direct taper issues: request for updated crossover & substitution taper schedule

    Hi everyone,

 

    Since my last post I continued on direct taper w/Ativan, per the schedule below thinking that with the small dose I’m down to (.0292 mg 3x/day) and with the last 2 weekly cuts at only .0062 3x/day (meaning cutting .0186 each week) that I wouldn’t have a problem. I was pretty ok til a few days ago when sleep subsided by a couple hours, worries/anxiety returned significantly and I might be feeling interdose withdrawal.

 

    Now I’m convinced switching to valium.

 

    1) Could you please help with an updated crossover and taper schedule? I’m sleeping maybe 4 hours per night, thinking maybe I should even go back up to what I was taking 8/28-9/3 (.0354 mg 3x/day). I’d appreciate a plan that lets me keep taking Ativan 3x/day as I crossover to valium. I’m titrating so that is not a problem. I just don’t want to shock my body again switching to 2x/day or whatever.

 

    2) Have you heard of other people being so sensitive at such low doses?

 

    3) I’ve kind of asked this before but if I have a bad reaction to crossing over to valium can I just stop valium or would I then be stuck addicted to both valium AND ativan, needing to taper both?

 

    4) In ballpark terms, what proportion of people would you estimate have trouble crossing over versus those that do fine? 1 %, 10%, 30%?

 

    5) My doctor’s manual says 6 to 1 is the ration for valium to ativan yet on this forum & Ashton manual it seems to be 10 to 1, or am I mistaken? I’m nervous about getting it wrong.

 

    Here are my dosages and history of cuts:

 

    6/19/10 began Lorazepam .5 mg 3x/day

 

    7/15/10-7/21 cut to .25 mg 3x/day (following a psychiatrist's advice but this is when I began to have severe withdrawal symptoms)

 

    7/22-7/27 cut to .25 mg 2x/day

 

    7/28-8/4 cut to .25mg 1x/day (before bed). severe withdrawal symptoms and with insomnia

 

    8/5-8/11: mistakenly cut in 1/2 again & spread out the .25mg 1x/day into .0625mg 2x/day (this is when i began titration since I couldn't cut the tablets any smaller)

 

    8/12-8/27: .0417 3x/day (instead of the .0625 2x a day, to avoid the interdose withdrawal). Slept much better and stabilized for perhaps 10 days.

 

    8/28-9/3: .0354 3x/day. Felt pretty fine with this

    9/4-9/13: .0292 3x/day. Ran into trouble by around 9/9, perhaps with even the previous cut catching up to me

 

 

    Thanks so much!

    cc

Do you want to start at .0292mg 3x/day with your crossover? Or go back to .0354mg 3x/day?  Or...?

Thanks! I'm torn but given my trouble the last few days I suppose the most responsible would be to go back to .0354mg 3x/day and start there.

The conversion of ativan to equivalent valium is pretty easy since 1mg ativan = 10mg valium for most people.  So 0.0354mg ativan is equivalent to .354 valium.  How you can come up with that amount is the question.  Maybe I missed it; what strength valium tablets do you have or are you getting?  It comes as small as 2mg.  Are you titrating by any chance?  I really can't figure out how you could accurately cut ativan - or any tablets - to amounts like 0.0354mg or 0.0292 without titrating.

Thanks for confirming the 10 to 1 ratio Beeper!    So sorry I forgot to mention I am titrating with a very good apothecary/pharmacy that does oil based reductions that last 60 days so the small numbers are not an issue. 

 

Would be very grateful if you or others could reply to my other questions.  Thanks in advance!

CC

Thanks for confirming the 10 to 1 ratio Beeper!    So sorry I forgot to mention I am titrating with a very good apothecary/pharmacy that does oil based reductions that last 60 days so the small numbers are not an issue. 

 

Would be very grateful if you or others could reply to my other questions.  Thanks in advance!

CC

 

The 10-1 ratio is from The Ashton Manual, CC.  Other sources do show different equivalencies.  If you find yourself feeling too sedated taking the Ashton level of valium, maybe you need a bit less.

 

I'm not up to coming up with another crossover schedule.  Maybe someone else can take that on.  You are on such a little amount of ativan, you could just subtitute once dose at a time.  Just tell your compounding pharmacist what you want to do and the ratio you want to use (10:1) and they can figure out how much valium to substitute for the 0.0354mg dose.  Just replace one dose every week or two for 3-6 weeks until you are on nothing but valium.

 

I don't know what you should do if you have a bad reaction to valium or what percentage of people have trouble crossing over.  I'm sure it's less than 50% so the odds are in your favor.

 

  2) Have you heard of other people being so sensitive at such low doses?

Yes, I've seen others who are sensitive to very low doses.

 

 

  3) I’ve kind of asked this before but if I have a bad reaction to crossing over to valium can I just stop valium or would I then be stuck addicted to both valium AND ativan, needing to taper both?

You would cross back over to the Ativan, but you could do it more quickly since the Valium would stay in your bloodstream while you crossed to the Ativan.

 

  4) In ballpark terms, what proportion of people would you estimate have trouble crossing over versus those that do fine? 1 %, 10%, 30%?

I've only seen a very small percentage of people who give up on the Valium, most adapt and do just fine.

 

 

Thank you Beeper and Pamster for the helpful replies! Both are very reassuring.  I really appreciate your time.

 

CC

Thanks so much again everyone, Beeper, Pamster etc.  Tomorrow I'll get the prescription for Valium & can begin crossing over. Before I do can you please confirm this is a good schedule? Basically my doctor used the Ashton manual (adapting the one on tapering 3mg Lorazepam)--.  Again I cant help but feel it is riduculous I'll be spending 6 weeks transitioning on such a miniscule amount, only then to have a taper plan that lasts 29 to 52 weeks! And since I only began taking Lorazepam in mid June.  Given the dosage is so smalll I'm hoping I can make bigger cuts once on Valium since the dosage is so small and hopefully be completely off closer to 20 weeks.  Do you think this is a possibility or am I really stuck with 29 to 52 weeks? Please see schedule below

 

Thanks again,

CC

 

Withdrawal from lorazepam (Ativan) with diazepam (Valium)

 

Morning Midday / Afternoon Evening / Night

Stage 1 Lorazepam .0292 Lorazepam .0292 Lorazepam .0146

(1 week) Diazepam none Diazepam none Diazepam .1460

 

Stage 2 Lorazepam .0146 Lorazepam .0292 Lorazepam .0146

(1 week) Diazepam .1460 Diazepam none Diazepam .1460

 

Stage 3 Lorazepam .0146 Lorazepam .0146 Lorazepam .0146

(1 week) Diazepam .1460 Diazepam .1460 Diazepam .1460

 

Stage 4 Lorazepam .0146 Lorazepam .0146 Lorazepam none

(1 week) Diazepam .1460 Diazepam .1460 Diazepam .292

 

Stage 5 Lorazepam none (AM) Lorazepam .0146

(1 week) Diazepam .292 Diazepam .1460 Diazepam .292

 

Stage 6

Lorazepam none

(1 week) Diazepam .292 Diazepam .292 Diazepam .292

 

Stage 7

(1-2 weeks) Diazepam .292 Diazepam .234 Diazepam .292

 

Stage 8

(1-2 weeks) Diazepam .234 Diazepam .234 Diazepam .292

 

Stage 9

(1-2 weeks) Diazepam .234 Diazepam .175 Diazepam .292

 

Stage 10

(1-2 weeks) Diazepam .175 Diazepam .175 Diazepam .292

 

Stage 11

(1-2 weeks) Diazepam .175 Diazepam .117 Diazepam .292

 

Stage 12

(1-2 weeks) Diazepam .175 Diazepam .058 Diazepam .292

 

Stage 13

stop D in AM

(1-2 weeks) Diazepam .175 Diazepam .292

 

Stage 14

(1-2 weeks) Diazepam .146 0 Diazepam .292

 

Stage 15

(1-2 weeks) Diazepam .117 0 Diazepam .292

 

Stage 16

(1-2 weeks) Diazepam .088 0 Diazepam .292

 

Stage 17

(1-2 weeks) Diazepam .059 0 Diazepam .292

 

Stage 18

(1-2 weeks) Diazepam .030 0 Diazepam .292

 

Stage 19

(1-2 weeks) Stop D in AM 0 Diazepam .292

 

Continue reducing night time diazepam by 10% every 1-2 weeks

 

One thing I don't understand about the crossover schedule is why you aren't dropping a dose when the equivalent amount of valium is added.  If you don't drop a dose, you are effectively increasing your benzo intake.  Obviously, if you do drop a dose of lorazepam when you add the equivalent valium rather than as it is described on the schedule you provided, you will crossover in 3 weeks, not 6.

 

The valium (diazepam) reduction schedule is quite conservative with only tiny reductions being made each week.  I realize he was probably trying to use the 10% guideline but that guideline doesn't need to be applied to smaller doses for most people.  If you are able to tolerate larger reductions, your taper will go much faster.

Thanks Beeper!  Really appreciate your insight on the potential for larger cuts given it is a tiny does.

 

Actually, the crossover is not increasing the total dosage.

For example, during Stage 1, which is 1 week long, it says I will take Lorazepam in the AM and PM at .0292 mg, but then at bedtime I take half of .0292 mg, or .0146 mg, and then substitute the dropped half dose with .146 mg of valium (diazepam), which is equal to .0146 mg of Lorazepam.  By Stage 6, a few weeks later you can see that I'm at the same equivalent dosage of diazepam as I am now on lorazepam

 

CC

I'd comment, but I take one look at your schedule and get overwhelmed, but that's just because I didn't taper, so I don't have practical experience.  It seems as if you're being quite thorough though. 

Thanks Beeper!  Really appreciate your insight on the potential for larger cuts given it is a tiny does.

 

Actually, the crossover is not increasing the total dosage.

For example, during Stage 1, which is 1 week long, it says I will take Lorazepam in the AM and PM at .0292 mg, but then at bedtime I take half of .0292 mg, or .0146 mg, and then substitute the dropped half dose with .146 mg of valium (diazepam), which is equal to .0146 mg of Lorazepam.  By Stage 6, a few weeks later you can see that I'm at the same equivalent dosage of diazepam as I am now on lorazepam

 

CC

 

I will take your word for it, CC. I guess I just can't quite follow what you typed in but you understand it so that's what's important.