Support with DLMT process and rate for Valium taper

Hi - I was graciously receiving support from Bob 7 on someone else's thread and decided to start my own here because I still have some confusion and don't want to muck up someone else's thread.

 

I am currently on 3.5 mg V. I am planning to dry cut until at least 3mg. From there, I am wondering if a DMLT might reduce sxs, and what the best way is to go about it.

 

Bob 7 suggested 300 days and 300 mil, or 150 days and 150 mil (removing 1 mil each day either way), depending on how fast I want to go.

 

Here are my questions:

 

1. Is the below math correct?

 

If I start with 3mg and 300 ml, and remove 1 mil. per day, I am tapering .01 mg per day, which means I'm tapering 1 mg of V per 100 days

 

If I start with 3mg and 150 ml, and remove 1 mil. per day, I am tapering .02 mg per day, which means I'm tapering 1mg of V per 50 days

 

etc.?

 

2. And if this is correct, is there anyone who's done this who might be able to chime in and say what rate worked best for them for V? .01 per day, .02 per day, etc.?

 

3. I may not have an endless supply to pills, so at some point, once I'm down to 2mg in the water taper, I may have to recalibrate to use 2mg tablet for my taper instead of using all 3mg. How would I do this?

 

4. What have folks found to be the most effective way of DLMT? I see lots of folks using a water and Valium suspension, and lots of folks struggling on liquid valium. And if I change from dry cutting to water tapering, do I have to hold for a period of time for adjustment?

 

This is all very new to me, so any support would be helpful.

 

Much gratitude!

 

Hi Openroad

I am dry cutting Valium. I tried the pharmacy liquid for a week and it made me nauseous but I recommend trying it since it is very easy to use and you may adjust to it. I have to go back to liquid soon since dry cutting is a hassle at lower doses. My doc is going to get me a liquid from a compound pharmacy that doesn’t have the sweeteners etc to see if I can adjust to it

As far as your question on rate of reduction we are all different you have to try it and journal your symptoms so you can modify your rate of reduction or amount of reduction to maintain your stability.

The math appears correct to me but I’m sure other bbs more experienced in these methods will reply

If you are pill limited you can always reduce a dose at a time using liquid and taking the other doses in tablet form.

Hope this helps some

Joeb

Thanks, Joeb! I'm dry-cutting right now, but think liquid daily taper will be better once I get a little further down. I'm hoping it will help me steer clear of some w/d sxs. Dry cutting with the scale right now is pretty easy, but I just did my first cut a week ago and it hit me really hard today and I want a smoother ride, if it's at all possible. Thanks for weighing in! (Pun intended )

Thanks, Joeb! I'm dry-cutting right now, but think liquid daily taper will be better once I get a little further down. I'm hoping it will help me steer clear of some w/d sxs. Dry cutting with the scale right now is pretty easy, but I just did my first cut a week ago and it hit me really hard today and I want a smoother ride, if it's at all possible. Thanks for weighing in! (Pun intended )

Hey Openroad your very welcome; at least you can joke I have a hard time even laughing anymore

I’m curious how much did you cut and what type of scale are you using?  My Gemini 20 is not very accurate but close, Valium has some forgiveness on accuracy due to the longer half life.

Also what are your WD symptoms ?

I get hit 3-5 days after a cut but feel overall crappy all the time.

Sedated, anxious and depressed not wanting to do anything

Being retired doesn’t help the boredom, do you work? Distraction is the key

Hope your sx calm down for you

Joeb

Hello openroad. Thank you for inviting me to comment on your thread.

 

1. Your math looks ok to me.

 

2.  I encourage you to (a) use your taper rate and symptoms to inform decisions about what amount to reduce and (b) be prepared to make adjustments in both your taper rate and amount as you proceed with your taper.  Members who make fixed amount reductions sometimes get into trouble because the percent of those fixed amounts gets larger as the total daily dose gets lower. 

 

Do you have a sense of what taper rate might work for you?  For example, your last cut from 4mg to 3.5mg was a 12.5% reduction in dose.  Given your response, that may be too large for you.  I also encourage you to hold for a while before you make another reduction so you can discover your withdrawal pattern (i.e. how long it takes for withdrawal symptoms to emerge, peak, and stabilize).

 

3.  To make a liquid with a concentration of 0.01mg using a 2mg tablet, you would disperse the tablet in 200mL of water.

 

4.a. I have a different take than you do about members who have used/are using the commercially manufactured, 5mg/5mL oral diazepam solution to taper.  Most of the ones I’ve read about have done fine with it.  A major advantage of using a manufacturer’s oral solution is dosing accuracy.  These liquids are true solutions so each and every milliliter contains exactly the same amount of drug.

 

Let me hasten to add that members have used a variety of liquids to taper/titrate diazepam.  Here’s a list:

 

manufacturer’s oral solution

compounded oral solution

compounded oral suspension

homebrew liquids made with regular tablets and (a) a commercial suspending vehicle such as OraPlus, (b) whole fat, homogenized milk, © water, and (d) water and alcohol.

 

We also have members who have titrated diazepam using ‘dry’ methods (pill shaving/weighing, powder grinding/weighing).

 

4.b. If you change from using a ‘dry’ technique to using a liquid, it’s a good idea to give yourself time to adjust to the change in dosage form.  For example, the bioavailability of the liquid form may be different than that of the solid. When changing dosage forms, it’s also advisable to hold all other variables constant (e.g. your dose).

 

Edit: typo

Libertas,

 

Thank you! I have a few follow-up answers/questions below - no rush! (I'm glad you like lists - me too!)

 

1. Cool.

 

2. This is exactly what I'm trying to figure out. You're right - I think my first cut (advised by my doc) was too big. I wasn't even stable on 4mg for more than a week, and then cut to 3.5, and have been 75% functional but also in a lot of discomfort. I am holding now, for sure. So, let's say I want to go down appx. 10% every two weeks ... how do I factor that into a DLMT? Is it even possible to come up with an algorithm for that? If I start at 3mg with 300ml, I'm going down .14mg in two weeks, which seems a little slow, no?

 

2a. Also, I'm wondering if it may be easier to go down 10% in 2 weeks on a DMT rather than cut and hold - same amount but slower progression, right? (I believe I'm in tolerance so trying to find the right balance of going slow enough to stay functional but fast enough to not lengthen my time on the drug unnecessarily.)

 

3. That makes sense but I guess I'm wondering if I start with 3mg (in, let's say 300 mil of water) and then, when I get to 2mg, and I want to switch to only using my 2mg pills ... how do I know when I get to 2mg? Would that be 100 days (or doses extracted) later? And then I just start over from 2mg with 200 mil, and I'm going at the same pace, I suppose?

 

4a. I'd actually be very happy to keep dry cutting (I'm doing it now and I have a good scale, I think) but it seems very hard to get the measurements right for a DMT. If I do go in that direction, Bob 7 had a good process he recommended with capsules and filler. I might try that. I could also ask my doc about liquid V - I have an appt on Monday. But part of me just wants to stick with the pills I have and not change too much in regard to the drug composition. Anyway, thanks for listing out all of the choices. I wish I knew what would be best!

 

4b. Got it - thanks!

 

I appreciate your patience with me!

Joeb -

 

I am not retired unfortunately  . I am trying desperately to keep working because I have to. I have my own business and I'd say I'm probably working about 40% time right now, plus taking one grad school class (had to drop the other three). I am in no way at my full capacity. My goal is to be more or less fully functional throughout this taper, but time will tell if I can make that happen.

 

I have this scale that Bob 7 recommended and really like it so far:

https://www.amazon.com/gp/product/B011J88S8M/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

 

I like dry cutting but want to do smaller cuts more frequently and not sure I can do that without making capsules. Weighing all my options right now. (Oops, I did it again.)

 

My sxs are in my signature. Not getting all of them right now, thankfully. But enough to make my days less predictable than I'd like! Sending good vibes your way.

Joeb -

 

I am not retired unfortunately  . I am trying desperately to keep working because I have to. I have my own business and I'd say I'm probably working about 40% time right now, plus taking one grad school class (had to drop the other three). I am in no way at my full capacity. My goal is to be more or less fully functional throughout this taper, but time will tell if I can make that happen.

 

I have this scale that Bob 7 recommended and really like it so far:

https://www.amazon.com/gp/product/B011J88S8M/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

 

I like dry cutting but want to do smaller cuts more frequently and not sure I can do that without making capsules. Weighing all my options right now. (Oops, I did it again.)

 

My sxs are in my signature. Not getting all of them right now, thankfully. But enough to make my days less predictable than I'd like! Sending good vibes your way.

Hey OR that scale is very similar to mine just a different brand. Mine seems very sensitive and weights vary every time I weigh something so I just get close.

I hope I can adjust to compounded liquid, I’m tired of shaving and weighing parts of tablets. Been doing it along time. Got one more cut then gotta weigh my options again

Thanks for the good vibes sending you some also.

Joeb

Hello again, openroad.  I’ve asked Bob7 to stop by to answer your questions.  The liquid titration approach he suggested to you is different than the one I use so he’s in a better position to respond.  Also, Bob7 is definitely your best source of information and guidance regarding dry tapering.

 

I’m the type of person who likes to have as many options as possible, so if I were in your shoes, I’d take advantage of the upcoming appointment to find out if my doc would be willing to prescribe either the 2mg/mL oral concentrate of lorazepam (which may be diluted), a compounded solution, or a compounded suspension to support a gradual, symptom-based, patient-directed taper as recommended in the document below:

 

Benzodiazepine Deprescribing Guidance Document (target audience is prescribers)

https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf

Libertas,

 

Thank you! I have a few follow-up answers/questions below - no rush! (I'm glad you like lists - me too!)

 

1. Cool.

 

2. This is exactly what I'm trying to figure out. You're right - I think my first cut (advised by my doc) was too big. I wasn't even stable on 4mg for more than a week, and then cut to 3.5, and have been 75% functional but also in a lot of discomfort. I am holding now, for sure. So, let's say I want to go down appx. 10% every two weeks ... how do I factor that into a DLMT? Is it even possible to come up with an algorithm for that? If I start at 3mg with 300ml, I'm going down .14mg in two weeks, which seems a little slow, no?

 

2a. Also, I'm wondering if it may be easier to go down 10% in 2 weeks on a DMT rather than cut and hold - same amount but slower progression, right? (I believe I'm in tolerance so trying to find the right balance of going slow enough to stay functional but fast enough to not lengthen my time on the drug unnecessarily.)

 

3. That makes sense but I guess I'm wondering if I start with 3mg (in, let's say 300 mil of water) and then, when I get to 2mg, and I want to switch to only using my 2mg pills ... how do I know when I get to 2mg? Would that be 100 days (or doses extracted) later? And then I just start over from 2mg with 200 mil, and I'm going at the same pace, I suppose?

 

4a. I'd actually be very happy to keep dry cutting (I'm doing it now and I have a good scale, I think) but it seems very hard to get the measurements right for a DMT. If I do go in that direction, Bob 7 had a good process he recommended with capsules and filler. I might try that. I could also ask my doc about liquid V - I have an appt on Monday. But part of me just wants to stick with the pills I have and not change too much in regard to the drug composition. Anyway, thanks for listing out all of the choices. I wish I knew what would be best!

 

4b. Got it - thanks!

 

I appreciate your patience with me!

For your question # 2, it is complicated so I wish you would try something simple first like the the method you are discussing in question 3.

 

For your question # 3, you certainly can start with 3mg in 300 mL of water and later switch to 2mg pills.  Again, you are being complicated and this will create anxiety.  I do not see why you are doing this to yourself.  I guess you are worried about saving medication?

I guess you have good reasons to complicate it so I am trusting here.  Here is how you can switch to 2mg pills:

 

For the first 100 days, you will always use 3mg pill in 300 mL of water.  Each day, remove 1 more mL of liquid and drink the rest.

When you reach 200 mL (on your 100th day), you will change to 2mg pills as follows.

Each day you will mix the 2mg pill in 200 mL of water BUT NOW you will start over.

On day 1, remove 1mL of liquid and drink the remaining 199mL

On day 2, remove 2mL of liquid and drink the remaining 198mL

continue for another 198 days.

Thanks, Libertas and Bob 7.

 

Bob 7 - Tbh, it's causing me more anxiety to *not* understand what I'm doing than to ask additional questions. That's just how my mind works. Like everyone, I'm dealing with multiple factors here. One is that I may not be able to have a steady supply of pills for a whole year, and also, if I am dissolving pills, being able to just taper from 1 pill (once I get to 2mg) will mean I don't have to keep weighing out the additional 1.5, which is less hassle and less room for error.

 

I'm also asking these questions about length of taper because I believe that I am in tolerance, and don't want to prolong the taper longer than it needs to be. But also, I am having sxs daily, so trying to find the right balance.

 

Anyway, it seems these are big decisions I have to make on my own, so thanks for all of your ideas and thoughts. Appreciate your time very much!

openroad,

 

I do not want to upset you.  Please forgive me if there was any bad feelings.

 

I do want to help you not to overthink your benzo condition.

 

There is no easy way to taper.  But the more you think about it, the worse you get.

 

Many have discovered the only real relief is from time and distraction.  You must distract yourself from the taper.  Pick the easiest taper possible, do it everyday, but then spend the rest of you day in the moment, living your life.  Find things which distract you, even for a moment.  Work harder on distraction then on benzo studies and you will feel better.

 

I’m the type of person who likes to have as many options as possible, so if I were in your shoes, I’d take advantage of the upcoming appointment to find out if my doc would be willing to prescribe either the 2mg/mL oral concentrate of lorazepam (which may be diluted), a compounded solution, or a compounded suspension to support a gradual, symptom-based, patient-directed taper as recommended in the document below:

 

Benzodiazepine Deprescribing Guidance Document (target audience is prescribers)

https://corxconsortium.org/wp-content/uploads/Benzo-Deperscribing.pdf

 

Libertas - This was helpful - thank you! (And look, I figured out how to create a quote, too.) Peace.