Need Help Tapering my sister off Diazepam Only have 5mg pills

[[Buddie]]

Hi

My sister was just released from the hospital from a benzo withdrawal episode.  We currently only have access to 5mg pills of Diazepam.   They are scored, and can be broken down into 2.5mg doses.  Once I get her to the point below 2.5mg doses, what is the best method to continue the taper?  Should I crush the pills, and try to evenly divide the powder?  Will that ensure enough diazepam, and not filler, is in each dose?   Should I mix the crushed pill with water, and then evenly divide the liquid, to better ensure even distribution of diazepam in each sub 2.5mg dose?  I have been reading around on the site but it isn't clear to me what to do in my specific situation.  I have downloaded the Universal Tapering Guide spreadsheet and am ready to begin a plan for her once I figure out how to give her sub 2.5mg doses.   I appreciate any help in this situation, even if it is to point me to another thread on this site that already answers this question, which I'm struggling to find myself.

Thanks

Good luck to everyone.

[[Buddie]]

Hi

My sister was just released from the hospital from a benzo withdrawal episode.  We currently only have access to 5mg pills of Diazepam.   They are scored, and can be broken down into 2.5mg doses.  Once I get her to the point below 2.5mg doses, what is the best method to continue the taper?  Should I crush the pills, and try to evenly divide the powder?  Will that ensure enough diazepam, and not filler, is in each dose?   Should I mix the crushed pill with water, and then evenly divide the liquid, to better ensure even distribution of diazepam in each sub 2.5mg dose?  I have been reading around on the site but it isn't clear to me what to do in my specific situation.  I have downloaded the Universal Tapering Guide spreadsheet and am ready to begin a plan for her once I figure out how to give her sub 2.5mg doses.   I appreciate any help in this situation, even if it is to point me to another thread on this site that already answers this question, which I'm struggling to find myself.

Thanks

Good luck to everyone.

Hi [...]

I would look at purchasing a precision jewellers scale from Amazon and taper your sister at between 5-10% following asymptotic based taper, only reducing once symptoms from the previous reduction have settled down to a tolerable baseline level. Please read through the Colorado Consortium Benzodiazepine Deprescribing Guidance in the below link to educate yourself about sensible tapers. I’ll allow provide a link to a jewellers scales commonly used here by members.

Colorado Consortium Benzodiazepine Deprescribing Guidance

https://www.amazon.ca/Smart-Weigh-GEM20-Precision-Milligram/dp/B00ESHDGOI/ref=sr_1_4?crid=1SQ52ZB5IN4KK&keywords=GEM20+precision+scale&qid=1672108933&s=industrial&sprefix=gem20+precision+scale%2Cindustrial%2C377&sr=1-4

[[Buddie]]

With the scale, you would taper by the tablet weight, not the active pharmaceutical ingredient. We’ll explain to you how to use the scale and calculate the set percentage reductions using a calculator. 

[[Buddie]]

Hi Winter Sun, thanks for the response!

I was under the impression that since you can't know which section of the tablet contained the actual medicine, it would be difficult to ensure accurate dosing at scales below 2.5mg (the pills i have score to 2.5mg).

I ordered the scale and read the pdf you linked.   Will the process be, to crush a full 5mg pill, and then use the scale to divide up the powder evenly, and administer those smaller doses either as dry powder or in a suspension?  How is it known that the same amount of  pharmaceutical ingredient is in each division at that point, and that some aren't only filler?  Or are we just doing the best we can kind of thing?

Thanks again for helping me in this situation, and good luck yourself.
SA

[[Buddie]]

Hi Winter Sun, thanks for the response!

I was under the impression that since you can't know which section of the tablet contained the actual medicine, it would be difficult to ensure accurate dosing at scales below 2.5mg (the pills i have score to 2.5mg).

I ordered the scale and read the pdf you linked.   Will the process be, to crush a full 5mg pill, and then use the scale to divide up the powder evenly, and administer those smaller doses either as dry powder or in a suspension?  How is it known that the same amount of  pharmaceutical ingredient is in each division at that point, and that some aren't only filler?  Or are we just doing the best we can kind of thing?

Thanks again for helping me in this situation, and good luck yourself.
SA

We have to trust that the API is evenly dispersed throughout the tablet. As far as I know (imagine), the tablets are made in large batches from a slurry, and when it comes to pharmaceutical grade tablets, the slurry would be thoroughly mixed until very evenly dispersed, so I completely trust that whatever dose I’m weighing contains exactly the amount of API it’s meant to contain. The only thing I would keep an eye on, is that each tablet weighs pretty much the same - maybe within a 0.004 range of each other, because, if the API is evenly dispersed through the mixing process and your average tablet weight is 0.172g, then a tablet weighing 0.178g must have slightly more API, and a tablet weighing 0.166g must contain slightly less API. But this would likely be much more of a problem with a much more potent benzo than diazepam, such as Xanax or klonopin, both being upwards of 15 times more potent.

There’s no need to make a suspension if you’re using a scale, and to be honest, I wouldn’t even bother crushing the tablet. Just trust that the API is evenly dispersed, put the tablet on the scale to get the total weight, then just use your fingers to break the tablet into two relatively equal pieces and if one half weighs more than the other, then file or break off a small amount from the larger half and add it to the smaller half until both halves are of equal weight. If the whole tablet weighs 0.172g, then both halves should weigh 0.086g. As your dose weight lowers with the taper, you simply file or break off slightly more until both halves are equal but also add up to the total daily dose weight, but I’ll do a better job of explaining it later.

The 0.172g is just an example, it’s the weight of my 2mg valium tabs, but the 5mg probably weigh more.