hitting wall with water titration of Temazepam (RESTORIL) need suggestions

[[we...]]

Greetings fellow travelers. 15 days ago titrated dose from 3.0mgs to 2.5mgs. I have been in a constant wave of my head feeling like a bowling ball, nauseous  and my ongoing 24/7 tinnitus is roaring with constant ear popping. Over the last year of withdrawal I have reduced and held for 14 days before reducing again and have had waves and windows but this last 2 week wave is not letting up. Should I perhaps up dose to 2.75mgs or try to ride this out and hold? Then withdraw by .25mgs instead of .5mgs Looked at BB daily liquid taper plan as well as Ashton and found them waaay beyond my right brain comprehension.

Any thoughts would be appreciated.

Stay safe all.

 

 

[[Pa...]]

Hi weepingwillow,

 

I'm sorry no one got back to you, what did you decide to do, did you up-dose or hold your taper? 

 

Pamster

[[we...]]

Thanks Pamster.

As our mental health journey is very individual so is our recovery. Decided to hold a bit longer and have resumed tapering. Down to 2mgs and am doing ok. Don't think tinnitus will ever go away nor will I get more than 5 hrs sleep per night but...am in a much better place than when I began withdrawal process.

Stay safe & sane.

[[Pa...]]

I'm so glad you came back to let us know how you're doing, I feel much better knowing you're okay.  You're so right, each journey is different but I'm so glad you listened to the signals your body was sending you, this is exactly what we like to see.

 

It's also heartening to hear you're in a much better place than when you began, let this knowledge give you the confidence to continue your way to freedom. 

[[Ji...]]

Hi weepingwillow53

 

How is it going with your liquid taper? Do you still have unsettling symptoms? I don't remember where but I seem to have read somewhere another post from you where you use water (only) + frantic shakes to dissolve Temazepam.

 

I have read the following properties of this benzo:

 

- Very slightly soluble in water and sparingly soluble in alcohol USP https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018163s064lbl.pdf

- Lipid (fat) solubility: "low to moderate" http://psychopharmacopeia.com/index.php/?generic=Restoril

- Soluble in propylene glycol http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con850256.pdf

 

I fear in your case you may have taken insufficient dose of benzo one day and too much benzo another day. Have you ever thought to use Temazepam Liquid Rx for your taper? I understand in the UK there is the liquid Temazepam 10mg/5ml Oral Solution that uses both Ethanol and PG as solvent. I wonder if there is something equivalent in the US.

 

All the best.

[[we...]]

Appreciate your reply and thoughts Jim Hawk. As per previous post, held longer than normal and have continued on with taper. Am very meticulous about nightly water and pull measurements. Perhaps it was just a wave? At the beginning of taper had looked for liquid RX in Canada but had no luck finding it.

Stay safe.

[[Li...]]

Hello, weepingwillow53. I wonder if it was a tsunami rather than a wave? Reducing your dose from 3.0 to 2.5 was a large decrease percentage-wise.  (I’ve included a link to an easy-to-use tool you can use to check this and other reductions moving forward.)

 

Hats off for checking if a prescription oral solution of temazepam is available in your country! (imo, if one decides to use a liquid to taper, this is the preferred option in terms of safety, efficacy, and accuracy.)

 

Given that an Rx prescription solution is not available in Canada, I wonder if you considered a professionally prepared compounded suspension?  I’ve included a reference below to a article authored by Canadian PharmD/MDs you might find of interest. It describes how community pharmacists can collaborate with physicians to address tapering challenges via prescribed, professionally prepared compounded suspensions.  It uses temazepam as an example.

 

It sounds like you are indeed being meticulous! For your consideration ... according to PubChem and DrugBank, the aqueous solubility of pure tempazepam (no other ingredients) is 164 mg per liter or 0.164 mg/mL.

 

In your first post to the forum, you indicated you were using a 15mg capsule in 40mL of water. 

 

15mg divided by 40mL = 0.375mg/mL

 

If I were in your shoes, I would consult with a compounding pharmacist about whether using more water (e.g. 15mg divided by 150mL = 0.1 mg/mL) might be advisable.

 

In closing, would you do me a favor?  Could you direct me to the “BB daily liquid taper plan” you referenced? I am not aware that BB offers such a plan/tool so would like to learn more.

 

Sending all best wishes your way for a successful taper ... Libertas

 

References

The challenges of benzodiazepine tapering and discontinuation and an underutilized interdisciplinary approach

UBCMJ. 2018: 10.1 (16-18)

https://med-fom-ubcmj.sites.olt.ubc.ca/files/2018/08/Commentary-2.pdf

 

Percentage Change Calculator

https://www.calculatorsoup.com/calculators/algebra/percent-change-calculator.php

[[we...]]

good day Libertas. Thank you for your reply and suggestions.You are right....a possible tsunami! Yes, in a perfect world liquid RX would have been my taper of choice. Forgot, (probably forgotten a lot of things in the 1 yr May16/19 since I started tapering ) Had researched and used a compound pharmacist for 3 months going from 22.5 mgs to 15mgs prior to liquid taper as I was originally opening 2nd 15mg (in Canada smallest capsule dosage is 15mgs) and eye balling reduction, then attempting to pore into empty gel capsule. Total failure!!! So, did use compounded capsules until I was able to get down to one 15 mgs capsule. At that time I started my own liquid taper as compounding pharmacy is quite a drive. Is your suggestion 1 dilute 15mg capsule in 150mls water and pull 0.1mg?

I am very right brain dominate so what else can I say? Did I specify it was a BB daily liquid taper plan? Perhaps it was a plan someone on forum had recommended which I referenced? Yet another, don't remember.

Stay safe & sane 

[[Li...]]

Hello again, weepingwillow53.

 

Like you, I live in a less than perfect world in terms of the formulations available for my benzodiazepine (clonazepam).  In the US, an FDA-approved prescription oral solution of clonazepam is not available, so I have been using a prescription compounded oral suspension that is based on a USP-compliant, stability-tested formulation.  It has worked well and is easy to use.

 

Like most of the members here in BenzoBuddies, I am not a pharmaceutical scientist, analytical chemist, pharmacist or any other “—ist” that qualifies me to give pharmaceutical advice (or even suggestions). 

 

The point I was attempting to convey in my previous PM was that if the aqueous solubility of pure temazepam is indeed 0.164mg/mL, then hypothetically it would take more water than you are currently using to dissolve 15mg of temazepam.

 

The 15mg/150mL example would (again hypothetically) have sufficient water to dissolve 15mg of temazepam (0.1mg/mL is below the threshold of the “best case” solubility of 0.164mg/mL).

 

You would use whatever taper rate/amount works for you to calculate how much liquid to measure and discard.  For example, to remove 0.2mg of temazepam from a liquid with a concentration of 0.1mg/mL, you would measure and discard 2mL of the liquid (2mL of a liquid with a concentration of 0.1mg/mL = 2 x 0.1 = 0.2mg).

 

I suspect the above is clear as mud.   Let’s hope another member comes along who can explain all of the above better than I have.

 

Thank you for the clarification regarding the “BB daily liquid taper plan.”  There are numerous taper planning tools/calculators/spreadsheets and members do indeed reference them. To my knowledge, BenzoBuddies has not developed a tool for this particular approach to tapering, so I wanted to double-check.

[[we...]]

Greetings Libertas. My very right brain did find that clear as mud. Read suggested article and had a peek at percentage calculator.  Have held at 2.0mgs for almost 3 wks now Have been using 40mls water since beginning of water titration.  All along my taper, I have been withdrawing what I don't take. So now I am withdrawing 13mls water and drinking 2mls liquid? Planning on going down .20mgs to 1.80mgs. Thoughts appreciated.

Stay safe

[[Li...]]

Hello again, weepingwillow53.

 

Given that a prescription oral solution of your benzodiazepine is not available in your country, I would use a prescription compounded oral suspension if I were in your shoes.  But that’s just my opinion.  Like all members of BenzoBuddies, I am here as a layperson not an “expert.”

 

If you wish to continue using your homemade liquid, I do have questions about how you prepare it as well as how you determine the amount of drug you ingest on a daily basis.

 

Are you still mixing the contents of a 15mg capsule in 40mL of water?

 

If so, you are creating a liquid with a (hypothetical) concentration of 0.375mg/mL (15mg divided by 40mL = 0.375mg/mL).

 

Ingesting 2mLs of the above liquid would equal 0.75mg of the drug (2mL times 0.375mg/mL = 0.75mg).

 

You have indicated your current dose is 2mg.  How are you arriving at that amount?  Are you dosing multiple times a day?  How much liquid are you ingesting each dose?

 

 

 

[[we...]]

Thanks Libertas. Understand you are no expert but really appreciating your thoughts. At night use a 150ml measuring glass with imprinted amounts and have always filled water to 40mls marker. (don't ask me why in the beginning of taper I decided to titrate with 40mls) I then pour that into a small glass jar with lid which has 15mg Restoril capsule already opened. I shake that vigorously and instantly pull out 10mls with a 10ml syringe and discard 10mls. I close glass jar and shake again, instantly open and pull out 3mls with a 5ml syringe and discard 3mls. I am pulling 13mls mixture out of 40ml water. So am I totally clueless or would that not leave me with 2mgs med in 40mls water? Was going to vet in a couple of days to get a couple of 1 ml syringes so I can pull accurate smaller doses as I attempt to reduce more from existing 13ml pull (found smaller markers on 5ml syringe not as ) Will add that to existing pull from 10/5ml syringes. As you said...clear as mud! Sleep & 24/7tinnitus has been worse the last few nights 3-4hrs normally 6hrs. Feeling crappy but have come this far and will push on.

Take good care

[[Pa...]]

Hi weepingwillow53,

 

I've been reading through your conversation with Libertas and while I'm not proficient with titration, I'm thinking that if you're are drinking 27mL of a 40mL mixture, you're consuming 67.5% of the mixture (27 divided by 40 = 0.675).

 

So, hypothetically, you're consuming 67.5% of the active drug substance in the mixture or 10.125mg (0.675 times 15mg of active drug substance in the capsule  = 10.125).

 

Does this sound about right?

 

Pamster

[[we...]]

Hi Pamster & Libertas. Thank you both for your interest and thoughts, but I don't have a clue if that sounds right Pamster. In the beginning, figured out my titration so I could easily wrap my brain around it and when I start to read about %s and dividing this by that...I am lost. As I move forward in this, (nothing ventured, nothing gained) decided Thu night to experiment..I increased water to 50mls from 40mls and stayed at 13ml solution draw. Not a good idea Felt absolutely terrible yesterday. Went back down to 40mls last night and feeling pre yesterday terrible. Think I will just carry on with my titration for dummies So..have been so wrapped up in my own journey, how are both of you doing in yours? Stay safe and take care.

"Even in darkness, it is possible to create light" - Elie Wiesel

[[Li...]]

Hello weepingwillow53.

 

I agree with Pamster re: your current dose given what you’ve shared about how you are preparing your homemade liquid and how much you are ingesting.

 

When you added more water to your liquid Thursday night, you decreased the concentration of your liquid.

 

I am concerned about you.  Is obtaining a prescription for a professionally compounded oral suspension of temazepam an option?