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Summer needs hep with her substitution schedule


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Hi Summer,

 

As requested, I've copied your PM (Personal Message) to the forum. This is the best board for you questions.

 

Colin,

 

Am a little confused as to where to post on the forum so you'll see the message.  Am pretty computer illiterate.

 

I tried the 1 mg xanex = 10 mg valium for 1 day.  Horrible day!  Terrible w/d symptoms.  So, I tried on my own yesterday to do a half xanex/half valium taper.  Ended up doing 2.5 mg xanex and 2.5 valium (had to take a whole valium in the middle of the night although tried to keep my dose down to 4 pills).  Yes, I agree I'm tapering at the same time I'm substituting.  Do you or anyone else think I should stay at 2.5 and 2.5 (for a little while before tapering any more)?  Can't get a good answer from my shrink or regular doctor.  Although Zep gave me a couple of doctors names a ways away from me that might do the Ashton taper (only problem is I can't drive over bridges yet - panic attacks) to get to them.

 

Please, please help.

 

I agree with you that the Xanex XR is a bad idea.  I could not figure out how to slow taper with that since pills cannot be broken.  Is there some way you could post this message with my reply on the right part of the forum and I can get at it from there.

 

Summer, as I've tried to explain before, you should be substituting just a small part of your Xanax for Valium. Since you've only be doing this for about a day or so, and because you seem to have gotten the procedure topsy-turvy, I suggest that you return to your normal dosing of Xanax immediately (no Valium), and we start this afresh in a couple of days.

 

Can you please post your normal Xanax daily dose, and the times you take it (and the dose) throughout the day. I seem to recall going over this with you on another post, but it would be sensible for you again to post your dosing details here, on this thread. I will look at the other posts too.

 

The basic idea is this: because your doctor is prescribing a dose for substitution that is likely to be less than an equivalent dose, you instead stop just a small part of your Xanax dose and substitute it with the equivalent dose as prescribed by your doctor. OK, so this is not enough, but since you are only substituting a very small part of your dose, the shortfall will be quite small. You will be, in effect, tapering at the same time as substituting your Xanax for Valium. This should be fine so long as you allow enough time between each additional substitution. Once I know the figures, I'll be able to tell you exactly what is likely to be manageable for you. and the amounts you need to take.

 

Take care.

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Bless you Colin.

 

What you say makes absolute sense.  My regular xanex dosage is 1 mg every 4 hours.  Have been taking an ambien at night to sleep most days. 

 

Since switching to the valium 10 mg, I also tried to stop the ambien at the same time.  Yesterday, after failing with the valium switch badly, I tried 2.5 mg/xanex and 2.5 10 mg valium tablets.  No sleep.  Heart pounding.  Headaches.  Sweating badly.  Horrible anxiety.  Tried hard not to take the extra valium, but at 3:30 a.m. could stand it no longer and took a 10 mg valium (tried taking 2 tyelenol PM tablets to sleep and slept for about 1 hour).

 

Agree I will go back to taking 1 mg xanex 4 X daily starting now.  How then should I taper?  I have a script of 10 mg valium filled.  Would like to slowly do the xanex-valium crossover.  Any idea of how I should do it considering I can't do the Ashton plan and am stuck with the 1 mg xanex = 10 mg valium?  You mentioned something about adding a little valium to the xanex - do I reduce a bit of the xanex and add a bit of valium?  If so, how much should I try?  I am willing to try anything at this point.  No one doctor will agree on a safe way to taper.  All of you know more than them and I am begging for a schedule to at least get started on.

 

Thanks so very much all of you.  I am actually crying now (and I never cry) because I know you wonderful people can help me. 

 

Please offer any suggestions.  I am seeing an anxiety specialist again tomorrow (I got the time wrong last time and only had a few minutes with him - not an M.D. so no scripts from him).  I am going to show him the Ashton manual and perhaps, if he agrees, can  talk my doctor into her method.  However, I don't think it will work (he does not like to talk meds), so any help you can give would be enormously appreciated.

 

Summer

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Hi Summer,

 

I wish I could give you some specific dosage information as I am new too...There is help on the way !

 

You sound like you could use a good hug and know that I am at least sending you a Cyber-Hug  :).....

 

I do not cry often but I hope that you can just let it all out ... When I give myself permission to do this and go with it I am much better off... Please hang in there and be tender with yourself...You are being so brave like everyone here... :angel:  I have you in my good thoughts and prayers Summer ... Take care, Cheryl :)

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Hi Summer,

 

By switching from 4mg Xanax to 40mg Valium, you are, effectively, cutting your daily dose in half, according to Ashton's figures. It is probably true that 4mg = 40mg Valium as a therapeutic dose, but Ashton found that, for the purposes of substitution, 4mg Xanax needs to be replaced with about 80mg of Valium. I have know idea why this is the case, but this was Prof. Ashton's clinical experience and I'm inclined to believe it.

 

The problem for your doctor, even s/he believed Ashton's equivalent to be correct, is that s/he might be opening themselves to possible criticism/litigation for prescribing such a large dose of Valium. They would need legitimate reasons for prescribing such a dose, and since the official equivalent dose would be just 40mg, than that's all they are likely to feel comfortable prescribing.

 

So, what to do? As I've already stated: follow a slow gradual substitution. Substitution should always be done gradually anyway!

 

The reason that your substituted dose did not work is that it was carried out two quickly. Valium takes far longer than Xanax to build up the bloodstream. This means that when you stop some of Xanax, and even if replaced with a truly equivalent dose of Valium, it will take time for the substitution to work. My guess would be that even replacing just a small part of you daily dose (0.5mg), you would need at least a week before you make the next small substitution. So, that's my suggestion, you aim make additional small substitutions once a week, but that you allow for longer if you are still feeling the effects of the last substitution. So, on to the numbers!

 

If you can split your Xanax into quarter tablets (0.25mg), this would be better. You would then make new cuts about every four days. If all you can do is halve them (0.5mg), then make the cuts about once a week, or longer if needed.

 

Step 1: 3.75mg Xanax, 2.5mg Valium.

Step 2: 3.5mg Xanax, 5mg Valium - (at 1 week).

Step 3: 3.25mg Xanax, 7.5mg Valium.

Step 4: 3mg Xanax, 10mg Valium - (at 2 weeks).

Step 5: 2.75mg Xanax, 12.5mg Valium.

Step 6: 2.5mg Xanax, 15mg Valium - (at 3 weeks).

Step 7: 2.25mg Xanax, 17.5mg Valium.

Step 8: 2mg Xanax, 20mg Valium - (at 4 weeks).

Step 9: 1.75mg Xanax, 22.5mg Valium.

Step 10: 1.5mg Xanax, 25mg Valium - (at 5 weeks).

Step 11: 1.25mg Xanax, 27.5mg Valium.

Step 12: 1mg Xanax, 30mg Valium - (at 6 weeks).

Step 13: 0.75mg Xanax, 32.5mg Valium.

Step 14: 0.5mg Xanax, 35mg Valium - (at 7 weeks).

Step 15: 0.25mg Xanax, 37.5mg Valium.

Step 16: 0mg Xanax, 40mg Valium - (at 8 weeks).

 

Remember, the above is just a guide. If you feel you need longer between each step, then take longer. Following this schedule means you will be tapering at the same time as substituting, so it might be too tough to go at the suggested rate. Also, the quarter tablet reductions (0.25mg Xanax) should be easier on your system than the 0.5mg reductions of Xanax, so that's what I recommend. If you make the smaller reductions, you are likely to be able to make fresh substitutions sooner than you would with the 0.5mg substitutions. Your crossover will not take longer, it will just be smoother with smaller substitutions. Whatever rate you go at, those are the numbers you need to follow to replace your Xanax with Valium.

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Thanks so much Colin, I will definitely try that schedule.  It makes much more sense and I believe it is possible.  Yes, I have enough xanex left Therese, thanks.
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Just wanted to let you know that I started on that schedule and had a much better day.  Thank you so much Colin.  I've read a few others posts about how they want to get off the benzs fast and I was trying to do that also.  I really want to jump ahead of the schedules, but now I know why it is best to follow a slow schedule.  Seems like every time I've tried to cut back too much, I go back 3 steps and end up with an increased dose.

 

I see the dr. before the 8 week switch to valium is up and he expects me to have just jumped from xanex to valium over night.  I hate to lie to him, however, if I tell him the truth (that I followed a slow schedule), I'm afraid he might get mad.  Should I just let him believe I transferred over right away and had no problems?  Any ideas?

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I dunno, you know you doctor best. I don't see what's so unreasonable about saying 'I had a terrible time switching, took some advice, and made the switch very gradually from 4mg Xanax to 40mg Valium - it worked for me'. However, I know some doctors have such inflated egos, they cannot accept that they are ever wrong. I would encourage honesty, but I do understand that can cause more problems than it solves in some situations. You do need to consider that you will need a supply of Xanax until you complete the crossover, and that means a prescription from your doctor.
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Hi, Summer,

 

I too think that it is best to be honest with your doctor. Withdrawal is stressful enough without having to keep track of what stories you're telling whom! Besides, as Colin pointed out, you do need Xanax from him. You could maybe just say something like, "Wow, doc, I talked to some friends who have switched to Valium, and they told me that it worked better for them if they did it really slow, so I decided to do that too." Just make it sound like it was just a "safety net" of sorts, like you're just being careful, and maybe that will soften the news.

 

Therese

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Thanks Colin and Therese,

 

I will definitely tell the doctor and see what happens. 

 

Supposed to have surgery for my knee (ACL Reconstruction) on 9/26 and am scared to death.  Not helping me any with withdrawal.  One problem I'm having is pain.  I'm trying hard not to increase my pain medicine while doing the xanex - valium crossover (or really taper).  I know I might have to increase my pain medicine after the surgery (on pain medicine for neck fusion and degenerative discs in neck now plus cortisone shot wore off in knee and now have that bad pain as well). 

 

Even my doctor told me I have to think about only withdrawing from one medicine at a time (chose to do the benzos first primarily because of severe pain (and upcoming surgery) and I really think they may be the hardest to do - been on them the longest time - 20 years - the xanex I mean).  Last night couldn't sleep at all because of pain and didn't want to take any more pain medicine (and absolutely will not go up on benzs).  Am getting pretty frustrated being on both types of medicine and wanting to be off both at once. 

 

Does anybody know of anyone who went off both types of meds?  I know I have to be on the pain meds for a while (especially with surgery coming up), but am kicking myself if I take one more pain pill than usual.  Very hard to keep both meds down at same time and sure could use some support from someone who was on the same meds.  Can't find anywhere online the site that someone wrote about where there are people who are on more than one type of prescription med.  Anyone know where that website is

 

Thanks again guys & gals!!!

Summer

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Hi Summer  :)

 

I was diagnosed with Fibromyalgia 10years ago and took Darvoset, Vicodin and Xanex during this time.  Sadly I abused them and ended up in detox...

 

Afterward I had to have foot surgery and was scared to death about taking painkillers because the opiates were my drug of choice.  I cannot recall if you over medicate on the painkillers....My solution was giving them over to a family member to dispense to me so that I would not overmedicate.  This worked well for me.

 

The Opiates and Benzos made me high as a kite and I liked it way to much.  But I am with you that taking it one med at a time just makes good common sense.  I think that once you can put together your gameplan you can relax because you will have a plan. At least this helped me so much.

 

Having a good support system with family and friends I was able to call was a Godsend for me.  I have you in my prayers and good thoughts .. Take care :) Cheryl

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Hi Cheryl,

 

Nice to hear from you.  How did it go when you were in the detox center?  I'm still taking way too much medicine.  Doing O.K. on the benz taper, but not the rest of the stuff.  What happened to your pain when you detoxed off the pain meds?  When you went to the detox center, did they get you off of the benz's at the same time as the pain meds?  How do they handle that?  Do they give you anything to make the withdrawal symptoms bearable?  Your idea about having my pain meds doled out seems good, but should I do that before or after my benz withdrawal is done?

 

Hope you are doing well.  Thanks for writing and advice.

 

Summer

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Hi Summer,

 

I hope that you are feeling better :)

 

When I went into detox I they took me off of my painkillers and Benzos cold turkey...I was not given anything to taper off...I was the only person in the program trying to withdraw from Presc. meds... :-[  So I was blended in with meth and alcohol abusers with alot of group therapy :wacko:

 

I believe that as this problem has ballooned much more since I was in rehab ....

 

So I am not surprised that I returned to my benzo use...I did go to a pain management specialist for some physical therapy.  Today as far as the pain goes I have muscle aches and spasms.  I find that if I regularly exercise, lots of BenGay, a good heat pad and rest help me alot. 

 

I know that the benzos have a muscle relaxing effect so I am taking it very slow to manage any pain....

 

Please hang in there ... I know that there are folks on the board also managing pain who will give you some good advice  :thumbsup:

 

Take care,

Cheryl

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Hi Cheryl & Everyone,

 

Guess you are the only one other than me that got on pain meds and benzs at the same time.

 

I'm following Colin's great schedule for the xanex to valium crossover and cut (since I'm going from 4 mg xanex to 40 mg valium vs. 80 mg).  One problem:  I have been taking a minimum of two 10 mg percocets a day for pain, along with an occasional 20 mg oxycodone (about thrice weekly) and a flexeril (also about thrice weekly).  I'm trying really hard to just do 20 mg of percocet a day while tapering from the xanex.

 

Is it reasonable to do this?  I feel like I am tapering from both drugs because I am not sure how much I was actually taking of the pain meds until I started writing it down about 1 month ago.  Perhaps I do belong in a detox center.  Maybe I should just get off the benzs and then worry about the tapering the pain meds next.

 

What to do?

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Hi Christine....

 

I think Colin can give you the best advise.....My gut tells me that one med at a time is what I would be leaning toward...You still have serious pain management issues to work through and find healthy alternatives when the time is right...Please dont rush or put yourself underpressure.  When surgery and truly serious illnesses involving pain are involve I believe a gentle approach is best....Colin, do you think that starting with the benzos is best ?

 

Hang in there Christine once your plan is set you can relax some and start to taper when it is right for you... :angel:

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Hi,

 

I have very little personal experience with meds other than Clonazepam. I have tried a number of anticonvulsants in the past, but for limited periods. For this reason, I usually keep my comments to benzos - that's what I know. However, it only makes sense to withdraw from one drug at a time. Not only is this less stressful, you will be sure that any particular withdrawal effect is the result of a particular med, and not a choice of two, or three, or how ever many drugs you might be tapering.

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Thanks so much all.  I am continuing to write down every pill I put in my mouth.  I am trying to keep at the same level of pain meds and all other meds (trazadone, percocet, flexeril) as I am currently taking while crossing over from the xanex to valium. 

 

Colin,

I want to thank you because I am having a lot of success crossing over from the xanex to the valium.  I did read where Prof. Ashton herself agrees with you and my dr. about not being able to write prescriptions for a whole 80 mg of valium which is equivalent to the 4 xanex I am on and realize it is reasonable to go down to the 10 mg equivalency.  I see my dr. a week from Friday and am aiming to have crossed over either all the way to 40 mg of valium or almost all the way (if things keep on progressing like they have been).    So far, I'm on 2 mg xanex and 20 mg valium and am thinking of trying to get to 1.5 mg xanex and 25 mg valium today.  Just realized I probably will not be able to make the 21st of Sept for the complete crossover, but will probably be able to get down to 1 xanex and 30 mg of valium by then (hopefully my doctor will be pleased, or at least not upset that I didn't complete the switchover).

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Hi Summer,

 

I am glad to hear that the crossover is going well. Again, I do caution you about switching too quickly though. It takes time for Valium to build up in your system. If you don't allow enough time at each new dose, it could have an accumulative underdosing effect and you end up suffering withdrawal symptoms. It takes a lot longer for Valium to build up to stable blood levels compared to Xanax. I don't have figures for it. I may try to work out a rough estimate some time, but I suspect that the maths involved will be very complicated, and probably beyond my abilities. :wacko:

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Colin,

 

Can you please explain about the accumulation withdrawal effects?  I have been tapering quite rapidly, and today I'm not feeling at all well.  I did go down to 1.5 xanex and 25 mg valium.  I read about Patrick's tapering from 4 mg of xanex to only 20 mg of valium very rapidly and have tried to do it quicker than your schedule suggests.  The thing I am most afraid of is having seizures since I have been on the benzs approximately 20 years.

 

Thanks so much.

 

Summer :D

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Hi Summer,

 

I did try to caution you about switching too quickly. This is especially important for you as your are, effectively, tapering at the same time.

 

Xanax has a short half-life. Any cut in its dose will be noticed very quickly. Valium has a long half-life; it will take some time for it build up in your system. The reason for this is that only a small proportion of Valium will metabolised between each dose. This means that the next dose will cause a rise in blood concentrations. This will continue to to be the case until the Valium is at such a level in your blood that you are metabolising as much between each dose as you add to your system with each new dose. As you blood levels rise, you metabolise more of the Valium in absolute terms. I'll use some made-up numbers to illustatrate the point.

 

After dose 1, blood levels are 100;

Blood levels reduce by 20% before the next dose, so blood levels are now 80;

After dose 2 (+100), blood levels are 180;

Blood levels reduce by 20% before the next dose, so blood levels are now 144;

After dose 3 (+100), blood levels are 244;

Blood levels reduce by 20% before the next dose, so blood levels are now 195;

After dose 4 (+100), blood levels are 295;

Blood levels reduce by 20% before the next dose, so blood levels are now 236;

After dose 5 (+100), blood levels are 336;

Blood levels reduce by 20% before the next dose, so blood levels are now 269;

After dose 6 (+100), blood levels are 369;

Blood levels reduce by 20% before the next dose, so blood levels are now 295;

After dose 7 (+100), blood levels are 395;

Blood levels reduce by 20% before the next dose, so blood levels are now 316;

After dose 8 (+100), blood levels are 416;

Blood levels reduce by 20% before the next dose, so blood levels are now 333;

After dose 9 (+100), blood levels are 433;

Blood levels reduce by 20% before the next dose, so blood levels are now 346;

After dose 10 (+100), blood levels are 446;

Blood levels reduce by 20% before the next dose, so blood levels are now 357;

After dose 11 (+100), blood levels are 457;

Blood levels reduce by 20% before the next dose, so blood levels are now 366;

After dose 12 (+100), blood levels are 466;

Blood levels reduce by 20% before the next dose, so blood levels are now 373;

After dose 13 (+100), blood levels are 473;

Blood levels reduce by 20% before the next dose, so blood levels are now 378.

 

Notice that the increase in blood levels is smaller-and-smaller with each new dose! With short half-life benzos, much more of the benzo is metabolised between each new dose, so you would reach a stable dose far more quickly. Try it if you like. Substitute the 20% reduction with 75% and see what happens. I didn't take the above to its natural conclusion, as (mathematically speaking) it would go on for ever, but increasing by smaller and smaller amounts. I could work the exact figure for my made-up example, but I cannot remember my school-boy differentiation and integration. I imagine it be no more than about 390 though. The important thing to notice that is that, at first, blood levels are increasing rapidly, but slow down with time. If you keep making switches too quickly, you will not be allowing enough time for the Valium to build up in your system.

 

* Please note, the numbers above are just illustrate the point. Drug absorption and metabolisation are very complicated and the maths is way beyond my abilities. The example dose illustarate how a long half-life effects accumulation of a drug within your system though. I'll do the same as I did above, but with a short half-life benzo, where you would be metabolising 75% of the drug between doses.

 

After dose 1, blood levels are 100;

Blood levels reduce by 75% before the next dose, so blood levels are now 25;

After dose 2 (+100), blood levels are 125;

Blood levels reduce by 75% before the next dose, so blood levels are now 131.25;

After dose 3, 132.82;

After dose 4, 133.2;

After dose 5, 133.3.

 

I'm sure you see my point!

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Colin,

 

Although I'm not very good at math, I think I do get your point.  Perhaps that explains why I was not agreeing with either the US or UK equivalency chart since 20 mg of valium does not seem to have anywhere near the effects of even .5 mg of xanex.  I guess that's because it has not built up in my system yet.  Can't believe my doctor thought I could just switch 4 mg xanex to 40 mg of valium overnight.  No wonder I've been having so much trouble (I know you did warn me about it).  I was thinking I could do it quickly like Patrick did, but perhaps he was not on the xanex for over 20 years.

 

I was actually starting to think that it would take 60 plus mg of valium to equal 1 mg of valium (although I admit, I did not try that).  The valium seems to do nothing for anxiety at all.

 

Thanks again so very, very much.

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Hi Summer,

 

I think you would probably benefit from stabilising your dose for while - until you feel more settled. I think the weekly switches was pretty optimistic, and you appear to being at at about double that. A switch once a week without including a taper is what I'd usually suggest. Take it easy; give yourself some time and space. ;)

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Thanks so much Colin,

 

I don't know why I'm in such a rush.  I think I will take it easy for a while and try and stabilize for at least 1 to 2 weeks.  I had also tried to come down on my pain medicine usage at the same time (not major, just minor) which is very idiotic.  Just aspire to be like others who are med-free.  I guess it's part of being the Me-generation - I want it now!

 

Thanks for your help!!

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