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Tapering lorazepam from 0.25 mg. Direct or substitution? Advice needed, please.


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Background: I started Ativan the last week of June 2021 at 0.25 mg - 0.75 per day, per doc order. Told to increase if needed. I took between 0.75 mg - 1 mg once daily between July 1, 2021 and July 19, 2021. So a total of roughly 4 weeks. Started taper with doc on July 20th. First 10 days of taper was 0.75 mg per day, second 10 days was 0.5 mg, third 10 days was 0.25 mg, final 10 days should have been 0.125 mg. I split each of these daily doses in half to take twice per day to prevent interdose withdrawal, but it still happened due to the short-acting nature of Ativan. I learned this the hard way. :(

 

I got down to 0.125 mg once per day, 7 days in and had to stop. The general withdrawal (and interdose withdrawal) was just too intense. Went back up to 0.25 mg. It's now been 10 days and I feel roughly stabilized again at 0.25 mg, split into 2 doses per day. Still having a lot of interdose withdrawal so need to get that sorted out. It was WAYYY too fast of a taper and at the time I didn't know any better. Cognitively, I feel like my marbles have finally recovered (mostly) but wow, was I completely dysfunctional for the last 10 days....and most of the way down the too-fast taper. Feel SO much more like myself today, finally!

 

My psychiatrist is useless so I found this wonderful group. My thought is to do a direct taper (dose 4x a day?) instead of going through the hassle and possible issues that a Valium substitution might bring since I'm already pretty low at 0.25 mg daily. And I have existing stomach issues that I don't want to irritate with Valium. Eager to get your thoughts/insights on this idea? Substitution vs direct from 0.25 mg? What's a reasonable taper plan look like for me?

 

Also, going to see if I can get a script for liquid Ativan at a local compounding pharmacy. I'm not sure how to instruct my doctor when it comes to writing the order (how much I'll need, etc.) Thoughts on this? He's never prescribed a liquid taper before and said I needed to figure that part out. How? If I can't get it compounded, using a scale to measure pill crumbs could be another option. Scales seems to be hit or miss on accuracy from my readings here. Water titration may work too. I just don't know if that's overkill for my situation?

 

Sorry for all the questions! Thank you all so much in advance! This group is so amazing and I can't wait to be a success story here one day. <3

 

 

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