What to do after the switch? Taper or not which protoclol?

[ignominous]

Well I've finally made it.

AF effortlessly since 21st Nov, that's 10 days.

So back to an old concern of mine that cropped up when we were informed that OA's and Dr Levin's new protocol was to maintain the switch dosage of Baclofen indefinitely. This has gone against popular protocol expounded first by OA and then by successful members here that have tapered their dose to a maintenance level.

I am unsure of the direction I should be taking now. As I implied, I had hoped to have this issue resolved by this time but it isn't and its pertinent.

And would welcome any input.

[gratitude]

What to do after the switch? Taper or not which protoclol?

why not call the good doctor levin and ask him? then post the response. would love to hear it. :thanks:

[gratitude]

What to do after the switch? Taper or not which protoclol?

or maybe someone has already done this and I missed it? if so, what was the reason for maintaining the switch dose? thanks again.

[ignominous]

What to do after the switch? Taper or not which protoclol?

I'm thinking of giving him another call but we didn't hit it off last time and he didn't answer that question.

Maybe I sounded like the gibbering fucked up defensive obnoxious opinionated alcoholic that I was or maybe it was just my natural ability to rub people up the wrong way. Maybe try again without the alcohol bit. Ha.

I would also like to hear from people who have tapered down successfully and what their take on it is.

Thanks for your response Grat

[ignominous]

What to do after the switch? Taper or not which protoclol?

This was posted on another thread by a similar by a similar name but with worse spelling that I started at the same time by mistake. So am transferring it here.

By christyacc Today

I'm not sure of the direction either but congratulations.


Thanks christy: Not sure where I'm going but will reduce a little slowly for starters and thanks, it really works.

[ignominous]

What to do after the switch? Taper or not which protoclol?

If anyone knows how to delete the other thread I'd like to know. Post here or pm me, please. Pleeeeeeeeeease. Its causing me considerable conternation but I shall no doubt live through it. Ha

This thread is the one with protocol spelled with an L on the end.

I posted 2 threads due to a combination of being high as a kite on Bac still and bad/unreliable internet connection.

[Seethepony]

What to do after the switch? Taper or not which protoclol?

I don't know about the rule, but here's my experience:
I am wobbling about on my baclofen dosage at the moment, trying to find a good minimum. Originally I stayed on the dose at which I became indifferent to alcohol - and that was anyway a pretty low dose, 70mg/ day - but I have found through trial and error that 40-50mg /day is enough, while less than 30 usually results in me going out on a bender, from which I immediately rebound due to horrific hangovers.
Sticking to my switch dosage always plagued me with some very minor but annoying SEs, mainly tiredness and inertia, and once or twice I deliberately went out to get drunk just to bang myself on the side of the head, and try to wake myself up. Going down a bit, even if it's only 20/30 mgs, means no SEs that I can think of while still effortlessly avoiding alcolhol.
I think we all need to experiment a bit to find the ideal dose.

[ignominous]

What to do after the switch? Taper or not which protoclol?

Good point about experimenting.
I'm reluctant to test my alcohol indifference level at the moment, taken me a life time to get here and don't want to play with it if possible.
Maybe that's what I will have to do. Test it. I'm a bit done with testing per se, having reached this level but its an option.
I'm hoping the rewiring in my brain will become more permanent I guess.
Eventually maybe wont have to rely on a drug to fix me. Very confused atm.
Do you feel that your maintenance dose will be permanent or do you think you will have to increase it over time?
Thanks for the reply

[Seethepony]

What to do after the switch? Taper or not which protoclol?

I have yet to hear anyone say their maintenance dose lost its efficacy. It would be alarming if that were the case, though, since then we'd all be doomed to ever increasing quantities of baclofen.
As it is, I think I will be cruising along on my modest 40-50 mg / day for, probably, as long as I live. I have zero will-power and baclofen has worked like a miracle for me. I see no reason to mess with it, short of finding the ideal dosage.

I wouldn't worry too much about experimenting. If I forget to take my baclofen - usually the only trigger that's left for me - I might wreck a week or two's sobriety but constant unbending sobriety was never my intention when I started out on Baclofen. I just needed something to stop me killing myself every night, and to that extent it's worked a thousand times better than I would ever have imagined. Drinking on baclofen isn't much fun so I am slowly warming to the notion of being a teetotaler , but I am not kicking myself too hard about it. Getting drunk once doesn't lead me back to square one and an endless orgy of piss-ups. It's more like falling in a lake full of crocodiles and slime, I just climb out, wash myself off and wonder what the hell made me fall in there? There's none of this total crumbling of the city walls that the people who "white knuckle it" seem to experience.

I didn't see any data about how long one should stick to the "switch" level - I went about two or three weeks before sloppiness and over confidence had me dabbling with lower levels.

Sorry for the long answer and good luck!

[tiptronic_ct]

What to do after the switch? Taper or not which protoclol?

:hallo: fellow bac-heads. I trust everyone is as well as can be?

Ig (not sure if it was #1 or #2) asked that I post on this thread, so here goes:

I see absolutely no reason why one cannot titrate down to a maintenance dose. I could only manage 2 weeks at my switch dose - the SEs did not abate over that period and it led me to be responsible for a car accident. I had sleepless nights due to insomnia and kept nodding off (sometimes it felt more like blacking out) during the day (including in rush hour traffic).

I've been at my maintenance dose (80mg, after a 270mg switch dose) for almost a year now, with no issues whatsoever. I don't even rely on p.r.n. (as-needed) doses any more. (They are usually taken as added "protection" if you think you're going into a stressful / trigger situation).

When I went down to 60 / 70, I didn't experience a loss of indifference, but anxiety did rear its ugly head, so I went back to 80.

The only danger is in titrating down too fast, since it takes a couple of days before your body reacts to the lowered dose. Caution must prevail. The same applies if you're switching brands, or even starting on a new batch of the same brand - start "mixing" the tablets to ensure an even, gradual cut-over.

I titrated down at a rate of 5 mg about every 2nd / 3rd day.

[ignominous]

What to do after the switch? Taper or not which protoclol?

Seethepony, I don't think there is a short answer to this.
There is no data about how long to stay at the switch level, that is why it doesn't sit comfortably with me. The new protocol comes from Dr Levin with the approval of OA and with no explanation.
With your input I'm warming to the idea of tapering down. Thats what I need, some perspective on this

[ignominous]

What to do after the switch? Taper or not which protoclol?

Hi Tips. Ha! Melding characters atm.
You didn't feel a loss of indifference so presumably you never had a drink? That is interesting.
I'm tapering down very slowly because I cannot function normally at this level of Bac, but intensely worried that this miracle will leave me.

[gratitude]

What to do after the switch? Taper or not which protoclol?

hey ig

first, I don't take bac so take whatever I say with that in mind.
you speak of re-wiring your brain. I think bac just fixes your brain's neurotransmitter level of gaba. which releases you of the craving to drink alcohol and hopefully takes care of some of the anxiety also. I believe( I am not a psychologist or a doctor) that to re- wire your brain you have to replace drinking -as a coping mechanism- with other more healthy coping mechanisms. new experiences are what rewires the brain. another bio-chemical pathway that gets reinforced by repitition over time. making it easier and easier to let go of the old behavior as you practice the new behaviors.
I have read your story. we are alot alike in our dysfunction. do you have any old hobbies that you let go for the drinking? anything you are passionate about? how about a mentor or therapist or best friend you can run things by. the reason I ask is that I believe exercise( my passion) kept me sober through my early sobriety. I had a replacement for the drinking. if I got anxious I just went out and crushed it on the bike. my thinking was also a bit skewed at first. until my brain calmed down a bit.
anyway, I can't address the bac but I can tell you that I admire your courage and congratulate you on your success. I'm sure you will find your answer here. gratitude

[ignominous]

What to do after the switch? Taper or not which protoclol?

I'm looking for something to fill the void, at the moment it seems to be introspection and MWO! I grew up where pleasure for pleasures sake was not encouraged or cultivated. I truly am looking for something to do just for enjoyment and I shall find something just not right now I fear.

I have had several decades where the only time I called my own was drinking time. This I'm sure is in common with many here. Hobbies are a thing of childhood and even searching there doesn't throw up any passion. I am sure something will emerge and am fairly busy keeping my life together right now. So not to worry.

Your response was from someone who understands and despite the fact that you're not a Bac junkie it means a great deal to me. Thanks and lol.

I shall definitely be doing more exercise, in my case swimming.

[Ne/Neva Eva]

What to do after the switch? Taper or not which protoclol?

I have had two conversations this week with Dr. Levin regarding the switch and the titration protocol following the switch.
The first was in relation to my own treatment, the second was a follow up to answer some of these questions specifically. I am more muddled then I have been in weeks, so bear with. Where I quote him is where I wrote down, to the best of my ability, exactly what he said.

The first conversation he said, "If I understand Olivier?s directive you are to stay at the switch dose indefinitely.? In the follow up last night, he elaborated. I asked him via email: Is the change due to a danger of relapse at lower doses?
His response: "My understanding from Olivier is that it's not that clear atm. It's different if you're having serious side effects, but if you're not you should stay at that level." [the switch dose] If one needs to titrate down then "to go down very slowly."
Regarding debilitating SEs he said: "If you have significant side effects it?s understandable to make a change and becomes a good idea to lower it down and ?. to go down slowly."
Paraphrasing him, from memory, he said that the most important thing was success. And that if one is having debilitating SEs then the chances of success are diminished for obvious reasons. That some may have to titrate up more slowly, but that almost all of us will find the switch and indifference if we can manage the SEs by titrating based on them.
He said: "The way to manage SEs is to take at least 3 doses, or sometimes 4 or even 5, so the amount that goes into your blood stream is consistent. That?s worked for a number of times with patients of mine."
He suggested that some of the SEs people experience, especially those of us self-medicating, are related to an underlying medical condition. Or more likely, in his opinion, it is a result of using more than one medication without consulting a physician familiar with high-dose baclofen. He would include many OTC drugs in this category, but not vitamins.

I'll recount the rest of our conversations on another thread sometime soon. I did ask him, again, if I could share the information here, and if I could continue to give out his contact information. He encouraged me to do both.

Belated official congrats, Ig. You've earned it.

:l to all.