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Question about liquid titration


[Cl...]

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Hey there,

 

Hope you had a happy holidays.

 

I would like to try the titration method as it look easier than cutting and weighting pills.

 

I have tried to use the liquid titration spreadsheet found in a youtube video showing to fill a cup with 300ml of water and to remove 1ml each day, example day 1, 1ml, day 2, 2ml and....

 

My problem is that it was done for a 5mg Valium pill. Me I want to titrate lorazepam 2mg, and when I try to complete the spreadsheet with my 2mg of Ativan/lorazepam , mine stop at 180 drink dose, and 120 discard liquid.

So my question is should I put 180 drink dose instead of 300 as the Ativan reach zero at 180 drink dose.

 

This is what it looks like

 

 

Hopefully someone can help.

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My current dose is 2mg of lorazepam/Ativan . I would like to taper off so I am trying to find the best way. The titration looks easier. The dry cutting can be hard to get the precise dose I want.
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If your tablets are 2 mgs, you could cut that in half and take one half and put the other one in your liquid and if they’re 1 mg, you could take one tablet and put the other one in the liquid.  You can reduce using the liquid then when you get to the point you’re only on 1 mg, you can start using titration for that too.

 

Or am I misunderstanding your question? 

 

Lorazepam comes in a liquid from the manufacturer if you can get your doctor to write you a script. 

 

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Sorry, I think my question was not clear enough. I'm from a non English speaking country.

So my question is about liquid titration. The examples I have seen are with 300ml of water and 5 mg pill of Valium. I did try testing the titration method by entering my data of 2 mg of Ativan/lorazepam in the excel spreadsheet and my medication reaches 0 at 180ml drink dose and not the 300ml. So should I taper with only 180ml in the jar instead of 300 ml? Hope this makes sense. Otherwise I will try to copy and paste the model I am using.

Thank you for any help.

 

 

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What spreadsheet are you trying to use?

 

Is it the one included with the ‘Use water to taper your benzo!’ video by Benzo Brains (see link below)? If so, that spreadsheet is 5 years old and it sounds like it has one (or more) glitches in it. Have you tried contacting Benzo Brains to ask if there is an updated version? (You could try contacting her via one of the more recent videos on her YouTube channel or via her website at BenzoBrains.com.)

 

You seem to understand the basic concept of this approach — remove 1mL more of the liquid each day and drink the remainder until all of the liquid is gone.  If you start with an initial volume of 300 mL, it will take 300 days to do this.  If you can’t get the spreadsheet to work, you could easily make a paper chart for yourself. For example:

 

Day 1 - 300mL

Day 2 - 299mL (remove 1 mL)

Day 3 - 298mL (remove 2 mL)

Day 4 - 297mL (remove 3 mL)

 

There are several issues with above approach you should know about.  If you would like to learn about these plus receive feedback on whether this approach would be a good fit in your case, we would be happy to help.  To help us help you, please add your medication history to your profile. Here are the instructions Add your history/signature

 

 

Link:

Use water to taper your benzo!

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I’d like to thank Libertas for jumping in, I can see now I wasn’t understanding your dilemma, you’re struggling with the worksheet, not the actual mechanics of your taper. 

 

In my opinion, the spreadsheets members find online are a problem because besides having flaws, we can’t map out our entire taper on paper before the fact, life presents too many variables.  What happens when you need to attend an event scheduled for the same time as a reduction?  Do you still make the cut knowing it could possibly impair your ability to attend?  What about an unexpected illness or family issue, do you adjust your taper to accommodate these events or do you stick to an arbitrary schedule you found online?  We advocate for symptom based tapers, these have been shown as the most effective method to keep us functional.

 

I hope you’ll take Libertas’s advice and make your own spreadsheet but also be prepared to deviate when life and symptoms demand.

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Thank you Libertas and Pamster.

Yes, it is the Excel spreadsheet of benzo brains. I am just looking for the easiest way to taper the 2 mg of lorazepam

My issue was that with the 2mg at 180 ml I reach zéro benzo so I was thinking maybe I should start with 180ml of water instead of 300 ml.

 

I have bought a pill cutter and I don't find dry cutting precise enough so that's why I wanted to do the titration with water

 

I am at lost with my benzo brain. For now I will stick to dry cutting.

 

@pamster: I take my medication only at night. I take my benzo with me in case I have to sleep somewhere else than home. Without benzo I can't sleep at all, but I am at risk of having withdrawal symptoms like it happened before when I was on Valium and imovan.

 

Anyway thank you guys for trying to help me.

 

If any of you have a good video or link about water titration with clear advice, I would be very grateful.

 

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Clinda,

 

If you want a liquid method which is free of spreadsheets and math, follow this video.

 

 

There is nothing to compute.  Just remove 1mL and drink the rest.

Bob

 

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Hello, Bob7.  Good to see you on the boards.  Two fwiw’s: (1) the spreadsheet Clinda is asking about is included with the video you referenced (there’s a link to it in the Description) and (2) here’s a shorter URL you can use to share this video with others:

 

Use water to taper your benzo!

 

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@[Li...]

 

I am myself confused. For now I will keep to dry cutting. Today I jumped from 2mg to 1,75mg and will keep cutting. Hopefully I will find a way to deal with the small doses. I must confessed that I am nervous.

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My best guess is there is a flaw in the spreadsheet.

 

The amount of water you use determines the length of the taper.  If you use 300mL the taper would take 300 days.  If you use 180mL, the taper would take 180 days. HOWEVER, this assumes that all goes well.  As Pamster has explained, this assumption is unlikely to be met.  Indeed it is not uncommon for individuals to report that they ‘hit a brick wall’ using this approach.

 

There are several reasons for this.  One of them is that this approach uses a fixed amount reduction.  Consequently, the taper rate increases over time until it sometimes reaches a ‘tipping point’ where the individual can no longer tolerate it.  For example, if you started with 300mL of water, over the first month, you would decrease the amount of liquid ingested from 300mL to 270mL …  this would be a 10% reduction in dose.  By the fifth month, you would decrease the amount ingested from 180mL to 150mL … this would be a 17% reduction in dose.

 

The fact that you have experienced issues discontinuing two other benzodiazepine receptor agonists (Valium/diazepam and Imovane/zoplicone) suggests you should be proceed very carefully with tapering lorazepam. 

 

How did you discontinue the Valium and Imovane?  Did you stop suddenly (i.e. cold turkey) or did you taper?  If you tapered, how did you taper?

 

How long have you been taking 2mg of lorazepam?  Are you experiencing any signs/symptoms of tolerance?  Interdose withdrawal?  Are you taking any medications or supplements that interact with lorazepam?

 

I’ll close by sharing one final obsevation about the do-it-yourself water titration approach demonstrated in the video:

 

The liquid created is a (very temporary) suspension.  This means there is no guarantee that each and every milliliter of the liquid will contain exactly the same amount of drug.  If you try this approach, be sure to shake the liquid vigorously before measuring the reduction amount.  It’s also import to measure the reduction as quickly as possible before the water insoluble particles of drug and excipient(s) settle out of suspension.

 

ADDENDUM:

 

Just checking … are you aware of our general guideline to keep reductions in the range of 5 to 10%?  The reduction you just made from 2mg to 1.75mg is a 12.5% reduction. If you have not already done so, I encourage you to read the benzodiazepine deprescribing guidance document below, especially section 3 on tapering principles.

 

Link:

Benzodiazepine Deprescribing Guidance Document (2022)

https://corxconsortium.org/wp-content/uploads/Benzo-Deprescribing.pdf

 

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@[Li...]

 

The Doctors stopped giving me Imovan and diazepam so it was cold turkey. When I understood that my insomnia was due to that, I went to a pharmacy with the prescription and took them back, but it was too late, when I took them I would sleep only 3 hours per night and then wake up incapable of sleeping, I could not take nap either.

 

She introduced lorazepam 2,5mg when I was rehospitalized because of the insomnia. After 1 month of good sleep she stopped it again, and after I asked her again she reintroduced the 1 mg ones. The 1mg ones made me sleep but the thing was I would go to bed at 10pm and wouldn't sleep till 1 am or more. I was still hospitalized during all of this. She decided to change again and even gave me 2 imovan to sleep I did not sleep at all and lost conciousness as it was days since I haven't slept well.

 

A doctor came to my room and asked me on what medication I slept well, I said temesta and theralene (which is a somnifere). This night he gave them to me and I was able to sleep. On 26th November I left the hospital.

 

I have every month an appointment with a Psychiatrist and it was with her that I started the sevrage, instead of the 2.5mg, she prescribed the 1 mg one, so I can take 2mg. I slept well on the 2mg. Last night I took a leap of faith and reduced to 1.75. I took time to fall asleep but I still slept ok. I know Benzo Buddies only advice to taper off 5 to 10%, but I felt like I could do it. For my next taper I will do 10%.

 

Have a great day and thanks a lot.

 

If there are benzo buddies from France, specially Paris and its suburbs please send a pm.

 

Have a nice day all of you

 

 

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