What dose to hold at, after accidentally skipping a dose+ rescue dose?

Hi all,

I'm here trying to help a family member who is tapering and accidentally skipped a dose, is miserable and not sure how to proceed after taking a couple of rescue doses. Any advice would be greatly appreciated.

 

Here is her account and history below:

 

"I have been reducing by about 1% per week for the past year from 4mg Valium. I reached the halfway point (2 mg) about a week and a half ago and realized that when I went to record my dosage that I was off by a day meaning I had either skipped a dose some time in the previous week or just forgotten to record it. Since I wasn’t feeling especially symptomatic and I have two alarms in my phone to remind me to take my dose, I figured that I just hadn’t recorded it. About a week later (a few days ago) it became apparent that I had actually skipped a dose when I started having full body convulsions, burning skin and other symptoms that I haven’t had to this degree before. I decided to take an extra half dose hoping my symptoms would abate which they did somewhat for 2 days. And then the convulsions, burning skin, and speech and movement difficulty came back strong. I took another half dose but am concerned that I have further confused my system and that I will start convulsing again as soon as it wears off. I feel so demoralized. Has anyone had a similar dosage misstep and if so, how long did it take to stabilize? If I do up my dosage to reduce convulsions, is there an increase level that seems most reasonable? Any insights would be greatly appreciated."

 

 

History:

Became dependent on Ativan 1 mg after two weeks of use in July 2019.

Switched to Valium for rapid taper 2019 (horrifying withdrawal)

Reinstated November 2019.

Been dry tapering off of 5 mg Valium since July 2020.

Reducing by about 1% per week for the past year,  reached the halfway point (2 mg) about a week and a half ago.

Then accidentally skipped dose, 7 days later horrible withdrawal, took additional 1mg that evening, better for a couple days then crashed again took an additional 1 mg, very symptomatic.

Symptoms include cog fog, depression, anxiety, fatigue and most recently (due to missed dosage) convulsions, insomnia, burning sensations.

 

Took Gabapentin only briefly 2 yrs ago, off now.

On 30 mg Remeron since January 2020

 

Question now: how to proceed? Updose until stable? And at what dosage?

In the inner compass article it talks about only up dosing if you reduced to rapidly. It appears she has had a safe taper so perhaps holding at current dose may be a good option. It's hard to say how she would react to an up dose. It doesn't always go well for people. There is an up dose group around here if you want to read people's stories or post the question there.