Author Topic: Titration instructions - Version 6th Oct. 07  (Read 60619 times)

[Buddie]

Titration instructions - Version 6th Oct. 07
« on: October 06, 2007, 11:35:58 pm »
We use 'titration' to describe a procedure where we make a liquid using water or milk and our benzodiazepine tablets. Making a liquid out of our benzo pills enables us to make very small, very accurate cuts to our benzo dose.

Titration is especially good for those who find making reductions to their benzodiazepines virtually impossible. This is especially true at low doses, where the size of the reductions that can be reliably obtained by pill-splitting (probably no smaller than one-quarter of a pill) can account for a large proportion our total dose. We recommend the use of 100ml measuring cylinders, with 1ml graduations, when making the benzo liquid. This means we can make reductions as small as one-hundredth of a pill.

The process is pretty straightforward, and requires no maths. All you need to do is provide us with the details of your benzodiazepine regimen, and we will provide a tailor-made table for you.

This is the preparation procedure we recommend:

  • Take one pill from your daily dose, and grind it into a fine powder with a pestle and mortar.
  • Add a little milk to the mortar and stir to collect up the powdered benzodiazepine. Pour out the benzo-milk liquid into your cylinder.
  • To ensure you have collected all of the benzodiazepine, add some more milk to the mortar and again stir. Add this liquid to the cylinder.
  • Now, carefully top up the cylinder to 100ml.
  • Stir the benzo-milk solution in the cylinder to ensure that benzodiazepine powder is evenly distributed throughout the liquid.
  • Refer to your titration table to see how much of this liquid you should take as part of your daily dose, and dispose of the remainder. Your cylinder should now contain the proportion of the single benzo tablet you require, as indicated by the titration table.
  • If your daily dose consists of more than one tablet, you should now crush the remaining tablets of your dose and add the benzo powder to the cylinder. The cylinder will now contain the whole of your daily dose.
  • The liquid in the cylinder can be split into as many doses you require over the day. If the volume is very small, top up the milk to a convenient level for you divide up over the day. Remember, the cylinder contains the whole of your daily dose at this stage, so you are only making the solution more dilute; you are not disposing of any more benzodiazepine.

You will need to join our forum for us to provide you with your own titration schedule. We will need to know the following:

  • The number of tablets (or fractions of tablets) you take per day, and the dose of those tablets. This is especially important if your daily dose comprises of tablets of differing strengths. As a double check, we also ask that you provide us with your daily dose in mg. If you are unsure of the dose, we will work through this with you.
  • The rate at which you want to taper. We can help you with this on the forum if you are not sure. We can easily alter the taper rate if you later decide it is too fast or too slow.
  • The volume of the cylinder you will be using, preferably 100 ml.
  • The increments (graduations) of your cylinder or other measuring equipment. Kitchen equipment tends to be rather inaccurate though. For example, if you have a 100ml cylinder, and it is marked at 5ml intervals, we can provide a titration table based upon 5ml increments, or (if you feel comfortable with estimating a measurement by eye), you might decide that you would like to use 2.5ml increments. The more parts into which the volume of liquid can be divided, the smoother the titration! Accuracy is important too though; keep measurements by eye to a reasonable level. Dividing 5ml into five 1ml parts by eye would not be sensible.

The formula we use will tell you how much of your benzo liquid to take each day. Some people will cut every day, while others less frequently, depending on the taper rate and the markings on your cylinder. So, when using a 100ml cylinder marked at 1ml intervals, you might be making reductions to your dose each day. A 100ml cylinder marked at 5ml intervals will result in larger less frequent reductions. The formula will indicate when you should make new reduction and by what amount.

The formula automatically reduces the size of the reductions as your dose falls. It is the size of the reductions relative to your total dose that is important. However, at very low doses, the taper rate becomes constant, or you would never get off the drug. This linear taper (of absolute cuts) kicks in at 1 tablet by default, and assumes that you are using the smallest dose available in your particular benzo. The dose at which these absolute cuts start can be altered to suit your circumstances though.

Here's a youtube two-part video utilising a slight variation to the above method, but it amounts to the same thing. Thanks, Tekksan.

Part 1
Part 2
« Last Edit: May 22, 2009, 10:33:05 am by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #1 on: October 11, 2007, 12:32:09 am »
I've been doing this for about 10 days and just wanted to add:

I am using the back of the spoon to crush the tablet and it works fine;

When I add milk to the crushed tablet, there is some binding/"clumping" happenning and I have to vigorously stir it for awhile - after that it seems that the medicine is evenly absorbed in the milk;

Yes, there are some traces of it left in the cup, but just keep pouring milk in it to 'clean it'.

[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #2 on: October 11, 2007, 12:19:45 pm »
Thanks for the feedback, [...].

We might add a note suggesting that the benzo is left a while to soak into the milk, and to give it a vigorous stirring.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #3 on: October 11, 2007, 04:36:09 pm »
In my experience the only way to get the milk film off the glass is to swirl with water, then drink that solution to insure complete consumption.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #4 on: October 11, 2007, 05:02:53 pm »
Hi,

If water works better when swirling out the benzo powder, then use a little water. This should be added to the cylinder just as you would if you were using milk. The cylinder should then be topped up with milk, as before.

I guess I should try this out for myself. Jana did this before, but she is no longer here. I'm not sure if I have any benzo tablets for experimenting though, so feedback from others would be welcome.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #5 on: October 12, 2007, 03:37:20 am »
Back when we were working on the instructions, I tried crushing tablets with the back of a spoon and mixing that into the milk, and it worked fine. I did this with Ativan, Valium, and Klonopin. I couldn't find my Xanax--guess I took it all way back when! :wacko: You just have to be careful to really crush it well in the container. I used a small 1/2-cup tupperware container. Then I added a little milk and used a spoon to mix up the liquid with the benzo in it. I didn't go any further with the cylinder, etc. So I think you can get by with a spoon as opposed to a mortar and pestle.

[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #6 on: October 12, 2007, 11:41:24 pm »
Has anyone else experienced problems when preparing their titrated benzodiazepines?
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #7 on: January 07, 2008, 11:57:52 pm »
pill crushers (where i am) are easier to find then a mortar & pestle they can be found at a pharmacy - hopefully every pharmacy.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #8 on: January 08, 2008, 12:06:45 am »
pill crushers (where i am) are easier to find then a mortar & pestle they can be found at a pharmacy - hopefully every pharmacy.

I even have a crusher/cutter combo. :socool:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Titration instructions - Version 6th Oct. 07
« Reply #9 on: January 08, 2008, 12:09:03 am »
impressed linda  8)
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.