Noticing not many try Titration with Xanax. Why?

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Hi,

 

I'm just joining today and just starting a titration of Xanax after 15 years of use after failing often and miserably at other kinds of withdrawing. However, in reading through the Titration, I don't see a lot of folks trying to titrate off of Xanax after reading a bunch of pages there.

 

Is there any reason for this?

 

I'm getting anxious because I did just try my first titration today.

[[ba...]]

If I had to take a guess,In my opinion is that the half life of xanax is very short,most really feel interdose withdrawl and swich to  benzo that have alonger half life  klop approx 52hrs, valium 200hrs half life hope this is helpful

[[pr...]]

Xanax can definitely be titrated, but Bando is right.

 

Xanax levels in the blood peak out about one to two hours after you take a dose and then they start to drop.  Once they drop too low, people get something called "interdose withdrawal" symptoms, which is exactly what it sounds like; you go into withdrawal between doses if you don't take it often enough.

 

What I have found works for people is to break up their dose into multiple daily dosing.  Personally I take some every three hours, but some people have done okay with every four hours.

 

This is also a problem with Ativan, which is another short-acting benzo.

 

This is why Heather Ashton recommends that people taking short-acting benzos transition to Valium instead and then taper off of it.  Other doctors suggest Klonopin as an alternative; it doesn't have as much long-acting effect as Valium, but people seem to do okay taking it twice a day.

 

However, it's completely possible to taper off Xanax using liquid titration.  I'm doing it and I've met other people (online) who are doing it or who have done it.  You just have to  dose at regular intervals throughout the day and night.  With Xanax it's very important to keep your doses regular and not be erratic with your dosing.

 

And you've probably also noticed that it's important to go slow.

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If it's starting to wear off that fast, that explains why I notice w/d at about 4 hours these days. Sometimes sooner. I didn't realize it was so quick. Good to know!

 

I'm stuck taking the medication every five or six hours for the time being. That's how it was prescribed -- 3X per day. If it gets intolerable as I go down, I'll divide it into another dose.

 

The other hard one for me is that I take a heavier dose (2 mg) before I teach two longer classes which are all lecture-based twice per week. I have no clue what to do there other than also taper that down because if I cut it out, I could easily screw up and have a panic attack and lose my job -- I'm already on the brink of that all the time. That's the hard one for me. I know it will make this take a bit longer. Oh well, right? Sigh. Just taper that down too, I guess. I've only been on that dose for that class since last August. Over the summer, I was just on the 3 mg each day. But now twice a week, I'm on 4 mg. Until May. If I had a panic attack, which hit so fast and hard and yes, people notice them, I would literally lose my job which I've spent 50K and 6 years in college for. I'd lose my ability to pay my share of the rent too. That's not funny so I'm going to be careful there. I can take a little w/d... sometimes I'll be in a really good one while in a meeting or something. That's not so bad. As long as I'm not standing in front of 30 people trying to keep everything running smoothly while falling apart inside.

 

If only I could just go to an island for a year or something, laugh!

[[ba...]]

Your determination will see you through this difficult time,keep us posted we are all here for you  bando

[[pr...]]

Once you start dissolving your tablets and titrating, you can dissolve the whole day's dose at once and then divide it evenly so you can take even amounts at even time intervals.

 

Taking 1 mg more on some days than others is kind of a recipe for panic attacks, though.  These drugs that distort and alter our neurotransmitters and hormone functions, most of the time taking variable dosages just screws things up worse.  Your system can never stabilize because you're constantly disrupting it.  Just FYI, it's what seems to happen with people.

 

These drugs don't just work like aspirin, work while they're in our systems and then go away.  They cause our brains to remodel themselves, to respond to them and try to control and react to the changes they (the drugs) cause.  So our brains are constantly struggling to stabilize themselves in the face of what the drugs do.  When the dosages are fluctuating, the CNS can never stabilize.

 

If I were you I would start with those 4 mg days and taper them down to 3 mg and then start tapering every day from the 3 mg down.

 

1 mg of Xanax is equivalent to 20 mg of Valium so as you can see either 3 mg or 4 is a fairly high dose (equivalent to 60-80 mg of Valium). 

 

If you do titrate/taper down you will probably get some relief from the side effects long before you get all the way down to zero.  All benzos cause cognitive side effects--distort our thinking and our social interactions and also slow us cognitively and damage our memory and our ability to learn and think.

 

You may want to set yourself an intermediate goal, say getting down to 1-2 mg a day; this might make it less scary.  If you take it slowly enough, though, and do regular dosing at regular time intervals day and night 24/7/365, you should find that the panic attacks are much less of a problem.  Xanax actually causes panic attacks.

 

You may want to take a good look at the option of crossing over to Valium.  You've been on benzos a good long while and it sounds like you've had at least one failed attempt to get off.  It might be worth investing the time and energy to cross over to Valium.  It sounds to me from the things you've been saying like this might be a better option for you.

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Thank you. I hadn't seen this. I'm going to try a taper my lecture dose. Others cautioned against it, but I need to stay functional and this is still an art, not a science. I'm hoping to try to keep my job. Thanks for your help. I trust your advice. I cut a little fast but seven days in, am doing alright so I'm going to go with it. As I go, i will try to integrate this. I confided in my mother today about this, and she was supportive and understood why I was not telling anyone.

 

No side effects today after my first dose. Wish I could make the water titration work better, but no chance of switching to valium after a previous failure that left my doctor skeptical of Ashton's methods. He believes to just reduce slowly. He's a good doctor, honestly. I'm going to tell him about water titration. But right now, not ready to tell anyone. Keeps me feeling in control still.

 

I can't believe i'm almost a week in and no seizures! That's great! You have no idea how much so. Also, I am pretty okay except when teaching. This is so far a piece of cake.

 

I'm down to 2.77 mg per day from 3 mg per day and plan to stay here for awhile, and also to titrate more slowly with a milliliter taper remover... does anyone know where to get one of these? We don't have Walgreens where I live, sorry. We have WalMart though and Target too. Any sections I should look in? Or do I need to go to the chemistry kids supply store? That would help, I think. from here on here on out. Thanks!

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Do you mean I can taper at two rates?  I think the 4 mg days could be tapered fast to 3 mg, now that you mention it. Fast for me is like 10% per week for those days. That sounds way better and more doable. Should I also keep tapering down the other days? Or wait until that's stable first? I've cut 8% off my OG dose and am proud since no seizures at least!

 

Thanks tons!!!

[[pr...]]

I was thinking just taper only those 4 mg days down to 3 mg, and then once you're at 3 mg proceed to taper every day.  That's what I'd try, I think.  (Maybe with propanolol for the "stage fright" but only with a doctor's approval.)

 

But of course the absolute most important thing is to listen to your own body, pay close attention to your own symptoms, and adjust accordingly. 

 

Well except for the other absolute most important thing, which is, don't do anything drastic, and don't get overly enthusiastic and cut fast because you're doing well at first; these tapers have a lag effect and catch up with people and bite their bu**s.  Better to go really slow at first and wait a long time between cuts until you have a chance to see what your personal recovery cycle is like; then you can speed up if that works for you.

 

And then the OTHER other absolute most important thing, which is, get those doses EVEN AND AT REGULAR TIME INTERVALS. 

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Somehow I double-posted, apologies... see next reply.

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I will see how I'm feeling on Tuesday, but at this point, it would mean updosing and so far, I'm doing pretty well. I might see if I get desperate again, but I appreciate the advice more than you would believe!!!

 

I do think I am doing something wrong with my math though. Not sure, but I think I must be. Can you (or anyone else) assist here?

 

Right now, I'm trying to taper by 4% per week (or two if it gets bad - or cut in half and taper at 2% for a week if needed). Did I do this correctly?

 

Each dose = 100 ml water + 1 mg Xanax - 4 ml

 

Take 3X per day.

 

Somehow, I can't wrap my mind around this. My spreadsheet, which is rough, says I've already gone down to 2.77 mg in week two. That's a lot more than 4%, isn't it? Or is it?

 

I cut an additional 2 ml in week two, so I should now be maybe at 6%, but also can't quite wrap my mind around it well.

 

Sorry, my math skills are not great. Not at all. Does this sound right? 6 ml/6% should be just cut to 2.94. Why is it cutting so fast to 2.77 ml? I want to make sure that stops. I'm okay, but not going to cut anymore until I figure this out. I'm confused... 

 

On the brighter note, I've been taken my medication at the same time every day even if my symptoms are horrific. So far, that's a serious change from how I normally take them, which is whenever I can't stand it anymore, and then sit around all evening involved in repetitive tasks or movie watching waiting to go to bed to stop feeling the interdose withdrawal!  It's no way to live at all.

[[pr...]]

"On the brighter note, I've been taken my medication at the same time every day even if my symptoms are horrific. So far, that's a serious change from how I normally take them, which is whenever I can't stand it anymore, and then sit around all evening involved in repetitive tasks or movie watching waiting to go to bed to stop feeling the interdose withdrawal!  It's no way to live at all."

 

Taking Xanax like that, as you're finding, is a recipe for anxiety and panic attacks.  We wait until the interdose withdrawal symptoms kick in and make us really panicky, then we take too much out of desperation. 

 

I think three times a day is not often enough, though.  Xanax levels in the blood peak out after less than two hours and then begin to drop.  I don't see people get much improvement unless they take doses no further than four hours apart around the clock.  If you do that, within a few days you should find that you are having less anxiety and much less panic. 

 

Personally I dose mine every three hours.  Around the clock.

 

As far as the math, I can't really follow what you're doing, so it's hard for me to figure out what's not working.  If you mix your total daily dose in 100 mL and remove 4 mL whatever is left will definitely be 96% of your total daily dose.  I don't know what kind of spreadsheet is telling you that you're taking 2.77 a day. 96% of 3 mg is 2.88.

 

To figure out how much you're taking, find your percentage.  If you're dissolving in 100 mL, the percentage you are taking is going to be the total number of mL you are taking.  Which is going to be 100 minus however many mL you have removed.  100 mL minus 2 mL for example would be 98%.

 

Then multiply by decimal-point-percentage.  For example, right now if you're removing 4 mL, you're taking 96%.  If you dissolved 3 mg in the 100 mL to begin with, you are taking 96% of 3 mg.  Multiply 3 by 0.96.  My  calculator tells me that is 2.88. 

 

Don't forget that you are actually cutting a little more than that if you are liquid titrating, because a small amount always sticks to any surface it's exposed to, so you aren't getting the full 2.88.  It's just a guideline to help you keep track as you go down. 

 

It sounds to me like you're going faster than I would recommend, also. 

 

But mostly, I think if you can just get those doses stable across the day, that's where you need to start, before figuring out how to taper further.

 

Patience is the key to benzo withdrawal--absolutely. 

 

 

 

[[bl...]]

I prepare the doses individually. That's the difference in math, I'm thinking.

 

Each dose (not all three doses):

 

100 ml water + 1 mg Xanax less "some." Right now, I'm taking out 10 ml of water per dose. That should leave me with 90 ml of water which contains .9 mg Xanax per dose.

 

.9 (each dose) X 3 (doses per day) = 2.7 mg per day

 

Right?

 

And 2.7 is 90% of 3, which makes a 10% total daily reduction (achieved over the course of about ten days so far, but my first cut was just a little too big).

 

BillyF seems good at math. He helped another poster with this. I admit to being math challenged. It took a while for me to figure this out.

 

I think it should be taken more often too. But I can't handle moving from a 1 mg regular dose to some significantly lower dose because that, in itself, induces severe withdrawal feelings too. I think because this is a higher dose still. I've tried, in the past, to space a 1 mg dose out into two .5 mg dosages to cope. That did NOT work out well for me. I feel like I've just not taken any meds and am always in withdrawal which is worse then. I think each person would be different here. Also, remember, I was having interdose withdrawals when I started, which means I'd been struggling with w/d for months when I started the taper because of the erratic way I took the pills, I guess. That's been pretty easy to adjust for me so far.

 

Whatever I'm doing is working though. I can tell because I'm not having a seizure or increased problems, and the symptoms aren't intolerable. That's the goal. To be able to slowly taper off the meds over a few months with as few symptoms as possible.

 

Right now, I'm tapering out 2.5 ml from each dose of 100 ml of water which contains 1 mg Xanax, repeating this three times per day, and then holding this for 4-5 days. I'll adjust to less if need be.

 

I don't even have tremors here. Haven't had any racing heart. Tracking my progress carefully, noting how I feel. More mental symptoms than physical ones. Past tapers with dry cuts have left me in a far, far, far worse condition. Presumably, just taking too much off.

[[bl...]]

 

 

As far as the math, I can't really follow what you're doing, so it's hard for me to figure out what's not working.  If you mix your total daily dose in 100 mL and remove 4 mL whatever is left will definitely be 96% of your total daily dose.  I don't know what kind of spreadsheet is telling you that you're taking 2.77 a day. 96% of 3 mg is 2.88.

 

 

I mix each dose in 100 ml, not my total daily dose, and then removed 7.5 ml from each dose to get 2.77

100 - 7.5= 92.5 ml

92.5 ml X 3 = 2.77 mg per day

 

I don't feel like I'm going too fast though. I did during my first cut. Now, I feel fine. I will watch it and if it's too high, I will be the first person to lower the rate! I plan to taper off over about six months. Right now, I'm going a bit faster because the dose is on the higher side. It's certainly in line with Ashton's recommendations, however, and others who say to titrate 5% or 10% over a week.

 

Is my math off? It's possible. Let me know. Thanks! My calculation is above. I'm not the math saaviest person by any means.

[[pr...]]

I can't follow your math--it's hard for me to follow math written the way we write in forums (in sentences).

 

Anyway if you're removing 7.5 mL from each 100 mL then you are removing 7.5% and taking 92.5%.  So whatever you mixed in the 100 mL, you are taking 92.5% of that.

 

I think the best guide to determine rate of taper is your own body.  So if you're feeling good, that's good. 

 

Just be aware that cuts usually have a cumulative effect and the effect has a sort of lag time, so often people will be feeling pretty good and gaily cutting away, and then all of a sudden it hits the fan.  That's why I recommend going extra slow at first--until you get a feel for how the cycle of cuts/symptoms/recovery works for your own body, not just day by day but also over the longer cycle of cumulative effects.

 

Caution at the beginning--so that you can get off to a nice stable start--pays off big time later on! (ask some other oldtimers around here if you don't believe me!)

 

Just my own two cents though.  The person who is the expert on you is YOU.

 

 

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Thanks prhiannon. I'm so bad with math, I'm probably expressing it poorly. I had a friend finally help me figure through it. I am definitely feeling what you're saying... cuts hitting a bit after the fact. Mainly the second day or third. I remember that really vividly from dry cuts too.

 

Well, I need to slow down a little. Today, I cut and it's a rough day for sure. Just 2.5 mg. But ugh.... argh... 

 

I'm so sleepy!