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To titrate or not to titrate???


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:-\

 

I have had a difficult time with these last two cuts and am considering titration.  It just seems so complicated to me.  I mean how do you really now that the crushed pill is really mixed evenly.  I have to drink a powdered probiotic every day and remnants of it are at the bottom of the glass when I'm finished drinking it.  This concerns me.

 

I am currently at 1.75mg and was scheduled to cut tonight.  I have decided to hold a day since I'm still not feeling so great. :(  Better than yesterday though.  The anxiety isn't nearly as bad today.

 

Part of me says just continue cutting the pills and just wait longer in between cuts. I have seen so many people get off benzo this way and they are now doing great just a few months off.  This is the method I know and what I am must comfortable with.  I just don't remember my friends having such difficult time at these lower doses like I am.

 

I can't afford to prolong this taper any longer than necessary due to the fact that I have health issues that need to be treated and the doctor is holding off treatment until I'm done with this taper.  Can I taper at a rate of .25mg every 8 days or so using the titration method?

 

Sandy

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Hi Sandy

Let me try and answer some of your questions, first I was wary of the process adn did equal dry and liquid mixtures to test it an I didn't notice a difference.

Milk being the medium the molecules of the benzos apparently cling to the fat in the milk and after mixing an swirling are equally distributed.

 

Once I removed the "cut" for the day I drank the rest however I made sure to swirl water in the jar to make sure every last drop was consumed.

 

Yes you can approximate .25mg cut in 8 days with the liquid.

Its not to tough I did it with a measuring cup marked with ml's and a baby dropper

 

Take care Bobers

PS we can get more specific if and when you decide ,at one dose a day it should be easy

 

 

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Hi, Sandy,

 

I had a difficult time at the end of the taper too. A lot of us do. So you're not unusual. :)

 

Have you considered asking your doctor for a prescription of liquid Valium? You don't have to make your own. Valium comes as a liquid straight from the pharmacy. I used it when I got to about 2 mg Valium and found it very helpful. You can still titrate with it--you don't have to make your own liquid to do titration.

 

Therese

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Hi, Sandy,

 

I had a difficult time at the end of the taper too. A lot of us do. So you're not unusual. :)

 

Have you considered asking your doctor for a prescription of liquid Valium? You don't have to make your own. Valium comes as a liquid straight from the pharmacy. I used it when I got to about 2 mg Valium and found it very helpful. You can still titrate with it--you don't have to make your own liquid to do titration.

 

Therese

 

Therese,

 

How would I titrate from liquid Valium?  Could you please explain the process to me?

 

Thanks!

Sandy :)

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Hi Sandy,

 

At the risk of complicating things, I may have another option for you.

 

I've been working an alternative titration system - perhaps you would like to be a guinea pig? :)

 

The system will tell you exactly much you will take and when. It will work with whatever measuring system you have in place. So, if you use a 100ml cylinder with 1ml graduations, we can work with that; we can also work with a 50ml cylinder marked with 5ml graduations (or if you can easily guess measurements half-way between markings, you could use 2.5ml intervals, for example); or even something like a 10 fluid ounces jug that you can measure off at 0.5 Fl.Oz intervals. It will reflect whatever measurements you find convenient. The more increments/intervals, the smoother the titrated taper. I need to know the following:

 

Your daily dose in mgs:

 

The tablet dose you use per day, and how many (or combinations of doses), such as a total of 6mg (1mg, 5mg):

 

The taper rate (what percentage of your dose do you want to cut over what period of time - 10%, 14 days, for example):

 

The Start Date (allow me a couple of days to iron out any bugs):

 

How many tablets will you be titrating at a time (I strongly recommend 1 tablet), or if you take a combination of tablets doses over the day, how many mgs will you be titrating (ideally, this will be a whole tablet, and the larger of doses of your tablets if there are differing doses being taken):

 

I think that's everything! I'll produce a table for you from those figures. If you need the taper to end by a specific date, that might take a little more figuring out, but I'll give it a go.

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Hi Sandy,

 

At the risk of complicating things, I may have another option for you.

 

I've been working an alternative titration system - perhaps you would like to be a guinea pig? :)

 

The system will tell you exactly much you will take and when. It will work with whatever measuring system you have in place. So, if you use a 100ml cylinder with 1ml graduations, we can work with that; we can also work with a 50ml cylinder marked with 5ml graduations (or if you can easily guess measurements half-way between markings, you could use 2.5ml intervals, for example); or even something like a 10 fluid ounces jug that you can measure off at 0.5 Fl.Oz intervals. It will reflect whatever measurements you find convenient. The more increments/intervals, the smoother the titrated taper. I need to know the following:

 

Your daily dose in mgs:

 

The tablet dose you use per day, and how many (or combinations of doses), such as a total of 6mg (1mg, 5mg):

 

The taper rate (what percentage of your dose do you want to cut over what period of time - 10%, 14 days, for example):

 

The Start Date (allow me a couple of days to iron out any bugs):

 

How many tablets will you be titrating at a time (I strongly recommend 1 tablet), or if you take a combination of tablets doses over the day, how many mgs will you be titrating (ideally, this will be a whole tablet, and the larger of doses of your tablets if there are differing doses being taken):

 

I think that's everything! I'll produce a table for you from those figures. If you need the taper to end by a specific date, that might take a little more figuring out, but I'll give it a go.

 

Colin,

 

As much as I would love to help out with this new method, I can't risk it right now.  I am having a very difficult time at the moment.  Very.

 

I would be interested in learning how to titrate to liquid Valium.  Could you assist me with that?  Would you recommend it?

 

I made a cut last night down to 1.5mg.  I am using 2 mg tablets to make these cuts.  I take my full dose at night time.  I would like to make reductions of a total of .25mg every 8 days.  I really need to be off by the end of October so I can be treated with the antibiotic for my GI infection. 

 

Maybe I should just keep rolling with the punches and hold longer between cuts?  Maybe I should start getting my capsules compounded down to .125mg and start making smaller (pill) cuts. :-\

 

Thanks for trying to help me.  I really apprciate you trying to help me and all the people here for that matter.

 

Thank you!

 

Sandy :)

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Hi Sandy,

 

I'll use those figures for the new method. The reason for the new method is to simplify the process of making the liquid. I am going to assume the following: you have a 100ml cylinder with 1ml graduations (or you can get hold of one). The new mathod means that you make up your liquid in exactly the same way each day, and the table will tell you how much of the liquid to drink. It will also tell when you should be making a cut, and by how much. Would yo be interested? We ca use the old method if you like, but the new one should be simpler and will give you detailed information about who much to take and when.

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Hi Sandy,

 

I'll use those figures for the new method. The reason for the new method is to simplify the process of making the liquid. I am going to assume the following: you have a 100ml cylinder with 1ml graduations (or you can get hold of one). The new mathod means that you make up your liquid in exactly the same way each day, and the table will tell you how much of the liquid to drink. It will also tell when you should be making a cut, and by how much. Would yo be interested? We ca use the old method if you like, but the new one should be simpler and will give you detailed information about who much to take and when.

 

Colin,

 

I do not have a cylinder but can look into purchasing one.  Would I purchase this at a pharmacy?  Can I use tablets or should I get liquid Valium?  I would like to continue taking my dose before bedtime.  Since I made this cut already I would like to see how things go this week.  Maybe I will get a break, but yes I would be interested in this new method if you think it will be easier on me as well as allowing me to complete my taper by the end Of October.

 

Thanks again!

 

Sandy :)

 

 

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I'll work on the method now. I'll see if I can wok in an end-date option - it should be possible. You go with whatever you feel most comfortable doing.
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I'll work on the method now. I'll see if I can wok in an end-date option - it should be possible. You go with whatever you feel most comfortable doing.

 

Thanks again for your help Colin.  I'm going to call  :phone: around to see if I can find a cylinder.

 

Sandy :)

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Hi, Sandy,

 

If you want to get the liquid Valium, you want the strength that is 1 mg Valium to 1 ml liquid. I think there may be another strength too, but you want the 1:1 ratio. What my doctor did is write me a script for whatever dose I was currently on--in your case, 1.5 mg--and then just say "Take as directed."

 

Liquid Valium is very easy to use. If you want 1.5 mg of Valium, you pull up 1.5 ml with the syringe. Then you squirt it into water and drink it. I thought it tasted like root beer gone bad the first time I tasted it. Not bad, but kind of strange.

 

To cut .25 mg every 8 days, that would mean you will cut .03 mg (.03 ml) every day. So when you pick up the liquid Valium, you need to ask the pharmacist for a 1ml syringe. You want to be sure it is marked in hundredths of a ml. There are also 10ml syringes, but that will not work if you are going to be cutting a tiny amount like .03 ml. The syringes are free and should be in a desk below the pharmacist's counter. I think maybe if you are in California you need a script for the syringe too. I seem to remember Flick saying something about that.

 

If you cut .03 mg each day, it will take you 50 days to complete your taper if you're starting at 1.5 mg Valium. If you cut .04 mg each day, it will take you about 38 days to finish your taper.

 

While I was tapering, I had a GI infection too--a fungal infection. A natural practitioner gave me something called Cumanda, an extract from some kind of rainforest bark. It was amazing! I felt so much better within just a week. Just thought I'd mention it in case you're interested. Don't know what kind of infection you have.

 

Therese

 

 

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Hi, Sandy,

 

If you want to get the liquid Valium, you want the strength that is 1 mg Valium to 1 ml liquid. I think there may be another strength too, but you want the 1:1 ratio. What my doctor did is write me a script for whatever dose I was currently on--in your case, 1.5 mg--and then just say "Take as directed."

 

Liquid Valium is very easy to use. If you want 1.5 mg of Valium, you pull up 1.5 ml with the syringe. Then you squirt it into water and drink it. I thought it tasted like root beer gone bad the first time I tasted it. Not bad, but kind of strange.

 

To cut .25 mg every 8 days, that would mean you will cut .03 mg (.03 ml) every day. So when you pick up the liquid Valium, you need to ask the pharmacist for a 1ml syringe. You want to be sure it is marked in hundredths of a ml. There are also 10ml syringes, but that will not work if you are going to be cutting a tiny amount like .03 ml. The syringes are free and should be in a desk below the pharmacist's counter. I think maybe if you are in California you need a script for the syringe too. I seem to remember Flick saying something about that.

 

If you cut .03 mg each day, it will take you 50 days to complete your taper if you're starting at 1.5 mg Valium. If you cut .04 mg each day, it will take you about 38 days to finish your taper.

 

While I was tapering, I had a GI infection too--a fungal infection. A natural practitioner gave me something called Cumanda, an extract from some kind of rainforest bark. It was amazing! I felt so much better within just a week. Just thought I'd mention it in case you're interested. Don't know what kind of infection you have.

 

Therese

 

 

 

Therese,

 

I am actually taking Diazepam (generic Valium).  Do you know if Diazepam comes in liquid as well?

 

I have SIBO (Small Intestinal Bacteria Overgrowth) from having food go through me partially undigested all these months.

 

Thanks!

 

Sandy :)

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Therese,

 

I see my doctor tomorrow and just want to make sure I have this right.

 

The prescription should read:

 

Liquid Valium (or diazepam) 1mg is equal to 1ml.

 

Current dose 1.5mg.  Take as directed.

 

 

Is the above right?

 

Or should it say tapering .03ml a night too?

 

Thanks so much!

 

Sandy :)

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This is what I'm going to suggest to my doctor:

 

A half of tablet would =  1.00mg

A compounded capsule=  .25mg

A 10ml syringe would =    .25mg

Equaling a grand total of    1.5mg

 

I would then eliminate one line on the syringe a night (.025ml) over a period of 10 days.  This would be equivalent to cutting .25mg every 10 days.

 

Does this sound right?

 

Sandy

 

 

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Sandy,

 

First of all, yes, generic diazepam does come as a liquid. I used generic during my taper.

 

It's up to your doc as to how he would like to write the script. He could say "Take 1.5 mg daily as directed," or he could say something like "Take 1.5 mg the first day and .03 mg less each day thereafter." He should know what to do; I think it's personal preference.

 

I think that the liquid Valium might always come in 5ml increments, so the script (if I remember right) says "Liquid diazepam, 5ml/5mg...". Of course, that is the same as 1ml = 1mg.

 

Sandy, although your math was correct, I personally would not do it that way because you are taking a *split* tablet in conjunction with the liquid. When you split a tablet, you do not get two *exactly* equal parts, and this inaccuracy may somewhat "undo" the accuracy you are aiming for with cutting a tiny bit every day. What I mean is, if you are cutting .03 mg every day with the liquid, but you split a pill into pieces of, say, 1.1 mg and .9 mg, you're not going to have a steady rate of decline in your system because of the inaccuracy in the split pills. You could do 2 mg in tablet form and .5 mg in liquid form, though, since that wouldn't require splitting pills.

 

The only other thing I noticed on your post was that you have "A 10ml syringe would = .25 mg." If you need to measure Valium in hundredths of a ml, then you need a 1ml syringe and not a 10ml one. The 10ml syringes are marked in increments of .2 ml, if I remember right. In any case, it is next to impossible to measure hundredths. At the point you're at, you'll need a 1ml syringe, since you're only going to be taking smaller and smaller doses of Valium.

 

Good luck with your doc!

 

Therese :)

 

 

 

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Therese,

 

Thank you so much for responding to my post.  I am so confused though. :wacko:  I have a call into the compounding pharmacist.  I hope that that will help me figure things out.

 

I do split pills all the time.  I have throughout this taper and I really think that I have been quite successful till this point.  I'm hoping that it will not pose too much of a problem.

 

Thanks so much for trying to help me through this.  I really do appreciate your efforts.

 

Sandy :)

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Sandy,

 

First of all, yes, generic diazepam does come as a liquid. I used generic during my taper.

 

It's up to your doc as to how he would like to write the script. He could say "Take 1.5 mg daily as directed," or he could say something like "Take 1.5 mg the first day and .03 mg less each day thereafter." He should know what to do; I think it's personal preference.

 

I think that the liquid Valium might always come in 5ml increments, so the script (if I remember right) says "Liquid diazepam, 5ml/5mg...". Of course, that is the same as 1ml = 1mg.

 

Sandy, although your math was correct, I personally would not do it that way because you are taking a *split* tablet in conjunction with the liquid. When you split a tablet, you do not get two *exactly* equal parts, and this inaccuracy may somewhat "undo" the accuracy you are aiming for with cutting a tiny bit every day. What I mean is, if you are cutting .03 mg every day with the liquid, but you split a pill into pieces of, say, 1.1 mg and .9 mg, you're not going to have a steady rate of decline in your system because of the inaccuracy in the split pills. You could do 2 mg in tablet form and .5 mg in liquid form, though, since that wouldn't require splitting pills.

 

The only other thing I noticed on your post was that you have "A 10ml syringe would = .25 mg." If you need to measure Valium in hundredths of a ml, then you need a 1ml syringe and not a 10ml one. The 10ml syringes are marked in increments of .2 ml, if I remember right. In any case, it is next to impossible to measure hundredths. At the point you're at, you'll need a 1ml syringe, since you're only going to be taking smaller and smaller doses of Valium.

 

Good luck with your doc!

 

Therese :)

 

 

 

 

 

Therese,

 

I see what you are saying now.  You recommending that I take all liquid diazepam.  I am having a hard time understanding the syringe thing.  Could you try and simplify it for me.  I wish there was a picture of one that I could look at.  Maybe then it would click.

 

So I am supposed to get a 1ml syringe that is marked in hundredths.  So 1ml is equal to 100 little lines on the syringe?  I am supposed to fill the syringe once to get the full 1mg dose than fill it halfway again to get .50mg dose.  Then every day after that fill it less by three lines?  The first cut would be 1.47ml.  (one syringe and 47 lines of the other?)

 

I tried to explain why I'm confused.  I'm sorry.  I'm just no good at math.

 

If you could reply asap since I will be seeing my doc tomorrow.

 

Thanks so much!

 

Sandy :)

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So I am supposed to get a 1ml syringe that is marked in hundredths.  So 1ml is equal to 100 little lines on the syringe?  I am supposed to fill the syringe once to get the full 1mg dose than fill it halfway again to get .50mg dose.  Then every day after that fill it less by three lines?  The first cut would be 1.47ml.  (one syringe and 47 lines of the another?)

 

You got it! :yippee:

 

Yes, that 1ml syringe has 100 marks on it, and each mark is equal to .01 mg Valium. It's divided up into ten main parts, each one a tenth of a ml (.1). Then the tenth-of-a-ml portions are in turn divided into ten tiny marks, letting you measure in hundredths. You can ask the pharmacist too, when you pick up the syringe. It takes a little getting used to, but you'll be up and running in no time.

 

The 10ml syringe has ten main marks on it, and each of the main marks is equal to 1 ml. Those 1ml portions are in turn divided up into 5 parts, which means each part is equal to .2 ml. So you can see how you would not be able to cut .03 ml if your syringe lets you measure only down to .2 ml.

 

Hope this helps!

 

Therese :)

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You got it! :yippee:

 

Yes, that 1ml syringe has 100 marks on it, and each mark is equal to .01 mg Valium. It's divided up into ten main parts, each one a tenth of a ml (.1). Then the tenth-of-a-ml portions are in turn divided into ten tiny marks, letting you measure in hundredths. You can ask the pharmacist too, when you pick up the syringe. It takes a little getting used to, but you'll be up and running in no time.

 

The 10ml syringe has ten main marks on it, and each of the main marks is equal to 1 ml. Those 1ml portions are in turn divided up into 5 parts, which means each part is equal to .2 ml. So you can see how you would not be able to cut .03 ml if your syringe lets you measure only down to .2 ml.

 

Hope this helps!

 

Therese :)

 

Yes, I think I finally got it. :thumbsup:  Thanks so much Therese!

 

Sandy :)

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