Dividing up the daily dose

Hi all,

I already posted this a few times but didn't get many responses, so I'm posting here now in hopes of getting a few more.

I'm currently taking the following doses of lorazepam (3 doses per day):

Daily dosage - 2.75 mg

Dose 1 (6 am) - 0.5 mg

Dose 2 (2 pm) - 0.5 mg

Dose 3 (10 pm) - 1.75 mg

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. 

Now I'm going to switch to four doses per day.

This is my proposed dosing:

Daily dosage - 2.75 mg

Dose 1 (9 am) - 0.35 mg

Dose 2 (3 pm) - 0.5 mg (so I can take a pill, since I have lorazepam prescriptions in both liquid form and pill form)

Dose 3 (9 pm) - 1.5 mg

Dose 4 (3 am) - 0.4 mg

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).

Does it matter if the four doses throughout the day are very different, or if there is one big dose and three much smaller but fairly equal doses?  Or should I try to do my best to get all 4 doses equal early on in the taper? I would really appreciate hearing about people's knowledge of/ 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 0.4 mg help minimize the suffering?   Thank you!

Hi KJT,

Hopefully in another week I will also be at 2.75 Ativan daily.  (I started tapering from 6mg. in Dec.

2018, you can see in my signature).

Originally I was taking 2mg. in the evening and 4mg. spread between two daytime doses.  Initially I wanted to guard my sleep and thought I would save the night dose until the end.

I changed my mind and like you decided to spread my doses between four daily doses and also try to lower my nighttime dose which I have been able to do gradually.  My current doses will be:

8pm.  1.375

2am  .46

8am  .46

2pm.  .46

When I reduced my evening dose from 2mg to 1.75 it was easy and didn't cause any sleep disturbance. 

When I reduced it gradually to 1.5 I had a bit of sleep difficulty but not every night.  On some nights when I have difficulty going to sleep, I take a low dual dose melatonin which has worked well.  On a couple of nights I have woken up early and taken the dose designated for 2am and gone back to sleep.  Usually I wake up closer to 6am and take the first .46 dose then.  This allows me to distribute my daily doses with some flexibility according to how I am feeling, but staying close to six hours between doses.

I usually set a goal for trying to taper  by .125 (1/8) at a time, using a symptom based DLMT, holding if I need to and reevaluating along the way what to do next.  On average I have made an adjustment to my plan about every two weeks at these higher levels.  I'll see how it goes as I decrease. 

I am planning to try to start tapering all doses simultaneously.  I imagine always keeping my evening dose higher, but will wait and see how it goes.  I know that if I don't sleep, I can't function, thus my reasoning for keeping the evening dose higher.  But if I can gradually taper it down along the way, hopefully I can minimize insomnia at the end of my taper.

I hope you hear from some people who are further along or have already completed their tapers to help you make some decisions about how to proceed for yourself. It sounds like you also want to preserve your sleep and also prevent interdose withdrawals.

I hope this is a little bit helpful.  Best of luck to you and I hope to watch your successful milestones.

Luey