Scared, Please help

[[Buddie]]

That’s unfortunate that a commercial lorazepam liquid is not available in your country.  Yes, the pharmacokinetics (e.g. absorption, metabolism) of the sublingual lorazepam formulation may indeed be different than those of regular tablets.  This is why I suggested you may need a different dose or dosing schedule if you switch dosage forms.

If you find yourself in need of a different prescriber, one of our other Canadian members recently posted about RAAM clinics at:

http://www.benzobuddies.org/forum/index.php?topic=275250.msg3436239#msg3436239

[[Buddie]]

Thank you very much for those informations. really appreciate your help !

[[Buddie]]

You’re most welcome!

[[Buddie]]

Hi, [...] and [...]
  you two have been very supportive - I appreciate it so much.I think recently my symptoms getting worse due to interdose withdrawal. Since yesterday I started to take twice 0.25mg Ativan(morning and evening) but still not effective as before I only took 0.25mg or 0.5mg by once per day. today I am going to take 3 times 0.25mg. I have already taken morning and afternoon doses, but still not feeling well.  I am so scared that I am also getting tolenenc as well. Normally how long does it take to stablelize? Do I need to switch to another long half life drug which I really don't want to. All of this make me really panic. Thank you!  Also I went to ER of mental hospital another day, the Psychiatrist didn't believe all my symptoms was caused by Ativan interdose withdrawal. It's so desperate to feel hopness.  Sorry for my English

[[Buddie]]

Your English is just fine, no worries, okay?

It’s very common to encounter those in the medical profession who don’t acknowledge our situation, try not to take it personally or be discouraged, this is why we’re here.  Most will use their doctors as prescribers only, they get the medication from the doctor but they taper on their own.

We have many members tapering directly from Ativan but some have had to make the cross to Valium or Clonazepam.  it’s challenging to cross to another benzo but interdose withdrawal makes it just too difficult to taper.  I’d give the 3 times a day dosing a few days to see if you can level out before giving up.

Our of curiosity, do you have a doctor who would be willing to cross you to a longer acting benzo?

[[Buddie]]

Thank you for your reply. I have a  Psychiatrist, but I need to wait 3 weeks to see him. He doesn't believe typing. I don't know if he is willing to change the drug. Even he does, I don't know if he can give good cross typing schedule.He told me as soon as I felt better, I can stop right way. I have already increased my dose from 0.25mg once per day to 3 times per day. but didn't feel much  effective.  The tolerance is mean I need to increase dose again? If I do need to increase,  Do I risk kindling?  I have learned so many from the forum. By the way , which drug you will recommend? Thank!

[[Buddie]]

If your doctor doesn’t think tapering is necessary then I doubt he’ll be willing to cross you over to a longer acting benzo like Valium/Diazepam or Klonopin/Clonazepam.

How bad are your symptoms, are you functional, are you able to perform your daily tasks? This is our definition of stable, it doesn’t mean feeling good, it means functional.  The reason I ask is because you may be at the point we say you’re stable enough to begin your taper.  You may not be stable but I thought I’d mention it.

It concerns me you’re increasing your dose, will your doctor keep filling your prescription if you’re taking more than he instructed?

I’m not worried about kindling, it applies to those who have completely ceased benzo’s then start taking them again.

[[Buddie]]

Hi, [...]
 Thank you for your reply. The past week my symptoms is bad, couldn't sleep, constantly had palpitations and chest pain. Currently I am not working, but still feel pretty tough every day.  The psychiatrist prescribed enough pills for me and asked me to take it 0.5mg twice per day until sertraline kicked in and I can stop without typing. He told me not to worry about dependence because the low dose and short period using and I believed him(biggest mistake in my life).  I only take 0.25mg -0.5mg per day.( During past 2 months, I didn't take every day, some time without taking it for 3-7days ).

3 weeks ago,  sertraline kicked in, I felt much better, then I stopped taking Ativan for 7 days without any problems. After that I started to feel intense physical symptoms creeping back and I started to take Ativan again. Still 0.25-0.5mg per day. But condition is getting worse. I started to suspect my Ativan using.  I went to ER to see another Psychiatrist, I was told it's nothing to do with Ativan, it's my anxiety.

I was so desperate to search answers online, finally I found BB. org and your guys are very kind and knowledgeable . Now I realized I have interdose withdrawal. I changed my dose from 0.25mg or 0.5mg once per day to twice 0.25mg per day Wednesday and yesterday 0.25mg 3 times per day. Last night  I could sleep. This morning I feel a little better. I hope the condition is more stable, then I can start to typering. I feel so bad to dragged my family down and scar unknown future.
 
Regarding the kindling, because I took Ativan so irregular, sometimes without taking for 7or 10, I am afraid which could cause kindling.

[[Buddie]]

It sounds like 0.25mg three times a day may be a good starting point for your taper.  I suggest you hold at that dose and dosing schedule for several days to allow time for blood serum concentration to reach steady state.  According to StatPearls (link below), lorazepam has an elimination half-life of 14±5 hours.  This means it can take from 3 to 5 days to reach steady state.

Will your current prescriber support you in stabilizing at this dose and dosing schedule?  Will your prescriber support you in implementing a gradual, symptom-based taper?

If not, is working with a RAAM clinic an option?

Link:
Lorazepam
https://www.statpearls.com/ArticleLibrary/viewarticle/24422

[[Buddie]]

 Thank you [...]
  I don't think I will get any support from any Dr here. I just spoke to my family doctor, he told me I don't need typing due to low dose and short term using. He told me take 0.5mg at night every another day for 1-2 weeks, then I can stop. I am so disappointed those drs. I think I have to do it by my own.
 My main problem is that the sublingual is so tiny to cut, I don't know if I can switch to oral tablets. I am very sensitive to medication, I afraid the different form may affect the effective.
 I have contact RAAM clinic , still waiting them to make appointment