Medazepam taper: looking for dosage advice

[[me...]]

Greetings, I'll try to be as brief as possible:

My story started last year in November when I had 6 weeks of relentless diarrhea which developed into insomnia and passing out on the toilet many times (I have a vagus nerve issue)
GI diagnosed me with GAD induced IBS-D, and put me on probiotics, a bowel movement slowing agent and 30 mg of Medazepam. This long acting benzo is perhaps less known in the western world, but it's heavily prescribed in Eastern Europe, and many non-western countries. There is very little information available on the internet about Medazepam, so I'm inserting this hard to find but valuable link for future Medazepam victims, it was buried deep within 10+ pages of google results:

https://tripsitter.com/benzodiazepines/medazepam/

Quote

Medazepam, sold under different brand names such as Azepamid, Nobrium, Tranquirax, Rudotel, Raporan, Ansilan, Mezapam, and others, is a benzodiazepine prodrug. The liver converts medazepam into the active form, diazepam

The GI put me on 30 mg, but upon reading the recommended dose being 20 mg in the leaflet I decided to overrule his advice and started doing 2x10mg per day.
He said to take it for 8 weeks and taper the last week with a half dose then stop.

My diarrhea and insomnia were gone within a week, and I felt really good, really normal for the entire 2 month duration. I considered myself healed and happily started the 1 week tapering. 3 days after the last dose, insomnia started. I still haven't connected the dots, I didn't know about benzo harm being a thing, but after 9 nights of insomnia, very little sleep (mostly shallow 4 hours with the help of zopiclone he prescribed me earlier) it all developed in the return of severe diarrhea that got worse and worse. On the last day I had to go 10 times and it looked like I was going to pass out so I bent the knee and took another dose of Medazepam and booked a visit to my GI. 

He told me that the medication is clearly working, why discontinue it, he has patients who are taking it for 20+ years. I didn't like that so I started researching and found out about tapering. My plan was to stabilize and start tapering without any assistance, since it would be hard to find anyone experienced in benzo WD, due to them being prescribed like candy in my country (Hungary). It's a different world here, we are decades behind in benzo awareness.

So after taking 20 mg for another month (I'm at 3 months total at this stage) I started noticing that the anxiolytic benefits were starting to get weaker (but sleep was still fine), so I decided it's time to taper. At this stage, I was taking half a pill (5 mg) in the morning, half midday and a complete (10 mg) at around 7 PM

I started a weekly schedule:

1st week: 1/2 off the morning pill (2.5 mg less)
2nd week: 1/2 off the evening pill (2.5 mg less). Midweek moved the midday half pill down to morning, and halved the morning pill as well. So 6.25 mg in the morning at this point.
3rd week: got rid of the 1/8 pill, and only taking 5 mg in the morning, and 7.5 mg at evening.

So in summary, after daily usage of 3 months (excluding a short 9-11 day beak) I'm down from 20 mg of Medazepam to 12.5 mg in almost 3 weeks. I have 3 more days to complete my 3rd week and decide the next step. First two weeks were going fine sleep-wise, but In the last 3 days I started developing insomnia, I had a terrible 1 hour night on Thursday, slept 6 hours the next day, and back to 2-4 hours last night. I have plenty of zopiclone but I'm afraid to use it. 

How should I proceed considering the hypnotic and anxiolytic effects are starting to fade away? should I go faster, slow down or stop?
Any advice is highly appreciated, thank you in advance!

[[Ka...]]

Hello @[me...] I am sorry for all you’ve experienced thus far. I have taken what seems a similar med diazepam/valium & can try to help with some pointers. 

I share some of your issues. At the start of my illness I had sudden insomnia/panic/anxiety together with crippling diarrhoea. All subsided with a benzo (plus zopiclone) & I thought all was fine. These meds assist us for a short spell yet can provide us with a false sense of security in that it is really a sticking plaster & if we continue then we can run into problems. Their effects subside. Side effects and withdrawal symptoms arise. 
On a positive note, you’ve not been taking medazepam for overly long & compared with some of us. And you are researching which is absolutely the right approach. The most valuable resource I’ve found is Benzo Information Coalition & I link here comprehensive info in case you’ve not come across this info: 
https://www.benzoinfo.com/benzodiazepine-tapering-strategies/

You’ll see at the start of the link The Maudsley Desprescribing Guidelines that are available via Amazon in print or kindle & serve to inform those prescribing (who can be clueless) & give invaluable info to us pill poppers. 
The cuts you’ve made are large. Usual recommendation is for small cuts say 5-10 per cent every 4 weeks. A slow approach will be best going forward & allow your system to adapt to reductions. 

Personally, I would advocate monitoring for GI problem & common sense will prevail with this. It’s good to keep a journal of your dose, watch symptoms & be led by them. Hold cuts as necessary to stabilise. 
I hope this helps. You are here which is very good indeed. 

Edited May 5 by [Ka...]
Per cent

[[me...]]

Hello @[Ka...] thank you for your kind, reassuring words. And thanks for the link, actually it's been my bible in the last couple of weeks. 

I've read some horror stories on BB written by short term victims, but you telling me that my 3 months is on the positive side is uplifting. That's my only hope really. 

So you recommend a much slower approach? wont that push me into long-term territory? It is said that longterm benzo starts at 6 months

Another question: what do you think about taking occasional zopiclone? should I completely avoid them during the taper?

[[Ka...]]

Yes, @[me...] we are all different but slower approach is two fold 1. It’s better for the system to adapt & for smoother withdrawal & for recovery  2. reinstatement of the med is avoided. 
 

I personally wouldn’t recommend occasional use of zopiclone. Z drugs work in same way as benzos. If you can possibly manage without adding a z drug that would be far better. 

 

[[me...]]

Thank you @[Ka...], one more question if I may: Is the suggested 5-10% reduction meant from the initial dose, or from the current? I think there is a mathematical difference but I have such brain fog now it's a miracle I can even type.

Edited May 5 by [me...]

[[Ka...]]

@[me...] That’s OK - from the current dose. 
By the way that link you found about medazepam is very good. Lots of useful info. 
 

[[...]]

@[me...], hi) I happen to know a bit about medazepam. It was exactly the benzo i did the tapering off bc of its long half-life and being less potent than my original one. I also happend to have a pack of it at hand then. As far as i know, medazepam isn't considered to have too much of hypnotic and myorelaxant properties. I switched to it overnight and felt the difference at once... But, perhaps, that's why it was easier, at least psychologically, for me to jump off it eventually.

I guess you're starting to feel less medazepam effects bc the tolerance is about to show up and i'd be careful not to allow it. As for me, nothing is worse than being in benzo tolerance. Your total use was 3 months. It's not much. And i think you don't need to have too long a taper. Having it long you risk growing tolerance further.

Sure there is the issue of your symptoms and how to avoid them. My opinion is they're still mostly your personal reaction to stress and must be treated some other way but benzo. Benzo doesn't treat anything just cover it for a while. I wish i knew that mysterious way... Hope you'll find the right solution with the help of BB and your doctor. 

I'm also sure you shouldn't take any z-drugs. They will most probably prolong the withdrawal.

Good luck to you with all my heart!)

 

[[me...]]

[[...]]

 

Thank you, @[me...] Sure i mean kind of "severe" tolerance. Drug that isn't working is just the "first" stage. My body got too adjusted to benzo presence and my original dose failed to cover all the adjustments eventually. My withdrawal started long before i began tapering. It was awful - severe headaches and weakness, restlessness, lack of sleep, flat muscles, etc - except the few hours right after taking benzo. I never guessed to updose much enough bc couldn't think the little pill was responsible. Perhaps, it was my luck.

I respect Katrina's opinion and it does make sense bc a long proper taper is supposed to really help our body to adapt to the changes caused by WD. However, i strongly believe it mostly applies to long term users who doesn't hit tolerance yet. Your benzo use isn't long at all that's why i think the quicker the better.  Sure you must listen to your body, taking into account that you're going to have some rough time anyway but i don't think it will last long. And i'd first think of sorting out your original stomach issues. It's all just my personal opinion based on my own experience and observations.

Sorry I'm not an expert at tapering. My taper was a disaster. I'd advise you to start a new thread on Tapering Strategies forum. I'm sure knowledgeable people will help you there much better. 

The same good Luck to you!

 

[[Ka...]]

@[me...] hello again. I’ve been thinking about your taper & re-reading Ashton - maybe this extract may help:

For example, if you are taking 40mg diazepam equivalent you could reduce at first by 2-4mg every week or two. When you are down to 20mg, reductions could be 1-2mg weekly or fortnightly. When you are down to 10mg, 1mg reductions are probably indicated

Every taper is unique & as such is your taper. You made large cuts in a shortish timeframe & I was referencing the usual recommendations. You can go at a pace that suits your individual situation and nothing is set in stone. I hope this may be helpful. 

this thread is now in taper section & others with similar experience can hopefully input. 

Edited May 7 by [Ka...]
Update

[[me...]]

Dear @[...] and @[Ka...] thank you for input, I'm sorry I can't currently respond in detail because I had another zero sleep night, I'm currently barely alive

[[...]]

Good time of the day @[me...]! How're you? I do hope you're better. Somehow, i feel responsible in a way bc my opinion made you doubt. I still stick to it but sure it all depends on too many things. You definitely need to have more thoughts on the matter. I've been thinking and my suggestion is why don't you start a new thread here concerning "Long taper versus shorter one for short term users"? I think ppl may be at a loss when they see "mysterious" medazepam. Perhaps it shouldn't be emphasised, but sure mentioned if you like. I don't think it's very important. Just a benzo suitable for tapering. Once again, it's all my own thinking,  just trying to help you!)