Could anyone advice of Maudsley tapering guidelines?

[[Dr...]]

Dear all, 

I hope this message finds you as well as possible. 

I recently bought the Maudsley Deprescribing Guidelines book and am very much interested in continuing my taper (once I've been stable long enough) with these guidelines. 

I would be looking at either the moderate or slow tapering for Lorazepam. 

My current doses are not equal yet, though. I'm on 0.5mg morning, 0.5mg afternoon and 1mg evening. 

How would I go down from 1mg in the evening to 0.5mg, so I can then continue using the guidelines (my symptoms will of course determine the rate at which I will taper)?

Would anyone know how to taper this evening dose, according to the Maudsley guidelines? 

Thanks so much in advance for your help! 

Blessings on your day! 

[[Fa...]]

Hi @[Dr...],

Your history shows that you had cut out your afternoon dose.  You have added that back in?

Maudsley is a hyperbolic taper, and my understanding is that it recommends 1-5% reductions every two to four weeks.  However, this is a symptoms-based taper, so of course timelines are only guidelines.

The simple answer to your question is that you start your taper of the PM dose using the Maudsley guidelines.  In order to work on your PM dose to get it down to .5mg, you would decide your reduction percentage and simply start reducing your PM dose only until you reach .5mg.  If you want to start your taper  with all doses being exactly .5mg, which I understand, your last reduction before hitting that will have to be calculated to hit that marker.  It's important not to increase your last reduction percentage beyond what has been working for you in order to hit the .5mg marker.  Better to have two smaller cuts in a row in order to reach the .5mg.  Does that make sense?

If you were to choose to reduce by 3% from 1 mg, that would take you down to .97mg.  Next 3% reduction of your current dose of .97mg would be .94mg, and so on.

I'm not sure if this is the information you are looking for as your question is broad.  But, this is how I would approach it.  The next question is what method are you using to taper?

Also, as I do not have the manual, I am not sure if there are specific recommendations for the different benzo types.  I use a hyperbolic taper within the 1-5% guidelines, symptoms-based.  The only varying factors I could see would be the number of doses per day being optimal based on a short acting benzo versus a long acting benzo.  I think that adding back the third dose was a good decision being on a short acting benzo.

I know that this stuff can be very overwhelming for our brains.  I'm sure that if I am missing anything of importance, someone will step up.  I think the important consideration is choosing the percentage of your reduction.  And, starting off slow is better as you can always play with it and increase if your body allows it.

Warmly,

F

 

 

 

[[Dr...]]

Dear @[Fa...],

Thank you for your reply. You are absolutely right: this stuff is overwhelming for the brain... And yes, I did bring back the afternoon dose. Thanks for pointing it out; I have now updated this on my profile.

The reductions following the Maudsley Guidelines are based on the Receptor Occupancy (RO) and not on a percentage over the last (total daily) dose.

So for example, the Moderate Taper for Lorazepam says: "A moderate taper with up to 2.8 percentage points of GABA occupancy between each step - with reductions made every 1-4 weeks."

There's a table included for it, but since my current doses are not equal I find it difficult how to start creating equal doses based on these guidelines (up to 2.8 % RO change per step).

I'm sure I'm not allowed to copy and paste complete tabels from the book, but here's a part of it that is relevant for my situation (please note that this is the Moderate Taper and I will also check out the Slow Taper):

So I would then start at step 25, when all my 3 doses would be 0.5mg.

I am actually now wondering whether I could not do steps 20 to 25 which reduces the total daily dose from 2mg to 1.5mg which is my situation. The difference would be that I would be doing the reductions on my night dose only, rather than reducing all three. I have no clue whether that makes sense...

And a step of 0.1mg might be too much for me at one, so I might look into micro tapering.

Any further advise is of course hugely appreciated.

Blessings on your day!

[[Fa...]]

Hi @[Dr...],

@[Li...] is very well-versed with this. I wonder if she may step in to discuss with you.

The chart you have attached is based on a 5% reduction based on the current dose.  So, the chart looks confusing, but it really isn't.

Having seen the chart, I do not see why you would not be able to work on your Night Dose first based on reducing whichever rate you feel comfortable starting with...whether that be 5% (moderate) or less...until you reach .5mg.

Warmly,

F

[[Li...]]

@[Fa...] 

Thank you for the shout out.   @[Dr...] has a second Taper Strategies thread (linked below).  I’ve shared my comments about MDG there, starting on page 3.   

 

[[Fa...]]

@[Li...]  Thank you for sharing this.  @[Dr...] is in good hands.

Warmly,

F