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Can I get help with substitution taper?


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Hey all, This is a little complicated.  I started my taper this week with my PCP prescribing alprazolam to a compound pharmacy.  I am currently dosing 4 x daily with a larger dose at bedtime because of debilitating insomnia.  It has gone like this..  .5 am, .5 midday, .5 evening and 1mg at bed.  This week he reduced me to .4 am, .4 midday.4 evening and still 1 mg at bedtime.  This is a bigger cut than I wanted and I’m worried.  Zero sleep last night and brain wired today.

I am wondering if substituting to diazepam would be a good option for me because of the sleep and also I have some interdose withdrawal, especially when I have not slept.  I see the conversation chart in the Ashton manual but I’m just not sure how to convert this with the drop I’ve made.  And I’m pretty sure I’ll have to figure this out for my PCP. 

Can anyone out there help me??  Any suggestions.  I just want to make this taper successful. Thanks

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WTS - I would do as much reading as possible before making a decision to switch over to valium from Xanax.  There seem to be a lot of arguments for and against you will want to weigh.


Here are a couple of pertinent links:

The first has a section discussing pros and cons of a crossover: https://www.benzoinfo.com/benzodiazepine-tapering-strategies/


Cross-Over to Valium Support Thread


You mentioned the cut your doctor is starting you with this week is bigger than you wanted and it's worrying you.  I agree - at 12% the cut  is bigger that the 5-10% guideline we typically suggest.    I'm wondering if the symptoms you're having might be toned down some if you make smaller cuts and longer holds between cuts - a symptoms led taper in other words.

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Following from your previous thread, here's a suggestion on how to do a crossover if you choose to proceed with it. So first let me explain what I'm thinking. I don't know how to calculate the 0.4mg's and I think it will be difficult to compensate/adjust for that in Valium. If you use the calculator to do equivalencies, you get 2.2mg Xanax = 33mg Valium. So lets round that to 35mg.


Now if you look at this crossover table: https://benzo.org.uk/manual/bzsched.htm#s7 you'll see each 1mg Xanax has been replaced by 10mg Valium except for the evening dose where the 1mg has been replaced by 20mg Valium (Stage 11 when crossover is completed). So your day doses are half of that and I'm thinking we half the Valium for all the day doses, and keep the evening the same as your evening dose is also the same. In the end you'll end up with 5mg, 5mg, 5mg, 20mg which combined is 35mg. This brings us close to the 33mg calculation.





0.5mg  0.5mg    0.5mg  1mg


Stage 1:

0.5mg    0.5mg    0.5mg      0.5mg

                                          10mg V


Stage 2:

0.5mg    0.25mg    0.5mg      0.5mg

              5mg                        10mg V


Stage 3:

0.25mg    0.25mg    0.5mg      0.5mg

  5mg        5mg                      10mg V


Stage 4:

0.25mg    0.25mg    0.25mg      0.5mg

  5mg        5mg        5mg          10mg V


Stage 5:

0.25mg    0.25mg    0.25mg      Stop X

  5mg        5mg        5mg          20mg V


Stage 6:

0.25mg    Stop X    0.25mg     

  5mg        5mg        5mg          20mg V


Stage 7:

Stop X                    0.25mg     

  5mg        5mg        5mg          20mg V


Stage 8:

                              Stop X

  5mg        5mg        5mg          20mg V


From this point you are equivalent to Stage 14 on the schedule I linked.


Where I've written 0.5mg Xanax, you'll take your current 0.4mg dose. I just used 0.5mg in this schedule for easy comparison to the Ashton schedule. Please have a look and see if this makes sense to you?


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