At .5mg and starting to struggle. Is taper too fast?

[[Sh...]]

I've tapered from 20mg to .5 mg in 18 months and switched to a liquid taper 6 months ago at 4mg. My incremental taper is currently 1ml a day which equates to a 1mg reduction over 100 days. So,at this rate 50 days to go. I have been struggling lately but am reluctant to reduce my taper rate because I want to get this done. My question is whether 1ml a day is a reasonable rate to taper from .5 mg to 0.  It would seem that my current  dose is so low that this taper rate should be ok to complete withdrawal. On the other hand it is higher that the 10% reduction Ashton recommends. Will appreciate any advice

[Guest [ba...]]

First - a big congratulations for getting as far as you've gotten.    :thumbsup:

 

The end of a taper can often be more problematic.  If you stick with 10% cuts, you'll never make it to zero.  If you go with a linear taper, the cuts get bigger and bigger (from a percent basis), and you might start feeling those cuts a lot more.

 

As long as you feel up to it, then go ahead with your linear taper.  However, you shouldn't get too goal oriented.  If symptoms start to get nasty, hold for a day or two.  No harm in extending your taper a few more days (or weeks).

 

A alternative approach is to average a linear taper rate with a 1st order (percentage-based) taper rate to give a hybrid taper rate.  It's slower than the linear taper, but faster than the 1st order taper.  You can even weight the two models differently as I have shown here with 1:1 and 4:1 hybrid models.

 

1st Order Linear 1:1 Hyb 4:1 Hyb

------- ------- ------- -------

0.500 0.500 0.500 0.500

0.450 0.450 0.450 0.450

0.405 0.400 0.403 0.404

0.365 0.350 0.357 0.362

0.328 0.300 0.314 0.322

0.295 0.250 0.273 0.286

0.266 0.200 0.233 0.253

0.239 0.150 0.195 0.221

0.215 0.100 0.158 0.192

0.194 0.050 0.122 0.165

0.174 0.000 0.087 0.139

0.157         0.053 0.116

0.141         0.021 0.093

0.127         0.000 0.072

0.114                 0.052

0.103                 0.032

0.093                 0.014

0.083                 0.000

0.075

0.068

0.061

0.055

0.049

 

Good luck!

[[Sh...]]

Thanks badsocref, I appreciate the time you took to respond.  I think I understand the hybrid idea i.e. straight average vs a weighted average, but I'm having trouble translating this to a liquid titration.  Is your schedule a weekly reduction or some other time period? I now reduce 1 ml a night. Thanks so much for your help. I wouldn't be where I am in term of titration without BB.

[[go...]]

I want to understand your taper plan but am clueless how this works. Thanks!

[Guest [ba...]]

I've posted on this before, but have no idea where.  Basically, with the standard Ashton-type taper, you reduce your med by a certain percentage.  If you take 1 mg today and want to cut 10%, you take 0.9 mg.  If you want to cut 10% again, you'd take 0.81 mg.  Further cuts would be 0.729, 0.656, 0.590, and so on.  Mathematically, this is a first order elimination model.  Doing a taper like this, one never reaches zero.  The cuts become smaller and smaller on a mass (weight) basis.  Eventually, one has to jump off the med, and that can be pretty abrupt/harsh.

 

Some people elect to do a linear taper.  They cut by the same mass (weight) each time.  For example, if you take 1 mg today, you might cut to 0.9 mg.  Next cut would be 0.8, then 0.7, then 0.6 and so on.  Ten cuts and you're at zero, but the percentage cut you make each time increases which can make each subsequent cut more difficult.

 

Each method has its advantages and disadvantages, so one can take advantage of the strengths of each by doing a compromise (average) between the two.  I call that a hybrid taper for lack of a better term.  There are lots of ways to do it.  The most simple would be to simply average the two methods.  Again if we start at 1 and do 'similar' cuts, they'd look like 0.9, 0.805, 0.714, 0.628 and so on.  14 steps to zero so a little slower than linear, but you get to zero without a big jump.  Here's a few graphs showing the respective taper dose curves for the various approaches.

 

http://enchantedskies.net/Three_Tapers.jpg

 

The hybrid rate can be further adjusted by weighting the two methods (linear and first order) differently.  For example, we can modify the taper curve by weighting the first order elimination more heavily.  The graph below shows the effect of weighting the first order elimination at 80% and the linear elimination at 20%

 

http://enchantedskies.net/Three_TapersB.jpg

 

This gives a curve more similar to the first order elimination, but it does reach zero without a jump.

 

If you haven't figured it out yet, I'm a bit of a chemistry/math nerd (It's Dr. Badsocref, fwiw).  If you're as benzo-brained as I was during my recovery, this may all seem way confusing.  I didn't come up with any of these ideas until I was healed.  i'm happy to prepare a few hybrid models for you to look at for your particular situation.  Then you can decide which approach might work for you.

[[Sh...]]

Thank you Dr. badsocref. You are indeed a chemistry/math nerd. I follow the concept but cannot seem to apply it to my situation except in a general fashion. I believe that I am doing a "fixed amount" reduction which is periodically adjusted downward to a smaller fixed amount reduction.  After converting 1mg of Diazapam to 100 milliliters of liquid, I reduce 1 milliliter each night. I've done this reduction for the past 6 weeks. So tonight I will take 47ml and tomorrow night my dose will be 46 ml and so on. I am managing, but not well some days and will start reducing by .75 ml each night.  Sunday night my dose will be 45.25ml. This is the lazy way of titrating but it has worked for me - for the most part.  I am at a pretty low dose and this may not be the best way of doing it although if I use comfort as my guide it will probably keep me going for a while.  Any additional guidance will be appreciated.

[Guest [ba...]]

Thank you Dr. badsocref. You are indeed a chemistry/math nerd. I follow the concept but cannot seem to apply it to my situation except in a general fashion. I believe that I am doing a "fixed amount" reduction which is periodically adjusted downward to a smaller fixed amount reduction.  After converting 1mg of Diazapam to 100 milliliters of liquid, I reduce 1 milliliter each night. I've done this reduction for the past 6 weeks. So tonight I will take 47ml and tomorrow night my dose will be 46 ml and so on. I am managing, but not well some days and will start reducing by .75 ml each night.  Sunday night my dose will be 45.25ml. This is the lazy way of titrating but it has worked for me - for the most part.  I am at a pretty low dose and this may not be the best way of doing it although if I use comfort as my guide it will probably keep me going for a while.  Any additional guidance will be appreciated.

 

I'd say that what you're doing is perfect.  You've got a plan.  You're pushing yourself a little, but adjusting as necessary.  I wouldn't change a thing. 

 

These purely mathematical guides are easy to make, but they cannot possibly take into account the complexity of life or of each individual's unique physiology.  Keep doing what you're doing.

[[go...]]

I have tapered from .75 xanax to .31 as of today. Began on October 8....would love a breakdown on where to go from here. I have been doing a taper that has me slowly introducing the new cut over 2 weeks. First cut is lower then I return to the prior level for 2 days, repeat once more than go to an every other day pattern for a week, then drop for good for about 10 days. If I were to go with your design, how would that look. My taper has been hellish. I am dry cutting.

 

 

[Guest [ba...]]

I have tapered from .75 xanax to .31 as of today. Began on October 8....would love a breakdown on where to go from here. I have been doing a taper that has me slowly introducing the new cut over 2 weeks. First cut is lower then I return to the prior level for 2 days, repeat once more than go to an every other day pattern for a week, then drop for good for about 10 days. If I were to go with your design, how would that look. My taper has been hellish. I am dry cutting.

 

Send me a PM with details including dates and amounts taken.  Might take me a couple of days to put this together - I have visitors in town.

[[Sh...]]

Thanks Dr. b.

[[...]]

I understand the hybrid except for how you calculated the hybrid amounts after the linear was zero.  It's no longer the "average", right....b/c the average would be simply half the exponential (1st order)?  Can you explain those values please?  Thanks!

[[Ch...]]

Answering your PM here.

 

At the end of my taper (.25mg) I was taking .0625mg four times a day.  Every week or so I dropped a dose, though I dropped the last few doses days apart with no backlash.

 

I was dosing 6 hours apart (roughly), and went to 8 hours apart, then 12 hours apart as the doses dropped.

 

Hope that helps!

 

[[go...]]

I am on once a day...so I cannot drop by your method. Thanks for the reply..maybe others will chime in and I can see how they did it.

[[Sh...]]

Goingtobedone, I'm no expert, but I can tell you that a daily liquid micro-taper is much more gentle than any kind of cutting.  I started with the Ashton 10% cut every two weeks.  It was too much,  so I stayed with the two week interval but reduced my cut % to .075 each interval. At about 4.5mg (down from 20mg) I started the liquid taper. It was intimidating at first, but now it's easy to make a 3 or 4 day batch at a time. For me the liquid is no walk in the park, but I can live a pretty normal life even though sometimes I have to push through.  I do take trazadone for sleep and still wake up in the middle of the night with heart palpitations.  Like you, I'm goingtobedine.

[[bu...]]

Goingtobedone, I'm no expert, but I can tell you that a daily liquid micro-taper is much more gentle than any kind of cutting.  I started with the Ashton 10% cut every two weeks.  It was too much,  so I stayed with the two week interval but reduced my cut % to .075 each interval. At about 4.5mg (down from 20mg) I started the liquid taper. It was intimidating at first, but now it's easy to make a 3 or 4 day batch at a time. For me the liquid is no walk in the park, but I can live a pretty normal life even though sometimes I have to push through.  I do take trazadone for sleep and still wake up in the middle of the night with heart palpitations.  Like you, I'm goingtobedine.

 

:thumbsup:

[[go...]]

I read somewhere that it is very difficult to microtaper Xanax. I have studied Challis's blog and she seems to have been quite successful without using a liquid. I am planning on going to .18 to .125 to .0625 then off. If it is possible, can someone explain in detail how it is done.

[[bu...]]

I read somewhere that it is very difficult to microtaper Xanax. I have studied Challis's blog and she seems to have been quite successful without using a liquid. I am planning on going to .18 to .125 to .0625 then off. If it is possible, can someone explain in detail how it is done.

 

Almost all statements that begin with "I read..." are false.  This one is false.

 

Ask your doc to give you a scrip for Alprozalam Intensol liquid.  This is a 1mg=1ml Rx solution, and can be diluted 9:1 (1mg=10ml) or even 99:1 (1mg=100ml) for a very easy microtaper.

[Guest [ba...]]

I understand the hybrid except for how you calculated the hybrid amounts after the linear was zero.  It's no longer the "average", right....b/c the average would be simply half the exponential (1st order)?  Can you explain those values please?  Thanks!

 

You have to allow the linear taper to continue into negative numbers and use those numbers to average against the first order value.  If you hold the linear at zero, the hybrid flattens out a lot, and will never reach zero.

[[...]]

Thanks badsocref. Now I get it.

The hard part is not the math but finding a "schedule" that works...