Valium 5mg titration - dry or liquid micro taper?

[[Buddie]]

I have crossed over from 2 doses of zolpidem (tablets, 10mg bedtime + 5mg early AM) to 5mg of Valium at bedtime (round pills manufactured by Teva). I feel stable enough to start a micro taper now.

I have access to both pills and the prescription oral solution from Roche in the 1mL = 10mg diazepam formulation (my doctor prescribes whichever I prefer). 30 drops are equal to 1mL, so the smallest possible gradation of 1 drop is .33mg.

I have bought a “precision” scale from Amazon as my initial intention was to do a dry micro taper, but having fiddled with it a bit, I’m not sure what it’s worth (link: https://www.amazon.fr/Brifit-Précision-Precision-Détalonnage-Électrostatiques/dp/B085C9RT67/ ).

Therefore I would feel more confident titrating with the prescription oral solution, but as it is quite concentrated, how can I micro dose accurately? With a 0.5mL syringe, the gradations would probably be too large. Are there pipettes with smaller gradations?

Otherwise, how feasible is it to dilute the prescription oral solution in water? (I can’t use alcohol or milk.) From what I’ve read, it tends to be difficult to dilute the solution in water as the drops fall to the bottom quickly.

[[Buddie]]

Is diazepam available in a less concentrated solution in your country?  For example, most of our US members who are tapering diazepam use a commercially manufactured 5mg/5mL (1mg/1mL) oral solution.

If obtaining a less concentrated solution is not an option, what are the ingredients in the 10mg/mL oral solution you currently have?

Also, what dosage diazepam tablets are available in your country? For example, in the US, diazepam is available in 2mg, 5mg, and 10mg scored tablets.

[[Buddie]]

The 10mg/mL solution is the only one available in my country. Apart from diazepam, it contains: Ethanol 96% proof, propylene glycol, orange yellow S (E110), purified water.

As for pills, I have 5mg pills currently, 10mg pills are also available, but my pharmacist says 2mg pills are so rarely sold that the manufacturer makes few of them so he never has them in stock.

[[Buddie]]

That’s unfortunate you cannot get a liquid with a lower concentration or lower dosage tablets.  However, let’s see if we can devise an approach that will work with what you have.

Diazepam is known to precipitate out of solution when it is diluted to certain volumes.  Unfortunately, we don’t know what those volume(s) are for the highly concentrated solution you have been prescribed. We also do not how stable such a diluted liquid would be over time.  Below is one approach for your consideration that might mitigate these risks. 

Prepare and use a 0.1mg/mL homebrew liquid each day as follows:

Measure 49.5mLs of purified water and pour it into a small glass container with a leak-proof lid.
Measure 0.5mL of the oral solution and add it to the container.
Put the lid on the container and shake the mixture.
Remove the lid.
Drink the drug/water mixture.
Rinse the container with more purified water.
Drink the rinse water.

Stage 1
Drink all 50mLs of the mixture for several days to discover how your body will react.  Keep a daily journal.  This can be as simple as rating your symptoms on a scale of 0 (none) to 10 (many, intolerable).  After a week or so, review the data in your journal.  If all is well, proceed to Stage 2.

Stage 2
Remove 1mL of the mixture, drink the remaining 49mLs. This will be a 0.1mg reduction in dose.  Hold at that dose to give withdrawal symptoms time to emerge, peak, and stabilize (i.e. stop changing in nature or number, become tolerable).

Stage 3
Remove 2mL of the mixture, drink the remaining 48mLs.  Hold at that dose until any withdrawal symptoms stabilize.

etc.

[[Buddie]]

Thank you so much for your guidance, [...].

I said I cannot use alcohol. I meant to say regular amounts of alcohol, such as what one glass of wine might contain. However, from what I’ve gleaned, the volumes used to dilute diazepam are much smaller. Would it be better and/or easier to use alcohol (and how much proof)?

Regarding purified water, is filtrated tap water good enough (Brita filter), or demineralized water, or does it have to be demineralized + UV-filtered etc?

[[Buddie]]

You are welcome.

You’ve lost me.  Why would you need to use alcohol?  Are you considering making a homebrew liquid using regular tablets?  If so, my vote would be to use the prescription liquid (which includes ethanol/alcohol as well as propylene glycol and water as solvents). The likelihood of getting doses that are both accurate and precise is higher with the professionally formulated and commercially manufactured product.

Re: what water to use … Brita purified or distilled water should be fine.  I just wouldn’t use tap water unless you know it is free from chemicals or contaminants that might interact with the active pharmaceutical ingredient.

[[Buddie]]

Sorry for creating confusion — nevermind. I hadn’t realized that alcohol or PG were only to be used with crushed pills and not the prescription oral solution. I indeed prefer using the latter.

I will buy distilled water. In terms of supplies, apart from this and the glass container with a leak-proof lid, I believe the only other supplies I need are 1) 0.5 or 1mL syringes 2) a 50 or 100mL syringe 3) a 10mL syringe?

Then I would proceed as follows:
1. draw 40mL of distilled water with a 50 or 100mL syringe
2. draw 9mL of distilled water with a 10mL syringe
3. draw 0.5mL of distilled water with a 0.5 or 1mL syringe
4. draw 0.5mL of prescription oral solution with a 0.5 or 1mL syringe (an unused one, or can I reuse that from step 3?)

Is that correct?

Also, do the syringes need to be sterile? And may I reuse them or do I need new ones every time?

[[Buddie]]

Hello, [...].

Thank you for the clarification regarding the alcohol.  Your procedure should work. However, here is an alternative approach for your consideration that is somewhat less laborious and prone to measurement error.

Gear
Water source container (e.g. a measuring cup; glass with a pouring spout)

Mixing/drinking container
- glass, wide mouth (to allow quick/easy measuring of the reduction amount with the syringe)
- approx 100-120mL capacity*
- leakproof lid

*In the US, 4oz glass mason jars with lids and 4oz glass baby food jars with leakproof lids are available (4 ounces is about 118 milliliters).

Graduated cylinder (this may come in handy later if you need to make a more dilute liquid)
- ATSM, Class A, Tolerance +/- 0.25mL, Borosilicate glass
- 50mL with graduations every 0.1mL

Oral Syringes
- 1mL, 3mL or 5mL, 10mL

Other
- Permanent marker
- Clear tape
- Dropper (optional)

Procedure
- Pour approx. 200mL of water into the water source container.
- Measure 49mL of water using the graduated cylinder. See link below for a tutorial.
- Pour the water from the cylinder into the mixing/drinking container.
- Measure 0.5mL of water using the 1mL syringe.
- Dispense the water in the syringe into the mixing/drinking container.
- Mark the meniscus at 49.5mL on the mixing/drinking container with a permanent marker.

Repeat the above steps several times until you are confident you have calibrated the mixing/drinking container at 49.5mL.  Put a piece of clear tape over the calibration mark to prevent it from rubbing off. 

After you have calibrated the mixing/drinking container, all you have to do to mix another batch is pour water into the container until it’s close to the meniscus.  Next, you would use one of your syringes (or a dropper) to slowly add water until it reaches the meniscus.  Finally, you would add 0.5mL of your concentrated diazepam oral solution to the water then follow the steps I outlined earlier.

In response to your questions plus a request and a note ….

(1) No, the syringes do not need to be sterile.

(2) Yes, you may reuse syringes. However, the syringes will wear out over time.  See link below for more information about using syringes.  (Tip: Putting a piece of clear tape over the graduation marks will prevent them from being rubbed off.)

(3) My request:  Did you mean to write PG (propylene glycol) instead of PEG (polyethylene glycol) in your latest post?  If so, would you be so kind as to change this to prevent confusion on the part of other guests/members?  We’ve had at least one member who (mistakenly) thought he could use Miralax — an over-the-counter laxative that contains PEG — as the solvent for a homebrew liquid.

(4) My note: I have several real world issues requiring my attention so my time on the forum will be limited for the next several days.  If you have additional questions, I’m confident other members will step in to answer them.

Links
Graduated Cylinder Technique
https://youtu.be/eUIcebi1GVc

Using Syringes | The Withdrawal Project
https://withdrawal.theinnercompass.org/taper/using-syringes

[[Buddie]]

Thank you once again. I have edited my previous reply to correct the PEG/PG confusion.

Unfortunately, as I am not in the US, I am not able to find a reseller that has graduated cylinders of class A in borosilicate glass that meet the ASTM norm with a tolerance of 0.25mL.

The closest match I can find is a class A Duran glass graduated cylinder with subdivisions every 1mL and a tolerance of 0.5mL. It meets the norm DIN EN ISO 4788. Link: https://www.dutscher.com/frontoffice/product?produitId=0M-09-09

Is this good enough?

EDIT: I splurged and ordered the Eisco Labs 50mL class A graduated cylinder in borosilicate glass, ASTM E1272 norm. $30 on Amazon with shipping fees to my country - so the shipping cost as much as the cylinder. Oh well.

It will take about 10 days to arrive so I will transition from pills to prescription oral solution in the meantime (15 drops = 5mg is my current dose).

[[Buddie]]

On behalf of myself and all future readers of your post, thank you for making that edit.

Here’s to splurging!  Eisco Labs looks like a solid brand. According to its website, Eisco glassware meets not only ATSM but also ISO standards.

Good for you for starting the transition to liquid at your current dose and then holding at that dose for at least 10 days.  Some individuals ‘register’ a change in dosage forms from solid to liquid whereas others do not.  The only way to know is to conduct your own single-subject experiment, with you as the subject.

If you have not already done so, I strongly encourage you to set up a daily tapering journal.  Your journal will be your primary data source for your experiment.

Consider collecting the following data about the liquid form of the drug:

- Onset of action (how long does it take before you first feel the effect the drug after ingesting the liquid)
- T max plasma (when do effects peak)
- Duration of action (how long do effects last)
- Potency (compared to the solid drug form, does the liquid form feel stronger, weaker, or about the same)

If you experience new/different symptoms during the transition, I encourage you to note how many days it takes for them to emerge, peak, and stabilize.  These data points will give you an important clue re: what your withdrawal pattern might be after you begin your taper.