Evolution of Serum Levels During Steady Valium or Librium Treatment

[[br...]]

Hi,

 

I shortened the thread title to make it easily readable but the correct title should read Longitudinal Assessment of Serum Levels of the Active Metabolite of Valium and Librium. It applies to both Valium and Librium since both drugs have the same active metabolite.

 

Furthermore it is not expressed in serum levels per se put as the *one time dose* that would be required to reach an equivalent serum level (what I called a One Time Dose Equivalent in the charts or OTDE).  Please, bear with me!

 

It started as a little Excel project to occupy myself for a couple minutes but was scaled up a bit and I thought that some of you might be interested in the results too.

 

According to Pr. Ashton the half-life of the active metabolite of Valium and Librium has a range going from 36 hours to 200 hours (this is a *huge* discrepancy and it impacts *considerably* the serum level of the active metabolite). That's why I decided to go with three hypothesis as far as half-life goes:

 

[*]36 hours

[*]100 hours; call it the average half-life if you will

[*]200 hours

 

I also went for three case scenarios which I thought would be representative of their treatment for quite a few Benzo Buddies:

 

[*]induction of 6 mg per day (this would be 2 mg three times a day -> see following post

[*]induction of 15 mg per day (5 mg three times a day) -> see third post

[*]taper plan from 10 mg and cutting 2 mg every two weeks -> see fourth post

 

I was quite shocked to see that the OTDE could be as high as 100+ mg depending on what the half-life of the drug is for you. It says a lot about benzo tolerance too : if you were to receive a 100 mg dose of diazepam as a first time user it would break your leg and put you in a comatose state in a matter of minutes. 

 

I am sorry if this had already been done, but I UTFSE and came empty-handed...

 

Just FYI the formula used in Excel is: =TD - PD*((1-24/HL)/2) where TD is Today's dose, PD is the OTDE (One Time Dose Equivalent) the day before today (d-1) and HL the half-life.

 

You might want to look into that formula as I am not 100% sure it is correct. However the OTDE scores look okay across the charts and I don't think the results are too far off the mark.

[[br...]]

Treatment: 6 mg per day. Starting at day 1, day of treatment induction.

 

First scenario: half-life of the active metabolite = 36 hours

 

 

Second scenario: half-life = 100 hours

 

 

Third scenario: half-life = 200 hours

 

 

Wow! If the half-life is 200 hours, after 60 days of 6 mg per day you have the same serum levels as if you had a one time dose of almost 100 mg! 

[[br...]]

On to a regimen of 15 mg Valium/Librum per day. Day 1 = Treatment induction

 

First scenario: half-life = 36 hours

 

 

 

Second scenario: half-life = 100 hours

 

 

 

Third scenario: half-life = 200 hours

 

 

Which means that after 60 days, you get the same serum levels that a one time dose of almost 250 mg would give you. Crazy tolerance, yet again.

[[br...]]

Now the more interesting stuff for most of us: what about the serum levels during a taper plan compared to what a one time dose would give you.

 

Again, the scenario goes like this:

 

• You have been on a 10 mg regimen for a long time (more than 3 months): that means that with the hypothesis of an half-life of 100 hours, you have a serum level that compares with the serum level of a one-time dose of 83 mg
  
• You start the taper plan at day 0 and decrement by 2 mg every every 14 days
  

 

If my formula is correct this should be your serum levels across the taper plan:

 

 

So this was my contribution to the BB "cult"...  I mean the Benzo Buddies community. I hope that the formula is correct (plus minus delta) otherwise the whole thread will have no purpose. 

 

Thanks for having "borne" with me that far and please comment!

 

[[li...]]

I didn't do the math. Presumably you are referring to desmethyldiazepam.

Personally, I'm inclined to assume a 50-100 hours half life. That 200 hours is excessive.

 

I wonder if that 200 hours includes the half life of diazepam plus its metabolite ?

 

I know that the levels of desmethyldiazepam can build up a lot. Messy drug, diazepam.

[[li...]]

This is part of why I hate diazepam. It cannot be adjusted, once in the body the accumulated load will do its thing.

 

I need a 'detox drug'. Can't taper clonazepam ('regular') I could do pheno, but I would have to do it on my own since noone here knows how to handle it.

 

I don't mean to whine, but if anyone knows ... Sorry about hijacking this thread a bit.

[[br...]]

This is part of why I hate diazepam. It cannot be adjusted, once in the body the accumulated load will do its thing.

 

I need a 'detox drug'. Can't taper clonazepam ('regular') I could do pheno, but I would have to do it on my own since noone here knows how to handle it.

 

I don't mean to whine, but if anyone knows ... Sorry about hijacking this thread a bit.

 

I don't think you're hijacking the thread. Barbs would be hard core on an outpatient basis and I don't think you'll find a GP or a psychiatrist handing out a prescription for barbs to toy around with at home: that'd be a recipe for disaster. 

 

Have you explored the flumazenil avenue? It's now a staple treatment of benzo withdrawal in Italy for patients who have failed to follow through with the protracted benzo taper plans. My understanding is that it occupies the GABA receptors as a competitive partial antagonist. But then again it needs to be closely monitored in a clinical setting for acute benzo withdrawal (and seizures!) and is only offered on an inpatient basis.

 

In a nutshell flumazenil is to benzos dependency what buprenorphine is to opiates dependency.

[[br...]]

I didn't do the math. Presumably you are referring to desmethyldiazepam.

Personally, I'm inclined to assume a 50-100 hours half life. That 200 hours is excessive.

 

I wonder if that 200 hours includes the half life of diazepam plus its metabolite ?

 

I know that the levels of desmethyldiazepam can build up a lot. Messy drug, diazepam.

 

Yep, likely desmethyldiazepam but it was only based on Pr. Ashton benzo equivalence table, i.e. "active metabolite" of both Valium and Librium.

[[li...]]

Flumazenil wouldn't work for me ... I already explored that option.

[[Ta...]]

What an amazing clever calculation.

 

I myself has spent time thinking the about the issue: are my halftime 36 or 200 hrs.

 

One main reason for taping is the fact that I cannot drive a car until I am under a VERY low blood concentration.

 

My old doctor just said it was noooo problem. Is I was stopped he could tell the police that I am fully able to operate a car even with a dose of 20-30 mg diazapam pr day.

 

But its not true. No user of diazapam are allowed to drive a car. Very smaal doses of Oxapax MAY be tolerated - but if you end up in an accident your can be held responible - insurance will be canceled and you can be ruined for lifetime. Thats how it works in Denmark..

 

So your calculation tells me that when I am currently taking 7,5 mg pr day - It will take me LONG time before I am "clear" to legally drive a car.

 

My wife and I loves going on trips in our motorhome. But since I found out that I am not able to drive - out numbers of trips has fallen a lot because she must do all driving.

 

I have earlier made some "drawings" for my new doctor because I knew those diazapam pills was stocking up in layers. It was far from your very accurate calculations...

 

THANK YOU for doing tihs. My doctor is very interested in what I tell about Benzo-Buddies. Your calculatiok will amaze him even more.

 

If a warning label on the pill-glass has said: WARNING - Take one pill a day for one week, and you cannot drive a car for 90 days. If I knew that 10'years ago, I would NEVER ever have touched those damm pills.

 

Using benzodiazapines is simply not for normal people - not even most doctors to controle.

 

Only psyciatric SPECIALISTS with a "benzo-education" shoud be allowed to give those pills. And should only be given under very special circulstances.

 

YES I knew that valium pr diazapam wasent free of dangers. I knew that it was very easy getting hooked. But NO ONE ever told me how long those pills worls. And again I would never take them iif I knew.

 

So for the first time I do feel that medical-industry carry a whole lot of responsebillity for not telling that my tolerance may very quick be 100 mg. I am sure they knew - I just wasent told.