Hyperbolic taper

[[al...]]

I currently am dry cutting and holding Valium 5-7%  every two weeks using a jewelers scale.   My question is what is a hyperbolic taper and do I start using that form of taper when I get low on my taper?  And if so how?

Thanks a head of time for any responses

 

 

 

 

 

 

 

 

 

 

 

 

 

[[Fa...]]

Hi again, @[al...].  I wouldn't worry myself too much with this topic.  You appear to be doing a great job with your exponential taper.  I believe we may have discussed this topic on the attached thread.  Hopefully re-visiting and watching the video from Dr. Mark Horowitz will be helpful if you are so inclined.

What we know about 'hyperbolic' tapering regimens is that they are reasonably well approximated by an exponential tapering regimen; however, in theory, an exponential taper will never end.  At some point you will have to abandon the exponential taper, and just begin making 'small enough' reductions on a 'gradual enough' schedule to keep symptoms tolerable and maintain functionality (e.g., reduce by .1, .15, or .2mg, and hold for 2 weeks).  Credit Libertas for that frustrating, yet accurate, depiction of how to reduce your dose.  It is the only universally acceptable, and accurate, tapering advice I've read to date in my opinion.  

[[Li...]]

Hello @[al...].

Just checking …

When you calculate your percent reductions, are you basing them on your original (starting) dose?  Or your previous dose?  Calculating percent reductions based on the original starting dose will result in a linear taper; calculating reductions based on the previous dose will result in an exponential taper. 

Hyperbolic tapering regimens are informed by the dose-receptor occupancy (binding) curve for a given drug molecule.  As the name implies, the shape of these curves is a hyperbola.  For example, Figure A in the graphic linked below shows the binding curve for the antipsychotic haloperidol (the binding curves for the benzodiazepines are also hyperbolic, I just haven’t found an example to link to as yet).

Hyperbolic relationship between receptor occupancy and dose

Notice that the binding curve is steep in the beginning when the dose is low and becomes flatter at higher doses.  In other words, very low doses have a much larger effect on target receptors than higher doses.

Hyperbolic tapering regimens follow the shape of the binding curve. The size of the dose reduction gets smaller as the dose gets lower.

My current understanding is that the math involved in calculating hyperbolic tapering regimens is drug-specific and somewhat complex.  Fortunately, per Mark Horowitz in the video referenced by @[Fa...], hyperbolic tapering regimens are reasonably well approximated by exponential tapering regimens.  Again, per Horowitz, a 2.5% GABA-A receptor occupancy reduction in a hyperbolic regimen approximates a 10% dose reduction in an exponential regimen.

[[al...]]

Yes , I make my reductions  based on my last dose , therefore I'm on an exponential taper.  So in summary I just need to go slower near the end because cuts have a greater impact as shown by the curve at the lower  doses.    

Thanks  for the replies! 

[[Li...]]

By Jove, you’ve got it @[al...]!  You are indeed currently implementing an exponential taper using a taper rate of 10-14% per month.  Given your history, your decision to use a moderate to slow taper rate is sound.

Are you keeping a daily taper log?  This will be your best source of data to determine whether or not you need to decrease your taper rate or make other adjustments in your taper.  Key data points to include in the log are: the date, dose times and amounts, a global rating of symptom severity (e.g. 0 = no symptoms, 10 = intolerable symptoms), and a global rating of overall functionality (0 = able to perform all essential daily tasks with no issues, 10 = unable to perform any essential daily tasks).  

Are you taking any other medications in addition to the Valium?  If so, have you checked for interactions among and between them and Valium?  Also, have you checked the FDA drug labels for possible adverse effects?  I ask because it is not uncommon for members to attribute withdrawal symptoms to tapering too quickly, when in reality other factors are in play.
 

[[al...]]

I do keep a taper log  each day that includes sxs if any and functionality rating with the dose and how long I've been on that current dose.  I take no other medications. 

So far I've been pretty fortunate with few sxs, however i do get the occasional wave that lasts a day or two, but not often.  My last taper 9 years ago which took 2 years was smooth and when I jumped I was ok.  Hoping it goes that way this time and for the last time.  

Thanks for the input! 

[[Li...]]

You’re most welcome, @[al...].  I’m glad your taper is not complicated by other medications and is going well.  

Tip of the hat for keeping a daily taper log! Monitoring symptoms/functionality and adjusting one’s taper as needed are key to success. (The only caveat is that one needs to be careful not to over monitor — obsessing, ruminating, and/or catastrophizing about withdrawal symptoms day in and day out is counter-productive.)