I need help formulating a substitution plan

I have been tapering off Ativan since mid-February, and am considering easing the process with Valium.  So, I would have lowered the dose by .125mg every three weeks, but I'm having severe interdose withdrawal symptoms.  Here is my current daily schedule (it's pretty simple).

 

4pm - .5mg of Ativan

11pm - .5mg of Ativan

 

I've gone from 1.5mg per day to 1mg per day but my body hasn't handled that too well because I may have gone too fast.  I could stretch the two dosage intervals apart some more so that I could take my Valium in between to avoid interdose withdrawal; like the first pill at noon and the second at 11pm or midnight. . . but I don't know if that's advisable. 

 

On a side-note:  Has anyone developed cardiac problems like palpitations when they went through withdrawal? They usually prelude to panic attacks.  I'm hoping that's normal (and that the valium would help with that).  Also, should I make a different thread about that in the "anxiety" forum?  I will be bringing it up with my doctor but I just want to know if anyone else experienced that. 

First, the palpitations are completely normal.  If I remember correctly, they are even mentioned in The Ashton Manual.  As for the substitution, I think that since valium is so long acting, sticking to the 2x/day schedule makes the most sense.  You could substitute on of your .5mg doses with 5mg valium, wait 1-2 weeks to make sure the valium has built up enough to replace the Ativan's effect, then substitute 5mg valium for the other dose.  Some people take valium just once/day so twice/day should work out okay for you.  It will take a while before you feel the effects of the valium substitution so please try to be patient.  I know, easier said than done but sometimes just nowing help is on the way can make the current situation easier to bear. 

I think I made a general plan that I feel like I can go along with safely.  How does this sound?

 

current

5pm - .5mg ativan

11pm - .5mg ativan

 

with valium

3pm - .5mg ativan

7pm - 10mg valium

11pm - .5mg ativan

 

after three weeks

2pm - .5mg ativan

7pm - 10mg valium

11pm - .25mg ativan

after five weeks

2pm - .5mg ativan

7pm - 8mg valium

11pm - .125mg ativan

 

after six weeks

2pm - .5mg ativan

7pm - 4mg valium

11pm 4mg valium

 

...and from there I would follow that kind of schedule until I replace my morning ativan dose too.

Doing your crossover the way you plan will increase your benzo use about 30%, MSW.  Adding 10mg valium while still keeping the two .5mg ativan is not what we (and The Asthon Manual)  would recommend, but rather replacing one of the .5mg ativan doses with 10mg valium, waiting two weeks and then replacing the other dose. 

Ah, got it. 

 

So with valium I'd do:

3pm - .5mg ativan

9pm - 10mg valium

...for two or three weeks. 

 

But what do I do after that?  Do I replace the other .5mg of ativan with 10 more mg of valium or 5mg of valium? 

The approximate equivalency for ativan is .5mg Ativan = 10 mg Valium.  So in the next step you would replace your second Ativan .5 mg dose with another 10mg of valium so you will be on a total of 20mg Valium.  You may find that you need to adjust the amount of valium a little, especially if it makes you very sedated, which is one of it's side effects.  The equivalency is just an approximation and the true equivalency varies somewhat between people because we all metabolize our benzos at different rates. 

Thank you, Beeper!  I really appreciate the help.  I will run all this by my doctor today. 

You could substitute on of your .5mg doses with 5mg valium, wait 1-2 weeks to make sure the valium has built up enough to replace the Ativan's effect, then substitute 5mg valium for the other dose.

 

I'm sorry, but I think I noticed an inconsistency.  Here you said to replace one of the .5mg of Ativan dosages with 5mg of Valium.  So (just for some much-needed reassurance) is .5mg Ativan equal to 5mg or 10mg of Valium?

You are right, I messed up.  The equivalency for Ativan is .5mg Ativan = 5mg valium, not 10mg.  The 10 mg is for .5mg Xanax or Klonopin.  So sorry about that.     (Would you believe me if I told you I was just trying to see if you were paying attention? I didn't think so.)