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Online Djd

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Re: Withdrawal symptoms

« Reply #2 on: September 03, 2015, 02:25:09 pm »

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Builder, just curious because I am going to start ( I hope) to do part liquid titrate, when I get stable again ( whenever that will be - I am very weak and sick right now from titrating too fast. ) how did you do you liquid taper - did they give you liquid valium or did you make your own. How did you decide what was the correct amount to titrate so you were symptom free?  Trial and error?  How do you feel now?  Thank you for any info you are willing to give .  I am trying to get it right and having a very difficult time.  And the psychiatrist was absolutely NO help at all and made it worse for me.

Thank you , builder.

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Djd.  Put on Xanax for post concussive syndrome in 2013

Started a good taper in 5/2015 crossed over from 1.5 Xanax to 30 Valium . Blew it by overtitrating. New Doctor upped me to 40 mls Valium cuz my withdrawals were so bad and even that didn't help. (I should have known bette, in my gut I knew it was not wthe way to help me , but everyone kept saying  " do what he says, he's trained in this type of stuff"  - not!  Started new taper per doctors instructions  .  I started titrating he had me go too fast , am at 32.5 mls and suffering terribly. I am hoping I can just hold here and stabilize and then micro taper.  If I can survive this !

Any encouragement is welcome, this is rough stuff , all of it.

Thanks everyone!

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.

[[Ma...]]

I announced this on my blog but I can't resist repeating it.

As of today I am below the equivalence of 1mg Xanax/day!!

 

 

 

 

And if my math is wrong, I don't want to know!!

Yayyy!!!!! So happy for you!  :smitten:

[[bu...]]

Djd...

 

Builder, just curious because I am going to start ( I hope) to do part liquid titrate, when I get stable again ( whenever that will be - I am very weak and sick right now from titrating too fast. ) how did you do you liquid taper - did they give you liquid valium or did you make your own. How did you decide what was the correct amount to titrate so you were symptom free?  Trial and error?  How do you feel now?  Thank you for any info you are willing to give .  I am trying to get it right and having a very difficult time.  And the psychiatrist was absolutely NO help at all and made it worse for me.

 

I used Rx liquid V (Roxane 5mg=5ml Diaaepam Oral Solution).  I have a long relationship with a highly competent caring doc.  When I discussed tapering, he said just said "tell me what you need, and I'll Rx it"  But if if had not had access to Rx liquid, I would have not hesitated to use vodka, in spite a history of alcoholism (sober 25+ years.

 

Since generally safe  guideline is to cut 10% a month, calculate 10% of your current dose, and divide that number by 30, and that's your daily cut.  Again, that's a guideline, you may want to increase of decrease the cut rate depending on how you respond.

 

I knew from historical experience from cut & hold that 10%/mo was about my limit, so I started lower.  I was at 9m/day, and started my microtaper at .025/day, which was about 8%/month.  Actually, since a daily taper is generally more tolerable than C&H, I feel it could have started faster.  I don't think I actually would have had any problem at 10%mo.

 

I usually diluted my Rx liquid 9:1 (10% concentration).  I generally prepared enough diluted med to last 10-14 days.  It needs to be stored at room temp, and protected from sunlight.

 

Many folks get intimidated by this method, but trust me, there is nothing difficult about it.

 

I'll post this to your post on the forum also.

[[...]]

Thanks builder, so much. 

So you would dilute the liquid Valium as follows -  1 ml Valium to 9 mls water? And then use a syringe to measure out how much to cut? Wasn't quite sure of that.  If my doctor won't give me liquid I will have to make my own and I am okay with that, I just want to know that I am doing it the right way.

Had you had some failed attempts prior to this type of titratin?  I am in a bad bad way right now.  I am supposing that I will have to wait until I feel considerably better before trying to cut again.  I am on such a high dose of Valium, having crossed over from Xanax and then having two failed or I should say messed up tapers from trying to cut too fast ( per docs instructions the second time - a psychiatrist!) that I am severely depressed about this whole thing, in addition to being basically non functional.  And the point of my trying the Ashton crossover was to make life manageable while grtting off this poison.  I'm am so discouraged that it is probably going to take me years to do this - have you any words of encouragement?  Thank you from ANYONE who cares to reply....

[[bu...]]

Thanks builder, so much. 

So you would dilute the liquid Valium as follows - 1) 1 ml Valium to 9 mls water? And then use a syringe to measure out how much to cut? Wasn't quite sure of that. If my doctor won't give me liquid I will have to make my own and I am okay with that, I just want to know that I am doing it the right way.

2) Had you had some failed attempts prior to this type of titratin?  I am in a bad bad way right now.  I am supposing that I will have to wait until I feel considerably better before trying to cut again.  I am on such a high dose of Valium, having crossed over from Xanax and then having two failed or I should say messed up tapers from trying to cut too fast ( per docs instructions the second time - a psychiatrist!) that I am severely depressed about this whole thing, in addition to being basically non functional.  And the point of my trying the Ashton crossover was to make life manageable while grtting off this poison.  I'm am so discouraged that it is probably going to take me years to do this - have you any words of encouragement?  Thank you from ANYONE who cares to reply....

 

1)  9:1 is what I used.  That is enough dilution that you shoul have no real problem making measurements to 3 decimal places (.001mg).  Many folks  prefer 99:1 because they seem to feel the "math" is easier.  But the only difference is wheher you move the decimal 1 place or 2 places.  Note that you don't measure out your "cut" you measure out your dose.  For example, starting from 9mg, I took 8mg tablets, then .975mg from liquid, .950mg from liquid, .925 liquid, etc, reducing by .025mg/day.

 

2) I failed 3 times to get from 9mg down to 8.5mg.  The first attempt was C&H with tablets, and the second 2 were water titration.  But diazepam is NOT water soluble.

[[ga...]]

 

1)  9: is what I used.  That is enough dilution that you shoul have no real problem making measurements to 3 decimal places (.001mg).  Many folks  prefer 99:1 because they seem to feel the "math" is easier.  But the only difference is wheher you move the decimal 1 place or 2 places.  Note that you don't measure out your "cut" you measure out your dose.  For example, starting from 9mg, I took 8mg tablets, then .975mg from liquid, .950mg from liquid, .925 liquid, etc, reducing by .025mg/day.

 

2) I failed 3 times to get from 9mg down to 8.5mg.  The first attempt was C&H with tablets, and the second 2 were water titration.  But diazepam is NOT water soluble.

 

builder, do you mean 9:1?

[[ga...]]

Thanks builder, so much. 

So you would dilute the liquid Valium as follows -  1 ml Valium to 9 mls water? And then use a syringe to measure out how much to cut? Wasn't quite sure of that.  If my doctor won't give me liquid I will have to make my own and I am okay with that, I just want to know that I am doing it the right way.

Had you had some failed attempts prior to this type of titratin?  I am in a bad bad way right now.  I am supposing that I will have to wait until I feel considerably better before trying to cut again.  I am on such a high dose of Valium, having crossed over from Xanax and then having two failed or I should say messed up tapers from trying to cut too fast ( per docs instructions the second time - a psychiatrist!) that I am severely depressed about this whole thing, in addition to being basically non functional.  And the point of my trying the Ashton crossover was to make life manageable while grtting off this poison.  I'm am so discouraged that it is probably going to take me years to do this - have you any words of encouragement?  Thank you from ANYONE who cares to reply....

 

I messed up my first taper, too, from tapering too fast per doctor's suggested rate. I had to up-dose and hold for awhile. Then I started to micro-taper even though I felt bad but functioning. Still felt bad, functioning but poorly. Then I partially crossed over to Librium. (I can't take Valium. I hyper-fast metabolize it.) I did not taper during the cross-over and it was a bit bumpy, but I could tell it was the right decision. I do find that these slower benzos are more depressing, but I preferred that to jumping out of my skin! The Valium may be contributing to your depression. I hear that improves with time, so hang in there!

 

You will have to decide if holding is better or if you want to try teeny tiny cuts every few days. It sounds from your post that maybe you are in a holding and waiting place. Meanwhile, see if you can get the liquid. It really does make titration simpler.

 

I'm in a better place now but it took awhile to get here. And I will never go back to fast tapering again. If it takes 2 years, so be it. (And it probably will.) Micro-tapering can be as fast or as slow as feels right to you. There's no rush.

 

Go to the stickies on the withdrawal support forum. There's a great post there about coping during withdrawal. If you post a question about coping on that forum, it doesn't hurt to add, "No scary stories, please." And then don't read the threads with the scary stories!

 

And know that you will not always feel this bad. Your brain is healing and complaining about it. But it will get to a better place where it complains less! We all heal.

 

P.S. Builder knows what he's talking about. He is one of our chemistry/math gurus. Follow his titration advice!

[[Ma...]]

Thanks builder, so much. 

So you would dilute the liquid Valium as follows -  1 ml Valium to 9 mls water? And then use a syringe to measure out how much to cut? Wasn't quite sure of that.  If my doctor won't give me liquid I will have to make my own and I am okay with that, I just want to know that I am doing it the right way.

Had you had some failed attempts prior to this type of titratin?  I am in a bad bad way right now.  I am supposing that I will have to wait until I feel considerably better before trying to cut again.  I am on such a high dose of Valium, having crossed over from Xanax and then having two failed or I should say messed up tapers from trying to cut too fast ( per docs instructions the second time - a psychiatrist!) that I am severely depressed about this whole thing, in addition to being basically non functional.  And the point of my trying the Ashton crossover was to make life manageable while grtting off this poison.  I'm am so discouraged that it is probably going to take me years to do this - have you any words of encouragement?  Thank you from ANYONE who cares to reply....

 

I messed up my first taper, too, from tapering too fast per doctor's suggested rate. I had to up-dose and hold for awhile. Then I started to micro-taper even though I felt bad but functioning. Still felt bad, functioning but poorly. Then I partially crossed over to Librium. (I can't take Valium. I hyper-fast metabolize it.) I did not taper during the cross-over and it was a bit bumpy, but I could tell it was the right decision. I do find that these slower benzos are more depressing, but I preferred that to jumping out of my skin! The Valium may be contributing to your depression. I hear that improves with time, so hang in there!

 

You will have to decide if holding is better or if you want to try teeny tiny cuts every few days. It sounds from your post that maybe you are in a holding and waiting place. Meanwhile, see if you can get the liquid. It really does make titration simpler.

 

I'm in a better place now but it took awhile to get here. And I will never go back to fast tapering again. If it takes 2 years, so be it. (And it probably will.) Micro-tapering can be as fast or as slow as feels right to you. There's no rush.

 

Go to the stickies on the withdrawal support forum. There's a great post there about coping during withdrawal. If you post a question about coping on that forum, it doesn't hurt to add, "No scary stories, please." And then don't read the threads with the scary stories!

 

And know that you will not always feel this bad. Your brain is healing and complaining about it. But it will get to a better place where it complains less! We all heal.

 

P.S. Builder knows what he's talking about. He is one of our chemistry/math gurus. Follow his titration advice!

 

Gardener,

I am sorry I know I have asked you this before, but could you remind me what tests you did to learn how you metabolize meds? I did the genetic test from 23andme that Marija suggested. I'm waiting for the results and then I have to send them to another site. She also suggested another test that I'm going to ask my dr if I can do. I metabolize klonopin very fast. I have to dose 4x a day and I get interdose withdrawals. I am hoping it will get better with MT.

 

Also just out of curiosity why did you choose Librium over klonopin? I know that it has a slightly longer half life, but not that much longer. It is also metabolized by the same liver enzyme as Xanax. I'm glad the Librium is working so well!

 

XO Maya

[[ga...]]

 

Gardener,

I am sorry I know I have asked you this before, but could you remind me what tests you did to learn how you metabolize meds? I did the genetic test from 23andme that Marija suggested. I'm waiting for the results and then I have to send them to another site. She also suggested another test that I'm going to ask my dr if I can do. I metabolize klonopin very fast. I have to dose 4x a day and I get interdose withdrawals. I am hoping it will get better with MT.

 

Also just out of curiosity why did you choose Librium over klonopin? I know that it has a slightly longer half life, but not that much longer. It is also metabolized by the same liver enzyme as Xanax. I'm glad the Librium is working so well!

 

XO Maya

 

I had tests for genes that control the production of liver enzymes. The two I was tested for were CYP450: 2C19 (mine was ultra-rapid) and 2D6 (I have none). Here's a link to a ton of them.

 

http://www.ct.gov/dcf/lib/dcf/ccmu/pdf/cyp_chart_nov_2013.pdf

 

You will a see that Xanax and Librium and Klonopin are all 3A4. I was not tested for 3A4 but was suspecting I was a fast metabolizer of that, too. I chose the slowest 3A4, Librium.

 

I have also heard that Klonopin (clonazepam) has a high rate of side effects, particularly regarding muscle problems. (And I have a friend who experienced this when she rapid-tapered K.) I already have muscle problems (myoclonus), so thought I'd better steer clear of that one.

 

While Librium appears to have a moderate-to-long half life, it actually breaks down into active metabolites that make its half life just about as long as Valium. So it is much slower than Klonopin. And I was looking for s-l-o-w.

 

The main drawbacks to Librium are:

1. you can't dry cut Librium because it only comes in capsules here in the US

2. it's very low potency so takes more alcohol to dissolve it (hence my partial cross-over to keep the L as low as possible)

3. some doctors aren't as familiar with it and might and consider it "old-fashioned" (L was the first benzo), ran into this with my primary but not with any psychiatrist or pharmacist

4. it's commonly used in alcohol detox, so might be stigmatizing (but not as stigmatizing as X, which is a street drug that some doctors freak about and refuse to prescribe)

5. I had to special order the 5mg capsules, the size I wanted; had no problem doing that, they are easy to get just a smaller size than most people want

 

Hope this was helpful!

 

P.S. I was dosing Xanax 6 times/day, holding for a month, and still feeling w/d. My psych didn't believe I could be having w/d on 6 times/day, but I could feel it. And I felt the difference instantly on the Librium. At half crossed I am functioning much better and having windows again!

[[bu...]]

 

1)  9: is what I used.  That is enough dilution that you shoul have no real problem making measurements to 3 decimal places (.001mg).  Many folks  prefer 99:1 because they seem to feel the "math" is easier.  But the only difference is wheher you move the decimal 1 place or 2 places.  Note that you don't measure out your "cut" you measure out your dose.  For example, starting from 9mg, I took 8mg tablets, then .975mg from liquid, .950mg from liquid, .925 liquid, etc, reducing by .025mg/day.

 

2) I failed 3 times to get from 9mg down to 8.5mg.  The first attempt was C&H with tablets, and the second 2 were water titration.  But diazepam is NOT water soluble.

 

builder, do you mean 9:1?

  Yes!

 

I fixed it.

 

Thanks

 

[[Ma...]]

 

Gardener,

I am sorry I know I have asked you this before, but could you remind me what tests you did to learn how you metabolize meds? I did the genetic test from 23andme that Marija suggested. I'm waiting for the results and then I have to send them to another site. She also suggested another test that I'm going to ask my dr if I can do. I metabolize klonopin very fast. I have to dose 4x a day and I get interdose withdrawals. I am hoping it will get better with MT.

 

Also just out of curiosity why did you choose Librium over klonopin? I know that it has a slightly longer half life, but not that much longer. It is also metabolized by the same liver enzyme as Xanax. I'm glad the Librium is working so well!

 

XO Maya

 

I had tests for genes that control the production of liver enzymes. The two I was tested for were CYP450: 2C19 (mine was ultra-rapid) and 2D6 (I have none). Here's a link to a ton of them.

 

http://www.ct.gov/dcf/lib/dcf/ccmu/pdf/cyp_chart_nov_2013.pdf

 

You will a see that Xanax and Librium and Klonopin are all 3A4. I was not tested for 3A4 but was suspecting I was a fast metabolizer of that, too. I chose the slowest 3A4, Librium.

 

I have also heard that Klonopin (clonazepam) has a high rate of side effects, particularly regarding muscle problems. (And I have a friend who experienced this when she rapid-tapered K.) I already have muscle problems (myoclonus), so thought I'd better steer clear of that one.

 

While Librium appears to have a moderate-to-long half life, it actually breaks down into active metabolites that make its half life just about as long as Valium. So it is much slower than Klonopin. And I was looking for s-l-o-w.

 

The main drawbacks to Librium are:

1. you can't dry cut Librium because it only comes in capsules here in the US

2. it's very low potency so takes more alcohol to dissolve it (hence my partial cross-over to keep the L as low as possible)

3. some doctors aren't as familiar with it and might and consider it "old-fashioned" (L was the first benzo), ran into this with my primary but not with any psychiatrist or pharmacist

4. it's commonly used in alcohol detox, so might be stigmatizing (but not as stigmatizing as X, which is a street drug that some doctors freak about and refuse to prescribe)

5. I had to special order the 5mg capsules, the size I wanted; had no problem doing that, they are easy to get just a smaller size than most people want

 

Hope this was helpful!

 

P.S. I was dosing Xanax 6 times/day, holding for a month, and still feeling w/d. My psych didn't believe I could be having w/d on 6 times/day, but I could feel it. And I felt the difference instantly on the Librium. At half crossed I am functioning much better and having windows again!

Thank you for the info! I hope my pdoc or PCP will let me take these tests.

 

I can't compare because I haven't been on other benzos more than a day or two, but klonopin definitely has a lot of side effects. I don't know if Librium is also a muscle relaxer, but klonopin is. Since getting under 4mg I have been having muscle pain. I am pretty achy right now.

 

It definitely makes sense why you choose Librium. I was just curious. I knew you would have good reason. My pdoc switches people on Xanax and Ativan to klonopin. He doesn't use the older benzos. He is misinformed. I wish I had a longer half life. I definitely metabolize klonopin fast. I don't know how I would react to Valium. Also I think you are right about the longer acting benzos being worse for depression. My worst tolerance wd symtoms were depression, fatigue, lower energy etc. I would comsider a partial c/o if tests showed I could metabolize it well and I hit a wall. I think a c/o is a scary thing to do. I'm glad you did it and it's helping so much!

 

This was very helpful! Thank you! 

 

 

[Guest [Ma...]]

Thanks builder, so much. 

So you would dilute the liquid Valium as follows -  1 ml Valium to 9 mls water? And then use a syringe to measure out how much to cut? Wasn't quite sure of that.  If my doctor won't give me liquid I will have to make my own and I am okay with that, I just want to know that I am doing it the right way.

Had you had some failed attempts prior to this type of titratin?  I am in a bad bad way right now.  I am supposing that I will have to wait until I feel considerably better before trying to cut again.  I am on such a high dose of Valium, having crossed over from Xanax and then having two failed or I should say messed up tapers from trying to cut too fast ( per docs instructions the second time - a psychiatrist!) that I am severely depressed about this whole thing, in addition to being basically non functional.  And the point of my trying the Ashton crossover was to make life manageable while grtting off this poison.  I'm am so discouraged that it is probably going to take me years to do this - have you any words of encouragement?  Thank you from ANYONE who cares to reply....

 

I messed up my first taper, too, from tapering too fast per doctor's suggested rate. I had to up-dose and hold for awhile. Then I started to micro-taper even though I felt bad but functioning. Still felt bad, functioning but poorly. Then I partially crossed over to Librium. (I can't take Valium. I hyper-fast metabolize it.) I did not taper during the cross-over and it was a bit bumpy, but I could tell it was the right decision. I do find that these slower benzos are more depressing, but I preferred that to jumping out of my skin! The Valium may be contributing to your depression. I hear that improves with time, so hang in there!

 

You will have to decide if holding is better or if you want to try teeny tiny cuts every few days. It sounds from your post that maybe you are in a holding and waiting place. Meanwhile, see if you can get the liquid. It really does make titration simpler.

 

I'm in a better place now but it took awhile to get here. And I will never go back to fast tapering again. If it takes 2 years, so be it. (And it probably will.) Micro-tapering can be as fast or as slow as feels right to you. There's no rush.

 

Go to the stickies on the withdrawal support forum. There's a great post there about coping during withdrawal. If you post a question about coping on that forum, it doesn't hurt to add, "No scary stories, please." And then don't read the threads with the scary stories!

 

And know that you will not always feel this bad. Your brain is healing and complaining about it. But it will get to a better place where it complains less! We all heal.

 

P.S. Builder knows what he's talking about. He is one of our chemistry/math gurus. Follow his titration advice!

 

Gardener,

I am sorry I know I have asked you this before, but could you remind me what tests you did to learn how you metabolize meds? I did the genetic test from 23andme that Marija suggested. I'm waiting for the results and then I have to send them to another site. She also suggested another test that I'm going to ask my dr if I can do. I metabolize klonopin very fast. I have to dose 4x a day and I get interdose withdrawals. I am hoping it will get better with MT.

 

Also just out of curiosity why did you choose Librium over klonopin? I know that it has a slightly longer half life, but not that much longer. It is also metabolized by the same liver enzyme as Xanax. I'm glad the Librium is working so well!

 

XO Maya

 

Hi Maya,

Here's some information that I found helpful as it was explained to me by my doctor.

 

The liver has 2 detox phases - phase I (P450) and phase II (conjugation pathways)

My doctors felt it important to test both in that the first affects the second.

 

For testing the P450 pathways, there are many labs to choose from, I chose

1.  Www.Genelex.com.

I also tested phase II NAT2 liver pathway which directly affects klonopin.

Klonopin, after passing through phase I CYP enzymes, will be acetylated (biotransformed for elimination) via NAT2. This was an important piece of the puzzle for me, and a big part of why I struggled with klonopin.  I was a slow acetylator and could not remove K from my body resulting in neuro toxcicity.

http://www.ncbi.nlm.nih.gov/m/pubmed/12899737/

 

2. Www.23andme.com. This company will test many genetic polymorphisms including phase I and some phase II enzymes specific to conjugation of benzodiazepines.  In particular, the UGT1A1 28.  This information will show how your liver handles a specific conjugation called glucoronidation. All benzos are biotransformed for elimination via glucoronidation.

23andme will supply raw genetic information only. Once you receive the raw data, up load the information for interpretation to 1 of several sites that will interpret the results for you, they are:

A.  Www.livewello.com

B.  Www.mthfrsupport.com (called the Sterling Report)

 

3. Www.gdx.net  Called Genova labs. I used this lab to identify my nutritional status. This was important to help support phase I and phase II liver detoxification (for me, everyone is different)

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

There are many labs offering nutritional evaluations. Check what's available in your area.

 

Good luck, Maya and let me know if you need help uploading the raw data.

 

Marija

 

[[ga...]]

 

Hi Maya,

Here's some information that I found helpful as it was explained to me by my doctor.

 

The liver has 2 detox phases - phase I (P450) and phase II (conjugation pathways)

My doctors felt it important to test both in that the first affects the second.

 

For testing the P450 pathways, there are many labs to choose from, I chose

1.  Www.Genelex.com.

I also tested phase II NAT2 liver pathway which directly affects klonopin.

Klonopin, after passing through phase I CYP enzymes, will be acetylated (biotransformed for elimination) via NAT2. This was an important piece of the puzzle for me, and a big part of why I struggled with klonopin.  I was a slow acetylator and could not remove K from my body resulting in neuro toxcicity.

http://www.ncbi.nlm.nih.gov/m/pubmed/12899737/

 

2. Www.23andme.com. This company will test many genetic polymorphisms including phase I and some phase II enzymes specific to conjugation of benzodiazepines.  In particular, the UGT1A1 28.  This information will show how your liver handles a specific conjugation called glucoronidation. All benzos are biotransformed for elimination via glucoronidation.

23andme will supply raw genetic information only. Once you receive the raw data, up load the information for interpretation to 1 of several sites that will interpret the results for you, they are:

A.  Www.livewello.com

B.  Www.mthfrsupport.com (called the Sterling Report)

 

3. Www.gdx.net  Called Genova labs. I used this lab to identify my nutritional status. This was important to help support phase I and phase II liver detoxification (for me, everyone is different)

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

There are many labs offering nutritional evaluations. Check what's available in your area.

 

Good luck, Maya and let me know if you need help uploading the raw data.

 

Marija

 

I sure wish my psych nurse could have ordered more of these tests for me, but she only had one lab she used, so I got what I got. The results did explain why I had such bad med reactions in the past. I sure hope the day comes when all this testing is standard operating procedure before any medication is prescribed!

[Guest [Ma...]]

 

Hi Maya,

Here's some information that I found helpful as it was explained to me by my doctor.

 

The liver has 2 detox phases - phase I (P450) and phase II (conjugation pathways)

My doctors felt it important to test both in that the first affects the second.

 

For testing the P450 pathways, there are many labs to choose from, I chose

1.  Www.Genelex.com.

I also tested phase II NAT2 liver pathway which directly affects klonopin.

Klonopin, after passing through phase I CYP enzymes, will be acetylated (biotransformed for elimination) via NAT2. This was an important piece of the puzzle for me, and a big part of why I struggled with klonopin.  I was a slow acetylator and could not remove K from my body resulting in neuro toxcicity.

http://www.ncbi.nlm.nih.gov/m/pubmed/12899737/

 

2. Www.23andme.com. This company will test many genetic polymorphisms including phase I and some phase II enzymes specific to conjugation of benzodiazepines.  In particular, the UGT1A1 28.  This information will show how your liver handles a specific conjugation called glucoronidation. All benzos are biotransformed for elimination via glucoronidation.

23andme will supply raw genetic information only. Once you receive the raw data, up load the information for interpretation to 1 of several sites that will interpret the results for you, they are:

A.  Www.livewello.com

B.  Www.mthfrsupport.com (called the Sterling Report)

 

3. Www.gdx.net  Called Genova labs. I used this lab to identify my nutritional status. This was important to help support phase I and phase II liver detoxification (for me, everyone is different)

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

There are many labs offering nutritional evaluations. Check what's available in your area.

 

Good luck, Maya and let me know if you need help uploading the raw data.

 

Marija

 

I sure wish my psych nurse could have ordered more of these tests for me, but she only had one lab she used, so I got what I got. The results did explain why I had such bad med reactions in the past. I sure hope the day comes when all this testing is standard operating procedure before any medication is prescribed!

 

I agree, Gardner.

I'm already testing my children and compiling genetic and nutritional binders for them so they will be fully informed, in the future, when meeting with their doctors.

 

Marija

[[Sh...]]

SG, Anne...Thanks for the input. I will do as you suggest with using one container to dissolve pills, then add water from the cylinder.  Day three.  I make new doses each night. So the reduction starts each evening. I started tapering the evening of September 1. Just decided it was time. We shall see what the future holds.

 

Shaani

 

 

[[bu...]]

Thanks builder, so much. 

So you would dilute the liquid Valium as follows -  1 ml Valium to 9 mls water? And then use a syringe to measure out how much to cut? Wasn't quite sure of that.  If my doctor won't give me liquid I will have to make my own and I am okay with that, I just want to know that I am doing it the right way.

Had you had some failed attempts prior to this type of titratin?  I am in a bad bad way right now.  I am supposing that I will have to wait until I feel considerably better before trying to cut again.  I am on such a high dose of Valium, having crossed over from Xanax and then having two failed or I should say messed up tapers from trying to cut too fast ( per docs instructions the second time - a psychiatrist!) that I am severely depressed about this whole thing, in addition to being basically non functional.  And the point of my trying the Ashton crossover was to make life manageable while grtting off this poison.  I'm am so discouraged that it is probably going to take me years to do this - have you any words of encouragement?  Thank you from ANYONE who cares to reply....

 

I messed up my first taper, too, from tapering too fast per doctor's suggested rate. I had to up-dose and hold for awhile. Then I started to micro-taper even though I felt bad but functioning. Still felt bad, functioning but poorly. Then I partially crossed over to Librium. (I can't take Valium. I hyper-fast metabolize it.) I did not taper during the cross-over and it was a bit bumpy, but I could tell it was the right decision. I do find that these slower benzos are more depressing, but I preferred that to jumping out of my skin! The Valium may be contributing to your depression. I hear that improves with time, so hang in there!

 

You will have to decide if holding is better or if you want to try teeny tiny cuts every few days. It sounds from your post that maybe you are in a holding and waiting place. Meanwhile, see if you can get the liquid. It really does make titration simpler.

 

I'm in a better place now but it took awhile to get here. And I will never go back to fast tapering again. If it takes 2 years, so be it. (And it probably will.) Micro-tapering can be as fast or as slow as feels right to you. There's no rush.

 

Go to the stickies on the withdrawal support forum. There's a great post there about coping during withdrawal. If you post a question about coping on that forum, it doesn't hurt to add, "No scary stories, please." And then don't read the threads with the scary stories!

 

And know that you will not always feel this bad. Your brain is healing and complaining about it. But it will get to a better place where it complains less! We all heal.

 

P.S. Builder knows what he's talking about. He is one of our chemistry/math gurus. Follow his titration advice!

 

Gardener,

I am sorry I know I have asked you this before, but could you remind me what tests you did to learn how you metabolize meds? I did the genetic test from 23andme that Marija suggested. I'm waiting for the results and then I have to send them to another site. She also suggested another test that I'm going to ask my dr if I can do. I metabolize klonopin very fast. I have to dose 4x a day and I get interdose withdrawals. I am hoping it will get better with MT.

 

Also just out of curiosity why did you choose Librium over klonopin? I know that it has a slightly longer half life, but not that much longer. It is also metabolized by the same liver enzyme as Xanax. I'm glad the Librium is working so well!

 

XO Maya

 

Hi Maya,

Here's some information that I found helpful as it was explained to me by my doctor.

 

The liver has 2 detox phases - phase I (P450) and phase II (conjugation pathways)

My doctors felt it important to test both in that the first affects the second.

 

For testing the P450 pathways, there are many labs to choose from, I chose

1.  Www.Genelex.com.

I also tested phase II NAT2 liver pathway which directly affects klonopin.

Klonopin, after passing through phase I CYP enzymes, will be acetylated (biotransformed for elimination) via NAT2. This was an important piece of the puzzle for me, and a big part of why I struggled with klonopin.  I was a slow acetylator and could not remove K from my body resulting in neuro toxcicity.

http://www.ncbi.nlm.nih.gov/m/pubmed/12899737/

 

2. Www.23andme.com. This company will test many genetic polymorphisms including phase I and some phase II enzymes specific to conjugation of benzodiazepines.  In particular, the UGT1A1 28.  This information will show how your liver handles a specific conjugation called glucoronidation. All benzos are biotransformed for elimination via glucoronidation.

23andme will supply raw genetic information only. Once you receive the raw data, up load the information for interpretation to 1 of several sites that will interpret the results for you, they are:

A.  Www.livewello.com

B.  Www.mthfrsupport.com (called the Sterling Report)

 

3. Www.gdx.net  Called Genova labs. I used this lab to identify my nutritional status. This was important to help support phase I and phase II liver detoxification (for me, everyone is different)

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

There are many labs offering nutritional evaluations. Check what's available in your area.

 

Good luck, Maya and let me know if you need help uploading the raw data.

 

Marija

 

Wow no idea what half that means but I am clearly metabolizing too fast. I don't have the option to do all of these tests. Am I going to be ok as I try to get down to 3 then 2 then 1 dose soon?! I am going to try to hold for a couple of weeks but I am feeling such an uptick in all of the worst symptoms again.

 

I am desperately trying to not updose. Just holding tight. Barely.

[[ga...]]

 

Wow no idea what half that means but I am clearly metabolizing too fast. I don't have the option to do all of these tests. Am I going to be ok as I try to get down to 3 then 2 then 1 dose soon?! I am going to try to hold for a couple of weeks but I am feeling such an uptick in all of the worst symptoms again.

 

I am desperately trying to not updose. Just holding tight. Barely.

 

I think if you feel that you are a fast metabolizer then you probably are. I wasn't tested for most stuff, but I just feel the Xanax going out of me faster than it supposedly should. Listen to your body! If your symptoms are bad, holding awhile might give your brain a chance to catch up with your taper.

 

I'm nowhere near the end, so I can't give advice about dropping doses. So sorry! Hope somebody else with experience getting off can help you with this. 

[Guest [Ma...]]

Butterfly1,

I'm so sorry you are feeling all the symptoms as you near the end of your taper.  From reading on the boards, seems to be common  to feel upticks towards the end.

The good news is - you are nearing the end!  Soon, you will be off and ready to fully heal.

 

As for the above testing, they were helpful but not curative.  Understanding my genetic vulnerabilities doesn't change the fact that moving forward must be done slowly, aiming for success the first time.

 

You are so close, Butterfly, stay strong and keep your eyes on the end!

 

Marija🌺

 

 

 

[[Kg...]]

Butterfly you will make it through this just slow down and take a break from cutting if you need to. Re: going to 2 doses than one I know that Ninja had to do this so you may want to ask him how that worked.  If it were me and it will be one day soon I hope -  I would cut out the dose that you think does the least for you first and then hold there for a few days as if it were a cut even though it isn't.  Then keep cutting and then do the same when you are down to 1 dose and then off - finally.  You may have to slow the rate of your taper but the point is to feel bearable s/x as you get off.  I agree with  you about up dosing - we've been through so much to get where we are that the thought of going up again is not what I would want to do either.  Just keep telling yourself that your body is healing and that you can do this - one minute at a time. 

[[Ul...]]

Jeff,

This is the link to the workbook:

http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131

 

I posted links about DBT and the skills on Gardener's blog. I hope it gives you the help it gave me!

 

XO Maya

 

Thanks, Maya! I'll get that workbook. I'm not sure yet how to get to Gardener's blog, but I'm sure I'll find it. I'll go to the Homepage of BB and look around.

 

Keep fighting the fight!

 

Hugs,

 

Jeff

 

It's called Seeds of Inspiration.

 

BTW, if you go to a person's profile, you can see their posts and that will usually lead you to their blog.

 

Hey, it's September. When's your appointment with your new psychiatrist? Soon?

 

You're a sweetheart! You remembered my appointment. Holy cow! I'd say your brain is rockin' more than you think. My appointment is September 16th. Still got the fingers crossed. Thank you so much for the kindness, and I really mean that. Keep on improving and moving downwards!!!

 

Hugs to you,

 

Jeff

[[Ul...]]

Jeff,

This is the link to the workbook:

http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131

 

I posted links about DBT and the skills on Gardener's blog. I hope it gives you the help it gave me!

 

XO Maya

 

Thanks, Maya! I'll get that workbook. I'm not sure yet how to get to Gardener's blog, but I'm sure I'll find it. I'll go to the Homepage of BB and look around.

 

Keep fighting the fight!

 

Hugs,

 

Jeff

Jeff,

I am so sorry. I thought I saw you on her blog. I'm out of it. I think that's great that you are getting the workbook! Let me know what you think or of you have any questions. Some things may seem simple or silly, but really make a difference when you do them. Also mindfulness takes practice. I hope you are doing well! I am on day 3 of my MT, so far so good. I think this will be much better for me! I hope you have adjusted to liquid.

 

XO Maya

 

Congrats, Maya! You're gonna smoke the taper. I can just tell. You're determined and you have the right attitude and strength. Oh, and thanks again for the workbook info. Ordered it late last night.  Next!

 

Jeff

[[ga...]]

 

You're a sweetheart! You remembered my appointment. Holy cow! I'd say your brain is rockin' more than you think. My appointment is September 16th. Still got the fingers crossed. Thank you so much for the kindness, and I really mean that. Keep on improving and moving downwards!!!

 

Hugs to you,

 

Jeff

 

Yup, I remembered you have an appointment in September and forgot an appointment I had last night.    Good old benzo brain!

 

We're all pulling for you, Jeff, and hope to hear good news from you soon!

[[...]]

Anyone,

Just wondering - when you do a liquid micro-taper and with vodka and water - do you have to stir it before you use it each day?

And also , if you use a liquid diazepam for microtitrating - how much do you dilute it ?  1 ml to 99 mls water? And then you do your daily titration from there , whatever amount I decide is manageable ? I'm math challenged and want to start microtitrating as soon as I'm well enough - but want to make sure I know what I'm talking about when I go see my doctor.

Not sure I'm understanding the liquid Valium titration way.  I would be doing pills and then liquid for titrating one ml per 20 days or per month. 

Thank you everyone !

[[...]]

 

1)  9: is what I used.  That is enough dilution that you shoul have no real problem making measurements to 3 decimal places (.001mg).  Many folks  prefer 99:1 because they seem to feel the "math" is easier.  But the only difference is wheher you move the decimal 1 place or 2 places.  Note that you don't measure out your "cut" you measure out your dose.  For example, starting from 9mg, I took 8mg tablets, then .975mg from liquid, .950mg from liquid, .925 liquid, etc, reducing by .025mg/day.

 

2) I failed 3 times to get from 9mg down to 8.5mg.  The first attempt was C&H with tablets, and the second 2 were water titration.  But diazepam is NOT water soluble.

 

builder, do you mean 9:1?

  Yes!

 

I fixed it.

 

Thanks

Builder, how do I measure out in three decimal points? Would I use a 10 ml syringe ?  I'm not quite sure about the measuring part - ( assuming I am prescribed a liquid Valium)

Thank you,

Jan

 

[[Ma...]]

 

Hi Maya,

Here's some information that I found helpful as it was explained to me by my doctor.

 

The liver has 2 detox phases - phase I (P450) and phase II (conjugation pathways)

My doctors felt it important to test both in that the first affects the second.

 

For testing the P450 pathways, there are many labs to choose from, I chose

1.  Www.Genelex.com.

I also tested phase II NAT2 liver pathway which directly affects klonopin.

Klonopin, after passing through phase I CYP enzymes, will be acetylated (biotransformed for elimination) via NAT2. This was an important piece of the puzzle for me, and a big part of why I struggled with klonopin.  I was a slow acetylator and could not remove K from my body resulting in neuro toxcicity.

http://www.ncbi.nlm.nih.gov/m/pubmed/12899737/

 

2. Www.23andme.com. This company will test many genetic polymorphisms including phase I and some phase II enzymes specific to conjugation of benzodiazepines.  In particular, the UGT1A1 28.  This information will show how your liver handles a specific conjugation called glucoronidation. All benzos are biotransformed for elimination via glucoronidation.

23andme will supply raw genetic information only. Once you receive the raw data, up load the information for interpretation to 1 of several sites that will interpret the results for you, they are:

A.  Www.livewello.com

B.  Www.mthfrsupport.com (called the Sterling Report)

 

3. Www.gdx.net  Called Genova labs. I used this lab to identify my nutritional status. This was important to help support phase I and phase II liver detoxification (for me, everyone is different)

http://www.bespokeclinic.ca/wp-content/uploads/2015/02/integrativefig_large3.jpg

 

There are many labs offering nutritional evaluations. Check what's available in your area.

 

Good luck, Maya and let me know if you need help uploading the raw data.

 

Marija

Marija,

Thank you so much! This is very helpful! I did the 23andme genetic test, but I won't the results back for at least a month and a half. I will speak with my drs about the other tests. I hope I can take them. I hope you are having a great day!

 

XO Maya