question about xanax titration

I have to wait until I wean off the beta blocker but I'm planning ahead. My next taper will be the xanax. I like the idea of doing the water titration. I am taking .125mg. which is a half of a small tablet. When crushed this will be a very small amount of powder. Will that make a difference?  It seems like a tiny amount of powder for 100ml of liquid. Also does it matter if you use milk or water?

I like to plan ahead, too, Carrie Anne. 

 

You'll find a discussion of the pros and cons of water vs milk (and even baby food and ice cream!) here:

 

http://www.benzobuddies.org/forum/index.php?topic=19081.0

 

You don't have to put the .125mg powder in 100ml if you want to taper off faster than the usual way.  If you go the 100ml route and remove 1ml more each day, it waill take you 100 days to get off that last little bit. If you want to take only 50 days, you could start from 50ml liquid.  Or go with something in between.  I'm afraid the possible ways of doing this titration are very numerous and you just have to pick one and give it a try, see how it works out for you.  Best of luck with whatever you choose.

There are possible advantages to milk with Valium but no advantages at all with Xanax.  Xanax does not have any special affinity for fat globules. 

 

When tapering Xanax it's best to take multiple small daily doses.  If you use milk you'll need to deal with refrigeration; that's something to consider.

 

I use water for all my tapers, but in particular I would definitely use it for Xanax, because I carry around the little bottles in my purse and I like not having to worry about refrigerating them.

 

I would recommend not crushing the tablet, just allow it to fall apart and dissolve directly in the liquid you're using.  You'll get just as small of particles, without losing some unpredictable amount of the powder in the process of crushing it and transferring it to the liquid. 

 

I would also recommend, if you have a doctor who will keep refilling your prescriptions, using the whole 0.25 mg tablet, rather than breaking it in half. 

 

It's really hard to get an accurate half-tablet unless you use a milligram scale.  If you do use a scale and measure you'll soon see how far off an "eyeball" half a tablet can be. 

 

If it were me, I'd just use the whole 0.25 mg tablet and make up two days' worth of liquid at once.  Or you can use the whole tablet and toss half of the liquid.  If you're using a graduated cylinder it's much easier to measure an accurate 1/2 of the liquid than it is to break an accurate 1/2 of a tablet. 

 

Okay, now that I've made things thoroughly confusing...well, hope something in here has helped anyway!

...I use water for all my tapers, but in particular I would definitely use it for Xanax, because I carry around the little bottles in my purse and I like not having to worry about refrigerating them.

 

 

Hello, prhiannon:

 

A late question, but I have just been directed to your posts and am finding them most informative. I'll soon be starting a liquid titration taper of Ativan from 2 mg 3X/day. Your comment about how much effect a dosing time change can have is very true--I started at 6 mg/day at bedtime, bolus dose! For 9 years. Gotta love those docs. In two months I've gone from 6 mg hs to 2 mg. Daily dose unchanged. Some over-sedation, but I'm adapting to it. I have a feeling that it will be several weeks or more before I come to a new equilibrium, at which point I could start dose rdxn. What do you think?

 

Big question: why do you use water as a solvent for compounds which are not soluble in water? Are all of the undissolved particles in the suspension so small that Brownian motion insures a homogeneous distribution without clumping? Ethyl alcohol or PG is generally used in pharmacies, and milk is popular, but I feel sure there must be a reason you choose water. You seem you know a lot about this subject.

 

For another day, I'd like to learn more about GABA receptor site downreg, especially any histological studies. Specifically, are the Ativan sites partially reabsorbed into the surrounding neural tissue or do they remain in place but lose their ability to function as stereospecific receptors for the Ativan ligand? I believe this may be ligand-specific, but am in way over my head at this level.

 

Aweigh

 

...I use water for all my tapers, but in particular I would definitely use it for Xanax, because I carry around the little bottles in my purse and I like not having to worry about refrigerating them.

 

 

Hello, prhiannon:

 

A late question, but I have just been directed to your posts and am finding them most informative. I'll soon be starting a liquid titration taper of Ativan from 2 mg 3X/day. Your comment about how much effect a dosing time change can have is very true--I started at 6 mg/day at bedtime, bolus dose! For 9 years. Gotta love those docs. In two months I've gone from 6 mg hs to 2 mg. Daily dose unchanged. Some over-sedation, but I'm adapting to it. I have a feeling that it will be several weeks or more before I come to a new equilibrium, at which point I could start dose rdxn. What do you think?

 

Big question: why do you use water as a solvent for compounds which are not soluble in water? Are all of the undissolved particles in the suspension so small that Brownian motion insures a homogeneous distribution without clumping? Ethyl alcohol or PG is generally used in pharmacies, and milk is popular, but I feel sure there must be a reason you choose water. You seem you know a lot about this subject.

 

For another day, I'd like to learn more about GABA receptor site downreg, especially any histological studies. Specifically, are the Ativan sites partially reabsorbed into the surrounding neural tissue or do they remain in place but lose their ability to function as stereospecific receptors for the Ativan ligand? I believe this may be ligand-specific, but am in way over my head at this level.

 

Aweigh

 

Hi Aweigh--

 

No benzos are soluble in water, or anything else drinkable.  Some are partially soluble in water and some in ethanol, but none are completely 100% soluble in anything potable.  All liquid titrations are done using suspensions in some medium or other.

 

I find that the pills themselves (the binders) do dissolve nicely in water.  Water's cheap and readily available.  It doesn't require refrigeration.  And using water as a medium you can see, with the naked eye, how evenly distributed the particles of filler are in the resulting suspension. 

 

I presume that the particles of the drug itself are at least as evenly distributed as the particles of filler, since they're much smaller and are intermixed with the filler.  Since I stir my suspensions as I measure them, Brownian motion's not an issue.  I do presume a fairly random distribution, although of course there is going to be variation on a micro scale.  I don't think this is a process that requires precision on that scale--the pills themselves aren't made with that level of precision.

 

There may be a slight advantage to using milk with Valium--I found a reference somewhere to its lipophilic properties causing it to cluster around microscopic fat globules, which of course are present in homogenized milk.  But it's not enough of a difference for me--for me, the convenience of being able to carry it with me while working or traveling without having to worry about refrigeration outweighs other considerations.

 

However, I'm doing an extremely slow taper.  I suspect that allows me a lot more room for random variation or bias due to error or technique.

 

As for GABA downregulation and the details of cellular physiology, I don't know the answer to your question.  You might try contacting Altostrata  over at the Surviving Antidepressants forum--she has a lot of science contacts and may know the answers herself or may be able to refer you to someone. 

 

My guess would be, based on general principles of cell biology, that the actual receptors are disassembled, the proteins broken down and removed by glial cells.  That would be consistent with how things are done elsewhere in the body.  I would imagine the histological studies have been done (at least in rats) SOMEwhere by some PhD candidate, so the info is probably out there.

 

If there's no urgent reason to start tapering sooner, I find that people pretty much always do best if they allow time, after med changes, to come to a solid homeostatic equilibrium before making further changes.  That said, since you're still taking the same total dose daily, if you're feeling pretty stable, it's probably safe to begin tapering slowly.  I find that my symptoms are the best guide to how well my brain has adapted to changes. 

 

My usual advice is contrarian--instead of starting out ambitious (like we all actually want to), start small, with tiny cuts and long breaks between.  Then gradually speed up until you find your symptoms starting to ramp up; then hold till they settle down.  Continue to experiment this way until you find your own body's level of tolerance for tapering.

 

Unfortunately most people do what I did at first--cut aggressively and then hit the wall, crash, gradually pick themselves up very painfully, cut too aggressively again, et cetera.  I can tell you from experience--OUCH.

 

It really turns out to go much more smoothly, and just as quickly in the long run, if you start out conservative and then slowly ramp up to the speed and level of cuts that your body can tolerate.

 

Thank goodness, it sounds like you understand the principle behind taking occasional breaks to allow the physical remodeling to catch up with the taper, and the importance of maintaining homeostasis as much as possible all the way down.  So often people think they're going to be better off if they go as fast as possible, but what ends up happening is that it takes them a year or two (or longer) to recover their health after a painful and aggressive taper--and they suffer the whole time, while tapering and while recovering as well.

 

Me, I vote for taking it slow, being functional and being able to enjoy your life and keep your job as you taper; and you don't end up so sick you wind up reinstating or taking a bunch of additional psych meds that screw up your chemistry even more.

 

I've wandered far beyond the scope of your post here.  Hopefully something I've written has been helpful, though. 

 

Also just an aside, I don't get to this forum as often as I used to--have just taken on too many other new projects in my life.  (Because I'm feeling so much better now that I'm down to much lower doses of psych meds and capable of doing things I haven't been able to do in a couple of decades! It's amazing how much you can appreciate just being normal--but that's another story.)

 

So please don't worry or take it personally if you post something in response to me and I don't reply.  I often don't get here for weeks at a time, and stuff just gets lost.

Hello, prhiannon:

Thank you for an amazing, detailed, very well written reply. Something's wrong with my notifications and I wouldn't have picked up your reply if I hadn't decided to just copy all of your posts to a Word doc and read them at my leisure. Always liked hardcopy better, anyway. That's how much I think of your writing.

 

As you say, you have touched on a lot, and there is more I'd like to discuss with you than I expect you have the time or inclination for...however, I gotta get this solvent business straight. The Merck Index lists Ativan's solubility in EtOH as 14 mg/mL, pretty soluble. The two commercial preps of oral solutions use EtOH in one case and propylene glycol (Ativan soly. 16 mg/mL) in the other (Ativan Intensol). The Intensol is sugar and EtOH free; both are at 2 mg/mL. I'm not sure what you mean by completely, 100% soluble, but I would take it to mean that the pure substance will dissolve completely in the solvent with no solid residue. So, I don't understand. And also, as you point out, the method may have a lot of slack and work well with both suspensions and solutions. In which case, it's a moot point.

 

Your general and specific advice about tapering is gold. Starting out slow and small is the way to avoid problems later on, or so I'm advised by many who should know. Consider the hexagram "Difficulty at the Beginning". All one has to do is read enough sigs and stories--the sadder the story, the more c/ts and Ashton tapers or 'detox' tx in it. One of the issues I'm grappling with right now in therapy is my anger toward doctors. No matter how guiltly they are or how much they lied to me, I'm going to have to work with them if I'm going to recover from this iatrogenic illness. And they don't take kindly to dirty looks 

 

When I actually begin the taper (2-4 weeks?) I'll probably be asking you some questions--but that doesn't mean you have to answer them, promptly or at all. I am lucky enough to have contact with 2 other buddies who may know as much about this as you appear to, plus I'm not not entirely at sea in a lab myself. Wife. Therapist. A doc who listens. So, I have pretty good support going in. It's not an accident.

 

The big question right now is whether I can get them to Rx Ativan oral soln. for me. I'm not going to push for it; I can make the soln. from tablets. But it would be so convenient.

 

If you answer this, please send your reply as a PM. My notifications are screwed up and people are sending me posts I don't know about.

 

Thank you deeply,

 

Aweigh

 

 

Hi, prhiannon:

 

Just wanted to let you know that I was able to figure out the business of solution vs suspension by reading a couple of your other posts. I hope you didn't go to the trouble of preparing a response yet. I just think like a chemist, so everything's gotta be in soln. for me. A pharmacist might have less trouble with suspensions. My understanding now is that it doesn't matter if the material is present as ions or particles, as long as the mixture/susp./soln. is homogeneous when divided. Is this basically correct?

 

Although I have been taking Ativan 6 mg/day for 9 years, I think I might have a chance at success with a direct taper from Ativan because I have no other hx with psych meds at all (except current opioid pain meds), a decent understanding of what is going on pharmacologically, and plenty of support. Some knowlegable people have warned me that Ativan is inherently hard to taper, and  my hx of 9 years at 6 mg / day will likely make the taper too difficult. I might as well just start the c/o to Valium or Klonopin now. Of couse, I don't want to hear this  :'(

 

Unless a failed direct taper from A would make the subsequent c/o and taper from V or K much harder, I don't see a reason not to try the direct taper first. I'll never know if it is possible for me unless I try it. I can do 4 X day dosing, I can bail to V or K if the sx are too much. What do you think?

 

Thanks very much,

 

Aweigh

Hi, prhiannon:

 

I tried to send you a PM, but your mailbox is now full. I have an idea I'd like to discuss with you. It's not about my precious taper, but rather about editing a book.

 

Aweigh