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Fast titration req from Lorazepam


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I would like some help working out a taper please.  Initially I was on 2.5mg per day (1 tablet) and was on this dose for about 4 months. I cut straight to 1/4 (0.625mg) of a tablet and seem to have stabilised after 7 days.  As I am pregnant I would like to taper off quickly. I think I went through the worst of it when I c/t for 2.5 days then reinstated at 1/4 my usual dose after not coping with the w/d. 

My doctor is not supporting me tapering, so I have about 10 tablets left to work with - she will NOT re-prescribe me Lorazepam, I already asked. 

 

...so how can I use 10 x 2.5 mg tablets to taper off a current dose of 0.625mg in say about 2 weeks?

 

Thanks DJC

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Hi DJC,

 

I don't understand your dosing. As far as I'm aware, Ativan is available in 0.5, 1, & 2mg tablets, but you state that you take 2.5mg tablets.

 

From the sound of it, you have only a ten day supply of tablets - I don't think titration will help for such a fast taper, complicates matters, and you are liable to waste benzo (especially with the method we use).

 

Assuming that you take one tablet per day (whatever its dose), and you have a ten-day supply, you could try tapering by taking 3/4 of a pill for 6 days (4 1/2 pills in total); 1/2 a pill for 7 days (3 1/2 pills in total); and 1/4 of a pill for 8 days (2 pills in total). This is a grand total of 10 pills.

 

This pattern might be better: 3/4 of a pill for 5 days (3 3/4 pills in total); 1/2 a pill for 7 days (3 1/2 pills in total); and 1/4 of a pill for 11 days (2 pills in total). This is a grand total of 10 pills. You are likely to be able to stand a short time of recovery with first cut, but need longer with the last. It also makes the taper longer 23 days, as opposed to 21 day for the first pattern - this is good thing.

 

I have to say though, if your daily dose is really 2.5mg Ativan (1 pill per day - these are highly unusual sized tablets, please double check the dose), tapering off this amount in 23 days is far too fast.

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I see that you are already on a quarter tablet. Can you please confirm the dose of your tablets - I've never heard of 2.5mg Ativan tablets.

 

So, you have forty doses left, not 10 as I mistakenly though - yes?

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Hi There,

 

Yes I can confirm that my tablets of Lorazepam are 2.5mg EACH. I'm in the southern hemisphere, not the US so maybe we do things diferently here. 

 

Yes I am currently stable on 1/4 of a tablet = 0.625mg.  I have 10 x 2.5mg tablets left.

 

Yes if I split them into quarter than I have 40 doses left.

 

Does this make sense?

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Hi,

 

Yes, this all makes sense. I know that some countries have uncommon sizes of benzo pills, but still had not come across 2.5mg tablets of Ativan.

 

Anyway, for how long do you wish the taper to last? For obvious reasons, you will not wish it to go on for too long, but I believe it is the third trimester that is the important one with regard to benzos. Perhaps Eljay will comment? How long have you been pregnant?

 

I've not worked this out properly, but it appears that you have enough pills to make titration work, worthwhile and practical. I will need a time scale though.

 

 

Edit: typos.

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Anyway, how long to wish the taper to last? For obvious reasons, you will not wish it to go on for too long, but I believe it is the third trimester that is the important one with regard to benzos. Perhaps Eljay will comment?

 

Actually each trimester has it's own unique risks, but the main thing is you are tapering off now, and are at a relatively low dose. Most of the risk occurs at high doses. 

It's important to share your current benzo use since conception with your OB though, as he/she is the pregnancy expert.  ;)

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Thaks for your comments. Im ony 3 weeks pregnant.  I want to taper off in about another 3 weeks. Have been able to keep going to work which is great. Apart from a bad 2 days when I cut from 2.5mg to 0.625 i'ts been pretty good this week and I think I am stable.  Probably ready for my next cut?

Thanks

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  Probably ready for my next cut?

Thanks

 

Yes, it sounds like you are ready.  3 weeks is a little bit fast, but I think doable under the circumstances. If it gets too uncomfortable, we can always adjust it to go a bit slower.

 

Colin will fix you up.  ;)

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I will work this up later today with tomorrow as the start date.

 

What is the size of your cylinder and increments marked on the cylinder?

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Hi DJC,

 

I've not heard from you.

 

I'm going to assume you have a 100ml cylinder, marked with 1ml increments. A full titration schedule is not needed for your situation. If th following does not fit your circumstances, just adjust to suit your needs.

 

100ml of liquid (full-fat homogenised milk is better than water), and a quarter of 2.5mg Lorazepam (0.625mg).

 

From the prepared liquid, drink just 93ml on the first day, and reduce the amount by a further 7ml for next four days. On the fifth day, you will be down to drinking just 65ml. On the sixth day, you should start reduce the liquid by just 5ml per day. So, on day six you will drink just 60ml. For the next six days, reduce you dose by a further 5ml. On day twelve, you will be down to just 30ml. On day thirteen, you should reduce your dose by just 3ml, so you will drink just 27ml. Reduce by a further 3ml each day until down to zero.

 

Day1: 93ml;

Day2: 86ml;

Day3: 79ml;

Day4: 72ml

Day5: 65ml;

Day6: 60ml;

Day7: 55ml;

Day8: 50ml;

Day9: 45ml;

Day10: 40ml;

Day11: 35ml;

Day12: 30ml;

Day13: 27ml;

Day14: 24ml;

Day15: 21ml;

Day16: 18ml;

Day17: 15ml;

Day18: 12ml;

Day19: 9ml;

Day20: 6ml;

Day21: 3ml;

Day22: 0ml.

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Hi Colin,

thanks alot for the schedule. I will go and purchase the 100ml cylinder and get started on the schedule you made for me tomorrow night. Have been on 0.3125 mg for 6 nights now and have been up and down - main problem is insomnia, plus some outbursts of anger which is very unlike me. I can only put that down to w/d effects (that's what I told my husband anyway!).

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