Ativan with Librium - where to go?

[[Buddie]]

Dear Buddies...

I'm asking for help as I'm having a very hard time..

My short story:

• I was put on Ativan in June 2022 (1mg x twice a day) to replace my Fioricet which I was taking since 2020.
• I quickly started experiencing interdose withdrawal and doctors added another 1 mg at noon.
• It didn’t go well (I think it was too much), so doctors suggested to cut it to 0.5mg x 6 times a day.
• It didn’t go well, so doctors suggested switching to Valium.
• Valium didn’t go well at all with me, and noon dose was replaced with 25 mg Librium: better reaction than Valium, but still worse than Ativan.
• Then I tried to add a second 25mg dose of Librium and it didn’t go well.
• So I went back to Ativan + Librium + Ativan and stayed there for a month now.
• Was very difficult during first 2 weeks, but then I got more a less stable and cut my noon 25 mg Librium to 10+10 mg and spread it in 2 hour window.
• One week later I cut my morning 1 mg Ativan by 0.25 mg.

My current regimen is the following:

• Ativan 0.75 mg at 6 am (but there might be uneven doses due to breaking hence not stable reaction).
• 10 mg Librium at noon.
• Another 10 mg Librium at 1 pm.
• 1 mg Ativan at 8 pm and I go to sleep at around midnight.

I don’t feel well at all after taking Librium – whether it is from Librium itself or from Ativan weaning off.

I also just received my pharmacogenomics results:

• Use as directed: Klonopin
• Moderate gene-drug interaction: Librium, Valium, Ativan

For those who did the test, how close did it correlate with your actual reaction to drugs?
Valium to me was not kind at all.
Could it be overdosing given my genomics test result? Like 0.5 mg Ativan x 6 times a day was too much?

Did anybody taper from 2 different benzos at once?

I have 3 options now:

• Taper on my current regimen: Ativan + Librium + Ativan
• Go back to all Ativan and try micro dosing, but prior experience was not very pleasant
• Try to switch to all Klonopin as per pharmacogenomics results

Any advice is highly appreciated.
Perhaps you came across similar situations and can point me to a thread on this forum or someone who had a similar issues.

Sincerely

[[Buddie]]

Thank you for providing so much detail but we need just a bit more.  Can you describe your crossing and taper efforts in more detail. 

How were you crossed to Valium, was it all at once or was it added in over time?

What was the Valium dose you replaced with the Librium and how long were you on the Valium before replacing it with Librium?

When you say things didn't go well, can you elaborate?

[[Buddie]]

Thank you so much for getting back to me.

On 1 mg x 3 Ativan doses I felt delirious, and had major interdose withdrawals.
Perhaps it was also a beginning of my journey, and my body and mind was not used to being in such a state.

I tried then 0.5 mg x 5 times per day plus 1 mg at night, was taking it every 4 hours or so.
Felt delirious, only tried it for 3 days.

So then doctors recommended to start switching to long-acting.

Initially l tried all 10mg Valium in one dose to replace 1mg Ativan dose - resulted in much pain all over the body, restless, tachycardia (pulse 170), crying

Then as a mid-day dose I tried 0.5 mg Ativan and 5 mg Valium for a few days - resulted in excessive crying and some pain, very sedated feeling.

So, I went back to all Ativan 1 mg x 3.

Then a few days later tried Valium again - full blown extreme pain reaction, unbearable extreme crying – don’t think I want to ever try again.

Then doctors suggested switching to Librium - full cross-over of a mid-day dose.
1 mg Ativan to 25 mg Librium – resulted in depression, can’t stop crying the entire day, out of it, but can’t sleep, repetitive, excessive worry, can’t speak, pain, feel despair like I’m never going to get out of this.

Tried to switch back to Valium - pain and depression.

Then back to 25 mg mid-day Librium - took it for 2 weeks, bad pain initially.
Then tried to introduce a second Librium 25 mg dose - ended up in ER with heart-attack like chest pain.
Went back to A-L-A.

Within 10 days, decreased mid-day Librium to 20 mg, still symptomatic, although less intense and less pain, but by no means comfortable.
20 mg is easier on my body than 25 mg.
Or am I getting used to?
Or is just too much for me given my genetic test?

Librium makes me have more intrusive thoughts, but then again so does Ativan on 3 times a day. 

Also I was stopped on Lexapro after 20 years. I am also very anemic, on prednisone 10 mg (was on very high dose for 3 months) and have adrenal insufficiency.  The prednisone and adrenal insufficiency have symptoms of their own, and I must taper it separately. Prednisone is def having a huge part and so is the inability to make my own cortisol.

With one long-acting in me seems to carry me through the night, but I feel the withdrawal now after Librium before my evening Ativan dose.

Should I try lower Librium dose to 10 or 15, or is it too much?

Again, thank you!!!!

[[Buddie]]

Perhaps I never did a proper cross-over and being on A-L-A is confusing to my body, especially given pharmacogenomics results.
I'm afraid to replace another A with L.

[[Buddie]]

What sticks out to me in your story is all of the switching, its taking a toll.  It can take weeks for Valium to reach full effectiveness in your body, its long acting which makes it a better choice for tapering than short acting drugs but the down side is, it can take longer to build up to provide coverage while crossing .  The proper way to cross to any benzo is to slowly withdraw your current drug while adding in the new one so you trying one dose at a time was the right way to go but you may not have given the Valium time to reach full effectiveness. 

As for Librium, it looks like you have the equivalency correct but the real problem I see is the constant switching.  Crossing takes time, we can't make judgements about the success off a crossover in a matter of hours or even days, the body doesn't like change, it craves consistency so its important to keep your eye on your goal and suffer through the disruption in hopes things will settle down.  I know this isn't ideal but if the end goal is to be free from dosing 5 and 6 times a day, then its worth it.

Many members mention the depression and sedation they feel on Valium but as they're body acclimates to it, these symptoms lift and they're happy they stuck with it.

I don't know what you should do but whatever it is, I hope you'll give it time to work.

How long ago did you stop the Lexepro, if it was recently I'd suggest holding off on tapering and the same goes for the prednisone, that has been known to cause increased symptoms so I'd sure hold in hopes of stabilizing a bit. 

[[Buddie]]

I don't want to butt in but I just want to mention as well that Prednisone is a steroid and steroids and benzo's should generally not be taken simultaneously. Lots of people have had severe reactions when using both.

[[Buddie]]

[...] and [...]

It is in line with what you were saying, [...]. I felt terrible on Librium but stuck with it, and it got better. Question is better because 25 -> 20 mg, or most likely because my body got used to it.
With Valium I just could not take it, reaction was too adverse.

Steroids definitely play a big role.
Woke up with tachycardia, withdrawal feeling, but that hasn’t happened in a few weeks.
Overall, today I feel terrible and desperate before my mid-day Librium, so it's either prednisone or withdrawal, because I take my Ativan dose at 8 pm.

In the evening I get intrusive thoughts, but it goes away once I take Ativan dose at night.

Do you recommend to now mix in Librium to my remaining Ativan doses and eventually switch to all Librium?

As is:
Ativan 0.75 mg + Librium 20 mg + Ativan 1 mg

To be:
(Ativan 0.55 + Librium 5 mg) + Librium 20 mg + Ativan 1 mg
or
Ativan 0.75 + Librium 20 mg + (Ativan 0.8 mg + Librium 5 mg)

My pharmacogenomics test says I react better to Klonopin, but I read it's too potent and more difficult to taper versus Librium and Ativan, is that so?

I'm so grateful for everyone here trying to help, I don't know what I would do without you

[[Buddie]]

I've not found that members who take Klonopin have any more difficulty than other benzo's, of course, everyone will say theirs is the worst to taper from but lets face it, they're all horrible.  I wouldn't recommend switching at this point, you seem to be acclimating to the Librium for the moment.

If you're comfortable with the Librium then it makes sense to get away from the constant Ativan dosing. 

Tell me about your Librium capsules, are they 10 mg and how are you planning to incorporate them at low doses?

[[Buddie]]

I am totally lost with your situation and I feel so bad to say it.

My personal opinion is no benzo is easier to taper than another. Each one has it's own challenges. (Many people will probably differ from me on this). My gut is telling me since we don't know what is causing your symptoms, I would not introduce another benzo in the mix. So I would not cross over to K. If this doesn't work you're stuck on 3 and that could be really difficult to taper from. BUT, I might be completely wrong. I have very little experience with Ativan and have never helped anyone with Librium. I'm just sharing my thoughts with you and there's nothing to substantiate them.

I think you should trust your gut. I'm terribly sorry I cannot give you more and better advice.   

[[Buddie]]

Tell me about your Librium capsules, are they 10 mg and how are you planning to incorporate them at low doses?

Sorry for not answering right away, been a rough stretch, but things got better during this past week and I got somewhat stable on A+L+A.

• I was also able to switch to all liquid Ativan
• Reduced my morning Ativan dose by 0.05 to 0.7
• Moved Ativan doses closes to each other: 8 am and 8 pm
• Found liquid librium. Could be as low as 1 mg = 1 ml. I ended up getting 2 mg = 1 ml for now. They use olive oil as preservative and it stays potent for a long time.

My current regimen is the following:

• Ativan 0.7 mg at 8 am
• 10 mg Librium at 1:30 pm
• 10 mg Librium at 3:00 pm
• 1 mg Ativan at 8 pm

I'm afraid to go back to all Ativan as I had major tachycardia on it and interdose withdrawal, so I want to try taper like this.

I've read that Ativan doses need to be dropped at the same time, is it true?
What's the best way to drop Librium?
Should I drop more % per interval? 7%? 10%
Should Librium be dropped separately from Ativan?
What to drop last?

I've made my taper journal, would appreciate it so much to hear your ideas and suggestions.
xls: https://we.tl/t-kNLa5ylITf



Thank you!!!