Liquid Diazepam

[[Li...]]

Hello, Helping Husband. Congratulations to you and your wife on reaching such a low dose — the finish line is in sight!  My understanding is the same as Joeb’s — given diazepam’s long half-life, it is unlikely that missing one dose (and a very small one at that) will cause issues.

[[He...]]

Thank you very much.  Your prompt replies set her mind at ease, even though it is what I've been telling her all day.  She feels better hearing it from you.

She is not on liquid valium.  She is afraid to make that switch..  She is still filing down the 2mg tablets.  When it gets too small, she will try to switch to one dose a day and see how that goes.

Thank you again.

[[He...]]

Thank you very much.  Your prompt replies set her mind at ease, even though it is what I've been telling her all day.  She feels better hearing it from you.

She is not on liquid valium.  She is afraid to make that switch..  She is still filing down the 2mg tablets.  When it gets too small, she will try to switch to one dose a day and see how that goes.

Thank you again.

[[Li...]]

You’re welcome, Helping Husband.  I’m glad we were able to set her mind at ease.  As you know full well, individuals in benzodiazepine withdrawal often need constant and considerable reassurance.

 

We have members who have dry tapered diazepam all the way down so it’s possible she may not need to switch to liquid at all.  Indeed, the fact that she forgot to take a dose could be a sign that the drug is having minimal effect at this point.

[[He...]]

Hi Everyone.  My wife has continued her taper off Valium tablets.  She is down to about 0.72mg per day.  She cuts 5% every 3 to 4 weeks.  Most days there are mild to severe waves.  She still has problems with sleepless nights and anxiety, but she is coping.  Today she accidently forgot to take her Bupropion, and was able to nap a couple of times during the day, which is something she never can do.  While the Bupropion is supposed to help with anxiety, it often seems to do the opposite.

She is wondering if she could hold her valium dose where it is and try to wean off the Bupropion.  If so, how should she go about it?  The 75mg tablets are not made to be split.

We appreciate any input you may have on this.  You are always very helpful as she goes thru this ordeal.

Thank you very much.

[[An...]]

Hi.  My wife has been tapering off 7.5 mg of Diazepam (Valium) since last March (2020) using both tablets and liquid (for the fractions).  She has tapered 0.15 mg every 2 to 3 weeks.

Last night she tapered to 1.9 mg of all liquid (from 2.05 mg Tablet and liquid).  She has not been feeling well all day.  Wave symptoms are all intensified quite a bit all day with no windows plus some shakiness, which is new.

Does the liquid work differently from the tablets?  Was it a good idea to switch to all liquid?

We switched for accuracy as the tablets do not divide accurately.

What do you recommend as the best way to taper below 2 mg valium.

Not sure how to post this question.

Thank you.

Helping Husband

 

I'm using a compound liquid diazepam and yes, the CNS has an adjustment period.  My compound pharmacist explained manufactured tablets have been researched for absorption rates in the stomach in order to deliver the drug in a user friendly manner.

Obviously the liquid is often absorbed long before it gets to the stomach, most often in the mouth, tongue and throat.

2) As far as "the best way" to taper below 2 mg V - the best way is whatever works for the patient.  Personally I like it because it allows for a very small and exact cut.  As you can see below, I use a combo of tabs and liquid.

FYI - there is a support group called something like "under 3 mg Valium group" or something like that.  I'd say you'll probably get some really good input.

 

Why not put in an empty gelatin capsule and swallow quickly (before the liquid starts to dissolve the capsule) if you want it in the stomach bf absorption into bloodstream occurs?

[[Li...]]

AntiBenzo7: I appreciate your lending a helping hand, but thought you’d want to know the post you responded to was from over one year ago (February 2021).  Helping Husband will correct me I’m wrong, but he and his wife have an approach that is working for them. 

 

Helping Husband: Greetings and salutations. Please congratulate your wife (and yourself) for tapering to a dose of just 0.72mg of diazepam a day.  It’s been a long and sometimes difficult journey, but you are very close to reaching your goal of successfully discontinuing diazepam.  Well done!

 

Entering diazepam and bupropion into a drug interactions checker (see link below), yields the following message for professionals:

 

MONITOR: Excessive use or abrupt discontinuation of benzodiazepines and other sedatives after chronic ingestion may precipitate seizures in patients receiving bupropion. Conversely, bupropion may antagonize the central pharmacologic effects of sedatives. Bupropion can cause agitation, anxiety, and insomnia and has been shown to decrease the sedative effect of diazepam in healthy volunteers given single doses of the drugs.

 

(‘Antagonize’ means that bupropion can negate the sedative effect of the diazepam.)

 

You and your wife would want to discuss the above with her doctor, but tapering off bupropion sounds like a sensible tack to take.

 

Surviving Antidepressants (SA) has a helpful tip sheet on how to taper bupropion, including information about how to deal with modified release tablets (what you refer to as ‘tablets that cannot be split’). The first post in the thread was written by the owner/founder of SA who has personal experience with tapering this particular AD. See link below.

 

Links:

Drug Interactions Checker - For Drugs, Food & Alcohol

https://www.drugs.com/drug_interactions.html

 

Tips for tapering off Wellbutrin, SR, XR, XL / Zyban (buproprion) - Tapering - Surviving Antidepressants

https://www.survivingantidepressants.org/topic/877-tips-for-tapering-off-wellbutrin-sr-xr-xl-zyban-buproprion/

 

[[ni...]]

so I was planning on switching to liquid diazapam to made titration slower and smaller (micro taper?), so is it worth staying at same level until body adjusts to liquid form?

[[He...]]

Thank you Libertas.  You always come through for us.  She took her Buptopion this morning (after missing her dose yesterday) and is having a bad day (anxiety and waves).  She is understandably very unsure of what to do tomorrow.  We will check the references you gave us and try to figure it out.  She is very frustrated and nervous today, not being sure of what to do.

We'll keep you posted.

Thank you

[[Pa...]]

so I was planning on switching to liquid diazapam to made titration slower and smaller (micro taper?), so is it worth staying at same level until body adjusts to liquid form?

 

Changes in medication form can be interpreted by your body as a reduction so yes, it's a good idea to hold a bit before making a cut. 

[[Li...]]

Thank you Libertas.  You always come through for us.  She took her Buptopion this morning (after missing her dose yesterday) and is having a bad day (anxiety and waves).  She is understandably very unsure of what to do tomorrow.  We will check the references you gave us and try to figure it out.  She is very frustrated and nervous today, not being sure of what to do.

We'll keep you posted.

Thank you

 

You are most welcome, Helping Husband.  I admire the courage and determination you and your wife have shown throughout this process and am honored to help in any way I can.

 

Please let me know if I can assist in ‘interpreting’ the information about tapering bupropion from Surviving Antidepressants. Based on what you’ve shared and what I learned today about the drug interaction with diazepam, it sounds like the bupropion may have been hurting your wife more than helping.  Did you notice any change in her withdrawal symptoms after she started taking it?

[[He...]]

Libertas,

She had been on Bupropion since before she even knew about Benzo Withdrawal Syndrom.  She had been on Zoloft for a while, but that began to give her problems after working well for quite some time.  Then she was switched to Welbutrin.  It wasn't until March of 2020 that we learned about the Benzos.  They were probably a big part of the problem all along, but who knew?

So we can't speak of any change when whe began Bupropion.  She is still very unsure and frightened to go off it at this time.  She can't tolerate things getting worse.  Of course, we won't know until we try.

Thank you.

[[Li...]]

Hello again, Helping Husband.

 

Thank you for sharing the background on your wife’s use of Wellbutrin/bupropion.  I now wonder if it might be partially or completely negating the effect of the small amount (0.72mg) of diazepam she is still taking?  If so, her effective dose may be lower than 0.72mg.  If this is the case, she may be closer to the benzo withdrawal ‘finish line’ than we might think.  As you probably know, Ashton recommended a quit dose of 0.5mg daily (see quote from Ashton below).

 

Your wife’s reluctance to taper the Wellbutrin before she finishes her Valium taper is completely understandable.  However, per the thread from Surviving Antidepressants (SA): “Bupropion tends to be energizing and often causes anxiety, agitation, nervousness, loss of appetite, and insomnia as side effects.”  So she may want to consider tapering it at some point. 

 

The good news is that, also per SA: “Wellbutrin (bupropion) is an atypical antidepressant with a lower reported rate of withdrawal syndrome compared to the SSRIs and SNRIs such as Paxil, Effexor, or Cymbalta.”  Needless to say, she would still be wise to taper the Wellbutrin, but this suggests she may not have as difficult a time doing so as she has had with the Valium.

 

Getting off the last tablet: Stopping the last few milligrams is often viewed as particularly difficult. This is mainly due to fear of how you will cope without any drug at all. In fact, the final parting is surprisingly easy. People are usually delighted by the new sense of freedom gained. In any case the 1mg or 0.5mg diazepam per day which you are taking at the end of your schedule is having little effect apart from keeping the dependence going. Do not be tempted to spin out the withdrawal to a ridiculously slow rate towards the end (such as 0.25mg each month). Take the plunge when you reach 0.5mg daily; full recovery cannot begin until you have got off your tablets completely.

 

Source:

Ashton Manual, Chapter II

How to Withdraw from Benzodiazepines After Long-Term Use

https://benzo.org.uk/manual/bzcha02.htm

[[He...]]

Libertas,

I should correct something.  I stated that she is at 0.72 mg diazepam, but actually she has been 0.t78 mg since March 12th.  She has held that.  After looking at the reference to the website about "Tips for tapering off Welbutrin ", we were indeed quite bewildered.  I started to print out some of it and it was about 39 pages, so I only printed about 10 and then stopped. 

We decided to call our doctor who had prescribed the Welbutrin the next day.  He said to split them in half (They ar  She is very fragile and doesn't know what to do now.e not SR, XR, or XL) and take 1/2 tablet for a week and then stop.  He said that 75 mg is a very low dose and that they can be split, even though they are not scored. She was afraid to do that, so we divided the tablet into quarters.  The next day she took 3/4 of a tablet.  That was Wednesday.

She felt okay all day and slept well Wednesday and Thursday nights.  Friday was not a good day and she did not sleep Friday night more than a couple of hours.  She had a wave when she went to bed and today (Saturday) the wave has not let up and is quite severe.

Now she is super anxious, unsure, in pain, and all the rest that goes with a bad wave. She is very fragile right now and doesn't know what to do now.  She has held her Diazepam dose at 0.78 mg and will hold that until she can get off the Bupropion

We need some help today.  She is already convinced that she will not sleep again tonight, and who knows what tomorrow will bring.

Thank you for listening.

[[Li...]]

Hello, Helping Husband.

 

In my opinion, there’s no such thing as a ‘very low dose’ of any psychoactive drug.

 

The 50% reduction your doctor recommended is quite large. Surviving Antidepressants (SA) recommends an initial test reduction of 10%.  You and your wife were wise to make a smaller (25%) reduction. However, given her reaction, that was still too much for her.

 

Before we proceed further, I want to make sure we have a compete and correct medication history for your wife.  Would you please review the following and let us know?  Also, please let us know the month/year she started Zoloft as well as the month/year she switched to 75mg of buproprion immediate release.

 

DRAFT Medication History:

 

2012 - Rx temazepam 15 mg for sleep; rarely took it

2017 - began taking temazepam more frequently

Sept 2019 - per prescriber, began to take 30mg temazepam every other day during the week, with none on weekends. Did not work. Per prescriber, returned to taking 15mg temazepam plus Xanax. Got worse.

Mar 4, 2020 - began crossover to 7.5mg of diazepam

Mar 13, 2020 - began tapering diazepam

Aug. 1, 2020 - 3.5mg of diazepam

Aug. 11, 2020 - 3.25mg

July 27, 2021 - 1.4mg (0.7mg x 2)

Oct 20, 2021 - 1.14mg (0.57mg x 2)

Feb 10, 2022 - 0.87mg (0.435mg x 2)

Mar 29, 2022 - 0.78mg (0.39 x 2)  *AT WHAT TIMES DOES SHE TAKE THESE DOSES?

 

Other meds: Began taking Zoloft in *MONTH/YEAR.  Switched to Wellbutrin/buproprion in *MONTH/YEAR. Current dose is 75mg of buproprion immediate release at 10 am daily.  Also taking Lopressor and Eliquis.

 

Drug interactions: Diazepam and buproprion: moderate; Lopressor (metoprolol) and bupropion: moderate

 

Edit: Added draft medication history for review

 

[[Tr...]]

Hello Helping Husband - this thread is wonderful and you are wonderful. I am a 44 yo mother of 2, I am tapering Valium as well. Your dedication to helping your wife is so heartwarming.

I was on Wellbutrin for a while before I began tapering Valium and  I chose to get off of it because it was stimulating. I am still on Zoloft.

 

The 75mg of Wellbutrin is a lower dose (many are on extended release 150 or 300mg), but all psych meds are a bit more potent in the elderly. If she is on board with tapering it, I think it could help her in the long run. When I came off I did not taper it like I would an SSRI (Zoloft, Prozac) over months and months because I felt like it was causing anxiety and I wanted that variable gone.

 

I think lowering her dose as you are doing may be fine - or just hold where she is and finish the Valium. You’re getting so close. ❤️

What is her Zoloft dose? How long has she been on it? How long on Wellbutrin as well (same questions that Libertas posted).

Thank you for showing such love and long suffering for your dear wife on this journey.

I am lucky enough to have a husband that helps me immensely through this process too. I don’t think I could do it without him. Bless you.

[[He...]]

Libertas, we will try to give a better picture of her medication history.

In 2010 she was put on Temazepam 15 mg for insomnia, which she rarely took.

In 2012 was prescribed xanax 0.25 mg for anxiety or sleep.  Taken rarely.

  Began to develop digestive issues.  Medical tests were negative

In April of 2015 she was given Zoloft 100mg daily which worked well for anxiety.

  Digestive issues continued plus severe diarrhia.

In June of 2019 D/C'd Zoloft and began Buspiron 15mg x 2 daily.  Developed chest pain.  Had one episode of A-fib in hospital.  All tests negative. Was put on Metoprolol and Elequis, which she is still taking.

Oct 2019 put on Clonazepam 0.5 mg prn.  Too strong took 1/4 tab prn.  D/C'd 3 after weeks.

10/30/2019 put on Atavan 0.5 mg. Took 1/4 tab for 4 weeks.

Put back on Xanax 0.25 mg, only took 1/2 tab prn.

Began Wellbutrin 75 mg daily.

Learned about Benzo Withdrawal Syndrom in March of 2020.

Switched from Temazepam 15 mg (which she had been taking for several years)

to Diazepam 7.5 mg and began her taper.

Hope this covers it.

Thank you.

 

 

[[He...]]

Today my wife had a pretty good day after a horrible day yesterday.  She was able to get better sleep last night and that certainly helps.  It is evening now and digestive issues are beginning, but overall it was a "good" day.

Treelover, thank you for your post.  It is good to know others are going through this as well.  Like my wife, your are impatient to get off the Benzos, but she has learned to go at least 3 "good" days (meaning not so terruble) in a row.  Then she cuts 5%.

It often seems that the lower she gets, the more severe are her waves.  Thanks to Libertas pointing out the antagonizing effect of Bupropion, she has decided to d/c that while holding the Diazepam taper.

We wish you success.

 

[[He...]]

One more thing:

she has found that taking Inosotol helps to relieve her anxiety to a decent extent.

[[Li...]]

Thank you for sharing more of your wife’s medication history with us, Helping Husband.  I’ve been puzzled by why she has had such a difficult withdrawal despite a gradual, symptom-based taper. Learning that she has had multiple episodes of starting and stopping multiple benzodiazepines since 2010 suggests central sensitization (kindling) may be a factor.  See links below for more information.

 

Do you and your wife wish assistance with developing a plan to taper the Wellbutrin/bupropion?  If so, would you feel comfortable joining and requesting help from the good folks at Surviving Antidepressants (see link below)?  SA has more in-house expertise on antidepressant discontinuation than we do.  If not, we can offer suggestions based on SA guidelines:

 

Start with a 10% reduction per month, as we recommend with other antidepresssants. Base your decrease on the last dosage: The amount of the decrease keeps getting smaller.

 

If you find 10%-per-month decreases cause no problem, you may wish to make them more often -- but no more often than every 2 weeks. If you get any kind of withdrawal symptom, stop tapering! You are either tapering too fast or making reductions that are too large.

 

FYI SA suggests the following methods for making ‘small enough’ reductions in dose: compounded liquid, homebrew liquid (see note), using a digital scale to weigh tablet fragments.

 

Note: A bit of good news is that bupropion hydrochloride is highly soluble in water. Consequently, you could make a very simple homebrew liquid using just a tablet and water.  For example, one 75mg tablet in 75mLs of water would yield a liquid with a concentration of 1mg/mL.  This would allow your wife to reduce her dose by as little as 1mg at a time.

 

Links:

 

Kindling - The Alliance for Benzodiazepine Best Practices

https://benzoreform.org/kindling/

 

Kindling - Benzodiazepine Information Coalition

https://www.benzoinfo.com/kindling/

 

Registration - Surviving Antidepressants

https://www.survivingantidepressants.org/register/

[[He...]]

Okay.  She had another very bad day today, after a good day yesterday. Ugh!

I registered with SA, but the site confused me.  I'm not great with computers.

It will take me some time to figure it out.

We just hope she can sleep tonight and perhaps tomorrow won't be as bad.  Can't tell if it's the Benzos or the Bupropion causing it.

[[Li...]]

Oh dear.  I’m sorry your wife had another bad day, but glad that yesterday was a good one.  Let’s hope for more good days to follow!

 

Tip of the hat for registering with SA.  I agree the site is a tad difficult to navigate.  If you can’t figure it out, scroll all the way to the bottom of the SA website page until you see the words ‘Privacy Policy’ and ‘Contact Us.’ Click ‘Contact Us’ and enter a request for assistance.  If that doesn’t work, let me know and I’ll contact them on your behalf.

 

I hope you will let us know what you learn from SA as well as continue to keep us posted on how you and your wife are doing.  We are all looking forward to the day when you let us know that your wife has successfully discontinued her benzodiazepine.

[[He...]]

Thank you, Libertas.  After trying to find some help in their posts, I sent a message as you suggested.  Awaiting a reply.

At this point she is not sure if the waves are coming from the benzos or the Bupropion.  Thinking of going back up to 75 mg of Bupropion tomorrow , or just trying to get through this mess.  It's going to be a bad night. 

[[Li...]]

My heart goes out to you and your wife.  If I were in her shoes, I would give serious consideration to reinstating the bupropion until I had a better handle on how best to approach discontinuing it.  Per Occam’s razor, unless she has made other changes to her meds or experienced a major life stressor, the simpler explanation of a phenomenon is preferred (i.e. the symptoms she is experiencing are due to a too-large-for-her reduction in bupropion).

[[He...]]

Today she went back to the 75 mg of Bupropion while holding the Diazepam at 0.78 mg.  She had mild waves today.  She will try to stay at these levels until she feels better for a few days and then try cutting the Buprospion by a smaller amount.  The thought of 10% every 4 weeks is very discouraging, as it would take nearly a year just to get off the Bupropion.  Then she would need to comtinue the Diazepam taper for many months after that (she has been tapering 5% every 4 to 4 weeks).  At our age we may  not  have that  much time left!