the pill and use milk or a small bit of alcohol or some pg, and use that to taper.

 

Whichever way you choose, the idea it to make tiny changes in the amount of benzo that you take when you make a cut, so as to minimize the awful withdrawal effects.  I tapered my benzo down using a liquid taper as that allowed me to make very tiny cuts, but I have heard that is also possible using a jeweler's scale as well.  Poke around the boards and see which one you want to do.

 

Thank you! I'm not sure I can figure this out by myself. I have a really complicated regimen for all the health issues that's pretty overwhelming and I have zero medical support at home. I have minimal social support- when you get chronically ill, people fall off! Is there any way to get some sort of a formula?

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We'll help you figure this out, you'll just need to tell us if you'd like to weigh your dose to taper, use liquid titration or ask your Dr to write you a script to take to a compounding pharmacy so they'll do the work for you.  Here is a video of what weighing your doses looks like, a jewelers scale costs less than 25.00 USD on Amazon. 

 

 

Liquid titration: https://www.benzoinfo.com/benzodiazepine-tapering-strategies/

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Thank you Pamster! Let me check with my doctor about the compounding option. She may or may not know how to do that. And I need to gauge her willingness. I do get three other medicines compounded (including low dose naltrexone for pain). Do most docs know how to prescribe benzos for compound titration?
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If your Dr is willing to prescribe other compounded medications, she may be open to doing this one as well.  I don't believe it will be much different than getting your other medications compounded, she'll set the dosage and the pharmacy will make it up.  Hopefully she'll be on board with a slow taper and we can help you with the reduction percentages when you get it.
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We don't have many members who use Triazolam so I'm not sure, some members who use other benzo's get their compounded medication in a dry capsule form, others get liquid.  I'll be interested to hear what route you may go in. 
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I spoke with a doctor and he thinks (because my dose of triazolam is so small- currently half of a .25mg) that I can go to half of a .125mg for a month and then half of a .125mg every other night for a month and then we'll check in to see if I'm doing well enough to stop or if we need to go to a few nights per week. He made sure I was still taking my CoQ10, Resveratol, and N-acetyl-cysteine to support the oxidative stress and mitochondrial issues from being floxed. And I am. Does this raise any red flags for anyone?
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One red flag is taking the medication every other night, Professor Ashton made a point of saying that a steady slow decline is best in order to keep the blood levels as even as possible.  Think about it, Triazolam has an extremely short half life so by taking it every other day, you'd be putting yourself at risk for increased symptoms because your body would see it as a cold turkey.  It would be much better to talk half of that dose every night rather than skipping nights.

 

Another consideration is while the plan may be good on paper, the reality of it may be much different, this is why we stress symptom based tapers.  Putting a plan in place is a good idea but being willing to adjust it is wise.  I'm glad your Dr is willing to go a few more weeks if necessary, oftentimes members need to slow down towards the end of their tapers.

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A second red flag is that 0.125mg of triazolam/Halcion is not a “small” dose.  Triazolam is a potent benzodiazepine — 0.5mg of triazolam is equivalent to 10mg of diazepam (according to Ashton) and 15mg of diazepam (according to ClinCalc).

 

Other relevant properties of triazolam include a short onset of action (15-30 minutes) with peak plasma levels reached within 2 hours and (as Pamster has noted) a short mean plasma half-life (1.5 to 5.5 hours).

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A second red flag is that 0.125mg of triazolam/Halcion is not a “small” dose.  Triazolam is a potent benzodiazepine — 0.5mg of triazolam is equivalent to 10mg of diazepam (according to Ashton) and 15mg of diazepam (according to ClinCalc).

 

Other relevant properties of triazolam include a short onset of action (15-30 minutes) with peak plasma levels reached within 2 hours and (as Pamster has noted) a short mean plasma half-life (1.5 to 5.5 hours).

 

This science is new to me Libertas. I'm following what you're saying. Beyond a few recreational moments in high school, I don't have much experience with diazepam, just the triazolam. The short half life, thus complications with the alteration of every other night definitely doesn't seem to make sense. Can you help me understand your thoughts on what the information you provided means to you? Thank you so much!!

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Hello again, WonderWoman22.

 

The high potency of triazolam means that adding (or removing) a small amount of the drug can have a big impact.

 

The short half life means triazolam is eliminated quickly from the body.  The general rule of thumb is that it takes 5.5 half-lives for a drug to be removed. So, if the half-life of triazolam ranges from 1.5 to 5.5 hours, it can take as little as 8.25 hours (1.5 X 5.5) or as long as 30.25 hours (5.5 X 5.5) for elimination. (Elimination of a drug varies from person to person due to factors like age, weight, other medications taken, other medical conditions present, kidney function, liver function, etc.)

 

Here’s what Professor Ashton had to say about triazolam:

 

CHAPTER II:  SLOW WITHDRAWAL SCHEDULES

 

In my experience, the only exception to the general rule of slow reduction is triazolam (Halcion). This benzodiazepine is eliminated so quickly (half-life 2 hours) that you are practically withdrawn each day, after a dose the night before. For this reason, triazolam can be stopped abruptly without substitution of a long-acting benzodiazepine. If withdrawal symptoms occur, you could take a short course of diazepam starting at about 10mg, decreasing the dosage as shown on Schedule 2.

 

Source:

Benzodiazepines: How They Work & How to Withdraw

Prof C H Ashton DM, FRCP, 2002

https://www.benzo.org.uk/manual/bzsched.htm

 

 

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Hello again, WonderWoman22.

 

The high potency of triazolam means that adding (or removing) a small amount of the drug can have a big impact.

 

The short half life means triazolam is eliminated quickly from the body.  The general rule of thumb is that it takes 5.5 half-lives for a drug to be removed. So, if the half-life of triazolam ranges from 1.5 to 5.5 hours, it can take as little as 8.25 hours (1.5 X 5.5) or as long as 30.25 hours (5.5 X 5.5) for elimination. (Elimination of a drug varies from person to person due to factors like age, weight, other medications taken, other medical conditions present, kidney function, liver function, etc.)

 

Here’s what Professor Ashton had to say about triazolam:

 

CHAPTER II:  SLOW WITHDRAWAL SCHEDULES

 

In my experience, the only exception to the general rule of slow reduction is triazolam (Halcion). This benzodiazepine is eliminated so quickly (half-life 2 hours) that you are practically withdrawn each day, after a dose the night before. For this reason, triazolam can be stopped abruptly without substitution of a long-acting benzodiazepine. If withdrawal symptoms occur, you could take a short course of diazepam starting at about 10mg, decreasing the dosage as shown on Schedule 2.

 

Source:

Benzodiazepines: How They Work & How to Withdraw

Prof C H Ashton DM, FRCP, 2002

https://www.benzo.org.uk/manual/bzsched.htm

 

Libertas,

This makes sense to me! So it sounds like triazolam is a strong benzo with a short half life and according to Ashton, some people can cold turkey triazolam and others cannot. Given that I have been on triazolam for 15 years and I have been floxed by cipro, I probably shouldn't cold turkey come off. I will attempt to slowly and steadily taper over several months and definitely avoid an every other night scenario. I do not want to transition to another benzo and then taper/withdraw from that one. Thank you!! :smitten:

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