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Taper Help | Zolpidem & Valium


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[No...]

Hello,


I’m in a bit of a situation here. I was prescribed Ambien 6 months ago after a back injury. My dose escalated all the way up to 22.5mg at one point. I’m presently at 13.5mg. I started experiencing severe anxiety and coped for quite some time. I was prescribed 5mg of Valium 7 weeks ago after it got worse. I’ve realized it’s doing me no favors. My rebound anxiety is getting awful and I’ve been taking it daily.

I’m looking for some guidance. Would you taper the Valium first or the Ambien? My doctor recommended a 4 week taper for the Valium. Let me know your thoughts.

 

TL;DR:

Ambien 13.5mg for 6 months

Valium 5mg for 7 weeks

Which to taper first?


Thanks!

Nolan

Edited by [No...]
Dosage adjustments
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[Co...]

Hello @[No...]. Welcome to BenzoBuddies.

The usual advice is to taper off the shorter acting Ambien/zolpidem first, and then the Valium. However, given that Ambien has such a short half-life, when taken just once per day, it is usually in and out the body too quickly to lead to dependency. Whereas, Valium has very long half-life, and usually leads to dependency after extended use. Given your short-term use of Valium, this can flip the better path forward.

What constitutes 'extended use' is a grey area as it relates to dependency. In a small number of people, dependency can start in as little as two weeks of regular use of (most) benzodiazepines. How dependent you might be after 7 weeks use of Valium (without an attempt to withdraw from it to learn from experience) is anyone's guess. But the chances are that dependency has not occurred or is shallow. So, I think, it might be better to first withdraw from Valium as quickly as practicable.

5mg Valium is a low dose. Do you use 5mg pills? Do you think you can manage to quarter them? When trying to avoid developing dependency, it is usually better to withdraw over a short period (else you risk developing dependency during your taper). I think your doctor's recommendation for a four week taper is sensible.

Once you have completed your taper off Valium, it would be prudent to then allow a few weeks to adjust to your new medication regimen. Further to this, because of Valium's long half-life value, it will take a few weeks after your last dose for it to be fully out of your system anyway.

Having said all that, when you write about 'rebound anxiety', was this occurring before or after you started taking Valium? I'd like an answer to this before I finalise my thoughts to you.

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[No...]
On 10/04/2024 at 00:24, [[C...] said:

Hello @[No...]. Welcome to BenzoBuddies.

The usual advice is to taper off the shorter acting Ambien/zolpidem first, and then the Valium. However, given that Ambien has such a short half-life, when taken just once per day, it is usually in and out the body too quickly to lead to dependency. Whereas, Valium has very long half-life, and usually leads to dependency after extended use. Given your short-term use of Valium, this can flip the better path forward.

What constitutes 'extended use' is a grey area as it relates to dependency. In a small number of people, dependency can start in as little as two weeks of regular use of (most) benzodiazepines. How dependent you might be after 7 weeks use of Valium (without an attempt to withdraw from it to learn from experience) is anyone's guess. But the chances are that dependency has not occurred or is shallow. So, I think, it might be better to first withdraw from Valium as quickly as practicable.

5mg Valium is a low dose. Do you use 5mg pills? Do you think you can manage to quarter them? When trying to avoid developing dependency, it is usually better to withdraw over a short period (else you risk developing dependency during your taper). I think your doctor's recommendation for a four week taper is sensible.

Once you have completed your taper off Valium, it would be prudent to then allow a few weeks to adjust to your new medication regimen. Further to this, because of Valium's long half-life value, it will take a few weeks after your last dose for it to be fully out of your system anyway.

Having said all that, when you write about 'rebound anxiety', was this occurring before or after you started taking Valium? I'd like an answer to this before I finalise my thoughts to you.

The rebound anxiety started happening after the Valium was introduced. I now experience it about 20 hours after my last dose. I have withdrawn from Valium once before and I was in a much better place mentally. I should have never turned back to it or Ambien.

My prior history was Valium 10mg for several years. I tapered over the course of 3 months and I did fine.

My anxiety really started coming back when Ambien was introduced 6 months ago but got considerably worse reintroducing Valium. Is it a kindling effect?

I have 5mg tablets and take the whole thing around the same time. He also prescribed me 2mg tablets to make it easier. I do agree to get the Valium off my back first.

Thank you for the help.

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[al...]

Do you take Ambien once a night or do you take it two or three times? I would say that Valium is not a very strong benzodiazepine while Ambien is quite a strong Z-drug so if the anxiety comes from the Ambien use 5 mg Valium may simply be too weak to control anxiety if it comes from Ambien (I don't mean you should take a bigger dose). I would try to lower the Ambien dose gradually because I guess that after Ambien exceeds 10 mg it starts acting like a benzodiazepine. Going down to 10 mg and then to 5 mg might improve the daily anxiety. But I guess your brain will simply need some time to adjust. I would also try some relaxation technics and breathing excercises to control the daily anxiety.

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[No...]
9 hours ago, [[a...] said:

Do you take Ambien once a night or do you take it two or three times? I would say that Valium is not a very strong benzodiazepine while Ambien is quite a strong Z-drug so if the anxiety comes from the Ambien use 5 mg Valium may simply be too weak to control anxiety if it comes from Ambien (I don't mean you should take a bigger dose). I would try to lower the Ambien dose gradually because I guess that after Ambien exceeds 10 mg it starts acting like a benzodiazepine. Going down to 10 mg and then to 5 mg might improve the daily anxiety. But I guess your brain will simply need some time to adjust. I would also try some relaxation technics and breathing excercises to control the daily anxiety.

The Ambien is once daily before bed. I chose to do the Valium first and went down to 4mg. I hope it’s the right choice?

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[No...]
35 minutes ago, [[N...] said:

The Ambien is once daily before bed. I chose to do the Valium first and went down to 4mg. I hope it’s the right choice?

You do make a really good point though. Am I going to put myself through misery tapering Valium and still hammering my receptors with 12.5mg of Ambien?

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[No...]

Any additional insight on whether to taper the Valium or Ambien first? I chickened out and went back up to 5mg Valium and I feel guilty. I was scared that being on Ambien will make it pointless. What are your thoughts?

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[al...]
1 hour ago, [[N...] said:

Any additional insight on whether to taper the Valium or Ambien first? I chickened out and went back up to 5mg Valium and I feel guilty. I was scared that being on Ambien will make it pointless. What are your thoughts?

Don't feel guilty and don't be scared. Your situation is not at all that alarming- I am in much bigger trouble. I guess first thing to do is to take a deep breath and to acknowledge your situation is not bad. If you feel very anxious during the day take Valium and try to follow you doctors guidance. If you feel that you want to stay on 5 mg Valium a bit longer then discuss it with him/her. I would use Valium as an aid in tapering Ambien and I would taper both. I guess slowly tapering Ambien is crucial here because as I wrote before going down to 10 mg or less might be a game changer to your brain. It's because there are 4 GABA receptors and and 10 mg or less of Ambien only affects 1 of them. Anything above starts to affect all 4. If you go down to 10 mg the other 3 GABA receptors will start to heal naturally. It will also be a perfect moment to start saying goodbye to Valium. Also don't underestimate behavioural methods of handling anxiety- breathing excercises (let's say 10-15 minutes 5 times daily), meditation (two times daily) (I use Jon Kabat-Zinn app, I guess it's called JKZ), sports, walking in a forest or a park, talking to friends, helping others or other forms of distraction. I recently read in dr Ashton's Manual that feeling anxious is a normal symptom during tapering and one should see it as a sign of a healing process. It shows that the brain has started the healing process. If you keep going down you will start experiencing breaks from anxiety. Also after doing a dose reduction when the symptoms stabilize remember to give yourself some time to regain strenght and rest before going down further.

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[Co...]
On 12/04/2024 at 04:12, [[N...] said:

My anxiety really started coming back when Ambien was introduced 6 months ago but got considerably worse reintroducing Valium. Is it a kindling effect?

'Kindling' refers to each new round being more difficult to tolerate than previous rounds. This is well established with alcohol, and there is increasingly good evidence for this occurring with benzodiazepines too (in some people).

I am not saying that introducing reintroducing Ambien or starting Valium is not the culprit - it might be. But it is not 'kindling'.

Kindling (sedative–hypnotic withdrawal) - Wikipedia

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[No...]
7 hours ago, [[C...] said:

'Kindling' refers to each new round being more difficult to tolerate than previous rounds. This is well established with alcohol, and there is increasingly good evidence for this occurring with benzodiazepines too (in some people).

I am not saying that introducing reintroducing Ambien or starting Valium is not the culprit - it might be. But it is not 'kindling'.

Kindling (sedative–hypnotic withdrawal) - Wikipedia

Thank you for the information. What are your thoughts on which substance should be withdrawn first? Would I be silly to do both at the same time gradually?

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[No...]
9 hours ago, [[a...] said:

Don't feel guilty and don't be scared. Your situation is not at all that alarming- I am in much bigger trouble. I guess first thing to do is to take a deep breath and to acknowledge your situation is not bad. If you feel very anxious during the day take Valium and try to follow you doctors guidance. If you feel that you want to stay on 5 mg Valium a bit longer then discuss it with him/her. I would use Valium as an aid in tapering Ambien and I would taper both. I guess slowly tapering Ambien is crucial here because as I wrote before going down to 10 mg or less might be a game changer to your brain. It's because there are 4 GABA receptors and and 10 mg or less of Ambien only affects 1 of them. Anything above starts to affect all 4. If you go down to 10 mg the other 3 GABA receptors will start to heal naturally. It will also be a perfect moment to start saying goodbye to Valium. Also don't underestimate behavioural methods of handling anxiety- breathing excercises (let's say 10-15 minutes 5 times daily), meditation (two times daily) (I use Jon Kabat-Zinn app, I guess it's called JKZ), sports, walking in a forest or a park, talking to friends, helping others or other forms of distraction. I recently read in dr Ashton's Manual that feeling anxious is a normal symptom during tapering and one should see it as a sign of a healing process. It shows that the brain has started the healing process. If you keep going down you will start experiencing breaks from anxiety. Also after doing a dose reduction when the symptoms stabilize remember to give yourself some time to regain strenght and rest before going down further.

Thank you for the information. Do you have some literature on the Ambien above 10mg effecting multiple sites? Would it be silly to do gradual reductions of both at the same time? I’m going to make an attempt tonight.

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[No...]
On 10/04/2024 at 00:24, [[C...] said:

Hello @[No...]. Welcome to BenzoBuddies.

The usual advice is to taper off the shorter acting Ambien/zolpidem first, and then the Valium. However, given that Ambien has such a short half-life, when taken just once per day, it is usually in and out the body too quickly to lead to dependency. Whereas, Valium has very long half-life, and usually leads to dependency after extended use. Given your short-term use of Valium, this can flip the better path forward.

What constitutes 'extended use' is a grey area as it relates to dependency. In a small number of people, dependency can start in as little as two weeks of regular use of (most) benzodiazepines. How dependent you might be after 7 weeks use of Valium (without an attempt to withdraw from it to learn from experience) is anyone's guess. But the chances are that dependency has not occurred or is shallow. So, I think, it might be better to first withdraw from Valium as quickly as practicable.

5mg Valium is a low dose. Do you use 5mg pills? Do you think you can manage to quarter them? When trying to avoid developing dependency, it is usually better to withdraw over a short period (else you risk developing dependency during your taper). I think your doctor's recommendation for a four week taper is sensible.

Once you have completed your taper off Valium, it would be prudent to then allow a few weeks to adjust to your new medication regimen. Further to this, because of Valium's long half-life value, it will take a few weeks after your last dose for it to be fully out of your system anyway.

Having said all that, when you write about 'rebound anxiety', was this occurring before or after you started taking Valium? I'd like an answer to this before I finalise my thoughts to you.

Could you please let me know your final thoughts? I’m ready to get going. I may also be introducing Pristiq my old antidepressant that did work.

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[Co...]
1 hour ago, [[N...] said:

Thank you for the information. What are your thoughts on which substance should be withdrawn first? Would I be silly to do both at the same time gradually?

Hi @[No...]

I cannot provide you with instructions. The decision is yours. But I did provide my thoughts on this in an earlier post:

I would add that we generally suggest to withdraw from one benzodiazepine at a time.

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[Co...]
1 hour ago, [[N...] said:

Could you please let me know your final thoughts? I’m ready to get going. I may also be introducing Pristiq my old antidepressant that did work.

My suggestion is similar. Unless your doctor instructs you otherwise,* make one change at a time. This way, if you experience problems, it is generally much easier to identify the cause.

* Of course there occasions where prompt action and multiple chances at the same time are warranted.

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[No...]
23 minutes ago, [[C...] said:

My suggestion is similar. Unless your doctor instructs you otherwise,* make one change at a time. This way, if you experience problems, it is generally much easier to identify the cause.

* Of course there occasions where prompt action and multiple chances at the same time are warranted.

Got it, thank you. Here’s the plan: reduce Valium from 5mg to 4mg. Hold it for a week. Keep the Ambien at 12.5mg. Good plan?

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[No...]
2 minutes ago, [[N...] said:

Got it, thank you. Here’s the plan: reduce Valium from 5mg to 4mg. Hold it for a week. Keep the Ambien at 12.5mg. Good plan?

It’s either that or get the Ambien under 10mg and then taper the Valium?

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[Co...]
3 minutes ago, [[N...] said:

Got it, thank you. Here’s the plan: reduce Valium from 5mg to 4mg. Hold it for a week. Keep the Ambien at 12.5mg. Good plan?

Sounds reasonable to me. Good luck! :)

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[Co...]
1 minute ago, [[N...] said:

It’s either that or get the Ambien under 10mg and then taper the Valium?

I'd suggest to avoid over-thinking it. Of course you should play it by ear - do not have your plans set in stone. But, generally, members will taper off one benzodiazepine and then the other.

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[No...]
27 minutes ago, [[C...] said:

I'd suggest to avoid over-thinking it. Of course you should play it by ear - do not have your plans set in stone. But, generally, members will taper off one benzodiazepine and then the other.

I love this website. You guys are great. Thank you for the help. So thinking I’m “unable” to recover while taking Ambien at the same time is silly?

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[No...]
59 minutes ago, [[N...] said:

I love this website. You guys are great. Thank you for the help. So thinking I’m “unable” to recover while taking Ambien at the same time is silly?

Sorry, I have a lot of uncertainty 😊 I wonder if doing the Ambien first old be a smoother transition because what you said earlier about the shorter half life?

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[No...]

Hello,

I’d like to get this dialed back to one medicine pretty quickly and I’ve even began looking at facilities to help me. I’m in Washington state. Anyone with experience around the area?

ambien 12.5mg for 5.5 months and Valium 5mg for almost 8 weeks is crippling me. Crazy how much worse these things can make you. 
 

I am really going downhill since starting these medications. My doctor wants to onboard an antidepressant but I worry that’s not what’s causing all my issues.

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[al...]
13 hours ago, [[N...] said:

Thank you for the information. Do you have some literature on the Ambien above 10mg effecting multiple sites? Would it be silly to do gradual reductions of both at the same time? I’m going to make an attempt tonight.

It wouldn't be silly at all. I will look for the literature about Ambien and will share it with You.

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[Co...]
10 hours ago, [[N...] said:

Sorry, I have a lot of uncertainty 😊 I wonder if doing the Ambien first old be a smoother transition because what you said earlier about the shorter half life?

As per my earlier comments, the only concern about tapering off the Ambien first is that you may have no to low dependency due to your approx. 8 weeks use of Valium, and probably none due to Ambien (because of its very short half-life and your one-a-day use). But the longer you take Valium, the greater the chance of developing or deepening your dependency.

There is no way for us to be precise about these things. But in your shoes, I think I would attempt to taper off Valium first and see how it goes. If you develop difficulties doing this, and depending what they are, you might decide to switch your taper to the Ambien.

I understand your reticence, but to get off, you will need to take a first step. And only you can make the decision about doing this and the particular path you take.

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[Co...]
1 hour ago, [[N...] said:

Hello,

I’d like to get this dialed back to one medicine pretty quickly and I’ve even began looking at facilities to help me. I’m in Washington state. Anyone with experience around the area?

ambien 12.5mg for 5.5 months and Valium 5mg for almost 8 weeks is crippling me. Crazy how much worse these things can make you. 

I am really going downhill since starting these medications. My doctor wants to onboard an antidepressant but I worry that’s not what’s causing all my issues.

You will need to talk more to your doctor about this, the reasons for the suggestion, the risks vs the potential benefits. This is true of every medicine of course. And I'm not going to get into making medical decisions for you - these, properly, should be between you and your doctor.

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[No...]
18 hours ago, [[a...] said:

It wouldn't be silly at all. I will look for the literature about Ambien and will share it with You.

Thank you, please let me know.

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