Lorazepam taper

I’ve been benzo free for many years up until Christmas 2020.  I contracted covid, got pretty sick, and had to quarantine in my bedroom for 14 days.  The quarantine caused my anxiety to go through the roof!  I wasn’t able to sleep for days.  Couldn’t see a doc cause I had covid, and my psychiatrist’s office was closed and I couldn’t get ahold of him.  I couldn’t take it anymore and ended up taking lorazepam.  I am now on .5mg twice a day - under doctor supervision of course.  I’ve only been on it for like two weeks now.  Am able to sleep now.  But I feel very weird when it wears off.  Doc wants to also add buspar hoping to get me off lorazepam soon.  I am very medication sensitive.  I will want to micro taper off lorazepam using Ora plus.  I forget how to do it.  Can anyone please help?  Also, any advice on the buspar?  I’ve always been real hesitant taking new drugs.  I research everything and it scares me.  I’m on mirtazipine for over 20+ years.  Buspar has a possible major reaction with mirtazipine but my doc says the risk is low for issues and he has other patients that do well on that combo.  I’m scared to take it.  And I’m scared about being on lorazepam again!

General Directions for Compounding ORA-Sweet*/ORA-Plus Suspensions

ORA-Sweet and ORA-Plus should be combined in a 50/50 ratio to achieve optimal formulation.

• Calculate the total amount of active ingredient and volume of solution needed to create a suspension of the proper concentration.

• Crush tablets to a fine powder.

• Add a small amount of ORA-Plus and triturate to a thick, smooth paste. Add the remainder of the ORA-Plus by geometric dilution. The amount of ORA-Plus should be 50% of the total solution.

• Bring the suspension to a final volume using ORA-Sweet*. Mix briefly with a mortar and pestle until a uniform suspension is formed.

• Dispense in a tight, light resistant amber bottle with appropriate labeling.

• Label with an expiration date.

Do you think since ive only been on the Ativan for 12 days, I can cut pretty aggressively to get off or do I need to micro taper?  Anyone have any experience being on Buspar along with an antidepressant?  Wondering if the buspar will make my Ativan stoppage smoother?  Thanks for the reply!  Can I use sterile water instead of the ora sweet?

 

The rate at which you can taper is something you'll have to determine.  There's no way to guess.  The general advice is to listen to your body.  If symptoms are minimal, you can probably accelerate the taper A LITTLE.  If symptoms get nasty, then slow down (or stop) the taper.

 

Ativan is very poorly soluble in water.  Many people crush/solubilize the pill in 3-4 ml of alcohol or propylene glycol first (stronger is better), then dilute with water and drink.  ORA-Plus is probably a better approach, but the alcohol method has worked for a lot of people.

 

I can't comment on buspar (no knowledge).

I agree with badsocref.  You are the only one who can determine what taper rate works for you. 

 

Given that you have only been taking lorazepam/Ativan for two weeks, if I were in your shoes, I would try to taper as quickly as tolerable in hope of avoiding (or lessening the degree of) physical dependence on the drug.  However, this is the third time you have discontinued a benzodiazepine so you might want to start with a “low-ish” rate and then increase it if withdrawal symptoms are tolerable.

 

Are you aware that an FDA-approved, oral solution of lorazepam/Ativan is available?  Also, several members of the Tapering Ativan Support group are working with compounding pharmacies that have formulations for oral solutions as well as for oral suspensions of lorazepam. 

 

FYI - My understanding is that liquid formulations of lorazepam are subject to temperature-related degradation so should be stored in the refrigerator (in addition to being protected from light).

I purchased the oraplus and orasweet.  Also bought propylene glycol.  Which is better?  Can I use both?  If I used the propylene glycol, how much do I use to make 50ml bottle?  I read that propylene glycol isn’t the best thing for you and can be toxic which is pushing me towards to oraplus/orasweet route

I'd use the Ora-stuff.  It's made specifically for what you're doing.

I take the Ativan twice a day.  At noon and before bed around 11pm.  I definitely feel the need for it in the morning and then again around 7pm.  Should I be taking it 3 times a day to have a more even blood concentration before I start tapering.  I am definitely suffering in the morning and evenings

Many Lorazepam users take it 3 or 4 times a day, I'd get into that routine before starting your taper.

My doctor wants me off ASAP.  Told me that since I’ve only been on for 3 weeks, I can just cut the bedtime dose out.  A 50% cut.  Can’t sleep since and feel really crappy - you wouldn’t think 3 weeks would do that to you.  His plan is to take me off completely at the end of this week.  He wouldn’t budge on 3 doses to level me out first and then start tapering. I asked to be switched to a longer acting benzo and he still said no.  I was so close to going to the ER the last two nights

I'm so sorry to hear this, it blows my mind that a Dr would inflict needless suffering in order to stick to a timetable not based in fact.  Your body is already dependent and a few more days in order to stabilize isn't going to make a difference and doing a slow taper will keep you out of the ER.  I'm so frustrated, how can we help?

Since the covid pandemic, I can’t get ahold of my regular psychiatrist.  They are only doing telephone appointments- but haven’t been able to get a return call.  So that I why I switched to this new doctor.  Very disturbing that you can’t get ahold of your doctor.  Maybe I need to get a second opinion.  Is it possible that I’m already dependent after only 3 weeks on a relatively low dose?

Given your inability to sleep and 'feeling really crappy', it sounds like you are dependent, we have many members who are sensitized to the drug from previous use and discontinuation.

 

I wish you could reach your psychiatrist, I'm not sure how much luck you'll have finding another Dr to help you taper, many are getting away from prescribing these drugs. 

I found a doctor that will taper me slowly off benzos.  My doc said my old doc might have done some damage when he cut half my dose and I was in hell for 4 days.  Do you agree with damage?  New doc said most likely will need to stabilize on a higher dose of Ativan, then switch to a longer lasting one then stabilize on new benzo, then start cutting slowly.  I am really scared.  I keep obsessing about it not working this time.

This is wonderful news, wow, he sounds very knowledgeable!  Obsessing about this process is one of our withdrawal symptoms, we're consumed by it so you're fitting right in with the rest of us.  Try not to let fear rule you because fear causes stress and stress makes our symptoms worse, the best thing you can do is educate yourself about what's happening to you so you won't fear it.

 

I think you're in very good hands, I agree with the plan your new Dr has outlined and as for damage, no need to worry about that either.  The damage done comes in the forum of nasty symptoms and when you recover, all of this will be behind you.

 

Let us know what the plan is so we can offer some suggestions okay?

Is diazepam the most addictive of the benzos?  I’m worried about switching over to Valium and then not being able to get off.  Is diazepam the best to ween off from?

Has anyone tried a detox center to get help with benzos.  Or do they get you off too quickly?  The reason i started Ativan was severe anxiety - almost going to the ER bad.

All benzo's cause dependence, and Valium is the gold standard for tapering because it comes in 2 mg pills making them easy to split and it's half life is so long you don't have to dose 2,3 or 4 times a day, although many members will dose at least two times.

 

The only issues I hear from Valium users is at first it can cause depression and sedation but members seem to acclimate to it after awhile.  Of course, there are those who aren't able to make the switch and need to go back to their original drug so there are things to consider.

 

Actually most members will taper directly from their benzo, would you feel more comfortable dealing with the beast you know rather than the one you don't?  I can give you some links to thread devoted to members tapering from the different benzo's so you can ask some specific questions.

 

Valium Support Group

 

Ativan Tapering Thread

 

Will your Dr cross you over properly, taking the time to build the Valium up in your bloodstream while discontinuing the Ativan?

 

Has anyone tried a detox center to get help with benzos.  Or do they get you off too quickly?  The reason i started Ativan was severe anxiety - almost going to the ER bad.

 

Not a good idea, I've only heard one member out of thousands who said they felt is was successful.  Most detox facilities will taper you too fast then send you home to suffer, then most will reinstate and taper after all of that pain and spending all of that money. 

Doc did say that I might be taking both when the crossover happens.  Is klonopin a good one to taper from since it is long acting?  I was successful tapering from klonopin before.  That taper lasted over a year

I can’t stop thinking if I didn’t get covid, I would never had a crisis anxiety event.  I would still be benzo free today ☹️

I’m upping my Ativan from the cut.  So going from .5mg once a day to .5mg 3 times a day.  How long will it take for me to stabilize to this dose?

Looping and intrusive thoughts are common, I hope you could find some distraction to divert the direction they're taking. 

 

I wish I knew how long it will take you to stabilize and at what dose, this might be a good question to ask the folks on the Ativan tapering thread, they're very knowledgeable and kind and could give you some first hand advice.

 

If you're more comfortable with Klonopin then that might be an option.

Is 1.5mg of lorazepam a lot?  The highest benzo dose I’ve ever been on is .5mg clonazepam.  .5mg klonazepam is equivalent to 1mg Ativan.  So the 1.5mg Ativan is now the highest dose for me.

I've seen members who up-dose after reducing too much or too fast have to go higher than their original dose in order to get stable, it's difficult to pull the body out of withdrawals once they set in.  I hope you won't have to go any higher, how are you feeling?