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need full instructions on how to taper off .4375 mg Xanax


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My current total daily dose of Xanax is .4375.  I take .125 mg at 6a and 3p and my nightime dose taken around 10p is .1875 mg.  Of course I am getting interdose withdrawals and it has been a bummer but I can do this.  I am committed to getting off this med without the use of other psych meds.  I am seeing a psych doctor on the 28th and I doubt he will be of much help as far as crossing over to Valium so I plan on using the liquid titration taper for the Xanax.  I currently have .5 mg Xanax pills which I have been cutting in half , then quarters and into eighths using a single edge razor blade.  I am shaving off the nightime .25 mg to come up with approximately .0625 mg. cut.  Do you think it is a good idea to tell the psych doc that I am still on .5 mg Xanax three times a day (as I was the first week) and that I want to taper within 2 months in order to get 2 months supply of the Xanax?  If he won't do this then I will have to taper a little faster.  I would like to do the milk titration method tapering 10% every 7 to 10 days and start as soon as I have the taper plan.  I understand the crushing and mixing of the med but I am unsure (even after reading your chart) how much to withdraw and how often to taper.  A written plan, especially for me, would be of great help.  It is such a battle to get help from the medical field.  Believe it or not, I am an RN and am stunned by the lack of knowledge these doctors have.  Thanks for the help.

 

Patty

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Hi Patty,

 

We need to revisit all the instructions for titration and withdrawal. Things evolve over time so that they no longer fit well together, and they probably could be simplified anyway.

 

I can provide an individualised plan working to any taper rate you wish. The method we employ means making up a standard amount of liquid, and discarding a greater and greater amount of this liquid so that your dose decreases over time. This means that you 'waste' benzo, so there is no direct way of eeking out your supply as you dose diminishes. However, with a little effort, you can actually make your supply last longer and still use our method. Typically, you will make up 100ml of liquid each day (though, we can work up a schedule with any sized cylinder), and you will typically reduce the amount you drink by 1-2ml per day, or 1 ml every 1-2 days (depending upon your taper rate). So, for example, if you were to drink 75ml one day, you could save the remaining 25ml for the following day. The next day, your schedule might indicate that you drink 74ml, so you would use the 25ml from the day before, and 49ml from your present day's volume of liquid. This would leave 51ml. The next day, your schedule might indicate that you drink 73ml, so you would drink the 51ml remaining from the day before, and 22ml from this day's volume. This will leave 78ml. The next day, you might be required to drink 72ml - this means that you do no need to make up any liquid for this day - you would drink 72ml from the 78ml left over from the day before.

 

At low doses, this - in theory (and because of how our schedule works at low doses) - means that your supply of tablets would last exactly twice as long. However, because at lower doses (20ml from the 100ml, for example) means that a single volume of liquid would last 5 days or more, you will need to discard some of the liquid (since it is made up using milk, it is unlikely to remain drinkable for this long). However, this variation on the method will still stretch out your supply for much longer - 50% or more at a guess.

 

Here are the example figures again in a different format:

 

100ml volume of liquid, 1ml less each day:

Day1 | 75ml - 25ml remaining;

Day2 | 74ml (25ml + 49ml) | 51ml remaining from day2;

Day3 | 73ml (51ml + 22ml) | 78ml remaining from day3;

Day4 | 72ml (72ml from day3 | no new volume of liquid required) | 6ml remaining from day3;

Day5 | 71ml (6ml from day3 + 65ml from new volume) | 35ml remaining from day5;

 

Yes, it is more messing about, but it might make a big difference to you if you cannot acquire more Xanax.

 

If you read the other threads on this board, you will notice than many of those using titration have a link in their signature to their schedule. You will note that the schedules provide you with exact amounts to be taken, and dates of all reductions to the dose. We will need to know the size of cylinder used (and the size of the marked increments), and the desired taper rate. If all you have is an end date (because you have a restricted supply of Xanax), I will work out a schedule (and taper rate) to suit.

 

I hope I've not made things more complicated. If you can acquire more Xanax, it is lot more straightforward to just make up a fresh batch each day.

 

Edit: I corrected the day numbers in the list.

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Wow.  Thank you, Colin.  That was a lot of work.  I have enough .5 mg Xanax until I see the psych doc on the 28th.  I ordered the equipment and it should be coming any day (100 ml measuring cylinder,the syringe and a conical flask.  I will use a small bowl and use the back of a spoon to crush up the tab.  I will be asking the doctor for the .5 mg tabs.  I can't wait to start but I have to make sure I can get more Xanax, which I think I can.  Get this stuff out of my system.  Thank you, thank you.

 

Patty

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Hi stoney just wanted to wish you luck with the titration. I have been doing it for going on 2 months now, and have had good success with it.

Just learn from my mistake , you might want to give a thought to picking up a spare cylinder, unless you are getting a plastic one.

 

They are not that sturdy and break VERY easily!

 

But again, good luck to you. I look forward to reading about your progress :)

 

Take care,

Scott

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Thanks, Scot.  The cylinder is plastic.  For some reason I ordered a 500 ml flask (go figure).  I also have a 10 ml syringe.  I also had ordered the wrong cylinder (10 ml) and am waiting for the 100 ml cylinder to arrive.  Brain fog.  I have been holding at .4375 mg Xanax for 5 days and think I will stick to that until I see the psych doc on the 28th.  Colin, the taper plan you gave me is not the one I will be using, right?  I will need one at the .4375 mg rate so I can take to the doctor's office.  Again, do I ask for the .5 mg tablets?  Or would the .25 mg tablets suffice and how many tabs do I need at the dose you suggest.  I have to have this all in my head (or should I say on paper) before I see him.  I have been feeling pretty good from the last taper.  I had a couple of days I got slammed pretty hard for a few hours.  Nothing like I was going through before I stabilized on .5 mg on 7/11.  I am ready for anything.  At least, for now, I have windows of relief so I can rest up.  Gosh only knows what is going to happen for the rest of the journey but BRING IT ON.  Just got to get back into life's wonderful world.

 

Patty

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Hi,

 

No, the above 'schedule' was just a made-up example to demonstrate how you could make your pills stretch further.

 

I can make up a schedule for any size tablets you wish. I would recommend either the 0.25 or 0.5mg tablets though. The method we employ titrates just one of the tablets at a time. This means that if you use 0.25mg tablets, you would take one whole (or split it into half or quarters, to be taken over the day - recommended) and the second one would be titrated, taken all in one go, or split over the day. When down to zero on the second titrated tablet, you would then start to titrate the remaining tablet instead. If you obtain the 0.5mg tablets, you are already at less than one tablet, so you would be taking no untitrated tablets.

 

If you are explaining this to your doctor, this is not 'titration' in the strict sense. We will not be making up a liquid to a specific concentration. Rather, this method is about allowing you to split a pill into 100ths, so that you can frequent small cuts, rather than infrequent larger cuts to your dose. We contend that small frequent cuts are far better tolerared than large infrequent cuts. 'Titration' is just shorthand to describe this method, that's all.

 

If you need a schedule before you see your doctor, I will need to know your proposed taper rate. This might be, for example, 10% every 7 days - the is converted by the Excel spreadsheet into a daily withdrawal rate, and the nearest value from 100ml is indicated in the schedule.

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Hi Colin,

I am very confused about your previous post.  I don't understand what you mean when you siad that if I used .25 mg tabs I would take the whole (or split it into halves or quaters, to be taken over the day-recommended).  Does this mean that you suggest just cutting the tab without using a liquid titration?  Also, what do you mean "and the second one would be titrated, taken all in one go, or split up during the day"?  Does this mean that this is my second option?  I was assuming that once I got the .25 mg Xanax tabs I would start the liquid titration taper withdrawing 1 ml daily and then drinking the remainder to my schedule of 6a, 2p and 10p.  I can't believe I am just not getting it.  Help!!!

 

Patty

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I meant to ask whether a 7 day or a 10 titration is recommended.  I know I can go at my own speed and can get a new titration if one is not working.  Thanks.

 

Patty

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I am very confused about your previous post.  ....  I can't believe I am just not getting it.  Help!!!

 

Patty

 

Me, too, Patty. I understand the principle of liquid titration but when it comes to the details, my eyes glaze over.  Probably the main reason I dry cut to the end.  Hope I can blame it on benzo fog; that way I have hope of clearer think down the road.  Keep asking until you know you understand.  You write very intelligent posts so I feel sure you'll will get it.  :thumbsup:

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Hi patty,

 

I was right where you are right now with the being confused. Just keep asking questions until you FULLY understand it. All the numbers and everything at first is very confusing. But after your first time of preparing and mixing the solution, you will be an expert. It is really easy. But it is one of those things you just have to do in order to get a grasp on it. Then it will become second nature everyday to prepare the solution :)

 

I think things will be much clearer for you once your schedule is made up , so you can actually see it on the spreadsheet.

 

I think what Colin meant is that with the .25mg pills , and your total daily dose being .4375mg. this would utilize 2 of those 0.25mg pills to achieve your daily dose. But, you will not be crushing TWO pills up and mixing with the solution. With that said, Only one of the pills would actually be crushed and mixed (titrated) while the other pill would not be titrated, you would either take the other pill  whole, or cut it and split the whole pill over the day. Then once you get down to 0.25mg's (one 0.25mg pill) you would just begin titration (preparing the liquid) of the one pill each day. Not sure if this helped you understand at all. :)

 

Basically think of it like this if you were to get the 0.25mg pills: take one whole 0.25 pill (or split it up thougout the day) then you would prepare pill #2 in the solution, draw out and dispose of the reduction amount indicated by your schedule, and then drink.

 

If it were me, I would try to get the 0.5 mg pills. That way you could just work with one pill each day using the liquid titration. (this is what I'm doing)

 

I'm sure Colin would be along to explain this more clearly for you. He is very good at this. But Like I said if you have any questions or are unsure about anything ASK QUESTIONS..I asked a ton when they were setting my schedule up.

 

 

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I'm sure Colin would be along to explain this more clearly for you. He is very good at this. But Like I said if you have any questions or are unsure about anything ASK QUESTIONS..I asked a ton when they were setting my schedule up.

 

No need - you seem to have explained better I would have done. ;)

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Thanks to all.  Ok, I think I have it.  I am dry cutting now.  I will wait until around 7/31/08 before doing the liquid titration.  That is when I plan on being at 0.25 mg daily (I will listen to my body).  I will ask the psych dr. for the .25 mg tabs.  Can we successfuly liquid titrate with that?  I don't want to push my luck with the dr.  I am trying to work around his thought processes.  I was a psych nurse or 5 years and I swear they have more problems than the patients.  I accidentally took .125 mg Xanax last night and slept only 3 hours last night.  I woke up with mild stomach pains and tremors.  Rough morning but I calmed down even before the afternoon dose.  I will continue at this rate ( .125 mg 3 times daily).  Dear Lord, hope I am doing the right thing. 

Got to fix the clock on this site.  Way off.  I will fix my sig line, too.

Colin, I thought you were leaving for awhile.  Nice that you are here.  The other moderators are truly wonderful, too.

 

Gratefully,

Patty

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Hi,

 

Yes, you have it - I'm sure. Let us know if you would like to start titration from your presnt dose (I can start the schedule at any dose).

 

I do intend to wind down some of my duties - it will take a few weeks. I'll still be here to help out where needed though.

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Hi Colin and Scott33,

OK, I have a 100 ml measuring cylinder with 2 ml increments, a conical flask and a 10 ml syringe with 1 ml increments.  My current daily total of Xanax is .375 mg daily (.125 mg at 6a, 2p and 10p).  I am going to ask the psych doc for .25 mg tabs because my request to see him was to withdraw from Xanax.  I do not want to go into the titration method with him.  I will just tell him I am taking .5 mg xanax 3 x daily.  This will insure that I at least get the Xanax.  Hope this makes sense.  I will also tell him I want to withdraw slowly.  I will start titrating on the 28th.  I will definately need further info to make sure I am doing the titration properly.  I want to taper every 5 days.  I think I can handle that.  What do you think?  Does the milk have to be homogenized?  I drink organic pasteurized milk now.  Going back to the taper protocol, has anybody withdrawn 2 ml instead of 1 and in this case I would want to taper every 7 days.  I guess these questions have to be answered before you can me up with a plan.  I hope I don't sound like I am all over the place.  Thanks so-o-o much for your help.

 

Patty

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Hi stoney,

 

When you say you want to taper every 5 or 7 days, ok..at what rate per 5 or 7 days?  for example I am titrating at 10% per 12 days. Some people do 10% per 2 weeks, or 10% every 7 days..this is up to you.... I was using homenegized whole fat milk to begin my titration. From what I understand the benzo has an affinity for the fat in the milk.

However, I have currently switched over to using Soy milk and it is working just as well for me. your milk should be fine. Colin please correct me if I am wrong on that.

 

Your schedule can indeed be drawn up using the 2ml increments, but the  percentage rate at which you are going to taper is what you need to decide.  Like I said I am doing 10% every 12 days and have had very little in the way of problems. You can always slow down OR speed up with this method at any time during the taper.

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Hi Scott33,

I just read your whole tapering post.  You have hung in there and I appreciate you are able to help us out.  I think it will probably be wise to taper at 10% every 7 days.  Can the .25 mg Xanax tabs work?

The breathing issues you had were exactly like mine in the very beginning.  I felt I couldn't breath even though I knew I was getting air.  I considered it part of a panic attack.  I tried not to dwell on it because it made it worse.  I would do a lot of deep breathing and go on the internet.  I did not move around much.  Probably the worst symptom of all.  Just have to remind myself that I am not dying and I am getting oxygen.

Love and hugs,

Patty

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When I developed a bad asthma condition, I became involved with the American Lung Association.  At the time, their "motto" was:  When you can't breathe, nothing else matters".  No wonder that sensation of not getting enough oxygen was your most troubling symptom!
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Hi Scott33,

I just read your whole tapering post.  You have hung in there and I appreciate you are able to help us out.  I think it will probably be wise to taper at 10% every 7 days.  Can the .25 mg Xanax tabs work?

The breathing issues you had were exactly like mine in the very beginning.  I felt I couldn't breath even though I knew I was getting air.  I considered it part of a panic attack.  I tried not to dwell on it because it made it worse.  I would do a lot of deep breathing and go on the internet.  I did not move around much.  Probably the worst symptom of all.  Just have to remind myself that I am not dying and I am getting oxygen.

Love and hugs,

Patty

 

Thanks for your kind words Patty :)

 

yep the .25mg tabs will work..remember though you will only be titrating one of them and taking 1/2 (.125mg)of the other .25mg tab to achieve your daily dose of .375 until you are down to .25mg and then you will be titrating just the one pill

Colin is gone for the night, he is the schedule master :) .  I'm sure you will have your schedule before the day you want to start!

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just to summarize:

100ml cylinder with 2ml markings

tab strength is 0.25mg

current daily dose .375mg

10% per 7 days is what you want (this would be too fast for me, but you can always slow down if need be)

and you want to start on the 28th

 

If Colin needs anymore info he will let you know, but this should cover it.

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Hi Stoneyco,

 

The titration spreadsheet will work with any sized cylinder, with any size increments. a 100ml cylinder marked with 2ml increments is more than sufficient to enable a smooth taper off your benzos.

 

The spreadsheet will automatically convert your taper rate to a daily rate. This daily rate is then used to calculate your dose every day, rounding the amount to the nearest 2ml on your cylinder scale. For example, if you request a taper rate of 10% every seven days, you will avertage a 10% cut in your dose over any seven day period. If you request a taper rate of 12% every ten days, your dose will be reduced by 12% over any ten day period. You have no calculations to make - just supply me with the taper rate; your cylinder specifications (already provided); your dose and size of tablets being used; and your start date. I'll work out all the numbers. ;)

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Thanks again, Colin.  I will notify you on the 28th the dose of the Xanax prescribed.  We will work from there.

 

Patty

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patty,

just wanted to wish you luck.... you will do great.......

you are in great hands here..... remember slow and steady.....

 

-scott

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Thanks Colin and Scott.  I will get back to you after I see the doctor.  Thanks for the BIG support.

 

Patty xo

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You know what?  Could you make my taper plan up so I can have it on hand just in case I feel I can present it to the doctor.  Maybe he will be flexible and work with me.  I want to do 10% every 7 days.  Thanks, Colin.  You have all the other info in the previous posts.  Can't thank you enough.

 

Patty xo

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patty is this correct?

 

100ml cylinder with 2ml markings

tab strength is 0.25mg

current daily dose .375mg

10% per 7 days is what you want

and you want to start on the 29th

 

just making sure, because I know you currently have the 0.5mg tabs, and were going to ask fir the 0.25 tabs.... so do you want the schedule drawn up for the 0.25mg tablets

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