Tapering off Alprazolam

[[hd...]]

 

Jana,

 

My story with Benzos began last December. I have just come back from Europe to the USA and I got a sinus infection. My doctor prescribed an antibiotic (fluoroquinolones) that gave me some serious side effects including "anxiety" and "insomnia" among many others. The one that bothered me the most was anxiety to the point that I had to quit a job that I'd just started. I went back to the doctor and he gave me some samples of Niravam (Alprazolam) and told me that should take care of it. What he did not tell me is how dangerous and addictive these drugs are. Indeed, my anxiety went away while I was taking it. By the time I finished the samples, I had started a new job and my anxiety came back. I asked the doctor for another prescription and he gave me one but this time for Alprazolam tablets in 0.5 mg twice a day as needed. Again, he did not warned me or asked me to call him when it was time to get off them. I continue taking them for about two months then I started to feel OK and decided to quit on my own. At that time I did not know about benzos and potential dangerous withdrawal side effects. I did not go cold turkey because I felt I still needed some for my insomnia, so I decided to cut by 50% of my daily dosage. I started by splitting the tablets in two and taking one at noon ad one before bed (to help me sleep). Soon after I started to have some side effects, like pins and needles in head and lower legs, itchy skin, burning sensation in arms, lower legs, forearms and wrists, joint pain in my knees and elbows, muscle twitching, fasciculations, anxiety came back (one or two episodes a day), brain fog, confusion, short memory loss, etc. Then, I decided to cut back again and take the 0.25 mg at bed time and another dosage if I needed during the day. That did not last long because I had a hard time trying to go to sleep so I decided to take the whole 0.5 mg at bedtime. At that point I let my doctor know that I was trying to taper off but I was having side effects so he came up with a withdrawal plan. He suggested continuing with the 0.5 mg dose for another two weeks and then reducing it to 0.25 for a week, then 0.25 every other day, then 0.25 every two days, then 0.25 every three days and so on for a total of six weeks. I took some herbal teas like kava, passiflora to help with the side effects but I quit taking them after I learned about potential interactions. Before I started to reduce again from 0.5mg to 0.25mg I bought some supplements that I think have helped me. I have been taking L-Theanine as needed and Homeopathic sleep aid called Calm Forte. The withdrawal side effects have continued and maybe increased a little since I reduced the dosage to 0.25mg, especially when the effect of the medication is wearing off. My heart will start beating faster and the pain and burning sensations will hit me. It is then when I take the L-Theanine and that helps me calm down. I work from noon to midnight so I don't take my benzo dose until bedtime. I sleep well, thanks to the help of the other supplement. The other side effects are not that bad but they are annoying; the constant muscle twitching, and the electric shock like sensations in my lower legs, burning wrists, etc. I now know that these may be due to the reduction by 50% instead of a more gradual one at the beginning. So my concern is, how long are these side effects are going to last? Are they protracted or acute. Should I reinstate the dosage and start a gradual reduction or should I just continue with my tapering, considering that my withdrawal side effects are bearable? Is the plan that the doctor gave me a good plan or should I reduce more gradually? I forgot to mention that I am also on Norvasc for high blood pressure as a result of one of the other side effects for the antibiotic he prescribed at the beginning. I have also noticed that my side effects will flare up when I drink a couple of glasses of wine, which I have stopped since noticed it. I want to get off this medication ASAP; I want to be normal and healthy again. To be honest I don't want to go back to a stronger dosage (if that is the case) to get rid of the withdrawal side effects. But if I did, what are the guarantees that the side effects are going to go away? I know that there are many of you that have been on these poisonous medications for longer periods than I have. I can't just imagine what you have gone through.  I just don't want the side effects to get worse. Any advice will be greatly appreciated.

 

Sincerely,

 

hdanrod

 

P.S.  It is amazing what these drugs can do to you in so little time.

[[Co...]]

Hi hdanrod,

 

Welcome to BenzoBuddies. I'm afraid I have a bad head at the moment - it would help if you could list what you are taking at the moment, and at what dosages. Also, a brief timeline of what's been happening with your meds. I'm just finding it tough to do much reading - I think it will help other readers too, as there is lot of information in your introduction.

 

I understand your desire to quit as soon as possible, but you will benefit hugley by making a controlled withdrawal - we will help you.

[[Th...]]

Hi, hdanrod,

 

Welcome to BenzoBuddies! Luckily, my benzo fog is better today, so I'll try to make a summary for Colin.

 

Colin, in a nutshell, hdanrod was prescribed Xanax (Niravam--appears to be an orally dissolving version) after he had severe anxiety and insomnia after taking fluroquinolones. He took 1 mg Xanax daily for about two months, then decided to try to get off. He cut to half his dose and experienced the whole list of w/d symptoms: anxiety attacks, twitching, burning skin, pain, electric shock feelings, etc. He went back to his doctor, who suggested he stay at the reduced dose (.5 mg) for two weeks, then cut to .25 for one week, then start going every other day, etc. He is now down to .25 mg a day, and the symptoms are increasing if anything, especially as the med wears off. He's on Norvasc for high blood pressure, also a result of the fluoroquinolones. He is sleeping well (he takes Calms Forte for sleep), and he says the symptoms he has are annoying but not bad.

 

hdanrod, you are right that your symptoms are caused by too great a reduction in dose. Xanax is a very potent benzo, and your cuts have been very large. I do not think your doctor's taper plan is a good one, as it is very fast and also requires skipping days between doses at the end, which makes it impossible to maintain a steady supply of the drug in your bloodstream.

 

Unfortunately, there's no way to tell how long your symptoms will last. They may go away in a couple of weeks, or they may hang around for months. Withdrawing from benzos can be very unpredictable.

 

If I were you, I would try for a slower taper. Do you think your doctor will cooperate? Since you describe your symptoms as more annoying than distressing, I would perhaps go back one step and stay at the .5 mg daily for a while, until you feel your symptoms start to subside somewhat. Then I would proceed with a slower taper than the doctor recommended.

 

Part of your problem is that you are having what we call "interdose withdrawals." The half-life of Xanax is very short, so it doesn't stay in the body long. We find that people on short-acting benzos do better if they divide their daily dose into three parts over the day. To do that, you could crush your daily dose in, say, 6 tablespoons of full-fat homogenized milk and then divide that into three doses of 2 tablespoons each, to be taken 8 hours apart. You could put one of the doses in a bottle and take it with you to work. Benzos are fat soluble, which is why we recommend using milk as a base.

 

Another crude method would be to crush the tablet alone and then divide the powder into little piles. You could add lactose to the powder to give you more bulk and enable for more accurate division.

 

Another alternative, if your doctor is willing, is to switch you to an equivalent dose of Valium, which has a much-longer half-life than Xanax. Valium also comes in a ready-made liquid form, so you can make any size cuts you want. Xanax is 20 times as potent as Valium, so that needs to be kept in mind when prescribing the equivalent dose.

 

Quite a few of us here use Calms Forte, and I'm glad you're getting some relief with the theanine. I think you are right to stay away from the kava and passionflower. It's imperative to stay away from alcohol, because alcohol works on the same receptors as benzos--so it's like taking extra benzo. It will really mess up your taper.

 

Let's see what Colin has to say. He's much more experienced at this than I.

 

Therese

[[hd...]]

Therese,

 

Sorry for the late respose, my internet was down all day yesterday.  Let me see if I understand you correctly or maybe Collin can help. Should I go back to my original dose or just to the 0.5mg?  Because I was still experiencing w/d symptoms at 0.5mg and my original dose was 1.0 mg twice a day.  What would be a better choice for you, going back to the original dose and do a slow taper or switching to Valium?  Can a compound pharmacy prepare all these cuts for you?  I'm going to try to talk to my doctor, he has not been very helpful all this time.

 

Hector

[[hd...]]

Collin,

 

Any comments?

 

hdanrod

[[Co...]]

Hi,

 

I think you might benefit from going back to your last stable dose - would that be 1mg/day? However, although you have been feeling poorly since then, you will have been adjusting, and you could well find that the dose you need to feel stable is less than that. If you are on 0.25mg/day, you might try 0.5mg (0.25mg twice a day) and see if that does the trick. Once you have stabilised, you can then make a slow withdrawal, either by titrating your benzo (making it into a liquid), or maybe substitution for Valium.

 

A compounding pharmacy can certainly make these doses up for you - it could work out to be fairly expensive though. I am unsure of the costs. If the benzo comes in a liquid forum, this will allow you to make small adjustments between the the different prescriptions. It is important to have your doctor on board as they will be writing the prescriptions.

[[hd...]]

 

Hi Collin,

 

Thanks for your response.  I can always try to go back to 0.5 mg (0.25 mg twice a day).  My original prescription was 1.0 mg on 0.5mg pills twice a day.  I did this for about 1 1/2 month then I cut to 0.5 mg on 0.25 mg twice a day ( did not do this for very long) and then I decided to take the whole 0.5mg at night to help me sleep.  Maybe you are right, because I don't recall having side effects when I was on 0.25 mg twice a day.  How long should I take this dose back before estabilizing? And if the w/d symptoms don't go away should I go back to the original 1 mg twice a day?  My w/d symptoms are not that bad, they start late in the evening like 4hrs before my next dose.  Someone else adviced me (since the symptoms are bearable) to continue with the 0.25 mg of benzo for another week and then slowly transition to the equivalent of Valium and then start a slow withdrawal of 0.5mg o Valium every 7-10 days:

 

Week 1

0.125mgs xanax , 2.5mgs valium PM

 

Week 2

5mgs valium

You can then reduce your dosage by 0.5mgs valium each week or so. 0.5mgs is equal to a quarter of a 2mg tablet[/color]

 

What do you think about this? 

 

This is also the first time I heard the word tritation, how do I make the benzos into liquid?  And how do you measure it once it is in a liquid form?

 

Thanks,

 

hdanrod

[[bo...]]

Hi Hdan:

 

 

This is only my personnel experience, I too averaged 1 mg Xanax for 6 weeks, not as orderly as you as I took varying doses from .5 to 1.5 on any  given day. I tried to mix the 2 benzos and it didn't work for me,. because of the different half life's. I went straight to Valium at a lower dose than reccommended, but higher than your indicating you would start at. for me it was 12 mg Valium split into 2 doses till I felt fairly normal not long, then I started to taper fairly rapidly dropping from 12 to 5 mgs in 52 days. only taking it a night. hit a bit of a wall and have slowed down to dropping a .5 every 7 days.

 

Unfortunately my experience may or may not be yours as I understand it, it could be better slower or faster depending on your response to tapering. Again this is just my personal experience nothing written in stone.

 

Bobers

 

 

[[Co...]]

Most people benefit from a transition to Valium - I would not recommend that you do it all in one go. I'll discuss this more later. I have other work to do right now. I only popped in for a moment.

 

IF you feel things are improving, then you could try staying at the dose you are on for longer. If they have not been improving, then it would be better to reverse that last cut sooner rather than later.

 

 

[[Th...]]

Hector,

 

It looks like the schedule you got from the other place includes a crossover period--one week on a combo of Xanax and Valium, and the next week on the entire Valium dose. Then you start cutting. This transition period is a good idea. I think Bobers is an exception that he wasn't able to tolerate the two half-lives and switched directly to Valium.

 

When we talk about stabilizing, we mean that your symptoms are bearable and are not getting worse. So the goal is not to take enough benzo so that the symptoms *go away*. The goal is to be on enough benzo that you feel functional and like you can handle the withdrawal. The only people who can go through a taper symptom-free are those people who are not dependent at all. The rest of us get symptoms. The idea of a taper is to keep the symptoms to a minimum.

 

The taper plan you were given is not bad, though it is on the fast side. Maybe you can handle it; there's no way to know at this point since you are so early in your taper. Things normally become more difficult as you get nearer the end.

 

How are you feeling on this latest cut (to .25 mg)? Are things getting better, or are you feeling worse?

[[hd...]]

 

Hi Therese,

 

My symptoms on the transition from 0.5 mg to 0.25 are basically the same.  They have not gotten worse or better, some days I'm symptom free and some others I get them but not too bad.  What does that mean?  Does it mean that I'm doing OK?  I try to stay at least two weeks on a specific dose to estabilized.  I have until next Monday to start another reduction. What worries me the most is the insomnia.  I'm sleeping good thanks to Calms Forte.  I called my doctor yesterday to ask for some valium and he wants to see me.  He may not want to give me the valium.  Therese, what if I decided to tough if out and finish with Alprazalom but with smaller reductions from now on, like 10% every 7-10 days?  I can take the drugs to a compounding pharmacy and have them prepare them for me, or do you have another suggestion?

 

Thanks,

 

Hector

[[Co...]]

Hi Hector,

 

You will need a prescription to have your meds compounded. If you get them in liquid form, you could even make small reductions yourself between new prescriptions.

 

You are unlikely to feel completely normal during withdrawal - some discomfort can be expected. If the cuts are making you feel really ill, then you are tapering off too quickly. By all means push a little, but don't make yourself ill, as you are far more likely to fail to complete your withdrawal, or alternatively you could end up feeling dreadful for a long time afterwards.

[[Th...]]

Hector,

 

It sounds like all things considered, you're doing pretty well, especially if some days you are symptom free. People who taper too quickly off of benzos feel like they're in hell, and I'm not exaggerating. They sometimes don't sleep for days, and many experience anxiety that they never thought possible. And this is 24 hours  a day, with no symptom-free days. It sounds like you are not in this category.

 

If you cannot get the Valium, I do think you would be all right trying to finish your taper with the alprazolam, making small cuts.

 

As Colin pointed out, your doctor needs to write a prescription to get a liquid solution made. Maybe you could tell your doctor that you are experiencing a lot of symptoms before it's time to take your next dose, so you need to cut your daily dose in two. That's becoming more difficult the further down you get. A liquid would make that easier. It would also be a way to get around taking the last doses every other day, every third day, etc., which your doctor wanted for the end of the taper, because you can just tailor-make your dose.

 

If you can't get a liquid or get the Valium, Colin and I are working on some numbers to make a milk solution from any benzo. But it does involve some work. You will need a measuring cup with ml markings on the side, plus a syringe from the pharmacy. Getting something compounded from the pharmacy would be much easier.

[[hd...]]

 

Thanks you guys.  My heart goes out to all of you that have suffered more than I have.  I can just imagine what you have gone through. I made an appointment to see my doctor on Tuesday.  I found a lot of relief and help on L-Thianine and Calms Forte.  I sleep pretty well considering thanks to Calms Forte. But the tingling, burning and electric shock sensations in my lower legs and arms are annoying and I don't want them to get worse. I get through the day OK.  I also tried to walk for about 45 minutes every day and that seems to help.  I would really be very interested in your milk formula if the doctor don't want to cooperate.  I have plenty of pills that I can crush and mix.  Now, if that's the case would you recommend to split the daily dose (mixed with milk) in 3 times daily just like you suggested before? Or should I continue just taking one at bed time?  How is the liquid formula prepare? Have any of you ever had it? Thanks a lot for your prompt responses and support.  I feel a lot better and full of hope every time I read your replies.

[[Th...]]

We're still working on the milk formula, but we hope to have it ready soon. In any case, your last cut was still quite recent, so we wouldn't have you start titrating for a while yet anyway.

 

If you do the titration, yes, we would recommend splitting the daily dose into at least two parts, possibly three. You could try two and see if you can get away with it. If you find increased symptoms a few hours before it's time to take your next dose, then that's a sign you need to take the drug more frequently.

 

The milk formula would be prepared just with regular homogenized milk. You dissolve the pills in milk at a particular solution, say, 1 mg drug to 1 ml milk. You would need a measuring cup with ml's marked, and you would need a syringe from the pharmacist (to measure small amounts of the solution). That's just kind of an overview.

 

I've never titrated myself, and I don't think Colin has either. But one of our former moderators did--in fact, it was the only way she could make a cut. If I could not have gotten the Valium for myself (I was on Klonopin), I would have had to make some form of liquid solution, because the quarter-tablet cuts were too big for me to handle, and you just can't cut the tablets any smaller. So you have to be creative in ways to figure out how to make smaller cuts.

 

I'm glad you feel hopeful! I know how horrible things can look in the beginning. But with proper planning, you can be free of benzos. It's still difficult--but very worthwhile. I still have bad days, but my good days are much more numerous than the bad days. When I started, it was just the opposite--I would hope for just one good day, just one.

[[hd...]]

Therese,

 

I will let yo know tomorrow how it goes with my doctor.  It does not sound like you were on benzos for a long time. Was your taper bad? Were you able to get any sleep during your withdrawal?  That's what worry me the most, not being able to sleep.  I can put up with the physical symptoms and with the few anxiety episodes. How long do you recommend to stay in any particular cut?

[[hd...]]

Therese,

 

You have adviced this to me a few posts before:

 

We find that people on short-acting benzos do better if they divide their daily dose into three parts over the day. To do that, you could crush your daily dose in, say, 6 tablespoons of full-fat homogenized milk and then divide that into three doses of 2 tablespoons each, to be taken 8 hours apart.

 

Can I do this with 8 tablespoons instead of 6? And then do a teaspoon reduction at a time?  That will be at least 1/8 cut of the medication, right?  Does't milk go bad during the course of the day or do you keep it refrigerated?  I'm thinking I will take this road instead of switching to liquid or Valium, I will still see my dcotor today though.

 

Thanks,

 

Hdan

[[Th...]]

Do you mean cutting by 1 tablespoon, not 1 teaspoon? I'm assuming you meant tablespoon, since you were talking about cutting 1/8 of the dose after making a benzo solution of 8 tablespoons.

 

I think that cut is too large, to be honest. If you're on .25 mg of Xanax, that would be a cut of .03 mg (.25 / 8 = .03), or the equivalent of .6 mg Valium. That's a big cut for someone tapering a benzo at the lower doses.

 

How about cutting 1 teaspoon instead? That would be only .01 mg of Xanax, or the equivalent of .2 mg Valium.

 

It's best to start out small because you can always increase the frequency of the cuts if things go well. But if you make too large a cut, you can really suffer for it. That's why we recommend small, frequent cuts instead of large, infrequent cuts.

 

Yes, you'll need to keep your milk solution refrigerated, since milk is perishable. And make sure you use homogenized, full-fat milk. Skim will not work.

 

As far as frequency of cuts, it's really up to you, how you feel. With Xanax, you should be able to feel the cut relatively quickly. If you want, you can start with making the teaspoon (not tablespoon) cuts every week and see how it goes. If symptoms start to increase, you can just hold at one dose until you feel ready to continue. If you feel great, you can try making cuts sooner than 1 week.

 

By the time I finish my taper, I will have been on benzos for almost two years exactly. I had one botched taper, where I tapered too quickly. That lasted two months. During that time, unless I took melatonin, I could not sleep and would just lie awake in bed all night. I felt like I had just drunk an entire pot of coffee, I was that wired. My current taper is much better, thanks to internet support groups like BenzoBuddies! The beginning was rough, but once I started cutting at a slower rate to allow my body the time it needed to heal, I did much better. So it's really an individual thing as to how much you want to cut.

 

Don't worry too much about the insomnia. People around here take all kinds of things to help them sleep, so we have options. And if you taper slowly enough, you can keep all that stuff at a manageable level.

 

Therese

 

 

[[hd...]]

Yes,  that's what I meant.  One teaspoon at a time.  If I mix the .25 mg in 8 tablespoons that will be the equivalent to 16 teaspoons, right?  In that case I meant to say a cut of 1/16 every week.  That will be 4 months of tapering.  Or you think that 8 teaspoons is too much milk?

[[Co...]]

Maybe it's not the same here in the UK (maybe we use different names, or different volumes), but here 2 teaspoons=1 desertspoon. 3 teaspoons=1 tablespoon. So, 8 tablespoons = 24 teaspoons!

[[Th...]]

In the US, it's the same as the UK: 3 teaspoons = 1 tablespoon. But I've never heard of a desertspoon!

 

So I was envisioning you dissolving the .25 mg Xanax in 24 teaspoons of milk, then cutting 1 teaspoon of that, so you would be cutting 1/24 of your solution instead of 1/16.

 

Yes, I suppose the 8 tablespoons is quite a lot of milk. I will admit that I have not made a milk solution myself yet. I did try to dissolve a Klonopin and a Valium tablet tonight. It didn't require much milk. I just put the tablet in a little 1/2 C. Tupperware container, then added a bit of milk, just enough to almost cover the tablet. Then I let it sit for about ten minutes, at which point it was quite soft. I then crushed the tablet against the side of the Tupperware with the back of a spoon. It seemed to mash up pretty nicely.

 

But...I'm thinking that this will be more accurate if you dissolve an entire tablet in milk rather than a quartered tablet (you have .5 mg Xanax tabs, right?). If you start with dissolving a cut tablet, you're already a little "off" in dose because the tablets never cut exactly the same way twice. Sorry, if I didn't have a benzo brain I might have thought of this before...

 

Maybe you would like to dissolve a .5 mg pill in 1/4 C. milk. Then divide that into two parts (2 tablespoons each) to get your daily dose of .25 mg. Then you can throw out your cut for the day. If you throw out 1/4 teaspoon from each .25 dose, that would be a cut of 1/24 of your dose (a pretty small cut). If you throw out 1/2 teaspoon from each .25 dose, that would be a cut of 1/12 (a little on the big side). Unfortunately, you are kind of limited with how much you can cut if you are using measuring utensils rather than a syringe. You could try making the smaller cuts and doing them more frequently.

 

After you make the cut by throwing out some of the liquid, you could divide your dose into two roughly equal parts so that you don't get the interdose withdrawals during the day.

 

Does this make any sense? I feel like I'm being confusing. 

[[Co...]]

Yes, working from the whole tablet is far more accurate. Also, once you reach the stage of disposing of half (or more) of the titrated pill, you could instead keep the part that you would normally throw away, and use it for the next day instead! Useful if money is particularly tight.

[[hd...]]

 

Got it!!  I have 0.25 mg Alprazolam pills, so I think dissolving the whole tablet will be better also. A little confusing but makes sense. What's the equivalent in mgs to Valium?

[[Th...]]

A dose of 0.25 mg alprazolam is equivalent to 5 mg Valium.

 

I've been playing around a little bit with dissolving tablets in milk. I've found that it works just as well, maybe better, to crush the tablet (dry, no milk) against the side of the container with a spoon. I did this the other night. I crushed it very fine, then I added the milk.

 

Glad you could follow! And good thing you have .25 mg pills. That makes things easier too.

[[hd...]]

Hi Therese, Collin:

 

Sorry I did not answer earlier but I was away for a few days.  It's been a while since my last post but here is the latest.  I did not go to see my physician that originally prescribe the benzos because he was not cooperating. Instead I switched to another that my cardiologist recommended.  He was more understanding about the way I want to taper off, but he gave me another plan.  I told him that I have found a compounding pharmacy that was willing to make smaller cuts for me.  The plan that he and the compounding pharmacy agreed on was to taper off 0.05mg every two weeks.  This is the equivalent to 1mg of valium if I'm not mistaken.  The pharmacy prepared two months 0.05mg (1/5) Alprazolam capsules which I have in my posession. What should I do?  I know for what you have told me that these are pretty big cuts but that's why he wants me to be 2 weeks on each dose. I have not started because I wanted your advice first.  The other way would be to open one capsule and discard half and that would mean that I would be making 1/10 cuts, correct?  I also wanted to tell you that in the last few days my sysmptoms have increase in intensity but not too bad (still bearable).  More and stronger pins and needles sensations in arms,lower legs, and the palms of my hands. My left lower leg hurts and goes numb specially late at night.  Also pressure and pins and needles sensations on the top of my head and I'm not sleeping as well as I was a week ago. I wake up early and I take a couple of Calms Forte to go back to sleep.  I just want to get it over with.  I was planning to start tonight but I will wait until I hear from you guys.  I hope everything is OK with you.

 

Cheers,

 

hdanrod