Initial 5 or 10% Valium taper?

[[Bu...]]

I also feel like Valium is making me really sick or the Candida.  Should I go back to Klonopin?  I don't know.  This whole process is really difficult.  I've been on Valium since July 11th.  If I could get the GI issues and thrush under control things would be a lot better, but the thrush is not going away and it's been a month.   

[[Ji...]]

Hi Buddie8

 

Here below are some information about the kind of antibiotics to absolutely stay away from while tapering benzo according to Ashton.

 

...The fluoroquinolone class features a robust, broad-spectrum antibiotic effect and includes many popular drugs such as ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin (Noroxin), levofloxacin (Levaquin), moxifloxacin (Avelox), and gemifloxacin (Factive).

 

...The primary receptor type affected is the GABA-A receptor, which is the exact same receptor that benzodiazepines act on.[1]

 

When a fluoroquinolone binds to a GABA receptor, the result is the polar opposite of the effect of CNS depressants like benzodiazepines. Fluoroquinolones are antagonists of the GABA-A receptor, meaning that they prevent the binding of GABA and can displace other molecules bound to the receptor, such as benzodiazepines.[1] GABA is an inhibitory neurotransmitter and drugs which enhance its action, like benzodiazepines, cause sedation. The GABA receptor blockade caused by a fluoroquinolone results in a CNS stimulant effect, with neurological manifestations ranging from mild insomnia and agitation to hallucinations and seizures.[2] Anyone can suffer these side effects, but individuals prescribed benzodiazepines are notably much more prone to experiencing these adverse neuropsychiatric reactions.

 

Please make sure with your doctor that none of the antibiotics against thrush he is prescribing is part of the above family.

 

As for the potential use of Gabapentin and the currently used Zoloft I frequently read, like many psychotropic medications when used together with a benzo, they both can make your taper more problematic with more and long symptoms to face.

 

What would be the percentage if I did .05 mg reduction every day for 14 days?

It would be exactly the same as 0.1 mg reduction every two days for 14 days. It is indeed 7.4% reduction every 14 days.

 

 

[[Bu...]]

Definitely staying away from the fluoroquinolones. My doc didn’t see any interaction with Bactrim or Nystatin, but we’re holding off diflucan because it could raise the levels of the Valium.

 

In terms of my tapering protocol, what do you suggest?  I want to be firm with my doc and just tell him exactly what I want instead of let’s try this first and see how it goes.  Or I just continue dry cutting every 14 days.  He initially said .1 mg every two days for ten days which is too much.

 

Should I push the compounding pharmacy approach with .1mg/1ml and have them mix it? 

 

Sorry for so many questions.

[[Ji...]]

Hi Buddy8

 

As the taper pace suggested by your doctor 7.4%/14 days is within the recommended range of 5-10% every 10-14 days, I think you should ask your doctor to let you taper 0.05 mg/day instead of 0.1 mg every 2 days to minimize inter-dose withdrawal symptoms. If he accepts then it will put him to change his position and you will use a diluted solution 0.1 mg/ml instead of the original undiluted 1 mg/ml. By diluting 10 times, you will have less problem to draw up 0.05 mg (=0.5 ml instead of 0.05 ml) with a 1 ml insulin syringe.

 

If you feel you can by yourself add 9 ml of water to 1 ml of Rx thus obtain 10 ml of solution of 0.1 mg/ml then a compound solution by pharmacy will not be necessary. And by the end of 14 days you will have reduced exactly the same amount your doctor has requested.

 

[[Bu...]]

I will propose that.  How would your app look if I were to do that?  I'm having a little trouble with it.  Thank you so much.  I really appreciate it.

[[Bu...]]

I don't think he will let me mix it myself.  I will have to go through a compounding pharmacy so .1 mg/1ml.  Would there be any other specifics in terms of suspension?  Ora Plus.  Also, I think I would like to try to just switch over to liquid without the tablets.  Do you think that's a bad idea?

[[Ji...]]

Hi Buddy8

 

How would your app look if I were to do that?

The app takes into account only the 0.1 mg/ml parameter of the solution. Whether the solution is home-prepared or pharma-compound solution, both will work.

 

Would there be any other specifics in terms of suspension?

If the pharmacist can prepare a DISSOLVED solution (Ex: using Ethanol or PG) instead of a SUSPENDED solution (Ex: with ORA-Plus) then I would prefer the dissolved solution. I don't have any preference for the suspension agent.

 

I would like to try to just switch over to liquid without the tablets.

If it is a dissolved solution then there won't be any problem. With a suspended solution, some buddies reported a diminution of effects. In this case combine with tablets can smooth out the unplanned reduction.

 

[[Ji...]]

Hi Buddy8

 

After our exchanges I searched for insulin syringes smaller than 1 ml and I can find a number of them. Here is an example of 0.3 ml and 0.5 ml syringe. It could come handy when handling 0.05 ml of solution.

 

 

The 1 ml syringe can do it too but it will be more difficult and less accurate.

 

[[Bu...]]

Thanks so much for this info.  Also, how do you add an attachment?  It doesn't seem to work?

 

 

[[Ji...]]

HI Buddy8 

 

Also, how do you add an attachment?

 

http://www.benzobuddies.org/forum/index.php?topic=69369.0

 

I use imgur.com free account and paste the pictures in it. When completed, I paste the proposed BB link back to my text.

 

[[Ly...]]

Hello Jim,

I am on your liquid taper plan using the "20% every 14 days" reduction percentage.  I am assuming it’s the “percentage reduction”  versus the “quantity reduction,” because I notice the amounts of the reduction vary by smaller quantities as the taper drops lower and lower on the chart.  Is this correct?  On the top of my printout, the Reduction quantity lists it as N/A.  My computer doesn’t allow me to use your program and you had to help me with a pdf at the library when I had trouble earlier.

 

You told me that by doing the 20% reduction for the earlier doses only [NOT including the evening 1 mg. pill], would actually make my total for the day only 10%.  I am fine with that.

 

I am doing my first two doses [.5 mg. a.m. and .5 mg. afternoon] as a liquid taper reserving the evening 1 mg. as a tablet for a sleep aid at this point, planning to start reducing it later.  My original plan was to reduce this way until off the earlier doses.  I am currently at .7874 mg./day for the 2 early doses.  I had originally wanted to reduce my total daily dose down to 1 mg. at an accelerated rate [as tolerated] and then to back it down for the last mg. since I know it can be more difficult the lower in reductions.  I notice that your reduction chart takes me to .0248, for the two early doses, as of May 2019 and is reduced by tiny amounts as the taper ends.  When would I want to start reducing the evening dose to average about 5% daily dose reduction [early and bedtime doses totaled]?  I hope this doesn’t sound confusing.  I just don’t want to be taking the time to drop down ever so little for the earlier doses for so long while wanting to start on the evening dose.  I am aiming for a 5% total daily reduction, as tolerated, once I get my two early doses down lower.  Any suggestions?  I am not able to do just one dose a day.  The interdose sxs are too hard.  I know that would make everything so much more easy, but not able at this point.

 

Thank you very much.

[[Ji...]]

Hi LynnM

 

I am on your liquid taper plan using the "20% every...

Well, I think I must have given you half a dozen of those plans and now I'm not so sure anymore about what, when, why

 

On the top of my printout, the Reduction quantity lists it as N/A.

That definitely means it was a slow and "gentle" Fixed Percent reduction. By the way, are you doing Dry Taper or Liquid Taper?

 

My computer doesn’t allow me to use your program and you had to help me with a pdf at the library when I had trouble earlier.

If you can have your computer revised soon enough then I don't have to produce the report, store it somewhere and send you the link. It takes me time, especially when the result is not what you wish and I have to do it over again, and I have limited amount of time I can stay each day on BB.

 

I am doing my first two doses [.5 mg. a.m. and .5 mg. afternoon] as a liquid taper reserving the evening 1 mg. as a tablet for a sleep aid at this point, planning to start reducing it later.

Fine.

 

I am currently at .7874 mg./day for the 2 early doses.

Congratulations! Compared to the starting 2 mg you have reduced more than 10% of the drug! (1-0.7874)/2). Great!

 

I had originally wanted to reduce my total daily dose down to 1 mg. at an accelerated rate [as tolerated] and then to back it down for the last mg.

Fine.

 

When would I want to start reducing the evening dose to average about 5% daily dose reduction [early and bedtime doses totaled]?

I do not see any problem if you want to taper 5%/14 days for all 3 doses (M: 3.937 mg, A: 3.937 mg, N: 1 mg). You simply reduce them three ALTOGETHER. Should you wish to taper faster with Fixed Quantity you can try it too. At the very beginning the 2 methods are pretty much equivalent in the cut. Then you will need probably to adapt the cut when the total daily dose drops to 1 mg (50%) or 0.66 mg (33%) to minimize withdrawal symptoms. What do you think?

 

I am not able to do just one dose a day.The interdose sxs are too hard. I know that would make everything so much more easy

Keep the 3 doses together until the cross line. I just wonder how much it is more complex with 3 doses. Perhaps you can weigh out all your doses once a day or once every 3 days? Remember that at the end of the day it's the total dose of the day that matters, the accuracy of each dose during the day doesn't need to be super accurate. Variations in each single cut will actually raise very little fluctuations of the drug in your bloodstream especially with a long acting benzo like Clonazepam.

 

Hope I answered your questions.

 

[[Ly...]]

Thank you for your help.

[[Ly...]]

I found that squirting the clonazepam mixed with the alcohol/H20 liquid directly in my mouth makes my tongue sore.  It's been getting worse.  Is it possible to squirt the solution in a small medicine cup and then add a small amount of water to it so it's not so strong and drink it down?  I also rinse the medicine cup out with a small amount of water to get any left-over residue.  My tongue no longer burns, but I want to be sure this does not affect the solution.  I know mixing it accurately is so that the dose is correct, but once it leaves the syringe, any food or water in the stomach should not affect it much, right?  My nighttime pills dissolve almost in my mouth when I them with a small amount of water, so there would not be much, if any difference, right?

 

Also, when I mixed my 20 pills with the water formulation you have on your taper schedule, my pills did NOT leave just a few particles floating on the bottom.  In a small jar, it leaves about 1/4 inch-thick of powdery sludge--fairly thick.  That's A LOT!  The first batch I just shook the jar and drew up the amount I needed.  But I noticed that there was a lot of material floating around in the syringe and I could feel it in my mouth.  The amount of sludge in the syringe would vary. 

 

My husband suggested to let the particles settle to the bottom when we made our next batch and then we poured off the top "clear-ish" solution.  It still had a very small amount of sludge/residue in it [hardly any at all].  Now, before drawing up the solution in the syringe, we just swish it around a bit to mix it together.  Is this ok to do? 

[[bu...]]

I found that squirting the clonazepam mixed with the alcohol/H20 liquid directly in my mouth makes my tongue sore.  It's been getting worse.

 

 

Once you metered out the appropriate amount of solution, you can squirt into a glass of water, fruit juice, softdrink, or anything else.  Once you measured out the correct amount, it doesn't matter how it gets delivered to your stomach.

[[Ji...]]

Hi LynnM

 

when I mixed my 20 pills with the water formulation you have on your taper schedule...

I really want to be sure I have suggested to use 20 tablets for the solution preparation. As they seem a lot for 1 mg to taper, could you please send me back the screen I have used? How exactly is the formulation with alcohol and water have you used?

 

[[Ly...]]

I don't know how to send you back the screen, so I will just type in what is at the top of the form I printed out from your taper plan site:

 

 

Daily Plan

Summary Medication: Name: Clonazepam - Tablet size .5 mg. - Planned quit dose: 0.025 mg/day - Suggested quit dose: 0.025 mg/day

Liquid solution: Number of tablets: 20 - Volume of liquid: 100 ml - Concentration: 0.10 mg/ml

Daily doses: Dose 1: .5 mg - Dose 2: .5 mg - Dose 3:0 mg - Dose 4:0 mg - Dose 5:0 mg - Dose 6:0 mg

Planned reduction: Start date 20.09.2018 - Reduction percent 20% - Reduction quantity: (N/A) mg - Period:

14 days - Reduction order: Across doses - Combine with tablets: No - Attenuated ending: No

 

I had told you that I was taking .5 mg. in a.m. [liquid] and .5 mg. [liquid] in early afternoon and 1 mg. tablet at bedtime.  I wanted a 20% reduction of my early doses even though I was NOT

including the evening pill in the reduction at this time.  You told me that it would, in fact, mean that it was in actuality only a 10% reduction for THE DAY.  That is what I wanted because sleep was a VERY big issue that caused me to reinstate back in Sept. of last year, so I wanted to keep that last 1 mg. as a tablet [you mentioned that some buddies found it easier using liquid and tablets to start with] and use it to help my sleep early on in my taper.  After I am low enough with the early doses, then I wanted to start working on the evening 1 mg. tablet at a VERY reduced rate. 

 

I wrote you earlier about what point you think I might want to start reducing the evening pill on a 5% percentage reduction plan, but didn't know when/how to convert over to that amount once I was getting very low on the earlier liquid doses since they reduce at such a slow pace while I am still on the 1 mg.  I was hoping to eliminate them or blend them into the 1 mg. amount once I was about at the place where I could do so without updosing. At that point I would simply convert the tablet over to the liquid and continue tapering down slowly.

 

I know this seems confusing.

 

Thank you.

 

[[Ly...]]

By the way, Jim, the solution is 20 ml. vodka and 80 ml. water to equal 100 ml solution in which I have placed the 20 pills.

 

Thanks.

[[Ly...]]

Oh, I used 20 pills because that's the only mg. they give me.  I had asked for 1 mg., but the doctor and the pharmacy continue giving me .5 mg.

 

That would be equal to ten 1 mg. pills per 100 ml liquid [20% vodka/80% water].

 

Thanks,

LynnM

[[Bu...]]

Hey Jim,

 

I'm a little confused because in the quote below you say to get them to prepare a dissolved solution,

 

If the pharmacist can prepare a DISSOLVED solution (Ex: using Ethanol or PG) instead of a SUSPENDED solution (Ex: with ORA-Plus) then I would prefer the dissolved solution. I don't have any preference for the suspension agent.

 

I would like to try to just switch over to liquid without the tablets.

If it is a dissolved solution then there won't be any problem. With a suspended solution, some buddies reported a diminution of effects. In this case combine with tablets can smooth out the unplanned reduction.

 

 

 

---- but, from september 14th you say - 2. Talk to a pharmacist and get a compound solution where benzo is suspended and not diluted. The concentration of benzo in this solution to be again 0.1 mg/ml. This will be more expensive and likely you will find a reduction of effects.

 

 

I'm assuming it should be dissolved? 

[[Ji...]]

Hi Buddy8

 

Talk to a pharmacist and get a compound solution where benzo is suspended and not diluted. The concentration of benzo in this solution to be again 0.1 mg/ml. This will be more expensive and likely you will find a reduction of effects.

To my knowledge most pharmacies propose a "suspended" solution where they use a viscous suspension agent like ORA-Plus or ORA-Sweet to keep benzo powder suspended in the solution. Rarer seem those who propose a "dissolved" solution where they use a solvent like alcohol to dissolve the benzo powder and make it uniformly distributed within the solution.

 

Should your pharmacist be able to provide only "suspended" solution, then ask for a solution that you can use right away out of the bottle without having to further dilute at home. In this case ask for 0.1 mg/ml solution.

 

[[Ji...]]

Hi LynnM

 

the solution is 20 ml. vodka and 80 ml. water to equal 100 ml solution in which I have placed the 20 pills.

I used 20 pills because that's the only mg. they give me.  I had asked for 1 mg., but the doctor and the pharmacy continue giving me .5 mg. That would be equal to ten 1 mg. pills per 100 ml liquid [20% vodka/80% water].

Although the 10 mg tablets would have half the excipients, the solution is perfect! Now that you've started to get used to this new brand and tablet size, do not try to change it.

 

I see you proceed pretty well in your third week. At the end of the next week you will have already tapered off 20% of 2 mg. Congratulations! Keep on going!

 

[[Bu...]]

Hi Buddy8

 

Talk to a pharmacist and get a compound solution where benzo is suspended and not diluted. The concentration of benzo in this solution to be again 0.1 mg/ml. This will be more expensive and likely you will find a reduction of effects.

To my knowledge most pharmacies propose a "suspended" solution where they use a viscous suspension agent like ORA-Plus or ORA-Sweet to keep benzo powder suspended in the solution. Rarer seem those who propose a "dissolved" solution where they use a solvent like alcohol to dissolve the benzo powder and make it uniformly distributed within the solution.

 

Should your pharmacist be able to provide only "suspended" solution, then ask for a solution that you can use right away out of the bottle without having to further dilute at home. In this case ask for 0.1 mg/ml solution.

 

 

 

Thanks, Jim.  What is the general size and quantity of the bottle?  Strength?  Sorry, I'm still working through this. 

[[Ji...]]

Hi Buddy8

 

What is the general size and quantity of the bottle?

I think it must be between 3-5 oz but it can vary from pharmacy. If you come to the pharmacy with the printed taper schedule, the professional could tell you how much he/she can deliver at a time and when for a renewal.

 

Strength?

0.1 mg/ml

 

 

 

[[Ly...]]

Thank you, Jim, for your all your help and encouragement.  You have a lot of patience.  Though we all do stretch you at times, you keep bouncing back and coming through for us.

 

You'll never know how many lives you've helped.

 

Blessings to you,

LynnM