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Help with Lorazepam to Valium crossover


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Hi there,

 

I’m in desperate need of help. I started taking Lorazepam at night over the summer with very inconsistent doses as needed for sleep and flights (0.25-.5 mg). I was postpartum so the sleep was the main reason. Eventually I increased my usage to every night, but still at very inconsistent doses, I would break off a crumble of a 2 mg tablet (never using more than .5)  and take it at inconsistent times of the night. I was experiencing minor interdose withdrawals, including depression, but didn’t know it. I thought I was experiencing post partum depression so I went to a psych NP and she swapped out Klonopin for the Ativan to take .5 at night. I did that for 2.5 weeks while trialing Zoloft and Seroquel and my symptoms became markedly worse (still not knowing it was benzo dependency) and i through away her meds. Bad idea, landed in the ER and they gave me 2 my IV Ativan and I’ve been “tapering” Ativan ever since October. Ever since I realized in mid October that benzos were the issue, I tried to get off as fast as possible and reduced from 1 mg to .5 mg Ativan in 5.5 weeks. Pure torture. This is before I found benzo buddies. I’ve been holding at .5 mg for 4 weeks now with zero relief or stability or improvement. I took all my dose at night so I’m in the process of splitting to 4x per day but this is not going well either. Increases agony and absolutely zero sleep. I have an appt with my pcp on 1/10 and she is open to a Valium switch. I need help with a crossover plan! At that point I will be taking .125 mg 4x per day. I’m wondering if I should just start by requesting the liquid over the tablets to make these small doses easier to deal with. She is also trying to switch me to the online equivalent, but I need to convince her to switch me to the Ashton equivalent of 5 mg. Please help! Mom of toddler in so much need. Can’t work or take care of my son. The akathesia is constant and disabling.

 

-Arianna

 

 

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Hi ABR,

I'm so sorry to hear about your struggles using and withdrawing from lorazepam. We can definitely help you consider and plan a crossover to diazepam.

 

Spreading out benzo doses is notoriously uncomfortable. Especially since you were relying on that single nightly dose for helping with insomnia, I can see how this transition would be especially uncomfortable. I also agree that you could benefit significantly from crossing to a longer-acting benzo, but there is some risk involved which I think is somewhat greater given your ongoing instability. Short-to-long benzo crossovers can be difficult at the best of times.

 

I do not recommend crossing directly to the commercial diazepam liquid solution. This drug form is a solution because the diazepam is dissolved by solvents; it also contains other potentially intolerable excipients (non-drug ingredients) such to resist microbial growth. In my opinion tablets contain far more inert and better tolerated excipients and I would personally want to transition to these to minimize the already significant challenges of a cross.

 

I don't know what "online equivalent" you're referring to, but there are a lot of different benzo conversion charts with with wildly divergent numbers. I trust Dr. Ashton's chart, especially when it comes to crossing to diazepam. I hope you doctor will provide you with 5mg/day of diazepam to cross to.

 

I suggest a 4 step crossover, given your four daily doses and the limitation of your 0.5mg lorazepam tablets. I suggest getting 5mg diazepam tablets for the crossover, because these can be split into 1/4s to get 1.25mg diazepam equivalents of 0.125mg lorazepam. Once you've crossed, I suggest transitioning to 2mg tablets for easier reductions and/or trialing the commercial liquid solution.

 

To cross, I suggest starting by replacing your very last dose of the day with 1.25mg diazepam, (1/4 of a 5mg tablet) and holding for at least 1 week before moving onto the next step. I suggest working counter-clockwise through the day for the next three steps, replacing each lorazepam dose with the diazepam and again holding for at least 1 week between steps.

 

If you don't have one already, I suggest sourcing a reliable pill splitter. I like the EqualSplit brand aluminum pill splitters on Amazon; I've found them very reliable for dividing my clonazepam doses into 1/4s.

 

Let us know how we can help.  :thumbsup:

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Hi ABR,

 

I do not recommend crossing directly to the commercial diazepam liquid solution. This drug form is a solution because the diazepam is dissolved by solvents; it also contains other potentially intolerable excipients (non-drug ingredients) such to resist microbial growth. In my opinion tablets contain far more inert and better tolerated excipients and I would personally want to transition to these to minimize the already significant challenges of a cross.

 

 

 

sns,

 

Let's try not to frighten members away from an option that might work for them. Of course, one should check ingredients to make sure there is nothing that might cause an allergic reaction. Those of us with allergies are used to doing this on a regular basis.  I've seen many people not have any issues at all with prescription liquid diazepam.  Additionally, it is far superior in terms of accuracy of potency to any substance we could create ourselves at home.

 

pianogirl

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Let's try not to frighten members away from an option that might work for them.

 

Thanks for considering my post pianogirl; however, you seem to have missed my point.

 

I do not recommend crossing directly to the commercial diazepam liquid solution.

 

There are many buddies who have reported being intolerant to the commercial liquid solution of diazepam. While it might work for someone, it also might not and I've found it's extremely difficult to navigate benzo tapering when adjusting more than one variable at a time.

 

Let's try not to frighten members away from a step-wise approach to benzo tapering that might work for them.  :thumbsup:

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Let's try not to frighten members away from an option that might work for them.

 

Thanks for considering my post pianogirl; however, you seem to have missed my point.

 

I do not recommend crossing directly to the commercial diazepam liquid solution.

 

There are many buddies who have reported being intolerant to the commercial liquid solution of diazepam. While it might work for someone, it also might not and I've found it's extremely difficult to navigate benzo tapering when adjusting more than one variable at a time.

 

Let's try not to frighten members away from a step-wise approach to benzo tapering that might work for them.  :thumbsup:

 

No I did not miss your point.  Frankly, we on the team are very concerned about instilling fear in our members because they decide on a path that is then negated by another member.  I do know of quite a lot of people, after being here for many years, who did fine on the commercial liquid diazepam. As I stated, we all need to look at what we are taking and make sure that it is not something that might elicit an allergic reaction. 

 

Let's try not to be the 'only' expert here on BB. After all, none of us are experts. This is a peer support forum.

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I'm sorry ABR. This is meant to be your tapering thread, to discuss your tapering needs. Pianogirl apparently is administrating for the BB team by interjecting her passive-aggressive and off-topic accusations as though they're corrections to my suggestions for your crossover. I am embarrassed to see this behavior from one of our administrators.

 

I stand by the suggestions I shared in response to your original post and, as always, you're welcome to cross and taper however you decide is right for you.

 

If we can be of any help, please let us know.  :thumbsup:

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I'm sorry ABR. This is meant to be your tapering thread, to discuss your tapering needs. Pianogirl apparently is administrating for the BB team by interjecting her passive-aggressive and off-topic accusations as though they're corrections to my suggestions for your crossover. I am embarrassed to see this behavior from one of our administrators.

 

I stand by the suggestions I shared in response to your original post and, as always, you're welcome to cross and taper however you decide is right for you.

 

If we can be of any help, please let us know.  :thumbsup:

 

Yes, this is indeed a thread started by ABR. However, we believe in transparency and when topics or opinions need to have another voice, another perspective we will address it on the thread.  This will be the case from here on out.

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ABR, if I could inject a bit of my experience here.

 

I followed Ashton's Schedule 3 below (I had to do some math the find my equivalent doses)  for my Ativan to valium crossover, and my taper, and had absolutely no problems with it.

 

https://benzo.org.uk/manual/bzsched.htm

 

Perhaps if you took this in to show your doc? It was really pretty painless. Ativan became too untenable for me -- the interdose w/ds were awful, even dosing 3 x a day. So I decided to cross over gradually to valium. I felt a little sedated I was on all valium -- for about a week. Then that passed. And I was rid of the i/d w/ds from Ativan, which was a blessing.  FYI, I used pills down to about 3 mgs, then switched to liquids.

 

So . . . this is just an idea that might work for you.

 

Best,

 

Katz

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  • 3 weeks later...
Thank you for all of this info. I am still in a bit of a stuck place. I have not created a signature but will need to do that. For background: I was taking Lorazepam .25-.5 prn for flights only. This year in July 2021 I started taking it every night for sleep, but I believe I’m pretty kindled because I took it on random nights, sometimes every night, and went up and down in doses. I started having tolerance and withdrawal symptoms but didn’t know it. I went to a psychiatric NP for “post partum depression”—what I thought it was in October, and she put me on .5 mg Klonopin for 2.5 weeks at night, while also trialing me on Zoloft and seroquel. Couldn’t tolerate either of those in that 3 week period so I said I quit all these meds and threw them away. Withdrawals hit, still didn’t know, thought it was just a crisis, and went to ER and they gave me 10 mg propranolol and 2 mg Ativan with a script of 1 mg Ativan to take home. 2 days later I realized it was benzos and began dropping my dose like crazy (hadn’t found BB yet). I basically cold Turkey’d that 2.5 weeks of Klonopin and went back to Ativan because that was the last thing I had in the hospital. The highest dose of Lorazepam I had was 2 mg one time in the hospital, and then about 2 or 3 doses of 1 mg in the days after that. So I started dropping quick, very unstable, and then held at .625 for 3 weeks. Went to .55 for 10 days then all hell ensued at .5 and I held there for 7 weeks. I barely stabilized, but improved a little and thought I was good enough to start tapering again. During that time I also switched to my 4x daily dosing and the at home liquid. This week I started by tapering by .003 mg for 6 days (only made it to .491) and my symptoms are completely intolerable. New symptoms of diaphragm squeezing and severe nausea have popped up, among many others. These symptoms were too severe to keep going or to even stay on that dose with and I’m so discouraged. So now I’m going to go back to .5, see if I can stabilize, and try to make the switch to Valium over a 4 week period. This has all happened over the last 3-4 months, and I know in benzo time this is not long. I am desperate to find a place where I can taper with manageable symptoms. I worry with all of the switching of meds that I am doing more harm than good, and that’s why I’ve tried to stay on lorazepam to taper, but I don’t think my body will let me. Any help is appreciated.
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Hello, ABR.  I’ve reviewed your posts and put together a draft signature for you (see below).  To help others help you, please consider making any revisions needed (e.g. replacing the ?? with the correct dates) then add it to your Profile.  If you’re not up to doing this yourself, I’m certain one of the administrators will be happy to assist.

 

0.25-0.5mg lorazepam PRN before air travel

July 2021 - lorazepam every night for sleep but inconsistent amounts; developed tolerance

Oct. 2021 - cold switch to 0.5mg clonazepam; took every night for about 3 weeks while also trialing Zoloft and Seroquel; quit all meds cold turkey

?? - went to ER; given 2mg Ativan IV and propranolol; took 1mg Ativan for about 3 days; tapered to 0.625mg, held for 3 weeks; tapered to 0.5mg, held for 7 weeks

?? - switched to dosing 4 time a day and homebrew liquid; tapered to 0.491mg lorazepam over 6 days (1.8% reduction), intolerable symptoms

?? - returned to total daily dose of 0.5mg lorazepam (4 divided doses of 0.125mg)

 

Did you have the appointment with your pcp on January 10?  Is she now willing to prescribe the Ashton equivalent of diazepam?  Did you discuss and agree on dosage form(s)?  If you’ll let us know the details, we can offer suggestions for a crossover plan.

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