Kingy: Paxil and diazepam withdrawal

[Kingy]

Hello, I recently reduced my Zolpidem from 10 mg to 7.5 mg. I am still sleeping but I am feeling the withdrawals. I want to get off sleeping tablets, stay on 10 mg of Diazepam and wait a while and then start tapering Paxil (very slowly) I am so tired all the time and have zero motivation. I just need some encouragement I think because I can't seem to get off the couch even though I am bored brainless. Thanks for any help

[LostInCanada]

Hey @Kingy I hear you. My routine/life is pretty simple. Not much going on. I am trying to work on appreciating the small things. Can you go for a short walk. Or just look at the sky, clouds and meditate on the beauty around us. I am in another wave with nausea and dizziness and still struggle with sleep. Just trying to take it one day at a time.

[Kingy]

Thanks for replying. I have been doing things and do try to practice gratitude etc the last few days have been bad and I am finding it very difficult at the moment. I know the tiredness will ease if I move but today I just can't. Tomorrow I see my Doctor so I will have to go out. I hope your wave don't last too long

[Altostrata]

@Kingy if you reduce your drugs arbitarily, you can feel bad effects. You had been tapering diazepam, why did you decide to cut zolpidem as well?

 

We strongly recommend changing only one drug at a time.

 

What times o'clock do you take your drugs now, with their dosages?

[Kingy]

.I planned to taper to 10 mg of diazepam then hold and then start tapering Paxil. I thought that I would hold on 10 mg of diazepam which I have for 8 weeks and taper Zolpidem down to 5 mg and hold for a while and then try to taper Paxil. I have been talking to another administrator. Do you think I have made a mistake? thank you for replying I appreciate any advice you can offer.

Zolpidem 5mg 12 am

Diazepam 5mg 5 am

Paxil 20mg 10 am

Zolpidem 2.5mg 4 pm

Diazepam 5mg 9 pm

[Altostrata]

I see @Shep was advising you.

 

1 hour ago, Kingy said:

.I planned to taper to 10 mg of diazepam then hold and then start tapering Paxil. I thought that I would hold on 10 mg of diazepam which I have for 8 weeks and taper Zolpidem down to 5 mg and hold for a while and then try to taper Paxil. I have been talking to another administrator. 

 

Okay, this makes sense, but there's nothing prior about the zolpidem taper.

Did your sleep settle down since you decreased zolpidem at the end of March?

[Kingy]

Yes I was being advised by Shep. I was thinking that the sleeping tablet was adding to my tiredness so I thought it may be a good idea to try and get down to 5 mg only taken at night. After that I will give my brain and body a 8 week rest and then start tapering Paxil very slowly. I learned here and through my own experience that trying a fast taper is doomed to failure. Thank you for replying, I do really appreciate it. If you have any ideas or advice please help, I need all I can get. Thank you. My sleep has not been affected by the drop of Zolpidem.

[Shep]

20 hours ago, Kingy said:

Hello, I recently reduced my Zolpidem from 10 mg to 7.5 mg. I am still sleeping but I am feeling the withdrawals. I want to get off sleeping tablets, stay on 10 mg of Diazepam and wait a while and then start tapering Paxil (very slowly) I am so tired all the time and have zero motivation. I just need some encouragement I think because I can't seem to get off the couch even though I am bored brainless. Thanks for any help

 

Kingy, in our last conversation, you were asking questions about tapering Paxil. But you decided to taper Zolpidem first? I'm not saying that's wrong, I'm just a bit confused by the change of plans. 

 

Going from 10 mg to 7.5 mg is a 25% reduction, which may be too much for your system to handle. According to your signature, you made this reduction on March 31, which is 11 days ago. If the withdrawals are too severe, you may want to updose a bit, perhaps to 8 or 9 mg. It's safe to updose a benzo within 2 - 4 weeks after a reduction.

 

Please post your thoughts on this. Sleep is a priority during withdrawal, so keeping a good sleep baseline is really important. 

 

EDIT: Sorry, Kingy, I just saw where you wrote that your sleep wasn't effected by the Zolpidem reduction. But by "I am still sleeping but I am feeling the withdrawals," what symptoms are you having? 

Edited April 11, 2023 by Shep
added edit

[Kingy]

Thank you for replying. I was thinking that if I could reduce the Zolpidem to 5 mg instead of 10 mg I would not feel so tired in the day. I did not think the withdrawals of Zolpidem would be as bad as diazepam. The reduction has not impacted my sleep however I feel extremely fatigued, maybe the cut was too much. I will see how I feel this week and if I can handle the withdrawals do you think it will be ok to stay at 7.5 of Zolpidem? The tablets are 10 mg so it's difficult to cut to 8 or 9 mg. Thank you for your help

[Shep]

21 hours ago, Kingy said:

I will see how I feel this week and if I can handle the withdrawals do you think it will be ok to stay at 7.5 of Zolpidem? The tablets are 10 mg so it's difficult to cut to 8 or 9 mg.

 

Why aren't you using your scale for this? It's going to be very difficult to taper off these drugs by cutting them. A scale is much more precise. You may be dealing with fluctuating doses by using this method. 

 

[Kingy]

I do have a scale but it is not calibrating accurately. I will try it again and see if I can get them to work properly. Is Zolpidem as hard as Diazepam to taper? What scales did you use? Thanks for the reply  

[Shep]

1 minute ago, Kingy said:

I do have a scale but it is not calibrating accurately. I will try it again and see if I can get them to work properly.   

 

Most people tapering on these forums speak highly of the Gemini 20 scale. 

 

Does your scale have a TARE button? Make sure you push that button before you weigh your pill. The TARE button resets the scale to zero. Here is a way to recalibrate your scale to help with accuracy:

 

Place the gram scale on a hard, flat, and level surface with plenty of room to prepare your dose.

 

Press the TARE button to zero it out.

 

Recalibrate the scale. Please see this video for more information, starting at around 3:30 minutes:

 

Smart Weigh GEM20 Digital Jewelry Scale Review

 

Your scale may be a bit different than in this video, so please have a read of the owner's manual for your scale for how to recalibrate.

 

Add the tray to the gram scale. 

 

Wait 5 - 10 seconds to let it settle on the scale.

 

Hit the TARE button again to zero it out.

 

5 minutes ago, Kingy said:

Is Zolpidem as hard as Diazepam to taper?

 

Since you're still on diazepam, the diazepam may help with the Zolpidem taper. Usually it's the last drug removed that is the hardest, especially when it comes to sleep. But as long as you do a slow and careful taper, you'll be fine. It's more about the speed than the drug for many people. 

 

 

[Kingy]

Thanks, I already have these scales and I do know how to use them. they were not taring properly, maybe the surface was not totally flat. I will try them again and let you know. Thanks for your time

[Kingy]

Hello, I split a 10mg Zolpidem in to two 5 mg (the tablet is scored) the 5mg weighs 0.065 which is 5 times 13=65. So if I shave 13 off that should leave the 5 mg to the equivalent of 4 mg. Is the a good method? anyhow thanks for your help 

[Shep]

On 4/14/2023 at 8:38 AM, Kingy said:

Hello, I split a 10mg Zolpidem in to two 5 mg (the tablet is scored) the 5mg weighs 0.065 which is 5 times 13=65. So if I shave 13 off that should leave the 5 mg to the equivalent of 4 mg. Is the a good method? anyhow thanks for your help 

 

Yes, your math is correct - removing .013 will give you the equivalent of 4 mg.

 

However, instead of shaving off the outer edge, you may want to crush up the pill so the filler and active ingredients are evenly distributed. 

 

Are you taking the 5 mg cut pill in addition to the 4 mg, for a total of 9 mg? 

[Kingy]

Thanks, yes I will be taking 8 or 9 mg and decrease by 1mg every 4 weeks or so until I reach 5 mg then I will give myself a rest and probably start tapering Paxil. Thanks for your help, I will let you know how I am going

[LostInCanada]

@Shep @Kingy I too was concerned about even drug distribution but Brassmonkey wrote this: 

It’s All in the Mix:

 

One of the biggest fears regarding tapering we encounter here at SA is that the active ingredients in a medication are not evenly distributed throughout the fillers. This leads to people thinking that if they are taking a small portion of a tablet or of the powder in a capsule that they will not be getting the “full dose” that they are expecting. This assumption is totally wrong.

 

The manufacturing of drugs in one of the most regulated processes in the world and is overseen by the coordinated effort of a number of international organizations. These include the Current Good Manufacturing Practice regulations enforced by the FDA, the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use, the World Health Organization, the Pan American Network on Drug Regulatory Harmonization (PANDRH), Internation Society for Pharmaceutical Engineering (ISPE), European Directorate for the Quality of Medicines and Healthcare (EDQM) and several others.

 

Each of these organizations has an extensive set of regulation on the manufacturing processes involved in making medications and has the power to enforce those regulations.  They also coordinate freely with each other to maintain unity in those processes and regulations. One of the foundations on which these regulations are based ins the Essential Standards for Pharmaceutical Manufacturing written by the American Society for Testing and Materials. Another document containing links to all the US federal guidelines for manufacture, testing and marketing drugs is here: https://www.dshs.state.tx.us/drugs/federal-regulations.aspx

[Kingy]

 

Thanks for sharing this with me, I appreciate it

[Shep]

@LostInCanada Thanks for posting that. That's good information.

 

@Kingy Looks like you're good to go as far as shaving off your pill. If you do decide to make up a batch ahead of time and store it in empty gel capsules, you may want to crush it first. Makes it easier to get into the capsules. 

[Kingy]

Thanks, I ordered a pill crusher. I will take very slow and contact you when I am ready to try and taper Paxil. Thanks

[Kingy]

Hello, I was down to 7.5 of Zolpidem and 10 mg of Diazepam. I was feeling so ill that today I have messed up by taking 15 mg of Diazepam and 10 mg of Zolpidem. I would not have done this unless I thought I was so ill. Can I just resume my 10 mg of Diazepam and 7.5 of Zolpidem tomorrow. The tiredness and lack of interest in anything is unbearable. please help

[Shep]

@Kingy I would look at that as a rescue dose and resume your normal dosing today. Please don't make any more changes for a few weeks. Once you take a rescue dose, it's important to let your nervous system stabilize. In the case of diazepam, due to the long half-life of 200 hours (8 days), it can take a long time for the blood level of this drug to go back to where it's been. 

 

Please look into non-drug coping and distractions (gentle music, video games, favorite internet or TV shows, working jigsaw puzzles, etc.) to get you through so you'll be able to cope through waves without increasing your drugs. In time, these non-drug coping techniques will become automatic and you'll learn to easily surf the waves. This is also teaching you how to handle stress when you're finally off the drugs and no longer have them to cope with life stressors. That's how we walk away from psychiatry with all the tools we need to handle whatever life sends our way. 

 

[Kingy]

Thank you, I took my normal dose today and will not make any changes for at least 4 weeks. I am so tired all the time and feel guilt and shame I can not do anything. I do distract with videos games, TV and internet, it's so frustrating not been able to do what I used to do. I will level out my dose and get back to you. 

[Kingy]

Hello, I am on 10 mg of Diazepam, 10 mg of Zolpidem (it gives me 6 to 8 hours sleep) and 20 mg of Paxil. I have held this for 3 or 4 weeks. I am wondering what to do next. I thought maybe try tapering Diazepam 1 mg every 4 weeks. Please tell me your thoughts. I am trying to get out and do things but it's like an endurance test. Thanks for your help

[Shep]

21 hours ago, Kingy said:

I thought maybe try tapering Diazepam 1 mg every 4 weeks.

 

1 mg off your current 10 mg dose is 10%, so that's fine. But after that reduction, if you were to continue to reduce 1 mg every 4 weeks, it would be more than our recommended 10% a month rule. For example, 1 mg off 10 mg is 10%. But for the next reduction off of 9 mg, if you were to remove 1 mg, that would be a reduction of 11.12%. And the following month, if you were to remove 1 mg from 8 mg, that would be a 12.5% reduction.

 

I'm not sure that's what you mean, but just wanted to mention this to be safe. 

 

22 hours ago, Kingy said:

Hello, I am on 10 mg of Diazepam, 10 mg of Zolpidem (it gives me 6 to 8 hours sleep) and 20 mg of Paxil. I have held this for 3 or 4 weeks.

 

 

How often are you getting 6 hours and how often are you getting 8 hours? How is the quality of your sleep? Do you feel rested?

 

The reason I'm asking is to see if it may be best to reduce the Paxil next and leave the sedating drugs to taper later. 

 

If you want, you can do a drug and symptoms journal for a few days here in your thread. We can go through it together to see what the next step should be. Here are the instructions:

 

How to do a drug and symptoms journal

 

 

[Kingy]

Thank you, I feel that the sedating meds are making me really tired and lethargic. The sleep I get is not restful, I wake up so tired that I feel I want to go to bed. I am certain I have reached tolerance with Diazepam. I am staying awake until 2, 3 up 5 am because I tend to be less anxious at night, I wake up around 1 pm. Also I am terrified of coming off Paxil, let me know your thoughts, Thank you so much for your time

[Shep]

On 5/2/2023 at 11:42 AM, Kingy said:

Hello, I was down to 7.5 of Zolpidem and 10 mg of Diazepam. I was feeling so ill that today I have messed up by taking 15 mg of Diazepam and 10 mg of Zolpidem. I would not have done this unless I thought I was so ill. Can I just resume my 10 mg of Diazepam and 7.5 of Zolpidem tomorrow. The tiredness and lack of interest in anything is unbearable. please help

 

16 hours ago, Kingy said:

I feel that the sedating meds are making me really tired and lethargic.

 

I just placed the 15 mg of that May 2nd updose in diazepam into this half-life calculator.

 

Drug half-life calculator

 

At a half-life of up to 200 hours, even at 14 days later (336 hours), you still have more than 25% of this one-off updose in your system. 

 

You may want to continue to hold. It may take a couple of months before that one-off updose is completely out of your system. Or you could make a slight reduction in the diazepam to try to counter the effects, but it's really hard to gage what that might be due to not knowing how fast you metabolize it and what other variables may be in play. All of this may be a severe wave that's working it's way out. This wave was severe enough that you did an updose, so rushing into try to do more fixes can sometimes backfire. 

 

 

[Kingy]

Thanks for replying, I think you are right, I should hold for a while, I am so desperate to feel better I am probably trying too hard and then up dosing because it becomes unbearable. I will hold and see how I feel in a 4 to 8 weeks. Thank you for your time

[Kingy]

Hello

I have swapped 10 mg of Zolpidem for 5 mg of Diazepam. So now I am on 20 mg of Paxil and 15 mg of Diazepam. I did this over a period of 3 weeks. It has not effected my sleep and I feel a little less tired threw the day. I am thinking of starting a 1 mg drop of Diazepam every 4 to 6 weeks starting from next week. I don't want to go back on sleeping tablets ever again. I would like to know your thoughts about this. Thank you in advance

[Shep]

20 hours ago, Kingy said:

Hello

I have swapped 10 mg of Zolpidem for 5 mg of Diazepam. So now I am on 20 mg of Paxil and 15 mg of Diazepam. I did this over a period of 3 weeks. 

 

Please update your signature to reflect this change.

 

When did you finish your crossover? Because of diazepam's long half-life, you may want to hold for awhile before tapering to ensure you get a solid baseline of how this change affects you as the diazepam slowly builds up in your system. 

 

20 hours ago, Kingy said:

I am thinking of starting a 1 mg drop of Diazepam every 4 to 6 weeks starting from next week.

 

The problem with dropping 1 mg every 4 to 6 weeks is eventually the drops will be more than 10%. By the time you're going down to 8 mg from 9 mg, for example, that's an 11.12% reduction. Going to 7 mg from 8 mg is a 12.5% reduction. And so forth. 

 

Just something to consider as you plan your taper. I wouldn't go faster than 10% a month, based on the prior month's dose.

 

What time(s) of day are you taking your drugs? Why are you wanting to get off the diazepam before getting off Paxil? 

[Kingy]

Hello, thank you for replying. I finished the crossover 10 days ago, I think you are right, I will hold for a few more weeks, maybe more. I am aware that I need to taper 10%, when I get to 10 mg of Diazepam I will adjust the dose drop accordingly, I know only too well that rushing this is a recipe for disaster. I am not sure why I am not tapering Paxil. I want to get off everything eventually. Do you think that when I get to 10 mg of Diazepam I should start tapering Paxil and keep taking Diazepam? Thank for your time

[Shep]

4 hours ago, Kingy said:

Do you think that when I get to 10 mg of Diazepam I should start tapering Paxil and keep taking Diazepam? Thank for your time

 

I would go by your sleep. You'll want to stay on enough diazepam to handle any insomnia that may come due to Paxil withdrawal. 

 

It's okay to stay on the diazepam and taper the Paxil first. Let the diazepam cushion the symptoms of Paxil withdrawal. 

[Kingy]

ok thanks, I will wait a few weeks before I start tapering again. Thank you for your help

[Kingy]

Hello just an update on my progress. I have waited 4 weeks or so and now I have dropped 1 mg of diazepam. I will wait 4 to 6 weeks before I do another cut. I am hoping to get to 10 mg of Diazepam, then hold a while and then start on Paxil. Thanks for any thoughts or advice

[Shep]

@Kingy How are you feeling? How is your sleep? 

[Kingy]

I am still sleeping ok. It's day 5 of my 1 mg cut and I can feel it, mostly in the daytimes. I still have zero motivation however I am making myself go out 2 or 3 times a week. I will wait for 4 to 6 weeks before I make another cut. Thank you for responding