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Crossover from Clonzapam to Ativan


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My new prescriber wants to do a crossover from Clonzapam to Ativan. I mentioned the Ashton Manual and they  usually do a Valium crossover but she insisted on Ativan. I'm not sure why and Im worried she may get me on a faster rate then I can handle. Has anyone successfully done this? Im having panic attacks over it. Im wondering if it would be better for me to do my own titration with Clonazapam.
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Going from a long acting benzo to a shorter acting one isn't a good idea, not sure why your Dr would suggest this.  If your Dr would support it, I feel you'd be better off doing your own thing with the Clonazepam. 
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Thank you both for your feedback. I thought the crossover to Ativan didn't make sense and you confirmed that for me. I  have so much anxiety that when I was talking to her I froze up. I tried to explain that Ashton recommends Valium but she insisted on the ativan. I wish I direclty told her that I wanted to do the Valium and denty the ativan.  She said her colleague has been practing 25 years and  he also does theCrossover to  ativan taper.  I have been so resistant and in tears of getting off this in my first appt and was in tears and completely panicked that I didn't want to rock the boat in the 2nd appt.  I am very scared to taper because even though I hate being on it, it is making me functional than without. I tried to get off of .5mg 13 years ago when I was only on it 3x a week for my severe insomnia. I went to a clinic where they make you sign that under no circumstances they will give any benzos. When the prescriber tried me on a bunch of different meds to get me off of it, I couldnt handle it and she said since my health is so poor she put me back on .5mg  but 3x a day! instead of one .5mg 3x a week.  I tapered down to 1 pill .5mg and had held that taper for 11 years.  So if I couldnt handle getting off of it when I was on it for a couple of months and taking it 3x a week, how will I do it after 13 years later when my health is at stake and Im more dependent on it? Im beyond terrified. I was ready to stay on it for life even though I hate being on it with all my heart. My adrenals and thyroid are hanging by a thread and Im unable to take meds because Im extremely sensitive. In my second appt my prescriber realized my situation and she said she realizes she has her work cut out for her. I look her up on yelp and she is fairly a new graduate.  She knows my terror and fear but she still plans on doing it.

 

Thanks for your help and support!

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I can see you're terrified, you know how painful and scary this is since you've had experience in the past.  When does your Dr intend to switch you over, do you still have time to try to change her mind?  We can provide some documentation which may help persuade her since you tend to freeze up, would that help?  We can also provide you with a list of questions which may help her understand this isn't a good idea, what do you think?

 

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I can see you're terrified, you know how painful and scary this is since you've had experience in the past.  When does your Dr intend to switch you over, do you still have time to try to change her mind?  We can provide some documentation which may help persuade her since you tend to freeze up, would that help?  We can also provide you with a list of questions which may help her understand this isn't a good idea, what do you think?

Thanks so much for your help Pamster  :smitten:She said she will put the order in so Im not sure if she has yet. I need to call the pharmacy. I  dont think I can change her mind until my next appt in 3 weeks. I am having phone appts because of the coronavirus crisis and I wish I could hand the info directly to her. She said she knows about the Ashton Manual but I don't know if she was telling the truth. She is a fairly new graduate. I looked her up.I think it would help to have the questions that may help her understand this isnt a good idea that I can discuss on the phone. I dont know how to phrase things without sounding like I know more than her since Im only a lay person and she is a professional. Maybe you can help with the wording of how to approach her with the info?

 

Much Gratitude with your time and help  :smitten:

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[48...]

To hopefully help alleviate some of your fears...

 

There's nothing wrong with tapering Ativan.  A fair number of people taper using it.  About the only change is a tendency to dose multiple times per day instead of just once.  That could actually give some advantages by more specifically targeting times in the day when you need the drug the most.  Also - valium has a way of making people feel drugged all day, and a lot of people don't like that feeling.

 

One nice advantage of Ativan is that you'll know the result of your cuts within a day.  It can take up to two weeks to fully realize a reduction in valium dosage.  So please don't get too attached to Ashton's valium approach.  It's just one approach - there are many that work.

 

How to deal with this after so many years?  Slowly, and with good therapy.  You and your therapist now get to try to discover how to have you manage feelings/emotions that were masked by the pill for many years.  It's an adventure for sure, but not one to fear.

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badsocref has given you some good feedback, but in case you'd still rather taper the drug you're currently taking, just a couple of questions from your Dr?

 

What will be the equivalent dose, charts vary but standard is .5 mg Clonazepam is equal to 1 mg Ativan

 

Will she allow for a gradual transition to allow your body to acclimate to the reduction of the Clonazepam and the introduction of a different benzo, you will most likely feel the difference.  They're both benzo's but they have unique differences.

 

Will she allow you to stay at the new dose of Ativan for a few days before starting to taper in order to stabilize?

 

Due to the shorter half life of the Ativan, will she allow you to dose several times per day in order to minimize inter-dose withdrawal symptoms?

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You might ask if they will taper you off of Librium.

 

My Dr said that valium was not on the table, and offered Librium instead. It's slow and steady and Im glad I did it. Many Drs don't prescribe valium because it's more abused and has a street value.

 

I agree it doesn't make a lot of sense to go to ativan now. Ask them to explain why they want this.

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badsocref has given you some good feedback, but in case you'd still rather taper the drug you're currently taking, just a couple of questions from your Dr?

 

What will be the equivalent dose, charts vary but standard is .5 mg Clonazepam is equal to 1 mg Ativan

 

Will she allow for a gradual transition to allow your body to acclimate to the reduction of the Clonazepam and the introduction of a different benzo, you will most likely feel the difference.  They're both benzo's but they have unique differences.

 

Will she allow you to stay at the new dose of Ativan for a few days before starting to taper in order to stabilize?

 

Due to the shorter half life of the Ativan, will she allow you to dose several times per day in order to minimize inter-dose withdrawal symptoms?

Thanks for the info and questions to ask. I just called the pharmacy so she has the prescription sent in already. I wish she talked over what she was going to do in detail. Yesterday, She told me she had to calculate the crossover. I asked  herif she can she let me know when she does but she didnt let me know and just sent it to the pharmacy.  The prescription is for 1mg Ativan 2x a day month suppley. My prescription was clonzapam .5m 2x  a day. So it looks like she is just transitioning me to another benzo with a  shorter acting before she starts tapering me off of the Ativan. Forgive me for my brain fog and trying to figure this out but does this make sense to you all? I am not sure I understand her reasoning. She told me that clonazapam is 4x stronger than Ativan. Im confused. Is there a chart somewhere where I can look this up? I asked the pharmacy but they didnt know. Pretty sad lol.  You would think they would know. Will call another pharmacy. Im very senstive to any changes even different generic manufactures of the same medication. Im afraid to try this Ativan.

 

 

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You might ask if they will taper you off of Librium.

 

My Dr said that valium was not on the table, and offered Librium instead. It's slow and steady and Im glad I did it. Many Drs don't prescribe valium because it's more abused and has a street value.

 

I agree it doesn't make a lot of sense to go to ativan now. Ask them to explain why they want this.

 

Thanks for the info on Librium. I am not familiar with this medication. Will look into it. I don't think this prescriber is willing to listen. Im not sure even how to ask her to listen without sounding like Im telling her what to do.

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Here is the table we use: https://www.benzo.org.uk/bzequiv.htm

 

She's right that Clonazepam is stronger than Ativan, not sure about 4 times more.  The equivalence looks right to me, and this will allow you to transition and stabilize before beginning your taper.  You will notice a difference in the two benzo's, I've never taken Ativan so I can't tell you what to expect.  Since Ativan is shorter acting, you may notice the change but the Clonazepam you're still on will help cushion the effects, I don't know.  You might want to talk to some folks on the tapering off Ativan support thread, it's located here: http://www.benzobuddies.org/forum/index.php?topic=44903.0

 

No need to start a new topic, just go to the last page and hit reply to ask your question, perhaps you could ask what to expect when making the switch and some tips from them about how to dose and cope with tapering from it.

 

 

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Here is the table we use: https://www.benzo.org.uk/bzequiv.htm

 

She's right that Clonazepam is stronger than Ativan, not sure about 4 times more.  The equivalence looks right to me, and this will allow you to transition and stabilize before beginning your taper.  You will notice a difference in the two benzo's, I've never taken Ativan so I can't tell you what to expect.  Since Ativan is shorter acting, you may notice the change but the Clonazepam you're still on will help cushion the effects, I don't know.  You might want to talk to some folks on the tapering off Ativan support thread, it's located here: http://www.benzobuddies.org/forum/index.php?topic=44903.0

 

No need to start a new topic, just go to the last page and hit reply to ask your question, perhaps you could ask what to expect when making the switch and some tips from them about how to dose and cope with tapering from it.

 

Thanks so much for the chart Pamster  :smitten:. I am not sure where she got 4x more with Ativan. The part that doesnt make sense to me is why cross me over to a shorter acting benzo when she knows how sensitive I am. I don't know how to talk to her or convince her. I am thinking of using the clonazapam I have and do a 5% titration reduction per 14 days would be easier on my system than doing it her way with the Ativan.  Do you think that would be a more gentle approach? I would go much slower but I dont have enough of the clonazapam to do so. Sorry Im all over the place in knowing what to do. Im just wanting to go the way where I suffer the least because I am dealing with preexisting conditions that are unbearable even with the Clonazapam that masks some of my pain and don't know how I will survive this.

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[48...]

I switched from klonopin to ativan.  I had become tolerant to klonopin and my doctor suggested I try Ativan.  It was a very easy switch.  No lengthy cross-over.  I just switched.

 

Sounds like the right ratio (2 to 1). 

 

I agree with Pamster that the size of the cuts are probably more important than the chosen benzo.

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badsocrefs calming words and experience should comfort you, they do me.  I wouldn't be in favor of tapering from the Clonazepam for exactly the reason you mentioned, you're sensitive to these drugs and you have other medical issues, not having enough pills to slow your taper down if you need to would be a concern. 

 

Maybe your best course of action is to work on acceptance and make the best of this situation.

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I switched from klonopin to ativan.  I had become tolerant to klonopin and my doctor suggested I try Ativan.  It was a very easy switch.  No lengthy cross-over.  I just switched.

 

Sounds like the right ratio (2 to 1). 

 

I agree with Pamster that the size of the cuts are probably more important than the chosen benzo.

 

Its good to hear that badsocref. I didn't realize you switched from K to A.  It's good to hear from your personal experience. Of course I realize we all have different sensitivities and what works for one person may not work for another. So you didn't notice interdose withdrawal issues because it was shorter acting? I wonder why the A worked better for you than the K? What are thoughts on it?  She is having me take it twice a day just like I would take the K twice a day.  How will they be able to give me small cuts with the A? What's the smallest dose it comes in? 

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[48...]

I believe that I had become dependent and was experiencing some level of interdose withdrawals - both with klonopin and with Ativan.  I only took klonopin/Ativan at night for sleep, so didn't follow it up with a morning dose.  Insomnia was the only reason I took these pills.  I did begin to have 'anger issues' during the day, which I attribute to tolerance withdrawal. 

 

A didn't work better for me than K.  They seemed to work very similarly to one another.  My doc actually gave me 3-4 different meds to try when klonopin stopped working well.  Ativan worked the best of the bunch, so that's what I went with for the next year (then I c/t'd).

 

I don't know what your doctor has planned for you.  A liquid taper is pretty easy - you just need some sort of measuring device (e.g. a graduated cylinder).  Weighing out pieces is also pretty easy - you just need a decent scale (available for $22 from Amazon).  However, a lot of doctors don't trust people to design or manage their own tapers, so yours might have you simply break your pills in halves or quarters, which will likely yield cuts of 25% or larger. 

 

You may have to convince your doc about a symptom-based micro-taper, if that's what you'd like to do.  Do your homework.  You may need to sound convincing.

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You might ask if they will taper you off of Librium.

 

My Dr said that valium was not on the table, and offered Librium instead. It's slow and steady and Im glad I did it. Many Drs don't prescribe valium because it's more abused and has a street value.

 

I agree it doesn't make a lot of sense to go to ativan now. Ask them to explain why they want this.

 

Thanks for the info on Librium. I am not familiar with this medication. Will look into it. I don't think this prescriber is willing to listen. Im not sure even how to ask her to listen without sounding like Im telling her what to do.

 

I get the feeling this Dr is projecting. They need to include you in the plan, meaning your ideas are taken into account in how to proceeed. It's the first principle. 

 

Anyway there would be no rational reason for them to dismiss Librium out of hand. It's the first, and weakest benzo. It's commonly used in rehabs and detoxes for alcoholics.

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Hello, lila7.  I am sorry your prescriber is insisting on such a rapid taper.  Have you tried asking her to review the following pamphlet from the Benzodiazepine Information Coalition:

 

Withdrawing Prescribed Benzodiazepine Patients Pamphlet

https://www.benzoinfo.com/wp-content/uploads/2020/03/Withdrawing-Prescribed-Benzodiazepine-Patients.pdf

 

Re: your question about what formats and doses (strengths) of Ativan/lorazepam are available ...

 

(1) Go to DailyMed at:

https://dailymed.nlm.nih.gov/dailymed/

 

(2) Enter “lorazepam” in the search box.  A list of all available formats as well as associated National Drug Codes and Packagers (manufacturers) will appear.

 

You’ll want to do a more in-depth review yourself, but it looks like the lowest strength tablet available is 0.5mg.  However, the good news is that an oral solution is also available.  It’s a 2mg/1mL concentrate that comes with an oral syringe calibrated to 0.05mL. This means you could measure a dose as low as 0.1mg using the provided syringe or 0.02mg using a syringe calibrated to 0.01mL.

 

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  • 2 months later...

I switched from klonopin to ativan.  I had become tolerant to klonopin and my doctor suggested I try Ativan.  It was a very easy switch.  No lengthy cross-over.  I just switched.

 

Sounds like the right ratio (2 to 1). 

 

I agree with Pamster that the size of the cuts are probably more important than the chosen benzo.

 

Hey badsocref,  :)

 

Not here to hijack this thread.  :thumbsup: I'm just curious about something that might also help the OP.

 

You said that you switched from Clonazepam to Ativan. However, you cold-turkied off  Ativan. That's impressive. If I had done so, I'm sure I would have died or ended in an ambulance, probably with brain damage. So I'm really impressed by your fortitude of will and constitution of body.

 

How did you manage to switch from a long-acting benzo to a short-acting benzo with zero withdrawal symptoms? I'm sure that the OP would also be curious because of her stubborn doctor's insistence on prescribing Ativan and only Ativan. 

 

All the best  :)

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[48...]

I switched from klonopin to ativan.  I had become tolerant to klonopin and my doctor suggested I try Ativan.  It was a very easy switch.  No lengthy cross-over.  I just switched.

 

Sounds like the right ratio (2 to 1). 

 

I agree with Pamster that the size of the cuts are probably more important than the chosen benzo.

 

Hey badsocref,  :)

 

Not here to hijack this thread.  :thumbsup: I'm just curious about something that might also help the OP.

 

You said that you switched from Clonazepam to Ativan. However, you cold-turkied off  Ativan. That's impressive. If I had done so, I'm sure I would have died or ended in an ambulance, probably with brain damage. So I'm really impressed by your fortitude of will and constitution of body.

 

How did you manage to switch from a long-acting benzo to a short-acting benzo with zero withdrawal symptoms? I'm sure that the OP would also be curious because of her stubborn doctor's insistence on prescribing Ativan and only Ativan. 

 

All the best  :)

 

When the klonopin started failing me, I was experiencing some symptoms that in retrospect I figure was tolerance withdrawal.  My sleep doc gave me a four different drugs to try (trazodone, Mirtazapine, Ativan and triazolam).  Looking back, that was kind of a rough time (11 days - I kept notes).  I tried mirtazapine and trazodone first, but they didn't work, so I was feeling pretty sleep deprived after the first few days.  The triazolam knocked me out so fast that it scared me.  I tried Ativan last and felt relief pretty quickly.  It still didn't work as well as the klonopin had originally worked, but I felt a lot better than I did when experimenting.  The tolerance withdrawal continued, but (again) I didn't know what it was at the time.  Eventually, I figured that out and knew it was time to quit.

 

So I guess I wouldn't claim zero symptoms, but the switch wasn't what I would call difficult.  The bad marks in my log are from the nights I took trazodone or mirtazapine, so not related to the switch to Ativan.  Still, the symptoms weren't anything terrible (other than poor sleep).  And once I settled on Ativan, there was no more issues worth noting.

 

There's a little more to it...  This all occurred toward the end of a long/brutal diet (102 pounds lost).  Hunger was a constant reminder.  It possibly masked some of the transition experience??  I was also taking some gabapentin (400mg at bedtime) which also possibly masked some of the transition experience.

 

fwiw - the diet ended about a week after the switch to Ativan, and there was nothing worth noting after that.  So no more than a couple of weeks of feeling sleep deprived mostly due to two drugs that didn't give me any sleep.

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Hey badsocref,

 

Thanks a ton for letting me know!  :) I'm trying to keep notes, too. I think it'll help others but also help me in not losing perspective and knowing from where I've come.

 

First, I have to mention your taking mirtazapine. I took that in the past before, and I can't recall a worst experience on a drug (well, one of the worst at that particular time). I happened to take that one night when a sudden storm destroyed part of my home. I was so sedated that I couldn't do anything but call my brother to come over, at which point I went to sleep again. I still get slack for that to this day. But no one seems to understand how strong that stuff is; it felt as if I'd taken 100 Benadryls. Maybe others respond better to that, so I don't want to frighten anyone, but that stuff is powerful.

 

Second, it sounds as if it was an uncomfortable time under any light, so I suppose I will have to expect, at the very least, some discomfort or side-effects. I think it will be worth it, however. What I'm taking now, if you haven't read one of my posts already, is an analogue to a Soviet Union benzo, made in the 1960's, to primarily treat schizophrenia. I wish I would have known this before, although I don't know if I would have had an option to take anything else. The literature was sparse several years ago. But I'm assuming that my lethargy has to be partly caused by taking this horrible benzo. So, considering what you have said, I think it will be worth a try to switch over right now to something that was actually made for anxiety and not something designed to sedate a whale because the analogue is actually stronger than the original due to a fluoride ring.

 

In summation, it seems to me that a change can be made from a substance with a longer half-life to a substance that doesn't have the equivalent half-life with minimal side-effects or withdrawals.

 

Thanks a ton! And I'm glad you made it off this horrible stuff  :)

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