Request - Feedback for 'Titration: Limits & Limitations'

[[Ma...]]

"b. Blood levels of benzodiazepines can drop between doses, probably by at least 10%, but possibly by 20% to 30% or even as high as 50% or more."

 

With Valium or other longer-acting benzos, this may not hold true. I wouldn't say at least 10%.

[[Co...]]

"b. Blood levels of benzodiazepines can drop between doses, probably by at least 10%, but possibly by 20% to 30% or even as high as 50% or more."

 

With Valium or other longer-acting benzos, this may not hold true. I wouldn't say at least 10%.

 

True. But the advisory does not specify any particular benzodiazepine. And, in fact, titration is of particular use/benefit when used with benzodiazepines with shorter half-life values. Titrating Valium/diazepine is unnecessary for the vast majority of people because it is of relatively low potency, its availability in low dose tablets, and precisely because of its relatively long half-life.

[[Li...]]

Each mL of IntensolTM Oral Solution (Concentrate) contains:

Diazepam........................................5 mg

Alcohol............................................19%

 

Hello, Oregon Katz.  Good to see you “on the boards” as always!

 

Thank you for sharing the above info about the ingredients for the prescription Intensol Oral Solution for diazepam. 

 

Just in case there are members who are considering the use of a prescription oral solution of diazepam but, for whatever reasons, have concerns about using a formulation that contains alcohol ....

 

I thought it might be helpful to note there are two different prescription oral solutions of diazepam available (at least in the U.S.).  Although the Intensol does indeed contain alcohol, the other prescription oral solution does not.  And, my understanding is that the preferred option for titration would be the one with the lower concentration (i.e. the one without alcohol).

 

I’ve included the ingredients lists for the two different formulations from one manufacturer below for the “inquiring minds want to know” folks. 

 

5mg/5mL (i.e. 1mg/1mL) prescription oral solution of diazepam (no alcohol)

 

ANHYDROUS CITRIC ACID (UNII: XF417D3PSL)  

D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)  

FD&C RED NO. 40 (UNII: WZB9127XOA)  

POLYETHYLENE GLYCOL 1000 (UNII: U076Q6Q621)  

PROPYLENE GLYCOL (UNII: 6DC9Q167V3)  

SODIUM CITRATE, UNSPECIFIED FORM (UNII: 1Q73Q2JULR)  

SORBITOL (UNII: 506T60A25R)  

WATER (UNII: 059QF0KO0R)

 

25mg/5 mL (i.e. 5mg/1mL) prescription oral Intensol of diazepam (contains alcohol)

 

ALCOHOL (UNII: 3K9958V90M) 190 mg  in 1 mL

D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)  

POLYETHYLENE GLYCOL 400 (UNII: B697894SGQ)  

PROPYLENE GLYCOL (UNII: 6DC9Q167V3)  

SUCCINIC ACID (UNII: AB6MNQ6J6L)  

WATER (UNII: 059QF0KO0R)

[[no...]]

Each mL of IntensolTM Oral Solution (Concentrate) contains:

Diazepam........................................5 mg

Alcohol............................................19%

 

Hello, Oregon Katz.  Good to see you “on the boards” as always!

 

Thank you for sharing the above info about the ingredients for the prescription Intensol Oral Solution for diazepam. 

 

Just in case there are members who are considering the use of a prescription oral solution of diazepam but, for whatever reasons, have concerns about using a formulation that contains alcohol ....

 

I thought it might be helpful to note there are two different prescription oral solutions of diazepam available (at least in the U.S.).  Although the Intensol does indeed contain alcohol, the other prescription oral solution does not.  And, my understanding is that the preferred option for titration would be the one with the lower concentration (i.e. the one without alcohol).

 

I’ve included the ingredients lists for the two different formulations from one manufacturer below for the “inquiring minds want to know” folks. 

 

5mg/5mL (i.e. 1mg/1mL) prescription oral solution of diazepam (no alcohol)

 

ANHYDROUS CITRIC ACID (UNII: XF417D3PSL)

D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)

FD&C RED NO. 40 (UNII: WZB9127XOA)

POLYETHYLENE GLYCOL 1000 (UNII: U076Q6Q621)

PROPYLENE GLYCOL (UNII: 6DC9Q167V3)

SODIUM CITRATE, UNSPECIFIED FORM (UNII: 1Q73Q2JULR)

SORBITOL (UNII: 506T60A25R)

WATER (UNII: 059QF0KO0R)

25mg/5 mL (i.e. 5mg/1mL) prescription oral Intensol of diazepam (contains alcohol)

 

ALCOHOL (UNII: 3K9958V90M) 190 mg  in 1 mL

D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)

POLYETHYLENE GLYCOL 400 (UNII: B697894SGQ)

PROPYLENE GLYCOL (UNII: 6DC9Q167V3)

SUCCINIC ACID (UNII: AB6MNQ6J6L)

WATER (UNII: 059QF0KO0R)

 

thanks so much for this Libertas!

 

i bolded and purple'd the stuff i found most important ...the sorbitol is a sweetener only and the D&C colors are just cosmetic color so what is left is the ingredients that matter in the alcohol free version.  off to google the other ingredients to see what comes up. 

[[Ho...]]

Ooo Libertas, can you provide links to the products?

 

Note that 190 mg alcohol per mL product is 19% alcohol.

 

nomoredrugsforme, the polyethylene glycol (PEG) 1000 and propylene glycol are probably what are used to dissolve the diazepam, although I can't tell how much of them are used in the products. Or maybe the PEG 1000 is only used as a thickener.

[[no...]]

Ooo Libertas, can you provide links to the products?

 

Note that 190 mg alcohol per mL product is 19% alcohol.

 

nomoredrugsforme, the polyethylene glycol (PEG) 1000 and propylene glycol are probably what are used to dissolve the diazepam, although I can't tell how much of them are used in the products. Or maybe the PEG 1000 is only used as a thickener.

 

thank you yes links!

 

i was wondering about the PE. i use PG as solvent for clonaz now. the citric acid and sodium  ones are preservatives yes?

if the pE 1000 is a thickener, is this more of a suspension or still only a solution??

[[Li...]]

Greetings, HopeToDoThis and nomoredrugsforme.  I’m heartened to learn I am not alone in the “inquiring minds want to know” category!

 

Instead of sending you links, how about if I describe how I found the info about the ingredients so you (and other “inquiring minds”  ) can find it yourselves?

 

My source is DailyMed - the official provider of FDA label information aka package inserts.  Here are the steps I followed.

 

(1) Enter the following URL in your web browser:

 

[nobbc]https://dailymed.nlm.nih.gov/dailymed[/nobbc]

 

(I am still fuzzy as to BB guidelines re: live links so have included just the URL above. You two are clearly tech savvy so will know how to copy and paste it into your web browser of choice.  Also, FYI, I am using an iPad running iOS 12.4 and Safari so what I see may not be exactly what you see.)

 

(2) When the DailyMed home page appears, enter the keyword “diazepam” then click the search icon (a magnifying glass).

 

(3) When the list of drug labels for diazepam appears, scroll down the list until you see:

 

DIAZEPAM solution

DIAZEPAM INTENSOL solution, concentrate

NDC Code(s): 0054-3185-44, 0054-3188-63

Packager: West-Ward Pharmaceuticals Corp.

 

(4) Click the text underlined in the previous step.

 

(5) When the Drug Label Information list appears, scroll down until you see INGREDIENTS AND APPEARANCE.

 

(6) Click the “plus sign” (“+”) immediately to the left of the text underlined in the previous step. Scroll down to view the ingredients.  The ingredients for the DIAZEPAM solution appear first.  The ingredients for the DIAZEPAM INTENSOL concentrate appear second.

 

[[Ho...]]

Ooo Libertas, can you provide links to the products?

 

Note that 190 mg alcohol per mL product is 19% alcohol.

 

nomoredrugsforme, the polyethylene glycol (PEG) 1000 and propylene glycol are probably what are used to dissolve the diazepam, although I can't tell how much of them are used in the products. Or maybe the PEG 1000 is only used as a thickener.

 

thank you yes links!

 

i was wondering about the PE. i use PG as solvent for clonaz now. the citric acid and sodium  ones are preservatives yes?

if the pE 1000 is a thickener, is this more of a suspension or still only a solution??

 

Oh we've strayed far from Colin's request for feedback. From what I've read, citric acid can be used as a preservative. I don't know why it's used in this formulation. As for the PEG 1000, it's only my guess that it's used as a thickener. PEG 1000 is very soluble in water. I used to use it in polymer research. A quick search on the web shows 670 mg per mL of water solubility. But I don't know if it's used for helping the diazepam dissolve, or if it has some other purpose in the formulation.

[[Es...]]

Each mL of IntensolTM Oral Solution (Concentrate) contains:

Diazepam........................................5 mg

Alcohol............................................19%

 

Hello, Oregon Katz.  Good to see you “on the boards” as always!

 

Thank you for sharing the above info about the ingredients for the prescription Intensol Oral Solution for diazepam. 

 

Just in case there are members who are considering the use of a prescription oral solution of diazepam but, for whatever reasons, have concerns about using a formulation that contains alcohol ....

 

I thought it might be helpful to note there are two different prescription oral solutions of diazepam available (at least in the U.S.).  Although the Intensol does indeed contain alcohol, the other prescription oral solution does not.  And, my understanding is that the preferred option for titration would be the one with the lower concentration (i.e. the one without alcohol).

 

I’ve included the ingredients lists for the two different formulations from one manufacturer below for the “inquiring minds want to know” folks. 

 

5mg/5mL (i.e. 1mg/1mL) prescription oral solution of diazepam (no alcohol)

 

ANHYDROUS CITRIC ACID (UNII: XF417D3PSL)

D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)

FD&C RED NO. 40 (UNII: WZB9127XOA)

POLYETHYLENE GLYCOL 1000 (UNII: U076Q6Q621)

PROPYLENE GLYCOL (UNII: 6DC9Q167V3)

SODIUM CITRATE, UNSPECIFIED FORM (UNII: 1Q73Q2JULR)

SORBITOL (UNII: 506T60A25R)

WATER (UNII: 059QF0KO0R)

 

25mg/5 mL (i.e. 5mg/1mL) prescription oral Intensol of diazepam (contains alcohol)

 

ALCOHOL (UNII: 3K9958V90M) 190 mg  in 1 mL

D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)

POLYETHYLENE GLYCOL 400 (UNII: B697894SGQ)

PROPYLENE GLYCOL (UNII: 6DC9Q167V3)

SUCCINIC ACID (UNII: AB6MNQ6J6L)

WATER (UNII: 059QF0KO0R)

 

This is a very valuable information for anyone with a history of alcohol abuse. Who wants to taper the BZD after having stayed away from alcohol for a sufficient period of time. Only a specialist who has treated a  patient cross-dependent on alcohol and BZD can assess how long this period of time should be.

 

Benzodiazepines are actually used as a drug of choice for the management of alcohol withdrawal, according to WHO, link here. The problem with Alcohol Use Disorder is that it often goes misdiagnosed, due to the insufficient information given to the doctor. And the patient's denial defense mechanism. As explained in this Medscape link. Alcohol is a socially accepted drug. It is a billion dollar market.

[[Co...]]

Hi all,

 

While there has been some broad-ranging (and valuable) feedback, I do wish to keep this particular discussion quite narrow. When the document was drafted, it was always intended to be a short, to the point synopsis of the problems (as we see them) relating to how titration of benzodiazepines has sometimes been portrayed both within and without BenzoBuddies.

 

I don't think I've read anything here which is not worthy of more detailed discussion. But I suggest that a new thread would be more productive for much of it. By all means start a thread and quote to the opening post any relevant posts from this thread.

 

Thank you.

[[...]]

i use the liquid taper method, so I'm all for it. I don't use the 1 + 2 + 8 method. That sounds like a messy mixture. Mine is much more dilute (5 days worth benzo + 25 mL vodka + 475 mL water). I am not worried about the alcohol at all. My mixture seems to be working for me. I had a setback, but I don't blame it on the liquid.

 

Honestly when I first read the draft I thought it was very down on the liquid taper route. But I think the real point is, it works for some people, it doesn't work for others. And don't let someone tell you what you're feeling isn't real.

 

I'm hoping more of the details like the use of alcohol (which can be substituted from what I've read on these boards) will be contained in a later post promised by Colin's statement

 

I should also like you to know that we will soon publish something more substantive about the actual process of creating a titration schedule.

 

(Language geek here: note the use of the British "should" whereas Americans would say "would" in this context.)

 

I am wondering why you think the 1+2+8 is a messy mixture?  This is what I have been using for my DLMT. I am just trying to understand.

Thanks

[[Ho...]]

i use the liquid taper method, so I'm all for it. I don't use the 1 + 2 + 8 method. That sounds like a messy mixture. Mine is much more dilute (5 days worth benzo + 25 mL vodka + 475 mL water). I am not worried about the alcohol at all. My mixture seems to be working for me. I had a setback, but I don't blame it on the liquid.

 

Honestly when I first read the draft I thought it was very down on the liquid taper route. But I think the real point is, it works for some people, it doesn't work for others. And don't let someone tell you what you're feeling isn't real.

 

I'm hoping more of the details like the use of alcohol (which can be substituted from what I've read on these boards) will be contained in a later post promised by Colin's statement

 

I should also like you to know that we will soon publish something more substantive about the actual process of creating a titration schedule.

 

(Language geek here: note the use of the British "should" whereas Americans would say "would" in this context.)

 

I am wondering why you think the 1+2+8 is a messy mixture?  This is what I have been using for my DLMT. I am just trying to understand.

Thanks

 

Hi Dana - it just seems like a small amount of liquid for a few pills to me is all. I never tried it, but it seems like it would be thick and messy and I'd have to measure out tiny differences that I didn't want to do. If it is working for you, great! Keep at it!

[[Co...]]

To aid discussion and suggestions, I've edited the opening post to include a copy of the draft version of the document.