Benzodiazepine Liquid Taper Help
  1. Principles
  2. Tablets (or pills) are commercially available at defined doses: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg ...They are meant to be swallowed entirely or split into halves or quarters of a tablet for lower doses. When it comes to split the tablet to even smaller parts, for instance 1/8, then parts crumble and the precise cuts are compromised. This lack of accuracy can be addressed by either reducing the tablet to fine powder and weighing out doses with a precision gram scale or with the Liquid Taper method. Liquid Taper allows much smaller changes to the doses than we possibly could with tablets and is the most precise method that could be used.

    The principles are based on the use of a solution instead of tablets. This is a simple operation when the medication is available as concentrated Rx liquid. In this case water can simply be added to get the final dissolved solution. When the prescribed medication is in tablet format then a conversion from tablets to liquid is required. This can be obtained by either: By using appropriate syringes, taperers draw up each day their dose(s) the same way they would with any liquid medication.
  3. Solution preparation
  4. Reduction quantity
    The precise rate of withdrawal is an individual matter. It depends on many factors including the dose and type of benzodiazepine used, duration of use, personality, lifestyle, previous experience, specific vulnerabilities, and the (perhaps genetically determined) speed of your recovery systems. The general recommendations are then to reduce the daily dose by somewhere between 5% and 10% every 10-14 days. You are called afterwards to be in control and proceed at the speed that is comfortable for you by lowering or accelerating this pace.
    The application has been designed so the 2 fields Percent and Quantity are mutually exclusive. Clear one field will reset the other and enter value in one field will disable the other. They reflect 2 different philosophies of taper:
    • Fixed reduction quantity per period of days (mg/days)
      A same and unchanged quantity will be reduced from the daily dose throughout the taper duration. The fixed reduction quantity method, also known as symptoms-based taper method, is easy to understand and to apply. It can eventually offer a shorter taper duration compared to the fixed reduction percent.
      The dark side of this approach is that by the end phase (~1/3) of the taper, many patients seem to become more vulnerable to the same reduction. The risks to feel symptoms due to a fast taper is real. The reduction quantity must be therefore adapted when symptoms occur. In the Taper Plan application, when there is 1/3 of the road to go before the jump dose, the option "Attenuated ending" adapts the reduction quantity to 1/3 of the initial cut. This option works only when the reduction is based on fixed quantity as opposed to fixed percent.
    • Fixed reduction percent per period of days (%/days)
      A same and unchanged percent (over a period of days) translated in quantity will be reduced from the daily dose throughout the taper duration. As the daily dose decreases, so does the reduction quantity. That implies a very low reduction evolution, a longer taper duration but it will likely raise less symptoms. This method is "gentler" from a symptoms viewpoint.
  5. Others
    • Daily basis or Periodic basis reduction?
      The reduction quantity might be applied at the daily basis with consequent decreasing daily dose or kept unchanged during the whole period of more days. Compared to the daily approach, the second method also known as "Cut and Hold" is more prone to symptoms. The application has been designed to work exclusively with a daily basis reduction.
    • Across doses or First doses first?
      Across doses: The reduction quantity will be applied simultaneously to all the doses of the day and proportionally to each single dose. Doses will be tapered off all together.
      First doses first: Reduction starts with the first dose until it will be extinguished then it starts with the second dose and so on. The taper will finish with the end of last dose.
    • Which Quit dose?
      Also known as Jump dose or Plunge dose, the suggested Quit dose is calculated as the equivalent of 0.5 mg Diazepam via a table (Table 1. BENZODIAZEPINES AND SIMILAR DRUGS) provided by Ashton manual.
  6. Conclusions
  7. "...A slow and steady benzodiazepine withdrawal, with you in control, is nearly always successful..." (H. Ashton).
DISCLAIMER: This help is not a substitute for professional advice provided by a qualified medical physician. Any taper plan including the one produced by this application should be reviewed and approved by your physician before starting the taper. Never change your prescribed dose of any prescription medication without consulting first the prescribing physician.