Ativan taper using tablets & liquid. Calculations, recommendations please...

Hi all,

I need some direction please regarding daily tapering. I recently had a bad result trying to switch to Valium from Ativan. I am now coming off Valium before I start my Ativan taper.

I have terrible withdrawal from cut and hold m. I don’t have scales to do dark cut safely it sounds complicated for my brain right now.

I’d like to taper off Ativan initially using tablets and liquid compounded from the pharmacy.

Questions regarding compounded liquid: I’d prefer to continue to use Ativan and not the generic Lorazapam if possible. Does anyone know if this is available in liquid form?

If a liquid is compounded what questions should I be asking regarding additives? How is it compounded and with what? Eg. Someone on this site has theirs compunded with almond oil?

Best compounded liquid recommendations in Australia? (most similar to Ativan)

Typical concentration mg/ml? Or please recommend for easy daily calculations.

Secondly, please help with calculations. Apparently there is a spreadsheet somewhere on here but I can’t find it.

Current dose 1.5mg 6Am, 0.5mg 1pm, 0.5mg 9.30pm

Will tablet using Ativan for 1mg & 0.5mg doses. Would like to use liquid to reduce starting with Am dose 1.5mg

Any help or advice much appreciated.

Aim 2.5% -5% reduction every 14 days depending on side effects.

These websites may help you find out if there is a liquid version of Ativan.

http://www.reconnexion.org.au/ 

https://www.tga.gov.au/search/node   

Some of your questions regarding compounding will need to be discussed with your pharmacist and doctor, do you have a compounding pharmacy near you?

You’ll want to double-check this, but according to the ATG (Australian Therapeutics Goods) database, a commercially manufactured oral solution of lorazepam is not available.

Fortunately, a team of pharmacists in The Netherlands developed and - even more importantly - tested a formulation that could be used by your compounding pharmacy to make an oral solution.  In addition to the active drug substance (lorazepam), the final formulation contained in volume concentration (%v/v) 87% glycerol, 10% polyethylene glycol 400 and 3% propylene glycol. The formulation was potency- and stability-tested and remained stable for 12 months at 4 °C (about 39 °F). For more information, see reference below.

Re: your question about what concentration liquid to use ...

The concentration of the Vossen et al formulation was 1mg/1mL.  For tapering purposes, a lower concentration (e.g. 0.1mg/mL) is desirable.  An experienced compounding pharmacist should be able to advise you on this.

Re: your question about using brand name Ativan tablets or generic lorazepam tablets as the drug source for a liquid ...

To minimize variability/increase accuracy in dosing, my understanding is that the preferred option is to use the active drug substance (also known as the Active Pharmaceutical Ingredient or API) as the drug source in liquid formulations (i.e. not regular tablets which contain the API as well as other ingredients).

Reference:

Vossen, A.C. & Velde, I. & Smeets, O.S.N.M. & Postma, D.J. & Eckhardt, M. & Vermes, A. & Koch, Birgit & Vulto, Arnold & Hanff, L.M.. (2017). Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug. European Journal of Pharmaceutical Sciences, pp. 205-210. Accessed online at: https://www.sciencedirect.com/science/article/pii/S0928098717300490

Thank you for your replies so far. I will check this with my compounding pharmacist.

Regarding calculations I suppose I need to check back in once I get the concentration confirmed.

Suppose I do get 0.1ml/1ml.... what is the calculation to reduce daily to equal

2.5% reduction over 14 days? Do you guys think 2.5% is a good place to start? I’d prefer to start at the lower end and see how my body reacts.

I was hoping to find or create a spreadsheet and input the formula to help with daily calculations.

Benzo Brain in w/d 

When you get more information from your pharmacist and find out what the concentration will be we can work it out.  There is a spreadsheet a member developed, I don't know how to use it but here it is.  http://benzo.alwaysdata.net/       

A word of caution about using a spreadsheet, tapers need to be symptom based so they need adjusting from time to time, it's not a good idea to get locked into a spreadsheet or schedule mindset, let your symptoms be your guide.

Thank you Pamster...my rock!  always to my rescue...

Yeah, the spreadsheet won’t be suitable for me.

I will definitely be listening to my body now and adjust dose/slower taper or/hold accordingly... already learnt my lesson the hard way.

Thanks again