Switching from 0.220 mg lorazepam to diazepam help required

I am a couple of months into tapering lorazepam, after getting down to 0.2mg I have been micro tapering with water. Interdose Wds are a problem. Thinking I should switch to diazepam- any advice would be welcome

Hello Zendog,

Before attempting a crossover, I suggest stabilizing if at all possible on your current benzo. Crossovers from a short-acting benzo to a long-acting benzo can be difficult and destabilizing even if you follow the slow, step-wise approach suggested by Dr. Ashton in her manual.

 

I'd like to know more about your situation before giving suggestions on how to stabilize.

 

What is your current dosage of lorazepam?

How often are you dosing the lorazepam during the day?

Did a specific reduction or dosage schedule change mark the appearance of interdose symptoms?

What is the procedure you use to create and dose your water suspension?

I am on 0.220 mg of lorazepam daily taking half the dose at 10am and remainder about 3pm.

 

I dissolve 0.250mg in water shake in jar til portion is dissolved and then discard the required amount every day to dose. ie today I withdrew 9ml on day 9 of my 60 day taper.

 

I was initiated on lorazepam 1mg bd in January after a period of atrial fibrillation and was prescribed amiodarone and had a hypertensive crisis. Subsequently I stopped all my cardiovascular medication and tool loraz erratically. Diagnosed with breast cancer in April and had an anaphylaxis during surgery in May. I recommenced lorazepam, was in a shocking state after having stopped HRT and reduced previous thyroid dose. I have just finished 5 weeks of radiation therapy. My oncologist had me on a dose reducing schedule that was far too abrupt. Recently reducing from 0.5mg bd first week to 0.5mg d second week and then 0.250mg bd to 0.250 d then 0.125mg d then alternate days. Came unstuck then and reached out to a FB group and got a water tapering schedule.

 

So my underlying conditions are also contributing to symptom load. My main problem is headache and feeling pretty uncomfortable. My GP is on board. Also taking Zolpidem at night (for now). Looking for a bit of stability and hope that I don't continue to feel worse before I feel better.

Thanks for more details Zendog; I'm sorry to hear about your health challenges. I hope we can help you navigate benzo tapering.

 

I understand you were tapered too rapidly from 1mg/day, which I believe was your total daily dose during radiation therapy; I've never seen the abbreviations "bd" and "d", but I'm guessing they mean something like bd = both doses and d = dose, since for example you describe going from 0.5mg bd to 0.5mg d. Please correct me if I'm wrong. 50% per week; these are some VERY quick reductions. I understand your body got overwhelmed.

 

To be at 0.2mg now with your water suspension of deconstructed tablets, you'd have needed to take an updose since the 0.125mg alternating days.

 

What was the dosage of this updose, and how long ago did you take it?

Did you hold at the updose and wait for a full recovery from WD symptoms (called stabilizing)?

I have been doing water for 11 days starting at .250mg. Week prior to that was 0125mg alternate days. I think I lasted 4 days of this before becoming completely overwhelmed.

I think I’m going to stay the course on lorazepam. Sorry about my abbreviations bd is twice daily.

 

I have to start oestrogen blockers on the 27th and the usual story is expect to have a lot of pain and extreme menopausal symptoms. Preparing for another onslaught.

 

Has anything helped you mitigate symptoms?

I was on LORAZ for years - hideous drug as re short half life means if I didn't take the EXACT dose at the EXACT time everyday, I would get the worst insomnia for days on end - awake til 4am - I got so sick of it. 

I crossed over last year from LORAZ to DIAZ ...so much better and I feel it is gentler on my body - it's the long half life - it doesn't have nearly the same side effects if you mess up a dose my a tiny amount or miss the timing ...

I am a beginner at this but I sure am glad I switched over before I try to taper off. 

I have been doing water for 11 days starting at .250mg. Week prior to that was 0125mg alternate days. I think I lasted 4 days of this before becoming completely overwhelmed.

I think I’m going to stay the course on lorazepam. Sorry about my abbreviations bd is twice daily.

 

I have to start oestrogen blockers on the 27th and the usual story is expect to have a lot of pain and extreme menopausal symptoms. Preparing for another onslaught.

 

Has anything helped you mitigate symptoms?

 

Thanks for these additional details. Staying the course can work. I think at your dosage, unless your interdose is severe and unresponsive to holding and stabilizing, a crossover could be more work and risk than rewards.

 

I'd say two major factors help me to minimize withdrawal symptoms: small reductions based on symptoms (daily micro taper, aka DMT), and regular blood serum levels. It sounds like you're already doing a micro taper, daily or otherwise. If you're not familiar with it, I like Jim Hawk's DMT schedule generator; takes all the math out of small reductions, which I think are ideal for a medicine like lorazepam.

 

This is my instruction for how to use the generator (and avoid the glitch):

http://www.benzobuddies.org/forum/index.php?topic=254653.5#post_generator

 

Regarding blood serum levels, for clonazepam (half-life ~35hrs), I'm finding that twice a day is sufficient dosing for me. For lorazepam (half-life ~9hrs), I'd be inclined to dose 3-5x per day if possible. With your water suspension, I imagine it's not much work to just break up the remaining liquid after your discard into as many doses as you want.

 

If it's easy, I'd be inclined to dose lorazepam 5x/day. My thinking is to leave 8 hours between doses at night, and dose the remaining 16 hours every four hours. Just an idea to consider.

 

I'm toast and it's bedtime; if I missed your questions please ask me again! 

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