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The Worst Choice for Tapering


[Al...]

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Diazepam is the standard drug for tapering, but why? Most would answer that it's because of it's long half-life. That's correct, but it means almost nothing. Diazepam is highly lipophilic and it's notorious for it's unpredictable duration of action. Continual daily doses of diazepam quickly build to a high concentration in the body, far in excess of the actual dose for any given day. For this reasons it was largely replaced in the E.R. by lorazepam, a benzo with a longer and far more predictable duration of action. Than there is the alprazolam versus diazepam problem. Not all benzos are identical. Alprazolam possess unique chemical and physical properties. It's the only drug in it's class that significantly increases the dopamine level in the striatum. It also possess antidepressant properties because of its similarities with the tricyclic antidepressants. For the reassons I mentioned above, alprazolam should never be replaced with anything.

 

DISCLAIMER: This is a personal opinion based on articles from mainstream medical journals and it should be read accordingly. Feel free to bring your own pro or anti valium arguments into this discussion.

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I don't have experience with any other benzo except for valium. So in absolute term without comparison, I found valium is the most unpredictable drug too. Totally mysterious and no rytham makes you complete lost in managing regardless how analytical you are
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Hi 4mom! I've used most benzos and diazepam was by far the worst. I could never count on it's duration of action which can last for only 15 minutes in some cases. And this is not a subjective opinion. You can find this fact in the medical literature.
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With our own experience, even no existing science  can valid, I tend to trust my own feeling. There are much that human don't know yet and we should be open minded. Another perfect example is this covid. Common sense or known science can be very misleading.
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Diazepam is the standard drug for tapering, but why? Most would answer that it's because of it's long half-life. That's correct, but it means almost nothing. Diazepam is highly lipophilic and it's notorious for it's unpredictable duration of action. Continual daily doses of diazepam quickly build to a high concentration in the body, far in excess of the actual dose for any given day. For this reasons it was largely replaced in the E.R. by lorazepam, a benzo with a longer and far more predictable duration of action. Than there is the alprazolam versus diazepam problem. Not all benzos are identical. Alprazolam possess unique chemical and physical properties. It's the only drug in it's class that significantly increases the dopamine level in the striatum. It also possess antidepressant properties because of its similarities with the tricyclic antidepressants. For the reassons I mentioned above, alprazolam should never be replaced with anything.

 

DISCLAIMER: This is a personal opinion based on articles from mainstream medical journals and it should be read accordingly. Feel free to bring your own pro or anti valium arguments into this discussion.

 

 

 

It's highly individual...for some switching to Valium was a godsend  and for others it was a nightmare. Valium tho often viewed as the weakest hitting benzo can be the most sedating for some and lead to depression. I've been on Ativan, xanax, klonopin and Valium and they may all feel a little different in the end they all are horrible to get off of

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Valium has the longest half life but Klonopin has the longest duration of action. I regret switching from Klonopin to Valium in order to taper. Xanax is extremely weak I guess unless you take tons of it. Anyway, I should have just done a microtaper from Klonopin.
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My Dr said that they didn't use valium under their protocol (for me anyway). It was Librium, which is the slowest benzo. It was a good call as far as I can tell from here.

 

Folks should consider Librium. It was easy to calculate, no math, scales or powders.

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Librium gives less anxiety relief than Valium so basically no anxiety relief because Valium is about as strong as a cup of chamomile tea.
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Librium gives less anxiety relief than Valium so basically no anxiety relief because Valium is about as strong as a cup of chamomile tea.

 

I don't agree with your post. You have to choose one of these meds to taper off of. I don't think choosing based on the projected strength of the med, and imagined anxiety, is a good forward looking strategy.  I crosssed over even though i got less of a jolt out of the Librium. That was a feature, not a bug in my tapering process, and helped me get off.

 

Stronger benzos are not kind to your anxiety. They are vicious. I think you are wrong about the slower benzos effect on a taperer. They allow folks to stabilize and cut like everyone else, probably with more success.

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[96...]

fwiw - I've generally stopped suggesting that people cross-over to valium (or any other benzo).  The cross-over just adds another variable that can be alternatively dealt with by simply dosing 2-3 times a day with a shorter-acting benzo.

 

I don't know if anybody can say that one benzo is necessarily better or worse than another to taper with.  If one was consistently easier than the others, everybody would use the easy one.  I've not seen that trend during my time here.

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fwiw - I've generally stopped suggesting that people cross-over to valium (or any other benzo).  The cross-over just adds another variable that can be alternatively dealt with by simply dosing 2-3 times a day with a shorter-acting benzo.

 

I don't know if anybody can say that one benzo is necessarily better or worse than another to taper with.  If one was consistently easier than the others, everybody would use the easy one.  I've not seen that trend during my time here.

 

I had terror while on Ativan. i never missed one dose in 8 years, and I was dosing 4 times a day.

 

On Librium I didn't feel that at all. It really felt like I had changed the process for the better. Logically, I have to conclude i benefitted from the crossover.

 

I don't know if any med would be chosen by acclaim here and end a debate. It's a little chaotic. People are distinct. People only make it here after catastrophic life crises, and they have fears for their life or thier job. There is a lot of irrationality too.

 

I would not have been able to cut, fractionalize, weigh, powderize or calculate myself to freedom with Ativan. I only had to drop 5 mg Librium each time. That was a big part of it. It gave me a sence of security and vision. 

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I've heard so many things. That Klonopin is the worse to taper off, and Xanax, my doc says the best to taper off coupled with an SSRI AD.

 

I thought per the Ashton Manual it would be best to taper with valium? I just don't know, I expected klonopin to be the best considering it's long half life and duration in the body. But I've heard that it's the worst to taper off from if you've been on it long term. Yet again I've read success stories of people getting off it who've been on long term.

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I was originally on .5 xanax 1-3 times a day and getting hit with rebound anxiety,  The doctor switched me to .5mg klonopin taken twice a day on a regular basis.  I switched over immediately and went back to a normal life with no anxiety attacks. 

 

I was fine for about 2 years. But then the anxiety attacks very suddenly returned.  It seemed like they hit me a few hours after taking my Klonopin.  I am not sure if it was some type of paradoxical effect or if the .5mg klonopin was not enough. 

 

I tried substituting a 10 mg valium for one of the doses of .5mg klonopin and the anxiety attacks went away.  I wound up switching from .5 mg klonopin twice a day to 10 mg of valium taken twice a day.  All of this happened over a four day period--from the beginning of the new anxiety attacks to the full switch over to valium.. 

 

Even though I was familiar with this board and familiar with Ashton protocols, I felt I needed to get off the Klonopin right away and was able to switch over to valium in a much shorter time period.  In my case it worked.  But from reading many accounts, it is obvious that it varies from person to person.  But I was able to switch from xanax to klonopin and then from klonopin to valium right away.  With both cases where I switched from xanax to klonopin and from klonopin to valium I did so in far less time than the Ashton tables suggest.  Perhaps I am different than most people in this regard. 

 

I have found the valium to be easier to taper from because its effects seems to last longer and it is available in relatively smaller equivalencies.  I eventually went to liquid valium.

 

I have become hesitant to provide people on the board advice because as I have read in some cases valium does not work for them.  More importantly, it seems that some doctors will not prescribe valium.  So I don't want to give someone a possible easier way to taper and then have their doctor refuse it and destroy their hopes--which would make them feel worse.  Also, it seems that the tone of the board has become more weighted more towards having people taper off the benzo that they are on rather than to switch over to valium/diazepam.

 

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If you take a genetic test, and it shows that you can metabolize Valium, would that be enough to make the switch? Now I am reading that some people who took the test, showed they could metabolize valium, switched, and then had a horrible time on them.

 

 

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When I began my Librium taper I gave up my demands on the benzo to treat me a certain way and let me feel like I want to all the the time. It's a slower drug by the science, and I made my decision based on that alone. I had no genetic testing done. I could be ok feeling more sluggish but not in terror all the time.

 

Has sentiment really gone against crossing over?

 

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[96...]

Has sentiment really gone against crossing over?

 

That's a discussion I want to have with the other mods and some of the 'old timers'.  I know that I don't recommend crossing over very often these days.  That's based on...

- Watching a lot of people not cross over and do about as 'well' as people who do cross over. 

- A 'proper' (Ashton) crossover takes a couple of months that could be used for tapering.

- A fair number of people who have crossed over to valium haven't liked the way that it makes them feel. 

- Crossover ratios are approximate.  Individual physiologies vary and as someone pointed out, valium's pharmacology is complicated. 

 

It's not like we're going to reach absolute consensus about this, but it would be good to kind of catch up on observations and theory.

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Has sentiment really gone against crossing over?

 

That's a discussion I want to have with the other mods and some of the 'old timers'.  I know that I don't recommend crossing over very often these days.  That's based on...

- Watching a lot of people not cross over and do about as 'well' as people who do cross over. 

- A 'proper' (Ashton) crossover takes a couple of months that could be used for tapering.

- A fair number of people who have crossed over to valium haven't liked the way that it makes them feel. 

- Crossover ratios are approximate.  Individual physiologies vary and as someone pointed out, valium's pharmacology is complicated. 

 

It's not like we're going to reach absolute consensus about this, but it would be good to kind of catch up on observations and theory.

 

It sounds very anecdotal from your end. Did you cross over? 

 

I crossed to Librium, and rapid reduced my dosage by 40% at the same time. I don't believe I could have achieved that on Ativan. I feel like Librium was a stablilizer for me. It would be a shame to throw out a good tool.

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[96...]

I crossed from klonopin to ativan about 11 months before I did my c/t.  I didn't do it with the intention of tapering.  I had no interest in tapering at that point.  It was a pretty easy cross-over.  I didn't know any better so just stopped 'K' and started 'A'.  It didn't really work any better, but I didn't want to keep bugging the doctor.

 

I think part of the decision regarding crossing over has to do with the reason a person starts benzos in the first place.  I did it just for insomnia.  I didn't want/need daytime coverage. 

 

Yes, this is all anecdotal although the posts (by forum members) are there to review/verify.  So while not a proper study, we might still see a trend.  It's not like we're going to see a Nature paper on benzo crossover strategies.

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badsocref: Launching a discussion about what we know/might know/want to know/don’t know about Substitution is an excellent idea! I hope you’ll do so.

 

“Want to know” questions I have include: (1) Do Substitution success rates vary based on the benzodiazepine an individual is crossing from? (e.g. there is some evidence that alprazalom may not be fully cross-tolerant with diazepam) and (2) Why are some US-based healthcare professionals reluctant to prescribe diazepam? What can be done to change this so that all individuals in the US who wish to consider Substitution as an option can do so?

 

confuseduser: Kudos for raising the point about reluctant prescribers upthread.

 

drad dog: I agree. We need as many tools in the tapering toolbox as possible. Substitution doesn’t work for all individuals but it does work for some.  In the case of clonazepam, my reading of the anecdotal tea leaves is that Substitution has helped multiple members who were not able to taper using other methods.

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I crossed from klonopin to ativan about 11 months before I did my c/t.  I didn't do it with the intention of tapering.  I had no interest in tapering at that point.  It was a pretty easy cross-over.  I didn't know any better so just stopped 'K' and started 'A'.  It didn't really work any better, but I didn't want to keep bugging the doctor.

 

I think part of the decision regarding crossing over has to do with the reason a person starts benzos in the first place.  I did it just for insomnia.  I didn't want/need daytime coverage. 

 

Yes, this is all anecdotal although the posts (by forum members) are there to review/verify.  So while not a proper study, we might still see a trend.  It's not like we're going to see a Nature paper on benzo crossover strategies.

 

Your cross was to a faster drug, but a crossover in a taper would be to a slower drug.

 

I once got swapped from one SSRI to another and I assumed that was an easy thing to do all the time, but I got reminded later on that it was to a faster SSRI. If I go backwards which I will want to do when I taper the SSRI, I won't be able to do it that easily. 

 

I didn't mean "anecdotal." I just meant I don't see much evidence against the crossover so far.

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badsocref: Launching a discussion about what we know/might know/want to know/don’t know about Substitution is an excellent idea! I hope you’ll do so.

 

“Want to know” questions I have include: (1) Do Substitution success rates vary based on the benzodiazepine an individual is crossing from? (e.g. there is some evidence that alprazalom may not be fully cross-tolerant with diazepam) and (2) Why are some US-based healthcare professionals reluctant to prescribe diazepam? What can be done to change this so that all individuals in the US who wish to consider Substitution as an option can do so?

 

confuseduser: Kudos for raising the point about reluctant prescribers upthread.

 

drad dog: I agree. We need as many tools in the tapering toolbox as possible. Substitution doesn’t work for all individuals but it does work for some.  In the case of clonazepam, my reading of the anecdotal tea leaves is that Substitution has helped multiple members who were not able to taper using other methods.

 

Simple answer: Valium has a street value. Librium doesn't. If you ask for Librium they will do it.

 

I think what's needed is some protocol for who should not cross over. But what would that be? What common sense reasons are there to not do it under known facts? If it's just that it doesn't work for everyone: that is true of almost all other medical facts too.

 

 

 

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[96...]
I started a discussion with the team.  If there's no buy-in at that level, the idea isn't worth pursuing.  Also, I actually need permission to data mine from the forum.  Hopefully, we'll have a useful discussion and then move it out into the forum for further discussion.
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confuseduser: Kudos for raising the point about reluctant prescribers upthread.

 

I think I overstated it.  I have read posts by people whose doctors did not want to switch them to valium, as well as people who have had problems with valium.  I have also read lots of posts from people who switched to valium.  For me switching to Valium was indispensable.  In my case I can't imagine how I could have made it if I had not switched over to valium from the klonopin.  I think valium is a better option.  Unfortunately not all doctors go along and some people may have problems.

 

The late Dr. Ashton advocated switching people to Valium because has a longer half-life which makes it works better against interdose withdrawal, and it was easier to taper with because it was available in smaller comparative doses.  I could definitely see this in my case.  I cannot imagine trying to taper the klonopin when I was having the issues with it.

 

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That's a discussion I want to have with the other mods and some of the 'old timers'.  I know that I don't recommend crossing over very often these days.  That's based on...

- Watching a lot of people not cross over and do about as 'well' as people who do cross over. 

- A 'proper' (Ashton) crossover takes a couple of months that could be used for tapering.

- A fair number of people who have crossed over to valium haven't liked the way that it makes them feel. 

- Crossover ratios are approximate.  Individual physiologies vary and as someone pointed out, valium's pharmacology is complicated. 

 

It's not like we're going to reach absolute consensus about this, but it would be good to kind of catch up on observations and theory.

 

I personally don't like this.  The board was founded with an emphasis on Dr. Ashton and her work and experience.  She advocated switching people to Valium because has a longer half-life which makes it works better against interdose withdrawal, and because it was easier to taper with because it was available in smaller comparative doses.  As I said, I could definitely see this in my case.  I cannot imagine trying to taper the klonopin when I was having the issues with it.  A quick direct Switchover to valium eliminated those issues and allowed me to taper relatively comfortably, though things got rocky at times once I got to lower doses.

 

With all due respect, Badsocref, you were able to cold turkey and stick it out through it sounds like you had a very difficult time.  Many of us cannot do this, or even more difficult types of tapers.  We need to minimize suffering and keep ourselves as functional as possible to allow us to carry on our lives.  I think the switchover to valium works best for this for *many* people.  Unfortunately some doctors may not support this, and some people have issues with it.  Given the nature of this messageboard, we are going to hear the worst experiences and not those of people who had minimal issues using the Ashton taper.

 

In reading people's accounts, I feel horrible for people whose doctors are not supportive, or who have problems with the switchover.  But I don't think that means that we should abandon the method that seeks to make it the easiest on the person tapering.

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[96...]

I believe you'll see a continued emphasis on the Ashton Manual.  We are just beginning a discussion of current trends/observations, and it's turning out to be a good discussion.

 

Nobody's going to throw out the baby with the bathwater.

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