Diazepam taper

[[Li...]]

Hello, Faith Hope Love.

 

I’m so glad you are hanging in there.  You do indeed have many blessings to give you every reason to carry on.

 

Thanks for catching that error in the hyperbolic taper link.  I’ve corrected it.

 

The concept of make ‘small enough’ reductions in dose on a ‘gradual enough’ schedule to keep withdrawal symptoms tolerable and maintain high functionality is actually mine, not Maugham1’s.  I appreciate the feedback that you find it understandable and helpful.

 

I hope you will continue to keep me — and hence our community — updated on your progress from time to time.  I rarely make predictions (‘He who lives by the crystal ball ultimately eats crushed glass.’) But I’ll make one in your case — you will be successful in your quest to discontinue diazepam!

 

 

[[Pa...]]

I’m joining Libertas in her prediction and I’m not at all worried about that “crushed glass”l, I see success in your future.

[[Fa...]]

Thank you both for the encouragement and support!

 

Libertas, your concept/advice is about the only "across the board" certainty for anyone that has found this forum IMO.  I'm sure it can be very frustrating and vague for most members to read and accept that, but I don't see another way to provide sound advice. 

 

It is certainly not a fun process.  The past 2 nights I have had trouble falling asleep and resorted to using unisom both nights after 2 hours in bed.  I was able to get 2-3 hours after that, but less than my new normal.  I hadn't had trouble falling asleep in some time nor had the need to take a unisom.  These were night 11 and 12 using the tablet/liquid combo so I have noted in my log.  I reduced by only .01mg/ml last night after night 11 but will now hold dose tonight until my sleep returns to baseline.  Too early to tell the reason, and there may not be one.  Maybe I was just due for a couple worse nights. 

[[Fa...]]

In need of advice.  I seemed to be doing fine with the pharma liquid / tablet combo but recently my sleep has become pretty bad and inconsistent. My log is below. Any feedback/advice would be greatly appreciated. 

 

4/19/23 - 10 (tablet /liquid combo)

4/20 - 10

4/21 - 10

4/22 - 9.98

4/23 - 9.96

4/24 - 9.94

4/25 - 9.92

4/26 - 9.90

4/27 - 9.88

4/28 - 9.86

4/29 - 9.84 (worse sleep, 2-3 hours light, couldn’t fall asleep, unisom)

4/30 - 9.83 (worse sleep, 2-3 hours light, couldn’t fall asleep, unisom)

5/1 - 9.82 (slightly better, fell asleep 30 minutes, no unisom)

5/2 - 9.80 (back to baseline, fell asleep less than 30 min, at least 4-5 hours)

5/3 - 9.78 (worse, maybe 2-3 hours very light dream choppy, couldn’t fall asleep, unisom)

5/4 - 9.78 (fell asleep quickly, then very broken in and out, no unisom)

5/5 - 9.78 (no sleep, unisom 1am no help, maybe around 3-5am some micro sleep)

[[Li...]]

Hello, Faith Hope Love.

 

I’m sorry to hear you are experiencing sleep issues.  As I’m sure you know, this is one of the most common withdrawal symptoms.

 

Am I understanding correctly that you began to reduce your dose just 3 days after you switched from using all tablets to a tablet liquid combination?

[[Fa...]]

Thanks, Libertas.  Yes, that is correct.  I had been holding at 10mg for about a month on tablets only and then felt the same after switching to tablet/liquid combo.  I should have waited longer, but figured since I was feeling ok, sleeping the same, using mainly 9mg in tablets and reducing in what I thought to be small increments, I would be ok.  Would you recommend I just continue to hold for while to give the pharma liquid a better chance or increase dose?

[[Li...]]

You’re welcome.  Yes, I would suggest a hold.  Ironically, one of the upsides of tapering diazepam — its long half-life — can also be a downside.  It can take a while for withdrawal symptoms to fully manifest and stabilize after a taper change (e.g. a change in dosage form, a reduction in dose).

 

As the below-linked entry from the Merck Manuals explains:

 

Bioavailability of a drug is largely determined by the properties of the dosage form, which depend partly on its design and manufacture. Differences in bioavailability among formulations of a given drug can have clinical significance; thus, knowing whether drug formulations are equivalent is essential.

 

Some individuals experience the switch from solid to liquid dosage form as a reduction in dose.  It’s possible this is what is happening in your case.  (It’s difficult to know for certain given that you made two taper changes simultaneously — a change in dosage form and a series of dose reductions.)

 

Do you have a sense of your personal taper ‘speed limit’ (taper rate)? How about your personal withdrawal pattern (i.e., how many days/weeks does it take for withdrawal symptoms to emerge, peak, and stabilize)?

 

If not, you might consider conducting an experiment to determine the above after you stabilize on your current dose and tablet/liquid combo.  To do this, you could make a ‘small enough’ reduction in dose based on your best guess as to what percent reduction might work for you and then hold at that dose for two or so weeks to observe/evaluate how you respond to the reduction.  Alternatively, you could make a series of smaller reductions on a daily or weekly basis until you reach your best-guess percent reduction and then hold for two or so weeks.

 

Link:

Drug Bioavailability - Clinical Pharmacology - Merck Manuals Professional Edition - 2022

https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-bioavailability

 

 

 

[[Fa...]]

Thanks, Libertas.  Was having a bad week (and day especially) and really appreciate your reassurance.  I returned to baseline again last night so hopefully it evens out a bit soon.  More or less just frustrated, but I need to remain positive yet realistic.  I am holding at 9.78 for a short bit.  I only reduced roughly 2-3% in about 2 weeks, so most likely agree that the main reason was that I did not give my body time to adjust to the liquid and made some small cuts in addition.  I most likely also need to come to terms with some worse nights and learn how to hold, cope, adjust, resume taper etc..

 

I do not have a true sense of my personal taper 'speed limit' as ever since my failed rapid taper (and reinstatement) last September, my version of 'stabilizing' after 4 months was still mostly inconsistent, but 4-6 hours of broken choppy sleep for 4-5 days per week seemed to be best case.  I then cut from 11mg to 10.5mg (4.5% reduction) and held for 2 weeks with no change.  I then cut to 10mg 2 weeks later and was doing ok but traveled out of state and have a lot of stress with work, 6 year old, new baby etc.. and didn't handle that cut as well.  Then held a month and transitioned to this experiment.

 

So in essence I know I can handle a 5% cut.  I do not have a set schedule everyday, and saying my average day was hectic would be a gross understatement.  This hectic and chaotic life is a true blessing (and I certainly don't want to sound like I am ungrateful) however in regards to tapering off diazepam I would say that my CNS is never a 'stable variable'.  I have a major business deal closing this week in addition to an all day board retreat 1.5 hours away.  These types of weekly events are now very stressful to me where they use to be just another normal week.  Coaching 6 year old tee ball doesn't bother me thankfully and is a great distraction/escape which I enjoy (however practice at 10am yesterday after 0 sleep was not easy).

 

After I stabilize, I will try again reducing by .02mg/ml per day but maybe add a 2 day hold in after 5 days (a .1mg/ml reduction per week).  This would be less than a 5% monthly reduction so hopefully I could handle that.  Thank you so much for being available for support and reassurance.  My family has mentioned me trying to up the mirtazapine for a week "to see" since I am already on it if I continue to have a tough time with sleep.  I am holding off on that for now.  I know it helped Maugham1 and some others at 15mg and 22.5mg, but just like all adjunct meds, it has not helped some.  It would also add a medicine to taper longer, but if it worked, I could care less and just stay on it.  All the research I personally found stated the lower doses to be more sedating however I don't believe any of that research factored in benzodiazepine withdrawal.  I have only tried it at 7.5mg and it probably helped a little at my worst and basically put an end to my sleepless nights until 2 nights ago.

[[Fa...]]

Down to 9.5mg this evening  .  Reduced around 5% this past month.  Had more 5mg tablets than I realized so still using those.  9mg in tablets and .5mg/ml liquid as of tonight.  I feel like I am continuing to level out/improve a bit with the sleep even though it is still not great.  Acceptance.  Only one sleepless night (or near sleepless) this past month so must remain grateful. 

 

Still have a long way to go.  My next step in experiment will be to drop to 8mg in tablets and higher percentage in liquid.  Shouldn’t be a huge adjustment, however, probably would be a good time to implement a hold!  Grateful for you both Libertas and Pamster!

[[Li...]]

Greetings once again, Faith Hope Love.  Thank you for yet another good news update!  As I’ve stated before, you are doing all the right things to maximize the likelihood of a successful withdrawal and recovery from benzodiazepine use.

 

Now it’s my turn to express my gratitude to you for the support you have been providing to other members.  Your posts are compassionate, clear, concise,  and helpful.  They also convey important concepts.  For example, taper planning is an iterative process (or, as you conceptualize it, a series of experiments) not a one-time event. 

[[Fa...]]

Thanks, Libertas!  I have tried to help where I can with my limited lived experience.  Everyone is different, but as we discussed upthread, the only sound advice/certainty for anyone that has found this site tapering IMO, is your statement: to make ‘small enough’ reductions in dose on a ‘gradual enough’ schedule to keep withdrawal symptoms tolerable and maintain high functionality.  That is going to look different for everyone.

 

I certainly wish I was not tapering through my severe injury that occurred last year, but here I am, and continue to trudge forward.  I have a life and family to fight for, and believe that I will heal from this! 

 

From April 22, 2023 to May 22, 2023, I tapered down at a rate of 4.4%.  From May 22 to June 22, I tapered down at a rate of 4.8%.

 

As of today, I am now down to 9mg diazepam and am doing better overall than I have been since the injury occurred last year.  I believe my sleep is non-linearly improving.  No sleepless nights this past month.  Usually 4-6 hours of mainly broken and light sleep with many vivid dreams.  I assume the dreams are vivid, and I am able to remember, due to the many awakenings.  However, the awakenings are not as severe as they once were with what seem to be lessening adrenaline surges.  I also apparently didn't hear thunder storm last night that woke my wife up, so I know I am getting some occasional deeper sleep than I perceive.

 

Anyways, just wanted to post an update to this thread, and I hope everything is well with you and Pamster!  Any other buddie that is reading, I wish you the best and never give up hope!

[[Li...]]

Good to hear from you, Faith Hope Love.  It sounds like you are responding well to the ‘small enough/gradual enough/functional enough for me’ approach to tapering.  Sleeping through a thunderstorm is a very positive sign!  (My spouse and I were just reminiscing about one of our dogs that always went bonkers during thunderstorms — no one got any sleep on those nights. )

 

[[Fa...]]

Thank you for your support and assurance, Libertas.  Slept from 11:30pm - 4:30am uninterrupted last night, so agree I am seeing some positive signs!

 

I too had a dog that lost his mind during storms. This was pre benzo injury, so I could get back in a normal decent sleep easily (or get caught up the next night).  He would attempt to dig a hole in the floor of our home.  He was unfortunately usually more successful than my bride or I would have preferred.

 

We now have a sleep walking 6 year old boy and 4.5 month old baby girl that like to make commotion in the wee hours.  This is what we signed up for and love them both dearly however.  His sleep walking started last weekend after he took a line drive off his glove to the eye in an all star summer ball game.  Walked in my room at 2am that night wanting me to open his mouthwash telling me he had to get ready to leave  .  He’s had a few other nights of similar behavior this past week he doesn’t remember.  We took him to the doctor, nothing major noted and behavior is subsiding.  Most likely just trauma.  It certainly still looks traumatic a week later, but he thinks he looks tough.

 

I digress, as this is a titration tapering thread, however I appreciate you greatly and hope you have a nice remainder of your weekend.

 

[[Li...]]

You are welcome, Faith Hope Love.  Five hours of uninterrupted sleep sounds heavenly! 

 

Our dog didn’t attempt to dig a hole in floor but he did keep trying to ‘claw’ his way into our arms - he weighed about as much as I did so that did not go well.

 

I’m so sorry your son got hit in the eye at his ball game.  Ouch!  I’m glad he checked out ok and am impressed he has already learned the importance of good dental hygiene (e.g. asking you to open his bottle of mouthwash albeit at a slightly unusual hour).

 

I appreciate you as well.  Hearing from members like you who are doing well with their tapers is a boon!

 

[[Pa...]]

Dogs and thunderstorms or dogs and fireworks, both scenarios are trouble in my house.  Faith Hope Love, I wanted to mention i used to sleepwalk as a child, I eventually grew out of it during around 30 years of age but your sons is because of a trauma?  I’ll be interested to hear if it fades as he recovers. 

[[Fa...]]

That is interesting, Pamster.  My wife used to sleep walk as child as well.  She grew out of it around 13 years of age.

 

Another morning/night he was sitting up in his bed at 5am with all the lights on, in what appeared to be a trance, staring into space with no TV on etc...  We have no idea how long he was in that state.  He did respond to my wife asking him what he was doing with "I can't sleep."  We turned lights off, and he did go back into a regular sleep until about 8am that morning.  Again, he had no recollection of this incident. 

 

His eye is almost healed now after nearly 2 weeks.  We are just assuming trauma, as we cannot identify any other cause for the sudden onset of behavior in our son.  He was sleep walking/talking, without recollection, 3 or 4 nights in a row starting the night of the incident.  The behavior has since ceased and hopefully stays that way.

[[Pa...]]

I’m relieved to hear this disturbing behavior is fading, I’m sure you’ve been very worried.  Sleepwalking is weird, I was basically acting out my dreams but I remember being responsive to those who spoke to me trying to bring me out of it. 

[[Fa...]]

Hi, @[Li...] and @[Pa...]!

Just wanted to update my tapering thread and say hello.  My son has only sleep walked once more since we last spoke.  So that is a good sign!

I am now down to 8.5mg diazepam as of tonight.  It certainly is a tedious journey.  Since I last updated (was doing well from 9.5mg to 9mg), I was determined to find out for sure how I handled the liquid vs. tablets as I felt this was important personal information and last time I was changing 2 variables at once so I had no concrete data.  

I ran out of 5mg tablets at 9.1mg, was doing well, and held for a few days prior and few days after switching to 8mg tablet form and 1.1mg/ml of liquid (12.1% liquid).  Again, after exactly 11 days my sleep deteriorated and become more inconsistent.  I now know I need to probably hold 10-14 days prior to increasing liquid portion of my dose and probably also 10-14 days after switching.  Hopefully that will allow my body time to settle and adjust, as my next planned increase in liquid is more than double my previous percentage - 6mg tablet and 2mg/ml liquid (25% liquid).

I have still been reducing daily by .02mg, or .01mg, and have held a few days on a couple occasions.  I still have not snapped out of the worse/inconsistent sleep.  From 9mg to 8.5mg, it has looked more like every other night I fall asleep fairly easily and get 4-6 broken hours with a good 2-3 hour stretch at beginning (which is only time my sleep resembles my old sleep).  The other nights, I am unable to fall asleep and sometimes take unisom around 1am.  I usually still get 2-3 hours of light sleep these nights but it's rough.  As a result, I reduced less than previous month stretches from 6/22 to 7/22 - at a rate of 3.8%.  

I believe my body is now telling me to hold for a week or two and see if my sleep is able to return to a more consistent baseline before continuing to trudge forward towards 8mg diazepam, so that is what I will do.  Any words of advice/feedback/suggestion/encouragement are always welcome.     

[[Pa...]]

Hopefully Libertas will stop by with some input on the mechanics of your taper, I'm lost when it comes to that but I'm so impressed with your record keeping and the your attention to what your body is telling you.  You're truly allowing your body to let you know when or if it's time to reduce again.  I'm sorry to hear your sleep has been impacted so much but its another clue and you're following them all.

I also want to thank you for using a single thread to keep us apprised, this helps everyone see your situation all in one place which helps you and others reading. 

I'm encouraged to hear you've held between reductions, even though they're small, you see the power they have and by holding I believe you can avoid them piling up and overwhelming you.

I also want to thank you for contributing to other members even through your misery, we have some of the most compassionate people in the world right here and it makes me humble. 

[[Li...]]

Hello, @[Fa...]. Wonderful to hear from you as always.  I’m dealing with a family emergency so must be brief.  I agree with all the points @[Pa...] made.  After a quick first-read, nothing jumps out at me in terms of the ‘mechanics’ of your taper — but I’ll give your post a more careful read after I get the family brush fire tamped down.

[[Fa...]]

Thanks for checking in @[Pa...] and @[Li...].  I truly appreciate you both for the encouragement and kind words.  I would not be down to 8.5mg diazepam, and 'relatively' well, without your help.  Sure, I feel varying degrees of terrible everyday, but at this point reducing the diazepam slow and steady is the only option I am aware...so I trudge forward.  I sincerely hope everything is ok with your family @[Li...] and that things are resolving and not dire.  

I was mainly documenting for myself and others, as lived experience seems to be of paramount importance.  I'd say for me personally, the 'mechanical' error was not holding for longer prior to increasing the liquid portion of my dose, and not holding for longer after increasing the liquid portion of my dose.  It does not appear that I am able to 'slow-er-er' taper myself out of it.  It was a risk, and experiment, I chose to undertake.  I wanted to confirm how changing dosage form affected me.  

I believe my body is extremely sensitive and considers the bioavailability of the liquid diazepam as a reduction in dose vs. the tablet.  I also wanted to push forward and see if I could slow down my taper rate and still 'stabilize'.  I now know.  I am optimistic I can hold for a bit and regain a level of 'stability'.  I am also certain that I will be holding at 8mg in tablet form before dropping 2mg in tablet and adding 2mg/ml in liquid!

My plan is to continue to live to the best of my ability, taper, learn and share.  Talk soon.

[[Fa...]]

I am now down to 8mg diazepam!  I ended up holding for 13 days once I reached 8.5mg.  After 13 days, it did not seem as if my sleep was improving so I resumed daily reductions again.  The hold must have helped however, as my sleep showed slight improvement almost immediately once I resumed my daily reductions.  I was able to continue daily reductions down to 8mg without feeling the need to hold any days.

From 7/22 to 8/22, I reduced at an exponential rate of 3.2% (which included 13 days of holding).  From 8/22 to 9/22, I reduced at an exponential rate of 5.5% (which included 0 days of holding).  

My current strategy is to keep 'suggested' exponential tapering (and associated hyperbolic) regimens in mind, but technically I will be tapering linearly for the time being (with the intent to slightly 'push' up my monthly exponential rate reduction).  I will continue to 'actively' reduce .21mg every 14 days, via alternating daily reductions of .02mg/ml and .01mg/ml.  I will obviously hold if my body tells me such, but I want to see how this strategy works for awhile.  My goal is to never 'actively' taper more than 10% of my current dose per month, but also never taper less than .1mg every 2 weeks (i.e., when a .20-.25mg/ml per month reduction becomes more than a 10% monthly reduction of my previous dose, I will throw out tracking percentages as the taper will never end).  

Unless my body tells me otherwise, I will be holding 10-14 days at .5mg intervals to 'catch my breathe'.  The 4 occasions I have left changing dosage form (dropping 2mg tablets for 2mg/ml liquid), I will hold 10-14 days after I stop my daily reduction period, and then I will hold 10-14 days after I switch dosage form to ensure my body has caught a breathe from the daily reductions and also acclimated to the new dosage form change.

With that said, I have 2 trips in the month of October and this is my 3rd day of holding at 8mg (all tablet form).  I will be holding longer than I would like at 8mg tablet form, as they are important trips for me (one being my wife and I's anniversary trip Oct. 22-25).  I will most likely wait upon my return from this trip to drop a 2mg tablet, swap it for 2mg/ml liquid, and continue to trudge forward.  I am doing fairly well currently so maybe it will be interesting to see what a 1 month hold does.. 

[[de...]]

Congrats on getting down to 8mg.   Well done!  

[[Fa...]]

After holding at 8mg diazepam for one month, I am doing fairly well (all considering).  I wouldn't say I have improved much, but I have not gotten worse.  I had just a few off-nights of sleep within this past month (1-3 hours); however, 2 of the 3 nights were during travel where sleeping was not ideal with light, noise, and other distractions.  The other nights I was able to get 4-6 hours of my 'new normal' sleep - perhaps even slightly better quality sleep than in the past.

With that said, I have decided to pause my diazepam taper with the goal of tapering off my prescribed 60mg/day baclofen dose first (for reasons stated within my baclofen taper thread):

 

[[Pa...]]

It’s sad that one of the measurements of our progress is this statement. 

19 hours ago, [[F...] said:

I wouldn't say I have improved much, but I have not gotten worse.

I applaud your willingness and bravery to use what you’ve learned in hopes of finding a solution that works for you.  I also want to thank you for starting your other thread documenting your journey off of Baclofen, I know it will benefit others.