Help with Ativan crossover to Valium

[[Buddie]]

Hello and thanks for being here.

Started on benzos 18 months ago ([...] 08) to contain a horrific reaction to Singulair: panic, wild moods, suicidal depression etc. Identified Singulair as problem and stopped it late May 08, back to work by August, but still using benzos now 10 months later. Chronic insomnia issues and several depressions earlier in my life.  75 Mirtazepine working for the depression.  Eat well, meditate, do yoga, cognitive therapy, exercise, trying to hold to minimal to no caffiene or alcohol, etc.  My psychiatrist has been flexible and we've tried lots of benzo combinations to keep me functioning.

At this point I want to work toward getting free of the benzos.  I had reintroduced Clonazepam 1.0 for sleep early June and have just crossed over to Valium for sleep.  Rocky crossover - too fast and too low on the Valium - now at 6 Valium hs (too low?).  Meanwhile my 'as needed' Ativan has creeped up to 1.5 daily from 1.0, more on very bad days.  There have been a few.

My wife thinks I need to get on a stable daily dose of one benzo and taper slowly from there.

I am unsure how to crossover the Ativan to Valium.  (Clonazapam is not good for me - ugly, terrible angry/despondant mood swings even with small dose reductions.)  I am worried about sedation.  I know Ashton equivalency of my 6 Valium hs and 1.5 Ativan daily would be 21 mg Valium/day.  I fear I'd be falling down and slurring my speech.

Suggestions??? 

 

[[Buddie]]

Hi [...],

Welcome to BenzoBuddies!!

Looks like you are quite educated in the benzo world already!  As you know, crossing over to the Valium from Ativan should be done gradually. You may want to look at The Ashton Manual schedules to see how the crossovers are done. There is no reason you have to cross to the exact amounts, as the amounts there are mostly suggestions. It really should be an individual thing. Just see how you feel and if you feel your symptoms are being met by enough Valium, then stop, stabilize there for a good week or two and then start the slow taper from there!! 

If you have any more questions, just ask!!

T2

[[Buddie]]

Hello and thanks for being here.

Started on benzos 18 months ago ([...] 08) to contain a horrific reaction to Singulair: panic, wild moods, suicidal depression etc. Identified Singulair as problem and stopped it late May 08, back to work by August, but still using benzos now 10 months later. Chronic insomnia issues and several depressions earlier in my life.  75 Mirtazepine working for the depression.  Eat well, meditate, do yoga, cognitive therapy, exercise, trying to hold to minimal to no caffiene or alcohol, etc.  My psychiatrist has been flexible and we've tried lots of benzo combinations to keep me functioning.

At this point I want to work toward getting free of the benzos.  I had reintroduced Clonazepam 1.0 for sleep early June and have just crossed over to Valium for sleep.  Rocky crossover - too fast and too low on the Valium - now at 6 Valium hs (too low?).  Meanwhile my 'as needed' Ativan has creeped up to 1.5 daily from 1.0, more on very bad days.  There have been a few.

My wife thinks I need to get on a stable daily dose of one benzo and taper slowly from there.

I am unsure how to crossover the Ativan to Valium.  (Clonazapam is not good for me - ugly, terrible angry/despondant mood swings even with small dose reductions.)  I am worried about sedation.  I know Ashton equivalency of my 6 Valium hs and 1.5 Ativan daily would be 21 mg Valium/day.  I fear I'd be falling down and slurring my speech.

Suggestions??? 

 

Welcome to BenzoBuddies, [...].   

Sounds like you have a very smart wife.  Ativan is short acting which is why it can give you more immediate relief prn.  I tapered directly off it without crossing over to valium.  Since you are already on (6 mg?) valium and have a pdoc who will work with you, you might want to take a look at Table #8 in Ch. 2 of The Ashton Manual.  She shows a substitution crossover schedule from 3 mg ativan (lorazepam) to 30 mg valium so it should be easy to cut the amounts in half and create a crossover schedule that will work for you. 

http://www.benzo.org.uk/manual/bzsched.htm#s8

The benzo equivalencies are just estimates and vary greatly from person to person.  I would start with the full amount of valium called for in the (reduced by 1/2) schedule initially but cut back on the ativan if you feel too sedated.  If you have more leeway for activity on the weekend, you might want to start your new schedule to see how it effects you and make your adjustments then.  Those who are going onto valium for the first time often feel somewhat sedated to begin with but that wears off.  Valium has a long half-life and can take several days to reach full potency. 

[[Buddie]]

Thank you for your responses.  Here is the plan after reading up more on Ashton and other sources:

step 1: .5A (Ativan)   .5A   .5A      8V (Valium)   This corrects undershooting the bedtime dose.

step 2: .5A   .5A   .25A&1V   8V

step 3: .5A    .25A&1V  .25A&1V   8V

and so on until the three daytime .5 Ativan doses are replaced with 2 mg Valium doses in 6 steps.

Then reduce the 2 mg daytime Valium doses to 1 mg doses in 3 more steps.

Then knock out the 1 mg daytime Valium doses one by one in 3 more steps.

Then taper the nightime Valium one mg at a time over 8 steps.

I will let my body tell me how long to spend at each step.  The first crossover steps are conservative but I think that is a good thing. I've made some large jumps and it was awful.  Ashton has an Ativan to Valium equivalency that is twice what is in US pharmacology texts (1 Ativan =10 Valium vs USA 1 Ativan = 5 Valium).  Hard to know which is the better exchange for me.  If Ashton is right, those first steps will still be a manageable taper of <10% a step.  And  if US is right, no harm in a crossover at a steady dose. There is still the progress of simplifying to a single drug and being on a fixed dose and changing the "as needed" behavior/head set.  All good goals.

OK, here we go!

[[Buddie]]

Sounds like a good plan to me, [...].    Since valium takes a while to build up in your system, going slow with the ativan reduction at the beginning should help compensate for the difference in half-lives.  Do come back and let us know how it's going from time to time.  I think you are going to do great. 

[[Buddie]]

Hey [...], I just started the Ativan/Valium Ashton substitution yesterday. I will be on the lookout for your progess and I will share whatever I find out or experience that might be of help. Hang in there.

[[Buddie]]

hey River boat---sounds alot like the bouncing around I was doing on the ativan. Ok so I did my first day today but I kinda messed up in that I woke at 4:30 am and took 2 mg of valium (never really got back to sleep) but felt more sedated in am,but went to work made it through the day ,but I think I am on the right track---taking a fixed dose takes all the obsessing and then guilt out of the equation(as compared to prn dosing)

So in sum last night @ 10pm took Valium 8mg,Mirtazapine 75(antidepressant),slept for a while then awoke at 4:30am, took Valium 2mg ,took 0.5 mg Ativan at 7:30, took 0.5 mg Ativan at 11 am, and 0.25 Ativan/ 1mg valium at 4pm. I do note some  sedation type of feelings but I guess that is part of the situation and not unexpected.

Tonight plan is for 8 Valium with Mirtazapine, and avoid dose  if I awaken during the night.

I really appreciate the support from folks!---Thanks [...]

[[Buddie]]

Hi there [...]- Welcome to BB.

Your in good hands here.

I started the journey crossing from Ativan to Valium at 30mgs and am living proof that it can be done. It's not an easy road to come off Benzos but with support from others who have made the journey and are currently in it you will make it.

[...]

[[Buddie]]

I am updating over on my buddy blog, but wanted to come back here and post an update about my taper schedule.

My plan above had me trading out .25 Ativan for 1 Valium during my crossover.  I knew Ashton sets the equivalency higher at .25 Ativan equaling 2.5 Valium, but it seemed I would end up on way too much Valium that way.  So I used a figure closer to USA writings. Then I made a second mistake going too fast (3 steps in 9 days).  Ended up doing pretty bad and feeling unable to concentrate for work.

I changed the schedule plan to substitute each .25 Ativan with 2 Valium.  And backed up to step 1 from step 3.  This puts me at .5 Ativan morning, .5 Ativan midday, split dose of .25Ativan and 2 Valium late afternoon and 8 Valium at night. 

Still no cakewalk but much better.

[...]

[[Buddie]]

Hey [...] - thinking about how you are doing. I am on my second week of ashton substitution (ativan to valium) and so far, so good. For me, following her chart EXACTLY is working great.