Help with substitution method

Looking for guidance. PLEASE HELP!

So, let’s get a little more info. You’ve been on lorazepam (Ativan) for a few years.

 

How much Ativan are you on and how often do you take it?

It will be 3 years at end of March.  I have been all over the place with it.  Started with .25 once a day then took another .25 during the day if needed.  I started it for extreme anxiety brought on by life circumstances and mental illness. Still dealing with all that also. Severe depression and anxiety. Nut stable at my current dose which is 1mg a day. Last week, took 1 1/2 mg and 2 of those 2 mg. I am back down to 1 mg this week but anxiety has been creeping up again. 

Okay, got it. Given that you were prescribed for anxiety, you do know anxiety will be at least a bit worse tapering off Ativan, right? 

Is this something you want to do, or have to do?

 

 

I need to go slow and in small dosage drops.  5% or less is what I have heard.

Yes, slower is much better to make it easier for your body to catch up as the Ativan is lowered.

 

How many times a day do you take it?

Also

 

I feel that it is something I have to do. I have never felt good since all this started but now my cognition is bad don’t want to eat brain fog. On 40mg of Paxil and 100 of trazadone for sleep. It’s just awful. Just so afraid to let doctors start messing around with pills and more pills and their way of speeding you through withdrawal and just making this so much worse. Things are bad enough, can’t take it if this go further downhill.

 

I agree, these meds often make us feel bad overall.  I know I feel way better now than I did.  I just want to make sure you’re aware this can be a little difficult as far as anxiety, and be ready for that. Anxiety is a normal and expected part of the process, it’s just best to know that up front.

 

 

Once a day mostly.  If I need more, I do it in .5mg doses.  To this point, I have not taken 1mg at one time then another 1 mg if I need it later, but as I told you earlier, not stable on the 1mg dose. I have thought about going to liquid a liquid dose and dosage reduction would be more reliable. I don’t know if my insurance would cover the liquid dose. I have Medicaid insurance and they are strict with what they will cover and not cover.

 

Just really beside myself.

I have tried several times to withdrawal but it was on my own and there were no preside measuring just breaking off little pieces that I thought were close to the same size and trying to make it through a month before trying to reduce again. Never made it,  had to always reinstate.

Lorazepam is only effective for a few hours, 4-5 hours roughly. Then you usually start to feel anxious because you’re actually withdrawing after the 4-5 hours, until the next dose.  If you’re dosing once a day, no wonder this is so hard.

 

Have you ever tried taking it more times a day, for instance, .5 twice a day or half of a .5mg pill four times a day?

I think you’re going to do better if you dose regularly.  Same time, same amount, every day.

Will my mind and body let me do that since I take such a big dose only once a day? How many hours between the doses and what if anxiety gets so bad between doses that I can’t wait till the next dose?

I think your day will be much smoother as a result of taking your dose more often, you may actually feel some relief.  How are you sleeping, do you need it to go to sleep?  What time of day is your most stressful when you seem to need the drug the most?  This is how people decide what times to take their dose, what do you think?

Hi Pamster,

 

I deal with stress as soon as I get out of bed. Seems as if I can’t handle even the smallest of stresses. With not working and living on savings and just so many issues in my head every waking moment, I am not comfortable at anytime when I’m awake.  I take the 1mg in the morning between 8 and 10.

I don’t use it for sleep,  Trazadone 100 mg for that with 10mg of melatonin. Sleep is never relaxing sleep and very broken every 2 or 3 hrs.

Mornings are pretty bad for most people withdrawing from benzo's, you might have a look, there might be something that could help. Understanding Morning Anxiety

 

Since your daylight hours are your most stressful and even though you're getting broken sleep, you can get to sleep.  So design your dose schedule according to your daytime stress levels.  Maybe...

 

8:00

12:00

4:00

8:00

Pamster....

 

Here is another thing.....I’m not stable on the 1mg anymore....I have tried to go to 1.5 mg but it doesn’t really help at all.  2 mg, I felt better but was only on that for 2 days.  Thing is Pamster, I’m just truly afraid of moving higher. I know the more you take, the harder it becomes to get off of but yet I feel so awful now.  Your suggestion to my issue would be a great help.....in fact, would you be there for me through this whole process because I want to try and start tapering as soon as possible but I need to be stable first.  What do you think?  I have never taken followed my doctors prescription and have always taken less.  What do you think about direct tapering vs switching to Valium then tapering.

I really need good strong advise because I really don’t know where to start or what to do!!

In your situation I might go up in dose for a bit to get stable, then once stable I’d start to cut. During the updose you could go to four times a day dosing.

 

It might look like this:

 

.5mg 8 a.m.

 

.25mg noon

 

.25mg  4 p.m.

 

.25mg. 8 p.m.

 

 

If that dosing schedule feels doable, I’d stay at that level for a week then begin to cut.  I’d start with the morning dose so that all the doses were then equal.

 

What do you think?

Your symptoms sound very typical, the anxiety, the pacing, the fear all of it, everyone here pretty much lives with this every day.  I know that doesn't bring you much comfort but perhaps if you look around the forum a bit and join in some of the conversations, you'll feel their strength and if not that, then you can join in their misery at least.

 

What we need to know from you is, do you have a Dr who will support a crossover to Valium?

I believe I do yes.  He has always worked with me and made some decisions together.  I have taken your advise and started dosing 4 times a day instead of one. Every 4 hrs. I have 1mg pills....they have a score line but they done always split exactly even and when splitting the .5 it’s even alittle worse. Is the microgram differences going to have any impact with not having exact mg splits?

As long as you take all of the pieces in one day, you should be okay, many have gone before you using this method, so have faith in it.

 

If I were you, I'd make a copy of the  The Ashton Manual slow taper schedule that most applies to your situation and take it to your Dr and ask him if he's willing to cross you slowly and and reduce following her method.  I'd also make sure your Dr would be willing to go slower than the manual suggests, this is important as not everyone is the same and you should be able to taper at the rate your body requires.

This is why it's a good idea to take a printout of a sample taper, it's especially important that the crossover is done right.  Here is a resource for you and him. https://benzoreform.org/

 

Your dosing 4 times a day should help you feel better.

My schedule

 

8:00 am .50

12:00 pm .25

4:00 pm .25

8:00 pm .25

 

Didn’t know if I was going to make the 4:00 dose and have to dose before that. Was having a rough time. Actually don’t feel any better than yesterday. 

 

Once I’m comfortable and I start the Valium, and complete the Valium cross over, I should never go back to the lorazepam correct?