Need help with substitution taper plan Xanax/Valium

Hi,

 

This is where I'm at now. 4 yrs use of Xanax. First 2 years was prescribed .5 mg.

The last 2 years I've gone up to 1.0 mg. (.50 mg 2 x's a day)

 

On Oct 6 I introduced Valium in the evening 2.5 mg..and cut the xanax in half

I have continued that for 5 days. So here's what that looks like:

 

.25 mg xanax in the am

.25 mg. in the afternoon

2.25 valium in the eve.

 

My Dr. ordered the valium at my request and I did show her Ashton Manual but she told me I need to figure out the taper. I want to do this as quickly as possible but at the same time I want to do it correctly and hopefully not deal with w/d for a "protracted" time. If anyone can give me info. I would really appreciate it. I'm thinking maybe the dosing is too low? I have insomnia, but eventually I do get sleep..in the morning. This wouldn't be feasible if I were working but am on disability so I can live with that for now. About 10:00p tonight I started to feel my heart palpitating (a little) and some anxiety so I took my evening dose of valium. I'm ok now. Bottom line is: I do not want to become addicted to valium. I'm trying to become free of meds. Thanks for reading.

One other thing. After picking up the valium I read somewhere that valium can be toxic if you have liver problems (liver disease). Is this true? Even if it is small dose?

Hi wishful,

 

According to the equivalency table we use, 1 mg of Xanax is equal to 20 mgs of Valium.  http://www.benzo.org.uk/bzequiv.htm  I'm concerned you've not been given enough Valium to properly cross over.  Please remember that a slow taper is best, as it hopefully minimizes withdrawal symptoms allowing you to remain functional. 

 

Your body is already dependent on benzo's, so whether you're tapering Valium or Xanax makes no difference.  As long as you're tapering, you're reducing your dependence.

Hi Pampster,

Thank you for replying. So, I guess what I should do is ask Dr. to call in 10mg script? I'm thinking to stay on this .25 mg 2 x's a day then evening 2.5 mg Valium for another week?? Then when I do the cross over go to 10mg Valium?

or maybe .25mg am, .125mg afternoon, then 2.5 mg valium eve.

Hi wishful,

 

If you're feeling okay on just .5 mgs of Xanax and 2.5 mgs of Valium, then there is probably no need to go up any further in dose on the Valium.  Usually it takes a few days for the Valium to build up in your system, so some people feel quite bad when they first cross over, but you sound like you're doing fairly well.  Holding this dose for another week sounds like a good idea, do you plan to cross over totally from the Xanax to Valium, then taper from it?

Hi Pampster,

Yes, that is my intention..cross over to valium I think the week after next. I am not functioning so well..but there are other reasons for that too. What I would like is a loose schedule that I could work from. My math is not so good right now. I went to the Ashton Manual..which startes the taper at 6mg Xanax. I have to do this in a shorter period of time..not a year... I definitely have a dependence but it's not over the top..and I need to be off these things as soon as safely possible. I do feel like I'm walking in the dark..the way I have started this taper. Before now I never knew that I could have protracted w/d or whatever that is called. I also recently read, I think somewhere here on this forum..that valium can cause toxicity in someone with liver disease (that's the reason I want to keep the dose down)...which I have. Is there a professional around who could answer this question? I am just now finding my way around the site

Hi wishful,

 

We don't have any professionals on the site, most of our members just post what they learn from other sources.  You could start a thread about liver toxicity and see if you get responses.

 

I'm really not sure what to suggest as far as your taper goes, but if we followed our equivalency tables, it would look something like this.

 

Your dose now--.50 Xanax and 2.5 mg of Valium

Next stage, 1 to 2 weeks--.25 Xanax, 7.5 mgs Valium

Next stage, hold for 1 to 2 weeks before beginning taper--12.5 mgs Valium, crossover complete

 

Professor Ashton tapered her patients at a rate of 1 mg per stage, but I've seen others go slower.

Thanks for the advice Pampster,

 

Am I incorrect when I say that .5 mg xanax = 10 mg valium

 

if I am correct..why would I go up to 12.5mg when I do the crossover?

 

You are correct when you say that .5 mg Xanax is equal to 10 mgs of Valium, so if you were to use our equivalency table, at the end of your crossover from 1 mg Xanax, you would be on a total of 20 mgs Valium.

 

You're short cutting the amount and the time by only substituting 2.5 mgs of Valium for .5 mgs of Xanax right off the bat, so instead of going up in dose, you've tapered as you've substituted, do you understand?  I know it's hard to think when we're in the midst of benzo withdrawal. 

I am so glad to see you are finally receiving replies to your questions! Although I have been at this for a long time I am very new to this forum and I feel quite sick so I am also not very helpful! I am happy that you were able to post here and you are very lucky that Pamster responded! She has helped me quite a lot with her grace and competence and you can be sure that you are getting the information you need. It is SO hard to figure out these charts! When I switched over from Klonopin to Valium I spent one hour with the NP that is helping me and afterwards I realized SHE had made a mistake. So even people who are not in benzo fog have trouble. But once you get the idea: you get it and it will become second nature to you. What I have learned is that the benzo is on its own time table-- rushed or not-- healing will take place at the same rate! So go easy on your taper and time will heal.

That's what I keep telling myself

Love,

Chrysanthemum

  I so appreciate your posts..yea, I have to be patient..just don't want to stay on any benzo any longer than absoutely necessary. My worry is that I will become dependant on the Valium. I wish the Dr. was more involved..but I guess I am lucky just to get the script. Here int he States I understand that many of the 'professionals' are unwilling to go the valium route.

So thanks again. 

 

wishful1

Tapering slowly allows you to control the symptoms while making reductions, getting off the drug faster only means you'll have more healing to do once off of the drug.  I quit cold turkey, and it took me over a year to heal, and I didn't have the luxury of being able to somewhat control the symptoms, I was at their mercy.  You don't have to do this, you can control your taper, and hopefully allow some healing as you do. 

Hi Pampster,

I don't know why it has taken me so long to reply to your last comment..advice. I have stage 3 liver disease (biopsy 2006, modt likelu worse now) and I am scared of something I read about liver disease and valium due to its long life and possible toxicity to abnormal function of liver. That's why I am trying to taper xanax to as lw as possible before total c/o...so that I can get off the valium quicker. Right now I cannot see a hepatologist due to insurance issues. I am still at .5 mg xanax and 2.5 mg valium. So maybe I should try to stop the afternnon dose of .25mg xanax? Then I could next week start 10mg valium? I guess I'll try that today...since I have yet to take the afternoon dose..(got up late due to insomnia). I'll just listen to what my body is tellin me, right?

Just a thought, I think there are some e-mail addresses at the Ashton link..maybe they could answer this question about the valium? Can't hurt to try. Thank you so much for your help...it's really beneficial that someone is listening as I am doing this without help of family or friends. I live alone and everything I have read says not to do this alone..oh well, I dont have a choice.

Hi Chrysanthemum,

Thanks for your response. For he life of me, I don't know why it took so long for me to respond. I was looking at your signature and see that you are precribed opana for spine injury. I was prescribed oxycodone and finished tapering that 59 days ago. I never thought that benzos would be harder to get off of...oy. Anyhow, thanks so much for your response to my questions. just knowing someone is reading and cares is a comfort. We can do this...baby steps, right? 

Hope to hear from you again.

Hi Chrysanthemum,

Thanks for your response. For he life of me, I don't know why it took so long for me to respond. I was looking at your signature and see that you are precribed opana for spine injury. I was prescribed oxycodone and finished tapering that 59 days ago. I never thought that benzos would be harder to get off of...oy. Anyhow, thanks so much for your response to my questions. just knowing someone is reading and cares is a comfort. We can do this...baby steps, right? 

Hope to hear from you again.

yes! we can do this. I actually texted my NP about Valium and liver toxicity to see if I could help get you an answer. If you have tapered oxycodone then you have also been tapering the benzo at the same time as they have a synergistic effect on each other. I read your post to Pam about having stage 3 liver disease. What does that mean? Why can't you see a hematologist? I cannot imagine dealing with health insurance issues on top of all of this. HEY! I see where you say you are alone: this is VERY DIFFICULT to do and I am sorry you don't have more support. I felt your loneliness the first night you wrote which is why I wrote back even though I didn't know the answer! haha

I have reduced my opana from approximately 80 mg to 20 and when I am done with the Valium I hope to reduce it more. One of the problems that I have been having is an increase in pain but I think it may be rebound pain. My pain Dr. thinks I will need to stay at this level forever but I am hoping not. When I was lowering my pain dose I definitely felt opiate withdrawal AND benzo withdrawal. AND I found that you are never supposed to take the two of them together... that they are quite toxic. SO I am sure that will help your liver as well.

 

If my NP has any answers I will tell you.

If you want to tell me your health story I am here to listen. If not, I understand that too. I am home essentially on the couch wiped out from my last dose drop.

 

Be well.

Love

Chrysanthemum

Hi Chrysanthemum,(that's a mouthful..next time ok if I just type Chrys?)

 

I have hepatitis C..treated that 3 x's and it didnt work for me. Those treatments caused chaos (rheumatoid arthritis, thyroid malfunction, osteoarthritis, fibromyalgia..sure I'm forgetting something, oh yea, neuropathy) and yet the Hep C is continuing to foul up my liver and more. No doubt it will give my liver a break to be off the pain meds..benzos. That was so nice of you to text your NP..really. I didn't take the afternoon dose and went to .25mg xanax and 7.5 mg. valium this eve...see how that goes. What you wrote sounds good but I don't really understand what it means..could you please clarify? [i]"If you have tapered oxycodone then you have also been tapering the benzo at the same time as they have a synergistic effect on each other."[/i]

That was the reason I stopped the oxy..i wanted to see what my 'real' pain was and go from there. I believe I had a toxic reaction with the combo as well. What was that like for you?

I finally got out of the apt. today..did a little grocery shopping..it was good. This isolating is pretty awful..gotta work on that. I went out without the afternoon dose..and then got myself a bit stressed thinking about that. It's amazing..all of a sudden I realised my shoulders, neck arms, hands are all tensed up. and I have to consciously relax parts of my body..it's a trip. I have to do that when trying to go to sleep. Who would have ever guessed that this COULD happen? I appreciate your kindness. Do u ever go into chatroom?

Look forward to hearing from you

In individuals who take valium for prolonged periods frequent liver function tests should be done and the dose of Valium adjusted if there is liver impairment. The possibility of liver damage should always be considered especially in indiviuduals using Valium and other over the counter analgesics or alcohol.

 

I got that offline. My NP also said if a person already has liver disease any medication like Valium can cause liver enzymes to increase.

 

It seems like you have a pretty serious issue with your liver! Wouldn't your Dr.'s be involved in your process?

 

Hang in there.

Love,

Chrysanthemum

Hi Chrysanthemum,(that's a mouthful..next time ok if I just type Chrys?)

 

I have hepatitis C..treated that 3 x's and it didnt work for me. Those treatments caused chaos (rheumatoid arthritis, thyroid malfunction, osteoarthritis, fibromyalgia..sure I'm forgetting something, oh yea, neuropathy) and yet the Hep C is continuing to foul up my liver and more. No doubt it will give my liver a break to be off the pain meds..benzos. That was so nice of you to text your NP..really. I didn't take the afternoon dose and went to .25mg xanax and 7.5 mg. valium this eve...see how that goes. What you wrote sounds good but I don't really understand what it means..could you please clarify? [i]"If you have tapered oxycodone then you have also been tapering the benzo at the same time as they have a synergistic effect on each other."[/i]

That was the reason I stopped the oxy..i wanted to see what my 'real' pain was and go from there. I believe I had a toxic reaction with the combo as well. What was that like for you?

I finally got out of the apt. today..did a little grocery shopping..it was good. This isolating is pretty awful..gotta work on that. I went out without the afternoon dose..and then got myself a bit stressed thinking about that. It's amazing..all of a sudden I realised my shoulders, neck arms, hands are all tensed up. and I have to consciously relax parts of my body..it's a trip. I have to do that when trying to go to sleep. Who would have ever guessed that this COULD happen? I appreciate your kindness. Do u ever go into chatroom?

Look forward to hearing from you

oh my goodness yep Chrys is fine or even C~ I sent you that other post before I read this one. I will try and explain although I feel sick so take that in consideration.  My understanding is that the opiate and the benzo work together in a toxic way but they make each other stronger too. (The combination causes sleep apnea and severe fatigue).... So, therefore when you reduce one of the medications you are really reducing the other a bit too just because they are interacting. So, when you are reducing the opiates you have all the side effects of opiate withdrawal PLUS some of the side effects of benzo withdrawal, too. Does this make sense? You have more prolonged symptoms/ Does this make sense?!

I am so glad you were out and about! It always helps to get out. Why are you so isolated? {No, I don't go in chat. Too big of a commitment for me right now} Feel better and tell me if you understood what I meant.

Love,

Chrysanthemum

Hi Chrys,

Well that explains alot..I did have prolonged w/d's and it did seen like it was more than the opiate..thank you so much for explaining. What's going on with you now? You are sick? I'm sorry to hear that. Today I am feeling better than I have in awhile..2 steps forward, 1 step back..prefer to think like that than 1 step forward, 2 steps back 

You're an 

 

'til soon

:smitten:

Hi Chrys,

Well that explains alot..I did have prolonged w/d's and it did seen like it was more than the opiate..thank you so much for explaining. What's going on with you now? You are sick? I'm sorry to hear that. Today I am feeling better than I have in awhile..2 steps forward, 1 step back..prefer to think like that than 1 step forward, 2 steps back 

You're an 

 

'til soon

:smitten:

Yes! It was worse than just the opiate. I think you will do better just withdrawing from the benzo without that in your system. How long were you on the combination? I have been on both for a bit over two years and it has just been hellish. I have been essentially recovering from a HUGE back surgery and then dealing with medication issues since May of 2009. I would much rather go through opiate withdrawal but I know that my body is not ready to be completely rid of pain medication so I got down as far as I could without too much increased pain and then concentrated on the benzo. It has been a long long road.

Yes, I am sick ! I reduced my dose by 1 mg on Sunday and I feel terrible. It is so hard to compare symptoms with people but I do believe that the double whammy of the opiate~ benzo makes it a much more difficult withdrawal than just one of them alone. On the other hand I luckily am not dealing with "addiction issues"-- obviously I am physically dependent but do not crave more drugs. When I first started withdrawing in the summer of 2009~ lowering my baclofen dose and starting the klonopin withdrawal and lowering my pain meds I had no idea that this was withdrawal-- I was so sick I couldn't function. Of course as time went on I learned that it was withdrawal and have steadily reduced my dose since. When I lower my dose now, I am pretty much couch ridden... I can make a little dinner for the kids, and get my youngest up in the morning for school and that is about it... HOWEVER, the combination of the benzo-opiate was making me really sick in a different way so I have no choice but to move this process along and hope for a better quality life at the end of it. I have cleared my calendar of everything and am going to focus on getting off these last two mg of Valium. It sounds ridiculous even to me-- that is why I eventually found this group.. I thought I can not be the only person so sick from this!

 

At the end of the day... it is a leap of faith.

 

Be well and stay in touch

Chrysanthemum

Hi again,

I have been prescribed the two for 4 years. Didnt realise until lately that I have been in withdrawal from both for a long time. I just thought I was sick..instead it was my body craving more and more and I didn't go beyond my script..I just didnt know. I am very glad I didn't, at the same time..it's awful that I suffered needlessly. I don't crave either...I know I was dependant but I never called Dr. and asked for early script...or went to the streets..which now I know is quite common. I thank God that I remained on low doses (relatively) and it didnt come to that. I am on the road to recovery. This is also my priority...tapering off the benzo.

I'm glad I found this forum and communicating with you. 

I'm glad you understand the distinction between addiction and dependence, many don't.  I'm sorry you were made to suffer for so long, but now you're on your way to good health.  The only problem is, it hurts getting there. 

Hi,

I just wanted to put it in print and hope I am not crossing over too quickly from xanax. I was tapering and substituting xanax and valium:

.25 mg. xanax = am

2.5 mg valium = afternoon

5.0 mg. valium = eve.

 

Today

 

2.5 mg valium = am

2.5 mg valium = afternoon

5.0 mg. vlium = eve.

 

I just hope for very few s/x. I have to travel soon and I was going to wait until the trip was over..but I just want to be finished with benzos forever asap

Hi Pampster,

Thanks for your reply. I started a new post..I should have continued on this thread..oh well. Today is 63 days oxy free..very glad. I now take OTC (ibuprophen) sparingly just to take the edge off. Having a clear head is my goal. 

Discontinued the xanax starting today. I am going to go for 10mg valium...I hope it's enough. I think it will be. It better be because after reading everything..it looks like it would be very counterproductive to up the dosage after the fact? Maybe I should do .125 xanax in the am??

Hi Pampster,

Thanks for your reply. I started a new post..I should have continued on this thread..oh well. Today is 63 days oxy free..very glad. I now take OTC (ibuprophen) sparingly just to take the edge off. Having a clear head is my goal. 

Discontinued the xanax starting today. I am going to go for 10mg valium...I hope it's enough. I think it will be. It better be because after reading everything..it looks like it would be very counterproductive to up the dosage after the fact? Maybe I should do .125 xanax in the am??

Congrats on the oxy-free! How great is that!

When I did a switch over to Valium, the charts all said the equivalent to my dose was 5 mg. I had not really been successful at the dose I dropped to .375 of Klonopin to .25 but I did the .25 Klonopin equivalent. It did not go well at all and I was so anxious and crying all the time that I had lost the ability to even see it myself. My NP was very concerned and called me everyday and finally insisted that I up my dose to 8 mg. My symptoms immediately abated and then I quickly dropped to 7 mg within a few days and then I stabilised there for quite awhile before I tapered down. My point is: it is not an exact science so I do not think it is counterproductive to up the dose after the fact. I think of that as ADJUSTMENT. Once you stabilise, then YES, do not up your dose. I never do. Even if I feel terrible withdrawal bc then I feel like those hours of withdrawal I went through were for nothing. So, see how it goes. Maybe the switch over will work out exactly right. But be kind and flexible the first few weeks. The goal is success.

Love,

Chrysanthemum