Need advice on switch from Lorazepam (Ativan) do Diazepam (Valium)

[[Dr...]]

2 minutes ago, [[E...] said:

@[Dr...] Thanks for the positive update!  I would be very happy to help you prepare for your taper.  The information that @[Li...] suggested is exactly what I will need to help you.

It is probably best for you to decide if you want to reduce the evening dose first.  Lowering your evening dose would be my first option, but only you can determine what is best for you given your symptoms throughout the day and evening.  Lowering your day doses, at this point, may increase your day symptoms.  Lowering your evening dose may decrease the sedative effect.

Just let me know and we can work on a plan.  Hope you are having a good day!

Thanks @[El...] for your fast reply! So much appreciated. I think I'd like to start with the evening dose as the morning and afternoon are already quite low and right now I'm starting to feel better during the day, which wasn't the case for the past few weeks when I no longer had an afternoon dose and only 0.3 in the morning.

As mentioned before, it seems like the evening dose is not helping me sleep. 

I'll try to answer all the questions as soon as possible. 

My partner is really unhappy with the idea of weighing and shaving and would rather cut. I can't seem to convince him that cutting is less accurate and therfore more dangerous. How can I convince him? I would need him on board. How does one cut or shave? What tools would we need for that? 

[[Li...]]

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

One of the main questions for when I go forward though, is whether I should start tapering the evening dose or all 3 doses at the same time. 

I'm currently on 0.4 morning, 0.4 afternoon and 1mg in the evening. 

Given that (1) you’ve indicated your evening dose is not helping you all that much with sleep and (2) your evening dose is much higher than your morning and afternoon doses, I agree with @[El...]’s suggestion to begin by lowering your evening dose to bring it more into alignment with your morning and afternoon doses.

[[El...]]

When you get your scale, if you take your pill splitter and cut your pill in half, you will find that generally the two halves are not equal in weight. Let me give you an example. This morning I took my 0.5 mg pill (which has an average weight of 0.0604 grams). Upon cutting it in “half” with my pill splitter, instead of each half weighing 0.0302 grams, ½ weighed 0.0287 grams and the other half weighed 0.0317 grams. This is an approximately 5% variation on each end from the expected weight of 0.0302 grams.  And 5% is what I typically reduce over a course of 2-3 weeks. This variation would probably send my already fragile CNS into turmoil. So, perhaps when you get your scale, you will be able to show your partner a similar inaccuracy and be able to convince them that not just cutting, but also shaving and weighing your pill will probably give you more balanced dosing.

When preparing your doses for tapering you will need a pill splitter, tweezers, a straight edged razer blade, a metal weighing pan, and a metal nail file. For the most accurate weighing, two 10 mg calibration weights will also help. All of these items are fairly inexpensive and can be purchased on Amazon.

Hope this helps.

 

[[Dr...]]

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

When you get your scale, if you take your pill splitter and cut your pill in half, you will find that generally the two halves are not equal in weight. Let me give you an example. This morning I took my 0.5 mg pill (which has an average weight of 0.0604 grams). Upon cutting it in “half” with my pill splitter, instead of each half weighing 0.0302 grams, ½ weighed 0.0287 grams and the other half weighed 0.0317 grams. This is an approximately 5% variation on each end from the expected weight of 0.0302 grams.  And 5% is what I typically reduce over a course of 2-3 weeks. This variation would probably send my already fragile CNS into turmoil. So, perhaps when you get your scale, you will be able to show your partner a similar inaccuracy and be able to convince them that not just cutting, but also shaving and weighing your pill will probably give you more balanced dosing.

When preparing your doses for tapering you will need a pill splitter, tweezers, a straight edged razer blade, a metal weighing pan, and a metal nail file. For the most accurate weighing, two 10 mg calibration weights will also help. All of these items are fairly inexpensive and can be purchased on Amazon.

Hope this helps.

Thanks so much for the explanation @[El...]! It's stressing me out though, all the items you mentioned. So afraid I would buy something wrong...

Is there any way you could send me a link to the exact items that I should buy on Amazon? That way I know for sure that I'm buying the correct items. I understand if that's a bit much to ask, but I'm hoping you could help me out here when you have the time. 

Also, this morning I weighed 10 pills (the 1mg pills) with a simple scale we had at home (the new one is on the way from China...) and I find it terribly difficult to know what the weight is. I put a pill on the scale and every millisecond it would show a different number... So it would show anything between 0.04 gram and 0.17 gram. I tried not to move it touch anything during the weighing and tried to hold my breath and then see what number was shown most or longest. But that doesn't seem very accurate... How do I deal with that? Most people use a simple jeweler's scale, right? How can anyone come up with stable numbers? 

[[El...]]

@[Dr...] Your new 0.0001 gram scale should be much more stable. Mine always stays within +/-0.0002 grams during the course of weighing.  Perhaps you should wait until you get your new scale to find the average weight of 10 pills.

Here is a rather long link to the equipment you will need.  Please don't be intimidated!  It looks more complicated than it really is.

https://www.amazon.com/uxcell-Calibration-Precision-Digital-Balance/dp/B07YFYKJH5/ref=sr_1_5?crid=PSRA6I82WLG4&dib=eyJ2IjoiMSJ9.ys44QaCDZCsnPfit1G60RpGzKA-TVEae5TLdwzsMSKm87a5IFeVBUm65F6IvEXVnKrd5Br_s73e8tgyMVHYFHny1amLLZJPSQrL8jmnsXVBBQx5y-Oc-QU0ulokcG3Xk_BqutXSpzhqF-rH2fm818-cfACDL5xHN7J85I4aPo9260rpd3W3qX2o3QBV2sj-YSSO2kRenRSXif5pz2ydpculqgwRE7BMewRuKpldFWa4.mD7ByfF7Osy7bMeqxG1gmUOIwOXMruKgN7Ck5EzmHWI&dib_tag=se&keywords=10+g+calibration+weights&qid=1719478712&sprefix=10g+calibration+weights%2Caps%2C89&sr=8-5

https://www.amazon.com/Red-Devil-3275-Single-Edge-Dispenser/dp/B001SBLCKW/ref=sr_1_26_sspa?crid=6K46B6MLORJH&dib=eyJ2IjoiMSJ9.R4Qo5-YAiikcROJyYsAe3b5L_smXT-W84OXYf1rz27a07-CFNMjg2sliP7F4fyYBBIXSuAVBCQHQyMJ5rPgucVnHIaN346pvrDoNUMAGJQcQpQlzJKCKoiScwAgdtjdT1f2BOaFo1gtWkO0XlVwmTjldXdFJc7aY8rDziHXirVegqVd5sSrgnopot7XQFzkj1Gl5R1dspqJRF51fkhDHCGupGxtXN36lUsyohRRQKFvsEQrS3rlSgTC4YtHxxpusqVeKYfq3KAYcEjDUy5xk8XWDpoq2CQGUF5RVRVW7W7s.MJrMm8dBWo5YmSJjlFfAQI8GnNAjsQrF0RYSkY-6keI&dib_tag=se&keywords=single+blade+razor+blades+refills&qid=1719478548&sprefix=single+blade+razer+blade%2Caps%2C114&sr=8-26-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9tdGY&psc=1

https://www.amazon.com/Cutter-Splitter-Doubles-Cutter-Keychain/dp/B07ZQ623WM/ref=sr_1_1_sspa?crid=N7OROAL2Z666&dib=eyJ2IjoiMSJ9.htEWAqNL08rP8ZHV_ZRWcKRg3BGZso0NqXjqtUyMt_XLTYg2IxH_EQARYtGd3aElDL0nVkp1USo4RHcbMlK_PEGAiRhY8FveNg0oi-2Enobqoh9sRHKDDjqp18vd5Coq0rgGACcGeYgCmKyAWYaGW-Ps9Fr4JiMOL7XMCHQCmQ1vcVdWT4CsQnG50S9eSI_JcweXt4dT9frItmoSqWi5iD4RQysALgah2Bl09R_jfPa8p9AzzDRN-_gtozFyCqs7LRJKFPlfdBZouOQy_mc92gzqeMDSTiImf3kdGP4aYBk.X229KgaH3BLEcxC46y-C7CGf13CMHz_o2fdEPZk9Hz0&dib_tag=se&keywords=pill+cutter&qid=1719478303&sprefix=Pill%2Caps%2C125&sr=8-1-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1

https://www.amazon.com/Swords-Germany-Quality-Sapphire-Solingen/dp/B007242LWC/ref=sr_1_12_sspa?content-id=amzn1.sym.b02cd478-bf8a-4028-a2ed-89cf0c172d2d%3Aamzn1.sym.b02cd478-bf8a-4028-a2ed-89cf0c172d2d&dib=eyJ2IjoiMSJ9.Gzo7BRYXBog_pTKYFuBb3g8rBXn4mMAGcdkfB03ZK6xCz7WtVpQNyMOAgtW8EtY6FJWUiF_5K9kmfoW5LgvImWyVZfQlR2LkfJz1pwAQjiGWLzILC6EJ1QAN9jLsXltT_QFFW-G0ZWwwN4I2Lx1Bnz1Yu9UBRzhG1WtkuC5gMPT46XCQoAV2uMTei20L08eNBnuuay7vYoGEPi8sL1MeWwZH5nbfYboBDyIYumb3pKQkURq8sUetLPjFX7mdrkitdDsLTAHzYMgrl6vWYwyxaxgfRCRj1JiozM9QgPWQ9hg.Eibf1zR-hvuCFfQfM66OdIZBQpJ1U78D8j9uvdMN3lM&dib_tag=se&keywords=stainless+steel+nail+file&pd_rd_r=a45cd384-4108-437a-b147-1d5f74cf14e9&pd_rd_w=7oggc&pd_rd_wg=qrDeg&pf_rd_p=b02cd478-bf8a-4028-a2ed-89cf0c172d2d&pf_rd_r=CESRMARPEXN2T725BWBY&qid=1719478238&sr=8-12-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9tdGY&psc=1

https://www.amazon.com/DGBRSM-Weighing-Plastic-Diamond-Electronic/dp/B09ZTM751Q/ref=sr_1_3?crid=1BYJ4PUT5HJNY&dib=eyJ2IjoiMSJ9.qNZDNzd7YEuJlJso69pNId6QgYJzAygaEcswKLUvxYCWRTx0RbychA-cmz48KZhPUjXWkYZJK3kCjS1IFJBbzSxX22Hj2h3E6DI1nsL56h3flwJvuqZjr7VahbhqvOnWDg6-zhWw0sQDeAQ4d9ydGMLQOLxT9gnX_LLMA0N3DZpwrq9RNubP8AnIPlqQ9EUvdxDeYCZT4FIQbBkBeY_zG1b0Io9mApfWy-igSA-YCJl7ghZsmTGYRJDNkZ9fMw-eOBpF-tAPA96J5XF4HGv39ayW3Gay81ns4LGF3mFLFbI.RB2w1p_SnZLgkddUDXz4s8w7q3kSkXJgBy0xjq2SsHU&dib_tag=se&keywords=Medicine+weighing+dish&qid=1719477967&sprefix=medicine+weighing+dish%2Caps%2C76&sr=8-3

https://www.amazon.com/Stainless-Tweezers-Dressing-Forceps-Serrated/dp/B00EKQ7FZI/ref=sr_1_5?crid=34Q59WQKAHEHQ&dib=eyJ2IjoiMSJ9.hBfpfk49Ert0UxHpuGMEyUGBLuNRq3l2bFx92yxNk1XgVtWli9-rh4IQSaWfa3mcMNkjfL_e5fbZoE70WKt8CwZmTbiUpYryFoyNm_Ry09QIo-LzPZC1OtgM3C8xQhzcyL4ZP_HyRFDsiZl5WGngVBt2UhU9aRCYXBRTDzJXq7BYvaqfMNwNihxI9VCRY7AAjXV3k_TxbVn1pMvDkt1ExN5aTS_OsYHYe-FxMPE7qQY.RvtHZlan1zknIAKSkf4pojonYqhqd70JyS6Tpemt-WU&dib_tag=se&keywords=medical%2Btweezers&qid=1719476547&sprefix=Medica%2Btweezers%2Caps%2C108&sr=8-5&th=1

 

[[Dr...]]

@[El...] en @[Li...], following up on the questions you asked me in order to be able to provide me with advise on my next steps, I have first updated my Excel sheet with some relevant information. The attached Excel sheet show the intake (in mg) of Lorazepam as per the 17th of November, when I first started taking it and shows the taperings steps from January 24th onwards. It shows that I first tapered the afternoon dose and shows the daily steps. I then held for about 2 weeks and then started tapering the morning dose. The daily steps for that are also shown.

The day rate is the number I gave for the day, from 1 (bad day) to 10 (good day)

The number of hours  of sleep are self explenatory

The other numbers (pain, tiredness, brainfog, restlessness): a higher number means more pain, brainfog etc. 1 would mean hardly any issue, 10 would mean lots of pain, brainfog, etc.

I hope this already helps answering the question regarding what my taperings steps so far have been.

I'll come back to the other questions as soon as possible.

With love from Holland!

Dagboek in cijfers.xlsx

[[Dr...]]

5 hours ago, [[E...] said:

@[Dr...] Your new 0.0001 gram scale should be much more stable. Mine always stays within +/-0.0002 grams during the course of weighing.  Perhaps you should wait until you get your new scale to find the average weight of 10 pills.

Here is a rather long link to the equipment you will need.  Please don't be intimidated!  It looks more complicated than it really is.

https://www.amazon.com/uxcell-Calibration-Precision-Digital-Balance/dp/B07YFYKJH5/ref=sr_1_5?crid=PSRA6I82WLG4&dib=eyJ2IjoiMSJ9.ys44QaCDZCsnPfit1G60RpGzKA-TVEae5TLdwzsMSKm87a5IFeVBUm65F6IvEXVnKrd5Br_s73e8tgyMVHYFHny1amLLZJPSQrL8jmnsXVBBQx5y-Oc-QU0ulokcG3Xk_BqutXSpzhqF-rH2fm818-cfACDL5xHN7J85I4aPo9260rpd3W3qX2o3QBV2sj-YSSO2kRenRSXif5pz2ydpculqgwRE7BMewRuKpldFWa4.mD7ByfF7Osy7bMeqxG1gmUOIwOXMruKgN7Ck5EzmHWI&dib_tag=se&keywords=10+g+calibration+weights&qid=1719478712&sprefix=10g+calibration+weights%2Caps%2C89&sr=8-5

https://www.amazon.com/Red-Devil-3275-Single-Edge-Dispenser/dp/B001SBLCKW/ref=sr_1_26_sspa?crid=6K46B6MLORJH&dib=eyJ2IjoiMSJ9.R4Qo5-YAiikcROJyYsAe3b5L_smXT-W84OXYf1rz27a07-CFNMjg2sliP7F4fyYBBIXSuAVBCQHQyMJ5rPgucVnHIaN346pvrDoNUMAGJQcQpQlzJKCKoiScwAgdtjdT1f2BOaFo1gtWkO0XlVwmTjldXdFJc7aY8rDziHXirVegqVd5sSrgnopot7XQFzkj1Gl5R1dspqJRF51fkhDHCGupGxtXN36lUsyohRRQKFvsEQrS3rlSgTC4YtHxxpusqVeKYfq3KAYcEjDUy5xk8XWDpoq2CQGUF5RVRVW7W7s.MJrMm8dBWo5YmSJjlFfAQI8GnNAjsQrF0RYSkY-6keI&dib_tag=se&keywords=single+blade+razor+blades+refills&qid=1719478548&sprefix=single+blade+razer+blade%2Caps%2C114&sr=8-26-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9tdGY&psc=1

https://www.amazon.com/Cutter-Splitter-Doubles-Cutter-Keychain/dp/B07ZQ623WM/ref=sr_1_1_sspa?crid=N7OROAL2Z666&dib=eyJ2IjoiMSJ9.htEWAqNL08rP8ZHV_ZRWcKRg3BGZso0NqXjqtUyMt_XLTYg2IxH_EQARYtGd3aElDL0nVkp1USo4RHcbMlK_PEGAiRhY8FveNg0oi-2Enobqoh9sRHKDDjqp18vd5Coq0rgGACcGeYgCmKyAWYaGW-Ps9Fr4JiMOL7XMCHQCmQ1vcVdWT4CsQnG50S9eSI_JcweXt4dT9frItmoSqWi5iD4RQysALgah2Bl09R_jfPa8p9AzzDRN-_gtozFyCqs7LRJKFPlfdBZouOQy_mc92gzqeMDSTiImf3kdGP4aYBk.X229KgaH3BLEcxC46y-C7CGf13CMHz_o2fdEPZk9Hz0&dib_tag=se&keywords=pill+cutter&qid=1719478303&sprefix=Pill%2Caps%2C125&sr=8-1-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1

https://www.amazon.com/Swords-Germany-Quality-Sapphire-Solingen/dp/B007242LWC/ref=sr_1_12_sspa?content-id=amzn1.sym.b02cd478-bf8a-4028-a2ed-89cf0c172d2d%3Aamzn1.sym.b02cd478-bf8a-4028-a2ed-89cf0c172d2d&dib=eyJ2IjoiMSJ9.Gzo7BRYXBog_pTKYFuBb3g8rBXn4mMAGcdkfB03ZK6xCz7WtVpQNyMOAgtW8EtY6FJWUiF_5K9kmfoW5LgvImWyVZfQlR2LkfJz1pwAQjiGWLzILC6EJ1QAN9jLsXltT_QFFW-G0ZWwwN4I2Lx1Bnz1Yu9UBRzhG1WtkuC5gMPT46XCQoAV2uMTei20L08eNBnuuay7vYoGEPi8sL1MeWwZH5nbfYboBDyIYumb3pKQkURq8sUetLPjFX7mdrkitdDsLTAHzYMgrl6vWYwyxaxgfRCRj1JiozM9QgPWQ9hg.Eibf1zR-hvuCFfQfM66OdIZBQpJ1U78D8j9uvdMN3lM&dib_tag=se&keywords=stainless+steel+nail+file&pd_rd_r=a45cd384-4108-437a-b147-1d5f74cf14e9&pd_rd_w=7oggc&pd_rd_wg=qrDeg&pf_rd_p=b02cd478-bf8a-4028-a2ed-89cf0c172d2d&pf_rd_r=CESRMARPEXN2T725BWBY&qid=1719478238&sr=8-12-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9tdGY&psc=1

https://www.amazon.com/DGBRSM-Weighing-Plastic-Diamond-Electronic/dp/B09ZTM751Q/ref=sr_1_3?crid=1BYJ4PUT5HJNY&dib=eyJ2IjoiMSJ9.qNZDNzd7YEuJlJso69pNId6QgYJzAygaEcswKLUvxYCWRTx0RbychA-cmz48KZhPUjXWkYZJK3kCjS1IFJBbzSxX22Hj2h3E6DI1nsL56h3flwJvuqZjr7VahbhqvOnWDg6-zhWw0sQDeAQ4d9ydGMLQOLxT9gnX_LLMA0N3DZpwrq9RNubP8AnIPlqQ9EUvdxDeYCZT4FIQbBkBeY_zG1b0Io9mApfWy-igSA-YCJl7ghZsmTGYRJDNkZ9fMw-eOBpF-tAPA96J5XF4HGv39ayW3Gay81ns4LGF3mFLFbI.RB2w1p_SnZLgkddUDXz4s8w7q3kSkXJgBy0xjq2SsHU&dib_tag=se&keywords=Medicine+weighing+dish&qid=1719477967&sprefix=medicine+weighing+dish%2Caps%2C76&sr=8-3

https://www.amazon.com/Stainless-Tweezers-Dressing-Forceps-Serrated/dp/B00EKQ7FZI/ref=sr_1_5?crid=34Q59WQKAHEHQ&dib=eyJ2IjoiMSJ9.hBfpfk49Ert0UxHpuGMEyUGBLuNRq3l2bFx92yxNk1XgVtWli9-rh4IQSaWfa3mcMNkjfL_e5fbZoE70WKt8CwZmTbiUpYryFoyNm_Ry09QIo-LzPZC1OtgM3C8xQhzcyL4ZP_HyRFDsiZl5WGngVBt2UhU9aRCYXBRTDzJXq7BYvaqfMNwNihxI9VCRY7AAjXV3k_TxbVn1pMvDkt1ExN5aTS_OsYHYe-FxMPE7qQY.RvtHZlan1zknIAKSkf4pojonYqhqd70JyS6Tpemt-WU&dib_tag=se&keywords=medical%2Btweezers&qid=1719476547&sprefix=Medica%2Btweezers%2Caps%2C108&sr=8-5&th=1

Thanks so much for this, @[El...]. I'll try to order everything tomorrow. I'm not sure whether the new scale will arrive in time as my tapering medication will soon run out. I have no problem getting 1mg and 0.5mg pills through my GP, so won't be without medication but it would mean I can't do the needed cuts to 0.4mg for morning and afternoon. Well, I could do the cuts but not accurately enough?! How do people with simple scales do this? 

[[Li...]]

@[Dr...] That’s quite a spreadsheet.  I’m having trouble reading it on my small screen.  It would be helpful if you could just provide us with a summary in a post.

• What was your total daily dose before you started the taper?
• What was your total daily dose on the first day of your taper? (Month 1)
• Counting 4 weeks from the above date, what was the date and what was your total daily dose? (Month 2)
• Counting 4 weeks from the Month 2 date, what was the date and what was your total daily dose? (Month 3)
• Continue repeating the above until you reach the date when you had to terminate your taper.

[[Dr...]]

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

@[Dr...] That’s quite a spreadsheet.  I’m having trouble reading it on my small screen.  It would be helpful if you could just provide us with a summary in a post.

• What was your total daily dose before you started the taper?
• What was your total daily dose on the first day of your taper? (Month 1)
• Counting 4 weeks from the above date, what was the date and what was your total daily dose? (Month 2)
• Counting 4 weeks from the Month 2 date, what was the date and what was your total daily dose? (Month 3)
• Continue repeating the above until you reach the date when you had to terminate your taper.

@[Li...], apologies for that. Please find attached a revised sheet with just the dose, the total daily dose and the dose per morning, afternoon and evening?

Does this work?

Dagboek in cijfers_extract BenzoBuddies.xlsx

Edited Thursday at 16:25 by [Dr...]
New Excel sheet added

[[Li...]]

@[Dr...] That works.  Your ballpark monthly taper rates were:

Month 1:  26%
Month 2:  9%
Month 3:  32%

[[Dr...]]

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

@[Dr...] That works.  Your ballpark monthly taper rates were:

Month 1:  26%
Month 2:  9%
Month 3:  32%

@[Li...], glad the revised Excel worked out better. What would this mean going forward?

As you can see from the tapering schedule I was on and that was recommended by the tapering pharmacy, I tapered almost every day and nearer the end I would have more days where I would hold at a certain dose. 

Usually it's recommended to taper 5 to 10 % of the last dose, right? Is that per week, two weeks, month? 

 

[[Dr...]]

@[Li...] and @[El...],

Let me try to answer the questions you asked:

 

• The amount of active drug substance in the tablets you will use, expressed in milligrams

I will be using 0,4 mg tablets for the moment, for the morning and afternoon dose. But probably soon will have to switch to 0.5mg tablets. 

• The average weight of 10 tablets, expressed in either grams or milligrams

Well, I tried to weigh ten 0.5mg tablets yesterday and that seemed horribly inaccurate... The weighing scale would give me a different weight for the same tablet every millisecond, ranging from 0.07mg to 0.17mg... The newly ordered scale is on its way but might not arrive for another 1,5 to 2 weeks!!! 

• The initial taper rate you wish to trial (given your history, I suggest you consider a conservative rate of 5-10%.   It would also be very helpful to know what taper rate you were using with the Tapering Strips.

The tapering rate from the strips was defined by @[Li...], based on my Excel. I'd like to try 10 percent, but as I'm now on 1,8mg that would mean dropping 0.18mg?! As you can see from my tapering with the tapering strips, I was tapering in steps of 0.05mg. So a 0.18mg or even 0.09mg (5%) would seem like a huge step for my system. Or could I work up to the 5 or 10% over the course of a couple of days or weeks? Is that then called a micro taper? Might that be better for my nervous system? 

• The taper interval you wish to trial (e.g. do you wish to make reductions every day, every other day, every week, every other week, once a month)

I'm not sure at all. Would love your suggestions. Maybe it could be a bit in line with the tapering I've already done, so daily steps but then maybe a hold somewhere after a week? Two weeks? How are you doing your taper, @[El...]? 

 

[[Dr...]]

@[Li...] and @[El...], I only now found out that we have liquid lorazepam in The Netherlands (1 mg/ml1). Have not further researched it yet, but would that not be easier for me than cutting and shaving tablets? Or is it not so straightforward?

[[Li...]]

7 hours ago, [[D...] said:

Usually it's recommended to taper 5 to 10 % of the last dose, right? Is that per week, two weeks, month? 

Yes, the general guideline used in this community is to make 5-10% reductions based on the most recent dose (not the starting dose).  Consequently, reductions become smaller and smaller as the total dose gets lower.  Some individuals are able to tolerate 5-10% reductions every two weeks whereas others can only tolerate 5-10% reductions every month.    

7 hours ago, [[D...] said:

I'd like to try 10 percent, but as I'm now on 1,8mg that would mean dropping 0.18mg?!

In your shoes, I’d begin with a trial reduction of 5% given your history.  It’s far easier to speed up a ‘too slow’ taper than it is to recover from a ‘too fast’ taper.  However, that’s me.  This is your taper so it’s your call as to what taper rate to try. 

You are correct.  A 10% reduction from your current total daily dose would be 0.18mg.  

3 hours ago, [[D...] said:

I only now found out that we have liquid lorazepam in The Netherlands (1 mg/ml1).

This is good news!  Is it the formulation described in this paper perchance?  My personal experience and observation is that using a commercially manufactured or professionally compounded liquid allows greater flexibility in tapering and also requires less time/effort to implement than do-it-yourself techniques.  Moreover, these researchers found that commercial/compounded lorazepam liquids yielded more accurate and/or precise doses compared to do-it-youself liquids.

[[Dr...]]

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

This is good news!  Is it the formulation described in this paper perchance?  My personal experience and observation is that using a commercially manufactured or professionally compounded liquid allows greater flexibility in tapering and also requires less time/effort to implement than do-it-yourself techniques.  Moreover, these researchers found that commercial/compounded lorazepam liquids yielded more accurate and/or precise doses compared to do-it-youself liquids.

@[Li...], I'm not entirely sure whether it is that formulation but I would think so. It can be prescribed here in The Netherlands and yes, I can imagine that it would be much more accurate than doing it yourself.

As I'm quite stressed about the accuracy when either cutting or even when taking the liquid formulation, I decided to give the tapering pharmacist one more call and explain what I have been doing last week with regards to the changes and to reintroducing the afternoon dose. He still says that all the research up till now (the tapering pharmacy works together with a university for research) shows that tapering per dose should be doable. A psychiatrist (that is part of the research team) that I contacted today said the exact same thing. But... my pharmacist is okay with me tapering three doses together!

I didn't think he would be willing to support me in this way as he was always clear that tapering can be done per dose. We have a first idea about a plan now, but I wanted to check in with you and @[El...] to see whether this would be an okay way to go forward and the plan can always be changed upon my needs.

First, I'd like to go towards slightly more equal doses although it might be wise to keep the evening dose higher than the morning and afternoon dose. The pharmacist does believe that my sleep will (partially) return when I'm more stable and says it would be wise to not cut the evening dose too much. But in the end, the decision is up to me.

The plan would be:

1. Over the next month (can also be longer, please advise) I will updose the morning and afternoon intake to 0.5mg and at the same time reduce the evening intake from 1mg to 0.8mg. I would thus continue to be on a total daily dose of 1.8mg but a bit more equal than now. The steps can unfortunately only be done in steps of 0.05mg (lowest dose the pharmacy produces). Any ideas on how to make a good transition?
2. When I'm on 0.5 - 0.5 - 0.8 there will be a plan to taper over a period of 9 months. I don't know what that plan will look like as I would still need to go through the official route and request an advice from his pharmacy, but the tapering will no longer be done per dose although there might be separate moments for tapering the morning/afternoon intake and the evening intake, so that I don't taper all 3 together at once. So with a small interval? And again, the steps will have to be 0.05mg steps. Once I have his tapering plan/schedule, I could share it here with you. The 9 months is not set in stone, as I am in the lead and can always go slower and take more time. The only 'issue' is the 0.05mg steps, that might become too high nearer the end. But maybe for the first months I would be okay?

I really don't know yet what the percentages will look like when the pharmacist drafts his plan, but I know that I now have the time to think things through and run it past you to see whether I'm not doing anything unadvisable.

I'm very relieved that I can continue to use the taperings strips, and taper all doses as this would give me a very secure feeling that the milligrams are consistent and I don't make any mistakes with weighing. I'm just hoping it will work out percentage wise.

Hoping that this is something that you wouldn't advise against as I have felt so much stress the past couple of days about how to go forward without the strips and how to do this myself.

Added later: maybe 9 months is not doable? I used a spreadsheet and calculated how much time I would need when I would make a 7% cut every two weeks. After 15 months I would still be at 0.25mg left... What length of time is realistic for a first plan (knowing that this can change at any given time, as I might need to stabilise more)?

Edited 22 hours ago by [Dr...]

[[Li...]]

7 hours ago, [[D...] said:

He still says that all the research up till now (the tapering pharmacy works together with a university for research) shows that tapering per dose should be doable.

Did the tapering pharmacist provide you with citations to support this claim?  If so, I’d be interested in reading/reviewing them.  The published papers I’ve encountered about Tapering Strips have all focused on tapering anti-depressants — findings may or may not apply to benzodiazepines.  For example, lorazepam has a relatively short half-life so it is common for individuals to take it several times a day to maintain even blood serum levels; eliminating one dose at a time instead of making reductions across multiple daily doses runs counter to this.

7 hours ago, [[D...] said:

What length of time is realistic for a first plan

Two of the most important lessons to master about tapering are:

(1) Toss out the calendar.  It is impossible to predict how long a taper will take for a given individual — the taper will take as long as it takes.

(2) Let your symptoms be your guide.  Your experience of withdrawal should guide your taper.  For example, an upward trend in the intensity or number of withdrawal symptoms may be a signal that you need to hold at your current dose and/or adjust your dose and/or adjust your taper rate.

 

[[Dr...]]

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

17 hours ago, [[D...] said:

He still says that all the research up till now (the tapering pharmacy works together with a university for research) shows that tapering per dose should be doable.

Did the tapering pharmacist provide you with citations to support this claim?  If so, I’d be interested in reading/reviewing them.

@[Li...], I'll check in with him or the psychiatrist from the research team to see whether they can provide me with the research they're referring to. Don't know whether that is something that's been published or not.

With the tapering strips come evaluation forms that participants are asked to fill out. This gives both the person filling them out (me) a daily insight into their symptoms, as well as provide the researchers with feedback. 

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

2) Let your symptoms be your guide.  Your experience of withdrawal should guide your taper.  For example, an upward trend in the intensity or number of withdrawal symptoms may be a signal that you need to hold at your current dose and/or adjust your dose and/or adjust your taper rate

This is actually what the daily evaluation forms from the tapering strips are for. At any given moment I can hold or adjust, so it's very flexible. We can make the tapering last as long as is required. 

I'm very stressed right now with all the decisions running around in my brain, so will reach out again later. 

Enjoy the weekend!