I need advice on switching from lorazepam to ketazolam.

Hello,

I currently have tinnitus and other anxiety related nervous symptoms. I take 0.37mg of lorazepam in the morning and 0.37mg in the evening.

It is effective against anxiety, but since I have neck problems that add muscle tension that lorazepam at that dose does not resolve for me, the doctor has suggested I take half to one tablet of Ketazolam 15mg at night and stop the orfidal.

He says there is no problem with doing the overnight benzos substitution, but I am afraid of a rebound effect from the tinnitus or anxiety.

I don't know if anyone with experience can guide me on a more progressive and safer change to avoid unwanted rebound effects.

Thank you very much.

May I ask why you were put on the Lorazepam to begin with and how long you've taken it?  The reason I ask is because benzo dependence can cause muscle tension, anxiety and tinnitus.

Also what was your beginning dose, have you had to increase it?

I wonder this along with Pam. Many people are put on valium as a muscle relaxant. So I wonder about the lorazepam. I was on it years ago (it started my benzo nightmare) and can't recall any muscle-relaxing qualities. The Mayo Clinic says this:

Diazepam is used to relieve symptoms of anxiety and alcohol withdrawal. This medicine may also be used to treat certain seizure disorders and help relax muscles or relieve muscle spasm.

However, given the likelihood of developing benzo dependency, if it were me, I'd prefer a different class of drug altogether. Ketazolam is still a benzo. Indeed,  when I had back spasms, my doc prescribed Flexeril, which worked very well. There are probably many other choices.  I don't want to second-guess your doctor . . . just want you to be aware of the likelihood of benzo dependency. Maybe you could discuss other options for your muscle spasms with him/her?

Best to you,

Katz

Hello,

In February this year I started with tinnitus but already in March I had nervous symptoms (extrasystoles, palpitations in the body, dizziness, flashes in the eyes...not all at once, it was changing).

I started with clonazepam (Rivotril 2,5mg) and a beta-blocker (bisoprolol fumarate 2,5mg). Since April 1 I was taking 4 drops per day of rivotril. I felt pain in my ears for example, but I didn't realize that it was muscle tension, because so far I had felt the muscle tension in my back and neck, it didn't go up to my skull. So for a long time the issue of muscle tension was not the focus of attention. I stopped the Rivotril on August 13, but not because I was feeling well, it was because I was told that I had been on the benzodiazepine for too long. In those weeks I realized that turmeric infusions helped me and that helped me to stop the benzodiazepine although in the last week I got a skin reaction that lasted about 3 weeks (even when I was no longer taking turmeric or rivotril).

I spent 4 days trying to take natural things, but I smelled lavender essential oil and it made my tinnitus really bad, so I called a psychiatrist and asked him what to take and he told me to take orfidal.

I had had such a hard time in the rivotril withdrawal and natural remedy days that I didn't even question it, and in all those weeks the muscle tension was very high and I was realizing that it was influencing my tinnitus.

This is also when the flashes in my eyes that I still see started.

On August 18 I started Orfidal. The psychiatrist told me 1mg in the morning and another at night but I quickly saw that with less I could handle the anxiety and have been taking almost the 0.37mg morning and night since the beginning and have not had to up it.

I spoke to the ENT who has a suspicion that the tinnitus could be from jaw tension and he told me to take the muscle relaxant Sirdalud (tizanidine 2mg), which was compatible with what I was taking.

I took 0.4mg of Sirdalud one day and got a skin reaction. Although the sirdalud relaxes my muscles a lot and the tinnitus decreased a lot and I had no anxiety symptoms. I also noticed as if the effect was enhanced (perhaps due to interaction with the orfidal or beta-blocker)

As I was not sure if the skin reaction was due to the sirdalud, I let 2 days go by without taking it and took 0.2mg in the morning and also took the beta blocker. That day I did not take the orfidal in the morning and was fine all day, the potency of the sirdalud was strangely high for how little I took. I also had some skin rash.

In the evening I didn't need the orfidal but decided to take the dose that was due and I started shaking and that night my tinnitus was out of control.

So I don't know what to do, the sirdalud in theory is compatible but I don't know if it interacts with the beta blocker or if it had to do with me skipping the morning orfidal but right now I'm afraid to try it again.

I am trying to get off the beta blocker as I don't have extrasystoles and maybe there I could try again.

The problem is that I have a lot of muscle tension and the psychiatrist thought ketazolam, I also prefer something else, and more if I can't switch overnight to ketazolam without withdrawal effects.

On the other hand, do you think the eye flashes are an effect of rivotril withdrawal?

Thank you for your help

Thank you for explaining your situation to us, I can see your trouble started before the Rivotril.  I can see you're doing your best to try to figure out what is causing what, these darn medications, if we somehow manage to fix one thing, it seems to mess up something else. 

I've read members discuss skin rashes and itchiness in relation to benzo withdrawal long after they've discontinued the drug and many members have mentioned vision problems as well so it's difficult to know what is causing your issues since there have been a number of different supplements and medications in the mix. 

I hope you can find something to help you that isn't a benzodiazepine because as both Katz and I mentioned, they can cause the issues you're trying to fix.  If you'd still like to cross over to Ketazolam I suggest phasing out the Orfidal while introducing the Ketazolam, your dose is so low that you could accomplish this in a few days, what do you think?

Well, I don't know, when I stopped taking rivotril my dose was very low, and yet I had a bad time, I get anxiety symptoms and I stop sleeping completely.Also in the last week the flashes appeared.

If the flashes are from benzo withdrawal, and yet now I take orfidal which is a benzo, does it make sense that they are still appearing a month and a half later? Have you ever heard of such a case?

I'm suggesting that because you're on a fairly low dose of Orfidal you can probably accomplish the crossover to Ketazolam in a few days to a week.  I would never suggest stopping any amount of benzo cold turkey, these drugs are too powerful, even at low doses because if your body is dependent, the drug has already caused your brain to change and adapt to it's presence.

Have you ever seen a doctor for ocular migraines?

Thank you very much for your help, but I could not be able to decrease the amount of orfidal without suffering too much anxiety. As for ocular migraine, I googled the term because I didn't know it and what I found doesn't look like what I suffer from, anyway I will ask the neurologist.

Thanks again

Do you think I can do that safely? Let's say that's a little bit my doubt, if there can be a stage where I take both but I don't know in what percentages.

Also the ketazolam is in capsules and to dose it I would have to open the capsule and discard some of the contents and I don't know if that is something that can be done, do you know anything about this?

Thank you very much

Adding in one drug while withdrawing another is a common practice, this is what Professor Ashton suggested in her clinics, this is an example of a crossover schedule from Lorazepam to Diazepam. https://www.benzo.org.uk/manual/bzsched.htm#s8

We can help you determine the right amounts if you would like to try this because the goal is to not suffer horrible withdrawals while making the transition from one drug to another before you even begin your taper. 

In order to do this I would suggest purchasing a jewelers scale and weighing your capsules and their contents to determine the correct amount to discard and we have some really smart people on the forum who can help you do this, its not me of course. 

Hello,

Hello,

Yes I would like to try, if someone can help me to determine the quantities. Or I don't know if there is any table of the method whose benzos are similar to mine and maybe they can guide me. Is it sufficient for the jewelry scale to be accurate to 0.01 gram?

I thought that the capsules could not be opened, because when I asked the doctor he told me that it was not possible, but I understand that for you it is a common practice and you consider it safe. Knowing this with certainty would help me to take the step, not only to avoid the symptoms of withdrawal of lorazepam, but also because it would also reassure me in order to withdraw ketazolam in the future, to be able to discard part of the content little by little and not taking the whole capsule on alternate days as my doctor suggests.

Thanks for your help.

Hello,

 

Hello,

 

Yes I would like to try, if someone can help me to determine the quantities. Or I don't know if there is any table of the method whose benzos are similar to mine and maybe they can guide me. Is it sufficient for the jewelry scale to be accurate to 0.01 gram?

 

I thought that the capsules could not be opened, because when I asked the doctor he told me that it was not possible, but I understand that for you it is a common practice and you consider it safe. Knowing this with certainty would help me to take the step, not only to avoid the symptoms of withdrawal of lorazepam, but also because it would also reassure me in order to withdraw ketazolam in the future, to be able to discard part of the content little by little and not taking the whole capsule on alternate days as my doctor suggests.

 

Thanks for your help.

I may have misspoke, I've watched members open capsules containing other drugs but I don't know specifically if anyone has done this with Ketazolam.  I have to go out of town for a couple of days but if no one jumps in this thread with their experience I suggest creating another one putting this question into the subject title to get more attention to this issue.  I'll check in when I get back.

Did your doctor give a reason why this isn't possible, is your capsule some kind of modified release?

Zen,

I have talked to many people using capsules.  They have no trouble twisting them open.  They can then use the two capsule ends to eyeball the amount of drug in each end and get a good estimate of 1/2 and 1/4 of a dose.

You might try a scale too.  Here is the one I use:

https://www.amazon.com/Smart-Weigh-Precision-Milligram-Calibration/dp/B011J88S8M/ref=sr_1_1?ie=UTF8&qid=1541012152&sr=8-1&keywords=Smart+Weigh+Premium+High+Precision+Digital+Milligram+Scale+with+Case%2C+Tweezers%2C+Calibration+Weights+and+Three+Weighing+Pans%2C+50+x+0.001g

I can help you with the math if needed.

@[Pa...]

@Bob7 Thank you very much for the link and for your offer. I am from Spain and unfortunately on Amazon.es I have not found any scales like that. From Amazon.com they send it to me although it says that it would arrive on November 2.

As for the proportions to change from one benzo to another, it would be very helpful if you could guide me, as I am very lost and scared with this issue.

Thank you very much!

I am not a doctor but I am good with math.

I would be happy to help you.

Questions:

(1) Do you have the prescription for Ketazolam?  If so, what is the mg in each pill?

(2) What instructions did the doctor give you for switching from lorazepam to ketazolam?

(3) Do you want to wait for the scale on Nov 2 or start now?

L

Thank you very much, you are so kind!

Concerning your questions:

(1) I have to take 1 capsule of 15mg at night. The doctor told me that 1mg of orfidal is "equivalent" to 15 mg of ketazolam. I actually take 0.375mg of orfidal in the morning and 0.375mg of orfidal at night, so the doctor told me: "in total you take 0.75mg of orfidal, which is similar to the 15mg of ketazolam" (i supponse because he assumes the capsule cannot be opened and cannot be dosed).

So I actually understand that he is upping my dosage, when in fact it is not necessary.

(2) The instructions were the first day in the morning you take your 0.375mg dose of orfidal and at night you take the 15mg ketazolam capsule and then never take the orfidal again, only one capsule of ketazolam at night.

(3) I would start now, although I am scared to death that something will go wrong and I will have a tinnitus rebound.

Thank you so much for your help, I don't understand how the doctors tell me to change benzo's overnight.

Since they are both benzos, you have a good chance to switching rather quickly but doing it in one day seems unnecessary.

Do you want me to suggest a conversion schedule for you?  If so, tell me:

How many pills of orfidal do you have left and what is the mg dose of the whole orfidal pill?

Is the orfidal a tablet or a capsule?

Hello,

Orfidal I have it in tablets whose dosage is 1mg. I have 23 tablets left.

I usually try to split the tablet in the morning so that the remaining part I can use for the night dose, but sometimes it splits into so many little pieces that it is difficult for me to visualize the 0.375mg for the night and I have to discard that part and split a new tablet to take the night dose.

I bought the scale from your link, in the end there was another more urgent shipping option and it says it will arrive on October 25.

If you can help me with the schedule I would appreciate it.

My question is, are all the benzos compatible with each other? Couldn't it be that lorazepam and ketazolam don't interact well when taken together? Maybe this is a silly question but I am concerned.

Thank you very much

You have a right to be concerned. 

I am not a doctor but I have been helping people and understand Dr. Ashton methods too.

I think the switch will be as good as everyone else.  Try to be at peace about it.

The biggest issues I see with changing benzos is often the brain worries about it so much, it creates anxiety issues.  Remember, you brain can create as much anxiety as you let it.  What you focus on, grows.  If you focus on this worry, it could make things worse.  You need to let go of things out of your control. 

You have so many people who have done this before you.  Read their success stories to get peace.

I guess the plan is to wait for your scale or do you want to just eyeball cutting tablets to get started?

Well, tomorrow I have an appointment with my doctor, because I'm on sick leave and I have to renew it.

I don't know very well how she will take the fact that I haven't done the benzos change, let's see if I can do something to gain time until the scale arrives, because I imagine that cutting the tablets by eye will bring a lot of errors. Is there anything else I should get?

Thank you so much for your invaluable help and reassuring words.

The scale is all you really need right now.

For both of your pills, you will need to tell me the weight of the pill.

For the capsule one, just open capsule and pour it onto the little bowl which comes with the scale.

Do you know how to tare a scale?  You tare a scale to force it to read zero.  For example, you put the bowl on the scale and then press the tare button so it reads zero.  Then add the benzo to get the weight.

Hi Zen00, I can see you're in excellent hands, I just wanted to remind you that Ketazolam is a longer acting drug than the Orfidal so as I said in another post, even though you're on a small dose of Orfidal its still a good idea to add in the Ketazolam as you're withdrawing the Orfidal.  This is why Professor Ashton recommended adding in a longer acting drug while withdrawing the shorter acting because the short acting drug will leave your system sooner, we don't want you to be left without coverage while transitioning to the other benzo. 

We can't gauge it perfectly of course because we don't all have the same physiology but we do our best to keep you on an even keep while transitioning to the other drug. Please don't worry about the drugs interacting with each other, while each benzo has a different method of action, they're both benzo's so where it counts they're the same. 

@[Bo...]

@Pamster Thank you very much, you both help me a lot.

Anyway, what I do not visualize is that if I take my dose of orfidal in the morning that lasts until night, and at night I take the dose needed for 24h, I would have to have coverage all the time, don't you think?

 

@Pamster Thank you very much, you both help me a lot.

Anyway, what I do not visualize is that if I take my dose of orfidal in the morning that lasts until night, and at night I take the dose needed for 24h, I would have to have coverage all the time, don't you think?

I'm not sure I understand your concerns, are you worried about mixing the two drugs or do you feel like you'll be increasing your dose?