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Need help for ativan taper


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I would appreciate advice on tapering  Ativan. I'm down to .25mg twice per day. I cut the pills. Anyway, I was going to taper the 2nd dose down to .125mg today but am already feeling horrible. Although nothing new about that in this whole process for me. Shaky, sweating, constantly worried about my health and symptoms, 24/7 fear/anxiety and just feeling rotten. I'm just not sure that any of that will change even if I wait. I know I never should up my dose but should I taper down now? What do you think? Thanks.
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Hi ELENA777 :smitten:

 

To be able to assist you, may I ask a few questions please?

- At what dose did you start your taper journey?

- How long did it take to arrive to the current 2 x 0.25 mg/day?

- What quantity was this last cut?

- Did your symptoms arrive with this last cut or were they there even before following previous cuts?

- Did you use a pill splitter and cut a 0.5 mg pill to 4 equal parts?

- At what time of the day do you take these 2 x 0.25 mg Ativan?

- Is there any reason why you prefer to taper the 2nd dose first?

 

Hope I do not disappoint you with so many questions.

 

Have a good start!

 

:hug:

 

PS: If you can update your signature with the history of your benzo journey, it will help other buddies to provide their viewpoint.

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Hi Jim, Thanks for your reply and taking the time. I have been on Ativan for over 6 years. I used to always take .5mg at night to sleep but over the years it ended up increasing to 1.5 to 2mg per day. Although the higher dose was not even helping my anxiety anymore.

I haven't been keeping a good record of my progress but i think i started tapering at the end of April or perhaps even mid May. I was making cuts this whole time with a pill splitter. 1 mg pills are cut into fourths and sometimes the .25mg piece I have split also.

My symptoms have been there since I began taper. Maybe because of tolerance or the interdose withdrawal I've heard mentioned. Although the shakiness and sweating seem worse now.

I take .25mg at around 9:30am and then 9:30pm everyday. It's been about 2  1/2 weeks at this dose.

No real preference of what dose to taper first since I'm not really sure what's best.

I hope I've provided the needed information.  Please let me know what you think. Also, what should be included in the signature and how do I update,that? Thanks!

 

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Hi Elena :smitten:

 

I'll try to answer point by point.

 

Although the higher dose was not even helping my anxiety anymore.

After a few months/years of regular use benzos lose much of their efficacy because of the development of tolerance. It is normal and your body is just having a progressively reduced level of reaction to the drug after repeated exposure to it.

 

1 mg pills are cut into fourths and sometimes the .25mg piece I have split also.

This is what I did too :D. Before I realized my error and switched to liquid benzo medication. When you cut a quarter, it's perhaps too much. Have a look here: http://www.benzobuddies.org/forum/index.php?topic=204178.0

 

I take .25mg at around 9:30am and then 9:30pm everyday.

Lorazepam is known as having short half-life elimination (12 hours). It is possible that what you are experiencing is a mixture of withdrawal due to tolerance and inter-dose withdrawal.

 

I think you can find some answers to your case with this thread: http://www.benzobuddies.org/forum/index.php?topic=204598.20

 

If questions, please ask.

 

:hug:

 

 

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Hi Jim,

Wow, you're very knowledgeable in this and kind to help others. I read the posts you linked to. I will say that it looks like I should be liquid dosing but it seems pretty confusing. I really have no idea how to go about it. How much and how often to dose? How to make the liquid mixture? Also, I am wondering if I need to hold for now or quickly figure out how to change what I'm doing. I know I don't seem to be doing very well right now.  :(

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Hi Elena :smitten:

 

I should be liquid dosing but it seems pretty confusing

That too frightened me a lot at the beginning from its alien name :D. Have a look here: http://benzo.alwaysdata.net/ . Go to the Help section first and make sure no questions remain unanswered.

 

I am wondering if I need to hold for now or quickly figure out how to change what I'm doing

A number of things will need to be fine tuned before you can start to taper in an informed manner. They will come up and we can discuss them as they arrive. Meanwhile here is what many buddies suggest: hold and wait until the storm passes. It will pass if you give your body the time it needs to make physical/chemical adjustments so it can get back to what it perceives as "normal".

 

Wish you a good start and a smooth journey towards a full recovery!

 

:hug:

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Hi Jim,

Okay, I'll hold. I guess the amount of time to stabilize is different for everyone so I'll hold on to the thought that the storm will pass. I'm hoping I'll have more questions later. Thank you for helping.

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Hi Elena :smitten:

 

Waiting to be ready for the first reduction, we can perhaps think to minimize meanwhile the inter-dose withdrawal while maintaining the same daily quantity. Instead of 2 x 0.25 mg, what if we manage to have 4 doses of 0.125 mg each thoughtfully distributed across 24 hours? For instance 7:00 AM, 12:00 PM, 5:00 PM, 11:00 PM leaving the longest interval of 8 hours in the night when you sleep and where we might expect less symptoms?

 

By going through this BB you will read about buddies in your same situation trying various methods to taper off Lorazepam. There are buddies who cross-over to Valium to benefit from the long half-life elimination of Diazepam. Others just directly dried cut. Many preferred to cut a good portion and hold. Many others went for micro taper where they reduced a tiny portion of benzo each day. Others preferred liquid taper. Evaluate them all and make sure you understand the pros and cons of each method.

 

As for accuracy of the doses, many use a pill splitter to cut a tablet to quarters. Others reduce a few tablets to powder and weigh out the needed quantity by means of a precision gram scale (0.001 g). Others separated like with coke lines the powder to several lines by eyeballing. Others use a nail file to scrape away the unused quantity (1 scrape today, 2 scrape tomorrow, 3 scrapes...). Amongst them the Liquid taper method appears to offer highest accuracy.

 

Hope it helps in your research.

 

:hug:

 

 

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Hi Jim,

I just wanted to say again how grateful I am for your help. I am immediately going to switch to 4 doses of 0.125mg per day as you suggested. So far, all I've done is use a pill splitter to hopefully get the pieces about right. It is easy for me to start to feel that nothing will help so now I have the start of a plan and some hope. If it is okay I would appreciate your continued input about my taper situation. Thanks so much!  :)

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Hi Elena :smitten:

 

going to switch to 4 doses of 0.125mg per day

As it requires splitting your 1 mg tablet to 8 equal parts, how are you going to achieve it? Do you have everything ready to go with solution?

 

:hug:

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Hello Jim,

Oh, should I start the solution as soon as possible while still holding? I was not sure about that and no I have nothing ready. Today I started the .125mg 4x per day but am still just trying to use a pill splitter which you know from experience is not easy to get the pieces exact. Since I really don't know how to proceed, would you advise me about the steps to make the solution and the supplies needed? Yesterday,  I did order a 1ml syringe and a small, inexpensive digital scale which I'm not really sure I needed. Still trying to figure this all out. I want to feel better again. Thank you.  :)

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Hi Elena :smitten:

 

Normally you don't need a gram scale when you liquid taper.

 

How to proceed with your first batch of benzo solution:

 

1.  tools

- syringes in 2 sizes:

  . 1 ml with 50 or 100 divisions

  . 10 ml with 50 or 100 divisions

If available in both 50 and 100 divisions, take the 100 divisions. Could be found on Amazon or local pharmacies. The 1 ml syringe will be essential when doses are small.

https://imgur.com/IjVB0G1

- A glass storage jar with a lid (re-purposed jelly, salad dressing, pickle/olive etc...). The jar and the lid must be kept very clean during the course of the taper to avoid contamination to the solution. It must not be too large for preservation purpose but not to small when needed to be thoroughly washed.

- Vodka 40% alcohol (80 proof) found at any liquor store

 

2. Solution preparation:

- Put 2 x 1 mg tablets of Ativan in the above empty jar. The solution will suffice for 4 days in your case.

- Use the 1 ml syringe to draw up 4 ml of Vodka and inject in the same jar. Wait 10-15 minutes. Stir from time to time if needed (normally not needed). There will be minuscule particles left at the bottom. They are excipients (coating, disintegrator, binder, filler...) and not main ingredient. Just stir before drawing up the dose. Some buddies split the tablet in small parts before, some others reduce the tablets to powder first. They are useful but not required.

- When the tablets are completely dissolved in Vodka, use the 10 ml syringe to draw up 196 ml of tap water and add to the jar

You now have a volume of 200 ml of solution with 0.01 mg/ml of benzo concentration. Keep the solution away from direct sunlight. Refrigeration is not needed but does not harm.

 

3. Take your doses:

During the hold period you will be taking 4 doses of 0.125 mg per day. Each dose will be provided by 12.5 ml of solution that you will draw up and drink by using both 10 ml and 1 ml syringes. Rinse a few times with tap water and drink them too.

 

A number of buddies experienced a drop in effect going from tablets to liquid. This drop is estimated to be about 5-10%. Others seem to hint the drop is higher. To approach with caution, I propose you first take ONE liquid dose over 4 to make sure your body well copes with the change. The other 3 doses continue to be in tablets. Since you have bought a gram scale (Gemini 20? with 0.001 g resolution?), you can use it to ensure the accuracy of the 3 remaining doses. How to?

 

A. Each tablet weighs differently from each other. Take 10 of them and weigh the whole bunch. Then divide by 10 to obtain the average weight of each. This value is good until all the tablets from the same bottle get exhausted. This value corresponds to 1 mg of Lorazepam. Divide this value by 8 and you get the quantity to weigh out with your scale and swallow.

 

Example:

- 10 tablets weigh 1.723 g

- 1 tablet average weight is 0.172 g (= 1.723 / 10)

- 1/8 of a tablet weighs 0.022 g (= 0.172 /8) and corresponds to 0.125 mg of Lorazepam

 

B. Reduce 4 or 5 tablets to powder. Many use a pestle and mortar, others the back of a spoon on a hard surface. They both work. Keep the powder in a closed jar.

 

C. Let the scale equipment stabilize in the environment during one day. Calibrate the scale at the beginning. Possibly keep it in a same place shielded from air flow and temperature variations. Vibrations can also turn the operation difficult. Do not lean on the table during operation.

 

 

If questions, please ask.

 

Hope it helps.

 

:hug:

 

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Hi Jim,

Thank you for the detailed  instructions. I will carefully read it over many times and be sure I understand. I think the scale I ordered is the wrong  one being .01 gm instead of .001 gm and the syringe does not have enough divisions. I'll have to start over gathering supplies.

A question I already have is about tap water. I wonder what additives are in my city's water so can distilled water be used instead?

Also, should the doses be taken by mouth directly from the syringes and is that what you meant about rinsing syringes with water?

You said the solution can have a weaker effect so I would still take 4 doses, right? 3 tablet doses and 1 liquid dose?  This is to see how I react to it. How long until I should change to all liquid doses?

I think that is all for now but I'm only getting started. Also, still very grateful to you for suggesting I change to the .125mg 4x dosing. I am already hopeful that this will have a good effect on lessening my symptoms.

:) :)

 

 

 

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Hi Elena  :smitten:

 

I think the scale I ordered is the wrong  one being .01 gm instead of .001 gm

The minimum resolution required is 0.001 g or 1 mg to ensure enough accuracy in doses. Buddies use to pay USD 20 for this model from Amazon: https://www.amazon.com/Smart-Weigh-GEM20-Precision-Milligram/dp/B00ESHDGOI/ref=sr_1_4?ie=UTF8&qid=1530096387&sr=8-4&keywords=gram+scale+.001 . It is perhaps not of top quality but it can assist alright in this taper exercise.

 

I wonder what additives are in my city's water so can distilled water be used instead?

The distilled water is safe to drink but is not required. The disadvantage to drinking this water is that most of the natural minerals in the water are gone. Up to you.

 

should the doses be taken by mouth directly from the syringes and is that what you meant about rinsing syringes with water?

Correct.

 

You said the solution can have a weaker effect so I would still take 4 doses, right?

Right.

 

3 tablet doses and 1 liquid dose?

Yes. Then 2 tablet doses and 2 liquid doses. Then 1 tablet doses and 3 liquid doses. Then all liquid doses. Keep 2, 3 days between each change and make sure the symptoms are manageable. If symptoms, hold until they pass.

 

This is to see how I react to it. How long until I should change to all liquid doses?

Correct. With Lorazepam short half-life, I would say after 2, 3 days after each change you should already feel differences, if any.

 

Hope I answered your questions.

 

:hug:

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Hi Jim

I hope you are well. You are definitely a mentor because you have already done this. I am feeling pretty negative today but i have to keep trying to not feel hopeless. Mornings are particularly bad. I've heard other benzo users say it is because of a drop in cortisol. I wonder if this is true?

Anyway, thanks for the recommendation for a scale. Do you also have a brand of syringes you recommend. I want to be sure I get the correct one this time.

I think I understand how to ease into taking the 4 liquid doses. Once I have done this, what is the process to start reducing the amount taken? And what should I look for in stabilization before ever tapering down the next step?

Also, is it possible to use water instead of vodka in the solution if there is concern about using alcohol? Just curious.

Well, I think there is a time difference between our 2 locations but have a great day!  :thumbsup:

 

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Hi Elena,

 

Mornings are particularly bad

Starting at wake time? Can it mean that the night dose badly worn out after a long interval?

 

Do you also have a brand of syringes you recommend

This point can frequently be seen in this BB. Buddies are usually redirected to Amazon for the syringes. If you navigate the BB by using the search function, you will probably find the types you need.

 

Once I have done this, what is the process to start reducing the amount taken?

You will generate and follow your own taper plan. Probably something like this:

 

NcOHfV8.png

 

is it possible to use water instead of vodka in the solution if there is concern about using alcohol?

No. Benzo is neither soluble nor suspended in water. Alcohol will help to dissolve benzo and make it change its state from solid to liquid thus getting benzo uniformly distributed in the solution.

 

Hope symptoms improve. Hang in!

 

:hug:

 

 

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Hi again,

I appreciate your reply. A lot of information to sort through. I am trying to not give up even if I feel I want to! I hope you don't mind if I ask you more questions on this post when I've had a chance to consider everything. Thanks! :) :) :)

 

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Hi Jim,

I'm not sure you're still following this post but thought I would see. I'm still not doing too well. I'm having a lot of physical and mental symptoms, very pessimistic and fearful . I did the .125mg ativan 4x per day instead of .25mg twice per day for around 3 days. However, when it didn't seem to help, I went back to .25mg twice per day. Was that a mistake?

 

I've been holding this dose for 4 weeks and am not yet stabilized. I really think I was not even stabilized when I started the taper, basically this whole time. What do you think?

 

I have not started a liquid taper and am still waiting for the Gemini scale I ordered to arrive. Also, my family does not want me to use any alcohol for a liquid taper and I really need their help with all of this since I'm not handling much right now.

If it were you, would you use a simple water solution for a liquid taper if that was your only option? Or would it be completely ineffective without alcohol in your opinion?

 

Also, is it even possible to use the dry cut taper method with 1mg ativan pills and a scale?

 

The other thing I've been contemplating is switching to valium and to then taper off the valium. This may not be possible because my therapist is unsympathetic and may not agree to the switch. I have no choice but to work with her although she seems to know nothing about tapering.

 

So hopefully you see this post and can help me again. Thanks.

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Hi Elena :smitten:

 

Was that a mistake?

The drug quantity might fluctuate differently in your plasma during the day but as long as your daily total dose remains the same there is no problem. By the way, do you feel comfortable to state that following these 3 days of "trial" with no improvement that your symptoms are not from inter-dose withdrawal?

 

I've been holding this dose for 4 weeks and am not yet stabilized.

When you are on benzo for some time the drug goes into your brain/body and make alterations to your brain/body chemistry. Those are changes that your body adapts to and as it adapts it learns to function that way. As it functions that way, with time it becomes more ingrained into your physiology. When benzo comes short, be it by a slow kind taper or by tolerance, your body struggles fighting its way to go back to functioning the way it did before the drug stepped in.  Although hugely in distress, your body is actually in the process of recuperating, rewiring itself, re-balancing neuro chemistry. That does not happen overnight, it takes time. This is a significant brain/body changing, healing, repairing the brain damages these drugs have inflicted to your organism during long, long time. In the Long Hold Support Group, there are buddies who keep on holding months.

 

If it were you, would you use a simple water solution for a liquid taper if that was your only option?

Many have tried. Most failed amid symptoms as there's no way to obtain enough dose accuracy. For information we are talking about ml of alcohol, far away from alcohol in a glass of wine. You will hardly feel anything in your solution. The liquid Rivotril I took strongly tasted alcohol pharmaceutical manufacturer uses to dissolve Clonazepam.

 

is it even possible to use the dry cut taper method with 1mg ativan pills and a scale?

It largely depends on how much you weigh out. 1 mg Ativan pill for instance weighs about 0.170 g . The jump point of Lorazepam is 0.05 mg/day. That means arriving to that point the quantity of pill powder to weigh out is 8.5 mg which is very small thus making the weighing operation challenging. Nevertheless many buddies managed to get through and healed.

 

The other thing I've been contemplating is switching to valium and to then taper off the valium.

Switching to Valium will have the following problems:

- New introduced benzo you don't know how your body will react in presence of it

- Cross-over requires some time making the taper longer

In your case with the quantity of Lorazepam that low, I'd rather stay with it until the final jump and not take the risk with Valium.

 

I have no choice but to work with her although she seems to know nothing about tapering.

That concerns the majority of doctors. But if you come to talk to them with a solid planning in your hands they will have no choice but to accept to support you.

 

Hope I answered your questions.

 

:hug:

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Hi Jim,

Thank you for your reply. I hope you are doing well. Is it okay for me to keep contacting you about my taper? It is generous of you to share your knowledge. No one I know in person has this information.

I started again to take 4 doses of .125mg ativan spread throughout the day. I don't know how to tell if interdose withdrawal is the cause of no improvement in my symptoms. How do I know if that's the case?  How does that differ from tolerance? I know when I was taking almost 2mg per day of ativan , it wasn't helping much anymore. Now I am on much less and I'm still miserable.

How long do you think I should hold this dose?

Your explanation of how the body, although in distress, is still actually healing was helpful to understand. I actually felt a little fight return in me because I am so sad and discouraged much of the time.

I am really reconsidering the idea of replacing with valium as perhaps a bad idea. So, the dose of ativan I am taking is considered low? Yet still I have such bad withdrawal. So, perhaps the valium will not lessen that anyway? It could make it worse, right?

The dose to jump is .05mg? Since, I am still at .5mg per day, there still is so far to go. Who would think that such a small bit of pill is still such a problem for me? Anyway, I hope to hear from you again. Thanks.  :)

 

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Hi Elena :smitten:

 

I started again to take 4 doses of .125mg ativan spread throughout the day

Although the daily quantity remains more or less the same, I would suggest you to avoid going back and forth with doses thus submitting your body to unnecessary fluctuations of drug. When manageable, possibly stick to it unless destabilizing symptoms occur.

 

I don't know how to tell if interdose withdrawal is the cause of no improvement in my symptoms.

If from 2 doses you spread to 4 doses across the day and symptoms remain the same then they are not inter-dose withdrawal related.

 

I know when I was taking almost 2mg per day of ativan , it wasn't helping much anymore

It is known that Benzodiazepines are no longer effective after a few weeks or months of regular use. They lose much of their efficacy because of the development of tolerance. When tolerance develops, "withdrawal" symptoms can appear although you continue to take the drug. Thus the symptoms suffered by many long-term users are a mixture of adverse effects of the drugs and "withdrawal" effects due to tolerance.

 

Since, I am still at .5mg per day, there still is so far to go.

Probably yes, it depends on what "far" means. A rough calculation with a conservative reduction of 5%/14 days will lead to a taper period of 8-9 months. I personally tapered in 9 months. Others just don't care and gently taper in years. You learn to accept and live with it and stop to think about it as something special to deal with.

 

Hope I answered your questions.

 

 

 

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Hi Jim,

I hope i am not too bothersome. I have found a family member, my mom, who is supportive of me doing the liquid alcohol taper. She will help me with your instructions. The Gemini scale is ordered but again I ordered the wrong syringe. Would you be able to post a link where to buy the 10ml 100 division and 1 ml 100 division syringes? That would help me so much to do this correctly. Please let me know. Thanks!  :smitten:  :)

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Hey Jim Hawk don’t mean to interrupt this post but I’m new here and have no idea what I’m doing. You seem very knowledgeable in all the questions need to ask. I posted my questions in the introduction section and the taper section. How can I get you to see my post I really need some help. Thank you!!
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