Lorazapam withdrawal transition to valium

Please help! I have been weaning off of Ativan for almost three years. Dry cutting down to .25mg. Tried twice, almost made it,, then after a few nights of succesive no sleep I was back to .25mg. Mostly no or little sleep. Found a psychiatrist, showed him the method of switching to valium. He suddenly put me on 5 mg. of valium after I showed him the Ashton equivelency chart. Two weeks on five and now on 4mg of valium. No sleep at all. Getting so nervous as night approached he prescribed escsitolopram for anxiety and depression. Can you tell me where I can print out how the transition should work as I"m now in a terrible state of continual no sleep at eighty five years old. Can you tell me so I can show him how to transition gradually as it said in the description of the method "we will help you with that"  Please help as soon as possible. Thank you anyone out there .

Hi Litefoot, I'm sorry that you are suffering, I completely understand.

 

It would be helpful if you post exactly your dosing schedule and how you switched over. It appears that you did it all at once. It also looks like you went to a higher Valium dose than the Ashton conversion which is 10:1 Valium to Ativan which would be 2.5 mg.  My doc wanted me to do this since he said i was on a "low dose" and wanted to put me on a higher dose of Valium than the conversion, but i finally convinced him to let me gradually do it and use the  Ashton conversion dose.

 

You may have to go back and add a portion of Ativan since it takes longer for Valium to settle in your system so you are probably experiencing withdrawal from the Ativan. i will defer to some of the more experienced buddies on this aspect and what recommendations on how to approach it

 

To share exactly what I did. A very smart BB member "Slownsteady" put me on a good recommendation to switch over. The important thing is to do it in a stepwise fashion.  by replacing 1 dose at a time with Valium and holding in between before doing the next dose The Ashton manual  (https://www.benzoinfo.com/ashtonmanual/chapter2a/#switching) provides the rationale for how to do it. She has withdrawal schedules but they are designed for higher doses, so for lower doses you will have to improvise. I'm sure some of the experienced bb's will chime in to help you with a crossover schedule for your UNIQUE situation of crossing over so abruptly, that's how i got mine.

 

My dosing schedule was .125A 9am, .125A 3pm, .125A 9pm

Following the Ashton  conversion I replaced the night dose with 1.25V and held for a week (or longer to reach stability), Then replaced the morning dose with 1.25V (or longer to reach stability), and then the midday dose (or longer to reach stability) and am still holding at 3 weeks to reach stability before i start tapering.

 

Hope this helps some, again I'm certain you will get some replies with recommendations but ultimately its up to you to decide what you think is best.

 

 

 

 

 

 

Hi Litefoot,

I think Joeb did an excellent job giving feedback on your situation Litefoot, summarizing his own experiences with a recent and very similar cross, and the need for a step-wise crossover similar to what Dr. Ashton used to prescribe for her patients. I may be repeating things here...

 

I think a sudden cross to diazepam from a short-acting benzo like lorazepam is usually very hard for taperers. The lorazepam gets eliminated from the blood stream in a matter of day, while the diazepam takes many days, often several weeks, to get up to potency. The result is essentially a huge reduction in blood serum levels of GABAa agonists, and a sharp, albeit temporary, increase in withdrawal symptoms.

 

I'm fairly certain the symptoms you're experiencing are caused by the sudden cross, and I don't expect that your doctor's methods to remedy this situation will be very effective. Prescribing excess diazepam, and then adding a new antidepressant do not make sense to me as solutions for the problems your doctor has created for your nervous system.

 

From what I understand, an over-prescription of diazepam is not usually sufficient to fix the blood serum level drop in a short-to-long benzo cross, and over-prescribing a new drug can cause increased side-effects, which for diazepam include depression and sedation. A slow, step-wise cross gives time to trial the new drug incrementally and make sure that the side-effects are well tolerated and ideally to make sure that time is given for your body to stabilize and adapt along the way.

 

Adding escitalopram also doesn't make sense to me. Beginning a new SSRI notoriously causes an period of increased anxiety (maybe a few weeks or so?), adding to the short-term problems caused by the sudden benzo switch. I suspect that by the time you've adjusted to the SSRI, the diazepam will be up to strength already. Sadly, I am concerned that your doctor does not understand what they're doing.

 

I'm sorry that this reply is coming so late after your original post; I think the Ashton manual, as Joeb linked to, is the best resource to show doctors about how to consider a step-wise crossover to diazepam. I think she had 12 years running a clinic where this was the singular method for withdrawing patients from short-acting benzos. IMO her suggested taper timelines are a bit rushed for at-home tapering and are formulaic (formulaic taper plans have low success rates), but I think her step-wise crossing timelines are a good starting point for planning a successful short-to-long benzo crossover.

https://benzoreform.org/wp-content/uploads/2020/11/Pamphlet-3-BZRA-Discontinuation-1-Getting-Started-v1.2.pdf

 

My suggestions would be to first consider dropping the SSRI, especially if it's causing you increased anxiety; these have their own, sometimes horrific withdrawal process after long-term use (survivingantidepressants.org).

 

And secondly, since an Ashton equivalent for your previous 0.25mg of lorazepam would be 2.5mg diazepam, as Joeb mentioned , I suggest considering pulling back on your diazepam dosage if you feel significantly sedated or depressed within the first couple weeks of use. It might be tricky to judge if and when to make a dosage adjustment like this as I'd expect physical dependence to the new dosage amount would be developing day by day; if I was stable and comfortable at 5mg then I'd just start a slow, symptom-based taper from there.

 

You can do this! Please let us know how we can help.