Crossover advice

My doc won’t renew my Ativan prescription. I am taking .75mg a day and been on it for 9 weeks.  I only have three 1mg pills left. He gave me eight .25mg. I am going to be scrambling for a new doc. In the meantime, I have 23 capsules of 15mg of Restoril. How would I cross over in an emergency?

Oh dear, this is terrible news!  According to the chart we use, 1 mg of Ativan is equal to 20 mgs of Ristoril, I wonder if your 15 mg capsules might be almost equivalent to you .75 mgs of Ativan?  https://www.benzo.org.uk/bzequiv.htm

 

I hope you don't have to resort to using the Ristoril, do you have experience with it, how does it make you feel as compared to the Ativan?

Restoril knock me out faster. Only took it for a week. It’s a capsule too so it is more difficult to cut

Is it beads or powder?

 

Have you tried getting an appointment with a Nurse Practitioner, I've seen others on the forum say they can sometimes be a little more understanding about prescribing benzo's if you explain your purpose.

You could try dissoving it in high-fat homogenised milk, and the measuring it with syringe. According to the online conversion that I saw, 15 mg temazepam's equivalent to 3 mg lorazepam (range given is 0.75 mg to 6 mg), so you could try a lower dose (3.75 mg temazepam), before going on a higher dose just to be on the safe-side.

You could try dissoving it in high-fat homogenised milk, and the measuring it with syringe. According to the online conversion that I saw, 15 mg temazepam's equivalent to 3 mg lorazepam (range given is 0.75 mg to 6 mg), so you could try a lower dose (3.75 mg temazepam), before going on a higher dose just to be on the safe-side.

 

This is what is so tough about switching to another benzo in an emergency, the discrepancy between equivalency tables is huge leaving you as the rat in this experiment.

Thanks everyone. This will not be pleasant but it is better than a CT

 

The capsules have powder in them

I was hoping you could perhaps count the beads but paceniks idea might be a better option, or you could use a jewelers scale to weigh your doses.  Hopefully you can find another prescriber. 

Just measure the powdered inside? I have gel caps I can pour it in.

Yes, we have a member who perfected using capsules to make his dose, would you like me to ask him to stop by?

Yes, please

Just sent a request. 

Hi ShortTimeTom,

 

Pamster asked me to stop by.

 

I see you have been cut off from your benzo.

 

Based on your inventory of pills, let us compute how many equivalent doses of 0.75 mg Ativan your have left).

-Three pills at 1mg each (That is worth 4 of your 0.75mg Ativan doses)

-Eight pills at 0.25 mg each (That is worth 3.6 of your 0.75 mg Ativan doses)

-23 capsules of Restoril at 15mg each (I compute that is worth about 23 of your 0.75 mg Ativan doses)

 

Adding all this together (4 + 3.6 + 23) = 30.6 doses left if you take 0.75 mg equivalent Ativan.

 

So you have about 1 month before you run out if you continue at 0.75 mg equivalent Ativan.

 

QUESTIONS:

(1) Are you going to try and find another doctor to get more benzos in the next month?

(2) If the answer to the first question is no, then do you want me to compute for you how to taper with just the benzos you have left?  It will be difficult because you are limited on benzo, but I think we can do it, you are not a long term user.

(3) Do you own a scale?

 

 

.75mg a day and been on it for 9 weeks.  I only have three 1mg pills left. He gave me eight .25mg. I am going to be scrambling for a new doc. In the meantime, I have 23 capsules of 15mg of Restoril. How would I cross over in an emergency?

Hi ShortTimeTom,

 

Pamster asked me to stop by.

 

I see you have been cut off from your benzo.

 

Based on your inventory of pills, let us compute how many equivalent doses of 0.75 mg Ativan your have left).

-Three pills at 1mg each (That is worth 4 of your 0.75mg Ativan doses)

-Eight pills at 0.25 mg each (That is worth 3.6 of your 0.75 mg Ativan doses)

-23 capsules of Restoril at 15mg each (I compute that is worth about 23 of your 0.75 mg Ativan doses)

 

Adding all this together (4 + 3.6 + 23) = 30.6 doses left if you take 0.75 mg equivalent Ativan.

 

So you have about 1 month before you run out if you continue at 0.75 mg equivalent Ativan.

 

QUESTIONS:

(1) Are you going to try and find another doctor to get more benzos in the next month?

(2) If the answer to the first question is no, then do you want me to compute for you how to taper with just the benzos you have left?  It will be difficult because you are limited on benzo, but I think we can do it, you are not a long term user.

(3) Do you own a scale?

 

 

.75mg a day and been on it for 9 weeks.  I only have three 1mg pills left. He gave me eight .25mg. I am going to be scrambling for a new doc. In the meantime, I have 23 capsules of 15mg of Restoril. How would I cross over in an emergency?

 

1)  I have been trying for 3 weeks to find another provider.  I have not been successful.  Two said no since they wouldn't prescribe me more benzos.  I wasn't happy with how my doc has handled my situation for a while.

2) Yes, please compute how I would need to taper with what I have.  I don't have much faith in finding a provider in a short period of time who will help me.

3) Yes, I own a scale.

 

Thank you very much!

Step 1 - I need to know the weights of each of your types of pills.  To be clear.

 

Give me the weight of one 1 mg pill (I assume this is a tablet)

Give me the weight of one 0.25mg pill (I assume this is a tablet)

Give me the weight of one 15mg capsule (please open the capsule and pour out to weight the powder only).  Put it in a plastic bag so you do not lose it.

Step 1 - I need to know the weights of each of your types of pills.  To be clear.

 

Give me the weight of one 1 mg pill (I assume this is a tablet)

Give me the weight of one 0.25mg pill (I assume this is a tablet)

Give me the weight of one 15mg capsule (please open the capsule and pour out to weight the powder only).  Put it in a plastic bag so you do not lose it.

 

Here it is with some quantity updates:

 

1mg tablet 120mg (I have 3.25 tablets)

.25 mg tablet 60 mg (He gave me 6 not 8 )

15mg capsule 222mg (I have 22 not 23)

 

Thank you for the weights.

I made a note of the update in terms of pill quantities.

I am working on the math for your taper.

Stay tuned.

 

This is the most complicated taper plan I have ever created due to the 3 types of pills.

 

You have two options:

 

Crush the Ativan tablets into a bowl and then open all the Restoril capsules into the same bowl and mix together.  I can then compute how much you should take per day from this mixture.  This is the easy option for you to follow.

 

OR

 

We taper you will just Ativan until your reach zero and then start with the Restoril.  I am a little worried about this because you will change from Ativan to Restoril all at once.

 

Which option do you want to do?

 

 

Both sound scary. If I had to make a choice, then it would be the first option.

Be at peace, I am very careful with the math.

 

Here is what you will do:

 

(1) Crush the Ativan tablets in a bowl with a spoon to get a powder.

(2) Open the Restoril Capsule and put the powder into the same bowl.

(3) Mix together well.

 

When done, you will have 5,634 mg weight of mixed powder (you might want to check this with your scale)

 

Within this 5,634 mg of powder is 21.25 mg equivalent Ativan.

 

To get your 0.75 mg dose (equivalent Ativan), you need to weigh 198.8 mg of the powder.

 

NOW FOR THE TAPER.

 

Before I make your taper schedule, I need ask a couple of questions.

(1) Do you understand everything so far?

(2) Do you think you can create the powder in a bowl and prove the total weight is about 5,634 mg (this will be a good check of the math).

(3) How fast do you want to taper?  We may not have a choice as we need to create the taper schedule to match what you have left.

 

I need to think on item 3 for a bit.  I cannot finish it now, I have an appointment this evening for a few hours.  Please consider questions 1 and 2 above and I will get back to you.

 

Yes, I understand 1 and 2. I want to go as slow as possible.

 

 

I have computed your taper.  This is the slowest way to go.  You will reduce a little each day until you reach zero benzo in about 2 months.

 

As a safety factor, this taper will leave you with 10% left over when done (about 500mg will be left out of the 5634mg bowl).

 

You need this safety factor to account for spillage and in case you want to hold at the lower doses (during the last 2 weeks of your taper).

 

Use the chart below.  For example, on day one, eat 195.1 mg from the bowl, on day two, eat 191.3mg from the bowl, and so on.

 

Day Weight in Bowl Weight for Dose (mg)

1 5634.0 195.1

2 5438.9 191.3

3 5247.6 187.5

4 5060.1 183.7

5 4876.4 180.0

6 4696.4 176.2

7 4520.3 172.4

8 4347.9 168.6

9 4179.2 164.8

10 4014.4 161.1

11 3853.3 157.3

12 3696.0 153.5

13 3542.5 149.7

14 3392.8 146.0

15 3246.8 142.2

16 3104.7 138.4

17 2966.3 134.6

18 2831.6 130.8

19 2700.8 127.1

20 2573.7 123.3

21 2450.5 119.5

22 2331.0 115.7

23 2215.2 112.0

24 2103.3 108.2

25 1995.1 104.4

26 1890.7 100.6

27 1790.1 96.8

28 1693.2 93.1

29 1600.2 89.3

30 1510.9 85.5

31 1425.4 81.7

32 1343.7 77.9

33 1265.7 74.2

34 1191.6 70.4

35 1121.2 66.6

36 1054.6 62.8

37 991.7 59.1

38 932.7 55.3

39 877.4 51.5

40 825.9 47.7

41 778.2 43.9

42 734.2 40.2

43 694.0 36.4

44 657.7 32.6

45 625.0 28.8

46 596.2 25.1

47 571.2 21.3

48 549.9 17.5

49 532.4 13.7

50 518.7 9.9

51 508.7 6.2

52 502.6 2.4

 

Thank you. I will keep you updated

I have a 7:45 am appointment with a new doc in the morning. Thoughts on what I should ask to get? Stay on Ativan? I was already in tolerance withdrawal. The intradose withdrawal has been rough today.

Best thing would be to stay on Ativan and if they understand tapering, have them help you with a 3 or 4 month slow taper.

If they try to taper you in 2 weeks, then they are from the old school of Benzo understanding (they still believe the Benzo manufacturer's claims).