Slow increases in dose?

[Ne/Neva Eva]

Has anyone actually followed the suggestion to increase 20mg of bac per week?

I am making suggestions based on this protocol. I know that we have all pretty much agreed (as if we agree on anything!? :H) that one can go up while listening to one's body and until one experiences SEs...

But! I can't think of anyone who has actually followed the guideline of 20mg/week? Which, atm, is the only one we have from an actual physician, I think?

Thanks for your thoughts!

[bleep]

Slow increases in dose?

We are both drawing from the same data pool, but I also can't remember anyone who followed that advice.

It's just unnecessarily slow, IMHO. While I can see it minimising the SE's, I believe you should get to indifference as soon as you can, and that is achieved by going up at a reasonable clip.

What reasons could there be for going so slowly, since we know you can still minimise SE's by going quicker?

[Ne/Neva Eva]

Slow increases in dose?

bleep;1085251 wrote:
What reasons could there be for going so slowly, since we know you can still minimise SE's by going quicker?

Is that true, though? I can't decide.

What about giving the brain time to adjust gradually?

He's AF (by choice. who does that???) and on 60mg/day in the first week, with no SEs. (took me ~6 weeks to get there. )

If noone has actually tried that protocol and that's the one that is supposed to limit
SEs, I'm thinking to suggest it maybe.
Serenity may be the only one who came close to using it, and she is still the bac-poster-child, in my eyes.

What did Murph do, Murph?

[bleep]

Slow increases in dose?

I'm assuming you mean hubby is AF and on 60? Well, on the Dr's protocol, he'd still be on 15mg's, or 20mg's, and would have wasted 3 weeks.

Everyone seems to have a level they can tolerate with little or no SE's - maybe the answer is to find that level quickly, and then try something more sensible, like 20mg's per week?

I just know that there's no way I could have done it that way. Impatience gnawed at me from day 1, I would have done it even quicker if I thought it was possible. Impatience seems to be a factor that a lot of us experience, I doubt you'd have gotten Charlie, or Murph, for example, to follow that protocol, especially since it's self administered to begin with.

[ignominious]

Slow increases in dose?

I also don't know anyone who has followed the 20mg/week rule.

I think its not a bad schedule to suggest as it is slow enough to let your brain catch up with whats going on and frankly waiting 2.5 months to get to 230 is not too long in the scheme of things.

Oh yeah. That's how long it took me. But not at regular 20/week increases.

Congrats to hubby. Way to go!

[bleep]

Slow increases in dose?

Ne/Neva Eva;1085254 wrote: Is that true, though? I can't decide.

...?

Sorry, realised I hadn't answered this - While they will be greater than if you went at 20mg's per week, you can still keep them to tolerable levels and go quicker than this, is what I meant.

I think the ideal way to do this is in an inpatient rehab setting, going as quick as possible, under supervision of doctors and the like.

At home, something closer to the 20mg's a week setting would probably allow you to function pretty much like a normal human being, so maybe there is something to be said for it?

As I'm typing this, I'm wondering what the rush is? Why not just take 20mg's a week and cure yourself effortlessly, over a slightly longer period? I'll have to think about it for a bit.

[Murphyx]

Slow increases in dose?

I went to 150 in 8 days and only stayed at that level because my brain was so shagged I literally couldn't increase it. But if I hadn't stopped at 150 for a few days I probably wouldn't have realised that I'd switched and would have continued on unnecessarily high, like I think Bleep and others may have done.

Giving the brain a chance to catch up is really important IMO, but I can't imagine it needs a week between increases. I think the general suggestion of starting at 20 and increasing by 20 every three days, SEs permitting, is quite reasonable.

[_serenity_]

Slow increases in dose?

I did. Sorta. I went up faster than prescribed in the beginning.

[Isolde]

Slow increases in dose?

I did, I did!
I actually followed the 20mg/week rule during both of my upward titrations.

Though I didn't have a horrible time with SEs, it most certainly wasn't "like water", either!! :H I experienced pretty much all the same stuff the majority of others did. First great sleep and euphoria, with a little bit of the congestion/trouble breathing issue, then sleep disturbances, body tension/energy, and of course the daytime somnolence and tinnitus.

Although, the SEs varied dramatically depending on my brand of bac. The stuff I was getting from 4RX that I was on all the way up through my first switch was Fexobac. I got the closed eyed visuals and occasional body paralysis during sleep that can really freak a person out. But when I went even higher the second time around, it was with the US stuff from my doctor. I've searched for a brand on it, even checked online, but it just says "Baclofen". I haven't gotten nearly as bad SEs on this stuff, even though I was taking a higher dose. While I'm sure that's due in large part to the brand, maybe it also has something to do with having been on bac for awhile now.

[Ne/Neva Eva]

Slow increases in dose?

Thanks everyone who has weighed in.

Is, duly noted. I am not sure it alters the SEs. I wonder if it helps to keep the dose lower, though. Something akin to what murphy suggested.

Though neither you nor Sere found indifference at a particularly low dose... Just not astronomical. It would just be nice to avoid a double-bac-bill at levels that dwarf the FDA amount, you know?

Serenity, check your email! :H I've been waiting for your input. Obviously rather impatiently given the time where you are! sorry.
SEs for you? Did you feel as though they were mitigated?

[_serenity_]

Slow increases in dose?

Hey! Let's see. I couldn't bear to stay at the very low doses the first 3-4 weeks I was on Bac, so I was going up faster than prescribed. Shockingly, I also ran out of pills faster than expected. I had ordered a bac-up supply from Goldpharma which arrived just as my pills were running out. Anyway, in early January I was up to 110-130 when I should have been at 70 or so. The chronic anxiety disappeared, but I had also begun experiencing some pretty bad nausea/dizziness. I also didn't want to keep having to order expensive bac from overseas. I spent most of January in a holding pattern, until my titration schedule caught up to what I was already taking. Then I kept to the 20/week increase. I dreaded the increase day! I'm glad it didn't take long to hit my switch after that.

The one thing I think helps re: the 20 mg/week increase, is that it really gives your body the chance to adjust before moving on to a higher dose. I went up to 190/day a good 5 days before I reached indifference.

[beatle]

Slow increases in dose?

Since we all have different chemistries, it would make sense that different brains need longer to adjust to dose increases. The 20mg/week protocol is probably deigned to cover the brains that need the most time to adjust. If that is the case (which I assume it is), each person could try pushing it up a tad (30mg/week, or increase 20/mg ever 5 days, for example) and see how it works for them. If they can do it a bit faster without increasing the SEs, it would be worth a try, I'd think.

[terryk]

Slow increases in dose?

I had a bad experience with rapid titration (I posted a bit of it here before). It involved complete detachment with reality, constant visual/auditory hallucinations, rapid pulse/high bp, and severe electric shocks to my hands that caused me to drop anything I was holding for more than 15-20 seconds (many broken dishes and glasses). This was a jump from 150 to 235+ in a day or two and the SE were still increasing after 5 days when I eventually wound up in the ER, wrestled down and strapped to a gurney by 5 security guards (head/each arm/each leg). Admitted to the hospital for 5 days, my baclofen dose was restricted to 80mg/day and dosed sporadically. Then the real fun began and I had my partner smuggle in more baclofen to counteract my withdrawal unbeknown to my doctors . I was ready to give up and titrate down at that point, but realized I had to stabilize at 150 before I could do anything else. After 10 days, things calmed down a bit and I switched from a loaded dosing scheme of 8/12/6 40/40/80 to an even 8/4/12 60/60/60. Things improved and the side effects lessened, so I decided to start back titrating up. Upon each increase, I would notice my side effects would peak on the 2nd or 3rd day after the increase. So if I increased one day and didn't feel anything the 2nd day, I came to learn that *another* increase would bite me in the ass with even more hallucinations, shocks to the fingers and somnolence. Even at an increase of 10mg/5-7 days I would get more shocks for 2 days, the typical "slide show/color" hallucinations, a really terrible feeling sleepiness, and the most disturbing part: upon waking up from micro-naps, 25% of the time I would be greeted by the image of someone standing right over my face about to *kill?* me. Every single time I would scream and lunge across the bed or couch at this apparition and try to tear it apart with my fists. Very disturbing for me and more so for my girlfriend who learned very quickly to stay far away from me if she had to wake me up.

Maybe 3-4 months later I reached my switch (9/26/10 - after 7 months total) at 280mg/day and have floated around there: 240mg/day 8/2/7/12 60/60/60/60 today. My side effects peaked around 2 weeks *after* my switch, but are 99% completely gone now. PRN doses *really* screw me up entirely (I can't take them), missing a dose and waiting until the next is FAR better for me than trying to double and catch up (LeVin agrees here).

So there you have it. I had quite a severe drinking problem to combat - 15-24+ units a day + benzos for years. 4 trips to the ER, 2 outpatient and 2 inhouse detoxes. I had to keep my titration slow and steady. I'm a big guy who's been around the block a few times I'm pretty sure about where I stand in the world - I'm much more stoic rhinoceros than whiny bitch (used in a non-gender specific way here), so I know the side effects are very real and can be difficult for anyone.

Just my take. -tk

[Ne/Neva Eva]

Slow increases in dose?

Thanks so much, Terry. For the info and the laugh.

(and for the details, sere)

Slow and steady it will be, I think... I imagine it's still not going to be as simple as I'd hoped. Even though we all know better.
It's just plain hard for many of us.

[terryk]

Slow increases in dose?

I'm not against a faster titration. I'm sure that it works for many, many people. -tk