Restarting Taper after long hold

[[Ca...]]

My Rite Aid pharmacist says that she stocks liquid valium. This is in NY

[[Ca...]]

I am still holding at 14 mgs which I updosed to amost three months ago. Today the wave was so bad that I updosed four mgs. I have to decide whether to go back to cut and weigh or do a liquid valium taper. I have a prescriber in NY and worked with Nicole Lamberson on a taper plan. I have so much anxiety about which way to go that I feel paralyzed.

Rob - what State are you in?

[[Li...]]

Hello @[ro...].  

Given that a liquid worked well for you before,  I suggest you use that approach again.

May I ask why you think your current prescriber would not be willing to prescribe a manufacturer’s liquid?   

If it turns out you do need to find a different prescriber, it would be helpful if you would share the name of your state with us.

Two FYIs … 

(1) The Benzodiazepine Information Coalition maintains a state-by-state list of “benzodiazepine cooperative providers” at: 

https://www.benzoinfo.com/doctors/

Be sure to read the Important Information section about the purpose of this list.

(2) Some of our members have found it helpful to find and work with a nurse practitioner instead of a MD or DO.

 

[[ro...]]

My current supplier would rapidly take me off of the Valium. They have not had patients who had W/D symptoms. This doctor does not believe in Tapering and if I mention any symptoms they would refer me to a psychiatrist. I need to find a benzo-wise doctor. I live in Florida on the East Coast. The nearest city to me is Daytona Beach. Some of those Doctors on that list are far away. I would have to drive for hours to see the Doctors on that list. If I would do that would they prescribe liquid diazepam?

[[Li...]]

@[ro...]

Thank you for the additional information. It sounds like your prescriber would not be amendable to learning more about safe tapering. 

Finding a benzo-wise (or at least benzo-cooperative) prescriber will take some legwork on your part.  Below is a list of Florida prescribers I’ve read about (this is not an endorsement on my part, I’m just sharing info).  Also, be forewarned that some of these prescribers are private pay.

I hope other members who know about prescribers who are licensed in Florida will contribute to this thread.

I am not familiar with Florida geography so do not know if any of the prescribers I’ve listed are physically located in your vicinity.  If a prescriber is licensed in your state, they may be able to prescribe via virtual appointments.  That’s something you’ll want to ask about.

Re: whether they will be willing to prescribe liquid diazepam …

That’s another question you’’ll want to ask. 

Given that you used a compounded liquid diazepam successfully in the past, you could try contacting compounding pharmacists in your area to explain your situation and ask if they are working/have worked with prescribers who help patients taper benzodiazepines via liquid compounds.  If so, would the compounding pharmacist be willing to share the names of said prescribers.

Last but not least …

Please be reassured that if you are unable to locate a new prescriber, members here can help you devise a taper strategy using the tablets you are currently prescribed.

Florida Prescribers

Harmony Psychiatric Care
https://hupcfl.com/

Jezel Rosa, Jezel Rosa, APRN, PMHNP-BC
https://www.psychologytoday.com/us/psychiatrists/jezel-rosa-vero-beach-fl/976047

Jennifer Giordano, DO
https://www.trueyoupsych.com/

Mark Leeds, DO
https://drleeds.com/

 

[[ro...]]

Libertas, Thank you for providing the links to Doctors and nurse practitioners in Florida.

I have to find out how far away from me these providers are. Miami Is about 300 miles away I live in North Central Florida. I need to find out on the map where these Doctors are located. Also, I have to consider the cost. I have Medicare for insurance. Some of these doctors don't accept insurance. I hope I will not have to see a Doctor often, I just need a prescription for the liquid diazepam solution. I would make tiny cuts and hold. I would keep reducing my dose depending on what my symptoms are

[[ro...]]

I did text 2 of the Doctors on the list. It would be a 6-hour drive to visit the Doctor. I am hoping they would agree to Tele Visits. I could then talk to them face-to-face on my computer. I still need to check those other doctors on that Benzodiazepine Information Coalition list. I don't know where every city on that list is. I guess I will need to find out. Next, I need to know if any of them take Medicare. It could get to be very expensive if they don't. I have some hope now. Some Doctors have empathy and understand how difficult it is for patients to taper and understand how difficult W/D can be. These doctors may not charge as much because they have compassion and empathy

[[ro...]]

Thank You, Libertas for providing me with that link to the Florida doctors. I sure hope I will find someone who will let me do a liquid diazepam solution taper. The tiny cuts I could make doing this would help immensely.

[[ro...]]

4 hours ago, [[r...] said:

Thank You, Libertas for providing me with that link to the Florida doctors. I sure hope I will find someone who will let me do a liquid diazepam solution taper. The tiny cuts I could make doing this would help immensely.

I contacted via text on the internet the 4 Florida Prescibers you posted. I am waiting for them to get back.

Is there a tapering method should I not be able to get any of these Doctors to prescribe me the liquid diazepam solution? I am so afraid just thinking about it. I have no family or friends to support me. I only have the benzobuddies forum. I want to avoid getting more severe symptoms. My only hope is to go very slow with a taper. I am 69 years old and I don't have the neuroplasticity of younger people. So I may be on a very long Taper. Changes in my brain will take a long time and I am scared I will never be normal again, I worry years may pass and I will have symptoms that won't ever go away. Can I get any feedback from the community where people my age have been able to recover and be normal again? Please anyone who has been in a similar situation and has recovered tell me your success story

[[ro...]]

Carol Jean, I hope you can get on the liquid diazepam solution. I believe this is the best way to go for you. You can make precise accurate cuts using this method. In 2014 I was on diazepam suspended in almond oil. I was given different syringes so  I was able to make tiny cuts in the dosage. I just had to hold or do a slight updose when the symptoms got bad. I also could call the doctor prescribing the diazepam. He always listened to my concerns and would recommend how much to change my dose and how long to hold.

It was never a 10% or 5% cut, rather it was based on my symptoms. His support is what I attribute to being able to taper from 30mg of diazepam down to 12.8mg. This doctor was in his 80s but he was addicted for 5 years and he knew how difficult it was to taper. He didn't charge that much money for his services. He just wanted to help people who were trying to taper and get off of benzos. Wish there were more doctors out there that cared about people. He wasn't trying to get wealthy. His charge for helping people was very reasonable and affordable

 

[[ro...]]

On 29/05/2024 at 19:44, [[C...] said:

My Rite Aid pharmacist says that she stocks liquid valium. This is in NY

I am in North East Florida Jacksonville is 90 miles North from me

[[ro...]]

On 29/05/2024 at 19:51, [[C...] said:

I am still holding at 14 mgs which I updosed to amost three months ago. Today the wave was so bad that I updosed four mgs. I have to decide whether to go back to cut and weigh or do a liquid valium taper. I have a prescriber in NY and worked with Nicole Lamberson on a taper plan. I have so much anxiety about which way to go that I feel paralyzed.

Rob - what State are you in?

Florida. I am 90 miles South of Jacksonville and also 90 miles East of Orlando

[[Ca...]]

Dr. Josef Witt Doering from the Taper Clinic takes patients from Florida. He is very expensive.

[[Li...]]

15 hours ago, [[r...] said:

Is there a tapering method should I not be able to get any of these Doctors to prescribe me the liquid diazepam solution? I am so afraid just thinking about it. I have no family or friends to support me. I only have the benzobuddies forum.

Please don’t be afraid, @[ro...].  Members have used several different techniques to obtain ‘small enough’ doses using your current 5mg tablets.  Examples include: 

• Pill-splitting
• Pill-shaving and weighing
• Pill-crushing and powder weighing
• Liquid made with pill(s) and manufacturer’s suspending vehicle (e.g. OraPlus, SyrSpend)
• Liquid made with pill(s) and milk
• Liquid made with pills(s) and water

Members often use a combination of techniques.  For example, whole tablets, split tablets, and liquid.

Am I remembering correctly that your current total daily dose is 15mg of diazepam?  If so, what is your daily dosing schedule (i.e. how many milligrams of diazepam do you take at what times)?

Do you recall what monthly taper rate you were able to tolerate when you were tapering using the compounded liquid?

 

 

[[ro...]]

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

Please don’t be afraid, @[ro...].  Members have used several different techniques to obtain ‘small enough’ doses using your current 5mg tablets.  Examples include: 

• Pill-splitting
• Pill-shaving and weighing
• Pill-crushing and powder weighing
• Liquid made with pill(s) and manufacturer’s suspending vehicle (e.g. OraPlus, SyrSpend)
• Liquid made with pill(s) and milk
• Liquid made with pills(s) and water

Members often use a combination of techniques.  For example, whole tablets, split tablets, and liquid.

Am I remembering correctly that your current total daily dose is 15mg of diazepam?  If so, what is your daily dosing schedule (i.e. how many milligrams of diazepam do you take at what times)?

Do you recall what monthly taper rate you were able to tolerate when you were tapering using the compounded liquid?

Libertas, I am afraid The only success I ever had was when I did the compounded Liquid diazepam solution. Pill cutting didn't work well at all. As I posted earlier the 5 mg pill weight is 168mg. Of that amount, only 5 mg out of 168 mg is diazepam. I don't understand how I can accurately, precisely, and consistently reduce using the above methods. With a graduated oral syringe I can make tiny cuts. So I am now taking a 5mg pill every 8 hours. That is 15 mg per day. 8 am, 4 PM, and midnight.

So when I was using the compounded liquid I could taper down to 12.8 mg. That is when I  started having bad symptoms: burning throat and mouth and burning eyes. Also Tinnitus in my left ear. This is when Dr Armstrong died. I had to then go on 5mg pills. At 15mg all of the burning sensations went away. Only the Tinnitus remained but it was mild. So for 10 years from 2014, I had no burning sensations. Only had mild Tinnitus. I was tapering maybe at about 5% per month but the taper rate varied. I would try tapering at 10%  but this was too much. I decided to updose when symptoms were bad and then make a smaller cut and hold. Until symptoms were reduced. My cuts were all symptom-based. 

 

Right now my symptoms are the same as they were back in 2014. I find it strange that I have these same symptoms. I don't know why many people on these forums have different symptoms. I don't understand why some people can stop taking benzos and have very minor or almost no symptoms. I thought the GABA A receptors would be downregulated in everyone who is taking Benzos

I get bad anxiety when I have these burning sensations. I gargle with oral mouthwash to numb the pain and use a washcloth with cold water to put over my eyes. Also, use sore throat lozenges and sugarless gum. it helps somewhat Also use Icecubes

 So from that list of Doctors I have 2 televisits scheduled for June 11th.

Harmony Psychiatric Care    and Jennifer Giordano, DO https://www.trueyoupsych.com
https://hupcfl.com/.  Harmony is in Florida and they will take Medicare for payment.

Jennifer is in Michigan but can prescribe for patients in Florida. She doesn't take Medicare.

I wrote to 2 other providers here in Florida. I am waiting to hear back from them.

 

How are you doing Libertas? I never checked your profile and asked about your taper and symptoms. I am assuming you are still tapering because you are on this forum. Some BB members have tapered successfully but choose to be on the forum to help others,     Thank You for providing me with those lists of Doctors

 

[[Li...]]

@[ro...]  It sounds like you are taking all the right steps to find a prescriber.  Well done!  It also sounds like you have a good handle on how to implement a response-guided (symptom-based) taper. 

I am aware you wish to use a liquid to taper but I included the full range of do-it-yourself techniques used by members for the benefit of other readers of this thread.

Given your current total daily dose and dosing schedule, here’s one possibility for a Phase 1 taper plan for your consideration:

Dose 1:
2.5mg in tablet form + 2.5mg in liquid form, taper liquid to 0 as tolerated

Dose 2:
2.5mg in tablet form + 2.5mg in liquid form, taper liquid to 0 as tolerated

Dose 3:
2.5mg in tablet form + 2.5mg in liquid form, taper liquid to 0 as tolerated

If you wish to use a monthly taper rate of 5%, your Month 1 goal would be to reduce your total daily dose from 15mg to 14.25mg.
 

[[ro...]]

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

@[ro...]  It sounds like you are taking all the right steps to find a prescriber.  Well done!  It also sounds like you have a good handle on how to implement a response-guided (symptom-based) taper. 

I am aware you wish to use a liquid to taper but I included the full range of do-it-yourself techniques used by members for the benefit of other readers of this thread.

Given your current total daily dose and dosing schedule, here’s one possibility for a Phase 1 taper plan for your consideration:

Dose 1:
2.5mg in tablet form + 2.5mg in liquid form, taper liquid to 0 as tolerated

Dose 2:
2.5mg in tablet form + 2.5mg in liquid form, taper liquid to 0 as tolerated

Dose 3:
2.5mg in tablet form + 2.5mg in liquid form, taper liquid to 0 as tolerated

If you wish to use a monthly taper rate of 5%, your Month 1 goal would be to reduce your total daily dose from 15mg to 14.25mg.
 

I think I would like to taper at a lower rate than 5% maybe 3 or 2% per month. I am not in a race and wish to avoid symptoms. My Taper will be based on the symptoms. I need to be able to function. I was on the Harmony United Psychiatric site. I thought I saw that they could prescribe a Liquid diazepam solution.

I would rather use a liquid rather than a pill-liquid combination, Would it be against the Benzobuddy guidelines to message that other member and tell them which Doctor group I am looking into? I am going to ask Harmony about doing an all-liquid Taper. So will that other BB member living in Florida follow my thread on the BB forum? It is Okay if they want to. I will let them know about Harmony. On the website, they say they take most insurance. I do like Jennifer in Mi, She doesn't take insurance but she will provide a receipt. Then the receipt can be submitted to the insurance. I am not sure if Medicare would cover this cost and I will need to find out. Have the Florida BB member post on my topic and I would just repeat what you wrote to me

Thank You, I hope you are feeling well and are healthy. Life sucks when you are so sick and in so much pain

[[Li...]]

Hello again @[ro...]. Your kind wishes are much appreciated.

Given your wish to implement an all liquid taper, I wonder whether a prescriber would be willing to prescribe the required amount of the 1mg/mL oral diazepam solution?  At your current dose, you would need 450mL of the liquid for the first 30 days.   I also wonder if the pharmacy would be willing to dispense that amount?  (The liquid is supplied to the pharmacy in 500mL bottles).  My experience and observation is that both prescribers and pharmacists can get ‘nervous’ about prescribing and dispensing large amounts of a controlled substance.

I share the above with you not to alarm you but rather to make sure this is on your radar screen as a possible issue.  It may well be that both your prescriber and pharmacy would be AOK with this.

Happily, there’s an alternative — a 5mg/mL concentrated Diazepam Intensol.  I suggest you click the link in the previous sentence to learn more about it. 

If memory serves, @[Md...] is currently using a combination of regular tablets and the diazepam concentrate so may be willing to stop by this thread to share their experience with making ‘small enough’ reductions in dose using the concentrated liquid.

Re: contacting the other member via PM … I suggest you leave it up to them to decide whether or not they wish to contact you via this thread.  They have your member name and a link to the thread.

 

 

 

 

[[Li...]]

@[ro...] In thinking about your case, I remembered a clever tapering strategy a compounding pharmacist devised for one of our members several years ago.

Like you, the member wished to use only liquid to taper but was taking a dose that would have required a large amount of a low-enough-concentration-for-tapering liquid.  To address this, the compounder prepared two different formulations for her.  A bottle of ‘high’ concentration liquid she used for the majority of her dose and a bottle of a ‘low’ concentration liquid she used to make ‘small enough’ reductions in dose.  

 

[[ro...]]

1 minute ago, [[L...] said:

@[ro...] In thinking about your case, I remembered a clever tapering strategy a compounding pharmacist devised for one of our members several years ago.

Like you, the member wished to use only liquid to taper but was taking a dose that would have required a large amount of a low-enough-concentration-for-tapering liquid.  To address this, the compounder prepared two different formulations for her.  A bottle of ‘high’ concentration liquid she used for the majority of her dose and a bottle of a ‘low’ concentration liquid she used to make ‘small enough’ reductions in dose.  

I will see when I have my Telemedicine visit with both Doctors on June 11th. I guess I will have to tell my doctor to stop prescribing The 5mg pills. I should probably go to CVS and see what liquid diazepam solutions they have. I want to make sure that I have a source of diazepam before I have my Neurologist stop writing scripts.

Thanks for all your help, I appreciate it. I gave the other lady the list of Doctors and told her I would let her know how my visit went

[[Li...]]

You’re welcome.  Yes you should definitely ask the pharmacist at CVS if they stock and dispense diazepam solutions and if so what concentrations If CVS doesn’t pan out, try another pharmacy.   If memory serves, we’ve had members in the past who had success with Walmart. Also, independent pharmacies are sometimes more patient-centered than the large chains.

I suggest you refrain from saying anything to your neurologist about what you’re hoping to do.  Based on what you’ve shared with us about them, it sounds like the less they know the better until you have everything in place to switch to a different prescriber.

[[ro...]]

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

You’re welcome.  Yes you should definitely ask the pharmacist at CVS if they stock and dispense diazepam solutions and if so what concentrations If CVS doesn’t pan out, try another pharmacy.   If memory serves, we’ve had members in the past who had success with Walmart. Also, independent pharmacies are sometimes more patient-centered than the large chains.

I suggest you refrain from saying anything to your neurologist about what you’re hoping to do.  Based on what you’ve shared with us about them, it sounds like the less they know the better until you have everything in place to switch to a different prescriber.

I could also ask the providers I have appointments with if they have pharmacy names that carry liquid diazepam solutions. I may have to hold off on my refill of the pills from the Neurologist. I am sure they will not prescribe if I have Valium pills from another Doctor. I just need to have a source to get pills should these places not prescribe them. So I have some time to wait for a refill and once I am on the liquid Diazepam solution I will not ask for a renewal of the script from the Neurologist. Thank You for helping me find those doctors on the list. I helped out that other lady by telling her about these providers. She was very grateful but you deserve all the credit. So Thank you,   Rob

[[Li...]]

You’re most welcome @[ro...].  I’m glad the information I shared with you was helpful to another member.

I don’t know what the rules and regs are in Florida re: having multiple Rx’s for a controlled substance.  In my state, it’s ok to have multiple Rx’s (e.g. when a prescriber needs to change an Rx for a patient who has an existing Rx) as long as you don’t try to get them filled at the same time.  That will trigger a flag in the state PDMP (Prescription Drug Monitoring Program).  You might want to check out the rules and regs for Florida’s PDMP or seek more information from a knowledgeable pharmacist about this.

I also suggest you keep the option of working with a compounding pharmacist in mind if you run into issues with obtaining the manufacturer’s liquid. 

[[ro...]]

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

You’re most welcome @[ro...].  I’m glad the information I shared with you was helpful to another member.

I don’t know what the rules and regs are in Florida re: having multiple Rx’s for a controlled substance.  In my state, it’s ok to have multiple Rx’s (e.g. when a prescriber needs to change an Rx for a patient who has an existing Rx) as long as you don’t try to get them filled at the same time.  That will trigger a flag in the state PDMP (Prescription Drug Monitoring Program).  You might want to check out the rules and regs for Florida’s PDMP or seek more information from a knowledgeable pharmacist about this.

I also suggest you keep the option of working with a compounding pharmacist in mind if you run into issues with obtaining the manufacturer’s liquid. 

Thanks again Libertas. I will keep it in mind and investigate the rules in FL. The pharmacies are all networked together to prevent people from getting multiple prescriptions. Oxycontin was a big draw to Florida. People couldn't get numerous scripts for it. This may apply to Benzos.  As you wrote they are controlled substances. If a manufacturer's liquid is unavailable, I will ask the provider to get a compounded diazepam solution.  I would hope the providers I will contact would know where I can get either the manufacturer's Diazepam solution. The other option is they would know of compounding pharmacies that can make a diazepam solution.

I fear that at my age my brain does not have the neuroplasticity of a younger person and my GABA receptors may never upregulate. If this happened I would be in permanent withdrawal and may have severe symptoms forever. Hopefully, these providers may have experience with this and will give me an honest answer

[[ro...]]

There is one thing I am curious about. Some BB members crush their pills and put the powder in a milk solution.

In a previous post, I wrote about weighing a 5Mg pill and it weighed 168mg, of this 168 mg only 5mg is diazepam and the rest is fillers and binders, A compounded diazepam solution is made with 100% diazepam powder put in oil. The compounding pharmacy I used had almond oil and diazepam powder. So when I received the compounded diazepam solution I was told just to turn the bottle upside down and then right side up a few times just to make sure the diazepam was pretty evenly distributed. What are the odds of doing this same thing with a ground-up 5mg diazepam dissolved in milk? Only 5 mg out of a total of 168 mg is diazepam the balance is the fillers and binders. Guess having used a compounded diazepam solution has made me suspicious of making a solution using crushed pills