Need Advice on Valium Taper

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I have been taking Valium for post spine surgery muscle spasms since June 25. I began with taking it 5 mg tid a day. In August I dropped the dose to 2.5 mg tid. At the beginning of September I dropped down to taking the 2.5 mg dose bid. Everything was going well and I was feeling good so I went to taking one 2.5 mg dose a day on Sept 22. I did that with no issues so on Oct 1, I started taking 1.25 mg once daily. On the evening of Oct 2, I began having withdrawal symptoms including high blood pressure, sweating, headache, ear ringing, neck and face pain, nausea, numbness in hands and feet, insomnia. My doctor suggested taking more to improve the withdrawal symptoms so I took a 2.5 mg. It made me feel worse so I went back to the 1.25 mg daily. I worked through it and the symptoms began to improve (but still had some of them) by day 5. Things kept getting better until day 8 when the symptoms got worse again. I stayed on the same dose and things are improving again. My doctor is suggesting going 1.25 mg bid. I hesitate to do that because I would be increasing my dose again. I'm wondering if anyone here has any advice on how to move forward. Thank you!

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Welcome to Benzo Buddies!   Glad you are here!     Some other members will weigh in who have lots of experiencing with tapering.   Are you currently taking 1.25 mgs/once a day?   As far as symptoms go, they will definitely wax and wane even while holding at a particular dose.   This is the nature of recovery from benzo withdrawal.   Your body is trying to get used to a lower dose and is reacting.      As your body tries to regain its "balance", symptoms will calm down for a little while and then intensify again.   We recommend using a tapering schedule by listening to your symptoms.   Your body will let you know when it is good to make another cut.   Also, as you get to a low dose, your overall symptoms may intensify.

Like I said, I am not super experienced with tapering schedules, but another member will coming along and give you some guidance.

 

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Hi! Thank you for the reply. I am taking 1.25 mg/once a day. I've been on that dose since Oct 1. My body is still trying to balance the symptoms of withdrawal. How do I know when it's time to make a change in dosage? And what dosage do I change to? 

 

[Guest [...]]

This time you may need to hold longer before your next cut, @[...]

I assume you are tapering 5mg tablets, is this correct? 

 

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Thanks for the response. My doctor is trying to have me take 1.25 mg twice a day. I think that would send me backward. What are your thoughts? If is stay here, how long do I stay? What do I do next? Thank you! 

Here is my dosage schedule since beginning.

June 25 - Mid July        5 mg 3 times a day

Mid July - Mid Aug        2.5 mg 3 times a day (no withdrawal issues)

Mid Aug - Sept 2          2.5 mg twice a day (no withdrawal issues)

Sept 1 - Sept 11            2.5 mg once daily (no withdrawal issues)

Sept 12 -13                  1.25 mg once daily (began having withdrawal symptoms but thought it was from steroids)

Sept 14 - 21                  2.5 mg twice a day (no issues)

Sept 22- Sept 30          2.5 mg once a day (no withdrawal symptoms)

Oct 1 - 2                         1.25 mg once a day  (having withdrawal symptoms)

Oct 3                               2.5 mg once a day (made symptoms worse)

Oct 4 - Oct 11                 1.25 mg once a day (having lots of withdrawal symptoms with lots of ups and downs in severity)

 

 

Edited October 12, 2023 by [...]

[Guest [...]]

Hi @[...]

Looking at your taper, it appears to have been quite uneventful down to 2.5mg once per day, with you only becoming symptomatic once you dropped to 1.25mg once per day.

The fact that you were able to drop all the way down so comfortably says to me that you are probably better off only holding where you are until Oct 18, which would be two weeks from your most recent reduction. It is suggested one holds one’s dose for 10 - 14 days before making the next reduction. You may even choose to hold slightly longer to see if your symptoms continue to settle. 

In the meantime, I would probably look at having 2mg diazepam tabs prescribed as it will make your reductions easier and more accurate. If you switch to 2mg tabs to make your next reduction, you can simply break the 2mg tabs in half, allowing you to reduce to an accurate 1mg dose per day (a reduction of 0.25), rather than inaccurately trying to break up 5mg tabs. 

What do you think? 

 

 

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3 hours ago, [[W...] said:

Hi @[...]

Looking at your taper, it appears to have been quite uneventful down to 2.5mg once per day, with you only becoming symptomatic once you dropped to 1.25mg once per day.

The fact that you were able to drop all the way down so comfortably says to me that you are probably better off only holding where you are until Oct 18, which would be two weeks from your most recent reduction. It is suggested one holds one’s dose for 10 - 14 days before making the next reduction. You may even choose to hold slightly longer to see if your symptoms continue to settle. 

In the meantime, I would probably look at having 2mg diazepam tabs prescribed as it will make your reductions easier and more accurate. If you switch to 2mg tabs to make your next reduction, you can simply break the 2mg tabs in half, allowing you to reduce to an accurate 1mg dose per day (a reduction of 0.25), rather than inaccurately trying to break up 5mg tabs. 

What do you think? 

 

Thank you so much for replying. I think that sounds like a good plan. My doctor has been unresponsive to my messages. If I am unable to get 2 mg tabs, would another option be to try dropping one dose a week, followed by two doses then next week and so on? 

[Guest [...]]

Hi @Cam

No, you should definitely Not remove doses in that way. Doing that would put you into interdose withdrawals because the blood serum levels would end up dipping so low between doses. The brain craves consistency. 

You really only have two options, and the first option is to try and divide your 5mg tab into 5 equal portions (very difficult) by eye. The second option is to purchase a jewellers scale and weigh the tablet, divide the total weight of the tablet by 5 to get your 1mg dose weight. Then you can get accurate daily doses down until you ‘jump’. 

Basically, you would calculate total weight of 5mg tab… then divide total weight by 80%  = new 1mg dose weight. 

We can go over this if needed once you have the scales. It’s very simple. 

Here’s a link to a common scale used by members.
 

https://www.amazon.com.au/Smart-Weigh-GEM20-Precision-Milligram/dp/B00ESHDGOI/ref=asc_df_B00ESHDGOI/?tag=googleshopdsk-22&linkCode=df0&hvadid=341792399930&hvpos=&hvnetw=g&hvrand=16652301027427719060&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9072357&hvtargid=pla-304071963067&psc=1

Note - the price is AUS$

Of course, you can try to do it by eye, but the inaccuracies from dose to dose may increase symptoms. 

 

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6 hours ago, [[W...] said:

Hi @Cam

No, you should definitely Not remove doses in that way. Doing that would put you into interdose withdrawals because the blood serum levels would end up dipping so low between doses. The brain craves consistency. 

You really only have two options, and the first option is to try and divide your 5mg tab into 5 equal portions (very difficult) by eye. The second option is to purchase a jewellers scale and weigh the tablet, divide the total weight of the tablet by 5 to get your 1mg dose weight. Then you can get accurate daily doses down until you ‘jump’. 

Basically, you would calculate total weight of 5mg tab… then divide total weight by 80%  = new 1mg dose weight. 

We can go over this if needed once you have the scales. It’s very simple. 

Here’s a link to a common scale used by members.
 

https://www.amazon.com.au/Smart-Weigh-GEM20-Precision-Milligram/dp/B00ESHDGOI/ref=asc_df_B00ESHDGOI/?tag=googleshopdsk-22&linkCode=df0&hvadid=341792399930&hvpos=&hvnetw=g&hvrand=16652301027427719060&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9072357&hvtargid=pla-304071963067&psc=1

Note - the price is AUS$

Of course, you can try to do it by eye, but the inaccuracies from dose to dose may increase symptoms. 

Thank you! I will wait at 1.25 mg until I'm free of symptoms. I am still having withdrawal symtoms with muscle tightness, ringing in the ears and insomnia being the worse ones. Hopefully my doctor will be willing to prescribe the 2 mg pills when I'm ready to taper down again. 

[Guest [...]]

You’re welcome! 

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@[Wi...] I have been holding at 1.25 mg daily and still experience withdrawal symptoms to varying degrees every day. The last 3-5 days I have noticed that when I take the medication, I feel worse. At the beginning of the day my symptoms are very mild and hardly noticeable.

I take the medication in the early afternoon and soon after I notice a big increase in withdrawal symptoms.

What could be happening? Any advice for me moving forward? Should I continue to hold here until I am symptom free. I'm wondering if I'm at tolerance and that is why it gets worse when I take the medication. If I am, how do I proceed? 

Thanks for any info you can provide. 

[Guest [...]]

Hi @[...]

Your taper has been quite fast and erratic… up and down with large increases and decreases in dose, and still going from 15mg per day to 1.25mg within 13 - 14 weeks. Your reductions since September have been 100% up-doses and reductions, and it has only been just over 3 weeks since your last reduction from 2.5mg to 1.25mg. Now being on such a low dose, it may not have the potency/therapeutic affect to fully stabilise you, and the combination of these factors may be the reason for your waves. Going by my own taper history, there were a couple of times when I was unstable and highly symptomatic where I dreaded taking my doses because they seemed to cause a paradoxical reaction post dosing. But, it wasn’t true paradoxical because as I stabilised on my holding dose, the doses eventually shifted from having a paradoxical effect to a therapeutic affect. 

However, we are all different, so it’s impossible to know whether you should hold longer on such a low dose in the hope of symptoms further settling, or to (this time) make a small reduction of 0.25mg and see how you tolerate it. Tapering really is about trial and error for all of us, but often, for many of us (not all), if we follow a few basic guidelines, we can minimise the risk of destabilisation and acute or severe symptom waves. 

It’s impossible to know how broad and intense your symptom profile is, but, the fact you tapered from 15mg in such a short period of time, I feel you’ve tolerated the quick taper considerably better than many other members would have. You may not feel stable right now, and symptoms may feel quite difficult, but, the question is ‘how intense are they’? which is a rhetorical question because everything is ‘relative’, as we can only ever gauge our symptoms (level of suffering) by our own previous experiences, and as many members have unfortunately discovered first hand… things can always get worse. 

Can you provide us with a list of what you consider to be your worst symptoms? 
 

Things to consider in deciding your next move

1) It has only been just over three weeks since you made a 100% reduction, which came off the back of another 100% reduction only 2 weeks prior to that. 

2) Do you hold longer and wait for the seemingly paradoxical post dosing symptoms to resolve? 

3) Is the low dose (1.25mg) enough for you to stabilise on, and if not, are your symptoms tolerable enough to continue tapering slowly (maybe 3 final two to three weekly reductions of 0.25mg each before jumping at 0.5mg)? 

Given you say your symptoms are mild and barely noticeable at the beginning of the day, personally, I would consider No. 3, reducing by that 0.25mg and holding for another couple of weeks. 

I hope this helps. 

Sorry it took a while to reply. 
 

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4 hours ago, [[W...] said:

Hi @[...]

Your taper has been quite fast and erratic… up and down with large increases and decreases in dose, and still going from 15mg per day to 1.25mg within 13 - 14 weeks. Your reductions since September have been 100% up-doses and reductions, and it has only been just over 3 weeks since your last reduction from 2.5mg to 1.25mg. Now being on such a low dose, it may not have the potency/therapeutic affect to fully stabilise you, and the combination of these factors may be the reason for your waves. Going by my own taper history, there were a couple of times when I was unstable and highly symptomatic where I dreaded taking my doses because they seemed to cause a paradoxical reaction post dosing. But, it wasn’t true paradoxical because as I stabilised on my holding dose, the doses eventually shifted from having a paradoxical effect to a therapeutic affect. 

However, we are all different, so it’s impossible to know whether you should hold longer on such a low dose in the hope of symptoms further settling, or to (this time) make a small reduction of 0.25mg and see how you tolerate it. Tapering really is about trial and error for all of us, but often, for many of us (not all), if we follow a few basic guidelines, we can minimise the risk of destabilisation and acute or severe symptom waves. 

It’s impossible to know how broad and intense your symptom profile is, but, the fact you tapered from 15mg in such a short period of time, I feel you’ve tolerated the quick taper considerably better than many other members would have. You may not feel stable right now, and symptoms may feel quite difficult, but, the question is ‘how intense are they’? which is a rhetorical question because everything is ‘relative’, as we can only ever gauge our symptoms (level of suffering) by our own previous experiences, and as many members have unfortunately discovered first hand… things can always get worse. 

Can you provide us with a list of what you consider to be your worst symptoms? 
 

Things to consider in deciding your next move

1) It has only been just over three weeks since you made a 100% reduction, which came off the back of another 100% reduction only 2 weeks prior to that. 

2) Do you hold longer and wait for the seemingly paradoxical post dosing symptoms to resolve? 

3) Is the low dose (1.25mg) enough for you to stabilise on, and if not, are your symptoms tolerable enough to continue tapering slowly (maybe 3 final two to three weekly reductions of 0.25mg each before jumping at 0.5mg)? 

Given you say your symptoms are mild and barely noticeable at the beginning of the day, personally, I would consider No. 3, reducing by that 0.25mg and holding for another couple of weeks. 

I hope this helps. 

Sorry it took a while to reply. 
 

@[Wi...] thank you so much for your thoughtful reply. I appreciate your help so much! The symptoms I am experiencing are very up and down. I'm going to tag @[Sc...] here too as she replied to another post I made.

My worst symptoms: tinnitus, muscle tightness/spasms, insomnia, poor memory, lack of concentration, sweating, flushing, irritability, headache, reflux, nausea, blood pressure fluctuations.  At one point I was having more symptoms, so it is encouraging that some have resolved. The tinnitus and muscle tightness are always present to some degree. At the worst, the symptoms prevent me from doing much more than sitting on the couch but most days I able to complete simple tasks around the house and attend appointments for physical therapy or run a quick errand. Sometimes I feel pretty normal.

When I wrote my question to you the other day I was up in the middle of the night with insomnia. In the morning, my symptoms were moderate instead of mild, as they had been previous mornings. Then after taking my medication in the early afternoon, my symptoms were mild and almost nonexistent for the rest of the day. Throughout the rest of the afternoon and evening the sweating and tinnitus flared a little but I was able to sleep much better last night. Now this morning the tinnitus and muscle spasms are moderate again but other symptoms are mild. I think you are right that I am still trying to stabilize on this dose. It likely is not a paradoxical reaction to the medication or I would react negatively every time I take it. Is the correct?

Yesterday my doctor replied to me and sent out the 5mg/5ml liquid. She recommended dropping to 1 ml for 7 days and then continuing to taper down by 20% every 7 days. This was all through the nurse, so I didn't get to ask any questions. 

It really is hard to know what to do. I agree with the fact that my last cut was too much and that sent me into a tailspin. Unfortunately, I had no guidance at the time and didn't know what I as dealing with. I wish I had found this group prior to that. Nevertheless, here I am, and I don't want to go backward by up dosing. I am almost 3 weeks into this dose and dealing with the symptoms. I'm so thankful I found this group and you are helping me through this.

Here are my thoughts:

1. Hold at 1.25 mg and give myself another week to stabilize. That would be a total of 4 weeks at 1.25 mg. Then I could dilute the oral solution and go in small increments from 1.25 mg to 1 mg over a period of 5 days or even 10 days. Perhaps this would more gently ease me into the lower dose. I could hold there then until I feel more stable and then try to move down to .5 mg the same way. 

2. I could start the tapering method above right now and hope for the best. 

Please let me know your thoughts whenever you have time. Thanks so much for your help!

 

 

[Guest [...]]

Hi @[...]

Yes… I would hold a little longer on the 1.25mg tablet. You don’t want to be switching to a liquid delivery system until you feel you have recovered to your baseline symptom level. Playing around too much with your doses, whether increases, decreases, or alternate delivery systems, can further rock the boat when you’re still vulnerable.

Wait and see if you continue to improve. Then, when you do switch to the liquid, start at 1.25ml (1.25mg) and hold for a week to get used to the new liquid delivery system before reducing to 1ml (1mg). 

If you were experiencing a true paradoxical reaction to the medication, yes… it would happen with every dose, and increasingly so with an up-dose. It sounds like you are experiencing something similar to what I experienced when I was destabilised and in acute. 

Going by certain symptoms you ‘didn’t’ mention, rather than the ones you did mention, you are not experiencing acute withdrawal, and it sounds like you are gradually stabilising. 

The 20% reductions your doctor suggests sound reasonable, although, I would hold for at least 10 - 14 days. Seven days doesn’t allow enough time to adjust to each reduction. 

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2 hours ago, [[W...] said:

Hi @[...]

Yes… I would hold a little longer on the 1.25mg tablet. You don’t want to be switching to a liquid delivery system until you feel you have recovered to your baseline symptom level. Playing around too much with your doses, whether increases, decreases, or alternate delivery systems, can further rock the boat when you’re still vulnerable.

Wait and see if you continue to improve. Then, when you do switch to the liquid, start at 1.25ml (1.25mg) and hold for a week to get used to the new liquid delivery system before reducing to 1ml (1mg). 

If you were experiencing a true paradoxical reaction to the medication, yes… it would happen with every dose, and increasingly so with an up-dose. It sounds like you are experiencing something similar to what I experienced when I was destabilised and in acute. 

Going by certain symptoms you ‘didn’t’ mention, rather than the ones you did mention, you are not experiencing acute withdrawal, and it sounds like you are gradually stabilising. 

The 20% reductions your doctor suggests sound reasonable, although, I would hold for at least 10 - 14 days. Seven days doesn’t allow enough time to adjust to each reduction. 

@[Wi...]Thank you for explaining that. I have been taking Depo Medrol injections for post surgical inflammation and need to take another one. Is this okay to do while having withdrawal symptoms?

 

[Guest [...]]

Hi @[...]

Youre welcome!

Im not at all familiar with Depo Medrol, but you could post your question on the Health Matters board and see if you get responses from other members who may be familiar with it. You could also use the search engine to find any previous posts on Depo Medrol. 

 

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@[Wi...] I tried taking the oral solution today. I took the same dose I have been taking in pill form, 1.25 mg. I notice a difference in that I have a headache and nausea along with increased sweating and tinnitus too. Is it too late to go back to the pills? I was thinking that if it isn't too late to go back to the pills, I may see if I could get 2 mg pills. If I could, would it be possible to taper all the way down to .25 mg using 2 mg pills and a scale? 

Any advice is very appreciated! 

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[Guest [...]]

Hi @[...]

Thats the reason you should switch to the same dose of liquid and hold for up to a week or so, to adjust to the new delivery system. 

Let us know how you fare over the coming days. 

[[...]]

@[Wi...] I held the liquid dose for a week and my symptoms were very mild and most had almost faded away.

Yesterday I tapered to the 1 mg dose. Very soon after I took it, I began noticing symptoms like pressure headache and face pain, sweating, irritability, flushing, tinnitus, tingling hands and feet, muscle tightness.

I take my dose around 1:30 pm. My symptoms had calmed some since that first 1 mg dose but now that I have taken a second dose, I'm noticing the same uptick in intensity of symptoms. 

Is this pretty normal or did I cut too much at once? 

Hope you are doing well!

[Guest [...]]

Hi @[...]

I’m also tapering Valium, and for me, the onset of reduction symptoms are generally felt around day 3, peak around day 5, and begin to resolve around day 9. 

I’m not sure why you would experience that uptick in symptoms as soon as you reduced (same day), but it could have to do with anticipation of an onset of symptoms knowing you’ve you’ve just cut. 

Based on the way you’ve tolerated such a rapid taper, I think a 0.25mg reduction (20%) was a reasonable cut. You can choose to reduce by 10% if it makes you feel more comfortable. This doesn’t mean being symptom free. You are at such a dose now that it would be providing very little therapeutic effect, but the dependancy is still there. 

Once you feel you’ve recovered from this most recent reduction, you can choose to reduce at whatever percentage you feel comfortable with, whether 20% again down to 0.80mg, or even 10% down to 0.90mg. It’s up to you.

The jump dose for Valium is considered to be 0.50mg, but you can taper lower and just walk off if you are too apprehensive to jump from 0.50mg, but tapering lower offers very little, if any, therapeutic effect, keeps you in dependancy, and only holds up the healing process. 

It’s normal to be experiencing an increase in symptoms at these lower doses from smaller reductions.

You are best placed to make the decision about the percentages you reduce by from here on, based on your symptoms. 

You should be very confident as you move towards the recovery phase. 

 

 

 

[[...]]

8 hours ago, [[W...] said:

Hi @[...]

I’m also tapering Valium, and for me, the onset of reduction symptoms are generally felt around day 3, peak around day 5, and begin to resolve around day 9. 

I’m not sure why you would experience that uptick in symptoms as soon as you reduced (same day), but it could have to do with anticipation of an onset of symptoms knowing you’ve you’ve just cut. 

Based on the way you’ve tolerated such a rapid taper, I think a 0.25mg reduction (20%) was a reasonable cut. You can choose to reduce by 10% if it makes you feel more comfortable. This doesn’t mean being symptom free. You are at such a dose now that it would be providing very little therapeutic effect, but the dependancy is still there. 

Once you feel you’ve recovered from this most recent reduction, you can choose to reduce at whatever percentage you feel comfortable with, whether 20% again down to 0.80mg, or even 10% down to 0.90mg. It’s up to you.

The jump dose for Valium is considered to be 0.50mg, but you can taper lower and just walk off if you are too apprehensive to jump from 0.50mg, but tapering lower offers very little, if any, therapeutic effect, keeps you in dependancy, and only holds up the healing process. 

It’s normal to be experiencing an increase in symptoms at these lower doses from smaller reductions.

You are best placed to make the decision about the percentages you reduce by from here on, based on your symptoms. 

You should be very confident as you move towards the recovery phase. 

 

 

@[Wi...] Thank you for your thoughtful advice. I appreciate you sticking with me.         I do not think I'm getting any therapeutic effect from the dose I'm on. I was really thinking that this cut would be pretty easy since I cut 20% instead of 50%. With the 50% cut the symptoms started on day 2 or 3 and didn't peak until around day 10 (I can't remember for sure). But it didn't start settling down until close to 4 weeks after the cut. The muscle tightness was the worst symptom of all. My symptoms never fully resolved so I could have been getting into a wave when I made the cut. It's hard to tell.                                                     I have another question, is the recovery phase typically shorter for people who have only been on Valium for a short period of time at a relatively low dose vs people who have been on for years at a high dose?

[Guest [...]]

You are at a low dose @[...], however, as uncomfortable as your symptoms may be, they do appear to be tolerable compared to many other members, especially considering you say the muscle tightness is your worst symptom. Of course, the muscle tightness is only to be expected, as benzo’s are muscle relaxants. 

In response to your question… Yes, that is correct… the shorter term users do tend to recover faster than longer term users. 

[[...]]

11 hours ago, [[W...] said:

You are at a low dose @[...], however, as uncomfortable as your symptoms may be, they do appear to be tolerable compared to many other members, especially considering you say the muscle tightness is your worst symptom. Of course, the muscle tightness is only to be expected, as benzo’s are muscle relaxants. 

In response to your question… Yes, that is correct… the shorter term users do tend to recover faster than longer term users. 

@[Wi...] yes, thankfully my symptoms are tolerable at this point and the muscle tightness isn't as bad as it got after the first cut. The muscle tightness was not tolerable after the first cut and lasted for about 2 1/2 weeks before settling down.

The reason I was taking the valium was for muscle spasms after a big spinal surgery. The withdrawal really sent me backward in my recovery. 

I'm relieved to know that the shorter term users tend to recover faster. I'm also encouraged that things are going better with this recent cut. 

Thanks again for your help! I hope your taper is going okay. Are you getting close to being done?

[Guest [...]]

You’re welcome!

I still have a way to go, @[...].

3.61mg V, tapering at 5% every two weeks, or just over.