Ativan Titration Help, Please

[[Buddie]]

I started tapering 2mg of Ativan (I was on it for about 4 months) with no issues (cut and hold). I was down to .25mg for the past week but experiencing side effects (anxiety, headaches) so I went up to previous dose .375mg. I ordered a scale (Gemini) to slow down the tapering (hasn't arrived yet).

I have not been able to find a step by step guide on how to taper using a scale. Have no clue how to use the scale. Do I crush the pill, shave off, etc? I think I prefer to cut or shave (I think this is referred to as dry cutting?).

 I am running out of the .5 mg pills and only have 2mg left. I am not sure if I will be able to get a prescription for more .5mg. Is it possible to use the 2mg to get to the smaller dosages?

Any help appreciated.

[[Buddie]]

I will help you.

It is better to have 0.5mg pills because dry cutting with a 2mg pills requires smaller and therefore more difficult, tiny cuts and tiny changes are hard for the scale to measure.  But send me a personal message when you get your scale and I will help you with the math for either 0.5 or 2 mg pills.

In the meantime, if you want to try something less complicated and which works well with 2mg pills, you could do a liquid method.  Do you want me to explain it while you wait for your scale?

B

[[Buddie]]

Hi [...],

I understand you have your scale and you want to taper with 0.5mg pills.

Do these steps so I can do your math:
(1) Learn how to tare your scale.  This is just a matter of pressing the tare button so it zeros the scale before you weigh anything.  Try it.  Does it make sense?
(2) Weigh 10 of you 0.5mg pill so we can divide that number by 10 to get the weight of one of your pills.  Tell me that result.
(3) Tell me your current dose (for example, is it 0.375mg)?
(4) Tell me how fast and often you want to taper.  If you don't know, then I suggest 7%.  That is, you taper 7% and then hold for 10 day or until your symptoms are tolerable, whichever is longer.

Bob

[[Buddie]]

(2) 10 of the 0.5mg pills gave me 0.600g (not sure if grams is what I should be measuring in)
(3)  current dose is .5mg
(4) I'm fine with your suggestion of 7% and holding for 10 day

Thank you!

[[Buddie]]

Hi [...],

Please confirm your pill (the one you weighed for me) is a 2mg pill.

Also, when you put just one pill on the scale, does it weigh about 0.06 grams?  How much does it change if you breathe (blow air) on your scale?

Bob

[[Buddie]]

The pills I weighed are .5mg.
1 pill weighs .062 grams
When I blew air on it it went to .065grams
(I then moved the pill a little bit on the plate and it read 0.75grams)

[[Buddie]]

I computed a 7% taper starting at 0.5mg.

After each reduction, wait at l0 days or until your symptoms are tolerable, whichever takes longer.

You will want remove bits from a pill to get it to the weight you need (see table below).
If you are interested, the equation is:
     scale weight in grams = (dose in mg)*(0.062 grams)/(0.5mg)

days   mg dose   grams on your scale
0      0.5          0.062
10     0.465      0.058
20     0.43        0.053
30     0.395      0.049
40     0.36        0.045
50     0.325      0.040
60     0.29        0.036
70     0.255      0.032
80     0.22        0.027
90     0.185      0.023
100   0.15        0.019
110   0.115      0.014
120   0.08        0.010
130   0.045      0.006
140   0.01        0.001

[[Buddie]]

Thank you Bob, you're the best!

When I get towards the end, will the scale be able to weigh the little pieces?

[[Buddie]]

Remember when you blew air on the scale?  The air pressure changed the reading by 0.003 grams. 
Most people are ok with little bits of error but if it is a big problem for you, then when you get below 1/8 of a pill, you can try the method in my signature link where you mix in a powder.  However, only do that as a last resort as it is very time consuming.

[[Buddie]]

Oh ok, I'm sure you'll be hearing from me when I get to that point. Thanks again for all your help!