Tapering & titration related basic questions

Some tapering and titration related questions:

1) Let's say someone is on 0.25mg K.

Is consistent 5 or 10% reduction(of 0.25mg) per week or per two weeks using cut and hold till 0mg feasible?

2) Do you have to hold longer as you go to lower doses?

3) I'm a bit sensitive to daily dose reduction is cut and hold better than daily micro tapering?

4) Can liquid titration be used in cut and hold method? or it is used mostly for Daily Micro Tapering?

5) If someone is approaching the end (last few weeks) of the taper which method is more suitable? Cut and hold? or DMT?

6) During the end how many days can one stay on the jump dose?

7) Is it safe/unsafe to quit from a dose that is lower than the jump dose for the particular drug?

8 ) is it true that the longer the overall planned tapering duration the harder it is to quit? or is it the other way around?

9) What is attenuated ending?

Hello Paxanimi!

1) From what I understand, the answer would depend entirely on the individual's neuroplasticity; basically, at this point in medical science, there's no easy way I know of to test this besides trying a safe reduction (5-10%), holding for two-weeks and seeing how someone responds.

2) The half-life of the benzo stays the same throughout the taper, but from what I've experienced and read around the forum, the recovery time to full functionality varies depending on individual and the amount of reduction taken. Generally a percent-based reduction is suggest across the forum, and the recovery time is usually consistent when the percent reduction remains consistent.

3) Generally daily micro tapering is used to create an artificially longer half-life for a medicine like clonazepam, xanax, ambien, and others. For diazepam and other benzos that share it's primary metabolite I would not suggest DMT because the half-life is so long anyways. With a longer half-life, either from the metabolite itself or by doing a DMT, the taperer should be able to experience reduced WD symptoms. I've never heard of anyone being sensitive to daily dose reductions unless those reductions are too large or taken inaccurately.

4) Yes, liquid titration can be used for a cut-and-hold taper.

5) Typically the end of a slow taper requires increased reduction accuracy. I don't think the frequency of reductions wouldn't need to change unless this was desired by the taperer.

6) Entirely up to the taperer. Ideally until feeling stable / fully functional.

7) To my knowledge, it is entirely safe to taper to any minute degree of dosage assuming the tapering method has this degree of accuracy. It's likely a waste of time past a certain point, but where that point is seems to depend on the individual and how rapidly they've tapered or how sensitive they are to reductions.

[nobbc][/nobbc] "The other way around" has been my experience. Longer taper duration seems to have a higher chance of success. Gail Dawson, benzo-wise psychiatrist, suggests 2-5%/month on her website; I think this is a bit ridiculous, but it suggests that even very very slow tapers are generally more successful for her clients.

9) I've heard of attenuated endings suggested for linear tapers specifically. A linear taper has a fixed quantity of medicine being reduced at regular intervals; an attenuated ending would be to change the quantity of medicine being reduced to a smaller amount 1/2 or 2/3rds of the way through the taper, for example to 1/3rd the original quantity.

I hope this helps. 

Thank you slownsteady for the answers. 

I understood all except the last one...

9) attenuated ending.

Can you elaborate that with an example?

Also, when is an attenuated ending necessary?

9) attenuated ending.

 

Can you elaborate that with an example?

Also, when is an attenuated ending necessary?

If you were reducing by 0.06mgs/2 weeks, this would be a linear taper. If you wanted to attenuate the ending, you might do this when you have 1/3 of your original dose remaining; at this time you could reduce your reduction quantity to 0.02mgs/2 weeks, and this would be an attenuated ending. Note the hold time stays the same, only the reduction quantity changes.

Linear tapers, even with attenuated endings, seem to carry a higher risk of severe WD symptoms especially towards the end of the taper. Linear tapers are attractive because they're simple, hence they're almost universally what are suggested by doctors. I do not suggest linear tapers, unless part of a very adaptable, symptom-based, patient-led taper where the patient has high functionality or needs the simplest way to taper despite the aforementioned risks.