Getting help planning Ativan taper

Greetings! 4 weeks ago I was prescribed Ativan at the Er to manage panic attacks associated with chest pain. All of my tests and labs are good and I have no physical health issues. But I was encouraged to keep taking the Ativan to manage anxiety for 3-4 weeks until I could determine which SSRI would work for me (I did a genetic test and needed to wait on results).

 

Well taking Ativan nightly 0.5mg to 1mg for 3 weeks was a big mistake. I am very sensitive to meds and I became physically dependent without even understanding what was happening to me. I was also experiencing interdose withdrawal symptoms during the day. A week and a half ago I quit cold turkey thinking that was ok. It was not. Terrible withdrawal. Finally figured out what was going on and dr put me back on Ativan 0.5mg twice a day and said I’ll need to do a taper. I feel like she wants to do a fast one and I think that’s a bad idea. I am still experiencing interdose withdrawals in the late morning and early evening. I’m very scared about this whole thing and want to be off this drug but do it safely, and I need a safe tapering timeline that goes slow because I’m so sensitive.

 

Can anyone help me plot out what that timeline looks like? I reinstated Ativan this past Sunday, so two days ago, taking 0.5mg around 12:30p and 0.5mg around 9p. It seems to be going ok, tho I wake up very jittery and experience a lot of anxiety for an hour or two. Then I’m ok for two hours, then experiencing mild anxiety and general brain fog and nervousness and some headache until my noon dose.

 

Thoughts on a taper schedule?

As it's only been two days since reinstatement I would recommend you hold your current dose for at least 2 weeks to give your body time to adjust and stabilize. I know you also mentioned splitting your doses in four - so if you would still like to attempt that, I think now would be a good time while you're still recovering from the reinstatement.

 

In the meantime we can plan your taper. I don't recommend a "taper schedule" as such where we plan the rest of taper until you're finished. I'd rather recommend we plan the next four cuts for example and then revise it based on your symptoms. People tend to get fixated on a schedule and ignore their symptoms and then they get into trouble. I suggest you start keeping a daily journal where you list your dose, your symptoms and you rate all your symptoms on a scale of 1-10. This should then give you an idea if your taper rate is working for you. If your symptoms change or the severity increases it's usually an indication you should adjust your taper.

 

To start I would suggest a reduction between 5 - 7.5%. My suggestion is based on the fact that you said you are very sensitive and you want to go slow. This is the lower end of the scale. If you can let us know at what percentage you want to taper, we can help. You would take your total daily dose 1.0 - % = ? . For example 1.0 - 7.5% = 0.925 which we can round to 0.93. It means from one of your doses you need to cut 0.07mg (1mg - 0.93 = 0.07). Most people seem to also try and keep their doses mostly even - so they'll do a couple of cuts from one dose and then switch to tapering the other dose, or alternate their cutting between doses.

 

Now you need to decide how you want to taper. Many people start by dry cutting and shaving and weighing their tablets. Have you decided on a method yet? If not I suggest you take some time to read through the threads on the tapering boards and see if there's any method you think you'll be most comfortable with.

 

It might also be helpful to look at our support group for people getting off Ativan: Ativan Tapering Thread

Thank you so much!!

 

I would like to spread 0.25mg out over four doses — what would the timing look like? I generally sleep 10-5 and then fall back asleep and get out of bed at 7. I am struggling with feeling very jittery when I wake up like I have had 5 cups of coffee, yet still tired. It’s a strange feeling. Please advise on timing of four doses.

 

Second, I have 1mg tablets that can work for next two weeks but my dr said she can provide liquid. I’d like to do the liquid instead of dry cut. Where do I get a syringe that can do such small doses?

 

Let’s try 7.5% taper?

Hello, imp0526.

 

Jelly baby has hit the proverbial nail on the head regarding the futility (and risk) of trying to plan a taper from start to finish. One of the keys to a successful taper is recognizing that taper plans are living documents — they must be monitored and adjusted on a regular basis depending on how the individual responds to reductions.

 

That’s good news that your doctor is willing to prescribe the oral lorazepam solution.  In the US, it’s available from several different packagers/manufacturers.  If I were in your shoes, I would ask her to prescribe the one distributed by West-Ward.  Per its official FDA Drug Label (see link below):

 

Lorazepam Intensol™ Oral Concentrate USP

The 2 mg per mL oral concentrate is supplied as a clear colorless solution.

NDC 0054-3532-44: Bottle of 30 mL with calibrated syringe (graduations 0.05 mL on the syringe).

 

As you can see, a calibrated oral syringe is included with the medicine.  However, to make smaller reductions in dose, some members make a do-it-yourself (DIY) liquid by mixing the lorazepam concentrate with distilled water and then measuring their dose(s) from the diluted liquid.

 

To use a diluted DIY liquid, you will need oral syringe(s) with the appropriate capacities and graduations. If you wish to learn more about this topic, I’ve included a link below to a video from the Dana-Fabre Cancer Institute.

 

To increase the likelihood of getting accurate measurements, you’ll want to invest in high-quality oral syringes, preferably ones that meet ISO standards.  Two examples are:

 

(1) Medisca PreciseDose oral syringes — sold only to compounding pharmacies; you could ask your pharmacist if s/he would be willing to order these for you and/or could refer you to a compounding pharmacy that could do so

 

(2) BD — available from medical supply companies such as Vitality Medical, see link below

 

We also have members who use BAXA ExactaMed Oral Liquid Medication Syringes, available on Amazon.  I do not know if these are ISO certified.

 

Links:

 

DailyMed - LORAZEPAM solution, concentrate- West-Ward

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5ff82103-cc57-4af9-9362-82a7c686271d

 

Using the Right Liquid Oral Syringe and Giving the Correct Amount

 

Oral Medicine Syringes | Vitality Medical

https://www.vitalitymedical.com/oral-syringe.html

 

 

Definitely don’t want to go too fast or stick to a hard schedule. Just want a loose idea of what to do over say the next month. Will try tomorrow to spread 0.25 mg over the day versus 0.5mg twice a day, but wondering what time I do those four doses…

If you have not already done so, I suggest you read through past posts and/or ask your question about dosing times on the Tapering Ativan Thread jelly baby provided earlier.  Some members also include their dosing schedules in their signatures.

 

Speaking of signatures, to help us help you, please consider adding one to your profile.  Here are the instructions:

 

Add your history/signature

 

Whatever you decide to do, I suggest you do it gradually.

 

ADDENDUM:

 

You can find past posts on this topic by entering the following search string in your search engine (e.g. Google, Bing, Duck Duck Go):

 

site:benzobuddies.org splitting doses Ativan lorazepam

 

Thanks so much for weighing in on this thread and the valuable information Libertas.

 

imp0526, I only dose once a day and I'm on a different benzo than you so I think when it comes to dosing times it would be best to ask the folks with first hand experience on the Ativan thread, like Libertas suggested.

 

It looks like we've made some real progress on how to proceed with your taper. Once you get the liquid we can help you with the maths. Just keep in mind some people are sensitive to switching over to liquid so we always recommend switching first for a couple of days before making any cuts.