Help please

[[Me...]]

I am on 0.5 Xanax 3x a day for almost 10 years. I want to begin to taper and completely come off of them due to realizing they just make me feel worse. What is the safest route to do so, what is stopping me is being terrified I will have a seizure! I also don’t want to take anything else other kind of medication and just straight taper off the Xanax.

[[El...]]

@[Me...] Hi!  Seizures are likely when a person has been on an extremely high dose...or tapers too fast or cold-turkeys..and has a history of seizures.  Have you ever tapered before?  Do you have any history of seizures?  

Generally, it is recommended to reduce between 5% and 10% every few weeks while monitoring your symptoms carefully.  If your withdrawal symptoms spike, you need to slow down.  If you are coping well, you might consider a slightly more rapid rate.

I do have a few questions.  Are you dosing more than once per day?  If so, how often?  Are your doses evenly spaced throughout the day and evenly weighted?  Do you suffer from any discomfort or feelings of withdrawal between doses? 

Let us know how we can guide you further!

[[Me...]]

I take 0.5 three times a day I have always done morning afternoon and at night. I have never had a seizure and just want to make sure I’m tapering properly I just think the fear of how long I’ve been on them is what scares me. 

[[El...]]

@[Me...] I think as long as you carry out a slow and thoughtful taper, you need not worry about seizures. I started taking Xanax in 1989…and although my new doctor switched to Ativan (still not sure why?), I have been fine during my taper.

How do plan to approach your taper? Are you planning to cut and weigh tablets…cut and hold…microtaper? If you would like, I would be happy to help with/explain any logistics.

 

[[Me...]]

I would love any insight!! My doctor had told me to start by cutting the afternoon in half wait two weeks then cut another in half but I am wondering if I should cut into quarters first. A half seems like a quick jump 

[[El...]]

@[Me...] Wow!  I would agree with you...based on the number of years on Xanax, an initial reduction of 16.8% is probably too large.  If you were to reduce by 0.125 grams (1/4 pill), that is still an 8.3% reduction..which is also on the "larger" size for an initial reduction.  Since the "rule of thumb" is reducing 5% to 10% every few weeks based on your symptoms, sometimes it is better yo proceed with your initial reduction slightly more cautiously to see how you feel.  It is easy to speed up a taper rate...but once a large reduction is made, it is sometimes more difficult to recover.

A couple of suggestions:  Is is possible for you to get 0.25 mg tablets?  1/4 pill would then be 0.0625 mg.  Or, have you considered cutting, filing and weighing your tablets?  This would probably be a good option because you can then keep all your doses evenly weighted.  Xanax has a fairly short half life.  Evenly weighted doses will help prevent peaks and valleys in your blood serum concentration preventing the possibility of interdose withdrawal as you proceed through your taper.

Is your doctor willing to let you follow a taper based on your symptoms (or, hopefully, lack thereof)?

[[Me...]]

I could probably switch to the lower dose, I know I had one person tell me to take the morning then in the afternoon talk 3/4 of a pill then my regular at night. Hold for 2 weeks like that then do 3/4 morning and afternoon, full at night and so on and so forth. I have never tapered before so I’m honestly clueless 

[[El...]]

@[Me...] I have also heard of people tapering in this fashion.  And, of course, many are successful.  And it may work great for you as well.

I just have 3 reservations.  The first is that by reducing your doses as indicated, your first reduction would be 8.3%.  You second reduction would be 9.1%.  And a third reduction would be 10%.  And the percentage will keep increasing with each further reduction.  Most, at least initially, try to reduce based on a comfortable percentage of their last reduction to minimize withdrawal symptoms.

My second reservation is the uneveness in your weighted doses.  This may not be a problem, of course.  But, again, since Xanax as a short half life, keeping doses evenly weighted and evenly spaced apart will help prevent interdose withdrawal.

My third reservation is putting a time frame on your reductions.  You may, indeed, be ready to reduce again in 2 weeks.  But it is important to listen to your symptoms and reduce accordingly.  Your body has had 10 years of Xanax.  A simple 2-3 month taper may not be enough time for your central nervous system to such a radical adaptation.

All that said is just to give you a "heads up" on potential difficulties.  But, it is more important to proceed in a manner that is comfortable for you.  We are all here to support you in every way!

[[Me...]]

I appreciate it! What would your suggestion be for tapering? I am willing to take any information to help do this the best way and I have read about the shaving and weighing but don’t really understand how to do that or even where to start 

[[El...]]

@[Me...] Good morning!

I tend to always suggest starting on a conservative initial reduction...knowing you can increase the percentage of the next reduction if symptoms do not become uncomfortable.  Unfortunately, symptoms will arise...but the goal is to remain functional and "well".

So personally, I would aim for no higher than an initial 5% reduction...maybe even as low as 3%.  Give yourself a couple of weeks at this dose.  During this time, record your symptoms daily. If at the end of this period you are functional and "well", you can increase you percent reduction or even keep it the same.  If you experience discomfort such that it is interfering with your life, hold longer until stable, than try a lower percent.

With that in mind, a 5% reduction would bring you to 1.425 mg (0.475 mg per dose).  A 3% reduction would bring you 1.455 mg (0.485 mg per dose).  But to make these reductions, you will need a jeweler's 0.001 g scale (available through Amazon for about $30), a pill splitter and a metal nail file.  Cutting and weighing tablets can be tedious...but it is relately straight-forward.  If you should decide to follow that route, once you purchase the scale, I can take you through the logistics of finding the average weight of you tablets ( in grams) and then calculating your doses in grams (vs. mg).

What do you think?

[[Me...]]

Ok! Thank you so much for your help!