Need advice on Ativan to Valium crossover

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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. 

Thanks Slow, this makes alot of sense, your perspective is always appreciated.

i have another question, the syringes that you use from your tool list. Why do you like them? they look hard to read from the online photo

Some other BBs have recommended the BD 30517. What do you think?

 

                                                                   

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Thanks Slow, this makes alot of sense, your perspective is always appreciated.

i have another question, the syringes that you use from your tool list. Why do you like them? they look hard to read from the online photo

Some other BBs have recommended the BD 30517. What do you think?                                                               

 

The syringes I link to match the quality of 1ml syringes I've received with my compounded medicine. They're easy for me to read and fit snugly in all the syringe adapters I've used.

 

Perhaps the best way to know what will work for you is to see these syringes in person. I think 4 are only like $7 or something. 

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Hey slow wud like your feedback on this. When i first considered switching it made alot of sense with the weaker and longer half life benzo in theory tapering from this level (3.5V vs .375 A) on Valium that larger cuts can be made with less sxs due to the comparison. But from reading the forum this does not appear to be the case. It just seems almost like starting over. i understand that the sxs are smoother but getting back down to the lower doses seems far in the distant future. I know i should be more positive but my experience on Ativan was hell. I'm still trying to figure out my taper plan, since originally I had planned to cut by at least .25 which according to Ashton is .025Ativan a small hard to dry cut amount. My smallest cut on Ativan was .125 due to pill size. Do you have any thoughts on this?

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Hi Joeb,

In my opinion a successful taper plan is actually a nervous system recovery plan. I set my goal at nervous system care and recovery, not tapering.

 

I read posts from so many buddies who are fixated on the numbers; I think my successful tapering is really just one small step at a time, while looking for the best opportunities to heal my nervous system.

 

Taking a steady, long-term dose of a potentially neurotoxic chemical like a benzodiazepine does not meet my goal of nervous system care and recovery, but the impact of rapid tapering or numbers-based tapering also won't meet my goal. Thus there are times in my taper when I don't taper; there have even been a few times in my taper when I've gone up in dose (not exactly tapering!). My priority is my nervous system, and I measure this system with functionality goals; I think that as a result of this approach, my taper has been very successful thus far.

 

I think you made a somewhat risky decision switching to diazepam, but it sounds like it has paid off and will continue to benefit you. I do not think you are starting over. I am very confident that you have been taking steps forward.

 

I do not think that diazepam will offer you larger lorazepam-equivalent benzo cuts, a faster taper, or anything like that. I think that the switch comes at the cost of time, slowing you down for a while, but offers the reward of a significantly more stable blood serum level, more convenient drug forms and potentially a faster overall nervous system recovery. I think these benefits can definitely out-weigh the costs for many buddies like yourself.

 

I think I hear you expressing the need for mental health skill-building; tapering is just one part of my tool kit for nervous system care, and I consider how I thinking about myself, how I frame the world I live in, and my place in it, as another huge part of caring for my nerves. IME this kind of skill-building doesn't happen automatically with dosage reductions.

 

I have two basic suggestions for you, besides what I've shared earlier about dosage schedule adjustments and a liquid transition...

 

First, I suggest acting on some kind of mental health skill-building opportunities; books, art, skilled psychotherapy, whatever you can handle; finding "reasonable risks" for therapy, as one of my previous therapists would have put it. Mental health is a big exploration, but it's also an important one that I think some buddies suffer for neglecting while they titrate.

 

And second, I suggest planning only one, singular diazepam reduction for when you're ready, and afterwards holding 2-3 weeks or until you notice a full return to your previous functionality before planning the next reduction. What you plan at that time will then have the benefit of your prior experience.

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Hi Slow hope all is going well with you. I remember seeing a post from you to another buddy regarding DLMT with Valium where you provided sort of a hybrid strategy based on the wd delay of Valium. I can’t seem to find it in the forum search. Could you please explain it to me since it made a lot of sense

And I’m getting ready to start when my daughter leaves next Friday

Thanks as always

Joeb

[[Li...]]

Have you tried this?

 

(1) Click his member name to display his member profile.

(2) Select “Show Posts” from the menu to view his past posts.

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Thank you Libertas.

 

Hi Joeb,

A hybrid approach to a DLMT of diazepam, hm... I was writing someone very recently who had a liquid solution of diazepam and I was suggesting taking weekly reductions. I think this is the same suggestion I gave you earlier in this thread. I'm pretty repetitive!  Or was it something else?

 

Have you taken any steps to transition to your liquid diazepam, or are you going to wait until your daughter leaves for this exploration?

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Hi Slow I decided to wait, she’s leaving Friday.

It was a much older post, I think it was something like taking small daily reductions for a few days then holding til the end of that week to evaluate symptoms but not sure. Does that sound right?

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Hi Slow I decided to wait, she’s leaving Friday.

It was a much older post, I think it was something like taking small daily reductions for a few days then holding til the end of that week to evaluate symptoms but not sure. Does that sound right?

 

Hi Joeb,

Honestly I have no idea what you could be thinking of. I stand by my suggestion to start with weekly diazepam reductions of 2.5%, ideally after making a slow step-wise trial of your commercial liquid solution.

 

I noticed you wrote on another thread asking OregonKatz about her diazepam taper; I'm pretty sure she did a water suspension of deconstructed tablets because she couldn't tolerate the commercial diazepam solution. Hopefully she'll get back to you and tell you more, but that was her journey and you're on yours. It's hard to judge the value of your commercial liquid if you haven't tried it yet...

 

I understand wanting to wait until your daughter has left; however, I am a little concerned that you are struggling with analysis paralysis, and not getting any new personal data to inform your tapering decisions. At some point, I think you'll need to get your feet wet! Life is in motion.

 

Let us know how we can help. 

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I think your correct Slow I’m over thinking and afraid to try anything

Also I think I may have missed a dose last night, omg, and now worried about what to do since I’m not sure. I tried to retrace out my steps but can’t remember. I hate to updose but also don’t want to get hit with wd not sure what to do

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Hi Joeb,

Regarding the missed dose, I suggest just forgetting about it. Either you took it and you'll be fine, or you missed it and you'll be fine. I suggest letting this be a reminder to use an alarm system and to keep some kind of a record of your doses when you take them.

 

For example I have an alarm app on my phone that goes off at 7am and 8pm, once for each dose. When it goes off, it asks me to write "notes" that it logs in a history. I put in "notes" every single time. This morning I dosed and wrote "0.25 0.56ml".

 

This says to me that I took 0.25mgs by tablet and 0.56ml of liquid. I also crossed off the liquid portion from my printed out DMT schedule. I also wrote the full daily dose, 0.6945mg in my daily tapering journal.

 

While some of these steps are redundant, the practice of doing them, especially the phone alarm and "notes" keeps me aware of my dose and requires me to confirm that I took it. You might benefit from creating some kind of similar alarm and record system.

 

In the morning I also put all of my tablet doses in a single separate container; this way if it's missing, I took it, and if it's in there, I didn't. It only took me one day of forgetting if I took a dose to realize the importance of memory support systems!

 

Thanks Slow, should I wait then on trying liquid a few days then just in case

 

I would not bother waiting. You can, of course, do whatever you want to. 

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Hi Slow, things worked out ok with my missed dose thanks again for calming my stress level!!

So I know you provided some suggestions in earlier posts but if you don’t mind I wud appreciate your perspective at this point in time. I’m trying to get past my analysis paralysis

I am stable after 8 weeks ( 5 on complete Valium); I still get some depression at times so wondering if it’s tolerance wd but for the most part stable. I want to maintain my 3 doses. 1.25 9am, 1.0 3pm, 1.25 9pm. I also want to reduce each dose at a time to equal out as I go down.

So my dilemma is first trying a .25mg cut (7%) on am dose to see how I respond to the new med OR

Transition to liquid to see if I adjust to it then start small weekly cuts or DLMT very small amts.

I’ve seen some buddies change over to partial liquid to try it out but not sure of what to do

Sorry I’m so indecisive but would like your thoughts

Joeb

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Hi Joeb,

I'm glad to hear you're feeling stable on the diazepam.  I don't associate occasional depression with tolerance; it could be, but I would be very hesitate to drum up extra anxiety about tolerable symptoms.

 

I understand that you want to keep your three daily doses. I understand that you'd like to start by evening them out, and then reduce equally as much as possible while you taper.

 

So my dilemma is first trying a .25mg cut (7%) on am dose to see how I respond to the new med OR

Transition to liquid to see if I adjust to it then start small weekly cuts or DLMT very small amts.

I’ve seen some buddies change over to partial liquid to try it out but not sure of what to do

 

As long as your tablet and liquid prescriptions are reliable, I suggest doing a phased approach. The first phase, based on your request, could be evening out your current doses. This would be taking your daily doses from 1.25, 1, 1.25 (3.5mg) to 1, 1, 1 (3mg).

 

I would consider doing this with a partial liquid substitution. The issue with a partial liquid substitution is that it may not be a perfect bio-availability match for your tablets, so when switching a portion of tablets to liquid there may be a nebulous dosage adjustment that happens; fortunately with a partial liquid switch this should be a smaller impact than a total liquid switch. Here's what I'm thinking...

 

A suggestion to consider is taking 1mg, 1mg, 1mg in tablets and using the following liquid substitution and liquid taper schedule. If you have 1mg/ml liquid (aka 5mg/5ml or whatever) then 0.25mg = 0.25ml, etc.

 

Liquid Substitution and then Reductions:

Week 1: 0.25mg, 0, 0.25mg

Week 2: 0.20mg, 0, 0.20mg

Week 3: 0.15mg, 0, 0.15mg

Week 4: 0.10mg, 0, 0.10mg

Week 5: 0.05mg, 0, 0.05mg

Week 6: No liquid.

 

The first week is just a hold period to monitor for and hopefully minimize any liquid adjustment issues. Then a suggested reduction schedule of 0.1mg/week split between your first and last dose, at a percent-rate which goes from ~6%/14 days to ~6.6%/14 days over the 6 weeks. I think this is a safe liquid and reduction trial, and if you were to try something like this I suggest at any time you feel unstable to simply hold at your current dose of tablets and liquid until you stabilize.

 

I do not suggest proceeding with reductions unless you're feeling functional dosing the liquid. Because I don't think you have tried the liquid yet, I suggest being observant during the first week for unusual symptoms and if they persist or are severely impacting your functionality, to consider returning to tablets. Not everyone can tolerate the commercial diazepam liquid, but I'm hopeful that you will.

 

Is this approach something you would consider implementing?

Or were you looking to try something else?

 

Let us know! 

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I think I’m going to try it. Thanks for the reply slow. I really need to get off the dime.

I do have one question. There are some bbs that reduce small amounts daily on Valium that will add up to the .1 reduction per week, do you think this practice wud be easier on the CNS? I do understand the downside is the delay in wd effects but wonder if they could be minimized with the daily cut?

This maybe getting ahead of things but if the adjustment to liquid goes well wud I still need to do a step wise conversion to all liquid on the remaining doses?

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There are some bbs that reduce small amounts daily on Valium that will add up to the .1 reduction per week, do you think this practice wud be easier on the CNS? I do understand the downside is the delay in wd effects but wonder if they could be minimized with the daily cut?

 

Hi Joeb,

I believe the small daily reduction amounts you're referring to is a daily micro taper (DMT). I generally do not suggest this for long-acting benzodiazepines, although many buddies have used this approach for them. My concern is that a with a DMT long-acting benzos could be very difficult to control symptomatically.

 

During a DMT, daily reductions accumulate over the half-life of the medication; for desmethyldiazepam (HL ~30-200hrs) this could be over many weeks. If a taperer outpaced themselves taking daily reductions of a drug like diazepam I think it's possible they wouldn't realize it for a month or more, and then holding to recover from from this error could take another month or more; this is a worse case scenario, but I think something similar has happened to buddies and could create very discouraging and uncomfortable period of recovery. I think even a significant updose would be slow to remedy such an outcome, because long-acting benzos accumulate slowly.

 

I have been using a DMT for tapering a medium-to-long-acting benzo myself (clonazepam), and I have had to be very attentive to early symptom intensity and hold as soon as possible to minimize my recovery times. As a result of my learning process, I have spent sometimes a whole week in dysfunction just waiting for my previous reductions to pass and my nerves to recover. I would not like to have the same experience on diazepam; I suspect that learning process would be even more confusing and uncomfortable.

 

I'm suggesting a weekly diazepam reduction rate, knowing that it's probably not quite long enough to realize each reduction; it is like a DMT in this way, and may have some of the same delayed impact and recovery I described above. But I think smaller, more frequent reductions are generally better tolerated, so my opinion is that weekly reductions could be a good compromise between the problems of daily reductions and the problems of bi-weekly or monthly reductions of long-acting benzos.

 

This maybe getting ahead of things but if the adjustment to liquid goes well wud I still need to do a step wise conversion to all liquid on the remaining doses?

 

IMO you never need to do a step-wise conversion to anything, ever. I think step-wise is just a wise step.  It's entirely up to you what precautions you take, as you have to live with the consequences of either rushing or delaying. Sometimes ithass paid off for me to push ahead, other times, I've needed to go very slowly. I personally prefer going slowly to start and then gradually speeding up or streamlining things if they're going well, even though this invites a measure of risk.

 

For example my dosage schedule adjustments when I first started tapering were built on spreadsheets, with 15 minute per-day rotation stages; step-wise dosage rescheduling. As a result I had two very tolerable dosage schedule changes. However, more recently when I wanted to move a part of one dose to another, I just switched it over on one day, paid for the sudden switch with a night of insomnia, and was recovered by the next night. My taper, my gambles.

 

If you are tolerating a portion of your dose as liquid, I do not think this guarantees that you will be able to suddenly switch to all liquid in comfort. But, of course, I can understand that it would be encouraging and you might try something like this to find out. My suggestions are just to give yourself options (i.e. have tablets to fall back on), pay close attention to your body and your thoughts during your taper (i.e. keep recording in your daily journal), and make room for some mistakes and some discomfort.

 

My personal opinion is to err on the side of caution and if I can, I like to let time do the heavy lifting for me. 

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Hi Slow,

I spent alot of time thinking over my first move and decided to try a .25 cut last Thursday morning. So now I am at 1mg morn, 1 mg mid day, 1.25 at night, Its been about 6 days and I am still stable with some minor tingling in my face that comes and goes mid day to evening. I plan to hold for at least 10-14 days then decided what to do next. Do you think thats a long enough hold? I've been reading alot on the site and came across some interesting postings from a bb named Chenraf. You seem to be technical in nature so i'm curious if you have seen this and what you think of his ideas. here is the the link

http://www.benzobuddies.org/forum/index.php?topic=104773.0

 

I'm still feeling overwhelmed in general on how to continue. Trying liquid seems to be the safest method but still not sure. The Valium half-life concerns me and I dont want to get into the weeds of wd.

 

thoughts?

 

Joeb

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Hi Joeb,

If you want to stay out of the weeds, I suggest giving yourself a good 2-4 weeks hold after this reduction since it's your first diazepam cut. If you keep careful records and pay attention to your symptomatic trends, I think you will learn a lot about your body and drug elimination rate. And when you feel fully functional after 2 weeks, that's when I would suggest considering another cut or a transition to liquid.

 

Chrenraf's thread was interesting; basically it sounds like seven years ago they finally figured out how to do symptom-based tapering after struggling with a rocky couple benzo crosses and overly rapid reductions, and then they made a connection between their waves of symptoms and the rate at which their body was eliminating the diazepam. Great stuff, but not exactly a "tailorable, adaptable, and symptom based controlled tapering program" as described.

 

I also don't find the "half-life scale" useful beyond a concept for buddies to generally understand. What will happen in your body may be similar to what Chrenraf was experiencing, or it may be very different. The half-life of desmethyldiazepam is 30-200 hours... I think that's a pretty large margin for difference! Understanding half-life elimination is awesome; I think presenting that it's similar for everybody is significantly misleading.

 

Lastly, it sounds like Chrenraf was eliminating diazepam from their body about as fast as I'm eliminating clonazepam; as I'm not a particularly slow clonazepam eliminator, I find this detail curious given the difference between the two drugs average half-lives (~35 for K, and ~60 for V).  I think we're all a little different and these differences can really matter when tapering a critical dose drug like benzos.

 

I look forward to what you learn with this reduction!

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

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Thank you Slow for the reply. After a week I feel pretty much the same except a slight tingling in the face midday and the typical Valium lack of motivation. It’s hard to tell if it’s my own frustration/depression of this situation or a small effect from the meds. Is this what people say is cog fog? I’ve heard the expression but never understood what it meant.

Anyway, thanks for the assessment on the chrenraf posting. Hope to hear from you soon.

If I go to liquid would you recommend the same transition schedule of changing the partial night dose to try it out?

 

 

 

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If you can't tell if your condition is general malaise or a withdrawal symptom, I'd say your symptoms are minor and this is a good thing!

 

Yes, I would suggest a conservative trial of liquid when your ready by substituting a portion of your total daily dosage. I think you'll be the best judge of what dose and how much to substitute.

 

Keep up the great work. 

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Hi Slow

Hope your doing well, been a while since. I am just about done with my 2 week hold and feeling stable.

Thinking about doing one more .25 cut from my night dose but still concerned with the Valium delay. I had some minor symptoms around days 3-6 but been ok with the exception of the usual sedated non motivated Valium feelings.

I’m currently at 3.25 so this cut wud get me to 3mg,

Not sure what to do. Really hate the uncertainty with the Valium

Joeb

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Hi Slow

Hope your doing well, been a while since. I am just about done with my 2 week hold and feeling stable.

Thinking about doing one more .25 cut from my night dose but still concerned with the Valium delay. I had some minor symptoms around days 3-6 but been ok with the exception of the usual sedated non motivated Valium feelings.

I’m currently at 3.25 so this cut wud get me to 3mg,

Not sure what to do. Really hate the uncertainty with the Valium

Joeb

 

Hi Joeb,

Great to hear from you!

 

I'm glad that your 0.25mg reduction was relatively gentle on you. It's good to hear that you were paying close attention to your symptoms and noticed a peak in intensity. I understand that very long-acting benzos like diazepam can be frightening when considering the possibility of some kind of delayed withdrawal response, but I think at the pace your going this is a minimal risk. I support your decision to take another 0.25mg reduction when you're ready.

 

Food for thought though, the average half-life of diazepam is 60hrs, and a rough rule of thumb is 5x a half-life to an almost entire elimination of medicine from the blood stream. However, desmethyldiazepam is some portion of that average diazepam half-life, and it's average half-life is 118hrs. So to be cautious you could use this desmethy half-life to base your hold time which would be (5 x 118hrs) / 24hrs/day = 24.5 days to an average near-complete body elimination of the pre-reduction dosages.

 

My general thought is that larger reductions and longer hold times = potentially more uncomfortable symptom intensity peaks, but potentially less reduction momentum to contend with.

 

If you're willing to hold 3-4 weeks between reductions and this would help you sleep better at night, I say why not? You're making great progress already, and if the tapering approach in itself can help to lower your anxiety, I'm for it.

 

Keep up the great work! 

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Hi Slow

Hope your doing well, been a while since. I am just about done with my 2 week hold and feeling stable.

Thinking about doing one more .25 cut from my night dose but still concerned with the Valium delay. I had some minor symptoms around days 3-6 but been ok with the exception of the usual sedated non motivated Valium feelings.

I’m currently at 3.25 so this cut wud get me to 3mg,

Not sure what to do. Really hate the uncertainty with the Valium

Joeb

 

Hi Joeb,

Great to hear from you!

 

I'm glad that your 0.25mg reduction was relatively gentle on you. It's good to hear that you were paying close attention to your symptoms and noticed a peak in intensity. I understand that very long-acting benzos like diazepam can be frightening when considering the possibility of some kind of delayed withdrawal response, but I think at the pace your going this is a minimal risk. I support your decision to take another 0.25mg reduction when you're ready.

 

Food for thought though, the average half-life of diazepam is 60hrs, and a rough rule of thumb is 5x a half-life to an almost entire elimination of medicine from the blood stream. However, desmethyldiazepam is some portion of that average diazepam half-life, and it's average half-life is 118hrs. So to be cautious you could use this desmethy half-life to base your hold time which would be (5 x 118hrs) / 24hrs/day = 24.5 days to an average near-complete body elimination of the pre-reduction dosages.

 

My general thought is that larger reductions and longer hold times = potentially more uncomfortable symptom intensity peaks, but potentially less reduction momentum to contend with.

 

If you're willing to hold 3-4 weeks between reductions and this would help you sleep better at night, I say why not? You're making great progress already, and if the tapering approach in itself can help to lower your anxiety, I'm for it.

 

Keep up the great work! 

Great to hear from you too Slow, and thank you for the very mindful reply.

Just a clarification, do you think it’s a high risk to reduce another .25 after this 2 week period based on the half life info you provided or do you mean holding longer 3-4 weeks after this additional cut?

I plan to try the liquid when I get to 3mg

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Great to hear from you too Slow, and thank you for the very mindful reply.

Just a clarification, do you think it’s a high risk to reduce another .25 after this 2 week period based on the half life info you provided or do you mean holding longer 3-4 weeks after this additional cut?

I plan to try the liquid when I get to 3mg

 

I was positing that holding for 3-4 weeks between reductions seems to me like more than enough time to avoid an overlap between reductions. So 1-2 more weeks of holding from your last reduction two weeks ago, and then 3-4 weeks between the next reduction and your liquid transition; I was not saying you need to do this, only that it's the rough elimination time-frame relative to the average desmethydiazepam elimination rate.

 

Personally, I think 2 weeks is more than enough time between reasonably sized reductions, since the following reduction probably takes another week to hit you anyways. Of course, I think that what you discover by taking reductions and keeping notes will be infinitely more valuable to you in making tapering decisions than anything myself or the internet might suggest.

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Thanks slow I understand what you meant now.

I highly respect your perspective and understand that journaling and assessing is most important.

There always seems like uncharted territory in this mess as well as unknown variables but one thing for sure you’ve taught me is slow and conservative is the best

Best to you slow and thanks again

Joeb