water/milk titration troubleshooting please help before hospitalized :)

[[Re...]]

Hi There

 

I am currently tapering 30mg Temazapem, that I had been taking for 2.5 months. I have been tapering for a month and a half, and am around 17. Initially my doctors had me doing 4 big cuts, and that really impacted my nervous system in a profound way. I went back up to 22.5 for a week, and then began a liquid titration. My doctor is really wonderful but I am worried I am still going too fast, as the symptoms are debilitating a lot of the time, including sometimes  severe allergic reactions to most things. She is considering hospitalizing me and doing a fast taper, and I know with every fiber of my being that this will be very detrimental to my health and sensitive nervous system.

 

The way we have been tapering is that I use 4oz. Of a mixture of water and coconut milk in a glass, I stir the mixture with a fork, and I pull out fluid. I pull out 15ML additional fluid every 3 days. I am very hopeful that due to me being a Highly Sensitive Person with complex trauma, that this is the only reason why I really struggling with the taper, and not due to another underlying health condition. So far, tests have come back negative aside from high cortisol.

 

An example of my taper is:

4 oz liquid, pull out 3.5 - 3 days

4 oz liquid, pull out 3 - 3 days

Etc.

 

I can’t hold too much because I have developed Candida and unfortunately have been unknowingly exposed to mold in my home, all of which is difficult to treat on a benzo, but can be exacerbated by withdrawal of course

 

Is there anyone out there that can please help me or offer advice for my doctor and I regarding a smoother taper? I really would like to feel as safe as possible throughout this process (managing the histamine reactions and such, as well as other symptoms), and I really want to avoid being hospitalized and/or going through a fast taper.

 

Thank you so much,

Resilience222

 

[[Li...]]

Hello Resilience222.  I am sorry you are struggling.

 

Can you tell us more about the homemade liquid you are preparing?

 

What volume of coconut milk are you using?  What is its fat content?  Is it homogenized?

 

What volume of water are you using?

 

What is the strength in milligrams of the tablets you are using?  How many of them do you use at a time?

 

Would your physician be willing to write a prescription for a professionally compounded suspension of temazepam?  This article might be of interest:

 

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

Edward Fang1, Ho Seung Jason Kim1, Jacky Tang1, Charles Choi1 Citation: UBCMJ. 2018: 10.1 (16-18)

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

[[Ji...]]

Hi Resilience222

 

I'm happy you are between us.

 

I have a couple of points I would like to discuss with you.

1. How you prepare your titration solution

- Temazepam (Restoril?) is known as NOT soluble in water and SPARINGLY soluble in alcohol. But is it lipid soluble? There seems to be not a lot of literature on this specific point. But it comes up regularly when I read about how Diazepam is well soluble in fat. So I guess it is somehow soluble in fatty liquid like coconut juice, but I'm not sure. Should you decide to continue this direction, use the coconut juice FIRST to dissolve benzo and add water ONLY when the benzo is completely dissolved. Pay attention to the quantity of needed coconut juice that must be sufficient in fat content.

- A different solution would be to use liquid Rx Temazepam Oral Solution (Eg: 10mg/5ml) and add water to make up the right volume. I think your PG would have no problem to prescribe it for your titration.

- The other solution would be to ask your pharmacist to prepare a suspended solution using SyrSpend® or Ora-Plus®, Ora-Sweet®...as suspension agent.

 

2. Your taper pace

In 1.5 month you went down from 30 mg to 17 mg. That is about 43% cut. The recommendations being to reduce between 5-10% every 10-14 days, that means you are on the fast end of the range but still within it. It did not however prevent you to feel unsettling symptoms as the sudden jump at the moment was really important.

 

I have a doubt: how many mg of Temazepam do you use to prepare you 4 oz solution? Do you put the total of 22.5 mg of Temazepam in the solution? Should it be the case then here are my comments:

4 oz liquid, pull out 3.5 - 3 days

- When you passed from 22.5 mg to 1/8 less, it is a cut of 12.5% that you kept going for 3 only days. It is fast.

 

4 oz liquid, pull out 3 - 3 days

- When you passed from 19.7 mg to 1/4 (of 22.5 mg) less, you passed to 14.1 mg. It is a cut of 28% that you kept going for 3 only days. It is definitely too fast.

 

In my opinion, your symptoms are likely the direct consequences of the sudden lack of benzo your body was used to.

 

I would then do the following:

1. Possibly delay the decision to get hospitalized to avoid an even faster taper that will be imposed on you

2. Obtain from your PG a prescription for Temazepam liquid Rx

3. Create a tentative Taper Plan (here) keeping in mind the recommendations are to reduce between 5-10% every 10-14 days.

4. Hold on the current dose and wait for your symptoms to stabilize to create a solid starting point for the taper

5. Launch yourself with the first micro reduced doses for a week or two.

6. Fine tune your Taper Plan, slow down if too fast, to adapt to the way your body reacts to the reduced dose

 

Wish you all the best!

 

❤

[[Li...]]

Hello again Resilience222.

 

Jim Hawk has asked a good question - is temazepam lipid soluble?  It’s a metabolite of diazepam, which is lipid soluble, so my guess (and it’s just a guess, I’m not a pharmaceutical scientist or analytical chemist) is that it is soluble at least to some degree. 

 

FYI Based on what I’ve read, my understanding is that the liquid formed when one combines regular tablets with homogenized milk is not a true solution but rather a “hybrid” (e.g. some of the molecules of the active drug substance may go into solution, some may be held in suspension, some may remain embedded in the excipients).  Regrettably, per the Titration: FAQs, we do not know because the characteristics and properties of homemade liquids have not been studied.

 

Do you live in the U.S.?  You’ll want to double-check this yourself, but according to DailyMed (URL below), a prescription oral solution of temazepam is not available.  That’s why I asked about a professionally prepared compounded suspension. 

 

If you have not already done so, I encourage you to take a look at the article I cited earlier.  There’s a figure on the second page that gives a reduction schedule for temazepam based on the Ashton Method.  It is important to note that, in her later communications, Ashton recommended longer withdrawal schedules for patients who have been taking benzodiazepines for longer periods and also emphasized the importance of flexibility (e.g., adjusting taper rates and schedules) to keep withdrawal symptoms tolerable to the patient.

 

DailyMed

https://dailymed.nlm.nih.gov

 

 

 

 

[[we...]]

Hi Resilience222,

 

  as per my profile, I too am tapering off temazepam and am also a highly sensitive person in so many ways. It breaks my heart to hear what you are going through. In the beginning of trying to figure out a taper I was so overwhelmed reading article after article, viewing video after video, trying to figure out mathematical  %s. The one thing I took away from it is ONE SIZE DEFINITELY DOES NOT FIT ALL! Am a bit confused about temazepam not being soluble in water. My titration from 22.5mgs to 2mgs has been done entirely with Brita filtered water??? Once I open capsule into small container with lid, I add the measured water, close lid, shake,shake,shake, instantly pull what I'm not using,close lid, shake,shake, shake some more, instantly drink,refill with some more water and keep turning container as I drink to get any particles off the sides. It has been a very slow and at times very agonizing process but I can see the light at the end of the tunnel.  Like others I think perhaps your tapering is too fast and too much.

Stay safe, breathe in calm and out stress.

 

[[Li...]]

Apologies to Resilience222 for temporarily hijacking your thread to respond to weepingwillow53 ...

 

According to the FDA-labels, temazepam is “slightly soluble in water.” 

 

PubChem, citing Drug Bank, gives an experimental solubility of:

 

164 mg/L (0.164 mg per 1 mL)

 

 

References

 

DailyMed

https://dailymed.nlm.nih.gov (enter “temazepam” in the search box)

 

PubChem

https://pubchem.ncbi.nlm.nih.gov/compound/Temazepam

[[we...]]

Hi Resilience222. Just checking in.

I have realized from a post recommending compounding pharmacy that i did not start out originally with water taper.  I tapered with the help of a compounded pharmacy rx from 22.5mgs to 15mgs. Then started water titration. Sorry about that. It is almost 1 yr since I started tapering and forgot that part. Profile now updated to reflect same.

 

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