[Ch...] Posted December 1, 2021 Share Posted December 1, 2021 Hello, my name is chase New here and will be around a lot. I was put on 4mg of Ativan 7 years ago for my sever Ocd which I still struggle with today. After years of trying to get off I'm finally ready and have everything in place with my doctor, I just need help with the crossover schedule please if anyone could help . As I have sever health Ocd, a slow, easy crossover would be ideal. I am currently on 2mg Ativan am *1030 2mg Ativan pm *730 should I convert it into 3 doses of valium as well as I am having withdrawals around 5pm from the Ativan? Thank you Link to comment Share on other sites More sharing options...
[Pa...] Posted December 2, 2021 Share Posted December 2, 2021 This example of a withdrawal schedule is for 3 mgs of Ativan but you can use it as a guide for your doses. Valium has a longer half life so you shouldn't need to dose 3 times a day but if you feel you'd be more comfortable then you can certainly add another dose. https://www.benzo.org.uk/manual/bzsched.htm#s8 Is your doctor going to allow you to convert your 4 mgs of Ativan to 40 mgs of Valium as per this table? https://www.benzo.org.uk/bzequiv.htm Link to comment Share on other sites More sharing options...
[Ch...] Posted December 3, 2021 Author Share Posted December 3, 2021 Thank you so much for your help and info! I am lucky and have a doctor whos completely ok with me taking as much time crossing over/ tapering as possible so the 40mg valium won't be a problem. Couple questions if you could help I would like to space out 3x a day would it be best for me to change my Ativan to 3x a day before I start the crossover or would it be best to be crossing over to where im taking valium 3x a day. Seems like it would be more complicated but want to make this as painless as possible. Link to comment Share on other sites More sharing options...
[Pa...] Posted December 3, 2021 Share Posted December 3, 2021 My opinion might be totally off base but I'll give it to you but also this link to the Valium Support Group because they certainly understand this process better than I. I would convert to the Valium at two doses a day then once fully crossed over, I'd see how I felt then add another dose if the need arises. Changing your Ativan dose first will be a change, crossing over will be a change and our body doesn't like change so if you cross over to Valium and find you don't need another dose then you can eliminate one of the changes. But as I said, check in with the folks in support groups, they can help you. Link to comment Share on other sites More sharing options...
[sl...] Posted December 3, 2021 Share Posted December 3, 2021 Hi Chase, In my humble opinion, a short-to-long benzo crossover benefits from as much neurological stability as possible before-hand. If you're uncomfortable with your current dosing strategy on lorazepam, I think this could make crossing more difficult. I agree with Pamster that on diazepam you may not need three doses per day, but you might really appreciate having them in place while your crossing because a short-to-long step-wise cross causes a dip in blood serum levels of benzos and IME this typically exacerbates any previous instability, such as interdose symptoms. If you have the time, and you're able to break up your lorazepam into 3-4 doses with a pill splitter, I suggest making the transition to 3-4 doses per day first, then after a week or two of stabilizing on your new schedule, beginning a slow, step-wise crossover to diazepam if this is your goal. I'm so glad to hear your doctor is supporting a patient-led taper and offering you an Ashton-equivalent diazepam dosage. We can help you plan a new dosing schedule and/or plan a crossover schedule if you'd like that support. Fortunately, I think a 4mg -> 40mg crossover is pretty simple to do with tablets; I'd consider something like 4 or 8 steps, with 8 steps being my preference just to minimize withdrawal symptoms. You can do this! Let us know how we can help. Link to comment Share on other sites More sharing options...
[Ch...] Posted December 5, 2021 Author Share Posted December 5, 2021 Hello slownsteady! Thank you so much for your time and help. After much consideration I think I should do the 4x a day dose if you could please help me with a plan. I am on 2mg Ativan pills twice a day, I could get the 1mg pills and make it a lot simpler if you think that would work. If you could please help me with a plan to break up my Ativan, do the crossover and then taper off the valium you might honestly save my life. Ive been a member since 2016 and never had to courage to finally do it until now (when im at rock bottom) I think the 8 step crossover would be ideal as well I cannot express my gratitude for everything. Im ready to take on this monster!!! Link to comment Share on other sites More sharing options...
[Ch...] Posted December 6, 2021 Author Share Posted December 6, 2021 Trying to switch today with physch so If you could please help with the plan that would be much appreciated Link to comment Share on other sites More sharing options...
[sl...] Posted December 6, 2021 Share Posted December 6, 2021 Hi Chaserick, I'll try to cover the basics, but let me know if you have questions. I think 1mg lorazepam tablets would be ideal, but you don't need them if you can split your 2mg tablets into 1/4s for the crossover. I use an aluminum pill splitter from Amazon; I like the EqualSplit brand. This is . If you're going to switch to dosing 4x per day, I suggest doing this before crossing, and ideally in two steps with a 1 week hold after each step (or longer if you need more time to stabilize). For some people like myself, changing the dosing schedule can cause an increase in symptom intensity. For others perhaps it's less of an issue, but I think it helps to be cautious. The two step dosing schedule change I'd suggest would be splitting your AM dose in half, and taking 1/2 earlier than the usual AM dose, and 1/2 a little later than usual. A week or so later, splitting the PM dose in half and again, taking 1/2 earlier and 1/2 later. The exact times don't matter so much IMO as long as you keep them consistent and try to get them evenly spaced apart while leaving adequate time for uninterrupted sleep. For example, a 4x day dosing schedule that I like is 8-5-6-5; 8 hours for sleep, dose, 5 hours, dose, 6 hours, dose, and then 5 hours, and a final dose before bed. This beats the 4x day schedule I did at 2mg clonazepam that was 6hrs between doses and had me waking up at 2am every night to dose. Here's how you might do the two steps: Step 1 - 5am 1mg, 10am 1mg; 7pm 2mg Step 2 - 5am 1mg, 10am 1mg; 4pm 1mg; 9pm 1mg I would give my body the time it needed to adjust to a big schedule change like this, and only once I'd regained my full functionality and stability would I attempt the cross. A basic Ashton-equivalent 8-step cross from 4mg lorazepam to 40mg diazepam would consist of each step converting 0.5mg of lorazepam to 5mg diazepam; tablets to produce 0.5mg lorazepam intervals (2mg cut into 1/4s for example) and tablets to produce 5mg diazepam intervals (10mg cut in half, or whole 5mg tablets for example) are required. With 4 daily doses, the schedule itself is pretty simple. I'd follow the example of Ashton's lorazepam cross schedule and start by replacing half the last PM dose, then half the first AM dose, then half the other two doses (starting with the first PM, personally), one at a time. Finally I'd repeat this order and replace the other half of each dose with diazepam. Here's what it could look like... Step 1 - 5am 1mgA, 10am 1mgA; 4pm 1mgA; 9pm 0.5mgA 5mgV Step 2 - 5am 0.5mgA 5mgV, 10am 1mgA; 4pm 1mgA; 9pm 0.5mgA 5mgV Step 3 - 5am 0.5mgA 5mgV, 10am 1mgA; 4pm 0.5mgA 5mgV; 9pm 0.5mgA 5mgV Step 4 - 5am 0.5mgA 5mgV, 10am 0.5mgA 5mgV; 4pm 0.5mgA 5mgV; 9pm 0.5mgA 5mgV Step 5 - 5am 0.5mgA 5mgV, 10am 0.5mgA 5mgV; 4pm 0.5mgA 5mgV; 9pm 10mgV Step 6 - 5am 10mgV, 10am 0.5mgA 5mgV; 4pm 0.5mgA 5mgV; 9pm 10mgV Step 7 - 5am 10mgV, 10am 0.5mgA 5mgV; 4pm 10mgV; 9pm 10mgV Step 8 - 5am 10mgV, 10am 10mgV; 4pm 10mgV; 9pm 10mgV I would hold for at least 1 week after each step, or longer if I was noticeably unstable. Since this is a drug trial, I would be on the look out for new and persistent side-effects related to the new medication; hopefully they'll be few and well-tolerated by such a relatively slow transition. Only once I was fully functional at each step would I continue onto the next. I've never done a crossover, so this is all hypothetical. But I hope this helps! Link to comment Share on other sites More sharing options...
[Ch...] Posted December 9, 2021 Author Share Posted December 9, 2021 Thank you so much for all the help So after talking with my physch, she told me that switching up the Ativan beforehand is just gonna make me more anxious and make things more difficult for me. She somewhat talked me into staying on the two doses, with this being her plan. Excuse my Benzo brain, but im trying to taper at 5% every two weeks at the very max, this plan im pretty sure is every week which im not ok with. Just a rough draft I told her if I get too many symptoms im gonna hold my next cut until I stabilize. Sorry to ask again but if you could help me revise this once more it will be a life changer. Week/target start date Lorazepam 2mg Lorazepam 2mg 40mg 1 (12/9/21) Lorazepam 2mg Lorazepam 1.5mg Valium 5mg 40mg 2 (12/16/21) Lorazepam 1.5mg Valium 5mg Lorazepam 1.5mg Valium 5mg 40mg 3 (12/23/21) Lorazepam 1.5mg Valium 5mg Lorazepam 1mg Valium 10mg 40mg 4 (12/30/21) Lorazepam 1mg Valium 10mg Lorazepam 1mg Valium 10mg 40mg 5 (1/6/22) Lorazepam 1mg Valium 10mg Lorazepam 0.5mg Valium 15mg 40mg 6 (1/13/22) Lorazepam 0.5mg Valium 15mg Lorazepam 0.5mg Valium 15mg 40mg 7 (1/20/22) Lorazepam 0.5mg Valium 15mg Stop lorazepam Valium 20mg 40mg 8 (1/27/22) Stop Lorazepam Valium 20mg Valium 20mg 40mg 9 Valium 18mg Valium 20mg 38mg 10 Valium 16mg Valium 20mg 36mg 11 Valium 14mg Valium 20mg 34mg 12 Valium 12mg Valium 20mg 32mg 1 Valium 10mg Valium 20mg 30mg 14 Valium 8mg Valium 20mg 28mg 15 Valium 6mg Valium 20mg 26mg 16 Valium 4mg Valium 20mg 24mg 17 Valium 2mg Valium 20mg 22mg 18 Stop AM valium Valium 20mg 20mg 19 Valium 18mg 18mg 20 Valium 16 mg 16mg 21 Valium 14 mg 14mg 22 Valium 12 mg 12mg 23 Valium 10 mg 10mg 24 Valium 9 mg 9mg 25 Valium 8 mg 8mg 26 Valium 7 mg 7mg 27 Valium 6 mg 6mg 28 Valium 5 mg 5mg 29 Valium 4 mg 4mg 30 Valium 3 mg 3mg 31 Valium 2 mg 2mg 32 Valium 1 mg 1mg Link to comment Share on other sites More sharing options...
[je...] Posted December 9, 2021 Share Posted December 9, 2021 Hi Chaserick I agree with your instincts that this schedule seems very fast. The proposed schedule would have you taper from 40mg to zero in 6 months. There is no way my body would have been able to manage that without severe withdrawal (I was at 40mg Valium equivalent at the start of the year and still tapering). Granted, every person is different and reacts differently. The other thing I've learned is that a taper schedule generally doesn't last for me. No matter how hard I try to "stick to the plan" withdrawal usually has a different plan and I need to be flexible. What I've noticed with many members is that if we get consumed by a plan and getting off by a certain time, we are likely setting ourselves up for a world of pain. My suggestion would be rather than planning your whole taper to the end, to plan your crossover as you have started, and then just decide on a starting taper rate. Your rate of 5% every two weeks sounds very reasonable to me. Then you can take it as it comes. If you're doing great, you can increase. If you need to slow down, you slow down, if you need to hold, you can hold. This is probably one the most difficult things - just being open and not having a fixed date when you know exactly when it will end. But I think those who surrender to the unknown probably have a better chance at a functional taper. You've received some very valuable input here already. All the best with your taper! Link to comment Share on other sites More sharing options...
[sl...] Posted December 9, 2021 Share Posted December 9, 2021 I completely agree with Jelly Baby. The crossover schedule looks pretty good to me, but the taper seems rushed and is formulaic. Formulaic plans have low success rates. Taper plans need to be custom. Evidence-Based BZRA Discontinuation If you want to stick with two doses of lorazepam, I think crossing to diazepam will hopefully resolve any interdose WD issues you're having along the way. I think if you want to work with your psyche doctor and roll with the crossover as planned, this sounds good. The only thing I'd modify is that I would not simply go from step to step every 7 days; I would wait as long as I needed to stabilize at each step. From what I understand, the lorazepam will leave your body much faster than the diazepam will build to potency and this can be destabilizing; taking an addition crossover step while still recovering from the previous could lead to overwhelming WD symptoms. I suggest trusting your body and taking time at each step to fully stabilize. This might stretch the timeline during the cross, so I suggest keeping good symptom notes and keeping your psychiatrist up-to-date if you need more time at a certain step. The best laid plans, and all that. Let us know if you need any more help. Link to comment Share on other sites More sharing options...
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