Help with titration taper please!

[[An...]]

That's good, thanks, thought the drugs were REALLY driving me nuts, perhaps if Colin could help out here!!!!

Regards

Annie6

[[Co...]]

I'd switch gradually using the following method.

 

First, I'm assuming you are using 1mg Lorazepam and 10ml Valium tablets. If the tablet strengths are different, get back to me.

 

I'd use the following Method:

 

1) Make up 100ml of liquid with a single 1ml tablet of Lorazepam.

 

2) Discard 25ml of the liquid Lorazepam, and pour out the remaining 75ml into a container.

 

3) Make up 100ml of liquid with a single 10mg tablet of Valium. Pour away 75ml, and keep the remaining 25ml in the cylinder.

 

4) Return the 75ml of liquid Lorazepam to the cylinder (you should have 100ml in total).

 

This liquid (75% Lorazepam; 25% Valium) is equivalent to 1mg of Lorazepam.

 

5) Discard 9ml, so that you are left with 91ml. This should be equivalent to your present dose of 91ml Lorazepam.

 

Do this for several days (at least), but a week or more might be better. Do not proceed until you feel you have adjusted to the change.

 

*********

 

When you are ready for the nest step:

 

6) Make up 100ml of liquid with a single 1ml tablet of Lorazepam.

 

7) Discard 50ml of the liquid Lorazepam, and pour out the remaining 50ml into a container.

 

Make up 100ml of liquid with a single 10mg tablet of Valium. Pour away 50ml, and keep the remaining 50ml in the cylinder.

 

9) Return the 50ml of liquid Lorazepam to the cylinder (you should have 100ml in total).

 

This liquid (50% Lorazepam; 50% Valium) is equivalent to 1mg of Lorazepam.

 

10) Discard 9ml, so that you are left with 91ml. This should be equivalent to your present dose of 91ml Lorazepam.

 

Do this for several days (at least), but a week or more might be better. Do not proceed until you feel you have adjusted to the change.

 

*********

 

When you are ready for the nest step:

 

11) Make up 100ml of liquid with a single 1ml tablet of Lorazepam.

 

12) Discard 75ml of the liquid Lorazepam, and pour out the remaining 25ml into a container.

 

13) Make up 100ml of liquid with a single 10mg tablet of Valium. Pour away 25ml, and keep the remaining 75ml in the cylinder.

 

14) Return the 25ml of liquid Lorazepam to the cylinder (you should have 100ml in total).

 

This liquid (25% Lorazepam; 75% Valium) is equivalent to 1mg of Lorazepam.

 

15) Discard 9ml, so that you are left with 91ml. This should be equivalent to your present dose of 91ml Lorazepam.

 

Do this for several days (at least), but a week or more might be better. Do not proceed until you feel you have adjusted to the change.

 

*********

 

The final stage is to simply make up 100ml of liquid with 10mg Valium, and no Lorazepam. Again, allow yourself a few days (at least) to adjust before continuing with titration. As before, pour away 9ml so that you left with 91ml. You have switched over in fours stages instead of one, and each stage should be equivalent to your present dose of Lorazepam.

[[An...]]

Hi Colin,

Many thanks, much appreciated.

Annie

[[An...]]

I started yesterday with 75% Lorazepam & 25% Valium, felt not too bad yesterday. Slept ok, but after my morning dose today have experienced shakyness & pins & neeedles/burning in arms & legs (anxiety I know)

Is this normal?  And do I just have to ride it out until I get used to change?  Help!  I have quite a lot on this weekend!

[[el...]]

Hi Annie,

 

Yes, this is normal. Yeah, you just kind of have to grin and bare it. Since lorezapam is short acting and valium is long acting, you are going to feel some wd while the valium is kicking in. That is why it's important not to switch over all in one go.   

[[An...]]

Thanks eljay, can accept that, as long as I know I feel its just one more step along the road!

Annie6

[[An...]]

Hi, am doing ok on the crossover to Valium, just wondered if my next step could be 40% valium 60% Lorazepam, I am asking this as I find the Valium seems to make me very sleepy/dopey. 

I am finding that my anxiety has been better since I started crossover, but a bit depressed on waking.  But I am sleeping better!

Thanks....would like reply before I make up titration tonight if poss!

Annie6

[[Co...]]

Hi,

 

Equivalent doses are ballpark figures - there is much individual variability. Of course, you could make a 40/60 division of doses of the two benzos, but in your shoes I would also consider substitution for less Valium if you find that you need less than 10mg Valium to 1ml Lorazepam to feel OK. After all, the more Valium you take, the longer your taper off Valium!

[[An...]]

Hi Colin,

Yes of course it makes sense!  Will try less valium, fingers crossed!

Thanks again,

Annie6

[[pa...]]

Good luck Annie!!

[[An...]]

Just to check a few points.  Went down to 7.5 mg of Valium  to 1mg of Lorazepam - and am taking my titration of 40% valium & 60% Lorazepam.  Was feeling ok - but am experiencing a bit of jitteryness - but first thing in the morning dose seems to make me dopey, so should I take a bit less in the morning and a bit more during the day and evening doses? This is 4th day on this dosage, should I just sit it out or change things a bit.

Thanks

Annie6

[[Co...]]

Hi Annie,

 

Because Valium has a much longer half-life than Lorazepam, the reduction in your Lorazepam will be fully expressed as a relative drop in blood levels with a day or so. However, the increase in Valium takes time to build up in your system. So, you should expect some withdrawal symptoms with each switch, but this should settle down over a few days or a week. Give it a few more days.

[[An...]]

Thanks Colin,

I guess I was just lucky with the first time....I felt fine within 2 days!  Still at least I am at work & getting on with my life - still feel better than before - I must have had tolerance withdrawl with that awful **** Loraz!  Am beginning to understand things better now!

Many thanks, once more - you are a real star, and hero,

Annie6

[[Co...]]

Hi Annie,

 

The thing is, you felt over dosed before - this makes sense. Two days after one of these switches, the Valium would be still building up. But, because your were taking a higher dose (10mg), blood levels would be higher for those first two days too, so you did not suffer withdrawal effects.

 

Another option is to take the higher dose for two days, but then switch to just 7.5mg. This will give an extra boost at the beginning of the switch, but blood levels will not continue to rise as much as they did when you were substituting for 10mg and staying there. If you drop to 7.5mg after two days, you blood levels will not drop, they will just rise more slowly and only to 0.75 the amount they would if you were taking 10mg.

 

As for the substitutions you have already completed at 10mg - you should not reduse these now, as you have fully adjusted to 10mg substitutions.

 

One day I'll draw up some graphs for this stuff!

[[An...]]

Hi Colin,

You must spend 24/7 on all our different problems!  I really am beginning to see how it works, and how individuals differ.

Once more I thank you!  Will try what you suggest - so far you have had it spot on!

Annie6

[[An...]]

Am on my last titration mix of mixing Lorazepam and Valium.  Will be on Valium only next week, and begin titrating down 1ml a day of 7.5mg

Your help, Colin, has been invaluable, and am managing really well.  My consultant was full of praise for your website, he is a great supporter of CBT - which I am doing. He HATES benzos and applauds your great work.

Annie

[[el...]]

Hi Annie,

 

I"m glad to hear you are doing well! And thanks for the nice feedback from your consultant. 

[[Co...]]

Hi Annie,

 

Thanks for your feedback and comments. It is good to hear that you are doing so well.

[[An...]]

Hi all,

Should have kept my big mouth shut! The problem I'm having is since going down to 30mls Lorazepam & 70mls valium on Friday is a very anxious feeling in my stomach & feeling a bit wobbly, normally as I have been cutting this has lasted one day and not severe, but the weekend and today it has contnued, have been cutting my Loraz titrations weekly - this has been fine, and by approx 20 -25mls per week.  Should I expect this now until I get on to the valium completely ? (am taking total of 90mls titration of the mix)

[[An...]]

forgot to say that am feeling a bit weepy (havent felt like that for ages) & legs & arms feel weak.  From having good appitite, has gone right off.  Annie

[[Co...]]

Hi,

 

If you hit a rough patch, simply stabilise your dose for a while. Hitting a rough patch for no apparent reason is pretty common. Try not to worry about it.

[[el...]]

Hi Annie,

 

I"m sorry you are going through a rough spot, but it will pass! Have you thought about starting a blog? You'll get lots of moral support and feedback on your symptoms there.   

[[An...]]

Hi all,

Not feeling a lot better...when you suggested stabilizing did you mean get used to current dose or go back to last weeks?  Also started titrating in flavoured water, but think will go back to milk, I feel it is better...or is it my imagination?

Annie

 

[[el...]]

Hi all,

Not feeling a lot better...when you suggested stabilizing did you mean get used to current dose or go back to last weeks?  Also started titrating in flavoured water, but think will go back to milk, I feel it is better...or is it my imagination?

Annie

 

 

Hi Annie,

he means stabilize on  your current dose. Just don't wait too long though. Sometimes its tempting to hold til you feel really good, but that doesn't always happen during a taper. Sometimes it's just best to continue.

 

Using water for titration is really a second choice for people who can't use milk for whatever reason. Milk is preferred though.

[[An...]]

Hi Eljay, thanks for that,  without meaning to be a bit thick!.....what is not too long? I have been crossing from the Loraz to the Valium at weekly intervals, Colin said 'a week or longer' so should I perhaps do this one for 10 days?