Water titration for slow and controlled psychiatric drug withdrawal

cylinderFor more extensive information to help in psychiatric drug withdrawal please visit:  Psychiatric drug withdrawal and protracted withdrawal syndrome round-up

The below method of tapering was developed by people withdrawing from benzos but it can be used for any drug with some modifications. I got these directions which I’ve edited slightly from a benzo board. It’s a very good way to taper any drug once the doses get small because it’s imperative that the tapers become smaller and smaller and dry cutting sometimes becomes impossible.

I don’t endorse these directions in a literal sense. I think that daily cuts, for example, are not wise, even in the tiny doses suggested here, but the technique is well described and you can make it work for you by adjusting some of the suggestions and going slower if need be.

NOT ALL DRUGS ARE WATER SOLUBLE…some meds do fine with this method and others will not. Also depending on level of sensitivity the degree of imprecision in this method may bother some people. The directions are here so that you may experiment. Google your drugs solubility requirements for more information. Also some drugs should not be crushed. Please find that out before doing so.

An alternative to water titration is using a milligram scale. You crush the pill and put it on the scale and take away tiny fractions by weight for each new taper.

If you have a cooperating psychiatrist you can also have your drugs compounded for you at the doses you need by a compounding pharmacy. Use google to find local pharmacies that might be able to help you. This can get expensive so it’s not always a viable option.

A special note:
If your particular drug does not dissolve well in water you can try a small amount of alcohol then dilute heavily with water. You can try other clear liquids too like club soda. Whatever does the best job.

Very important note:
It is dangerous to crush time released pills of any kind.

Note: This method is based upon the personal experiences of laypeople and is not intended to be medical advice. Please work with your doctor if you intend to withdraw from a psych med. It is very important to be as stable as possible before you start the taper.

Equipment needed:
a tall lab cylinder that holds 250 ml
a mortar and pestle
a small battery-operated mixer
a small lab cylinder that holds 10 ml
a dropper or syringe
a continuing supply of the drug you are taking
a notebook to track your process

Process:
Grind the tablet in the mortar and pestle. Fill the tall lab cylinder to a predetermined amount, such as 200 ml of water for a .5 mg klonopin dose. Pour a little of the water in the cylinder onto the powdered drug and grind it some more. Then rinse the mortar into the battery-operated mixer, using the water in the cylinder until all of the powder in the mortar and on the pestle has gone into the mixer, as well as the rest of the water in the cylinder. The mortar will become colored from the dye used in the pills, do not be concerned
about that.

Hit the spin button on the battery-operated mixer. This puts the benzodiazepine particles into suspension in the water. Benzos are not truly water soluble (drugs vary when it comes to solubility); however, putting the particles into suspension is sufficient to insure random dispersal for long enough to adjust your dosage.

On the first time you use this method, take the dropper and remove a small amount of the water. Use the small lab cylinder to measure this amount to 1 ml. Discard this amount and drink the water that remains in the mixer. Then add a little more water from a cup and hit spin again to get all the residue out of the mixer and drink that. For the next dose, repeat the process but discard 2mls of water and drink the rest.

In the given example, 1 ml of .5 mg klonopin dissolved in 200 ml of water equals .0025 mg or 1/200th of a pill. For 150 ml of water, a 1 ml reduction would be .0033 mg or 1/150th of a pill.

The advantage to this method is that as long as you have a sufficient supply of tablets, you can reduce at your own rate and make tiny reductions. The brain cannot differentiate between a dose of .4975 mg of klonopin and .4950 mg. The cumulative cuts do add up, however, but if you need to take a break and hold, then you can do so easily with this method. It is important to hold if you become ill, are going on a trip, or experience any unusual stress. (or have any strong withdrawal symptoms—withdrawal should be held anytime one feels sick in any way and not resumed until you feel better.)

It is better to travel down this way over a given period than making a bigger cut and holding there for the same period of time. The amount reduced in the timeframe will be the same, but it’s a gentler way to get there.

The math may seem daunting but you simply divide your dose by the milliliters of water you intend to use to find the amount of drug per 1 ml of water. A .5 mg klonopin divided by 200 ml of water equals .0025 mg.

It takes less than five minutes to prepare a dose.

You may have to experiment a bit to see what rate of speed is best for your taper. The rate of speed that people can comfortably go varies considerably, and is probably based on genetics, general health, age, and stress level while tapering.

It is a good idea to slow your rate of descent as you go lower in your dosage because the percentage of the 1 ml cuts increases as you go lower. For example, once you are halfway off, you could hold every fourth day. When you have a quarter of your starting dose totaper, you could hold every third day. When you have an eighth of your dose to taper, you could hold every other day. (In my opinion this can be way too fast for most people and with most drugs)

One rule of thumb is to allow at least ten weeks to go off the last 10% of your starting dose, 1% per week. Slowing down at the end is a good way to prevent protracted withdrawal symptoms from occurring after you are off the drug. Oftentimes those who taper by making larger cuts find that their worst suffers occurs after they reach zero, when the accumulated half-lives of the drug leaves their system in the following weeks. By slowing your taper to a crawl at the end you have a good chance of avoiding this danger.

Many people who take meds take them more than once a day. The water titration taper can be adjusted for those on multiple doses. For drugs like Ativan and Xanax, it is important to take at least two doses a day, most feel comfortable with at least three doses per day. When tapering by this method, the multiple doses need to be kept level or nearly so, all the way down to zero.

You can make a big batch of drug water for the entire day’s worth of doses and put the later doses in jars, or you can make your dose each time you need to take it, or you can make your doses separately but at the same time and store the ones for later in the day in jars, which can be taken with you to take throughout the day.

If you use a lot of water, you can cut each dose the same tiny amount. Or, you can cut the doses in rotation. For example, the first day you might take 1 ml off the first dose, but leave the second and third doses at the starting point. The second day you would take 1 ml off the first and second doses, but leave the third dose at the starting point. The third day you would take 1 ml off all three doses. The fourth day you would take 2 mls off the first dose, and 1 ml off the second and third doses. When dealing with multiple doses it is especially important to keep a notebook.

Diet is important while tapering. The focus should be on protein and vegetables, to keep your blood sugar stable and to help your brain regain its capacity to make GABA, which being on a benzo impairs. Sugar, caffeine, alcohol, aspartame and MSG are best avoided while tapering, as they can cause agitation and setbacks.

Patience and a good attitude are your allies during a taper. Don’t get too focused on the end date of your taper or you might forget to listen to your body. If you feel symptoms coming on, just be patient and hold. That’s called tapering sideways. It doesn’t mean you aren’t making progress, because while you are holding, the half-lives from your last few cuts are being processed, and your central nervous system is adjusting to having less drug. You are still making progress even while you take a needed break.

More on tapering:

●  Psychiatric drug withdrawal: Why taper by 10% of your dosage?

●  Psychiatric drug withdrawal 101

●  The slowness of slow tapers (safer withdrawal from psychiatric medications)

●  Trellis: this is your brain on (psych) drugs

*it is potentially dangerous to come off medications without careful planning. Please be sure to be well educated before undertaking any sort of discontinuation of medications. Do not assume your MD will know how to do it either. They are generally not trained in discontinuation and may not know how to recognize withdrawal issues. A lot of withdrawal issues are misdiagnosed to be psychiatric problems This is why it’s good to educate oneself and find a doctor who is willing to learn with you. See: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up

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About Monica Cassani

Author/Editor Beyond Meds: Everything Matters

12 Responses

  1. Sloopy Cowbell

    Another supremely helpful article, Gianna!

    I invested in some milligram scales for micro-tapering.

    I plumped for the Gemini-20 model (20g x 0.001g) supplied by American Weigh Systems (AWS).

    Tested against the calibration weights, the scales seem accurate to about five thousands of a gram (0.005g).

    For a cost of US$40, I am quite impressed.

    I haven’t yet put them to work since I am, erm, sideways tapering (!), but I couldn’t resist taking them for a test run.

    It was then that I encountered an immediate problem – the loss of powder mass during crushing.

    The pill mass just goes – vanishes – somehow lost in the bowl of the mortar or when tipping out the powder onto the scale pan.

    I start out with a 7.5mg Zyprexa tablet. Each pill weighs in at 315mg to 320mg. Yet after careful crushing, I am left with just 295mg of powder.

    Around 7% to 9% of the pill’s weight has been lost. I certainly didn’t sneeze but maybe I breathed the dust in?! No wonder psychiatric nurses wear gloves when dispensing drugs!

    I guess it’s not hard to ignore that lost percentage and calculate the taper accordingly with whatever remains.

    Regards,
    Sloopy!

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  2. Sloopy Cowbell

    Yes, I think the powder is simply caught in tiny imperfections on the surface of the mortar bowl.

    Someone said that I should use a stainless steel pestle and mortar. This one here is actually recommended for crushing tablets!

    4mg Risperdal tablets, oh my! Plenty of taper doses in those monsters!

    What about using a swizzle stick cocktail stirrer?

    And taper in style with a long glass, poured over ice, and decorated with a cocktail umbrella and a slice of lemon.

    A delightful drink for the warm summer evening.

    It just needs a name.

    Risperdal On The Rocks?!

    Yours,
    Sloopy!

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  3. Ana

    Good Gianna!
    Physicians don’t help people in the withdrawal process.
    It’s amazing people who are withdrawing have to be helped from other people who has already made the process alone.
    For illegal drugs there’s help. Not that good but at least there’s help.
    And I can assure you that withdrawing from legal drugs is as hard as illegal.
    Some physicians even assure that it’s harder to get out of legal drugs than legal.
    David Healy claims that for some people it’s impossible to get out of some psychiatric drug.

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  4. Hi Ana,
    I’ve been told by a number of people who’ve withdrawn from both illegal and psychiatric drugs that psychiatric drugs are worse….especially benzos…

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  5. sublife

    I have been taking seroquel for about three months now. Do I need to wean from this or can I just stop. I have plenty to wean …. I take 25 per night but have missed a few doses ..without problem. This was rx for sleep due to weaning off suboxone.

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  6. pat

    My beloved friend Helen (a pioneer in getting the word out about water titration from benzos, and from whose work much of the above is taken) would be so proud to be included here on your site. She lost her life in the battle, but for every person water titration helps, her life has more and more meaning. Thanks for passing this on G.

    Hugs,
    Pat

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  7. pourqois_pas

    Hello, i am trying to withraw from Clonoazapan and temazepam plus anti depressant. i am using the road back method on my own, my doctor won’t help. i am on a protein powder and i think i am having side affects from the powder, my legs and feet are aching and burning. has anybody out there tried this program with any success.

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