Can someone help me create a crossover schedule? From A to V?

hi everyone,

can i ask for some help?

I'm taking 0.38 A and want to switch to V because i've hit a wall... i can't seem to reduce anymore and i'm extremely symptomatic. I really want to do this crossover but not sure at my dose how to switch...

0.19 mg - 8:30am

0.19 mg - 2:30pm

5.89mg Zopiclone - 9:30pm (i am not switching out the Z drug i will taper that directly).

Please help. What is appropriate... i'm thinking 4 weeks to crossover to 3mg .My psych says my dosage = 2mg V but she is willing to let me sub for 3mg. I'm ok with this.

Thanks!

Jessica

Just using http://benzo.alwaysdata.net/tools/conversion.php I'm seeing that 0.39mg of lorazepam is suggested to be the equivalent of 3.9mg of diazepam. So theoretically, it looks like you'll be taking about a 25% cut while crossing over to 3mg of diazepam. I would not recommend doing any reduction while crossing over; if you can, I suggest crossing over to a dose of 4mg diazepam. 4mg will also be easier to introduce in a four stage step-wise crossover.

I agree with 4 weeks to crossover. I suggest doing it one week at a time, replacing half of your PM dose of lorazepam with 1mg of diazepam, then the other half a week later; then do the same two part substitution with the AM dose, assuming things are still going well at that point. This is basically a modification of Ashtons crossover approach.

I don't know where your psyche is getting her substitution equivalents but she seems far off from the numbers I'm used to. I'm going off of Ashton's equivalents, so you could probably send your psyche a link to the PDF of the Ashton Manual and a page number for the equivalency chart in there (I don't know it off the top of my head). I think the manual would be a more convincing reference than the little website listed above.

Here it is: https://www.benzoinfo.com/wp-content/uploads/2020/08/Ashton-Manual.pdf

And the equivalency chart is Table 1 on page 16. Diazepam is listed as 10mg for ever 1mg of Lorazepam. See the "Approximately Equivalent Oral dosages" collumn to the far right.

I hope this helps! You deserve a smooth and successful crossover! 

Thank you so much!

In your experience do you think majority do well with a crossover? I tried looking up history of posts but it's a mixed bag unless thsow that do well just don't post. I really hope it will help me.

Thank you so much!

In your experience do you think majority do well with a crossover? I tried looking up history of posts but it's a mixed bag unless thsow that do well just don't post. I really hope it will help me.

Ashton thought that the majority did well. Personally I think it's a gamble, but I don't mean to be discouraging. At your dosage of lorazepam I think it's really worth a try, and the step-wise crossover to an equivalent dosage is especially important for improving the odds of success.

I think you're on the right path, and really in the best position to succeed.

Any luck getting your psychiatrist to allow 4mg diazepam?

Not initially no but she said we can titrate depending on how it goes... ie. Go up if I have more anxiety, down if it's too sedating.

Do you think it's important to stabilize first before a crossover? Like what have you seen?

(To be honest I don't know if I could wait till I stabilize because there's no guarantee I will)

Sorry for all the questions I'm just so so nervous about doing this but I feel like I have to give it a try because I haven't made much moves in the last 5 months and I don't want to. 'not make it ya know'

No problem with all the questions; I just don't have a crystal ball. This will be a learning experience for you, and like I said, you're in the best position to succeed that I know of.

If your doctor will only prescribe 3mg of diazepam, here is my suggestion for how to taper...

I suggest doing the crossover that I was original describing, it will just end a little early once you have 3mg of diazepam in your daily dosage and you'd then switch to tapering the last bit of Ativan.

Summary:

Week 1: AM 0.2mg Ativan; PM 0.1mg Ativan, 1mg diazepam

Week 2: AM 0.2mg Ativan; PM 2mg diazepam

Week 3: AM 0.1mg Ativan, 1mg diazepam; PM 2mg diazepam

Week 4 onward... taper AM Ativan to 0.0mg.

It's the best I could come up with to make the crossover without cutting simultaneously. Do you have a large enough stash of Ativan pills to taper the last 0.1mg slowly?

Does this approach make sense to your situation?

hi slownsteady,

you're really awesome for helping me to do this and encouraging too so thank you!!

I was thinking a schedule like this and wanted your input. I didn't start today i will start tomorrow because i wanted your thoughts (plus i'm scared sh**) since i'm so unstable to begin with.

Morning

Midday

Evening

Daily Diazepam Equivalent

Starting Dose

Lorazepam 0.19mg

Lorazepam 0.19mg

3mg

Week 1

Lorazepam 0.13mg

Diazepam 0.5mg

Lorazepam 0.19mg

3mg

Week 2

Lorazepam 0.13mg

Diazepam 0.5mg

Lorazepam 0.13mg

Diazepam 0.5mg

3mg

Week 3

Lorazepam 0.07mg

Diazepam 0.5mg

Diazepam 0.5mg

Lorazepam 0.13mg

Diazepam 0.5mg

3mg

Week 4

Lorazepam 0.07mg

Diazepam 0.5mg

Diazepam 0.5mg

Lorazepam 0.07mg

Diazepam 0.5mg

Diazepam 0.5mg

3mg

Week 5

Diazepam 0.5mg

Diazepam 0.5mg

Diazepam 0.5mg

Lorazepam 0.07mg

Diazepam 0.5mg

Diazepam 0.5mg

3mg

Week 6

Diazepam 1.5mg

Diazepam 1.5mg

3mg

this was in a nice chart but it didn't copy/paste quite nicely as I'd hoped. I'm doing it based on the thought that 0.6 A = 0.5 D (based on my 3mg prescription). I'm hoping the crossover will be ok at this dose.

Question: over time since the 1/2 life is so long will the dose actually end up being higher in my system if i'm dosing daily? Re: metabolites and what not...

thanks!!

I'm sorry but I'm having trouble making sense of your crossover plan. I thought you were only dosing lorazepam twice a day, and taking Zopiclone before bed. Your chart mentioned Morning, Midday and Evening doses, but didn't mention Zopiclone, and I can't tell what is what.

The crossover schedule I suggested in my previous post has a slight updose from 0.38mg/day lorazepam to 0.4mg of lorazepam; this small updose happens simultaneously when you start at week one with your AM dose of 0.2mg lorazepam and your PM dose of 0.1mg lorazepam and 1mg of diazepam.

I don't recommend crossing over to less diazepam than is equivalent to your current lorazepam dose, that's why I left in the 0.1mg lorazepam in the AM at the end to taper on your own schedule.

Your diazepam dosage does not need to be equal throughout the day and it is commonly sedating, so I suggested that you end up eventually at 1mg in the AM and 2mg in the PM. Likely you can get by taking it just once a day, if you'd like, but I would leave that adjustment until you're fully crossed over and off the lorazepam. Diazepam has a very long-acting primary metabolite.

Did I miss something about your schedule or needs?

I wouldn't worry about the dosage compounding with the longer-acting metabolite; that's the goal of a longer-acting benzo, and ideally, it makes tapering a much smoother experience.

ok here it is more clearly (i'm leaving out the Zopiclone i'm not crossing that over)

Starting Dose

Lorazepam 0.19mg - AM

Lorazepam 0.19mg - PM

Week 1

Lorazepam 0.13mg - AM

Diazepam 0.5mg - AM

Lorazepam 0.19mg - PM

Week 2

Lorazepam 0.13mg - AM

Diazepam 0.5mg - AM

Lorazepam 0.13mg - PM

Diazepam 0.5mg - PM

Week 3

Lorazepam 0.07mg - AM

Diazepam 1 mg - AM

Lorazepam 0.13mg - PM

Diazepam 0.5mg - PM

Week 4

Lorazepam 0.07mg - AM

Diazepam 1 mg - AM

Lorazepam 0.07mg - PM

Diazepam 1 mg - PM

Week 5

Diazepam 1.5mg - AM

Lorazepam 0.07mg - PM

Diazepam 1 mg - PM

Week 6

Diazepam 1.5mg - AM

Diazepam 1.5mg - PM

I know the Ashton says 4mg equivalent but I have to go with what the psychiatrist is prescribing as 3mg equivalent they are monitoring my crossover plan I cannot manipulate it. Hopefully it will be okay. I've heard of some people getting away with less so i have to pray to my hgher power that i will be watched over. I'm scared of course and i"m causing myself way more phsyical symptoms as a result.

Oh, okay, this plan is much easier to read. Also I didn't understand you needed to get your crossover plan approved and monitored. I was thinking your doctor was just going to prescribe the diazepam and leave you to crossover. I think I understand now you'd like to be more involved with your doctor and this means presenting a crossover plan that ends at exactly 3mg diazepam.

I was trying to make you a plan that used Dr. Ashton's strategies, with your limited 3mg diazepam dosage. The plan I created allowed you to stabilize on the 3mg of diazepam (which like you mentioned will become more effective once the longer acting metabolite overlaps each dose), while hanging on to 0.1mg of lorazepam, so that you aren't actually decreasing your dose while crossing over. After the crossover I was suggesting tapering the remaining lorazepam before tapering the diazepam; again I wasn't thinking that your doctor would be monitoring this closely. I'm probably repeating myself; just wanted to make sure I was clear...

I see that your crossover plan focuses on replacing the AM dose with diazepam first. Many people find diazepam sedating, and Dr. Ashton's example crossover schedules demonstrate that she began by substituting the night dose, so I was thinking you might prefer to change your PM dose over first. She also would substitute one dose entirely to diazepam before moving on to the next. I can't say why she did this second strategy, but it's reflected in her manual.

Would you consider substituting your PM dose in it's entirety over the first two or three steps?

So I just checked the Ashton method and she does swap partial pm dose then partial am dose ... not full pm dose before am dose...  i remember i got that info from somewhere.

THe reason i'm worried about starting the evening dose is 2 fold... let me know your thoughts. My pm dose of Ativan is at 2:30 so if i only take a portion i'm going to experience withdrawals until nighttime. The other reason is that i am hypervigilant of my symptoms so if i take it at night and i don't sleep becauise i'm anxious that is going to suck as opposed to taking it in the am and being able to sit with myself and feel what the effect is. (i also have zopiclone to put me to sleep). plus i'm SO anxious during the day that if it is sedating i am hoping i could get in a good quality nap that i am never able to. I dont know.. i guess i'm just nervous about going to sleep and not knowing what to expect. (if i sleep).

My mistake! Thanks for checking the manual; I'm sorry about any confusion I caused. I am in benzo recovery...

I understand your thinking on this, and I appreciate you explaining yourself to me. I'm in support of your approach. You know how lorazepam effects you, and I don't. I actually think it's pretty clever how you created a slightly different benzo equivalency figure to get down to 3mg as you crossover. Since all the equivalency charts are "best guesses", I think you may have found the best compromise for keeping your symptoms minimal and your doctor happy.

I really hope you do get a nap! And a good one.

I'm sorry for my mistake, and I hope you can feel more confident about your crossover plan going forward; looks good from here! 

Hi Jess!

I, too am stuck on Lorazepam it seems.

I’m at .219mg (compound liquid) and every .001mg cut is pretty bad. I have stabilized each cut but if I continue at this pace, it will take forever long to taper the last little bit.

I’m considering a crossover.

Please keep me posted on how you do!

For some people, it’s seems to be the biggest help.

i started it yesterday. I feel 'off' thats the best way to describe it. Like i already wasn't stable and super anxious.. now i just feel a little drugged, a little anxious/panic feeling, run down, chest pain and didn't sleep well. All other symptoms are the same. (Well a 'little' less anxious i think but that was probably anticipatory)

I've heard that crossovers are uncomfortable so hopefully it gets better in time not sure I want to do this discomfort for 6 more weeks (although i just did not like the Ativan anymore)

I'm still really torn about how many weeks to do the crossover... like i just can't decide.

I hope i don't feel like total crap the whole rest of the way. It was bad but manageable until Feb when i started trying recommendations from the naturopath. That really crashed me hard and i never recovered. sigh. benzo withdrawal is horrid.

Slownsteady - has your taper always been pretty good or did you go thru any horrendous times?

I appreciate hearing how you're doing SuperJess; a little 'off' sounds manageable, if not comfortable. I imagine you're experiencing some anticipation anxiety as well as relief. I think you're very brave to do this crossover; it's a journey into the unknown and that can provoke fear in any of us. I think you'll know more in a week or two; I suggest doing your best to be patient and stick to your plan.

My taper has been horrible at times, and almost too easy other times. I had to reinstate after my second taper attempt ended in extreme mental instability; that was "doctor led", only I went 4x slower than he asked me to and still by week two I was a basket case. Cut-and-holds have been difficult but manageable, but trying to do a DMT was twice a horrendous failure, first with a pharmacy compounded suspension that had some "bitter blocker" that just crashed my whole system from day one, turning me into a sickly brain-dead lump until I figured out to quit the liquid. The second DMT was with an MCT-oil-only suspension, and the medicine in there just didn't do a thing; luckily in both DMT attempts I was on mostly tablets so they just became basic cut-and-holds, and I persevered.

I don't mean to brag, but I'm on my third DMT method attempt right now and it's working great. I use a homemade liquid clonazepam from tablets and I also have an analogous liquid that was compounded for me with the same basic recipe. I'm going slow, at 6%/14 days but it's become very manageable. I get small waves of symptoms, but I never seem to lose functionality. This monotony of symptoms has made it possible to do more effective psychotherapy, and to begin trialing supplements.

Your mention of hazardous recommendations from a naturopath is something I can relate with; I'm sorry to hear you haven't recovered from that experience. I have been the last two days very sick, exhausted, severely anxious and depressed (and I just said my taper is going great!). Hear me out...

My functional medicine doctor ran a couple very expensive tests and told me to trial the active form of B6, called P5P. I took literally three small sprinkles from a 25mg capsule Monday morning and I've been on a roller-coaster of dysfunction ever since. I spoke with him today, and he didn't have any idea why; he just told me another supplement to try and a book recommendation. He also recommended I try "Googling" about B6 reactions, and see what I come up with... Seriously.

So my taper is really going well now, but my health this moment is a bit dire. I'll be holding my dose tomorrow with tablets, and waiting to get all my functionality back. But I won't be taking any more B6!

You're not alone in struggling, or worrying, or making mistakes; but it's going to be worth it, I think. We suffer so much to learn about ourselves, yet this information is invaluable. Even if your crossover fails (which I doubt), I think you'll be wiser for it, and onto the next solution, until you're done with this poison. It's hellish sometimes, but I appreciate you're here with us on this journey. Maybe we'll get special powers after all this; I'm certainly learning to be more patient, for one.

As I sit here, wet from a long bath, I realize it's probably better that I begin aiming less and less for health, and more and more for just the grace to suffer well. That's the mood I'm in tonight.

I ramble on like this from time to time in my buddy blog, if you're ever interested...

Keep us posted!