Need help with Ativan taper below .25mg

Hello Friends,

I have been holding at .25mg Ativan for over 2 months (.125mg AM and .125mg PM). For my next cut I was planning moving down to .125 mg by dropping the AM dose.

Well... I actually forgot to take my PM dose last night, and accidentally experienced what it would be like if I dropped a dose. It was not good at all.

Can anyone explain how I can use a liquid to make my own smaller doses to use for the final taper? Or point me toward a resource?

I am pretty convinced after last night that I need a new strategy.

Thank you!

Bibs jo

*I also posted this on the direct thread as I am hoping to switch from direct to titration

Hi Bibsjo!

Generic lorazepam comes in a 2 mg/mL liquid concentrate that goes by the ominous name Intensol.  The instructions say:

"This medication is a high-strength concentrated liquid. Use the provided medicine dropper to carefully measure the exact amount of medication prescribed by your doctor. You may mix the measured dose with a small amount of juice, water, soda, applesauce or pudding. Stir in one dose and mix gently for a few seconds. After preparing one dose, drink or eat the entire mixture right away. Do not prepare a supply for future use."

You would have to take just a small portion of a very diluted dose, the balance of which cannot be saved for future use, so you would probably end up wasting a lot of it.  But at $8 to $13 per 30 mL bottle, it doesn't seem terribly expensive. 

https://www.webmd.com/drugs/2/drug-14588/lorazepam-intensol-oral/details#:~:text=This%20medication%20is%20a%20high,gently%20for%20a%20few%20seconds.

Here's a link to a more thorough description of Intensol. 

https://docs.boehringer-ingelheim.com/Prescribing%20Information/PIs/Roxane/Lorazepam/Lorazepam%20Intensol.pdf 

If you're in the US and your doctor is cooperative, this seems like a convenient tapering option.

The liquid comes with a dropper that delivers a minimum volume of 0.25 mL, equal to 0.5 mg.  So you could add that amount to 50 mL of water to get a 0.01 mg/mL solution. 

Using that solution, you have complete flexibility as to dose decrements. 

For example,

12.5 mL of 0.01 mg/mL solution = 0.125 mg lorazepam (discard 37.5 mL)

12.4 mL of 0.01 mg/mL solution = 0.124 mg lorazepam (discard 37.6 mL)

and so on, all the way down to

0.10 mL of 0.01 mg/mL solution = 0.001 mg lorazepam (discard 49.9 mL)

Hi Bibsjo!

 

Generic lorazepam comes in a 2 mg/mL liquid concentrate that goes by the ominous name Intensol.  The instructions say:

 

"This medication is a high-strength concentrated liquid. Use the provided medicine dropper to carefully measure the exact amount of medication prescribed by your doctor. You may mix the measured dose with a small amount of juice, water, soda, applesauce or pudding. Stir in one dose and mix gently for a few seconds. After preparing one dose, drink or eat the entire mixture right away. Do not prepare a supply for future use."

 

 

 

You would have to take just a small portion of a very diluted dose, the balance of which cannot be saved for future use, so you would probably end up wasting a lot of it.  But at $8 to $13 per 30 mL bottle, it doesn't seem terribly expensive. 

 

https://www.webmd.com/drugs/2/drug-14588/lorazepam-intensol-oral/details#:~:text=This%20medication%20is%20a%20high,gently%20for%20a%20few%20seconds.

Koko Lee,

Oh my gosh THANK YOU! I am in the US and I had no idea this was an option. I will run this by my doctor as soon as I can. He may be on vacation. Thank you again!

~ Bibs Jo

Bibsjo: Good for you for talking to your prescriber about the lorazepam Intensol.  If you decide to pursue this option, we could put together a “how to” sheet on preparing and measuring your doses in accordance with the manufacturer’s instructions for using an Intensol.  FYI This particular Intensol requires refrigeration.

Koko Lee:  Good to see you on the boards as always. FYI - it appears that at least one of the manufacturers in the US (West-Ward now owned by Hikma) has changed from a dropper to an oral syringe for the measuring device.

Source:

DailyMed

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

Oh my gosh THANK YOU! I am in the US and I had no idea this was an option. I will run this by my doctor as soon as I can.

My pleasure, Bibs jo!  I truly hope this possibility works out for you!

Bibsjo: Good for you for talking to your prescriber about the lorazepam Intensol.  If you decide to pursue this option, we could put together a “how to” sheet on preparing and measuring your doses in accordance with the manufacturer’s instructions for using an Intensol.  FYI This particular Intensol requires refrigeration.

 

Koko Lee:  Good to see you on the boards as always. FYI - it appears that at least one of the manufacturers in the US (West-Ward now owned by Hikma) has changed from a dropper to an oral syringe for the measuring device.

 

Source:

 

DailyMed

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

Thanks Libertas!  Your input is always helpful.