I need help and guidance with my dmlt

[[sl...]]

It's great to know that a 1mg/ml solution of diazepam is commercially available in the US. I thought there was one, but couldn't find it on the Drug Bank site.

 

Thanks Libertas. 

[[Ar...]]

SlownSteady and Libertas,  This is all so confusing, my doctor is not going to go for any changes at this point because i could not tolerate the polyethenol gylcol.  I am just so confused as to what I am supposed to dose to get down to 1mg per month at my current dose of 17mgs per day dosing twice a day.

[[Li...]]

I know it’s confusing to begin but once you find a process that works for you, it will quickly become routine.

 

Are you able to tolerate the 5mg/ml oral solution of diazepam?  I ask because the solution manufactured by West-Ward contains polyethylene glycol (PEG) as well as propylene glycol (PG), pharmaceutical grade alcohol, succinic acid, water, and a colorant.  The 1mg/ml solution manufactured by West-Ward also contains PEG and PG (but no alcohol) as well as anhydrous citric acid, sodium citrate, sorbitol, water, and a colorant.

 

Do you think you could follow a process similar to the following?

 

1. Measure your entire daily dose into a glass container with a leak-proof lid.

2. Dilute the liquid medicine in the container with distilled or purified water.

3. Shake the container.

4. Withdraw and discard a small amount of the medicine/water mixture using a syringe.

5. Shake the container again.

5. Divide the remaining medicine/water mixture into two equal parts for your two daily doses.

 

[[Ar...]]

Libertas, I am taking the CV Lannett concentration, no polyethenol gylcol.  I really don't want to dilute it, or make any changes to how I dose.  I just want to slowly decrease my dosages.  Any ideas as to how I can do this?

[[Li...]]

Hmm ... you might want to double-check with your pharmacist about the ingredients.  According to DailyMed, the Lannett concentrate does contain polyethylene glycol. Here are the ingredients listed on its official FDA drug label:

 

DIAZEPAM (UNII: Q3JTX2Q7TU)

POLYETHYLENE GLYCOL, UNSPECIFIED (UNII: 3WJQ0SDW1A)

PROPYLENE GLYCOL (UNII: 6DC9Q167V3)

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

ALUMINUM OXIDE (UNII: LMI26O6933)

ALCOHOL (UNII: 3K9958V90M)

SUCCINIC ACID (UNII: AB6MNQ6J6L)

WATER (UNII: 059QF0KO0R)

 

I agree with slownsteady that making “small enough” reductions in dose using such a concentrated liquid and a 1mL oral syringe is problematic. However, this is your taper so it’s your call as to how to proceed! (Assuming it’s possible to accurately and precisely measure a 5mg/mL liquid using a consumer-grade 1mL syringe with 100 gradations, one line on the syringe would equal 0.05mg of drug.)

[[sl...]]

Thanks again to Libertas for helping here. I'm all thumbs when it comes to DailyMed, and this discussion about ingredients seems very important. 

 

Ariana, if you're sticking with the 5mg/ml liquid, I proposed reducing by 0.08ml/week total at your current doses, and monitoring your symptoms over several weeks to see how your body responds to this reduction quantity. I also suggest doing some research online on how to use oral syringes accurately, to make sure that you're giving yourself the best chance of taking an accurate dose.

 

Perhaps an important question to ask is have you already been dosing the 5mg/ml liquid? If so, for how long and how are you tolerating it? 

[[Ar...]]

SlownSteady, so how many lines would that be in reduction of the 0.08 on the 100 graduation syringe?

[[sl...]]

SlownSteady, so how many lines would that be in reduction of the 0.08 on the 100 graduation syringe?

 

Each line on a 1ml syringe with 100 gradations is 0.01ml, so 0.08ml would be 8 lines. But since you're taking two doses, this would be 0.04ml (4 lines) reduced from each of two doses.

 

If you're at 1.7ml per each of two doses right now, a reduction of 0.04ml makes each reduced dose 1.66ml. The next reduction would be 1.62ml per dose. And so on. I'm just subtracting 0.04ml from each of two daily doses to reduce by 0.08ml total.

 

Dosing 1.66ml from a 1ml syringe is a full draw to the 1ml mark (100 lines), and then a second draw of 0.66ml (66 lines). There should be larger markings at the 0.1ml spots and numbers to help you find 100 lines and so on without having to count them all.

 

Also, I suggest taking steps to get the air bubble out of the syringe tip before measuring your final syringe draw volume. This is very easy with a syringe adapter; I just attach the syringe to the medicine bottle via the adapter, invert the syringe and bottle, and then pull the plunger up and down until the air is out of the syringe.

 

Perhaps an important question to ask is have you already been dosing the 5mg/ml liquid? If so, for how long and how are you tolerating it? 

[[Ar...]]

Ok.  Now I understand, Thank you.  I have been using this concentrate  since reducing from 20mgs with a 1ml syringe reducing 1 mg per month,  however, i just completed a 3 month hold.

[[Li...]]

Thank you for letting us know you have been able to tolerate the Lannett 5mg/mL diazepam concentrate. That’s good news.

 

FYI The less concentrated 1mg/mL oral solution also manufactured by Lannett contains similar ingredients to the concentrate so chances are good you would tolerate it as well.  Given that you do not wish to dilute the concentrate, the Lannett 1mg/mL solution is an option to consider if you discover you need to make smaller reductions in dose than those that can be achieved using the 5mg/mL solution.

 

Another option is the 1mg/mL oral solution manufactured by West-Ward (formerly Roxane). It has slightly fewer ingredients than the Lannett formulation and seems to be the one most commonly used by our members who are tapering diazepam using a commercial liquid.

[[sl...]]

Hi Ariana,

Thanks for sharing more information with us! I am glad to hear that you're tolerating your liquid.

 

Libertas raises a good point about considering your future taper rate based on your previous taper experiences, but we do not currently know if your 1mg/month reduction rate was your functional limit or if the 3 month hold was based on recovering your stability. I think it would help us if you could clarify more about your previous tapering experience.

 

Were your previous 1mg/month reductions symptomatic?

Was your 3-month hold an attempt to recovering stability?

[[3B...]]

Hi Ariana,

 

I hope I have found you? Please let me know by posting here if indeed I have. I'm sorry I could not answer your PM other than to try to lead you here.

 

You are in good hands with slownsteady & Libertas, they are very good with all of this, much better than I would be.

 

I know getting to the right place can be difficult sometimes. If you still have questions, I can try to answer them here and will follow this tread.

[[Ar...]]

Thank you for letting us know you have been able to tolerate the Lannett 5mg/mL diazepam concentrate. That’s good news.

 

FYI The less concentrated 1mg/mL oral solution also manufactured by Lannett contains similar ingredients to the concentrate so chances are good you would tolerate it as well.  Given that you do not wish to dilute the concentrate, the Lannett 1mg/mL solution is an option to consider if you discover you need to make smaller reductions in dose than those that can be achieved using the 5mg/mL solution.

 

Another option is the 1mg/mL oral solution manufactured by West-Ward (formerly Roxane). It has slightly fewer ingredients than the Lannett formulation and seems to be the one most commonly used by our members who are tapering diazepam using a commercial liquid.

/Thank  you Libertas.  However, I don't wish to change anything concerning the concentrate that I am on, only because that is what my body is used to.  I just want to reduce with the least possible withdrawl symtoms as i can.  I also believe in the holding aspect of it when i make a reduction in my dose.

[[Ar...]]

Hi Ariana,

Thanks for sharing more information with us! I am glad to hear that you're tolerating your liquid.

 

Libertas raises a good point about considering your future taper rate based on your previous taper experiences, but we do not currently know if your 1mg/month reduction rate was your functional limit or if the 3 month hold was based on recovering your stability. I think it would help us if you could clarify more about your previous tapering experience.

 

Were your previous 1mg/month reductions symptomatic?

Was your 3-month hold an attempt to recovering stability?

Hi SlownSteady, Thank you for getting back to me.  And yes, I am symptomatic every time I make a cut.  I get the nausea, anxiety, and pain especially in my chest area, I have to be very careful because 1 year ago I had 3 stents put into my heart, and valium is a muscle relaxer.  and this last cut i did which was .04 one week, and the next week another .04.  so that is one line on the 1mg syringe 2x a day in one week and another line reduction the next week, and i got alot of pain in my chest from that, and a burning pain in my stomach and spine.

 

And yes my 3 month hold was for stability for the 1mg cuts from 20 mgs that I did until 17 mgs.  so I have one more line to reduce to get to 16 and a half mgs.

[[Ar...]]

Hi Ariana,

 

I hope I have found you? Please let me know by posting here if indeed I have. I'm sorry I could not answer your PM other than to try to lead you here.

 

You are in good hands with slownsteady & Libertas, they are very good with all of this, much better than I would be.

 

I know getting to the right place can be difficult sometimes. If you still have questions, I can try to answer them here and will follow this tread.

 

Thank you, B3NN.  Yes slownsteady and Libertas have been very helpful.  I am hoping we can all work together to find a steady and slow taper for me, i know and realize that no taper is non symtomatic.  all the advice and guidance would be so apppreciated.  Thank you

[[sl...]]

Hi Ariana,

Thanks for sharing more information with us! I am glad to hear that you're tolerating your liquid.

 

Libertas raises a good point about considering your future taper rate based on your previous taper experiences, but we do not currently know if your 1mg/month reduction rate was your functional limit or if the 3 month hold was based on recovering your stability. I think it would help us if you could clarify more about your previous tapering experience.

 

Were your previous 1mg/month reductions symptomatic?

Was your 3-month hold an attempt to recovering stability?

 

Hi SlownSteady, Thank you for getting back to me.  And yes, I am symptomatic every time I make a cut.  I get the nausea, anxiety, and pain especially in my chest area, I have to be very careful because 1 year ago I had 3 stents put into my heart, and valium is a muscle relaxer.  and this last cut i did which was .04 one week, and the next week another .04.  so that is one line on the 1mg syringe 2x a day in one week and another line reduction the next week, and i got alot of pain in my chest from that, and a burning pain in my stomach and spine.

 

And yes my 3 month hold was for stability for the 1mg cuts from 20 mgs that I did until 17 mgs.  so I have one more line to reduce to get to 16 and a half mgs.

 

Hi again Ariana,

Good to hear back from you! Thanks for telling us more about your symptoms when you take reductions. It sounds like your recent weekly reductions have been very uncomfortable. You said that you reduced by "one line on the 1mg syringe 2x a day in one week and another line reduction the next week", but you said this was 0.04 one week and 0.04 another. These numbers don't make sense to me.

 

I understand that you have a 5mg/ml solution of diazepam and you're reducing by using a 1ml syringe with 100 gradations. Each line (of 100) on that syringe measures 0.05mg of diazepam with your current liquid. So if you reduced by "one line" 2x per day, that's a reduction of 0.1mg diazepam (2 x 0.05mg = 0.1mg).

 

I had suggested a reduction rate of 0.08ml per week, which would be 0.04ml per dose or 4 lines less per dose from your previous 1.7ml twice daily dose, which is 1.66ml per dose the first week and then 1.62ml per dose the next week. This suggestion was based on a suggested current 3%/week reduction i.e. a 6%/2 week reduction rate i.e. a 12%/month.

 

Where we left off Libertas had raise an important concern about your previous reduction rate of 1mg/month and trying to move forward at a slower rate for better functionality. I would not have stuck with this reduction rate suggestion had you given us more information.

 

Unfortunately I am unclear as to how much you've actually reduced since then. If it was 1 line per dose per week, then you'd have reduced from 1.7ml/dose to 1.68ml/dose over two weeks, a 0.6%/week reduction rate i.e. 1.2%/2 weeks i.e. 2.4%/month. This is a very slow rate of reduction, and I'm surprised that you had such severe symptoms.

 

From what little I've read about stents, heart disease and diazepam, it seems like the known risks are associated with continued use of diazepam, not with dosage reductions. Although of course dosage reduction comes with it's own problems.

https://www.ehealthme.com/ds/valium/stent-occlusion/

https://pubmed.ncbi.nlm.nih.gov/993359/

 

Could you clarify the reductions you took the last couple weeks?

What amount are you currently dosing? 

 

_{Edit: Typo}

[[Li...]]

I understand that you have a 5mg/ml solution of diazepam and you're reducing by using a 1ml syringe with 100 gradations. Each line (of 100) on that syringe measures 0.005mg of diazepam with your current liquid. So if you reduced by "one line" 2x per day, that's a reduction of 0.01mg diazepam (2 x 0.005mg = 0.01mg).

 

Wouldn’t one line on a 1mL syringe with 100 gradations equal 0.05mg of diazepam (5/100 = 0.05)?

 

 

[[sl...]]

Wouldn’t one line on a 1mL syringe with 100 gradations equal 0.05mg of diazepam (5/100 = 0.05)?

 

Yes, that's correct. My mistake; thanks Libertas. I think the rest of my post, percents and what not, are still accurate. Please let me know if I made any other mix ups. 

[[Ar...]]

Hi slownsteady, and liberatas,

I am now on 16mgs of the diazepam.  The 02 reductions twice a day on the 1mg syringe every 3 weeks is still making me very symtomatic.  I have not started using the the 100 graduation syringe as of yet.

 

Please give me a reduction plan on the 100 syringe that i could be less symtomatic.

 

I need your help, please.

 

Like how much to reduce at each dose, and how long do I hold at each reduction.

 

Thank you

[[Li...]]

Hello again, Ariana. 

 

Am I understanding correctly that you have been using a syringe with 50 graduations (not 100 graduations) to measure your doses? If so, then each line on the syringe equals 0.1mg of diazepam.

 

If you have been reducing both of your doses by one line (0.1mg), you have been making a 0.2mg reduction in dose every 3 weeks.

 

That may be too large of a reduction for you.

 

As a next step you could try using the 1mL syringe with 100 graduations.  Each line on that syringe would equal 0.05mg of diazepam.

 

If you reduce both of your doses by 1 line on the syringe with 100 graduations, your total reduction in dose will be 0.1 mg.

 

Given that you are using the concentrated liquid for your entire dose, I wonder if the liquid itself might be contributing to your issues?  You indicated earlier you could not tolerate polyethylene glycol (PEG).  The liquid you are using contains PEG as well as propylene glycol, alcohol (19%), D&C Yellow No. 10 aluminum lake, succinic acid, and purified water.

[[Ar...]]

Please someone help me with a taper plan.  I am down to 16mgs from 20 mgs. I am presently deducting 02 (1 line) twice a day from a 1mg syringe, and I am still having a hard time even with holds.  Please help.

[[Ka...]]

Ariana, you can hold as long as you need to during your taper.  A taper plan is an individual thing and everyone needs to do it in a way that works for them.  So if you are struggling with holds, perhaps you need to hold a bit longer?

 

I'll give you a link that you may find helpful.  This is a water taper and I don't know what sort you are doing but there may be info here that you will find useful:

 

 

It would be nice if you could update your signature to let us know exactly how you are tapering i.e. water, milk, compound pharmacy or manufacturer solution?  At what rate are you tapering?

[[Li...]]

Hello, Ariana.  Did you see my reply on your other thread? If not see, below.  I agree with Kate08, it would be very helpful if you would update your signature.

 

Hello again, Ariana. 

 

Am I understanding correctly that you have been using a syringe with 50 graduations (not 100 graduations) to measure your doses? If so, then each line on the syringe equals 0.1mg of diazepam.

 

If you have been reducing both of your doses by one line (0.1mg), you have been making a 0.2mg reduction in dose every 3 weeks.

 

That may be too large of a reduction for you.

 

As a next step you could try using the 1mL syringe with 100 graduations.  Each line on that syringe would equal 0.05mg of diazepam.

 

If you reduce both of your doses by 1 line on the syringe with 100 graduations, your total reduction in dose will be 0.1 mg.

 

Given that you are using the concentrated liquid for your entire dose, I wonder if the liquid itself might be contributing to your issues?  You indicated earlier you could not tolerate polyethylene glycol (PEG).  The liquid you are using contains PEG as well as propylene glycol, alcohol (19%), D&C Yellow No. 10 aluminum lake, succinic acid, and purified water.

[[Pa...]]

Hello Arianna, I've merged your two taper threads into one, its better to keep the information in one place so others can know what's been suggested and for you to refer back to. 

 

I see others have requested you provide us a signature so we can see at a glance what your medication history is as well as your current taper schedule.  Here are the instructions but if you need help just reply here with your details and a team member can put it into your signature for you. Add your history/signature