*Ativan-capsules-taper plan please help!*

[[Buddie]]

I am so torn on what method to use to start my 0.5mg Ativan taper. Please help!!
I have had a crazy few months not knowing what was going on with me & my symptoms. I had no idea that the Ativan was the issue with inconsistency of my doses and then the decrease in dose. None of the medical professionals I have seen had any explanation for my symptoms other that "extreme depression & anxiety". And now that I have stabilized after updosing to 0.5mg daily they still don't believe that the Ativan caused all of my issues! I can't get anyone to assist with a taper plan because they don't think I need one. I am so frustrated & scared.
These were my symptoms so you can see why I am terrified of a taper that isn't on point:
  0.25-0.5mg inconsistently-depression, heart palpitations, anxiety, irritability, noise sensitivity, decrease in self-care, crying when talking to others, some insomnia
  decreased to 0.25mg daily-all of the above intensified, needed to be around others, tinnitus, bad suicidal ideation, felt that I could not move my body, cognitive deficits, pretty nonfunctional-had to take a medical leave from work. Friends were even encouraging me to voluntarily commit myself to figure out what was wrong with me
  Updosed to 0.5mg Nov 23 & finally feel kinda my normal self as of Dec 18...It took 3 weeks...crazy!

I am sensitive to meds in general so I am nervous after reading everyone's posts! I am scared to change anything with the medication that I have after the crap that I just went through. I have to go back to work in 2 weeks and I have to be very functional to do my job during this entire taper.

I want to trust myself weighing my tablets and making reductions but I do not trust my math or accuracy. I can't seem to wrap my head around the weights and percentages of reductions. How would I get help with this so I don't screw it up? 

Has anyone had experience getting a compounding pharmacy to measure out your pills that you have and put into capsules? Or would they even use your own tablets?

Thank you!

[[Buddie]]

Just so you know, Ativan comes in liquid from from the manufacturer so your doctor could write you a script for that or even one you could take to a compounding pharmacy.  If you want to go the scale route, we can help you with the math and you don’t have to use capsules if you don’t want to, they’re convenient but challenging to make while feeling this way.  https://dailymed.nlm.nih.gov/dailymed/

Keep talking to us, lets figure this out.

[[Buddie]]

Thank you [...]!
I have called around to locate liquid Ativan 2mg/ml and it seems to be hard to find, most say it is backordered? I will keep calling around. I have seen a few posts where some have had an issue switching to liquid from pills? I am so med sensitive that this scares me, but do you think this is a better choice that cutting my pills and weighing them?
If I do weigh them out and don't use capsules, how would I keep up with the med? Like do you make up several doses at a time and store them somehow to use for the week or something?

[[Buddie]]

Hello, [...].

Tip of the hat for providing a clear, concise, and complete summary of your medication history in your signature!  This makes it much easier for other members to provide suggestions and support.

I haven’t read about members who are making their own lorazepam capsules.  However, we do have several currently active members who are using the ‘pill-shaving/weighing’ technique to obtain the doses they need. I hope one or more of them will stop by to provide input.

We also have a member who documented how he made his own do-it-yourself clonazepam capsules (see link below).

While we’re waiting, here are other steps you can take to prepare for your taper.  [...] has already given you a ‘leg up’ on the first one.

(1) What dosage forms of your benzodiazepine are available in your country?  As [...] has noted, in the US, an FDA-approved concentrated 2mg/mL oral solution of lorazepam is available (see link to one of the manufacturers below).  We have members who dilute this concentrate with water to achieve a lower concentration liquid; this in turn allows them to make smaller reductions in dose.

We also have members who are using compounded oral liquids and can share formulations if you’re interested. 

I have not personally read about members who have used compounded lorazepam capsules but I do know we have members who have used compounded clonazepam capsules.

(2) You have indicated you are taking lorazepam twice a day.  Are you experiencing any signs of interdose withdrawal (i.e., do your withdrawal symptoms increase as the time of your next dose approaches)?  If so, we can discuss ways to address this.

(3) Are you up-to-speed on basic tapering principles?  If not, see Section 3 of the Colorado Consortium’s Benzodiazepine Deprescribing Guidance Document linked below.

(4) Are you planning to do a symptom-based taper?  If so …

(4.1) What reduction amount (percent reduction of your current total daily dose) do you wish to try for your first reduction? 

(4.2) What reduction interval do you wish to try? 

The goal is to allow sufficient time for withdrawal symptoms to emerge, peak, and stabilize after a reduction.  If you don’t already have an idea of what interval to try, one approach to obtaining an initial estimate is to use the elimination half-life of the drug you are tapering.  For example, for a drug with an elimination half-life of between 20 to 40 hours, you would reduce your dose then hold at the new, reduced dose for 1 to 2 weeks to allow sufficient time to assess your response to the reduction.

Links:

DailyMed - LORAZEPAM solution, concentrate
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5ff82103-cc57-4af9-9362-82a7c686271d

Benzo Dry Taper Math
https://benzodrytapermath.com/

Benzodiazepine Deprescribing Guidance Document (2022)
https://corxconsortium.org/wp-content/uploads/Benzo-Deprescribing.pdf

[[Buddie]]

[...] thank you for taking the time to give me all the info & for responding!!
1. I am still in the process of trying to find the liquid ativan 2mg/ml, most pharmacies have it on backordered. (1) What dosage forms of your benzodiazepine are available in your country?  As [...] has noted, in the US, an FDA-approved concentrated 2mg/mL oral solution of lorazepam is available (see link to one of the manufacturers below).  We have members who dilute this concentrate with water to achieve a lower concentration liquid; this in turn allows them to make smaller reductions in dose.  I am still in the process of trying to find the liquid ativan 2mg/ml, most pharmacies have it on backordered.

We also have members who are using compounded oral liquids and can share formulations if you’re interested. I have to go to the compounding pharmacy and ask the pharmacist about this & the pills. When I called today, they said they do not compound Ativan, they didn't have a good reason why so I am going to go there and talk to them.

I have not personally read about members who have used compounded lorazepam capsules but I do know we have members who have used compounded clonazepam capsules.

(2) You have indicated you are taking lorazepam twice a day.  Are you experiencing any signs of interdose withdrawal (i.e., do your withdrawal symptoms increase as the time of your next dose approaches)?  If so, we can discuss ways to address this. I have been trying to pay attention a few hours before my dose is due for several days and I do not notice any symptoms so far.

(3) Are you up-to-speed on basic tapering principles?  If not, see Section 3 of the Colorado Consortium’s Benzodiazepine Deprescribing Guidance Document linked below. Thank you for providing the link!

(4) Are you planning to do a symptom-based taper?  If so … I guess so. The symptoms scare me, I think I am seriously scarred from what I just experienced.

(4.1) What reduction amount (percent reduction of your current total daily dose) do you wish to try for your first reduction? I was thinking 5%?

(4.2) What reduction interval do you wish to try? Should I do 5% for the first 2 weeks or for the full month? I don't want to drag things out, but like I said, I have to remain very functional to work and I work night shift so that will put a spin on whatever I do because I will have to figure also concentrate on sleeping during the day some. I am willing to go as slow as I need to so that I can hopefully have as little issues as possible.

[[Buddie]]

Lest we put the cart before the horse …

Would your doctor willing to prescribe either the lorazepam concentrate or a lorazepam compound (e.g. capsules or a liquid) if you decide to pursue one of these options?

Re: the pharmacy that told you they do not compound lorazepam ….

Not all pharmacies do compounding.  Here’s a link with suggestions on how to find a compounding pharmacy:

https://www.wikihow.health/Find-a-Compounding-Pharmacy

[[Buddie]]

Hello again, [...].

My apologies for the abbreviated response to your post last night.  It was getting past my bedtime.

It sounds like you are not experiencing interdose withdrawal on your current daily dosing schedule. 

A symptom-based taper simply means using your symptoms to guide your taper.  Indeed, you were using a symptom-based approach when you paid attention to how you were feeling in between doses.

The goal of a symptom-based taper is twofold.  First, to keep withdrawal symptoms tolerable. Second, to enable you to perform essential tasks (these vary by individual, in your case, one of those tasks is to remain functional in your night shift work).

Given your case history, your decision to trial a reduction of 5% or less is a sound one.

Re: your question about what reduction interval to try …

Discovering your unique symptom pattern (i.e. how long it takes for withdrawal symptoms to emerge, peak, and stabilize after a reduction) will require self-experimentation on your part.  If you have not already done so, I encourage you to start keeping a daily taper log; I also encourage you to review the data in your log on a regular basis to determine if you need to make adjustments in your taper plan.

One option to consider would be to make a 2.5% reduction, then hold for 2 weeks.  If your withdrawal symptoms are stable at that point (stable does not mean the complete absence of symptoms but rather symptoms have stopped changing in number and nature and are tolerable), you could make another 2.5% reduction.  If your symptoms are not stable after 2 weeks, you could continue holding until they are.

Let me close by asking if you have discovered our support group for members who are tapering Ativan/lorazepam?  You are welcome to post any questions you have there.  Reading through past posts and reviewing member signatures can also be helpful.  Here’s the link:

Tapering off Ativan Support Thread
http://www.benzobuddies.org/forum/index.php?topic=44903.0