Help w/lorazepam taper: switching to liquid??

[[Buddie]]

[...],

That makes a lot of sense, thank you for bringing up that point. I will consider this for how I reduce.
I got a script of the oral tabs yesterday and I wonder if it's worth switching over to them, or keeping the sublinguals for the majority of my dosing? Supposedly, the compound pharm said he is using a specific generic to compound, which is what I requested in oral tabs. But if I keep the majority of my dosing to pills, should I keep the same sublingual formula? Or since I am taking the liquid does it warrant the change to the same oral tab both taken as a pill and liquid? Sorry, I hope this makes sense!

I guess it depends on how sensitive you are. You can take a mix of the pills/sublinguals and liquid, that is not a problem. If your goal is to gain consistency across brands due to sensitivity my question would be if you've ever taken a different brand before and how you reacted?

[[Buddie]]

[...],

I agree, probably for the long run, it makes sense to switch over to the oral tabs so that it's similar to the liquid too.
The whole time I've been taking lorazepam, it's always been sublinguals...however there were a few times where I might've been given the wrong format by mistake (non sublingual) and had to use the tablets. I also did some planned psych admissions, where they did give me tablets until I have my own supplies approved.
But most of those crossovers were when I was also taking antidepressants...I always found that the benzo didn't feel so awful when it was paired with other meds. When I was during antidepressant-free periods, I had more challenges, and a few times I was suggested switching to clonazepam or diazepam. Both failed, and when I initially took those new benzos, I knew it wouldn't work because I didn't feel good at all- felt like I was drugged: just drowsy, super foggy, dizzy, head rushes, just super unpleasant. And during times when I was on antidepressants, I actually felt the good things when taking my benzos: being relaxed and calm, at ease, maybe even an increase in motivation and energy. I believe the combo of the drugs did that potentiated action. Part of me wonders how my experience would've been if I tapered the benzo before the antidepressant...Of course, at this stage I am doing everything I can to tell myself not to go back on the antidepressant. It's just interesting how my body reacted, and it really seems to dislike the benzos alone, and now this is what it is!

Anyway, I feel like a transition to the oral tablets is logical since it'll match the generic brand in my liquid. I wonder how gradually I should make this change?
I only have 3 nights left (incl tonight) of my 1mg sublinguals, which I take for my night dose. I have a 7-day supply of my 0.5 sublinguals, which I use for the remainder of the night dose and day doses...so might it make sense to transition the night dose first, especially since that's the dose I will begin reducing? My new oral tabs were just prescribed in 0.5 strength so I guess I can just try to switch to oral at night for now, and then when I'm ready to add the liquid, that'll be more smooth, finish out my day sublinguals and transition those doses to oral too? Does this make sense? Should I hold off on adding the liquid until the formula is entirely switched over?

Also, I really hate this, but since taking my full bedtime dose accidentally last night, I've felt a touch better today and there's a devil on my shoulder wondering if I should go back to my initial dosing (3mg) and restart the full taper :\
Please let me know what you think- really appreciate all the help you've provided so far!

[[Buddie]]

You can use a combination of your pills and sublinguals to taper, as long as you still get the same dose. But some people are extremely sensitive to changes and some doctors do not want to prescribe multiple types of the same medication. So this might be your biggest hurdle - getting multiple prescriptions for the same drug, if you don't switch - I don't know how they do things in Canada. It might be worth it to test and see how you go on the tablet.

If it were me, I would test the oral tablets on a lower dose first. So either your morning or afternoon dose. The reason for this is if you're sensitive and you react to the new brand, you've tested it on a much smaller scale rather than the 1.5mg. You'll then try it on just one of those doses and see how it goes before making a full transition.

I know it's tempting to updose and feel the relief, but if you're not suffering and you are functional I would not recommend updosing. For me, it took 3-4 months at high percentages tapering to get off 0.5mg when I was at a high dose and the last 0.5mg took me more than a year to taper. If it were me, I wouldn't do it unless I'm struggling severely to get through the day because it add months and months to your taper where you could be in recovery. (I'm not against updosing, I've updosed twice myself. But I feel it depends on the circumstances and whether it's worth it). You need to decide whether you're well enough to continue without updosing or if you feel too sick and need this updose to become functional.

[[Buddie]]

I see what you're saying...I feel like touching those smaller doses would be more cumbersome because they're already so small? Before splitting my doses, I was on those two afternoon/evening doses and they were so disproportionate...and I kept lowering the afternoon dose, per my psych's advice. I wonder if it makes sense to leave those because they're already so tiny in comparison to the night.

I also understand what you're saying about trying a reduction with the tablet...I'd have to first get the things I need to do that. Also, judging on how my symptoms would come on after previous reductions, it seems to be ok for 1.5-2 weeks and then things start to get really bad. I guess maybe I would follow a similar timeframe after reducing to see how my body does?

Since I started trying to reduce again in Jan, things have not been stable an I have not been about to function. In the worst of the withdrawals (moments before I decided to updose) it was incredibly unbearable and I was suffering immensely. It was as though I stopped the meds altogether, I was so physically ill all over my body. That's why I've been super scared and trying to get more advice, because it has been an extremely insufferable time. It also concerns me that I feel this intensely sick without being able to cut down.

I really don't want to updose because I feel the guilt from all the advice against doing it...but the reason why I've been wanting to is because I'm unable to cope with how terrible it is and it seems like too much. It's made it really challenging to make any decision, because I'm usually in hyper-survival mode trying to figure out why it's so bad and wanting it to just be manageable. I wonder if holding my lowered dose all these months hurt me in this way, and it's made me terrified to move forward with this. I'm doing my best, because I know I need to get off this to resume any quality of life, but I can't fathom how the next steps down will be if this is already how sick I am. It's just really hard to make decisions like this. I hope this makes sense

Also, I've tried to connect with others in similar positions as me (duration of dose, improper taper) on lorazepam because I keep reading stories of mild to moderate symptomology and I'm struggling to relate the intensity of how sick I'm getting. I understand that all of our experiences are so different, and right now I feel like an alien for how terrible the experience is and I'm struggling to relate (I think needing to feel like others have made through similar severity, or specifically mid-doses of chronic lorazepam use is a trauma response to the health and survival anxiety).

[[Buddie]]

I see what you're saying...I feel like touching those smaller doses would be more cumbersome because they're already so small? Before splitting my doses, I was on those two afternoon/evening doses and they were so disproportionate...and I kept lowering the afternoon dose, per my psych's advice. I wonder if it makes sense to leave those because they're already so tiny in comparison to the night.

I also understand what you're saying about trying a reduction with the tablet...I'd have to first get the things I need to do that. Also, judging on how my symptoms would come on after previous reductions, it seems to be ok for 1.5-2 weeks and then things start to get really bad. I guess maybe I would follow a similar timeframe after reducing to see how my body does?

I am not suggesting you reduce the tablet dose, I'm suggesting you first try switching from sublingual to tablet with the smaller dose. Once you've tried switching one single dose to tablet form, you'll know how your body is reacting to the tablets. Then you can switch the other doses to tablet form as well if you wish. When all your doses are switched to tablet, then you can start reducing.

Updosing should not be about guilt. It's about your physical state and symptoms. Nobody should ever feel 'guilted' into doing or not doing something. I don't know what your physical condition is like so I can't determine that for you. I can only give you my experience if that may help. When I updosed I was so severely sick, I didn't care what anyone thought. The only thing I didn't want to do was make my situation worse. I just wanted to know that it was okay to updose in my specific situation. Once I was told it was okay, I updosed immediately. I felt so sick, I couldn't even wait for my usual dosing time, I took my pills immediately. I needed relief, the suffering was too much. That is how sick I was. You also don't need to be as sick as I was to updose. You might have a gut feeling deep inside what you think you should be doing. If you feel you're struggling too much and it will help you to start from a higher dose, then there's no need to suffer. It is okay to updose. 

[[Buddie]]

Thank you for clarifying- will try first substituting one of the lower daytime doses for the oral tablet. It makes a lot of sense to start that way, then eventually switch them all, and then reduce.

You are definitely right, it is dependent on everyone's individual cases. I apologize if I was pressuring an answer from you! I also appreciate you sharing your experience in doing it and why, and giving this perspective about updosing. Thank you for all your help and prompt replies! I think I have a good plan to start off with, and hopefully this helps me have my feet on the ground better.

[[Buddie]]

Please don't feel like you were pressurising me. We are all just trying to express ourselves the best we can while we're struggling in withdrawal. I was only trying to say it's impossible for me to fully comprehend the severity of your symptoms and therefore it's so difficult to make these judgment calls. The only reference I have is my own experience. As long as you know, here at BB, we don't judge, we don't guilt, we will give you our advice but ultimately support whatever you decide to do.

[[Buddie]]

I am in Toronto. I am taking Sublingual Ativan for short period (around 4month) and low dose.
Currently dose is 0.5mg per day. I will start to typer when transfer from tablets to liquid. First I switched
afternoon dose for a few days, now I am switching morning dose. The pharmacist told me to put
the liquid under tongue for 3mins and swallow. So far I feel ok. I know most pharmacy don't use SL ativan to make liquid. But this pharmacy did. On their website, this pharmacy is only PCAB accredited pharmacy in Canada.

Hi [...],
I sent you a PM regarding specifics about that compound pharmacy. I hope it is ok to chat. Look forward to hearing from you!