Crossing to Liquid Valium - Need help, at end of Taper

[[an...]]

Hi Guys,

I need your help. I am down to .25 mg of Valium (been tapering .25 mg every 3 wks for almost 2 years). I decided to switch over to liquid compound Valium so I could taper off the last .25 mg slowly each day. Took my first liquid dose last night and am having some mild symptoms. Is this normal, I did not have symptoms with .25mg compound capsule and I have never been on the liquid before? Do some people jump at .25mg of Valium? Also, could anyone shed some insight on whether the compound should be refrigerated? My compound pharmacy said it does not need to be however they have made the liquid batch to last up to 30 days so I am not sure? Another compound pharmacy said that theirs would need to be refrigerated, very confussed. Any advice would be greatly appreciated....thanks so much

 

Maggie

Edited May 17 by [an...]

[[Co...]]

On 17/05/2024 at 18:00, [[a...] said:

Hi Guys,

I need your help. I am down to .25 mg of Valium (been tapering .25 mg every 3 wks for almost 2 years). I decided to switch over to liquid compound Valium so I could taper off the last .25 mg slowly each day. Took my first liquid dose last night and am having some mild symptoms. Is this normal, I did not have symptoms with .25mg compound capsule and I have never been on the liquid before?

There are small differences between formulations, both in actual delivered dose, and in how the dose is absorbed. But the differences should be fairly minor when both are taken by the oral route.

Having said that, what dose does it state on the bottle? Something along the lines of mg/ml or 0.1mg/drop or something - I expect it will vary according to country. I just think it worth us checking that you are taking a nominally equivalent dose.

On 17/05/2024 at 18:00, [[a...] said:

Do some people jump at .25mg of Valium?

Yes. Many people 'jump' at 0.25mg, or even 0.5 or 1mg. But you are not lots of people - you are you. It at BB, it is not at all unusual to taper down your 0.25mg Valium and lower. If you need to taper down further than 0.25mg before quitting, so be it.

On 17/05/2024 at 18:00, [[a...] said:

Also, could anyone shed some insight on whether the compound should be refrigerated?

It should say on the packaging. But yes, I expect that - being a liquid - it normally should be refrigerated after opening.

On 17/05/2024 at 18:00, [[a...] said:

My compound pharmacy said it does not need to be however they have made the liquid batch to last up to 30 days so I am not sure?

Ah. Compounded. Hmm. I would have thought a compounded (rather than manufactured liquid, with preservatives) would be more likely to require refrigeration. But I am guessing. Irrespective, it surely will do no harm to store it in the refrigerator and might well help to stabilise and prevent spoiling of the medication. In short, if this were me, I'd refrigerate it.

On 17/05/2024 at 18:00, [[a...] said:

Another compound pharmacy said that theirs would need to be refrigerated, very confussed. Any advice would be greatly appreciated....thanks so much

Maggie

Yeah. That rather confirms my suspicion. It could be that the two compounded medications vary significantly in their ingredients. Or, technically, refrigeration is not required but one pharmacy takes a belt and braces approach to storage of the compounded medication. Store it in the fridge is my suggestion.

[[Li...]]

On 17/05/2024 at 12:00, [[a...] said:

Also, could anyone shed some insight on whether the compound should be refrigerated?

If you have not already done so, I suggest you ask your compounding pharmacist if the formulation they are using for your compound has been stability tested and if so under what conditions.  Different formulations have different storage requirements.

For example, Hikma’s 5mg/mL oral diazepam solution has these requirements:

Store at 20° to 25°C (68° to 77°F). 
Discard opened bottle after 90 days.
PROTECT FROM LIGHT.

[[Co...]]

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

If you have not already done so, I suggest you ask your compounding pharmacist if the formulation they are using for your compound has been stability tested and if so under what conditions.  Different formulations have different storage requirements.

For example, Hikma’s 5mg/mL oral diazepam solution has these requirements:

Store at 20° to 25°C (68° to 77°F). 
Discard opened bottle after 90 days.
PROTECT FROM LIGHT.

That's much tighter storage requirements than I would have guessed for any formulation.

[[an...]]

The dosage on the bottle is ,25mg/1ml, and they said it does not need refriidgeration but to keep out of light. so confusing when one pharmacy says one thing and another says another. Sorry is 20 to 25C is that room temp? That being said, they said I could store it in the fridge but since I was having symptoms did not know what potential reactions could be if I stored it in the fridge so I took it out of the fridge, at this point I don't know.

Being at .25mg with virtually no symtoms leds me to believe I should have jumped, I have taken 3 doses now with similuar symptoms, should I try to stablize and then jump or jump now? I am worried I am having a reaction to the liquid since I have never take benzo in liquid dose before, my Tinnitus is through the roof. Any further advice would be greatly appreciated....

[[Li...]]

@[an...] What technique were you using to get ‘small enough’ doses before you switched to the liquid?  Can you return to using that technique?

[[Co...]]

9 minutes ago, [[a...] said:

The dosage on the bottle is ,25mg/1ml

So. Have you been taking 1ml?

9 minutes ago, [[a...] said:

Sorry is 20 to 25C is that room temp?

Yes. 68-77F

[[an...]]

Hi Colin, I took 1ml first night and symtoms started a few hours later. Reduced dosage by .005 (i think) 1/2 mark at .95 at top of 1ml suringe last two nights with similar symtoms.

Libertas, I was using a compound perscription with success (but very expensive). Very few symtoms except bad tinnitus which I already have severe tinnitus. I could go back to capsules at .25mg but I will have to wait until Tues, and get new script. I would also have to updose a little since I did go down slightly in dose last two nights. Since I am at such a low dose, don't know what to do. Help! 

[[Li...]]

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

I took 1ml first night and symtoms started a few hours later. Reduced dosage by .005 (i think) 1/2 mark at .95 at top of 1ml suringe last two nights with similar symtoms.

Ah.  You made two changes — a change in dosage form followed by a reduction in dose.  Generally speaking, it’s best to make only make one change at a time so we can evaluate the impact of that change.

In your shoes, I would give strong consideration to returning to the full 1mL dose and holding at that dose  for at least a week.

It is not uncommon for individuals to take a while to adjust to a change in dosage form.  The bioavailability/pharmacokinetics of the liquid may be slightly different than that of the solid dosage form.  Some individuals experience this as a slight reduction in dose; others experience slight changes in the onset and/or duration of action of the drug.

I also suggest you share your experience thus far with your compounding pharmacist and ask for more information about the formulation (ingredients) used to prepare your liquid. For example, did they use the same source of the active ingredient for the liquid they had been using for the capsules (i.e. tablets or bulk powder; if tablets, were they from the same manufacturer)?

 

[[an...]]

Libertas, thanks for your responses, greatly appreciated. If I go back to the 1ml would that not be an updose? I have had bad experiences with updosing. I wll be on the liquid 5 days by Monday, do you think thats enough time for me to stablize, considering jumping at that point since now feel i should have already jumped. Did check with the pharmacy and they use exact pill to formulate compound. Your continued advice is so appreciated...

Edited May 19 by [an...]

[[Li...]]

You’re welcome @[an...].  Tip of the hat for checking with the pharmacy on the source of the active ingredient.  That’s good news the same source was used.

Over the past four days (after you switched to liquid and made a reduction in dose), have your symptoms improved, worsened, or stayed about the same? Are your symptoms tolerable?

What was the most recent monthly taper rate you tolerated (e.g. 10% over 30 days)? 

How many days does it typically take you to stabilize after making a reduction in dose?

What does “1/2 mark at .95 at top of 1ml syringe” mean?  The mark at 0.95mL?  Or the mark halfway between the 1mL mark and the 0.95mL mark — i.e., 0.975mL?  (My goal is to determine the percent reduction in dose you made after you switched to the liquid — was it 5% or 2.5%?)

[[an...]]

Hi Libertas, I would say my symptoms had perhaps worsened a little with the second dose and then stayed pretty much the same I think but my tinnitus is just horrid.

I tapered .25mg every 3 weeks for most of my long taper and it went pretty good but I noticed by the last week I would start to get more symptoms which would improve when I changed my dosage. Yes I believe it would be ,95 of 1ml, the mark 1/2 way between 1ml and 0.9mls so I thinkg thats 0.95ml. Not sure what percentage is if that helps.

It was also suggested to my to go back on .25 capsule form but its been 4 days now and I worry about switching back again and getting more symptoms. I have just been taking the same dosage of the liquid because I have no other choice until Tues. So confused...

Edited May 20 by [an...]

[[Li...]]

@[an...]  My apologies but I’m finding it difficult to provide feedback because you have two different active taper strategies threads — this one involving @[Co...] and myself and the one below involving  @[Re...] and @[je...]. 

You made a 5% reduction in dose the second day after you switched to the  liquid.  So, if you wish to return to using capsules and avoid updosing, you could request a prescription for capsules containing 0.24mg of the active ingredient (actually 0.2375 but rounding up).

 

[[an...]]

Hi Libertas, thanks so much for super help. You are so kind and supportive Sorry about that, I think I posted wrong and ended up with 2 posts. Please follow this one. I have done some more reading and it seems many people choose to wean down further that .25mg before they jump so I don't feet stupid anymore. Also some that had difficulty was due to as you mentioned the does being an actual cut instead of equal, so updosing seemed to help. 

However since I am on such a low dose I am supprised that I am having any symptoms at all or is this often a possibilty?  I am concerned that I may be having some reaction to the liquid, but I just don't know. Is 5% a large dose for liquid? So scared now as my symptoms wane back and forth that I can't fix this and I have come so far. My options are to either updose and stay on liquid or switch back to .25 capsule or would I also need to updose as well. Not sure what to do? You continued advice and support is so appreciated. How did you get so good with the cuts, numbers and dosage percentages? 

[[an...]]

Hi Libertas, I also wanted to ask, should I be diluting my dosage with water and at what amount? If I do updose, how much should I updose to? I really do no know that I am doing with the liquid. Help! 

Edited May 20 by [an...]

[[Li...]]

Might I suggest you take this one step at a time @[an...]?

Do you wish to return to using compounded capsules or continue using the liquid?

[[an...]]

Hi Libertas,

I guess this is what i have to try and figure out. So afraid to make another mistake after tapering for so long. I did not dilute my .25/1ml sollution so it is definately concentrated. It definately felt like a cut in dosage but I am not very experienced with the liquid, I just want to get on the right track again. If I had enought capsules I would most likely have switched back to see if symtoms were eliminated. I guess I could do either b/c I am practically on the same dosage as the capsule. Do people have more success with liquid taper? It does give you more freedom to dose unlike the compound capsules which is why I wanted to switch. But I don't think I will taper down to 0 at this point, I am almost off. I have been holding on the same dosage for 5 days as of today still with symptoms. I am so greatful for you continued support and advice...

[[Li...]]

I know it’s difficult @[an...], but you are the only one who can make this decision. What is your gut telling you?  

 

[[an...]]

Hi Libertas, since my symtoms are still quite present after 5 days, I feel that going back to capsule would be good option since I really won't be updosing that much just really going back to the dosing method that was working. Am I correct to think this? The only other option would be to hold longer and updose if no success. So scared to make the wrong decision.....so thankful for you continued advice and support.

Edited May 21 by [an...]

[[an...]]

Hi Libertas,

Sorry I have not posted, was waiting for things to settle. I crossed over to pills again will little trouble back to .25mg. But I continued to have symtoms of a UTI infection that seemed to start with the switch to liquid Valium and continued to get worse. I went to the ER since it had been over a week and I felt like things were getting worse and Dr gave me antibiotic (one that I took last year with no issues). After few doses my symptoms got much worse and now I feel like I am in withdrawl again. I feel like I have totally ruined my taper! Don't know what to do, I am so stupid, I should have know better. Will my system recover from the antibiotic? Help! So scared. I am so angry at myselt, I can't seem to do anthing right. Thanks so much for listening and all your help...

 

Edited May 31 by [an...]

[[Li...]]

Hello @[an...].  I am just now seeing your post.  That’s great you have been able to transition back to using the compounded capsules.

Re: the antibiotic …

As you probably already know, it is not uncommon for individuals in benzo withdrawal to develop sensitivities to drugs/foods/substances they previously tolerated without issue.

I know you’re scared but please don’t be beat yourself up.  You’re trying your best to find your way through a difficult situation.  You’ll get there.  For now, just focus on getting your system calmed back down from the dosage form change, the UTI, and the antibiotic. 
 

[[an...]]

Hi Libertas, 

Thanks so much for your kind words. So should I stay on same dosage then? I worry about interdose tolerance. So stupid to take the antiboitic, the withdrawls are more intense. Feel like I have completely screwed things up. Was in such better place before tried liquid V. Do you think my symtoms can settle to previous levels? 

[[Li...]]

You’re welcome @[an...].  In your shoes, I would hold my dose constant and wait to see if my symptoms stabilize. 

[[an...]]

Hi Libertas @[Li...],

Thanks so much for all your support. I have had little change in the last week. I fear things will not return to normal. I feel so upset and hopeless. After just a few doses of antibiotic, I got horrible symtoms so scared these will remain. I feel like I am in withdrawl. If I hold at current dose, I will only be able to hold for so long. On such a low dosage I am worried about reaching tolerance and getting more symptoms. My Doc wants to me to updose to see if there is any improvement. At this point, I feel so unstable, Help! How can I move forward now? Await your super advice....

[[Li...]]

@[an...] My apologies but I won’t be able to respond.  I must limit my time on the forum due to other commitments.  I hope other members will stop by to assist.