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Valium 5mg titration - dry or liquid micro taper?


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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.

 

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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.

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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.

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Thank you so much for your guidance, Libertas.

 

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?

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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?

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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).

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Once again, thank you for sharing this with me, Libertas.

 

I kept a journal for the first 10 days of my cross-over to Valium but I haven’t updated it since. I will resume doing so and will include the information you have suggested noting down.

 

A (perhaps final) practical question: the mouth of the glass container in which the prescription oral solution is is quite narrow — around 11-12 millimeters wide. I am not sure that I will be able to insert a 1mL syringe. If this turns out to be impossible, may I resort to pouring 15 drops (0.5mL, i.e. 5mg Valium) into the 49.5mL of water?

 

As you can probably tell, using needles is not a part of my daily routine :). I suspect it will be fine. (I am using Nipro 1mL syringes (link: https://www.amazon.fr/SERINGUE-1ML-NIPRO-SERINGUES-STÉRILISÉES/dp/B09GXXYQNG )

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I might start my own thread in the taper journal section! Being chronically ill, I tend to have little energy to spare so I keep things as short as possible — meaning that for now, I am using the Notes app on my phone. This may turn out to be impractical for long term use.

 

There is a dropper supplied with the oral solution. Here is a picture where I popped it off — it’s the little green plastic thing inside the white cap on the left of the bottle.

 

It is, however, annoying to use, as drops, although they are of similar size, tend to come out quickly. Thus I often end up spilling a 16th drop on my tabletop. I am also susceptible to losing count when I am out of cognitive energy, which is no good. Using a needle would solve this issue.

 

Edit: Removed personal information.

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This looks very convenient. I will call my pharmacist tomorrow and ask them. I have no idea if people who use insulin need them, but if they do, he might have some.
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Unfortunately, my pharmacist doesn’t have adapter caps and I’ve had no luck finding any online. I assume it would be tricky / error prone to use a syringe without one, so I would probably be better off using the drop adapter and foregoing the 1mL syringe.
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A significant issue has arisen in that the only manufacturer in my country is out of stock for the prescription oral solution since March and until at least the end of April. I couldn’t renew my prescription at the pharmacy today. I hope the supply will stabilize for the coming months, otherwise it will complicate matters.

 

Unfortunately, this means that I have to delay my taper further. For now, I will revert to using pills.

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I'm sure sorry to hear you're experiencing supply chain issues but glad you have enough medication in tablet form. 
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Yes, I’m glad I asked my doc for a higher dosage of Valium than I needed to have extra pills in case of a supply problem. It’s a shame because it turns out that I prefer the prescription oral solution — it makes no difference to my symptoms, but it has a faster onset (30 mins vs 60+ for pills).

 

Anyway, my pharmacist has ordered the prescription oral solution so it will be on backlog. I hope it arrives soon.

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Good news: the graduated cylinder arrived today. Shipping from the US to my country was much faster than anticipated. I now have all of the equipment required to start the titration if I wish to proceed now.
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I did end up updosing to 7.5mg and have accordingly bought a 100mL graduated cylinder (same brand / line of cylinders).

 

I have thought some more about the dilution process and have some concerns (potentially easily addressed).

 

1. When shaking the diluted solution in the mixing recipient (4oz mason jar), there will probably be some leftover liquid on the (underside of the) lid. I will try to salvage it into the recipient, but some liquid may still be lost. As a result, the dosage of Valium may become erroneous. How much of a concern is this?

 

2. Planning ahead. When I will reach lower amounts of diazepam (1 to 3mg), it may become difficult to remove the unwanted/excess diluted solution by drawing it with a 5mL syringe from the mixing recipient. For instance, with a dose of 0.9mg diazepam, the diluted solution only amounts to 9mL. At this point, I will dilute the solution more than 100-fold (the current rate), probably anywhere between 200 or 250-fold.

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I did end up updosing to 7.5mg and have accordingly bought a 100mL graduated cylinder (same brand / line of cylinders).

 

I have thought some more about the dilution process and have some concerns (potentially easily addressed).

 

1. When shaking the diluted solution in the mixing recipient (4oz mason jar), there will probably be some leftover liquid on the (underside of the) lid. I will try to salvage it into the recipient, but some liquid may still be lost. As a result, the dosage of Valium may become erroneous. How much of a concern is this?

 

2. Planning ahead. When I will reach lower amounts of diazepam (1 to 3mg), it may become difficult to remove the unwanted/excess diluted solution by drawing it with a 5mL syringe from the mixing recipient. For instance, with a dose of 0.9mg diazepam, the diluted solution only amounts to 9mL. At this point, I will dilute the solution more than 100-fold (the current rate), probably anywhere between 200 or 250-fold.

For item 1, try to give yourself a break.  Perhaps since the few drops lost will be basically the same each time you make a new batch, after the first loss, it will be consistant?

For item 2, can you buy a larger syringe.  See this link https://smile.amazon.com/s?k=100+ml+syringe&crid=157MI1TYE69KF&sprefix=100+ml+syringe%2Caps%2C83&ref=nb_sb_noss_2

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1. Indeed, the loss of diluted solution should be consistent with every batch made.

 

I had forgotten from my lab sessions in high school that there is always some loss involved in chemistry (for example during chemical reactions)! It is not an exact science after all, and this is why rigorous error measurement/approximation matters so much.

 

That said, I’m not doing industrial chemistry here, so it does not in fact matter much in my case. I will still try to measure very approximately the amount of diluted solution that stays stuck to the underside of the lid. My guess is no more than 1-2mL.

 

I can either:

 

- try to adjust for the loss by drawing out 1-2mL less of diluted solution with the 5mL syringe in the final step

 

- not adjust for the loss, and instead assume that this will be the first dosage reduction of the taper (i.e. losing 1-2mL means tapering by 0.1 or 0.2mg).

 

The second option is probably easier in the longer run (possibly at the expense of a rougher start to my taper), as I won’t have to remember every time that I need to adjust for the loss when removing the excess diluted solution. Given the cognitive difficulties that come with my chronic illness, this is the safe/foolproof way.

 

In either case, as Libertas pointed out, what matters is that I record whether I experience withdrawal symptoms at first (and of course all throughout my taper).

 

2. A larger syringe has a longer tip, so I believe that this would only make drawing small volumes of diluted solution (under 10mL) more difficult, not easier. Am I mistaken, Bob7? (My apologies if this seems dumb, it is late in the evening and the past few days have been very taxing on me.)

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