24mg V across two daily dosings, How to start LMT? @builder and others

March 15, 2017

My current schedule is:

14mg V before bed, 10mg V in the afternoon, daily = 24mg V (diazepam)

I would like to start a daily reduction routine, as 4% every 2 weeks is proving too difficult using a pill splitter. I think the "cut and hold" method is shocking my system. I am hoping smooth daily reductions will make this easier.

Is it important to reduce both daily doses evenly, or can I cut down on one until it disappears? This is mainly for convenience, and lessening the fear of making a mistake. (I've never done liquid reductions before)

I will have a liquid suspension for 25mg/day prepared by a compounding pharmacy available to me. I'm trying to find 10ml and 1ml syringes on amazon, but they are expensive and seem labeled for single use. Is there a particular brand or design of syringe that is best suited for LMT?

If there's any info I've left out please ask.

March 15, 2017

My current schedule is:

14mg V before bed, 10mg V in the afternoon, daily = 24mg V (diazepam)

I would like to start a daily reduction routine, as 4% every 2 weeks is proving too difficult using a pill splitter. I think the "cut and hold" method is shocking my system. I am hoping smooth daily reductions will make this easier.

Is it important to reduce both daily doses evenly, or can I cut down on one until it disappears? This is mainly for convenience, and lessening the fear of making a mistake. (I've never done liquid reductions before)

I will have a liquid suspension for 25mg/day prepared by a compounding pharmacy available to me. I'm trying to find 10ml and 1ml syringes on amazon, but they are expensive and seem labeled for single use. Is there a particular brand or design of syringe that is best suited for LMT?

If there's any info I've left out please ask.

I believe your doses should be even. BD syringes are very good. I just got some more from amazon. They come in bags of 100, or at least that's what I get. I find they get hard to pull and I just throw them away when that happens.

Hope this helps.

Jenny

March 17, 2017

Because of V's long half-life, your doses do not need to be even. But I would alternate my cuts between the 2 so they don't get completely out of whack. Maybe ccut from the 14mg dose until it down to 10 and 10, then alternate.

Any basic oral syringes will do fine. They are NOT "precision instruments", but they are completely suitable for your purpose.

Tell me the concentration of your compounded liquid, and I will help you with a schedule.

BTW, V is available is an Rx liquid, which probably is a better alternative than a compounded liquid.

March 17, 2017

I believe your doses should be even. BD syringes are very good. I just got some more from amazon. They come in bags of 100, or at least that's what I get. I find they get hard to pull and I just throw them away when that happens.

Hope this helps.

Jenny

Thanks, just ordered some.

Because of V's long half-life, your doses do not need to be even. But I would alternate my cuts between the 2 so they don't get completely out of whack. Maybe ccut from the 14mg dose until it down to 10 and 10, then alternate.

Any basic oral syringes will do fine. They are NOT "precision instruments", but they are completely suitable for your purpose.

Tell me the concentration of your compounded liquid, and I will help you with a schedule.

BTW, V is available is an Rx liquid, which probably is a better alternative than a compounded liquid.

Thanks to you both for responding.

I am currently at 24mg V. 14mg before bed (midnight), and 10mg at 4pm in the afternoon. I got the following message from my psychiatrist:

We understand that you were wanting 25 mg/day, but we don't usually use liquid suspension, so we need you to tell us how much needs to be called in for a month's supply. Please let us know.

I plan to use pills as my base, and reduce 1mg using the liquid V every 2 weeks. So my next reduction might look like:

23mg + 1mg * (13/14) liquid day 1

23mg + 1mg * (12/14) liquid day 2

...

23 mg + 0 liquid day 14

Ideally I'd like as much liquid suspension as they can give me ($ value), but it needs to be easy to measure out. What dosage in suspension should I request?

@builder, I would prefer to reduce my dose every 2 weeks because it fits my routine, but if you think a 10-day schedule would be easier to meter (-0.1mg per day), and therefore a better approach, I can try that. Please advise.

March 17, 2017

@builder, I would prefer to reduce my dose every 2 weeks because it fits my routine, but if you think a 10-day schedule would be easier to meter (-0.1mg per day), and therefore a better approach, I can try that. Please advise.

I still need to know the concentration (mgs per ml) of your liquid.

And I still recommend you ask thee doc for scrip for Rx liquid V instead of a compounded suspension.

March 17, 2017

@builder, I would prefer to reduce my dose every 2 weeks because it fits my routine, but if you think a 10-day schedule would be easier to meter (-0.1mg per day), and therefore a better approach, I can try that. Please advise.

I still need to know the concentration (mgs per ml) of your liquid.

And I still recommend you ask thee doc for scrip for Rx liquid V instead of a compounded suspension.

Here's the information I have:

Valium

1mg / ml

30ml total volume

patient to decrease or taper as directed

~60 days supply (refrigerate if 90 days, counter-top safe if 30 days)

I also ordered 100 X 1ml syringes:

https://www.amazon.com/gp/product/B01599MCFW/ref=oh_aui_detailpage_o00_s00?ie=UTF8&psc=1

I ran your concern by the pharmacist at the compounding pharmacy, and she assured me the solution will be homogeneous. I assume your suggestion is warranted however, have you or someone you know had bad experiences using a compound pharmacy? My regular pharmacy (CVS) has been extremely uncooperative with my tapering (citing controlled substance codes), so I am very wary to put myself in their hands any more than I already am. Thanks for all your help.

March 17, 2017

There have been several instances of problems with compounded liquids/compounding pharmacies here on BB. That is NOT a blanket declaration that compounded liquids are bad. But the reliability and quality will depend on the care and expertise of the pharmacy. But if you use an Rx liquid, it will always be uniform and consistent, even in you don't like the pharmacy that you get it from. (You could probably choose a different pharmacy, if that really bothers you.)

But...here we go, based on your 1mg=1ml compounded liquid:

1mg/14 days =.07mg/day

So your daily schedule will be

23mg tablets 1mg (1ml) liquid

23mg tablets .93mg (.93ml) liquid

23mg tablets .86mg (.86ml) liquid

23mg tablets .78mg (.78ml) liquid

etc...

Most folks dilute the liquid so it is .1mg=1ml. This really makes it a lot easier to measure out your doses. When you get down to lower numbers, and want to make smaller daily cuts, that becomes pretty important.

March 18, 2017

There have been several instances of problems with compounded liquids/compounding pharmacies here on BB. That is NOT a blanket declaration that compounded liquids are bad. But the reliability and quality will depend on the care and expertise of the pharmacy. But if you use an Rx liquid, it will always be uniform and consistent, even in you don't like the pharmacy that you get it from. (You could probably choose a different pharmacy, if that really bothers you.)

But...here we go, based on your 1mg=1ml compounded liquid:

1mg/14 days =.07mg/day

So your daily schedule will be

23mg tablets 1mg (1ml) liquid
23mg tablets .93mg (.93ml) liquid
23mg tablets .86mg (.86ml) liquid
23mg tablets .78mg (.78ml) liquid
etc...

Most folks dilute the liquid so it is .1mg=1ml. This really makes it a lot easier to measure out your doses. When you get down to lower numbers, and want to make smaller daily cuts, that becomes pretty important.

Thanks very much for the numbers, general advice and information. I'll be starting the LMT this Monday the 20th, and will report how I'm doing in this thread. Hopefully I'll have good news for others who want to try this.

March 24, 2017

I started my LMT on Monday 3/20

Decided to go with 0.9, 0.8, ..., 0.0, 0.0, 0.0 over a 14 day period just to keep the math and calendar schedule easy.

The physical pain and muscle spasms have reduced considerably, but still a lot of depression, suicidal ideation and irritability. Hopefully things will continue to settle down.

March 27, 2017

All side-effects have disappeared, or are almost unnoticeable. For the first time in over a year I have hope that I can get through this!

Thanks so much.

March 27, 2017

I'm glad you are feeling better. You can get though this.

Jenny

March 27, 2017

All side-effects have disappeared, or are almost unnoticeable. For the first time in over a year I have hope that I can get through this!

Thanks so much.

March 30, 2017

TSFB - That's great news. Keep it up and continued good luck with your taper.

June 26, 2017

I seem to be hitting a wall and am in need of help.

~7 weeks ago I took a break and held at 20mg Diazepam and felt great.

I resumed my taper (-1mg across 2 week, then -1mg across the following 3 weeks) and am currently at 18mg Diazepam + 0.95ml...0.05ml (1mg = 1ml) suspension from a compound pharmacy. I will be down to 18mg dry pills in one week at this rate.

Two weeks ago the physical pain became extreme, now I'm having extremely disorganized thinking, memory problems, and inability to do basic tasks like self care etc. I'm irritable, paranoid, sleeping 12+ hours a day, etc etc.

I obviously need to slow down, this is not sustainable.

Builder cautioned me against using a compound pharmacy, but my regular Rx (CVS) will not fill a liquid prescription because they think I'm a drug dealer or w/e and refuse to help me. My only option seems to be creating my own solution in vodka as described by others on this forum.

I think I can only handle reducing by 3.5% or less every 2 weeks, any faster and the sxs become too extreme to endure.

@Builder or others, can you recommend a plan for me? Is there anything I haven't tried that might work? Is there anyone else who has been through a situation similar to mine that they found a way out of? If the vodka solution is the best way to go, can you direct me to a link to how to create my own suspension? I want to avoid using milk because I don't want to handle anything perishable. I need to find a way to reduce no faster than 3.5% every 2 weeks, regardless of my current dosage. That's a challenging computation for me, especially when I'm constrained to using the 1ml oral syringes. I don't know how precise they are.

I'm sorry if this is poorly written, I'm in too much pain to think clearly, please let me know if there's anything you need clarified to help answer my question. I can't put any more information in my sig because of the character limit.

Thanks in advance.

June 26, 2017

Builder cautioned me against using a compound pharmacy, but my regular Rx (CVS) will not fill a liquid prescription because they think I'm a drug dealer or w/e and refuse to help me. My only option seems to be creating my own solution in vodka as described by others on this forum.

I think I can only handle reducing by 3.5% or less every 2 weeks, any faster and the sxs become too extreme to endure.

@Builder or others, can you recommend a plan for me? Is there anything I haven't tried that might work? Is there anyone else who has been through a situation similar to mine that they found a way out of? If the vodka solution is the best way to go, can you direct me to a link to how to create my own suspension? I want to avoid using milk because I don't want to handle anything perishable. I need to find a way to reduce no faster than 3.5% every 2 weeks, regardless of my current dosage. That's a challenging computation for me, especially when I'm constrained to using the 1ml oral syringes. I don't know how precise they are.

Thanks in advance.

Very simple. Dissolve each 1mg of V in 2ml vodka, and add 8ml water. This give you a final solution with .1mg in each ml.

Tell me what size tablets you have, and I will recommend a specific procedure.

June 26, 2017

Builder cautioned me against using a compound pharmacy, but my regular Rx (CVS) will not fill a liquid prescription because they think I'm a drug dealer or w/e and refuse to help me. My only option seems to be creating my own solution in vodka as described by others on this forum.

I think I can only handle reducing by 3.5% or less every 2 weeks, any faster and the sxs become too extreme to endure.

@Builder or others, can you recommend a plan for me? Is there anything I haven't tried that might work? Is there anyone else who has been through a situation similar to mine that they found a way out of? If the vodka solution is the best way to go, can you direct me to a link to how to create my own suspension? I want to avoid using milk because I don't want to handle anything perishable. I need to find a way to reduce no faster than 3.5% every 2 weeks, regardless of my current dosage. That's a challenging computation for me, especially when I'm constrained to using the 1ml oral syringes. I don't know how precise they are.

Thanks in advance.

Very simple. Dissolve each 1mg of V in 2ml vodka, and add 8ml water. This give you a final solution with .1mg in each ml.

Tell me what size tablets you have, and I will recommend a specific procedure.

Thanks very much for responding.

The smallest tablet I have is 2mg. I'm not sure 4ml vodka would be enough to dissolve the tablet before mixing with water.

I have 2mg and 5mg tablets Diazepam.

1) What equipment will I need to accurately measure and store the compound?

2) Which oral syringes and container will I need to accurately measure and administer daily dosings?

3) How long will the compound 'last' in the refrigerator, and will I need to agitate (shake) the solution before use or will it be a homogeneous solution?

Thanks again.

June 26, 2017

Builder cautioned me against using a compound pharmacy, but my regular Rx (CVS) will not fill a liquid prescription because they think I'm a drug dealer or w/e and refuse to help me. My only option seems to be creating my own solution in vodka as described by others on this forum.

I think I can only handle reducing by 3.5% or less every 2 weeks, any faster and the sxs become too extreme to endure.

@Builder or others, can you recommend a plan for me? Is there anything I haven't tried that might work? Is there anyone else who has been through a situation similar to mine that they found a way out of? If the vodka solution is the best way to go, can you direct me to a link to how to create my own suspension? I want to avoid using milk because I don't want to handle anything perishable. I need to find a way to reduce no faster than 3.5% every 2 weeks, regardless of my current dosage. That's a challenging computation for me, especially when I'm constrained to using the 1ml oral syringes. I don't know how precise they are.

Thanks in advance.

Very simple. Dissolve each 1mg of V in 2ml vodka, and add 8ml water. This give you a final solution with .1mg in each ml.

Tell me what size tablets you have, and I will recommend a specific procedure.

Thanks very much for responding.

The smallest tablet I have is 2mg. I'm not sure 4ml vodka would be enough to dissolve the tablet before mixing with water.

I have 2mg and 5mg tablets Diazepam.

1) What equipment will I need to accurately measure and store the compound?
2) Which oral syringes and container will I need to accurately measure and administer daily dosings?
3) How long will the compound 'last' in the refrigerator, and will I need to agitate (shake) the solution before use or will it be a homogeneous solution?

Thanks again.

1) Yes, 4ml vodka will dissolve 2mg V. You can use more if you really want, just maintain the 1mg per 10ml total liquid ratio.

2) You will need a 1ml syringe, a 10ml syringe, and any common glass jar with lid. I used reclaimed pickle/olive/salad dressing etc jars. A 50-60ml syringe or a 100ml graduated cylinder will be helpful but not really required.

3) It's actually best stored at room temp. It will stay in solution, will not degrade, or lose potency, but I recommend making batches to last 10-14 days. As I say,it won't degrade, but it is subject to contamination. And note this will create a true, uniformly distributed solution, NOT a suspension.

If your 1) at 20mg, 2) have both 2) and 5mg tablets, and 3) want to cut 3.5%/2 weeks, I would start with a combo of tablets and liquid .

Dissolve 10mg in 20ml vodka and add 80 ml water. This will be a 10-12 day supply

20mg X 3.5%=.7mg

.7mg/14 days = .05mg/day reduction

19mg tablets 1mg (10ml) liquid

19mg tablets .95mg (9.5ml) liquid

19mg .90mg (9ml)

19mg .85mg (8.5ml)

19mg .80mg (8ml)

etc...

June 26, 2017

1) Yes, 4ml vodka will dissolve 2mg V. You can use more if you really want, just maintain the 1mg per 10ml total liquid ratio.

2) You will need a 1ml syringe, a 10ml syringe, and any common glass jar with lid. I used reclaimed pickle/olive/salad dressing etc jars. A 50-60ml syringe or a 100ml graduated cylinder will be helpful but not really required.

3) It's actually best stored at room temp. It will stay in solution, will not degrade, or lose potency, but I recommend making batches to last 10-14 days. As I say,it won't degrade, but it is subject to contamination. And note this will create a true, uniformly distributed solution, NOT a suspension.

If your 1) at 20mg, 2) have both 2) and 5mg tablets, and 3) want to cut 3.5%/2 weeks, I would start with a combo of tablets and liquid .

Dissolve 10mg in 20ml vodka and add 80 ml water. This will be a 10-12 day supply

20mg X 3.5%=.7mg
.7mg/14 days = .05mg/day reduction

19mg tablets 1mg (10ml) liquid
19mg tablets .95mg (9.5ml) liquid
19mg .90mg (9ml)
19mg .85mg (8.5ml)
19mg .80mg (8ml)
etc...

Thanks very much for the math and info.

What's strange is that I'm currently reducing from 19mg to 18mg using exactly what you are describing. Dropping 0.05mg every day, across 3 weeks (20 days to keep the math easy, 0.05ml reduction daily on a 1ml oral syringe), but I'm having very severe sxs.

Can you think of any other explanation besides the compound pharmacy screwing up?

It's puzzling.

June 26, 2017

1) Yes, 4ml vodka will dissolve 2mg V. You can use more if you really want, just maintain the 1mg per 10ml total liquid ratio.

2) You will need a 1ml syringe, a 10ml syringe, and any common glass jar with lid. I used reclaimed pickle/olive/salad dressing etc jars. A 50-60ml syringe or a 100ml graduated cylinder will be helpful but not really required.

3) It's actually best stored at room temp. It will stay in solution, will not degrade, or lose potency, but I recommend making batches to last 10-14 days. As I say,it won't degrade, but it is subject to contamination. And note this will create a true, uniformly distributed solution, NOT a suspension.

If your 1) at 20mg, 2) have both 2) and 5mg tablets, and 3) want to cut 3.5%/2 weeks, I would start with a combo of tablets and liquid .

Dissolve 10mg in 20ml vodka and add 80 ml water. This will be a 10-12 day supply

20mg X 3.5%=.7mg
.7mg/14 days = .05mg/day reduction

19mg tablets 1mg (10ml) liquid
19mg tablets .95mg (9.5ml) liquid
19mg .90mg (9ml)
19mg .85mg (8.5ml)
19mg .80mg (8ml)
etc...

Thanks very much for the math and info.

What's strange is that I'm currently reducing from 19mg to 18mg using exactly what you are describing. Dropping 0.05mg every day, across 3 weeks (20 days to keep the math easy, 0.05ml reduction daily on a 1ml oral syringe), but I'm having very severe sxs.

Can you think of any other explanation besides the compound pharmacy screwing up?

It's puzzling.

Others have had problems with compounded liquids.

Is your compounded liquid .1mg per ml, or are you diluting it? Most compounded liquids are suspensions, and generally cannot be readily diluted. And even if your using it exactly as prepared, suspensions are NOT as uniform as solutions.

And the other that always pisses people of when I say it, is not all sxs are WD sxs,

June 27, 2017

Others have had problems with compounded liquids.

Is your compounded liquid .1mg per ml, or are you diluting it? Most compounded liquids are suspensions, and generally cannot be readily diluted. And even if your using it exactly as prepared, suspensions are NOT as uniform as solutions.

And the other that always pisses people of when I say it, is not all sxs are WD sxs,

It's 1mg=1ml in a cherry flavored suspension. I am not diluting it. The compound pharmacy recommended storing it refrigerated, I shake it vigorously and then use a 1ml syringe to draw out:

18mg Diazepam Pills +

0.95ml

0.90ml

...

0.05ml

over the course of 20 days

The underlying condition that got me on this junk in the first place is Paranoid Schizophrenia. I spent 3 years trying all of the atypical-antipsychotics but couldn't tolerate the sxs. The rationale my Dr. used to get me on benzos was to short-circuit the physiological anxiety response the delusional thoughts created, thus 'breaking' the feedback circuit of paranoid thoughts and physical anxiety. Like most people on benzos, it worked great for a month or two...now I'm stuck with the physical addiction, no relief, and paradoxical reactions. Tapering down does aggravate my underlying condition, but I'm experiencing things like extreme physical pain in all of my nerve endings which I never had issue with before. Also, whenever I hold I feel so much better after a few weeks. I don't understand how reducing by just 3.5% current dosage every 2 weeks could cause so much physical pain.

June 29, 2017

@[bu...]

Let me ask this a different way.

Your sig indicates that your dry cuts were in increments of 0.5mg, with the only variable being time between reductions.

How did you determine how many days were a conservative estimate for each reduction?

June 30, 2017

@builder

Let me ask this a different way.

Your sig indicates that your dry cuts were in increments of 0.5mg, with the only variable being time between reductions.

How did you determine how many days were a conservative estimate for each reduction?

The first line of my siggy says "...daily cuts using tablets and liquid"

My siggy is just a series of benchmarks that I hit while doing a liquid taper. There were no "dry cuts"

As a generalization, my plan was to choose daily taper rate that would equate to between 3% and 6% per 14 days.

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