Advice Needed– .5 mg of nightly Xanax Taper

[[...]]

 

Hello everyone,

I started tapering off of Xanax 6 days ago, reducing my dose by 1/8th of a .5 mg tablet every night.  Although my intention is to remain flexible, my initial plan is to reduce the dose by that amount every thirty days and be done in eight months.  I haven’t been able to find a lot of info regarding tapering off from such a low amount, thus I’m looking for input and advice as to how I can optimize my opportunity for success and minimize withdrawal symptoms. The details of my situation are below.

·        I’m a 59 y/o female.

·        First prescribed and started using daily 8 years ago.

·        I’ve been taking one .5 mg tablet nightly for insomnia.

               o   I suffer mild to moderate anxiety, but the prescription was for insomnia that was exacerbated by the anxiety.  After a lot of work and                      therapy including CBT and improved life circumstances, I have it under better control now.

               o   Except for a couple of months during Covid lockdown when I took 1 mg to knock me out and keep me asleep 3-5 times a week, (and                      when I tried to quit, see info on that below) I’ve stuck with the .5 nightly dosage for almost the entire time since prescribed.

·        I’ve tried to quit three times:

              o   Two of which with a swifter tapering schedule (first time reducing .25 mg’s a night and cutting every week, the last being .125 mg’s                        less a night, reducing every two weeks).  Each time I completed the process but couldn’t stay Xanax-free for long, I took them back                        up due to my original problem, insomnia. 

             o   I tried cold turkey a couple of years ago (by advice the of my new doctor at the time) and tried Valerian Root and Melatonin instead                        per her suggestion, but of course that didn’t help nor last long.

             o   Other than the sleep issues and night sweats (which I associate with menopause), I do not recall any other withdrawal symptoms during these periods.

·        I have done everything I can think of to naturally improve my sleep and overall health; I’ve lost 30 pounds in the last 2 years, I exercise and meditate regularly, implemented “improved sleep hygiene” habits, greatly reduced my alcohol intake, and am eating very clean, consuming little to no sugar or processed foods.

I am dependent upon them for sleep, but don’t feel like I’m contending with full-blown addiction.  I don’t take them during the day, I never think about them until it’s time for bed, and except for those few months during Covid, have stuck with the .5 mg a night for eight years; that dosage is still doing the trick for me.

So far my taper is going smoothly, other than (as expected) I’m waking up more in the middle of the night and only getting 5-6 hours of sleep.

Any advice or thoughts out there?

[[ou...]]

Hi @[...] and welcome. We usually recommend going a bit slower, certainly more than your previous attempts, but since you don't seem to have any withdrawal problems your plan is generally sound. One important thing is that tapering is not a linear process. For example, cutting .0625mg represents only 1/8 of your original dose but it'd be 50% from a dose of .125mg. This means that you could probably manage .0625mg cuts every 2 weeks for the first half of your taper but you'd need to go slower after. Also, in order to go slower, it'd be better to make smaller cuts in the same interval than continue with the same cuts and hold for longer.

Edited November 27, 2023 by [ou...]

[[Co...]]

1 hour ago, [[o...] said:

Hi @[...] and welcome. We usually recommend going a bit slower, certainly more than your previous attempts, but since you don't seem to have any withdrawal problems your plan is generally sound. One important thing is that tapering is not a linear process. For example, cutting .0625mg represents only 1/8 of your original dose but it'd be 50% from a dose of .125mg. This means that you could probably manage .0625mg cuts every 2 weeks for the first half of your taper but you'd need to go slower after. Also, in order to go slower, it'd be better to make smaller cuts in the same interval than continue with the same cuts and hold for longer.

I think @[...] is intending to reduce her dose by 1/8 of 0.5mg tablet (0.0625mg) every 30 days. Did you read it - as I did at my first reading - that @[...] is reducing her dose by 1/8 of pill every night (to complete the taper in 8 days)?

We find that at low doses - where the benzodiazepine has a more marginal affect upon the whole GABA picture - the fact that size of the cut (in terms of percentage) is rising is not a problem. It is more just an inevitable mathematical reality, but not a problem in of itself.

But your general note of caution about going too fast is certainly correct. 8 days to complete the taper might well be be overly optimistic, even from a low dose. But after protracted use, I'd usually suggest making those kinds of reductions about every week, adjusting the frequency of cuts according to how the member reacts.

@[...] Given your past struggles with quitting, a more cautious approach this time round is only sensible. And cutting by 1/8 of a pill seems very reasonable to me. The key, I think, is to be flexible. If your taper becames progressively more difficult, the usual approach (at low doses) would be to allow more time between each cut as your taper progresses. If you find that cutting your dose by 1/8 of a pill - no matter how much time has elapsed from your previous cut - is too difficult, there are methods for achieving even smaller reductions. We can discuss those if and when the need arises. (They usually involve grinding the pill into a powder, using scales, or obtaining a suspension agent from the pharmacist. It is probably not worth considering right now. The point is, though, there are options available in that situation).

[[Li...]]

Per the OP’s first post:

“… my initial plan is to reduce the dose by that amount every thirty days and be done in eight months. “

[[ou...]]

21 minutes ago, [[C...] said:

We find that at low doses - where the benzodiazepine has a more marginal affect upon the whole GABA picture - the fact that size of the cut (in terms of percentage) is rising is not a problem. It is more just an inevitable mathematical reality, but not a problem in of itself.

Of course, I've been saying that for years. It's mathematically impossible to get to 0 with an exponential taper. In reality tapering should follow a hyperbolic pattern (https://benzobuddies.org/topic/273486-hyperbolic-tapering/) which approximates exponential tapering at medium to high doses but tends to become linear at low doses.

What I meant is that reducing by .0625mg/month is a linear taper and OP could even go a bit faster in the beginning (say every 2 weeks) and that near the end it'd be better to make smaller cuts if possible rather than shifting to monthly reductions.

[[...]]

1 hour ago, [[o...] said:

Hi @[...] and welcome. We usually recommend going a bit slower, certainly more than your previous attempts, but since you don't seem to have any withdrawal problems your plan is generally sound. One important thing is that tapering is not a linear process. For example, cutting .0625mg represents only 1/8 of your original dose but it'd be 50% from a dose of .125mg. This means that you could probably manage .0625mg cuts every 2 weeks for the first half of your taper but you'd need to go slower after. Also, in order to go slower, it'd be better to make smaller cuts in the same interval than continue with the same cuts and hold for longer.

Got it, that makes perfect sense.

[[...]]

36 minutes ago, [[C...] said:

We find that at low doses - where the benzodiazepine has a more marginal affect upon the whole GABA picture - the fact that size of the cut (in terms of percentage) is rising is not a problem. It is more just an inevitable mathematical reality, but not a problem in of itself.

This is exactly the kind of specific information I was looking for regarding long term use of a low dose.  I understand, thank you.

[[...]]

12 minutes ago, [[L...] said:

Per the OP’s first post:

“… my initial plan is to reduce the dose by that amount every thirty days and be done in eight months. “

Yes, correct; upon a second read I see how my original post could be confusing.  To clarify:  I'm reducing my dose by an eighth, and intend to stay at that level a month, then lower it again by that same amount, and so on until I'm free of this thing.

[[Co...]]

12 minutes ago, [[o...] said:

Of course, I've been saying that for years. It's mathematically impossible to get to 0 with an exponential taper. In reality tapering should follow a hyperbolic pattern (https://benzobuddies.org/topic/273486-hyperbolic-tapering/) which approximates exponential tapering at medium to high doses but tends to become linear at low doses.

12 minutes ago, [[o...] said:

What I meant is that reducing by .0625mg/month is a linear taper and OP could even go a bit faster in the beginning (say every 2 weeks) and that near the end it'd be better to make smaller cuts if possible rather than shifting to monthly reductions.

For this reason, about fifteen years ago, I developed a benzodiazepine taper/withdrawal spreadsheet for liquids. It would automatically generate a table which followed an exponential curve until lower doses, and switch to a linear taper at a low dose (usually, the the lowest dose pill available for the particular benzodiazepine - but this and all inputs were adjustable).

I then moved away from providing direct support for many years, but it was impractical for anyone else to produce HTML tables for other members. So, it was dropped.

[[Co...]]

[[Ed...]]

[[pi...]]

Hello @[Ed...] and welcome to Benzo Buddies!

I am sorry to read about all the grief and stress you’ve had in your life. Add to that a far too rapid taper by an uneducated provider and you have a recipe for very strong symptoms.

It would actually be best if you start your own thread on the forum. That way, we can address your unique situation.

The fact that you felt better updosing with the leftover medication points to withdrawal being the cause of your problems. By the way, the symptoms you describe are very common for benzo withdrawal. 

I am glad you are seeing a new provider soon. Hopefully they will continue to prescribe the drug so you can plan a sensible slow taper.

 We can help you with that, as well as provide support and encouragement. We look forward to hearing more from you, keep posting.

[[Ed...]]

Thank you so much, PianoGirl. Your reassurance - esp. that the symptoms were common for benzo withdrawal - is much appreciated! I will take your advice and start a new thread. I guess I'll just use basically the same text with minor adjustments.

Edited December 6, 2023 by [Ed...]