What is titration?
We do not use 'titration' in the strict medical sense of the term. In medicine, titration describes the gradual adjustment of the dose until the desired effect is achieved. In benzo-circles, 'titration' has come to describe a procedure where water or milk is used to make a liquid from benzodiazepine tablets. To avoid confusion, since this term is already widely used within benzo-circles, we too use 'titration' to describe the making of liquid benzodiazepine. Liquidising benzodiazepine tablets enables us to make very small, very accurate cuts to our dose.
Titration is especially useful for those who find making reductions to their dose 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 of the total dose. When making liquid benzodiazepine, we recommend the use of a 100ml measuring cylinders, with 1ml graduations. This will enable you to make reductions as small as one-hundredth of a pill.
The process is pretty straightforward, and requires of you no mathamatical ability. All you need to do is provide us with the details of your benzodiazepine regimen, and we will provide a tailor-made schedule to fulfil your requirements.
For us to provide you with a titration schedule, you must join the BenzoBuddies forum. We will need the following information to draw up a titration schedule for you, but we will help you with this.
- Start date: when you would like your titration schedule to start (please submit your request at least 48 hours before your start date).
- Dose: the dose you anticipate you be taking at the start date (in mgs).
- Tablet dose: the dose of your individual tablets.
- Number of tablets: the total number (and/or fractions) of tablets you take per day. Examples: 2 tabs; 2.5 tabs; 0.75 tabs. These are the number of tablets (not doses), and the tablets used must be of the same dosage. If you mix-and-match tablet sizes, ask for advice when making your request for a schedule.
- Taper rate: if you are unsure, ask for the input of others. The majority of people probably titrate at a rate of about 10% of their dose every 7-14 days. If you are unsure of where to start, and unless you have good reason to think you need a particularly slow taper, 1% per day is probably a good starting point. The taper plan can be altered later according to how you react.
- Cylinder details: We need to know the size of the cylinder you are using (100ml is recommended). We also need to know the size of the marked increments. Just make sure that there enough increments for the given cylinder to ensure that the pill can be divided into small fractions (100ml cylinder with 1ml increments is always fine; 100ml with 2-5ml increments is probably fine; 50ml with 5ml increments is not very useful). If you are using very large dose pills (for your given benzo), such as 10mg Valium or 2mg Xanax, you will absolutely need lots of increments. This probably means using a 100ml cylinder with 1ml increments.
Titration Preparation Procedure
We usually recommend the following preparation procedure:
- 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.
The following two videos will probably make the above preparation process much clearer. Thank you, Tekksan (a member of our forum), for providing these video tutorials.