Need advice on Ativan to Valium crossover

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Sorry to be confusing I’m not too well today

Correction combining mid day dose into the evening and morning

So 1.5 morning and 1.5 night

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Hi Slow I updated profile, feeling somewhat stable but also feel sedated and somewhat depressed which sucks. I don’t know if waiting will stop the depression or not. I am also taking 30mg mirt at night which really sucks since it adds to the sedation. Want to get off of it but worried about more w/d

Also not sure what to cut yet, i hope when cutting it lessens the sedation and depression. I was initially thinking .25 off the night and morning doses or cutting mid day dose by .5 and combining the remainder of the mid day dose of .5 into the morning dose so I would have 1.5mg night and (EDIT)1.5mg day. So tired of all this

Also my psych wants to reduce mirt and welbutrin and add some other anti-dep to help with the withdrawl. To me I don’t think Ad’s work and add more potential for side effects and wd.

 

Hi Joeb,

It sounds like you're experiencing some noticeable depression. I've heard that this often passes with continued use of diazepam; if you can, I suggest being patient while your body adjusts.

 

I agree with your concerns about adding more psyche drugs to the mix, specifically ADs; I would be especially cautious about starting an SSRI due to the initial increase in anxiety and the potential for another long withdrawal recovery process.

 

Judging from the tone of your last three posts, I think you'll see the most improvement by just spending more time to stabilize on diazepam. I do not suggest making a reduction from 3.5mg -> 3mg at this time; I would be wary about even moving my doses around in the day, since my personal experience has been that at least with clonazepam this caused me a period of increased instability.

 

If you can, I suggest holding tight and not adjusting anything, maybe for 2 weeks or until you're noticing significant mood and functionality improvements. If you feel too sedated, I suggest considering slowly reducing your mirtazipine dosage to see if this yields improvements.

 

These are just my suggestions for you to consider. I support whatever decisions you make.

 

Also you can press "Modify" in the upper right hand side of any post and change what you wrote for corrections or clarity.

 

Let us know if there's any way we can help.

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Thanks Slow appreciate your perspective as always. Thanks also for the tip on modifying I will do that in the future. It’s really hard for me to distract myself since I am retired. There’s a lot of things I could do but being depressed makes it hard and not enjoyable, and in particular with friends. I still can’t go to the I.e. grocery store but do force myself to go to the gym most mornings as well as acupuncture which I’m still not sure it’s helping but does get me out of the house. Even while in this transition which is no where as bad as cutting the Ativan I’m still not my old self. I really pray and hope this tapering works out better and I plan to try to be more patient.

I read some of your posts on going to liquid Valium and the challenges not only with switching to liquid but also the challenge of daily tapering with a long acting benzo like Valium. Makes a lot of sense. I’m hoping that I can dry cut and hold for a while with keeping functional through the with-drawl.

Gets to be very overwhelming and disheartening going sideways on a crossover not feeling like I’m making progress but in a way I am. Thanks again, is awesome how you are willing to help people even while you are going thru this nightmare also

I do have another question if u don’t mind. I get concerned that the time spent tapering adds to time on the drugs making it harder to get off the drug as well as increasing the possibility of post withdrawl symptoms. Is there any truth to this?

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Hi Joeb,

I truly believe that you are making great progress, and I am encouraged by your plan to practice patience. I am very familiar with the frustration of losing functionality while making sacrifices and working hard to feel better; these learning experiences for me have proven to be both necessary and extremely valuable in my journey, though this was very hard to see at the time. I am celebrating your ongoing bravery.

 

I get concerned that the time spent tapering adds to time on the drugs making it harder to get off the drug as well as increasing the possibility of post withdrawl symptoms. Is there any truth to this?

 

Well, I'm someone who wanted off of benzos after the second week, and I'm in the middle of a 2-3 year slow taper. Am I increasing my physical dependence and risking protracted withdrawal symptoms by tapering at a rate that usually supports me in being high-functioning and otherwise offers a relatively quick stabilization? I don't think so.

 

I find protracted withdrawal symptoms to be nebulous. I don't think this is because we lack descriptions of buddies struggling with these symptoms, but because I don't know where one can draw a line between what was caused during benzo use or recovery, and what is maintained by ongoing or underlying sources of neurological instability.

 

For anyone concerned about protracted withdrawal, I suggest considering that it might not be caused by benzo usage specifically but instead by neurological instability, for which one source can be poorly tolerated benzo dosing or adjustments.

 

It's my opinion that there are many sources of neurological instability in life and combined with the impact of benzo usage these could lead to ongoing symptoms. I believe that tapering benzos or other psyche drugs as gently as possible while focusing on developing stabilizing life-skills is as much as we can do to mitigate this risk.

 

I hope this helps! 

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Thanks for the kind words slow. I am truly super worried on how to approach my taper. I think microtapering daily sounds like a good way to go but not 100% sure. Dry cutting and holding on Ativan didn’t work I had very bad withdrawl mostly the entire 3 months. I know the Valium has some qualities that are better but nervous on how to approach it.  DLMT all sounds so complicated. and microtapering with theses inaccurate scales doesn’t sound good either.

I’m really lost Slow I am so frustrated and feel hopeless. This is not really me at all.

 

 

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Hi slow need your help...So my doctor agreed today to prescribe liquid Valium. I need help setting up a slow DLMT plan that will allow me to remain functional as well as be able to make progress. I would like to use a combination of tablets and liquid for the taper. My doc wants me to transfer to complete liquid.

Not sure this is a good approach. Need some advice on how to approach this. Need to simplify this so that it doesn’t encompass my entire life like it has been. My inclination is to merge to 1 dose at night and taper a portion of the tablet dose using liquid.

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Hi Joeb,

Have you stabilized on diazepam yet? Are you meeting your functionality goals?

 

Often while I've been unstable it's been difficult to make decisions. Once I recognize the largest problem is instability, I find I am in a much better place because my decisions get a lot simpler: all I need to do is hang out at my current dose and dose form until I see improvements. In my experience there's been no prize for rushing to make decisions and dosage changes while I'm unstable.

 

I think that at 3.5mg/day of diazepam, you're well within a range for which using liquid by itself might be the simplest long-term solution, if it's well tolerated. What is your reluctance to transitioning, slowly and step-wise, to dosing completely with liquid?

 

You also mention combining all your doses to a single nightly dose. This could also be a great long-term strategy, again, if it's well tolerated.

 

I suggest focusing right now on holding on tablets and improving your stability on diazepam. I thin that both of the courses of action you're consider, a liquid trial and a dosage schedule adjustment, carry a significant risk of increasing instability and symptom intensity on the short term. I suggest putting these decision off for a little longer while monitoring your functionality and symptoms.

 

Are you hoping that one of these changes you're considering will alleviate some of the symptoms you're currently experiencing? From my perspective you've just made a HUGE adjustment, switching between two significantly different benzos. This is an incredible accomplishment, something that other buddies are unable to do and which may have caused your body more distress than you realize.

 

It would make sense to me that you would be experiencing an ongoing period of discomfort and this can take the form of both increased anxiety and depression, among other things. In my experience depression and anxiety can lead to poor decision making; I think this is probably the most difficult and perhaps dangerous part of tapering psyche drugs. When I lose the ability to make good tapering decisions, I think it's important to be extremely cautious about making any changes.

 

If you're open to it, I suggest congratulating yourself on all the progress you've made during this crossover, taking time to visualize yourself as successful and very fortunate to be where you are now. I also suggest visualizing your symptoms as signs that your body could use more time, and putting aside fantasies of quick relief or rapid improvements.

 

You seem to be very strong Joeb. This is no doubt a challenging time, but you have come so far. I trust whatever decision you make will be the best for you, and I only suggest putting your decision-making ability in the context of ongoing instability. Time may be all you really need to continue to recover your functionality at this point. 

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Hi Slow, thanks for the very considerate and meaningful reply....to answer your first 2 questions I’m really not sure what stability is and if I can realistically get it. On the Ativan I only had 2 days out of 3 months that I felt close to my old self. I wonder If it’s possible to have that and taper. I am way better now than I was; getting to the gym more regular and don’t have the burning anxiety. I do feel sedated and somewhat depressed but it is hard to say if it’s from the meds, being sedated, the situation I’m in, boredom, or a combination of all. My stability goal would be to like the 2 days on Ativan I described above but not certain it’s attainable and still taper.

Agree with you on the decision making relative to stability. I am concerned staying on the medication too long will make it harder to get off. I am also concerned with the time delay Valium has with w/d

This seem like it wud make it very difficult to do the daily liquid or dry MT

I am in my second week of total Valium and plan to hold as a minimum next week, agree with your suggestions. Just trying to plan ahead but scared of extreme suffering again. Feel very lost and hopeless. What do you think slow?

 

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Hi Joeb,

When you say you're feeling lost and hopeless this sounds to me like depression. I wish I had more time to type or I'd try to get into ideas around how to make room for depression and ideally befriend this experience. But at the very least I want to give this reflection, that you may be struggling with a distorted sense of your situation; things are certainly not hopeless.

 

I think you are right to be concerned about the long half-life of diazepam in the context of a daily micro taper. Some people DMT their diazepam; I do not generally recommend it. Weekly diazepam reductions make the most sense to me, or every other week. If weekly diazepam reductions are too symptomatic, I suggest lowering the size or percent of reductions not the hold period.

 

Here are my opinions on stability...

The term stabilizing is, in my opinion, a downward trend in symptoms of neurological dysfunction. I'm "stabilizing" when my trend in symptom intensity is decreasing (or I've set myself up for this result). I consider myself "stable" or "stable enough" when I'm meeting my functionality goals.

 

I consider "functionality goals" to be the most important taper-adjustment metric for symptom-based tapering. I'm not sure if others have used this term before me, but it is the foundation of my taper.

 

To begin I set highly personal goals for the minimums of functionality in my life using, whenever possible, quantifiable metrics such as hours of sleep, calories of food (which I simplify to meals-per-day), pounds of body weight, duration of gentle exercise, etc. Some important functionality goals are not easily quantifiable, such as appetite, work performance, social enjoyment, and familial responsibilities; for these I am limited to qualitative measures, which can be measured as a yes/no or a better/same/worse for record-keeping.

 

I've found that functionality and thus stability are highly personal and highly subjective metrics, naturally. We are each living unique lives, and I think it's very important in symptom-based tapering to establish decision-making tools like personal functionality goals to help us plot a meaningful course through our individual circumstances.

 

Just a suggestion, but you might want to consider leaving your "old self" behind; I don't think this journey is without purpose. I believe you are learning and growing, and what you may have thought you were or thought you could become are falling away, like children's books you've outgrown but still remember enjoying. Perhaps it's time to tell a new story, and lean into this process of transformation and rebirth.

 

IMO, anxiety and depression perspectives hinge on outdated fantasies. I've found the habit of clinging to old ideas about safety, control, and intended outcomes, amidst life's sea of changing and mysterious possibilities, to be recipe for dis-ease. Something new is happening today; maybe there's a way that you can find and celebrate this mystery. A little creativity perhaps?

 

Do you have personal functionality goals to meet your minimum needs and responsibilities?

If so, are you meeting them?

Lastly, would you rather transition to liquid first or combine your doses first?

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Thanks Slow,

A lot of good perspectives. So much to think about I agree depression is keeping me from my goals but don’t know if it will ever go away on this crossover hold. Sedation making it worse. I’m very worn out and down in the dumps.

Would like to be able to go out and do things without having that gut wrenching depression. I think combining doses but not sure what’s best.

Liquid may take awhile to get

What do you think?

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Hi Joeb,

I hear you are feeling down in the dumps right now. I appreciate your patience in considering your options; I forgot mention how impressed I am that you're able to get to the gym more regularly.

 

After your able to meet your basic functionality goals, I suggest consolidating your doses. I think moving them to the PM would help relieve some of the day-time sedation and might help with your depression as well. You may experience more day-time anxiety, but I think still think consolidating your doses is worth a try; if day-time anxiety remains problematic, moving back a small portion for a single AM dose might help you feel more comfortable.

 

I suggest moving your daily doses to the PM in two or three steps, just to give you a chance to get used to the new blood serum levels; hopefully you'll see functionality improvements with each step. I suggest at least 2-3 days between each step for self-observation and to decide if and how to proceed.

 

Here's an example of how you might make this step-wise dose schedule change; in this example I very quickly got rid of your 0.25mg dosage intervals for ease of dosing with 2mg tablets.

 

Start: 1.25V 9am, 1.0 V 3pm, 1.25V, 9pm

Step 1: 1V 9am, 0.5 V 3pm, 2V, 9pm

Step 2: 1V 9am, 2.5V 9pm

Step 3: 3.5V 9am

 

Trialing liquid can be a slower transition, and may not be useful in addressing your present discomforts. But I think liquid could be a really valuable dose form when it comes to taking well-tolerated reductions. I suggest crossing that bridge when you're ready for reductions. A careful liquid diazepam trial, IMO, involves multiple steps and a week or more between steps; if you want a slow transition to liquid then having sufficient tablets on hand for this part of the journey could be very helpful. Some people just jump to liquid all at once and hold until they're stable again; that's an option as well, and one with less fussing and no need for a tablet reserve.

 

Keep up the great work! 

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Thanks so much slow you are truly a compassionate and considerate person. Your replies and perspectives truly help me try to cope. I really am having a hard time with all this...you make a lot of sense in what you suggested. Was wondering do you think possibly maybe I’m taking too

much Valium and cutting a small amount might help? Like .25 from the night or day dose?

 

On a separate note I really am concerned with how to safely use the liquid. If smaller doses are required to taper will I have to dilute it? And is it better to go all liquid vs tablets and liquid ?

Sorry for so many questions I’m just worried about doing it correctly

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Hi Joeb,

You might be taking too much diazepam. But I suggested first moving your blood serum peak to the night because this seems a less risky adjustment to me at your current dose; if this isn't enough then yes, the next thing I would suggest trying would be a gradual reduction in dosage. As I've mentioned before, many taperers crossing to diazepam experience increased sedation and depression initially; sometimes the solution to this is just time.

 

Taking a reduction now could help, but I think it's a gamble and in some cases this has been a very uncomfortable mistake. From what I've learned on the forum, making a crossover can be very confusing; the new medicine can be so unfamiliar that it seems like signs and symptoms that meant one thing on the previous benzo can have a very different effect on the new benzo.

 

For example, if you're actually still stabilizing and learning to how to dose and tolerate this new drug, a reduction in diazepam could actually increase depression and add other symptoms like increased anxiety, insomnia, etc. There's no way for me to know what will happen for you, so I'm just suggesting making adjustments in an order from what I consider least to greatest risk of neurological instability.

 

Of course, what you do is entirely up to you! You have to live with the consequences of these decisions, and I think what you learn will be the most valuable tool on this journey of yours.

 

Regarding liquids I think there is a 1mg/ml diazepam liquid available (labeled 5mg/5ml I think), but if not then I think the other common concentration is 5mg/ml. Even 5mg/ml can be reduced by 0.05mg intervals with a 1ml syringe with 100 gradations (a common tool, usually supplied with the liquid). I do not think dilution will be required with either concentration if you want to take once-weekly reductions.

 

I think transitioning to all liquid, if it's well tolerated, will make your life much simpler. But if you're doctor is willing to prescribe tablets and liquid concurrently and you feel more comfortable with this approach, then it could work. The only potential issue I see with dosing both tablets and a commercially manufactured liquid is that they might not be bioequivalent; with diazepam this may not be a problem but with clonazepam I've noticed this mismatch caused some tapering issues and I've switched back to liquid from tablets. If I was on a much lower dose (like you are) and a commercial liquid form of clonazepam was available to me and well-tolerated, I would switch to liquid entirely for my reductions to avoid this bioequivalency issue.

 

I think you will inevitably make mistakes while tapering (I've made plenty!); "doing it correctly" only seems to come with practice. My suggestions are only my best ideas for how to help reduce any harmful impact of your trials and discoveries. But you can do this! One step at a time.

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Hi Slow, I have yet to make any changes, wanted to wait it out and see what the current week brings. It seems like the days are improving and today I felt an incredible window to which I was able to enjoy the entire day free of depression and anxiety. I understand things can change at any time with benzos but it kind of puts me in a quandary of what to do. I think modifying consolidating doses as you suggested is a good idea, makes it easier to just dose twice or once a day rather than 3. I don’t like having to dose 3 times a day, but what is best for my stability I don’t really know.

 

It’s kind of a tease feeling good, makes me not want to go back to suffering again. But then again I am concerned with staying on the medicine too long and not reducing. I know you addressed this in a pre ious post but long holds scare me of getting tolerant or making it harder to come off the drug later.

 

Tapering tablets down to 1 mg seems much less complex than liquid if the cuts are small enough to maintain my stability but I won’t know for sure if I try. 

 

Also

I thought that going to Valium wud make it easier since the cut on Valium is much smaller than an Ativan cut due to the strength ratio which I thought was another good reason for crossing over in addiction to the longer half life. The smallest accurate dry cut I can make is .25 using combinations of my 2mg and 5mg tablets... but I see many bb’s having issues even with these “small” cuts.

 

I really want to maintain functionality/stability and go slow but not sure where to start.

Liquid scares me some in getting accurate readings on the syringe, and not screwing up the dose.

That’s why 1 dose a day wud help reduce that risk

Btw the liquid arrived yesterday unexpectedly but without syringes or adapter cap. I know I can get from pharmacy.

 

Also I really wud like to reduce the Remeron because it doesn’t appear to be doing anything but increase the sedated feeling. But I know it’s not good to change too many things but also concerned on being on that MED too long too.

 

Sorry about writing so much I’m just not sure what to do at this point

 

 

 

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Hi Joeb,

Sometimes just writing out my options can help me to make better decisions; this is your taper support thread so whatever you want to share about your tapering process is welcome.

 

I'm really glad to hear that you've held long enough to enjoy a window of stability. I know holding has felt like a gamble, so I'm relieved that your patience has paid off. Yes, it probably won't be consistent, but I expect the trend during this short holding period will be regular improvements. Windows are a very good sign IMO.

 

I think you might be making things harder for yourself by fixating so much on the nebulous potential for tolerance and increased physical dependence while slow tapering. The greater challenge, in my experience, is establishing and maintaining stability while taking reductions; stability IMO ideally comes first, and then begins the dance of how to slowly reduce while maintaining functionality.

 

Fear of tolerance, paradoxical reactions and increasing physical dependence has, in my experience on the forum, led to some very poor tapering decisions and declining health for other buddies. And from my distant vantage, these consequences too often appear self-inflicted.

 

I understand wanting to take a dry cut for your first reduction. It would be simpler if you could tolerate this reduction method, and if you can reduce by 0.25mg/week that might be a safe place to start; it's not a very flexible option though. I'm not sure there's much point in doing this if you can tolerate the liquid that's available to you. It sounds like you may need the liquid for some portion of your taper, and it also sounds like the newness of it is your largest concern. In my experience dosing liquid is very easy, provided you have a quality syringe and a syringe adapter.

 

I've never used a commercially manufactured benzo solution before; there isn't one for clonazepam in the US at this time. Are you saying your pharmacy was unwilling to provide a syringe and syringe adapter? This seems to me like they made an oversight; I would call and ask why they provided a liquid medicine without the tools necessary to use it. Hopefully it was a mistake they will correct. What was the concentration of the liquid?

 

It sounds to me like your next step is either moving your doses around in the day or titrating your mirtazapine dose; personally I'd consider leaving the mirtazapine alone, especially if I was only dosing it at night. I'd be inclined to wait until the end of my taper to titrate mirtazapine if I was tolerating it because I wouldn't know whether the diazepam or mirtazapine was causing my symptoms of increased sedation, and I would focus on adjusting my dose schedule of diazepine.

 

Suffering is unavoidable. But then, so is adaptation and skill-building.

What do you want to do next? 

[[Li...]]

Hello Joeb.

 

We have many members who have used/are using the FDA-approved, commercially manufactured 5mg/5mL oral solution of diazepam to taper.  You can read about their experiences plus connect with currently active members via the Valium/Diazepam Support Group at:

 

http://www.benzobuddies.org/forum/index.php?topic=96753.msg1238323#msg1238323

 

You also might find it helpful to read through past posts by members Momof7babes and/or kitsune556 to learn about the procedures they follow to dilute and use the 5mg/5mL solution.

 

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Thanks Libertas I'll definitely check it out, not comfortable with liquid and reading syringe lines, hopefully i can figure this out.

[[Li...]]

You are welcome, Joeb.  Here are two tutorials about syringes and how to use them that might help:

 

Using Syringes | The Withdrawal Project

https://withdrawal.theinnercompass.org/taper/using-syringes

 

How to Read Syringes: 8 Steps (with Pictures) - wikiHow

https://www.wikihow.com/Read-Syringes

 

 

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Thank you Libertas this is great info

Trying to come up with the most simplified approach to this.

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Hi Joeb,

Sometimes just writing out my options can help me to make better decisions; this is your taper support thread so whatever you want to share about your tapering process is welcome.

 

I'm really glad to hear that you've held long enough to enjoy a window of stability. I know holding has felt like a gamble, so I'm relieved that your patience has paid off. Yes, it probably won't be consistent, but I expect the trend during this short holding period will be regular improvements. Windows are a very good sign IMO.

 

I think you might be making things harder for yourself by fixating so much on the nebulous potential for tolerance and increased physical dependence while slow tapering. The greater challenge, in my experience, is establishing and maintaining stability while taking reductions; stability IMO ideally comes first, and then begins the dance of how to slowly reduce while maintaining functionality.

 

Fear of tolerance, paradoxical reactions and increasing physical dependence has, in my experience on the forum, led to some very poor tapering decisions and declining health for other buddies. And from my distant vantage, these consequences too often appear self-inflicted.

 

I understand wanting to take a dry cut for your first reduction. It would be simpler if you could tolerate this reduction method, and if you can reduce by 0.25mg/week that might be a safe place to start; it's not a very flexible option though. I'm not sure there's much point in doing this if you can tolerate the liquid that's available to you. It sounds like you may need the liquid for some portion of your taper, and it also sounds like the newness of it is your largest concern. In my experience dosing liquid is very easy, provided you have a quality syringe and a syringe adapter.

 

I've never used a commercially manufactured benzo solution before; there isn't one for clonazepam in the US at this time. Are you saying your pharmacy was unwilling to provide a syringe and syringe adapter? This seems to me like they made an oversight; I would call and ask why they provided a liquid medicine without the tools necessary to use it. Hopefully it was a mistake they will correct. What was the concentration of the liquid?

 

It sounds to me like your next step is either moving your doses around in the day or titrating your mirtazapine dose; personally I'd consider leaving the mirtazapine alone, especially if I was only dosing it at night. I'd be inclined to wait until the end of my taper to titrate mirtazapine if I was tolerating it because I wouldn't know whether the diazepam or mirtazapine was causing my symptoms of increased sedation, and I would focus on adjusting my dose schedule of diazepine.

 

Suffering is unavoidable. But then, so is adaptation and skill-building.

What do you want to do next? 

 

Hi Slow, I called and they do not supply syringes or adapter cap. Some of the local pharmacy’s don’t really have what I think I need either. My quandary is also finding a syringe with graduations that can be easily read without having to dilute the liquid. From reading on bb I may have to dilute it any way due to its thicker viscosity and taste. The 3 mg portion shouldn’t be hard but cutting from the .5 mg portion will be if I go with very small cuts Also not sure of taper plan yet, where to start.

The 1ml syringes on your tools link look hard to read but maybe just the photos on Amazon are not good

So... question - since Valium is low potency a .25mg cut would be considered small in comparison to Ativan correct?

I agree I need to decide on whether to dose 2 or 1 time per day.I wonder if dosing all at night if the Mirt combined will add to my sedated feeling in the am. Also with 1 dose will w/d be worse than with 2 doses. Not sure how to approach this

 

I think your right I need to write everything down and pick a plan

Sorry I’m all over the map on this, your help is greatly appreciated

 

Btw you were right today was not as good as yesterday but not as bad as Ativan

Hey Slow haven’t heard back from you hope your doing ok

[[sl...]]

Hi Slow, I called and they do not supply syringes or adapter cap. Some of the local pharmacy’s don’t really have what I think I need either. My quandary is also finding a syringe with graduations that can be easily read without having to dilute the liquid. From reading on bb I may have to dilute it any way due to its thicker viscosity and taste. The 3 mg portion shouldn’t be hard but cutting from the .5 mg portion will be if I go with very small cuts Also not sure of taper plan yet, where to start.

The 1ml syringes on your tools link look hard to read but maybe just the photos on Amazon are not good

So... question - since Valium is low potency a .25mg cut would be considered small in comparison to Ativan correct?

I agree I need to decide on whether to dose 2 or 1 time per day.I wonder if dosing all at night if the Mirt combined will add to my sedated feeling in the am. Also with 1 dose will w/d be worse than with 2 doses. Not sure how to approach this

 

I think your right I need to write everything down and pick a plan

Sorry I’m all over the map on this, your help is greatly appreciated

 

Btw you were right today was not as good as yesterday but not as bad as Ativan

Hey Slow haven’t heard back from you hope your doing ok

 

Hi Joeb,

I like your recent motto: "not as bad as Ativan". I know things are still difficult but at least things are improving!

 

I find it truly bizarre that a pharmacy would supply a liquid medicine without any tools to dose it. It's like they're a product distributor and not an actual pharmacy... but like I said before, I've never received a commercially manufactured solution from a basic drug store so maybe this is more common than I realize.

 

It sounds like you'd benefit from putting your ideas down, like you describe, on a piece of paper or similar; setting my priorities/timeline really helps me to tackle things one at a time and make progress. Analysis-paralysis is real.

 

What is your next step? Is it dosage schedule adjustments? Or something else?

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Hi Slow good to hear from you again. I am not sure exactly what I want to do. Here’s my quandary:

I am feeling stable finally. I am taking 1.25V at 9pm, 1.25V at 9am, and 1.0V at 3pm. The night dose pretty much carry’s me to the morning only sometimes mild depression but lately none. The morning dose takes me thru the day to the point that I don’t feel like I need the midday dose. I like the stability I have but also want to start reducing. Before going to liquid I would like to get to 1.5 morning and night without a midday dose but not being familiar with Valium I don’t know how the cuts would feel. I was originally thinking of taking first .25 off the morning dose. See how it goes then take .25 off the night dose and see how that goes. Then if good eliminate the midday dose by splitting it between the morning and night doses to get 1.5 and 1.5. I can do this since I have the 5mg pills.

If I try to reduce the midday dose instead of the above it’s harder to do since splitting a 2mg pill into .25 is much harder.

What do you think about this? Do you know of a better approach? I know there is no perfect answer but I want to maintain stability and go slow this time around but the unknowns of Valium scare me.

 

Also still feeling sedated in the morning

[[sl...]]

Hi Joeb,

My approach would be:

1) Dosage schedule adjustments

2) Liquid trial and transition

3) Symptom-based tapering

 

My opinion is to consolidate doses through schedule adjustment, not tapering; I'd find this easier to implement, easier to monitor, and I wouldn't get stuck with tapering options based on my tablet sizes. At 3.5mg/day I'd be looking at titration options for tapering. I would want to taper slowly with percent-based once-weekly reductions adjusted to minimize symptoms and maximize functionality, ideally by using something as flexible as a liquid form of the drug.

 

This is just what I would be considering. I support whatever you decide to try.

 

It sounds like your body is asking for a different distribution of medicine than your current dosing schedule. What is your reluctance to moving your dose portions around in the day to better match your needs?

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Hi slow, to answer your question my hesitation is that maybe I’m stable now with some contribution of dosing 3 times a day and I’m at a low total dose so at a near to be determined point having 3 doses would mimimize interdose w/d, but I’m not sure. I would much rather dose once or twice a day instead of 3 for convenience. I wrote down all the options it helps but still having a hard time on what to do.

Just curious was is your daily dose scheme.

How wud you envision a transfer to liquid stepwise?

 

 

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My dosing schedule is described in my signature.

 

If I was on 3.5mg/day and wanted to trial and transition to liquid diazepam I would be looking for 2-4 steps, with a hold time long enough to realize and recover from any withdrawal symptoms. I would consider replacing 1mg at a time with liquid and holding on that portion for 2-weeks to adjust, then replacing the next 1mg with liquid and holding again, and so on. I would also consider the dosing schedule and dose amounts to try to make this easier on myself, perhaps switching a whole dose at a time instead of just 1mg amounts.

 

Unless you have interdose w/d right now, I wouldn't take this concern too seriously. In my own taper I prefer to make small, safe adjustments, monitor my body over a sufficient period of time and then adapt methodologies based on what's actually needed or tolerated; I find that this works much better for me than trying to consider every possible outcome without feedback.

 

You'll get this.