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Replacing last "small" piece Lormetazepam with Lorazepam.


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I am tapering both Lorazepam and Lormetazepam, the last only for the night, and also a small piece Lorazepam for the night

 

I am now down to 0,345mg Lormetazepam and 0,348 mg Lorazepam for the night and I wonder if I can exchange this last piece of Lormetazepam for an equivalent amount of Lorazepam. Any experiences?

 

To my knowledge Lormetazepam is two times as strong as Lorazepam, but have a slightly shorter halflife.

Lormetazepam seems to have better sleep effects, but I also take 2,3 mg Mirtazipine for sleep, and this do it's job mostly fine.

 

I also make the replacement down to 1 mg Lorazepam for the night and  not 1,038 which the exact equivalent in Lorazepam of both nightdoeses Lorazepam and Lormetazepam together.

 

 

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I am tapering both Lorazepam and Lormetazepam, the last only for the night, and also a small piece Lorazepam for the night

 

I am now down to 0,345mg Lormetazepam and 0,348 mg Lorazepam for the night and I wonder if I can exchange this last piece of Lormetazepam for an equivalent amount of Lorazepam. Any experiences?

 

To my knowledge Lormetazepam is two times as strong as Lorazepam, but have a slightly shorter halflife.

Lormetazepam seems to have better sleep effects, but I also take 2,3 mg Mirtazipine for sleep, and this do it's job mostly fine.

 

I also make the replacement down to 1 mg Lorazepam for the night and  not 1,038 which the exact equivalent in Lorazepam of both nightdoeses Lorazepam and Lormetazepam together.

 

Hi Skinnered,

You mention that replacing your lormetazepam with the equivalent of lorazepam would equal a total nightly lorazepam dose of 1.038mg. I believe you made a math error as 0.345mg of lormetazepam converts to 0.1725mg lorazepam, since it's "two times as strong" as you say (http://benzo.alwaysdata.net/tools/conversion.php). 0.1725mg lorazepam plus your current 0.348mg lorazepam would be a total of 0.5205mg lorazepam for your nightly dose; this is a pretty big difference from 1.038mg! Please check my math.  :)

 

Since you're technically making a short-to-long benzo crossover between these two drugs, I suspect you might experience some temporary discomfort after making the switch. According to Wikipedia lormetazepam has a half-life range of 10-12 hours while lorazepam has a range of 10-20; very similar in my opinion but it's possible you could notice a dip in blood serum levels. Specifically because this is a sleep-aid for you, insomnia or other similar symptoms might be an issue for a couple days or so as you adjust. It's nothing like a diazepam cross, but I hope you can be patient if you feel a little off at first.

 

I hope you see the potential math mix-up in time to dose correctly. I'm really glad you're taking this step towards dosing simplicity and benzo freedom. I hope it makes things easier for you as you continue to taper. :thumbsup:

 

Did you have a question or you just wanted to confirm that this switch makes sense?

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To my knowledge Lormetazepam is two times as strong as Lorazepam, but have a slightly shorter halflife.

 

I misread this sentence earlier. I think the opposite of what you're saying is true: lorazepam is about twice as effective per milligram as lormetazepam.

 

My earlier post uses the conversion according to:

http://benzo.alwaysdata.net/tools/conversion.php

1mg lorazepam = 2mg lormetazepam

 

However the Ashton chart found here (https://www.benzo.org.uk/bzequiv.htm) says that 1mg lorazepam = 1-2mg lormetazepam.... so... if you need to go up a little in nightly dosage from 0.52mg to stabilize I wouldn't be entirely surprised.

 

Somewhere in the range of 0.52mg to 0.693mg seems like the Ashton equivalency in lorazepam of your combined nightly lormetazepam and lorazepam doses.

 

I'm wishing you the best Skinnered! I hope this helps. :thumbsup:

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Hi Slow&Steady thank you for thinking with me,

 

I read a few tables where it said Lormetazepam is stronger,  they compared it to an equivalent dose of Diazepam:

 

http://wiki.psychiatrienet.nl/wiki/Special:RunQuery/CalcBenzo

 

1 mg Lorazepam equals to 5 mg Diazepam

1 mg Lormetazepam equals to 10 mg Diazepam.

 

I am really confused now..?

 

Well I want just to scrap the Lormetazepam so I have to cut less (as I take just the amout of Lorazepam for the scrapped Lormetazepam) and won't have to order that anymore.

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Hi Slow&Steady thanky for thinking with me,

 

I read a few tables where it said Lormetazepam is stronger, as her where they compared it to an equivalent dose of Diazepam:

 

http://wiki.psychiatrienet.nl/wiki/Special:RunQuery/CalcBenzo

 

1 mg Lorazepam equals to 5 mg Diazepam

1 mg Lormetazepam equals to 10 mg Diazepam.

 

I am really confused now..?

 

Well I want just to scrap the Lormetazepam so I have to cut less (as I take just the amout of Lorazepam for the scrapped Lormetazepam) and won't have to order that anymore.

 

Hi Skinnered,

I'm happy to help.

 

That website you linked appears to have these two drugs in their database backwards; they cite two resources for their conversion rates, one of which is a Dutch "Handout" and the other is the Ashton Manual.

 

The Ashton Manual version they link to has this page:

https://www.benzo.org.uk/manual/bzcha01.htm#24

 

That chart is the same as what I linked to earlier; the Ashton Manual is saying 10mg diazepam = 1mg lorazepam = 1-2mg lormetazepam. To use your comparison earlier, this also is the same as saying...

 

1 mg Lorazepam equals to 10 mg Diazepam.

1 mg Lormetazepam equals to 5-10 mg Diazepam.

 

This is the near opposite of the results that the http://wiki.psychiatrienet.nl calculator provides... In the end, it appears that their cited reference  does not match their claimed conversion rates. I would trust the reference before I trusted the derived calculator; maybe someone made a mistake.

 

From what I understand, all equivalency charts are just guesses but I personally trust the clinical experience of Dr. Ashton over other resources. I suggest using that range I gave earlier; something between 0.52mg to 0.693mg lorazepam for your night dose.

 

The low end: (0.345mg [Lormetazepam] * 0.5) + 0.348mg [Lorazepam] = 0.5205mg Lorazepam

The high end: (0.345mg [Lormetazepam] * 1) + 0.348mg [Lorazepam] = 0.693mg Lorazepam

 

Maybe pick a dose between the two that's easy to split with tablets? I know you'll be the best judge of how to do this. Let us know your thoughts and any way we can help.  :)

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I hope its true, that means I am ~0,5mg lower then I thought :D

 

This website also have Lormetazepam two times as strong:

https://www.nhg.org/sites/default/files/content/nhg_org/images/thema/omrekentabel_benzodiaz._naar_diazepam_2_mg_tab.pdf

I will ask my psychiatrist also, but he could not anwser before tommorrow.

 

I really would trust Ashton above the rest too.

 

If so, go in the middle to be safe 0.5205+0.693*0,5=0,607mg (I've a scale with a precision of 0.0001 gram ;))

https://www.conrad.nl/p/kern-adb-analyse-weegschaal-weegbereik-max-120-g-resolutie-00001-g-werkt-op-stekkernetvoeding-meerdere-kleuren-1696128

 

 

Thanks for your help again.

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:laugh: Yay, smaller numbers! I'm glad you're not taking a massive updose after all your hard work.

 

I wish there was a consensus on benzo equivalencies; it's such an important issue for many taperers and yet the conversion rates can vary to the extreme. I trust Dr. Ashton's data because I think so much of her understanding of benzo tapering is compassionate, effective and evidence-based. I don't trust other equivalency data because I don't know who determined it and how they approach benzo tapering in general.

 

I LOVE that you have a decent scale; seriously, that is awesome. With the enclosure shut and on a level surface, I bet you could get very good milligram results with that device.  :)

 

I agree that the middle of the Ashton-equivalency dosage range sounds like your best bet. It's always a gamble with these things IME; I think you're very brave and you have the skills to navigate this journey! :thumbsup:

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Yes, more uniformity for accessing trusty information.

 

Its strange, all the Dutch websites seem to have it wrong and place Lormetazepam as the strongest.

It wouldn't suprice me if my psych would use this site(s) too, for giving me an answer.

In that case I will point him at what's written on the Ashton website and he can solve the contradiction.

 

When gooing lowe in dose I need the extra accuraty, so yes, a more proffesional scale is needed.

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Just about to post :D

 

The stupid psych called today and blindly referes to the Dutch charts :(

I refered to the Ashton website, but she said "we follow the Dutch charts".

No discussion was possible. She offered to ask one of her colleaques though.

 

I take a break from tapering now till new year and then I take the plunge and take 0,609 Lorazepam as replacement.

I have more trust in Ashton and the rest of the world then the lagging behind psych care here in the Netherlands.

 

I hope I don't make a big mistake by taking 0.609mg just after new year.

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Just about to post :D

 

The stupid psych called today and blindly referes to the Dutch charts :(

I refered to the Ashton website, but she said "we follow the Dutch charts".

No discussion was possible. She offered to ask one of her colleaques though.

 

I take a break from tapering now till new year and then I take the plunge and take 0,609 Lorazepam as replacement.

I have more trust in Ashton and the rest of the world then the lagging behind psych care here in the Netherlands.

 

I hope I don't make a big mistake by taking 0.609mg just after new year.

 

So the Dutch charts just mean that your doctor will prescribe you more lorazepam than you need right? Is this really a problem for at-home titration?  ;)

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Yeah indeed, unbelievable they don't see the importance to clear this up.

Psych care in the Netherlands is bad mostly.

They are stobborn and not very flexable or adapting to new insights.

 

 

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Yeah indeed, unbelievable they don't see the importance to clear this up.

Psych care in the Netherlands is bad mostly.

They are stobborn and not very flexable or adapting to new insights.

 

Well at least they're giving you more, and not less, medicine than you need. I'm glad that you know how much you want to take regardless of their stubborn prescriptions.

 

I hope your respite until the new year is a good one!  :thumbsup:

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Well, I still suffering from the last taper, 1,25% daydose and 2,7%, but it's different.

There still is morning anxiety, but it quickly converts to tension and bodystress now and keep more or less my mental and cognitive abilitys. But it's still though, esp. before dinner.

 

The last taper is now 12 days ago.

Withdrawal peaked at 3 or 4 days after mentally and arround 7-10 days physically.

 

I also think there much more involved in benzo withdrawal.

Gaba is the neurotransmitter regulator and I think there is more.

Why do I improve suddenly after dinner? Would bloodsugar/glucose also involved?

 

I think I have had the worst of the mental symptoms now, drug induced ocd is lessening  thank god and mentally I get stronger too.

But it aint over yet. The somatic symptoms can be very tough too. But I feel more control of my emotions, getting a more stable mood.

I gonna win this.

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I made a possible mistake, by taking a double dose by accident, would this hurt one time?

I am quite worried.

 

I found my box with one dose in it and didnt remember if I have it allready taken and just made the now dose in the box,  or just forgot to take it, I choose to take the dose.

 

Damn, I never make these mistakes.

 

 

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You will be ok.  Just take your next dose at the regular time.

 

Rest assured you are not the first member who has questioned whether or not they took a dose.  If you wish to receive more member input on this, might I encourage you to post to the Withdrawal Support board at:

 

http://www.benzobuddies.org/forum/index.php?board=145.0

 

The Withdrawal Support board gets more traffic than the taper planning boards.

 

PS It sounds like you might benefit from a back up system to track when you take your doses.  This could be as simple as a paper checklist where you mark off each dose as you take it. Or, you could use your phone to take a date/time stamped picture of the empty slot in your pillbox after you take a dose.

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Thank you very much, I was afraid for kindling.

Ok I will put it there when I make another error of some kind.

 

Yeah, a registration system would come in handy, I have done this in the past.

 

 

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You are most welcome.

 

The term ‘kindling’ is often misused here on the forum and, unfortunately, generates a great deal of anxiety.

 

Here is an overview from the Alliance for Benzodiazepine Best Practices on what is known and  — more importantly — not known about the kindling phenomenon with respect to benzodiazepines:

 

https://benzoreform.org/kindling/

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Ok one thing less to worry.

 

Btw, I also have doubts over my low dose Clomipramine, -21mg. It did never do any good for me, but its to risky to taper it along the benzo? Also it's working could be masked or comprimized by the benzo (tolerance) withdrawal?

 

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I’m glad you found the kindling overview helpful, Skinnered. 

 

I have no knowledge of or experience with clomipramine so am unable to address your questions about it. Have you tried posting to the Other Medications or Depression boards?  Or perhaps you could reach out to the folks at Surviving Antidepressants (SA)?  Here’s the SA tip sheet for clomipramine:

 

Tips for tapering off clomipramine (Anafranil) - Tapering - Surviving Antidepressants

https://www.survivingantidepressants.org/topic/19509-tips-for-tapering-off-clomipramine-anafranil/

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I am think to crossover to Valium.

The morning symptoms are not improving till diner every day.

 

I take 3x0.72mg Lorazepam for the day and 0,348mg for the night + 0,345mg Lormetazepam too.

What would my dose Valium be and how many doses.

Also the crossover dose change?

 

Slow, can you help me? I am to nervouss tp make a crossoverscheme.

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Hi Skinnered,

Yes, we can help you plan a diazepam crossover, if your doctor is willing to prescribe for this.

 

I understand that you're currently dosing 2.508mg of lorazepam and 0.345mg lormetazepam. The Ashton-equivalent of your combined lorazepam and lormetazepam dosages is therefore 26.805mg diazepam.

 

Are you still planning to replace your loremtazepam with the Ashton-equivalent of lorazepam?

Are you dosing 4x per day currently?

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I gonna call my doctor tomorrow.

 

Yes I dose 4 times, 2,52 mg Lorazepam and 0,345mg Lormetazepam.

Yes I want to replace the Lormetazepam according the Ashton  manual, but sitting in between, so 0,348 mg Lormetazepam  0,345x0,75? right?

 

Thank you very much, I have a feeling my nerves  can't handle it anymore atm.Totally overstimulated, but not much anxiety. I think I make the crossover in the newyear, january 2,  It would be more safe then now with the sensitived nervoussystem?

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I gonna call my doctor tomorrow.

 

Yes I dose 4 times, 2,52 mg Lorazepam and 0,345mg Lormetazepam.

Yes I want to replace the Lormetazepam sccording the Ashton  manual, but sitting in between, so 0,348 mg Lormetazepam  0,345x0,75? right?

 

Thank you very much, I have a feeling my nerves  can't handle it anymore atm.

 

Sorry I forgot you were going to be using 1mg lorazepam for 1.5mg loremtazepam; I think this is...

0.345mg lormetazepam x 0.6666... (i.e. 1/1.5) = 0.23mg lorazepam

 

2.52mg lorazepam = 25.2mg diazepam

0.345mg lormetazepam = 2.3mg diazepam

 

Total Ashton-equivalent = 27.5mg diazepam

I hope I got the numbers right this time...  :P

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Yes, I see now its 0,23mg Lorazepam

0,345/1.5=0,23.

 

Now the tough part, how to the crossover schedule.

 

I wait till 2 january as I am to afraid for changes atm

My bodystress is to the roof, while mentally I am not so bad.

 

Coming days I will study the Ashton crossover schemes.

I will copy and paste it here before I begin.

 

I hope this decision works out.

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