Utterly Hopeless. Liquid Taper from 22.5mg Diazepam with 1ml=5mg solution

[[Buddie]]

I can see you're struggling with the powerlessness this process foists on us, its a tough pill to swallow.  There is so much we can't control, so much we have to accept and it goes against who we are but I think you're making a good decision to hold.

[[Buddie]]

Hello, [...].

I agree with [...] that holding is a good decision.  While you’re holding, let’s see if we can troubleshoot your taper thus far.  To do so, I have a few questions for you:

(1) Can you help us understand the formula you are using to convert milliliters of liquid to milligrams of drug?

By my calculations, 0.78mL of a liquid with a concentration of 5mg/mL would equate to 3.9mg of drug (not 3.8875mg).  Here’s the formula:

0.78mL x 5mg/mL = 3.9mg

(2) What type of device are you using to measure the diazepam 25mg/5mL (5mg/mL) oral solution (concentrate)?  The calibrated oral syringe that came with the medication? A different device? Perhaps a 1mL syringe with 100 graduations?

(3) How did you switch from using all tablets to using tablets plus some liquid?  Did you begin by taking 0.8mL of the liquid (4mg of drug) for your first dose of the day? Did you notice any difference(s) between the liquid and the tablets in terms of onset of action, duration of action, potency?  Did you notice any changes in your symptoms?

(4) Is the following correct in terms of your taper thus far?

Phase 0: total daily dose = 22.5mg
7.5mg
7.5mg
7.5mg

Phase 1: total daily dose = 20mg (11.11% reduction)
5mg
7.5mg
7.5mg

Phase 2: total daily dose = 19mg (5% reduction)
4mg in tablet form to begin then switched to all liquid (0.8mL = 4mg)
7.5mg in tablets
7.5mg in tablets

Phase 3: total daily dose = 18.9mg (0.526% reduction)
3.9mg in liquid form (0.78mL = 3.9mg)
7.5mg in tablets
7.5mg in tablets

(4) What times do you take your three daily doses?

(5) What strength tablets do you have?  5mg?  2mg?  Both?

(6) Would your doctor be willing to prescribe a combination of regular tablets and liquid as long as needed? 

(7) Would your doctor be willing to prescribe the less concentrated 5mg/5mL (1mg/mL) oral solution of diazepam instead of the Intensol/concentrate?

[[Buddie]]

I can see you're struggling with the powerlessness this process foists on us, its a tough pill to swallow.  There is so much we can't control, so much we have to accept and it goes against who we are but I think you're making a good decision to hold.

wow you guys are so awesome!

Thank you so much this is unbelievable!

I was feeling guilty about holding, you just lifted a huge weight off of me, and I feel like with your guys help I can get a fresh start and so this!

[[Buddie]]

Hello, [...].

I agree with [...] that holding is a good decision.  While you’re holding, let’s see if we can troubleshoot your taper thus far.  To do so, I have a few questions for you:

(1) Can you help us understand the formula you are using to convert milliliters of liquid to milligrams of drug?

By my calculations, 0.78mL of a liquid with a concentration of 5mg/mL would equate to 3.9mg of drug (not 3.8875mg).  Here’s the formula:

0.78mL x 5mg/mL = 3.9mg

(2) What type of device are you using to measure the diazepam 25mg/5mL (5mg/mL) oral solution (concentrate)?  The calibrated oral syringe that came with the medication? A different device? Perhaps a 1mL syringe with 100 graduations?

(3) How did you switch from using all tablets to using tablets plus some liquid?  Did you begin by taking 0.8mL of the liquid (4mg of drug) for your first dose of the day? Did you notice any difference(s) between the liquid and the tablets in terms of onset of action, duration of action, potency?  Did you notice any changes in your symptoms?

(4) Is the following correct in terms of your taper thus far?

Phase 0: total daily dose = 22.5mg
7.5mg
7.5mg
7.5mg

Phase 1: total daily dose = 20mg (11.11% reduction)
5mg
7.5mg
7.5mg

Phase 2: total daily dose = 19mg (5% reduction)
4mg in tablet form to begin then switched to all liquid (0.8mL = 4mg)
7.5mg in tablets
7.5mg in tablets

Phase 3: total daily dose = 18.9mg (0.526% reduction)
3.9mg in liquid form (0.78mL = 3.9mg)
7.5mg in tablets
7.5mg in tablets

(4) What times do you take your three daily doses?

(5) What strength tablets do you have?  5mg?  2mg?  Both?

(6) Would your doctor be willing to prescribe a combination of regular tablets and liquid as long as needed? 

(7) Would your doctor be willing to prescribe the less concentrated 5mg/5mL (1mg/mL) oral solution of diazepam instead of the Intensol/concentrate?

[...], I know we don't know each other, but that's the most effort and thoughtfulness someone has put into my taper than anyone else in my life.

I have tears from your compassion and kindness. From the bottom of my heart, thank you, you are already filling me with hope! If there is anything I can do for you please let me know

Ok, so as far as the nuts and bolts you asked, let me answer each question in order:

-(questions #1 & #2) The syringe and liquid math-

As for the .78 you are correct it is 3.9 not 3.8875. The issue I have been dealing with is the syringe that comes with the liquid is only labeled in .1 graduations and is the 1ml= 5mg bottle so I have the liquid between the .8 graduation the top of the number 7 of the .7 ml graduation.

I just recently purchased the .01 disposable graduation syringes to use but the part that is breaking my brain is how to accurately transfer the exact liquid amount in my syringe to the new one.

 I have tried putting colored water in a tiny glass and tilting it, squeezing the amount out of the previous syringe but when I go to suck up the liquid with the .01 graduation syringe it is near impossible to get every drop without bubbles or some degree of liquid residual still in the glass.

As you know even one drop of the liquid would mean a cut lol. So yeah any other ideas how I could make the syringe transfer would be greatly appreciated

(questions #3 & #5) -Tablets and Liquids cuts-

I had a 25mg tablet a day script in 5mg tablet but only ever took 22.5mg and have never taken more than that:

Phase 0: total daily dose = 22.5mg[/b]

7.5 mg (1 and one half tablet) 7.5 mg (1 and one half tablet) 7.5 mg (1 and one half tablet)


Phase 1: total daily dose = 20mg (11.11% reduction)

5mg (1 5mg tablet) 7.5 mg (1 and one half tablet) 7.5 (1 and one half tablet)

Phase cut was removing a half tablet at once from my morning dose, no liquid at this point.

Phase 2: total daily dose = 19mg (5% reduction)
I switched directly from the 5mg tablet to the 1ml/5mg at once and reduced .1 .2ml to .8ml (.8ml x 5= 4mg liquid)

4mg liquid
7.5mg in tablets
7.5mg in tablets

Phase 3: total daily dose = 18.9mg (0.526% reduction)
3.9mg in liquid form (0.78mL = 3.9mg)
7.5mg in tablets
7.5mg in tablets

Each of your phase charts is correct.

Question #4 What times do you take your three daily doses?

2:30, 6:30, 10:30 to the minute for 3 years, never late, never early. I wanted to insure complete daily accuracy. if I alter the schedule at this point my body would not be happy lol.
For time changes I had been changing to 3:30 7:30 11:30, but for this upcoming time change I am contemplating keeping it at 2:30, 6:30, 10:30. It would be moving the dose time up an hour so I am not sure if that is wise.

(6) Would your doctor be willing to prescribe a combination of regular tablets and liquid as long as needed?

Currently I am getting my prescription from a neurologist, she has been giving me 6 month refills of both 1ml liquid and 5mg tablet form script.

 I believe her to be one of those older doctors that puts patients on benzos for extended periods. Nothing is certain, but I am thankful to have her as things stand currently.

(7) Would your doctor be willing to prescribe the less concentrated 5mg/5mL (1mg/mL) oral solution of diazepam instead of the Intensol/concentrate?

My previous psychiatrist who had been prescribing it I communicated I wanted to taper off and changed the prescription to only 30 days and prescribed a ton of Gabapentin which is why I had to find someone else.

So I would potentially risk her prescribing another rapid taper of her own design and losing the certainty of getting the necessary amount to do a micro taper on my own terms if that makes sense.

Thank you again for giving me hope in what has felt like a seemingly hopeless situation. I eagerly look forward to our continued conversation and am humbled by your compassion and generosity with your time.

Best to you.


 

[[Buddie]]

You are most welcome, [...].

It lifts my spirits to know that I have been able to lift yours!

As Colin, the founder of BenzoBuddies, is fond of saying, “I need to have a think” on the information you’ve provided before responding.

Let me close with two questions:

(1) What is the manufacturer of the concentrated 5mg/mL diazepam oral solution you are using? Is it Hikma/West-Ward or Lannett?

(2) Is your prescription for 30mLs per month of the above liquid?

[[Buddie]]

Hello again, [...].

Please look below for one possible approach to the next phase of your taper.  I tried to keep it as simple as possible given the following constraints:

- Only one tablet strength available (5mg)
- Only 30mL of liquid every 30 days (5mg per day)
- Highly concentrated liquid (5mg/1mL)
- Measuring device is 1mL syringe with graduations every 0.1mL

If you are feeling AOK after holding ...

Phase X Taper Plan
Dose 1: 5mg tablet
Dose 2: 5mg tablet + 2mg in liquid (0.4mL)
Dose 3: 5mg tablet + 2mg in liquid (0.4mL)

If you are still feeling a bit rocky after holding ...

Phase X Alternative Taper Plan
Dose 1: 5mg tablet
Dose 2: 5mg tablet + 2.5mg in liquid (0.5mL)
Dose 3: 5mg tablet + 2.5mg in liquid (0.5mL)

(1) Hold all doses constant until you have adjusted to the changes in dosing schedule.

(2) Hold Dose 1 constant at 5mg while reducing Dose 2 and Dose 3 to 5mg.

(3) Using the liquid portion of your doses, alternate between reducing Dose 2 and Dose 3 by 0.5mg (0.1mL) at whatever interval works for you (e.g. every week, every two weeks, every month).

(4) Keep a taper journal. On a daily basis, record your dosing times, amounts, and symptoms.  You will use the data in your journal to discover what taper rate (percent reduction over time) works for you during this phase of your taper as well as your withdrawal pattern — how long does it take for withdrawal symptoms to emerge, peak, and stabilize (i.e. stop changing)?

(5) If withdrawal symptoms become intolerable at any point, hold until they stabilize. Resume reductions when you feel ready to do so.

Note:

If you are unable to tolerate 0.5mg (0.1mL) reductions, we can discuss how to dilute the concentrated liquid. Or, perhaps at that point, you will feel comfortable talking to your prescriber about switching to the less concentrated 5mg/5mL (1mg/1mL) oral solution (this is what most members use).

[[Buddie]]

You are most welcome, [...].

It lifts my spirits to know that I have been able to lift yours!

As Colin, the founder of BenzoBuddies, is fond of saying, “I need to have a think” on the information you’ve provided before responding.

Let me close with two questions:

(1) What is the manufacturer of the concentrated 5mg/mL diazepam oral solution you are using? Is it Hikma/West-Ward or Lannett?


(2) Is your prescription for 30mLs per month of the above liquid?

Hey there!

(1) The bottle is from Roxanne Laborites it does not indicate any other manufacturer.

(2) That is correct it is 30ml per month (1 5mg dose liquid per day)

I greatly appreciate you laying out a plan for me. I will also have a think.

The only initial concern I have is moving around the dosage amounts because my body is so used to the mg for each dosage time.

One thing I was thinking is I could get down to 2.5mg of my initial dose liquid and then switch that to half a tablet.

So I would be setting the next phase goal as:

(1/2 tablet) 2.5mg

1ml 5 mg liquid (1/2 tablet) 7.5mg

1 tablet in a half 7.5mg

Then I could do equal reductions from the second and 3rd dose like you described alternating without having to up my dose. Since I am already in between 5 and 2.5 I kind of feel I have to get the liquid dose down from 4 to 2.5 then I can move the liquid if that makles sense?

Let me know what you think, thanks so much again!

I do need to mention that unfortunately I was put on other medications about 6 months ago (the psychiatrist was trying to get me to take over 10 at once saying it was the only way to heal) and I wasn't in a right state of mind so I unfortunately have other meds I am currently taking.

I have the goal to be medication free as I have been my whole life and and hate all allopathic medications.

I want to be completely honest, I am afraid of being judged but I would rather speak the truth.

The other medications I am currently taking are :

50mg lamictal once a day (doc wanted me to take 200, for mood and glutamate. Again I wish I would have never taken anything)

trileptal 900 a day (for tremors, mini-seizures and inability to speak without stuttering and walking problems. doc wanted me to take 2400)

remeron 15mg (I have lost 50lbs and had constant insomnia, he said it would give me my appetite back and sleep which it has but I wish I hadn't taken anything)

buspar 30 mg (prescribed 45)

He also prescribed me baclofyn gabapentin clonidine prazosin and others which I refused to take.

Eventually I realized he was gaslighting me and tricking me into taking meds and saying I had other mental problems that were nothing more than Benzo Withdrawal. I know longer see him. I am now seeing the neurologist who is refilling scripts but not adding anything.

Unfortunately I only now fully understand GABA and all of the realities of a proper approach to tapering.

I am currently not tapering off the other medications. I feel that doing so now in the midst of the benzo hell could be disastrous.

My plan is to taper each medication one at a time by starting at the top of the pyramid, the true culprit, the Valium, and then tapering the other meds.

I feel that luckily I haven't taken large amounts of the medications prescribed but I still feel that I need to mono-task the overall goal of freedom.

Have the meds reduced my symptoms? Yes, but I know that in the long run it wasn't worth it.

I'm sorry if I disappoint you, I wish I could go back in time, I can't.

Luckily I know now to stay away from all the other stuff, eat healthy self-care meditation etc.

I mean he was begging me to take 3600 gabapentin a day and I never gave in same with the others meds. He was truly a disaster.

Do you think that is ok for me to approach the situation the way I am?

I am very hard on myself, beating myself up over my own mistakes has been a life long problem for me.

I am trying to foster a more gentle approach to myself in order to feel better and empowered to beat this.

A sincere thanks to you, again, I wasn't trying to keep you in the dark about the other medications, I just wanted to first address the benzo issue then make know to you the other medications.

Thank you so much again.

Best to you.

[[Buddie]]

Please don't beat yourself up, you were working with the most logical person for someone in your situation, your doctor.  Its unfortunate you're now on many medications but we certainly don't judge and I agree with your decision to hold off eliminating or reducing any of your other medications, we advise tapering only one at a time.

[[Buddie]]

Please don't beat yourself up, you were working with the most logical person for someone in your situation, your doctor.  Its unfortunate you're now on many medications but we certainly don't judge and I agree with your decision to hold off eliminating or reducing any of your other medications, we advise tapering only one at a time.

Thank you [...] I really appreciate that, it means a great deal. I hope you are doing very well!

[[Buddie]]

Thank you for letting us know the manufacturer of the concentrate you are using.  I’m relieved it’s Roxane.

FYI Roxane was purchased by West-Ward which was then purchased by Hikma. 

The reason I asked is the other manufacturer — Lannett — informed the FDA in January it was discontinuing its concentrate.

This is your taper so it’s totally your call as to how to proceed!