tapering

been on Ativan 9 weeks now. Take .50mg per day( .25 morning .25 afternoon) Tried to get off it, doesnt work. How should I taper off such a small amount compared to others taking alot more. Hate the way it feels. Chest pains and stomach.Very tired the first couple of hours even at .25mg at a time.Please help

Hi sv66,

 

I'm sorry to hear that toy are having such a bad time. You are doing the right thing by quitting sooner rather than later though.

 

What size (dose) are you tablets? This affects what can be done.

The dose is a .50 mg tablet. I take .25 mg morning then .25 in afternoon. Need help off it. Whats a safe plan?

Hi,

 

I think that is the smallest Ativan tablet available. You are unlikely to be able to split the pills any smaller than into quarters. If this is the route you decide to take, then in your shoes I'd cut by 1/4 of the tablet, so that I was taking 0.375mg per day (3/4 of a tablet). Rather than take a quarter of one tablet for one daily dose, and half a tablet for the other dose, I'd instead take three doses of a 1/4 tablet over the day (8 hours apart). However, a better option is to make up a liquid from your daily pill, and remove just a small fraction from your daily dose. We can much better tolerate these small cuts, and consequently are usually able to make frequent cuts to compenate for the small reductions. We refer to this as 'titration'. If you are interested, we will post you some instructions.

Yes please. I see a specialist in anxiety in 2 weeks about this. My regular doctor is the one who prescribed( he doesn't understand what I'm going through). This is better than the valium cross over? I don't want to do that if  I don't have to.

Hi,

 

All we do is make suggestions, it is for you to decide what's the best option for you. A lot of doctors (especially in the USA) are very reluctant to prescribe Valium in the mistaken belief that it's worse than other benzos. Titration is something they might more easily accept, but of course you don't even need to tell them about it. I'm not suggesting that you don't discuss your withdrawal with your doctor, but if you use titration to make the withdrawal process smoother, this should be of little concern to them.

 

Sorry, I'll get back to you tomorrow about your titration schedule, or someone else might help in the meantime.

Hi, sv66,

 

I'm posting instructions for the titration. Please don't start until someone else has posted and has checked my math.

 

These are instructions specifically tailored to you. Other people's instructions will vary.

 

You will need a 100ml graduated cylinder marked at 1ml intervals; a supply of little covered jars; a 10ml syringe marked at .2ml intervals (optional); a stirring rod (a butter knife will substitute); and a daily supply of homogenised milk.

 

1. Crush one of your tablets in a jar with the back of a spoon.

 

2. Add a little HOMOGENIZED milk (the amount is not important, but it MUST be homogenized), and swirl it around to dissolve the benzo. Let this sit for a few minutes to be sure the benzo is completely dissolved, then swirl around again.

 

3. Add this mixture to the 100ml cylinder.

 

4. Add a little more milk to the jar, stir, and again empty into the cylinder. This is to make sure all of the benzo gets transferred to the cylinder.

 

5. Add more milk to the cylinder to bring the amount up to 70 ml. Mix well with either a stirring rod or a butter knife.

 

6. Dispose of 1ml of the benzo liquid every 2 days.

 

7. Divide the liquid up into two or three equal (or more) parts to take during the day. You can keep the doses in little covered jars in the fridge.

 

8. When you are done, be sure to rinse everything (cylinder and syringes) thoroughly since milk is perishable.

 

 

General Options & Tips

 

a. After step 5, if your solution in the cylinder(volume) measures 50 ml or less, double the amount by adding more milk and then cut twice as much (i.e., cut 2ml for each 1ml). If the amount measures 33ml or less, triple the amount by adding more milk and then cut three times as much (i.e., cut 3ml for each 1ml). This will make cutting and measuring the amounts for individual doses easier, and increase accuracy.

 

b. After step 6, before you divide up your solution into equal parts, add a little extra milk to the cylinder to make the amount nicely divisible by 2 or 3 (or however many doses you take a day). For example, if you have 29 ml of solution and wish to divide it into three doses, you could add an extra 1 ml of milk to the cylinder to bring the solution up to 30 ml, which is easily divisible by 3. Mix well after adding the extra milk.

 

c. To fine-tune the amount of milk you add to the cylinder, to bring it up to exactly the volume desired, simply draw some milk into the syringe and slowly add to the cylinder until you reach the specified amount.

 

d. To fine-tune the amount of benzo solution you are cutting for the day, pour the liquid into a fresh jar until left with a little less in the cylinder than you need. Simply draw some of the liquid from the jar into your syringe and slowly add to the cylinder until you reach the specified amount.

 

e. To measure out your dose if you are cutting a very large amount (for example, if you are throwing out 66ml of a 69ml solution) it would be easier to measure 3ml (with your syringe), consider this your dose for the day, and dispose of the remaining 66ml from the cylinder.

 

sv66,

 

If the titration sounds too difficult for you, you could try just dissolving your tablet in a certain amount of milk and then making a cut every two weeks or so. For instance, if you wanted to make a cut of 1/8 of your dose, you could dissolve the Ativan tablet in 1/2 cup of milk. 1/2 cup = 8 tablespoons. If you cut 1 tablespoon of your dose, that would be like cutting 1/8 of the tablet.

 

To be honest, some doctors are going to laugh at titration too. But if you find one who is keen on the idea, see if she/he will write you a prescription for a tailor-made liquid from a *compounding pharmacy*. A compounding pharmacy could take the doctor's prescription for Ativan and make it into a liquid (you have to have a doctor's instructions to do this, however; the pharmacist won't just do it if a patient asks). You could get a solution of, say, 1 mg Ativan in 20 ml liquid. Then you could cut a tiny bit of this every day instead of making your own liquid (we could help you with the amounts on that too--in general, we recommend cutting no more than 10% of your dose every two weeks). It woud be easier than making your own.

Hi sv66,

 

Therese's schedule is pretty slow; you might be able to speed it up. It isd a cse of trial and error, especially as you have taper history to base your taper rate upon. If the first few cuts go swimmingly, then you could try making the 1ml cut every day. However, you'll probably find that you will need to drop back to cuts every other day towards the end of you taper as ech 1ml cut will account for a larger-and-larger amount of your then dosage.

 

Effectively, this technique is fine pill-splitting. Therese's figures mean that you will be cutting 1/70 of your pill every two days - it really is that simple.

honestly, I've only been on .25 to .50 Mg a day for 9 weeks. Doctors say just take it when I need it. What do you think? I see a specialist in two weeks that deals with anxiety an medicine management.

The fact that you find it difficult to quit suggest dependency. Still, you have been on Ativan for a relatively short time, so you may be able to taper off fairly quickly, but there really is now way of knowing before you try. Start off slowly and see how it goes. Therese's suggestion using tablespoons might well offer steps small enough for you. You could try it, and if it is still too tough, use the measuring cylinder for even smaller cuts.

sv66,

 

You can be dependent on Ativan after only 9 weeks. As Colin said, the fact that you're having problems when you try to cut back suggests dependency.

 

The rate at which you can cut is very individual. But it does take a long time to get off these drugs once you are dependent.