Julia's Xanax Titration Taper

[[Ju...]]

I want to do a titration taper.  I work out of my home, so I mostly can do that.  However, the dose in the middle of the day might be problematic.  I am taking .25 mg of xanax now at 6am, 11:30 am, 5:30 pm and .125 mg at 10:30 pm.  Aslo, since I seem to be in tolerance withdrawal, when should I start?  Should I wait until my body equilibrates to the present dose before I step down at all ?

 

Direct Taper

 

Advantages: simple; wide support from doctors; probably all that's required by the majority of people in the general community looking to quit benzos.

 

Disadvantages: many benzos are too potent to allow a smooth taper for some people (or the pills prescribed are too large in dose for successful pill-splitting); many benzos have too short a half-life to allow a smooth taper (interdose withdrawal is often a problem); can be tricky to split pills accurately.

 

We suggest that unless past experience of attempted tapering indicates otherwise, members should initially try cutting their dose by no more than about 10%, and will probably make new cuts (about 10% of their dose at the time of the new cut) every 7-14 days. These figures are intended as ballpark estimates - mileage will vary.

 

 

Substitution Taper

 

Advantages: switching to an equivalent dose of Valium from a short half-life benzo (this must be carried out gradually) virtually guarantees that you will experience no interdose withdrawal effects; switching from a very potent benzo to Valium allows for much smaller cuts to your dose (more frequent small cuts are better tolerated than less frequent large cuts); if you have had problems sleeping, you may benefit from the sedating effects of Valium.

 

Disadvantages: some planning is required with a switch to Valium (but we will help you with this); an equivalent dose must be calculated and tweaked where necessary to suit the individual; many doctors (particularly in the USA) do not support a switch to Valium; switching will likely add to the overall time taken to withdraw; a small number of people appear to not tolerate the switch to Valium very well (this sometimes might be due to the wrong equivalent dose being prescribed or a failure to tweak the dose for the individual concerned according to how they react).

 

Prof. Ashton achieved very good results in her clinic by switching patients to Valium. Usually, her patients had already failed to quit benzos via the Direct route. If your doctor is supportive, and willing to adjust the equivalent dose as required, you are more likely to benefit from substitution.

 

 

Titration Taper

 

Advantages: allows for a very smooth taper, even when tapering from a large dose pill and/or potent pills; does not require a sympathetic doctor.

 

Disadvantages: ties you down to the kitchen, as a fresh batch must be prepared each day, and refrigeration is required too; your doctor might be unsupportive if you explain that you are 'titrating your benzos'; interdose withdrawal effects still might be a problem if you are taking a benzo with a short half-life; it is more complicated, and requires the purchase of some equipment.

 

We will work up a titration schedule for you, and post it to this website - just print it off. It will include the exact dose to be taken and the dates of changes to your dose. It might appear a little complicated at first sight, but once you have gone through the preparation once, you will find it is pretty straightforward.

[[Be...]]

I want to do a titration taper.  I work out of my home, so I mostly can do that.  However, the dose in the middle of the day might be problematic.  I am taking .25 mg of xanax now at 6am, 11:30 am, 5:30 pm and .125 mg at 10:30 pm.  Aslo, since I seem to be in tolerance withdrawal, when should I start?  Should I wait until my body equilibrates to the present dose before I step down at all ?

 

I'm glad you decided to try titration.  You may still get the occasional bump in the road, this is the method that creates the fewest symptoms.

 

You will need to get some supples first and then come back here and put in a request for a titration schedule with the following information:

 

The name of your benzo

Strength of the tablets you use

How much you are taking daily

How fast you want to taper (eg. 10% every 2 weeks)

The date you want to start tapering. 

(Please allow a few days between your request and start date to allow time for the development of the schedule).

 

You'll need a 100ml graduated cylinder with 1ml markings and a 10ml syringe.  Many people get their cylinders online; you can do a search on the phrase "100ml graduated cylinder" and find several sources.  You can get a syringe at the drug store or your vet, if you have one.  If you want to go all out, you can get a mortar and pestle to grind up the pills; most people just use a cup and the back of a spoon.

 

Now getting the supplies will take some time, so you will probably want to hold off reducing your dose until you can start the titration.  However, if you are experiencing tolerance withdrawal, you may not feel a great deal better by holding off.  It's a very individual thing.

 

I hope this is enough to get you started, but keep those questions coming.  Soon you will have a workable plan in place and once you perform your first titration reduction, you will see for yourself how easy it is. 

[[Ju...]]

HI.  I am having a little trouble navigating the forum --I think I replied to this before, but I am not sure it went through.  Just in case, I am sending again.

 

I would like to start my titration taper in about a week, i.e. Nov 16, 2008.  I am taking .875 mg of xanax per day.  The dose of the pills is .25 mg.  I take .25 mg at 6:00 am, .25 mg at 11:30 am, .25 mg at 5:30 pm and .125 mg at 10:30 pm. 

 

I have previously tried tapering off at about 15-20% every two weeks and had a horrible time.  I failed twice. I had terrible tachycardia and other horrific symptoms (but the tachycardia was the one I just couldn't tolerate)  I would like to taper very very very slowly in the hopes that it will be better this time.  Perhaps 3% every two weeks.

 

By the way I take a proto pump inhibitor which I think changes the bioavailability of different drugs --I don't know if this is a factor.

 

Thank you so much for your help developing a plan for me.  I am very grateful to find a place of support. 

[[Co...]]

Hi Julia,

 

Maybe this will help you: http://www.benzobuddies.org/forum/index.php?topic=9681.msg124366#post_structure. It outlines the structure of the forum boards, and the list of boards are clickable too (they will take you to the board listed).

 

The article on the Forum Structure is just part of the FUM (Forum User Manual). Any time you wish to refer to the Manual, just click the Forum User Manual link at the top-right of the forum.

 

There is also help with using most of the forum functions, such as posting, quoting, the PM (Personal Message) system, etc., on the forum main menu bar (just beneath the Shoutbox).

 

I hope this helps.

[[Co...]]

I would like to start my titration taper in about a week, i.e. Nov 16, 2008.  I am taking .875 mg of xanax per day.  The dose of the pills is .25 mg.  I take .25 mg at 6:00 am, .25 mg at 11:30 am, .25 mg at 5:30 pm and .125 mg at 10:30 pm. 

 

I have previously tried tapering off at about 15-20% every two weeks and had a horrible time.  I failed twice. I had terrible tachycardia and other horrific symptoms (but the tachycardia was the one I just couldn't tolerate)  I would like to taper very very very slowly in the hopes that it will be better this time.  Perhaps 3% every two weeks.

 

This is a very slow taper. It will take you well over a year to taper off at this rate. Might I suggest 5% every two weeks (still a very slow taper)? You can always slow down the frequency of your cuts if you feel it is too fast, but in all likelihood, you will be fine. I expect that after a while, after you have gained some confidence, you will be asking me to draw up a faster schedule! Post here when you have the equipment, and I'll post the schedule after a day or two.

 

By the way I take a proto pump inhibitor which I think changes the bioavailability of different drugs --I don't know if this is a factor.

 

Thank you so much for your help developing a plan for me.  I am very grateful to find a place of support. 

 

I'm not sure about this. If it does make a difference, it will probably only matter when start or stop taking the PPI. Starting or stopping might change bioavailability and therefore, blood levels. If your PPI does affect the bioavailability of your benzo (hopefully, someone else will be able to answer this), then stabilise your dose of benzo until you feel settled again.

[[Ju...]]

Hi  --thanks for the advice. I am willing to try 5% every two weeks.  I am very skittish becuase initially  my psychiatrist had suggested I taper off at 20% every  two weeks and I did so for about 8 weeks but my experience was completely  nightmarish.  I have never felt so horrible.  I had tapered down very low, but had to go back on the original dose, plus more, plus equilibrating for 2 months to feel remotely human. This is why I thought tapering down very slowly might work this time, but you are right,  doing it for a whole  year seems horrible.

 

I have a graduated cylindar with appropriate markings, and syringe.  I am ready to start in about a week or two -- perhaps I will wait till the day after Thanksgiving. 

 

Thank you again for your help.

 

Julia

[[Co...]]

Hi,

 

I'll draw up a schedule for the 28th Nov., and a taper rate of 5% every two weeks. I'll check through this thread later today to make sure I have all the information I need.

[[Ju...]]

Thanks.

 

I have some questions--if you plan to address them in the taper plans, just ignore them here.  If not, I will just indicate them : Once the xanax is dissolved in water, how long is it active?  You indicated that it would need to be refrigerated.  Just in case I have ordered some screw cap vials that hold about 30 mls of liquid, and a small  cooler pack so it would be possible to travel ---will this work?

[[Co...]]

Hi,

 

We recommend milk over water, hence the need for refridgeration. If you use water, then, surely, your liquid would be fine unrefrigerated for a day. Just be sure to shake well the liquid before making any measurements or taking a dose. This will ensure that the benzo particles are evenly distributed (they will tend to settle in water).

[[Ju...]]

Thanks, that is good to know. Is there a particular reason for the milk recommendation and is switching back and forth between milk or water depending on whether travel is needed for the day acceptable?

 

Thanks

Julia

[[Be...]]

Hi, Julia. 

 

Full fat milk is recommended because the benzo particles will bind to the fat which allows for more even dispersal when you draw off the amount to discard or drink.  It's fine to switch between water and milk.  When you are using water, stir real well and try to draw off your amount while the water is still in motion.  If you can't manage it, don't worry about it.  Just don't let the particles settle to the bottom.  Hope that all makes sense.

[[Co...]]

Hi Julia,

 

Sorry for the delay.

 

Here's your schedule: http://www.benzobuddies.org/spreadsheets/tt-julia-2008-11-29.html

 

Add the following code to your signature (in your profile):

 

[url=http://www.benzobuddies.org/spreadsheets/tt-julia-2008-11-29.html][u]My Titration Schedule[/u][/url].

 

Make up 100ml each day, using one whole 0.25mg pill. Drink the amount of liquid indicated for that day, and take the additional tablets indicated by the schedule. So, day1, you would drink 49ml (from 100ml of liquid made with one whole 0.25mg tablet), and three additional 0.25mg tablets. You would spilt up your dose over the day as deem fit. The second day, you would drink just 47ml from 100ml, and take three additional tablets. Let me know if you need the schedule adjusting at any stage.

[[Ju...]]

I started my very very  slow  titration  taper.  I have only been at  it for four days, and gone down an infinitesimal amount, and already I feel pretty bad.  When I started  I was already in tolerance withdrawal, though I waited about 3 1/2 weeks from my first tolerance withdrawal symptom to start  and and hadn't been feeling  too bad when I started my taper.  I am feeling pretty discouraged, because I thought if I tried a very slow taper I might manage to kick this stuff  this time around .  Anyone have any suggestions?

 

 

Julia

[[Th...]]

I started my very very  slow  titration  taper.  I have only been at  it for four days, and gone down an infinitesimal amount, and already I feel pretty bad.  When I started  I was already in tolerance withdrawal, though I waited about 3 1/2 weeks from my first tolerance withdrawal symptom to start  and and hadn't been feeling  too bad when I started my taper.  I am feeling pretty discouraged, because I thought if I tried a very slow taper I might manage to kick this stuff  this time around .  Anyone have any suggestions?

 

 

Julia

 

Hi Julia,

 

Sorry to hear it's not going so good. Are you crushing your .25mg pill into a fine powder and stirring it well before you drink the right amount? What kind of symptoms are you having? Have you had your thyroid checked lately? Your schedule is slow enough to not cause any problems. Maybe someone else will have some suggestions. Hang in there!

 

T2

[[...]]

I wish I could offer you something to help....

 

I guess I would like you to explain exactly how you are doing your titration.  And then maybe we'll "see" something that may be explainable OK?

 

[[Ju...]]

Thanks everyone. I'm dissolving my pill in a small amount of water in the graduated cylindar, watching to make sure it all dissolves, then adding full fat milk to the total amount.  I am afraid to crush because I seem to lose pieces when I do that.  I cover the top of the graduated cylindar and make sure I shake it to distribute the material throughout. I leave it for a while, and then later on shake again before I take my dose.

 

I had my thyroid checked about 6 months ago, but what I am experiencing seems to be typical withdrawal symptoms for me--I have been here before.  Lots of tachycardia, inability to concentrate, headache, a switching below my eye (which I always get in withdrawal and never have when I am comfortably on xanax) and believe are called fasilulations, anxiety, depression, stomach upset and hot and cold flashes.

 

I am going to hang in there, because I can't  stand to do this one more time, but its tough.

[[...]]

Ok, so you are doing as Colin instructed:  Make up 100ml each day, using one whole 0.25mg pill. Drink the amount of liquid indicated for that day, and take the additional tablets indicated by the schedule. So, day1, you would drink 49ml (from 100ml of liquid made with one whole 0.25mg tablet), and three additional 0.25mg tablets. You would spilt up your dose over the day as deem fit. The second day, you would drink just 47ml from 100ml, and take three additional tablets. Let me know if you need the schedule adjusting at any stage.

 

I'm guessing you discard the amount you don't consume.

 

You also say you have been here before, so it is not something new for you....you are just surprised at the intensity when you are cutting such small amounts?

 

 

[[Co...]]

Hi Julia,

 

I'm not saying that you are not experiencing problems, but I cannot see how this taper plan is the cause of your symptoms. You have cut your dose by about 1.4% over four days - this is tiny. You also need to consider that you take a short half-life benzo, so your blood levels drop by a huge amount between doses. If you can cope with these interdose changes, it must be unlikely that the 1.4% reduction in dose would have a noticeable effect. I am not saying that you are not experiencing problems, but you had a bad withdrawal experience in the past, so is it not possible that feel poorly because you expect to feel poorly? Tapering at this very slow rate should cause you no ill-effects, especially as you've only just started.

[[Be...]]

I started my very very  slow  titration  taper.  I have only been at  it for four days, and gone down an infinitesimal amount, and already I feel pretty bad.  When I started  I was already in tolerance withdrawal, though I waited about 3 1/2 weeks from my first tolerance withdrawal symptom to start  and and hadn't been feeling  too bad when I started my taper.  I am feeling pretty discouraged, because I thought if I tried a very slow taper I might manage to kick this stuff  this time around .  Anyone have any suggestions?

 

 

Julia

I don't know of anything but pressing forward, Julia.    It is very common to be experiencing some waves of tolerance withdrawal while tapering.  If it would help you psychologically to hold where you are for a few days, that's certainly okay.  

 

The only two things I know of that lessen tolerance withdrawal is taking more benzo (not an option, I know) and time.  I used to get the rapid heartbeat, blurry vision and sweats quite a lot while tapering.  I did find that practicing what I call controlled or slow breathing really helped with the anxiety. We have information about the breathing and meditations that seem to help; if you want it, just ask. I used ice packs for the sweats and things called "bed buddies" that heat in the microwave for the chills.  I've seen both peppermint and ginger teas or ginger ale recommended for the stomach upsets.  You pretty much have to find ways to treat the symptoms you can without benzos and simply accept the rest as just sensations that are temporary and won't kill you.  Not a very satisfactory answer, I know.  Believe me, if I had another solution, I'd tell you.

[[Ju...]]

Thanks for your replies, Colin, Beeper, Cal--

 

I am also very surprised at the intensity of  symptoms with such a small cut.  I have some theories:

 

1.  I was already in tolerance withdrawal, and thats why I am feeling so poorly, and it is coincidence that it is at the same time as my very small cut

 

2. Related - The proton  pump inhibitors that I take don't let one break things down in the  liver so quickly so my tolerance withdrawal (I had waited 3 1/2 weeks after my first tolerance withdrawal symptom, and had been feeling somewhat better and thought I had equilibrated but maybe not)  and whatever I do takes longer to equilibrate--I have a call in to my gastro-enterologist and hope he will address this with me.  Probably he won't know, as no professionals have been much help.

 

3.  I read somewhere that switching to a liquid form of a dose when you have been taking a pill sometimes has bad effects with benzos.  I discounted this becuase I couldn't really see any molecular reason why that should be so--but who knows? Nothing with this benzo nightmare seems to completely follow any formula or logic.

 

I am feeling slightly better today than yesterday    (though not great) and I didn't take my proton pump inhibitor today.  I am going to experiment to see if there is a connection. 

 

What do you think?  Do any of these theories correspond to anything you know or have experienced?

 

 

 

[[...]]

WEll, Julia, number 3 may have happened to me.  The reason I say "may" is because instead of cutting only 1 ml I did 2 ml for the first 2 days and that may be why I had a rev up of symptoms when I switched to titration.  WE will never kno....it did take a week after I switched to titration for me to feel better.  So, who knows, for sure?

 

Also, #1 could just be it.  Wouldn't it be nice if we could say for sure, but nothing is for sure and everyone is soooo different.

 

Just take it slow, that is one thing I KNOW is the best way to go with a taper.  This isn't a race and we want to be able to live while we are tapering.  So keep at it !

[[Be...]]

I've had to take a proton-pump inhibitor for many years for severe reflux. I'd be interested in what your gastro doc has to say, though, as you said, he may not know anything about benzos and withdrawal.

[[Ju...]]

Hi Beeper--

 

You indicated that you were interested in what my gastro-enterologist said about the ppis.  I have been off ppis for 5 days and my withdrawal symptoms feel better (they felt better after the first day off).  The doctor says he believes it is not correlated though he can't say that 100% positively, and told me to go ahead and experiment.  I  also did my own literature search and all the articles seem to say there is no correlation, and most  particularly  with aciphex (which is the one I am taking).  Apparently, ppis such as prilosec have a higher possibility of drug interaction (though the articles I read  addressed  valium  not xanax which I am taking,).  I guess the consensus seems to be that it is not a factor.  I am going to go back on the ppi and see what happens (Gerd is no fun either).  My subjective experience may be related to other factors, but I think I will in any case follow the doctors advice and experiment.  If I feel worse again re withdrawal symptoms, I will  go on and off the ppi  and try to see if the correlation is absolute.

regards

Julia

[[Be...]]

Thanks for the information, Julia. I've had to cut back on my ppi recently and my GERD is much worse.  I'm pretty sure they interfere with aspects of digestions and some docs don't let you take them for years on end.  At least your doc didn't say you had to stop the aciphex. This is no time of the year for GI problems.    I fyou come to any conclusions with your experiment, please post about it, okay? 

[[Ju...]]

Hi Beeper.  At this point, I have been back on the ppis for a week or so.  I had said I thought I felt better (with regard to withdrawal symptoms) when I was off  ppis, but this past week back on  I really didn't see that I felt worse.  So maybe there really isn't any effect.  I will go back off (after the holidays --as you said, this isn't a good time to go off)  and check it out once more .  I won't mention it again, unless I really can tell something definitive.

 

Julia