Builder - help with lorazepam DLMT

Hi Builder,

I'm back.  I can't find my previous posts to you so I'm starting over. Sorry about that. 

 

Can you please lay out in great detail (because I'm really scared about all of this and really bad at math) how to do my DLMT?

 

I currently have two lorazepam prescriptions: 1 in pill form (0.5 mg pills), and 1 in liquid form (2mg/mL concentrate).  I got the prescription in pill form so I could dose away from the house without having to worry about carrying around the liquid with ice packs (because it is supposed to remain refrigerated).

 

I currently take 2.75 mg lorazepam per day - 1 0.5 mg pill at 6 am; 1 0.5 mg pill at 2 pm; and 1.75 mg (0.875 mL) liquid at 10 pm.

 

I want to spread the doses out to 4 times per day, with the largest dose being at night.

 

Is the following calculation of my cut rate accurate?

2.75 mg x 5% = 0.137 mg

0.137 mg/ 14 days = 0.01 mg per day cut rate

 

What is the best way to make the solution, given the prescriptions I have?

 

What should my taper schedule be? And how exactly should I do it?

 

The more detail the better.  Again, I'm very freaked out by all of this and could really use detailed step by step instructions.

 

Thanks so much,

Kim

 

 

 

 

Also, if there is a compounded prescription of a particular strength that would make this easier, I think I could get my doctor to prescribe it to me.  ANYTHING to make this easier.

Hi Builder,

1)  I'm back.  I can't find my previous posts to you so I'm starting over. Sorry about that. 

 

2) Can you please lay out in great detail (because I'm really scared about all of this and really bad at math) how to do my DLMT?

 

I currently have two lorazepam prescriptions: 1 in pill form (0.5 mg pills), and 1 in liquid form (2mg/mL concentrate).  I got the prescription in pill form so I could dose away from the house without having to worry about carrying around the liquid with ice packs (because it is supposed to remain refrigerated).

 

I currently take 2.75 mg lorazepam per day - 1 0.5 mg pill at 6 am; 1 0.5 mg pill at 2 pm; and 1.75 mg (0.875 mL) liquid at 10 pm.

 

3) I want to spread the doses out to 4 times per day, with the largest dose being at night.

 

4) Is the following calculation of my cut rate accurate?

2.75 mg x 5% = 0.137 mg

0.137 mg/ 14 days = 0.01 mg per day cut rate

 

What is the best way to make the solution, given the prescriptions I have?

 

5) What should my taper schedule be? And how exactly should I do it?

 

The more detail the better.  Again, I'm very freaked out by all of this and could really use detailed step by step instructions.

 

Thanks so much,

Kim

 

1) Click on your name>profile>summary>showposts

 

2)  There really isn't anything to be scared about!  Diluting your liquid is like adding 3 cans of water to a can of frozen orange juice to make orange juice.  And you treat your dilute liquid just like you would any liquid med from the pharmacy...you just take "prescribed" dose at the scheduled time.  BTW, I know the Rx liquid says "refrigerate", but I guarantee you can keep it at room temp for several days with absolutely no problem.

 

3)  .5, .5, .5,  then the liquid for the last dose. 

 

4)  Your math is correct! (See how easy that was) 

 

It much easier to use the liquid to make your dose changes.  It will be really easy if you just dilute (like the orange juice  your Rx liquid  19:1. That will give you a finished concentration of .1mg=1ml   BTW, it  is an Intensol (concentrate) an is designed to be diluted.  Combine 8mls (16mg)  Rx liquid + 152ml water.  That gives you 160mls, ***.1mg per ml, approx a 9-10 supply.

 

5)  You have already (correctly) calculated your daily cut rate of .01mgs/day.  And since your diluted Rx liquid is .1mg=1ml, you reduce the liquid portion of your daily dose by .1ml.  To convert mgs to mls, multiply X 10 (move the decimal one place left)

 

***

EDIT:  I amended these numbers to correct an error

Thanks Builder!  This is super helpful!

 

Do you think the following schedule would work? I need the lorazepam most for sleep (which is the reason I started taking it to begin with), so Dose 3 (the 9 pm dose) is by far the largest of the four doses.

 

Daily dosage (mg) - 2.75

Daily dosage (mL) - 27.5

 

Day 1

Dose 1 (9 am) - 4 mL

Dose 2 (3 pm) - 4 mL

Dose 3 (9 pm) - 15.5 mL

Dose 4 (3 am) - 4 mL

 

Day 2

Dose 1 (9 am) - 4 mL

Dose 2 (3 pm) - 4 mL

Dose 3 (9 pm) - 15.4 mL

Dose 4 (3 am) - 4 mL

 

And then I'd keep reducing Dose 3 by 0.1 mL every day for awhile....

 

Would that work?

Thanks Builder!  This is super helpful!

 

Do you think the following schedule would work? I need the lorazepam most for sleep (which is the reason I started taking it to begin with), so Dose 3 (the 9 pm dose) is by far the largest of the four doses.

 

Daily dosage (mg) - 2.75

Daily dosage (mL) - 27.5

 

Day 1

Dose 1 (9 am) - 4 mL

Dose 2 (3 pm) - 4 mL

Dose 3 (9 pm) - 15.5 mL

Dose 4 (3 am) - 4 mL

 

Day 2

Dose 1 (9 am) - 4 mL

Dose 2 (3 pm) - 4 mL

Dose 3 (9 pm) - 15.4 mL

Dose 4 (3 am) - 4 mL

 

And then I'd keep reducing Dose 3 by 0.1 mL every day for awhile....

 

Would that work?

 

Looks good to me!  :thumbsup:

Thank you Builder!!! You've been such a tremendous help during a very difficult and stressful time.

Hi Builder,

I have another question. You said the final solution is 160 mL and that should be a 9-10 day supply.  But how can that be if I'm starting at 27.5 mL per day?  Wouldn't it be more like a 5-6 day supply?  Sorry, I'm confused...

Also, should I use distilled water to make my solution?  If so, I can just buy a bottle of distilled water at pretty much any grocery store, correct?

Also, should I use distilled water to make my solution?  If so, I can just buy a bottle of distilled water at pretty much any grocery store, correct?

 

Tap water is fine.  No need to buy distilled water.  The water is just a dilutant, it is NOT an "active ingredient".  You could use fruit juice, soda, kool-aid, or any liquid.  All your trying to do is set the concentration/ratio to a convenient number.

Hey Builder,

 

I just want to double check the math one more time before I start this....

 

Current lorazepam dosage: 2.75 mg per day

2.75 mg x 5% = 0.137 mg

0.137 mg/ 14 days = 0.01 mg per day taper rate

 

Current liquid lorazepam prescription: 2 mg/ mL

I will dilute my liquid 2 mg/mL prescription 19:1 by adding 8 mL (16 mg) of it to 152 mL water to get 160 mL of a 0.1 mg/ mL solution.

Each day I will reduce my daily dosage by 0.1 mL.

 

Proposed schedule

 

Day 1

Daily dosage - 27.5 mL

Dose 1 (9 am) - 3.5 mL

Dose 2 (3 pm) - 5 mL

Dose 3 (9 pm) - 15 mL

Dose 4 (3 am) - 4 mL

 

Day 2

Dose 1 - 3.5 mL

Dose 2 - 5 mL

Dose 3 - 14.9 mL

Dose 4 - 4 mL

 

And so on, reducing by 0.1 mL per day. 

 

Is this right?

 

Thank you!!!!

Your numbers are all correct.  And it will work fine that way, if that's what you want to do.  But all that precision in the 4 doses really isn't necessary.  A DLMT is about making gradual reductions, not precise reductions.

 

What I would do is pull the full days dose and put in a standard measuring cup, then top it up to 1 1/2 cups.  Then take 1 dose @ 3/4 cup, and 3 doses @ 1/4 cup.  That also means you will be reducing all doses evenly.

 

But your way will work.

The reason I divided the doses up the way I did is that my current doses are as follows:

 

Daily dosage - 2.75 mg (1.38 mL)

Dose 1 (6 am) - 0.5 mg (0.25 mL)

Dose 2 (2 pm) - 0.5 mg (0.25 mL)

Dose 3 (10 pm) - 1.75 mg (0.88 mL)

 

I originally started taking this drug only at bedtime for sleep.  After learning more about this drug and the interdose withdrawals that can occur, and to prepare for the taper, I started dividing my 1 bedtime dose per day into 3 doses per day. 

 

I'm already worried that by reducing the bedtime dose from 1.75 mg to 1.5 mg under my proposed taper schedule, that I won't sleep or that I'll get jolted awake (like I did when I tried to go off before, cold turkey, unwittingly).

 

This question is for builder but also anyone else out there.  Does it matter if the four doses throughout the day are very different, or if there is one big dose and three smaller but fairly equal doses?  Or should I try to do my best to get all 4 doses  equal early on in the taper? Would appreciate hearing about people's experiences with this.  Any suggestions for my particular case would be welcome as well.  For example, how much would I suffer if I went down from 1.75 mg at bedtime to 1.25 mg?  Would the newly added 3 am dose of 0.35 - 0.5 mg help minimize the suffering?   Thank you!

I basically gave you an easier alternative method to do multiple doses, in approx the same proportions you are using.  It's just an alternative,

 

BTW, based on my (limited) experience with lorazepam, and the advice of the pdoc that prescribed it, 4 uniform doses, evenly spaced was the recommendation.  But that was based on my condition and my circumstances.  Your situation could be different.

Thanks builder. I really appreciate it.

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