Need Advice with Compounded Taper - *UPDATE* next step?

Hello,

I have been tapering .25 Xanax since 7-12.  I have only been taking this a few months prior.

I have had trouble with the burning skin ever skin the taper started, and was having interdose prior to the taper.

I had no idea what interdose was, until i figured out it was the xanax that was causing my issues.

(My doctor never warned me about this, so I wanted off this medicine)

I started cutting the pills in 3/4's cuts for a week or so and then was advised that was too big of a cut to start with.

It was hard to cut the pills so my doc called a Compounding pharmacy,

I have been using the compounded liquid since 7-30.

I am taking 0.06ml (0.075mg) 3x per day.  (0.225mg/day)

I take CBD isolate at night 100-150mg

I am still having the burning skin and scalp, sometimes worse than others.

I am supposed to go down 10% each month, but I am not sure if I need to hold where I am, since I'm not having much relief.

Should I hold at this current dosage another month, or am I going to have the burning skin regardless if I hold or not?

I am wondering if the liquid is a little weaker than the pill, but I had the burning skin with the dry cut at 3/4 cuts as well.

The whole purpose of tapering is to reduce side effects, but it doesn't seem to be helping with mine.

I have some days where the burning isn't quite as bad, but lately it seems to be worse, most especially during stressful moments at work.

I am wondering if tapering is just making things worse and causing my body not to heal?

Any suggestions or help would be much appreciated.

Hello jordanjack,

I'm sorry to hear that you are struggling with this burning skin symptom!

I think there might be a typo in your post and in your signature.

I understand that you were on 0.25mg since April 2021, and then in June you only dosed every other day (a 50% reduction), and in July you did an updose to only a 25% reduction to 0.1875mg/day and dosed 3x per day.

Most recently I understand that you switched to a compounded liquid at 0.075mg 3x per day (0.225mg/day), but both in your post and on your signature you describe your liquid dose as "10% of the 0.25 pill" and "10% of the .25 dosage". 10% of 0.25mg would be 0.025mg. Instead, I understand you are taking 10% LESS than your original 0.25mg daily dose; this is what I think you are trying to say and a great deal different than the 90% reduction that you describe.

Your situation is a little complicated because it sounds like you've been experiencing burning skin ever since you started tapering. This suggests that your taper rate may have been to big from the start, and your nerves haven't gotten a chance to stabilize since you started.

First off, as I mentioned earlier dosing every other day is a 50% reduction. That is a high-risk way to take an exploratory reduction, IMO. Almost all of us have tried tapering too quickly, some doing a 50%+ reduction, but I think it's important to realize that this can be very disturbing for the nervous system. Since your burning skin started after this event, I surmise that this is a symptom that happens to you when your nervous system is destabilized and will improve with more stabilization.

Secondly, I don't know all the details, but it looks like you went from a 50% reduction to a 25% reduction of your original 0.25mg; an updose but not exactly a true respite from the previous approach, and I suspect your burning skin continued for lack of enough stability during this time.

Then when you went to liquid, it sounds like you updosed again (which I think is good), and are now on 0.225mg/day. I suggest holding at your current liquid dose for weeks until either you have recovered significantly from your withdrawal symptoms, or the interdose withdrawal returns. My hope is that a few weeks to a month would be enough time to mitigate your burning skin and any other aftermath from your previous large reductions.

I suggest forgoing any 10%/month deadline for reductions. I think your body is going to be your absolute best guide on how and when to take reductions, and burning skin is a sign I interpret to be saying "hold please, I'm making repairs". Symptom-based tapering is all about listening to these signs and navigating a balance between taking sometimes uncomfortable reductions and holding long enough to return to full functionality.

In my humble opinion, I think your burning skin symptom will heal and will only persist if you push your taper and your body too quickly.

Slow and steady wins this one! 

Hello jordanjack,

I'm sorry to hear that you are struggling with this burning skin symptom!

I think there might be a typo in your post and in your signature.

 

I understand that you were on 0.25mg since April 2021, and then in June you only dosed every other day (a 50% reduction), and in July you did an updose to only a 25% reduction to 0.1875mg/day and dosed 3x per day.

 

Most recently I understand that you switched to a compounded liquid at 0.075mg 3x per day (0.225mg/day), but both in your post and on your signature you describe your liquid dose as "10% of the 0.25 pill" and "10% of the .25 dosage". 10% of 0.25mg would be 0.025mg. Instead, I understand you are taking 10% LESS than your original 0.25mg daily dose; this is what I think you are trying to say and a great deal different than the 90% reduction that you describe.

 

Your situation is a little complicated because it sounds like you've been experiencing burning skin ever since you started tapering. This suggests that your taper rate may have been to big from the start, and your nerves haven't gotten a chance to stabilize since you started.

 

First off, as I mentioned earlier dosing every other day is a 50% reduction. That is a high-risk way to take an exploratory reduction, IMO. Almost all of us have tried tapering too quickly, some doing a 50%+ reduction, but I think it's important to realize that this can be very disturbing for the nervous system. Since your burning skin started after this event, I surmise that this is a symptom that happens to you when your nervous system is destabilized and will improve with more stabilization.

 

Secondly, I don't know all the details, but it looks like you went from a 50% reduction to a 25% reduction of your original 0.25mg; an updose but not exactly a true respite from the previous approach, and I suspect your burning skin continued for lack of enough stability during this time.

 

Then when you went to liquid, it sounds like you updosed again (which I think is good), and are now on 0.225mg/day. I suggest holding at your current liquid dose for weeks until either you have recovered significantly from your withdrawal symptoms, or the interdose withdrawal returns. My hope is that a few weeks to a month would be enough time to mitigate your burning skin and any other aftermath from your previous large reductions.

 

I suggest forgoing any 10%/month deadline for reductions. I think your body is going to be your absolute best guide on how and when to take reductions, and burning skin is a sign I interpret to be saying "hold please, I'm making repairs". Symptom-based tapering is all about listening to these signs and navigating a balance between taking sometimes uncomfortable reductions and holding long enough to return to full functionality.

 

In my humble opinion, I think your burning skin symptom will heal and will only persist if you push your taper and your body too quickly.

 

Slow and steady wins this one! 

Thank you Slownsteady. I appreciate your help so much.  Yes, you are correct on the dosage amount. I updated my profile too.

I agree, I think it cut too much at the start and have never really been stable. My doctor has not been very helpful with this, so I appreciate all your help and advice.

I am going to take your advice and just stay where I am until my body adjusts.... perhaps it will take another month. You are so kind to help me and offer encouragement.

Bless you!!

It's my pleasure to help you jordanjack.

I suggest considering a daily micro taper (DMT) when you're ready to begin reducing again; there are a number of benefits for this style of tapering, especially for short-acting benzos like alprazolam. Myself or someone else would be happy to consider the details with you and help you to use an online DMT schedule generator so there's no math involved. Just post again here or on a new topic if you'd like help with something like that.

I hope that you will see improvements soon! 

It's my pleasure to help you jordanjack.

 

I suggest considering a daily micro taper (DMT) when you're ready to begin reducing again; there are a number of benefits for this style of tapering, especially for short-acting benzos like alprazolam. Myself or someone else would be happy to consider the details with you and help you to use an online DMT schedule generator so there's no math involved. Just post again here or on a new topic if you'd like help with something like that.

 

I hope that you will see improvements soon! 

Thank you again Slownsteady.. I appreciate your willingness to help me. 

This is definately not easy.. and my burning skin has been so distressing to me.  Does the burning skin mean that healing is happening?

I will continue my current dosage as you advised and I pray that holding where I am for a while will help reduce this side effect.

If this doesnt help, then I may consider the DMT as you suggested.  It's just crazy that all this is happening with just a few months of usage.

But like you said, my dosage was so off and on until I started truly tapering, so perhaps I just need the stable dosage to calm things down.

You are very thoughtful.. thank you again.

I am sorry to hear how distressing your burning skin symptom is.

To my understanding, no, withdrawal symptoms themselves are not signs of healing; I think they indicate a nervous system overwhelmed by imbalance after becoming physically dependent on the sedative action of the benzodiazepines.

I understand that benzos basically make GABAa receptors extremely effective, so the nerves of the body are all experiencing an enhanced degree of inhibition. This isn't sustainable day-to-day functions, so the body compensates (maybe in some areas more than others) by possibly pruning GABAa receptors, desensitizing those receptors, and doing things to make GABA's antagonist, the stimulating glutamate, more abundant and effective.

If this is true, then when we take the benzo away, the nervous system becomes out of balance with too much glutamate activity (stimulating) and not enough GABA activity (inhibitory); if the imbalance is severe enough, nervous system dysfunction occurs and what we notice we label as withdrawal symptoms. How quickly someone can heal from benzo dependence seems to come down to how quickly their nervous system can recover stability after reductions; the dysfunctional symptoms (such as burning skin) caused by overly large reductions isn't necessary or helpful, IMO.

I suggest really listening to your body on this one jordanjack. It's no doubt doing the best it can to help you function within your complex lifestyle and circumstances, and I believe it will stabilize if you can hold steady on your dosage and ideally include other nervous-system supports like rest, relaxation, nutrition and gentle exercise.

The DMT could be a way to taper once you're stable. It should be fairly easy to adopt since you're already getting compounded liquid. For now, I suggest being kind to yourself and taking a break!

I am sorry to hear how distressing your burning skin symptom is.

 

To my understanding, no, withdrawal symptoms themselves are not signs of healing; I think they indicate a nervous system overwhelmed by imbalance after becoming physically dependent on the sedative action of the benzodiazepines.

 

I understand that benzos basically make GABAa receptors extremely effective, so the nerves of the body are all experiencing an enhanced degree of inhibition. This isn't sustainable day-to-day functions, so the body compensates (maybe in some areas more than others) by possibly pruning GABAa receptors, desensitizing those receptors, and doing things to make GABA's antagonist, the stimulating glutamate, more abundant and effective.

 

If this is true, then when we take the benzo away, the nervous system becomes out of balance with too much glutamate activity (stimulating) and not enough GABA activity (inhibitory); if the imbalance is severe enough, nervous system dysfunction occurs and what we notice we label as withdrawal symptoms. How quickly someone can heal from benzo dependence seems to come down to how quickly their nervous system can recover stability after reductions; the dysfunctional symptoms (such as burning skin) caused by overly large reductions isn't necessary or helpful, IMO.

 

I suggest really listening to your body on this one jordanjack. It's no doubt doing the best it can to help you function within your complex lifestyle and circumstances, and I believe it will stabilize if you can hold steady on your dosage and ideally include other nervous-system supports like rest, relaxation, nutrition and gentle exercise.

 

The DMT could be a way to taper once you're stable. It should be fairly easy to adopt since you're already getting compounded liquid. For now, I suggest being kind to yourself and taking a break!

Slow steady, Thank you so much! Wow, your knowledge is amazing and so helpful. Thank you!!!

I had no idea. I would have never taken the Xanax had I known. My pdoc was trying to start me on Lexapro and gave me the Xanax to help with start up of the AD. I only took the Lexapro for 5 days, as it didn’t agree with my body; so my doc just said, you can just keep taking the Xanax. No mention of the problems the drug may cause. So I took it off and on for a few months. Then, I noticed the burning skin that I now know was interdose symptoms.

I found the BB site and realized all this from reading the forum posts from kind people like you who have been so helpful.

I immediately wanted off the medicine. So my doc said to just take 3/4 of the pill cut in pieces to start weaning. So, that’s when I ran into issues with more WD issues.

I spoke to my doc today and we are going to hold where I am for another month, just like you recommended. Will my brain get damaged further by holding? I know I don’t have much choice.

I hope that by holding for a month at my current dosage that my CNS will be a bit more stable able to taper again. I’ve only been doing the compounded dosage for a little over two weeks, but at least I am now getting a consistent amount. I just hope that it doesn’t cause me to be dependent and cause more WD symptoms.

It’s a little distressing that I am going to have to taper longer than I actually was “on” the medicine.

I hope this doesn’t cause more problems for me. I read the longer you are on the medicine the more your body wants and then you get tolerance and then interdose symptoms. This is what makes me so worried. But, like you advised; I understand slow and steady is my best option.

Take good care of yourself as well!

Thank you again for being so kind.

Bless you 🙏

I'm sorry to hear that you were not given the opportunity for informed consent to the risks and consequences of your medication. This is all too common from what I've read, and what I experienced as well. It's also absolutely unacceptable, in my opinion.

I'm glad your doctor is supporting you in tapering as slowly as you need to. Finding the pace that we can tolerate is so important in my experience; it seems a lot like learning anything new: going too quickly just seems to waste time. I call these kinds of attempts "long shortcuts".

Yes, it seems like there is some neurotoxicity to benzos, and this can cause harm to the brain over time. I do not believe that this brain damage is permanent, and I think like all things in life we are taking the risk of harm to meet other important needs, in this case overall functionality and successful tapering. I believe the harm caused during a slow taper is minimal compared to staying on the medicine "indefinitely", and also far less than the harm that can be caused by an intolerably rapid taper.

I know it's crazy how long tapering can take for some of us. For comparison, my severe headaches were treated with clonazepam effectively for about two weeks before I began trying to taper the medicine; based on my experiences withdrawing I will likely be tapering for 2+ years. I still have headaches most days, but they're nothing compared to the effects a rapid withdrawal had on me.

And yet despite the apparent toxicity of this medicine, I am actually in many ways healthier at this time, slow tapering, than I was before I started the medication. I'm learning patience, self-awareness, and taking my mental health seriously with therapy and lifestyle practices that help to address both my withdrawal symptoms and underlying trauma. So I think that withdrawal can actually be a very positive experience: a time for personal growth and new understandings about ourselves and the world.

I think tapering as soon as you're starting to feel comfortable again is the best way to mitigate any increase in tolerance. I don't know that this is actually a physical dependence dynamic, but in my experience it's definitely a mental dynamic. By keeping myself regularly reducing I have largely avoided the emotional numbing and false-confidence that a steady benzo dose causes me. I may actually speed up my taper in the near future to continue to mitigate these effects for this goal of staying alert and open to my self. I'm finding it's a delicate balance, and I still err on the side of going slower and staying more functional. The medicine is losing it's grip, one way or another.

I really expect you'll see improvements sooner rather than later!

Keep us posted and I'll see you around the forum. 

I'm sorry to hear that you were not given the opportunity for informed consent to the risks and consequences of your medication. This is all too common from what I've read, and what I experienced as well. It's also absolutely unacceptable, in my opinion.

 

I'm glad your doctor is supporting you in tapering as slowly as you need to. Finding the pace that we can tolerate is so important in my experience; it seems a lot like learning anything new: going too quickly just seems to waste time. I call these kinds of attempts "long shortcuts".

 

Yes, it seems like there is some neurotoxicity to benzos, and this can cause harm to the brain over time. I do not believe that this brain damage is permanent, and I think like all things in life we are taking the risk of harm to meet other important needs, in this case overall functionality and successful tapering. I believe the harm caused during a slow taper is minimal compared to staying on the medicine "indefinitely", and also far less than the harm that can be caused by an intolerably rapid taper.

 

I know it's crazy how long tapering can take for some of us. For comparison, my severe headaches were treated with clonazepam effectively for about two weeks before I began trying to taper the medicine; based on my experiences withdrawing I will likely be tapering for 2+ years. I still have headaches most days, but they're nothing compared to the effects a rapid withdrawal had on me.

 

And yet despite the apparent toxicity of this medicine, I am actually in many ways healthier at this time, slow tapering, than I was before I started the medication. I'm learning patience, self-awareness, and taking my mental health seriously with therapy and lifestyle practices that help to address both my withdrawal symptoms and underlying trauma. So I think that withdrawal can actually be a very positive experience: a time for personal growth and new understandings about ourselves and the world.

 

I think tapering as soon as you're starting to feel comfortable again is the best way to mitigate any increase in tolerance. I don't know that this is actually a physical dependence dynamic, but in my experience it's definitely a mental dynamic. By keeping myself regularly reducing I have largely avoided the emotional numbing and false-confidence that a steady benzo dose causes me. I may actually speed up my taper in the near future to continue to mitigate these effects for this goal of staying alert and open to my self. I'm finding it's a delicate balance, and I still err on the side of going slower and staying more functional. The medicine is losing it's grip, one way or another.

 

I really expect you'll see improvements sooner rather than later!

Keep us posted and I'll see you around the forum. 

Thank you again Slownsteady! You are so knowledgeable and offer such great wisdom.

I appreciate all the information and encouragement you’ve provided to me. I have learned so much from you and our fellow Buddies. 

I hope you continue to heal and that renewed strength will soon be yours on your journey as well.

I’m so glad your headaches are better too as you continue to heal.

Bless you!! 

I'm sorry to hear that you were not given the opportunity for informed consent to the risks and consequences of your medication. This is all too common from what I've read, and what I experienced as well. It's also absolutely unacceptable, in my opinion.

 

I'm glad your doctor is supporting you in tapering as slowly as you need to. Finding the pace that we can tolerate is so important in my experience; it seems a lot like learning anything new: going too quickly just seems to waste time. I call these kinds of attempts "long shortcuts".

 

Yes, it seems like there is some neurotoxicity to benzos, and this can cause harm to the brain over time. I do not believe that this brain damage is permanent, and I think like all things in life we are taking the risk of harm to meet other important needs, in this case overall functionality and successful tapering. I believe the harm caused during a slow taper is minimal compared to staying on the medicine "indefinitely", and also far less than the harm that can be caused by an intolerably rapid taper.

 

I know it's crazy how long tapering can take for some of us. For comparison, my severe headaches were treated with clonazepam effectively for about two weeks before I began trying to taper the medicine; based on my experiences withdrawing I will likely be tapering for 2+ years. I still have headaches most days, but they're nothing compared to the effects a rapid withdrawal had on me.

 

And yet despite the apparent toxicity of this medicine, I am actually in many ways healthier at this time, slow tapering, than I was before I started the medication. I'm learning patience, self-awareness, and taking my mental health seriously with therapy and lifestyle practices that help to address both my withdrawal symptoms and underlying trauma. So I think that withdrawal can actually be a very positive experience: a time for personal growth and new understandings about ourselves and the world.

 

I think tapering as soon as you're starting to feel comfortable again is the best way to mitigate any increase in tolerance. I don't know that this is actually a physical dependence dynamic, but in my experience it's definitely a mental dynamic. By keeping myself regularly reducing I have largely avoided the emotional numbing and false-confidence that a steady benzo dose causes me. I may actually speed up my taper in the near future to continue to mitigate these effects for this goal of staying alert and open to my self. I'm finding it's a delicate balance, and I still err on the side of going slower and staying more functional. The medicine is losing it's grip, one way or another.

 

I really expect you'll see improvements sooner rather than later!

Keep us posted and I'll see you around the forum. 

Hi SlownSteady and friends,

I’ve been tapering for almost 2 months on the compounded liquid at 0.075mg 3x per day (0.225mg/day). I held an month in order to get steady. It’s almost time for me to taper again but I’m not sure that I should.

I still have the burning skin and scalp ( not as severe as it was at the start) but still having difficulty.

It flares up with work stress as well. I am now feeling more anxiety and also feeling some depression (which I’ve never really felt before the Benzo WD).

Perhaps I should hold another month in hopes that these symptoms will subside, or should I taper 5% less or should I do 10%?

I want off this medicine but don’t want to make things even worse.

Maybe I am in tolerance or the burning will never go away?

I feel very sad that I’m not healing like I hoped. I’m having a difficult time.

For such a small dosage and only on it for 2 months, I am so stressed about this situation and that my side effects aren’t better than I hoped for. The burning is causing me so much distress.

My pdoc is not very helpful, and I have to meet with her tomorrow.

I would appreciate help and advice.

Hi jordanjack,

I'm glad that you are able to get and use a compounded liquid form of alprazolam.

Unfortunately no one on here can honestly or ethically answer any questions about what you "should" do. You can ask, but we can only answer very indirectly to these types of questions. We're able to offer peer-support which is sharing our experiences and beliefs, as well as factual information about these drugs and our observations of their effects. We don't know your situation better than you do, which is why ultimately all tapering decisions are up to you.

I believe that the burning sensations will go away in time; you say it's lessened during your month-long hold, and I hope that gives you some confidence that this is a symptom related to the neurological imbalance taking place during your withdrawal. In my experience symptoms of neurological over-excitability, such as caused by benzo tapering, will be exacerbated by just about ANY other life stress; therefore mitigating as many of these stresses as possible and learning skills for relaxation has proved helpful for many buddies.

I suggest since stability has been difficult recently to start with a slower taper rate for now, maybe ~5%/14 days; also because you're on alprazolam I suggest considering a daily micro taper of your liquid, which might give you the least symptomatic intensity during reductions. Jim Hawk's schedule generator is a powerful tool; I have an instructional for it linked in my signature under my current-use tapering tools and techniques.

Lastly, I suggest letting go of your expectations for how this should go. I suggest considering that reality is brutally honest, and I think there's nothing much to do besides complain or learn and adapt. I suggest learning and adapting. A way to do this might be to accept the burning as a significant part of your current transition; it won't last forever. How can you make the best of it?

I hope this helps.