Flurazepam (Valdorm/Dalmane) tapering plan

[[Ma...]]

 

Good day,

I've recently started to eliminate this medication, because it causes me all-day drowsiness. My psychiatrist told me that I can go directly from 15mg per day to 0, but I prefer following a tapering plan.

My history for the context: 

• February 2023: I was admitted to a psychiatric clinic due to a nervous breakdown (I want to move to another city for work in late 2022 and my best friend here stopped talking to me, I did get a job here in February and best friend in the other city stopped talking to me, I started to smoke more and more cigarettes and my sleep worsened; my family was very against me since during the winter they discovered some stuff that I've hidden; my mother even threatened to cut my hair during my sleep, finally when I told them that I didn't want a job here they start yelling to me and it was downhill after that). I had to stay there for 22 days and I was diagnosed with depression and insomnia; they give me a lot of medications, including the benzodiazepine Delorazepam (20 drops at 1mg/ml) for the insomnia, Carbolithium (3*300mg), Zoloft (antidepressant), Akineton (Biperiden) because I've developed tremors and Risperidone (Risperdal)
• They didn't tell me about the potential for dependence and possible withdrawal of benzos, they just gave it to me for sleeping
• I lost my job in a few months because of the hospitalization and the recovery period, and when I did get out I was like a zombie due high amount of Delorazepam and the other meds (I had problems speaking, excessive salivation, difficulty in focusing, shaking legs, drowsiness during the day), plus I had yellow/brown finger due to excessive smoking, that continued during the hospitalization since there were almost nothing to do
• They assigned me a public psychiatrist that I visited once a month
• We slowly try to change the meds to find a combination that work, but with only 1 visit a month it was very difficult; meanwhile because of Zoloft I kept having suicidal thoughts (before I had it only when my family discover my secret and I felt extremely ashamed, and I threaten it when they were yelling at me); we also decreased Delorazepam to 15 drops and then 10.
• The psychiatrist suggested another hospitalization for speeding up the process of finding the right medications
• I was admitted in another facility where I stayed all September 2023, there they changed antidepressant to Remeron (Mirtazapine), switched my antipsychotic to Aripiprazole, kept Carbolithium and Akineton and they try to remove Delorazepam, but at the same time they wanted me to go to sleep at 10PM and I was lying in bed with nothing to do until midnight, which is my usual sleep time, so I told them that I had problem falling asleep and they gave me Flurazepam (45mg). They also briefly gave me Xanax but I had adverse reaction to it
• Again they didn’t inform me about possible dependence of benzos and we started with an higher dose than recommended (15-30mg for maximum for 4 weeks); when I visited my psychiatrist after discharge, he assured me about that this new medication didn’t accumulate in the body like Dolerazepam, but now I know that while Flurazepam itself does not have an high half-life, its metabolite N1-desalkyl-flurazepam has an half-life ranging from 47 to 100 hours, so it does indeed accumulate
• Meanwhile we eliminated the antipsychotic and my legs tremors stopped, so we also removed Akineton since I no longer needed it; we also decrease Flurazepam to 30mg
• One month ago I was still having day drowsiness so the psychiatrist reduced the dose to 15mg (smallest capsule available form); I experienced reduced sleep for about 1-2 weeks, and PAWS in the form of headache (which actually started when I stopped using cannabis in May 2022, but it did get worse when reducing the benzodiazepine)
• A few days ago I’ve went to him with again the same problem, and he told me that I can remove it and take only when needed; but I want to proceed with caution and avoid taking again the full 15mg

 

What I’m doing now to increase sleep and decrease mental fog:

•  Installed on all my devices blue-light filters
• Going to sleep at the same hour (23:00-23:30)
• Trying to be active during the day (mainly walking, stretching and exercises that don’t strain my back, since I’ve also a discal protrusion)
• Staying mentally active and challenging myself with brain training app and Dutch learning
• Avoiding alcohol and caffeine (my psychiatrist told me that I can drink a small beer per week, but I prefer to no drink at all)
• Halved the number of cigarettes I smoke per day (1-2 reduction per week); I am now smoking 8-9 per day
• Taking 2mg of melatonin 1hour/half an hour before sleep
   

For the tapering, I’ve read the Ashton’s manual, but I can’t directly proceed to 10-20% decrements; “luckily” Flurazepam is already a long-lasting benzodiazepine so I don’t have to switch. For the plan I have two options, since the smallest capsule is 15mg and I still have Delorazepam 1mg/1m on hand; for now I am going with option 1:

1) Open the capsule and put as much as possible of the powder in a water bottle, the drink half of it, a quarter, the an eight and then stop; so I will roughly assume 7.5mg, then 3.9 and then 2mg. Doing other fractions it’s too difficult; I will have to use a weight-scale and my family will notice.
 

• 1-2 weeks at 7.5mg
• 1-2 weeks at 3.9mg
• 1-2 weeks at 2mg
• Stop

2) Switch back to Delorazepam, for which I can count the drops, so it’s more accurate, but I don’t know the equivalent dose, and it’s not as much long acting as Flurazepam

Again I’ve experienced reduced sleep, headache, irritability, eyes soreness and redness (that can also be caused by working on programming projects for future interviews). I’m now on the 5^th day of 7.5mg and tonight I’ve managed to get 7h and 20mins sleep finally.
Considering that I’ve assumed benzodiazepines for a total of 1 year and 6 months, with option 1 am I going too fast? Surely is better than going from 15mg to 0 directly; I would like to do some interviews in October or November, so I don’t have much time to taper off and then face the withdrawal. I hope to get a job and move away from here (I’ve some friends in the Netherlands, where I can get a new psychiatrist and psychologist) so I can avoid spending another winter holiday with my family, that unfortunately for my situation it isn’t the happiest part of the year (it will be very crowed and also they will keep me asking why I still don’t have a job, or propose me some of their “brilliant” solution, like working in the countryside and throw away my Master’s degree). They also already complain that I can’t wake up at 5-6 AM and about the redness in my eyes; they don’t understand that it will take time for me to recover from benzodiazepines use.

Thank you in advance for the feedback!

Edited September 3, 2024 by [Ma...]

[[...]]

Hi, @[Ma...], welcome to BenzoBuddies! What a mix of ever changing medications for a short time... It must have been pretty trying on your nervous sistem. I'm glad you're considering coming off benzo and doing it by means of slow reduction. It's very wise of you. I also like the things you're doing now to improve your health condition.

Sorry could you clarify briefly some points? As far as i understand, you've been taking benzo daily (delorazepam, Feb - Sept, 2023; flurazepam, Sept - now; +occasional xanax) for one year and a half, 15 mg of flurazepam now, right? What other medications you're currently taking? I know you've mentioned it but i'm not comfortable with long posts yet and i'm afraid some other ppl here find it difficult too. We're still healing.

As for your taper plan, i'm bad at proper benzo reduction but i like number 1 more, although i'd do it a bit more slowly and certainly, it must be done symptom oriented. A taper should be flexible. Hope other members will join in and share their thoughts with you as well. Good luck!)

[[Ma...]]

Hi @[...],
thank you and I'm sorry for the length of the post; I was trying to be exhaustive.

Unfortunately I had to try several antidepressants and medications because of the side effects.
Yes, I have taken benzos for over one year and five months.

I'm currently still taking daily Remeron (Mirtazapine) 30mg, Carbolithium 3x300mg and Flurazepam around 7.5mg since four days (when my psychiatrist told me to remove it completely).
I stayed a 15mg for all August and small part of July.

Ok, thank you for the input, I will try to adapt the plan based on my symptoms!

 

Edited September 3, 2024 by [Ma...]

[[...]]

@[Ma...], no no, it's absolutely ok to write long posts and it's good you try to be exhaustive. I just meant to explain why some folks here, including myself, might find it difficult to take in such information. It doesn't refer to everyone at all.

I also tried several antidepressants while being in interdose withdrawal still on benzo. That's why i know it can be hard on us. To be honest, i took mirtazapine for 1++ year to relieve some benzo wd symptoms and stopped it not too long ago.

I understand you read the Ashton Manual. It recommends 10% reduction from a previous dose every couple of weeks for long term daily users. It was deduced basing on the experience of lots people going through wd. Just smth for you to take into account. Sure we're all different and the first thing to pay attention to is your body reaction, meaning symptoms. It's also necessary to make allowance for the fact that coming off the drugs will most probably cause unpleasant issues which have to be toughed out sometimes anyway.

You cut flurazepam in half 4 days ago. Have you felt anything weird since then?

[[Ar...]]

Hi Matt

Hubby tappered off 30mg Flurazepam.

The tapper took about 5 month, which I know understand is fast. Luckily it went relatively well.

Unfortunately I cant really assist with a tapper plan, since we were kind of winging the reductions.

However I can say this much.

Dropping from 15 mg to 0 or stopping at 7.5 mg would have caused hubby unnecessary suffering.

Kate already mentioned the 10% reduction.

Would your psyciatrist be open to familiarize himself with the Ashton manual?

 

 

[[Ma...]]

@[...] Ok, the psychiatrist also said that mirtazapine would help for the sleep, thanks to its sedative effects.

Since then I've been more irritable, I've got eyes redness (but that can be also due to long hours at the pc), headaches (but I'm used to them, since I've had them almost every day since May), and reduced sleep about 5:30-6:3,0 except yesterday night that I've slept 7:30 (luckily I am able to recover some sleep in the afternoon). Same as when I went from 30mg to 15mg, except for the eyes; and it lasted 2 weeks.

@[Ar...] Hi Arianna, 

Thank for the info, I will read Hubby's topic!

Edit: if you can provide the link it would be great, there are too much topics when I search "Hubby"

I would like to proceed slower and do 10% reductions but I really don't know how to achieve it, since the smallest capsule available to me is 15mg and also I would like to move from here in a few months and get a new psychiatrist in the Netherlands (but the waiting time for an English-speaking one is 3-4 months), so if stop the taper and keep taking Flurazapem as before, I will add another 6 months of use, but maybe I can taper more slowly with new one.

If possible, I would like to taper now that I'm not working and I can adjust my activities, instead of when I will have to work 8 hours per day and risk losing the job because of the withdrawal. Also as I've said before I don't want to spend another winter here, due to my family and the situations with ex best-friend's group (we have a lot of common friends since we were friend for 20+ years and almost all of them have sided with her and don't talk with me anymore; but during the winter holidays we have to meet to at the house of a neutral one for his birthday and they will start mocking me again for not having a job yet or in some other subtle forms).

I am not sure about the current psychiatrist, he's old school and he doesn't seem to understand benzodiazepines, nor the psychiatrists during the hospitalization. He told me that I should be fine removing Flurazepam completely, and that I could expect to not have all-day drowsiness in 1/2 weeks. I could try to ask him in a month, but I think I am on my own.

Edited September 4, 2024 by [Ma...]

[[...]]

Hi, @[Ma...], by the way, mirtazapine helped me most of all with headaches. Do you feel anything of the kind for yourself?

I understand your desire to finish with the tapering as soon as possible, within the time best suitable for you. Unfortunately, benzo withdrawal is a very unpredictable thing and doesn't often goes the way we'd like it. If you try to speed it up reducing rapidly, you might risk being stuck or starting all over again. That's why you should take your time and, first of all, listen to your body.

It's good you could sleep well yesterday. I hope it means your nervous system is adjusting by and by and you won't need too much time to finish the process. In fact, it's quite probable for you to be able come off pretty soon. Hard to say but who knows. Just don't force yourself too much.

[[Ar...]]

Hi Matt

I joined on hubby's (husbands) behalf 🙃

 

 He was already off the Benzo. So there is not much info I am afraid.

In some countries Flurazepam is available in 30 mg and 15 mg tablet form, which obviously is easier to tapper. Have you checked with your pharmacy?

Here it is manufactured by Meda Pharmaceuticals.

Do your capsules contain beads?

 

 

[[Ma...]]

@[...] I don't know about mirtazapine, but I'm glad to hear that can help, at least is manageable most of the days.

As I've said in the introduction the headaches started when I had to stop using cannabis in May (1 joint per week was allowed by my psychiatrist, half on Saturday, half on Sunday) because they've arrested my supplier, I've tried to reach a common friend (the one that actually initiated me 13 years ago) with my best friend (female), but he didn't want to help as expected.

I actually have the strong suspicion that they're the ones behind the arrests; in summer 2022 I was still talking and confiding in her, so I've told her that I've found a job, but I had to transfer in the South for training, before going to work in the city in the North where my best friend (male) live; I wasn't ready to gave up cannabis at the time (I was smoking everyday) so I needed to bring some with me to taper off; the day before my departure they arrested him; it could be a coincidence, but when I met this common friend who introduce me to the dealer, it said to me: "it was a dear friend, but it had to be done". I had another offer directly in the North, so I've tried that, but at the end they gave the job to another person. She also had inquired to the location of this new dealer while we were still friend, and in my naivety I told her the zone; so I should have expected that they would try again the same thing, it was only a matter of time.

Returning to the topic, for the headache I am taking Ketoprofen when it's too much, but it can't be used everyday due to its effect on the stomach; I've tried CBD that is the legal option here, but it only works for about 2 hours, after that the headache returns stronger, so it isn't a viable option. 

Thanks again for the input, I will adapt the plan and listen to my body; even if it takes longer and I will have to postpone moving from here to 2025. I only will have to resist another winter and one encounter with them and the endless lunches and dinners with the complete family, but it's better than restart the process! Then finally I will be able to move away as I started planning in 2022, before things went south.

@[Ar...] Yeah, I've read it it; thank you anyway!

I will enquiry the pharmacy if they have the tablet, it would be way better for tapering off.

No, my capsules contain white powder, and they are produced by Valeas; the powder is also very bitter when dissolved in water, so I would like to switch to another form.

Edited September 4, 2024 by [Ma...]

[[Ma...]]

Another thing that I'm experiencing while I'm still using Flurazepam, is reduced REM sleep (when you dream) and that doesn't help with memory formation; I've read the literature and it's a known effect, it increases overall sleep time at the cost of REM; I have a smart watch that can monitor it and I usually only get 10% of the total sleep (it should be 20-25%).

When I sleep in the afternoon I usually dream a lot, so I think I'm recovering part of it.

During my decrease from 30 to 15mg I have also experienced one time sleep paralysis during the afternoon nap; I knew about it from stories, but it was still frightening; I was hugging an hard pillow and I felt that it was blocking my arm blood's circulation, I had to wait 5 minutes before regain control of my body and be able to move it.

[[Ma...]]

I have inquired about other forms of Flurazepam, but only 15mg or 30 mg capsules are available in my country.

I will have to keep using the powder dissolved in water method.  

[[Ma...]]

I've done a simulation in Python, using as Flurazepam half-life 2.5 hours and for its metabolite 75 hours.

It seems that maintaining half dose for 2 weeks is indeed too fast; I will maintain it instead for 3-4 weeks.   

If you want to use the script you need to install Python, pip and import the library matplotlib (ask chatGPT for further instructions).

You will also need to insert 3-4 dummy weeks at the current dose in order to reach the  maximum concentration level, after that you can insert the reduced doses and see the effects.

2 weeks taper

3 weeks taper

4 weeks taper

No taper

medsGraph.py

Edited September 6, 2024 by [Ma...]

[[Ma...]]

Update: I've finished my 3rd week at 7.5 mg (I actually think it is more like 7mg because with the water method some powder is lost); anyway the sleep is getting better (7-8 hours, only a couple of times I've got 6), still some irritability, mental fog and persistent headache (but I am used to it at this point). I'm also monitoring my mental acuity with an app and I'm getting worse at memory tasks, but I've read that is common during the withdrawal; also problem solving is decreasing.

The only thing that worries me is that a couple of time I've felt dizzy; anyone has experienced that? 

To be cautions I will keep the current dose for another week and go with the 4-weeks plan, before halving again.
I'm also thing about maintaining the smallest dose (1.8mg) for 5-6 weeks since I cannot divide that again with my method. 

Good luck to everyone with their benzo journey!

[[Ma...]]

Update: I've finished tapering off 20 November.
In the following days I had reduced sleep (around 5 hours); now is getting better regarding the hours (8-9), but light sleep is still prevalent and I still feel tired.
Mental fog is strong especially in the morning, and cognitive skills (measured via Lumosity) are stalled or getting worse.
I haven't had any dizziness, but the mood is very low (depression is getting worse).

From what I've read first month is the worst, so hopefully it will get better soon.
I'm still avoiding caffeine and alcohol, physical training is very hard due to extremely long recovery (so I mainly walk).

I would like to try job interviews at the end of January or in February.
If you have any tips on how to speed up the process let me know!
Thanks!

[[Li...]]

Hello @[Ma...].  Congratulations on finishing your taper!   Thank you for keeping us updated as to your progress so others can learn from your experience.  

Re: your question …

Regrettably, there aren’t any magic bullets to speed up the recovery process.  It will take as long as it takes.  Moreover, recovery is non-linear so don’t be surprised if you experience windows (periods of feeling relatively well) and waves (periods of feeling not so great).

Just treat yourself gently during this period.  In addition to avoiding caffeine and alcohol and walking, eat a healthy diet, keep hydrated, get as much sleep as you can, and minimize stress as much as possible.

PS The Python simulation you created is very cool!

[[Ma...]]

Hello @[Li...] Thanks!

I hope the simulation can be helpful.

I'm grateful to have done a proper tapering or it could be worse, in terms of side-effects and recovery time; I think tapering is the most important factor to reduce the recovery time.

Thank you for the other suggestions.
Let's hope that when I will do the interviews I will be in a good window.

Just yesterday I discover that also chocolate contains caffeine and other stimulants, so I'll try to avoid it late in the day (yesterday I had some after dinner and I could not get to sleep until 2AM).