Ativan Liquid Taper question

Good Afternoon,

 

After experiencing 2 failed dry tapers I am contemplating doing a liquid titration micro taper over the next 9-10 months.

 

The one question I have is that I am trying to stabilize on 1mg of Ativan nightly. When I do my liquid taper should I take 1/3 in the morning say at 9am and then 2/3 at 9pm? I find my body is feeling for that extra day dose even though I've never taken a dose in the day before. I am not going to take more that 1mg in a 24 hr period as I'm not increasing my dose. Would this help level it off or would even 1/3 every 8 hours work better?

 

Also my plan is to do Alcohol and water. Is this the best option. I plan to make my solution every day. Thank you

I think it would make sense to me to try more doses, for a more even serum level. I'm currently dosing clonazepam at 5am, 1pm and 8pm. With Ativan being so short-acting, I guess the best schedule would be one you could live with; if you do move your doses around I suggest giving yourself a few days at a steady dose (without reducing) to get settled.

 

Why not use a liquid/tablet hybrid taper? I've written a long description of how to do one and the benefits in the link in my signature under 'Tools & Techniques'. The idea is to take as much of your dose in tablets as possible, and only use a liquid dose for the 1/4 pill your actively reducing. It's really convenient, if like me, you plan to reduce one dose at a time. You can still bounce around, reducing one dose 1/4, then reducing another dose 1/4, if say you wanted to even out your morning and night doses at some point.

 

Again, I'm on clonazepam which is long-acting, but I had 4 doses just two days ago; I had a 2am dose for maybe 4 months; ug! So I'm eliminating my doses individually at this time, then rotating my time table to balance things out; I plan to get to two doses a day and stay there for a while. The active duration of clonazepam is 10-12 hours; with lorazepam I think it's more like 4-6 hours.

 

You may have your eye on a totally different approach. If you like mixing up an alcohol and water batch every day, and you want to pull some percent, then split the remaining up for your doses, that works. I personally make a singular liquid batch that lasts me 30-60 days, and I only take one TINY liquid dose a day measured with a 1ml oral syringe; this lets me go heavy on the alcohol for dissolution and preservation (30% ethanol), but I'm only ever taking at MOST 1/20th of a teaspoon of ethanol per day, and usually much less.

 

So just some feedback and ideas. The "best option" will depend on YOU, and your needs, and your tools and temperament. If you can stand my verbosity, my suggestions in the link below for a clonazepam taper are pretty easily translatable to a lorazepam taper; I could help you make the connections.

 

Do you have an idea of how much ethanol you need per mg of Ativan?

What volume of water are you thinking about using?

Do you have pipettes or something else to draw off your reduction?

Or have you got any new ideas?

 

Third time is a charm! I'm on my third taper attempt too! 

Ativan's half-life is 10-20 hours, so 2 doses could cover it. However, you could go to 3 doses if you feel up to it. The key is being able to remember your dosage times and be consistent with taking the doses. Also, I suggest that you reduce across all the doses during the taper.

 

I have found that alcohol and water is the best option. I suggest that you make a batch that lasts you a week or two.

 

I have found micro-tapering to be the best option for me. It feels good knowing that I am reducing this every day, and on some bad days, I can even hold without any issues.

Ativan's half-life is 10-20 hours, so 2 days should cover it.

 

I think you mean "doses" instead of days, and I think there is a very big difference between the half-life and the active duration of a medicine. Clonazepam has an average half-life of 35hrs, I don't hear anyone recommending to take a dose of this medicine every day and a half. The active duration of clonazepam is actually around 10-12 hours. I believe lorazepam's active duration is 4-6 hours. This doesn't mean people can't go longer between doses, but the half life is not the same as the active "therapeutic" duration, to my knowledge. I'd suggest using the active duration as a dosage timing guideline, not the half-life.

 

Also, as you reduce, be sure to reduce across all the doses.

 

Is this a short-acting benzo taper suggestion? I eliminate a single dose at a time, and it hasn't been a problem. I can see why it might be easier just to reduce all of them at the same time, if your method allows. My approach makes it easier to target a single dose.

 

Also, sorry to be bashing your well meaning and thoughtful post darkarchon, but we try not to tell people what to do. I'm sure you know that's called being "prescriptive" and is against the ethics of the forum. It only takes a couple words to make "Make a batch that lasts you a week or two." into "I'd suggest making a batch that lasts you a week or two." Just a heads up.

 

I do really appreciate your post darkarchon. Good points about dosage times and consistency! 

I think you mean "doses" instead of days

Yes, I meant doses. Thank you. I will correct my earlier post.

 

I'd suggest using the active duration as a dosage timing guideline, not the half-life.

Very good point. Is there a chart somewhere showing the active durations of various benzos?

 

Is this a short-acting benzo taper suggestion?

This was a general suggestion. I will correct my post to indicate that it is a suggestion.

 

I'm sure you know that's called being "prescriptive" and is against the ethics of the forum.

Thank you. I will correct my post to indicate that it is a suggestion.

Thank you for the responses. I have a talk with my doctor next Tuesday about this. I've only ever tried Ativan and its all I'm used to. I've never taken 2 doses a day only at night. However should I ask my doctor about switching to a longer benzo such as Klonopin or Valium?

 

My plan is to take the 1mg and dissolve in 2ml of Alcohol and 298ml of water and make a 300 ml solution split into either a morning dose of 100ml or 150ml and a nightly dose of 200ml or 150ml. The plan is to then titrate out 1ml a day so I'm really only cutting about 1 percent every 3-4 days. This is a 300 day taper.

 

Thoughts on if this is a good option with Ativan? Also its the sublingual kind that dissolves under the tongue. Thank you

Thanks for sharing more details Twindubs. The stronger the ethanol content of your alcohol, the more successfully you'll dissolve the medicine. I use 180 proof (90% ethanol). I'm being lazy and not looking at the medical literature, but I think 1mg Ativan should dissolve in 2ml of something like 180 proof rather quickly. I don't think the ODT will be any problem; could be an advantage since they fall apart easily when wet. After waiting for some dissolution to happen in the ethanol (and stirring), only THEN would I do the dilution into water. Your numbers sound good. 300ml with an additional 1ml reduction per day seems like it adds up to a 4.6% reduction over the first 14 days.

 

If you keep removing 1ml more per day, all the way down to zero remaining then what you'll be doing is a linear reduction (also known as quantity based reduction). You'll be taking away 0.0033mg of Ativan per day, or 0.0467mg of Ativan per two weeks. The second two weeks you'll be reducing by 4.9%, then 5.1%, then 5.4%, then 5.7%, then 6.1%, and so on. By 6 months of this you'll be reducing by 9.6%/2 weeks and the percent reductions rises from there to the last month and a half where you'd be reducing 29%/2 weeks, then 41% and if you haven't already jumped, then your last two week reduction would be a 70% reduction to get to 0.02mg and then jump. Basically the last four months of this ten and a half month taper plan would be outside the recommended safe rate of reduction, which is 5-10%/2 weeks.

 

Of course no taper plan survives first contact with biology! So I'm not suggesting that you need to think too far ahead right now.

 

If you keep dissolving your 1mg in 2ml 180 proof, diluting to 300ml, and pull 1ml more than you did the day before (ideally from the middle of the vessel after vigorous stirring/shaking), you'll have "safe" taper rates until about 6 months from now. Your body might start complaining before this, and then I'd say it's time to either hold or adjust your approach.

 

I suggest keeping careful records, so that you'll know your mg/day and can adjust your tapering method without too much headache.

 

What tools do you have on hand or plan to buy to pull those ml reductions? Maybe a 5 or 10ml syringe to start? If you keep at this for a couple months you'll be pulling 60ml, so I guess you'll want slightly bigger syringes.

 

Keep us posted! 

Excellent! Will do! I'm still trying to decide on when I should take the doses and if I should do 3 equal doses of 100ml volume or 2 doses. I guess I will have to play around with it. Thanks!