I need help and guidance with my dmlt

I am on diazepam pharma grade liquid concentrate 5 to 1. I am on 18 mg per day but I dose twice a day. So that would be 1.8 ml twice a day. I want to do a 03 reduction per day. How do I do this?

Please help

 

 

Edit: Changed subject title.

Hi, Ariana.  Can you specify what help you are needing?  Just want to make sure you are posting in the right spot and getting whatever support you need. 

 

Thanks,

 

sunshine75

I want to start reducing 03 daily from 18 mg of diazepam

Gotcha.  I saw your other post as well and just messaged you that I had moved that one to the Titration board.  You should get the help you need in reducing over there. 

 

Best,

 

sunshine75

Can someone please help me with my taper

Please someone help me with the math on this taper of 03 daily.  The math is complicated because my liquid is 5 to 1 and i do not understand how to reduce this amount daily.  Please someone help

I'm not familiar with a 5 to 1 liquid. Is your liquid 5mg/1ml?

 

What is "03 reduction per day"? Are you talking percent? Milligrams? Milliliters?

1.0 ml equals 5 mg concentrate, and I want to reduce 0.3 ml per day that would equal to 1mg reduction in 33 days.  My liquid comes with a dropper and right now i am taking 1.8 ml twice a day which equals 9mgs twice a day to equal 18mg per day.

Following.

Maybe dilute your liquid with water and use this tool to get your reduction.

 

http://benzo.alwaysdata.net/titration/titrationForm.php

1.0 ml equals 5 mg concentrate, and I want to reduce 0.3 ml per day that would equal to 1mg reduction in 33 days.  My liquid comes with a dropper and right now i am taking 1.8 ml twice a day which equals 9mgs twice a day to equal 18mg per day.

 

Hello, Ariana.

 

0.3mL of a 5mg/1mL liquid would be 1.5mg of diazepam.

 

Perhaps you meant 0.003mL?

 

If you reduce your two daily doses by 0.003mL each every day for 33 days, you would reduce your total daily dose by 0.99mg.

 

1.0 ml equals 5 mg concentrate, and I want to reduce 0.3 ml per day that would equal to 1mg reduction in 33 days.  My liquid comes with a dropper and right now i am taking 1.8 ml twice a day which equals 9mgs twice a day to equal 18mg per day.

 

Hello, Ariana.

 

0.3mL of a 5mg/1mL liquid would be 1.5mg of diazepam.

 

Perhaps you meant 0.003mL?

 

If you reduce your two daily doses by 0.003mL each every day for 33 days, you would reduce your total daily dose by 0.99mg.

 

 

Libertas, thanks for making sense of this situation for me. Nice detective work! 

 

I do not suggest doing a DMT with diazepam. A DMT artificially extends the half-life of the medication, by creating a series of small, ideally daily, micro reductions that smooth out the overall reduction goal. This is a boon if your working with something like alprazolam or lorazepam, because these have short half lives. Diazepam generally has a sufficient half-life that it should be easy to simply take weekly or bi-weekly reductions to get the benefits of a DMT without the hassle. And there would be hassle.

 

Libertas is right, you'd need to be reducing by something like 0.003ml/dose, and this would require doing some diluting, which just gets complicated at your dosage level. Also artificially extending the half-life of diazepam can create some problems; if for example the reduction rate is too fast it's can take weeks to stabilize because of a back-log of daily reductions; I have this problem doing my clonazepam DMT but it's nowhere near as severe as it could be with diazepam.

 

I suggest a simple weekly reduction schedule; I think this is a good compromise between bi-weekly and daily, and hopefully will smooth out the ride a little without creating too much of a mess if the rate is too fast.

 

I suggest sourcing a 1ml syringe with 100 gradations; they're available online from Amazon (oral syringe 1ml 100 gradations) or often free from a pharmacy. With this syringe you can do a linear reduction of 0.02ml/dose per week, and end up with a 0.8mg reduction per month; or you could do a 0.03ml/dose per week reduction and end up with a 1.2mg reduction per month.

 

Your taper plan would look simply like...

(current ml/dose) - (reduction in ml/dose) = (next weeks ml/dose)

ex. 1.8ml/dose - 0.02ml = 1.78ml/dose

 

And to get your current daily dosage, you just add your daily doses together and multiply by 5.

ex. (1.78ml + 1.78ml) * 5 = 17.8mg diazepam

 

I hope this helps. It's just the easiest solution that comes to mind.

Let me know if you have questions or want a different approach. 

how much water do i use to dilute?

how much water do i use to dilute?

 

If you're referring to my post, I wasn't suggesting any dilution. Just a 1ml syringe with 100 gradations. 

Slow And Steady -  I looked amazon for the syringe, and i cannot find it.  Can you send me the link for the 1ml with 100 graduation

This is what I'm using currently...

[nobbc]https://www.amazon.com/dp/B01628CDEE[/nobbc]

Slownsteady, I finally got my syringes, now how do I figure out on the syringe how much i take dosing twice a day. I am currently on the cv lannet concentrate @17 mgs per day. so I am doing 1.7 mgs twice a day to equal my 17 mgs per day.  So how do I deduct the liquid, and how much do I dose twice a day?

Hi Ariana,

So I'm guessing you now have 1ml syringes with 100 gradations. I also understand that you're on a 5mg/ml liquid of diazepam, and that you want to dose 1.7mg 2x per day.

 

Calculate Milligrams of Diazepam to volume of 5mg/mL Liquid

(dose in milligrams of diazepam) / (volume concentration of liquid) = (volume of liquid to dose)

ex. 1.7mg / 5mg/mL = 0.34mL

 

So at 1.7mg 2x per day, I calculated that you'd dose 0.34mL of liquid twice a day.

 

To reduce this dosage, I suggest doing a percent-based, weekly reduction schedule. To calculate your % based reduction, add your two doses together to get your total daily dose; I'm going to use milliliters of your current liquid to keep things simple. This appears to be 0.68ml/day.

 

1. Calculate Percent Remaining from Percent Reduction

100 - (desired percent reduction) = (percent remaining)

ex. 100 - 2.5 = 97.5 <- for a example 2.5% weekly reduction schedule

 

2. Turn Percent Remaining into Decimal Form

(percent remaining) / 100 = (decimal percent remaining)

ex. 97.5 / 100 = 0.975

 

3. Calculate Percent-Rate Reduction of Current Dosage

(decimal percent remaining) * (current dose) = (reduced dose)

ex. 0.975 * 0.68mL = 0.66mL (rounded from 0.663mL)

 

I'm showing an example 2.5% reduction per week, which is what I would try to start. The results were the weekly reduction equation: 0.975 * (current dose) = (reduced dose); a first reduction at this rate would be from 0.68mL to 0.66mL. I would hold on this new dose for 7 days and then repeat this 3rd calculation to get my next reduction which would be to 0.64mL (rounded from 0.6435mL).

 

Because your liquid is so concentrated, I think in this example eventually you will need to hold for two weeks and take 5%/14 day reductions just to get a reduction amount that can be measured with a 1ml syringe with 100 gradations; I think you'll know you're at this point when your desired weekly dosage reduction rounded to the hundredths place is the same dose you were on previously. Alternatively, at that point you could get a prescription for a 1mg/ml liquid if it's available and we can help you switch to this concentration. Or you could explore the perhaps nebulous world of diluting your liquid.

 

You might want to update your signature with your new benzo and dosage.

Does this all make sense to you? 

No, I am totally confused!  So what you're saying is I don't need to use the 1ml 100 graduation at this point?  Also, I thought that ml and mg were the same in measurement.  Please clarify.  I am taking 17 mgs a day, trying to get to 16 mgs per day, and I dose twice per day.  So, I am really confused with all these numbers.  Please explain.

Hi Ariana,

I should have taken a longer look at your previous post, since the numbers don't make much sense. I must have been in a hurry; sorry for causing some confusion. It seems like you are struggling to use units correctly.

 

I thought that ml and mg were the same in measurement.

 

These are two very different units of measurement, although they can have a relationship.

mg = milligram, which is a measure of weight (like pounds or stone)

ml = milliliter, which is a measure of volume (like cubic inches or a measuring cup)

 

Your liquid is measured in mg/ml, which is a certain weight of medicine in a certain volume of liquid. I believe you said it was 5mg of diazepam weight in each 1ml of liquid volume; this is a 5mg/ml liquid.

 

So I understand now that you are on 17mg of diazepam per day, and using a 5mg/ml liquid. I also understand that you want to dose 8.5mg 2x per day. This is where I seem to have gone wrong last time, so here's what I wrote before with the examples updated for this new dosage.

 

Calculate Milligrams of Diazepam to volume of 5mg/mL Liquid

(dose in milligrams of diazepam) / (volume concentration of liquid) = (volume of liquid to dose)

ex. 8.5mg / 5mg/mL = 1.7mL

 

So at 8.5mg 2x per day, I calculated that you'd dose 1.7mL of liquid twice a day. I would do this by drawing twice with the 1ml syringe with 100 gradations; first pulling 1ml and consuming, then pulling 0.7ml and consuming.

 

To reduce this dosage, I suggest doing a percent-based, weekly reduction schedule. To calculate your % based reduction, add your two doses together to get your total daily dose; this appears to be 3.4ml/day. I'm going to use milliliters of your current liquid to keep things simple.

 

1. Calculate Percent Remaining from Percent Reduction

100 - (desired percent reduction) = (percent remaining)

ex. 100 - 2.5 = 97.5 <- for an example 2.5% weekly reduction schedule

 

2. Turn Percent Remaining into Decimal Form

(percent remaining) / 100 = (decimal percent remaining)

ex. 97.5 / 100 = 0.975

 

3. Calculate Percent-Rate Reduction of Current Dosage

(decimal percent remaining) * (current dose) = (reduced dose)

ex. 0.975 * 3.4mL = 3.32mL (rounded from 3.315mL)

 

I'm showing an example 2.5% reduction per week, which is what I would try to start. The results were the weekly reduction equation: 0.975 * (current dose) = (reduced dose); a first reduction at this rate would be from 3.4mL to 3.32mL total daily consumption. I would hold on this new daily dose for 7 days and then repeat this 3rd calculation to get my next reduction which would be to 3.23mL (rounded from 3.232125mL).

 

To get two daily doses, I would just divide the new total daily dosage by two. 3.4ml would be two doses of 1.7ml, 3.32 would be two doses of 1.66ml, etc.

 

If I ever wanted to change my reduction % rate, I can simply repeat steps 1 and 2 with my new (desired percent reduction), and then use the new (decimal percent remaining) to complete step 3 for each subsequent reduction.

 

Alternatively, I could do a quantity-based reduction which is simply reducing my total daily dose by some tolerable quantity of medicine every week, ex. 0.06ml; it's easier to do mathematically, but reported to increase in symptomatic intensity.

 

Did I manage to straight this out, or did I miss something? 

Updating your signature to describe your new medication and dosage would help.

SlownSteady,  On the 100 graduation syringe, how much does each line represent?  Do I just deduct 1 line on the syringe per week?

If your 1mL syringe has 100 gradations (marks), then each line equals 0.01mL.  0.01mL of a liquid with a concentration of 5mg/1mL equals 0.05mg of drug.

 

How viscous is your liquid?  Can you measure that small of an amount easily and consistently? 

 

Have you considered diluting a portion of your daily dose?  Given that you are still on a relatively high dose, you could use the undiluted/concentrated liquid for most of your dose, but use the diluted liquid to make “small enough” reductions.

SlownSteady,  On the 100 graduation syringe, how much does each line represent?  Do I just deduct 1 line on the syringe per week?

 

I think Libertas answered all your questions.

 

Reducing by just 0.01ml is pushing the limits of that measuring device and if your liquid is too viscous you may not be making these reductions reliably. Droplet size seems to vary by viscosity and this seems to make some difference in taking sub-milliliter reductions, perhaps depending on exactly how the liquid is collected and dispensed.

 

However, I personally wouldn't hesitate to use the single line measurements to dose or to make reductions of 5mg/ml diazepam at individual doses above 5mg. Below 5mg, I would want to use a less concentrated liquid form; I believe that this would require dilution or custom compounding, as I do not see a commercially available liquid form at a lower concentration, at least in the US and Canada.

https://go.drugbank.com/drugs/DB00829#products-header

 

For now if you want to try a quantity-based weekly reduction, I suggest considering removing 0.08ml per week from your total volume of liquid, which is 0.04ml removed from each of your two doses; at your current total daily dose of 3.4ml this is just under a 5%/2-week reduction rate. As you get further a long in your taper, you may wish to reduce this weekly quantity to minimize your symptoms; for now however I think 5%/2-weeks is a low and generally well tolerated reduction quantity at your current dosage. Does this make sense?

 

Percent-based reductions offer more symptomatic consistency in my experience. Did that math process look too confusing? 

Ariana: Are you in the US?  If so, according to DailyMed (see note below), diazepam is available in a 5mg/5ml (1mg/1mL) oral solution from two manufacturers:

 

West-Ward (formerly Roxane); NDC 0054-3188-63 (NDC = National Drug Code)

Lannett; NDC 0527-1767-65

 

We have many current and past members who have used this oral solution to taper diazepam.

 

Note: Operated by the US National Library of Medicine, DailyMed publishes drug labels for FDA-approved products.  Content is updated daily by the FDA. URL is https://dailymed.nlm.nih.gov/.