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Questions on how much , how fast to taper?


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I am cutting 1 mg per dose of lorazepam every  five to seven days lately.  I am down to .31 mg lorazepam 4x a day. About two pills altogether.  I am grateful to have few symptoms.  Should I be trying to go faster?  Will this get harder as the amount gets smaller?  If so,  why?  My husband doesn't understand how it could get worse with a tiny dose. 

 

I saw a new doc this morning who said he was familiar with the Ashton Manual but doesn't think I need to bother with weighing my dose.  Just thought I should break off a piece of  one of my daily doses.    SEems to me it works better to spread out the cut over four daily doses.  He was not pleased that I didnt' want to comply with his method so we parted company.  Does it work with Lorazepam to  dose 4x a day when you get down to tiny amounts?

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Your taper is working so I see no need to change it and good for you for making the choice to part ways with someone who doesn't understand this!  Most Ativan users will dose multiple times a day, why risk interdose if you can avoid it?  Of course, when you get very low in dose you'll be forced to eliminate doses but you can put that off as long as you need to.

 

You can of course taper faster but as with all of your reductions, these need to be based on your symptoms, try not to get ahead of yourself because there is healing to do once off of the drug as well so you might as well use it to mitigate your symptoms.

 

This document offers information and mentions your husbands question. Deprescribing Guidelines

● Hyperbolic (exponential) dose reductions are better tolerated than fixed reductions;42 i.e., dose

reductions should become smaller as the taper progresses.

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I am cutting 1 mg per dose of lorazepam every  five to seven days lately.  I am down to .31 mg lorazepam 4x a day. About two pills altogether.  I am grateful to have few symptoms.  Should I be trying to go faster?  Will this get harder as the amount gets smaller?  If so,  why?  My husband doesn't understand how it could get worse with a tiny dose. 

 

I saw a new doc this morning who said he was familiar with the Ashton Manual but doesn't think I need to bother with weighing my dose.  Just thought I should break off a piece of  one of my daily doses.    SEems to me it works better to spread out the cut over four daily doses.  He was not pleased that I didnt' want to comply with his method so we parted company.  Does it work with Lorazepam to  dose 4x a day when you get down to tiny amounts?

Don't be afraid to experiment during a taper and don't be afraid to back-track when you make mistakes.

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Thanks for the encouragement.  I am still up in the air about whether my regular doc,  an internist,  will continue to prescribe for me.  We are just not on the same page about this.    So I keep wondering  if it would be wise to taper faster to avoid possibly  being forced to go cold turkey.  I might try cutting 2 mg...I have cut more like 4 or 5 in a two day period before and it was too much but 2 might be possible.   

I have an appt. with a nurse practitioner at a psych clinic ,  but my impression is that they still don't know much about benzos.  I suspect that their idea of a slow taper is 6 weeks or so.    I am going to call my internist early next week and just ask if they are going to be able to  hang in there with me for a while.  I will read that thing about deprescribing soon.

 

 

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You mean the document about deprescribing?    I  called my doc today and heard back from her.  I thought she would just let me continue to cut my dose as I choose,  but no.  She decided that I should go from a half pill,  30 mg,  four times a day ,  which is 1 mg a day  to  a total of .75 mg a day and three doses.  So that is  a big change for me.  Then she wants me to  cut my dose to  2 times a day the following month,  and once a day the month after that.    I feel like the way I've been doing it is slow but  works,  because I have reduced my dose and it has been gentle on me.  Now I'm afraid I'll go into a stronger withdrawal and it won't be tolerable.  Or I'll end up having to back track. Like I said,  she is just not on the same page.  She has no idea of The Ashton Manual.  I took part of it in to her before and she just waved it away and said I don't have to do all that.    I think in effect she is ruining my taper but I don't know anyone who would support me in doing it as I've been doing it.
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I'm struggling to understand what your total daily dose is, your signature says 34 mgs but you mentioned this in your first post on this thread, also, what size are your pills?  "I am down to .31 mg lorazepam 4x a day. About two pills altogether."

 

Do you have any Lorazepam stockpiled or are you completely dependent on your doctor?

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For one thing I need to update my signature.  I am taking .5 mg lorazepam.  The amount I started taking last night and today is .30 on my scale.  A whole pill weighs about 60 mg.  so at 30 I'm at a half pill and I take it 4 x a day.  3 am , 9 am, 3 pm,  and 9 pm. 

 

I " stabilized"  at taking 43 mg 4 times a day and have cut it to 30.  I am not sure what to call these amounts...milligrams or what.  The pill is .5 mg but the weight is 60 mg for a whole pill. 

 

So my doc wants me to cut out an entire dose this month,  then two doses next month,  and cut down to one dose per day the third month.  She doesn't understand anything about interdose withdrawals with lorazepam and if I try to tell her anything she is apt to blow up and kick me out of her practice.  She is a nice lady most of the time but seems to get defensive and angry if you imply she's wrong about anything.

 

I do have a little bit of extra pills,  not much.  I  think I might need help figuring out how to  work within her rigid prescribing plan so I can ease into it a bit.  Like tonight she expects me to skip a dose.  But I could maybe try taking  instead of 30 mg,  take 20 mg of that dose today,  or for a few days,  and then  15 or 10 mg of that dose.    I really can't see going to two doses a day although I have to admit that so far my symptoms are mild.

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restore peace,

Help us understand your data.

If you put one of your 0.5mg lorazepam pills on the scale, does the display show 0.06?  If so, then most likely that means it weighs 0.06 grams and so you would call that 60 mg.

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I just weighed one and it says .o62.  So  I guess I left out the zero for that and for the cuts I made.  So my dosage amount today was .030. 

 

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I cut my 3 am dose last night from .030 to .026 which is not much of a cut but for me is a big cut.  I  had a worse night's sleep,  felt anxious and tight in my chest but it could have just been worry and fear due to this drastic change my doc wants to make to my taper.  I am scared.  Don't you think her plan for a taper is way too fast?  I   

don't know whether to try to talk to my doc,  mail her The Ashton Manual  or just try to negotiate a slower taper but a faster one than I've been doing. 

 

I thought I was doing well with my taper,  I felt confident I can do it,  but  I did  wonder if  maybe I was being too timid and slow.  I'd like to find some other doc or  nurse practitioner but  it seems impossible.  If I have to accept my doc's taper,  any ideas how to make it any easier?

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I just weighed one and it says .o62.  So  I guess I left out the zero for that and for the cuts I made.  So my dosage amount today was .030.

 

Thank you, I had to ask Bob7 to jump in because I was having a difficult time understanding your process, it doesn't help that I don't have experience. 

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I cut my 3 am dose last night from .030 to .026 which is not much of a cut but for me is a big cut.  I  had a worse night's sleep,  felt anxious and tight in my chest but it could have just been worry and fear due to this drastic change my doc wants to make to my taper.  I am scared.  Don't you think her plan for a taper is way too fast?  I   

don't know whether to try to talk to my doc,  mail her The Ashton Manual  or just try to negotiate a slower taper but a faster one than I've been doing. 

 

I thought I was doing well with my taper,  I felt confident I can do it,  but  I did  wonder if  maybe I was being too timid and slow.  I'd like to find some other doc or  nurse practitioner but  it seems impossible.  If I have to accept my doc's taper,  any ideas how to make it any easier?

 

I agree that last night could have been due to the stress your doctor has created in you, stress in my opinion is the number one contributor to increased symptom severity.

 

I've heard some NP's can be more understanding of this process but I'd suggest sending your doctor this document, it might land better since many doctors discount Professor Ashtons work. Deprescribing Guidelines

 

And as for your taper, you had confidence in it because it was working for you, it was your taper your way and that's what we like to see because it can keep you functional.  I'm sorry you aren't getting cooperation from your doctor.

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I  wrote a letter to my doctor and might drop it by her office along with the Deprescribing Guidelines.  Thank you for that...I could read it this time.   

 

In my letter I  explained to my doc how  the thing that seems to have helped me the most is  having even doses 4x a day.  How cutting out an entire dose will likely make me feel interdose withdrawals or could lead to kindling.  I told her I'd like to continue 4x a day but perhaps step up the amount of my cuts.  So she wants me to immediately drop .030 mg daily in the form of one dose.  So she wants me to have a total of .75 mg per day and do that for a month.  I'm thinking maybe she'd consider it if I said I can aim for getting to .075 mg per  day over a month's time,  or six weeks.  I think it's pitiful I have to try to convince or appease or  please in this matter.

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I  wrote a letter to my doctor and might drop it by her office along with the Deprescribing Guidelines.  Thank you for that...I could read it this time.   

 

In my letter I  explained to my doc how  the thing that seems to have helped me the most is  having even doses 4x a day.  How cutting out an entire dose will likely make me feel interdose withdrawals or could lead to kindling.  I told her I'd like to continue 4x a day but perhaps step up the amount of my cuts.  So she wants me to immediately drop .030 mg daily in the form of one dose.  So she wants me to have a total of .75 mg per day and do that for a month.  I'm thinking maybe she'd consider it if I said I can aim for getting to .075 mg per  day over a month's time,  or six weeks.  I think it's pitiful I have to try to convince or appease or  please in this matter.

 

I'm in total agreement.

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I'm completely striking out so far in trying to find someone else to prescribe for me.  Primary care docs around here don't prescribe benzos at all.  A psychiatric office said benzo dependency is best treated at a rehab facility!  A doctor who dealt in addiction died ten days ago.  I do have an appt.  with a psych nurse practitioner next week but  have little optimism.  Almost nobody is a slow taperer.  How do people ever find anyone? 

 

I  really don't want to try cutting out one whole dose.  I tried 4 mg of a dose and that ruined my entire day yesterday.  I  just felt off,  nervous,  sad,  a bit of derealization I think it's called...just not solidly in reality.  Down on myself.  A bit ashamed I have this problem though part of me objects to that.    It's hard to understand why psychiatrists wouldn't be familiar with this issue and deal with it all the time.

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A rehab facility, that in itself tells you their level of ignorance, they just don't want to take you as a patient!  I'm so sorry you're running into this, do you think you're going to have to speed up your taper? 
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I am feeling a little more hopeful today.  I have an appointment with a psychiatric nurse practitioner that I made about two months ago.  They're that booked up in these stressful times.  Anyway I can't assume she will not have any good plan.  She does work at a place that seems to deal with addiction so  like the last addiction place I went to they might be  really expecting  bad things from people who come to them...they seemed to be in self-protective mode.  Not able to  think about what works for me but what kind of firm liine they need to draw.  So I don't know what'll happen with this lady. 

 

Yesterday  I  found a psychiatrist in a somewhat distant town who sounds like she is caring and I emailed her a brief summary of what I'm doing and what my internist wanted me to do and told her why that won't work for me.  She wrote back that she can help me with a taper.  I hope she sees that a fast taper is not  what I want.  I hope  we can negotiate something,  if the nurse practitioner doesn't work out. 

 

I do think it would be smart to speed up my taper a bit.  I am afraid to cut more than one milligram at a time but I think I'll try two.    I still didn't send anything yet ,  such as the Deprescibing Guideline ,  to my internist.  I am thinking over what I might want to say.  Will wait till I see how these other two possibilities pan out.  But I think my doc is kind of bullying me to force these big cuts and not to ask me ,  " Do you think that would work for you?"  Just "  DO it because I say so,  you have no say in this."

 

If nothing works out  I might like to hear from Bob7 if he would help me.  For one thing,  even if someone works with me in a way that's tolerable,  I don't know that they'd know what to do when doses get really small.  I'd like to know how long I can possibly drop by 2 mg at a time till I need to slow down.  It might be good to  have something on paper I can show these two people so I could give them an idea of a timeline that I think could work.  ( hoping for some flexibility.)

 

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I'm glad you're working this but I know its terribly stressful and I'm sure seeing addiction specialists is humiliating because you're not an addict.  It would be okay if these specialists knew what to do for people wishing to withdraw safely and slowly but too few do.  I'm sorry for being a downer but I see so many who feel shame and it makes me sad.

 

Please let us know how it goes with the NP, I hope you can get a good supply but we'll be here to help you work with whatever you need.  :smitten:

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You mean the document about deprescribing?    I  called my doc today and heard back from her.  I thought she would just let me continue to cut my dose as I choose,  but no.  She decided that I should go from a half pill,  30 mg,  four times a day ,  which is 1 mg a day  to  a total of .75 mg a day and three doses.  So that is  a big change for me.  Then she wants me to  cut my dose to  2 times a day the following month,  and once a day the month after that.    I feel like the way I've been doing it is slow but  works,  because I have reduced my dose and it has been gentle on me.  Now I'm afraid I'll go into a stronger withdrawal and it won't be tolerable.  Or I'll end up having to back track. Like I said,  she is just not on the same page.  She has no idea of The Ashton Manual.  I took part of it in to her before and she just waved it away and said I don't have to do all that.    I think in effect she is ruining my taper but I don't know anyone who would support me in doing it as I've been doing it.

I am so glad I did not involve my first Dr. in my taper.  When they find out your tapering they almost have to try to control it in order to legally protect their asses.  Giving a patient a drug they don't want and it not helping them any longer is an open invitation to a fast ending of that prescription.  On the other hand a 'HAPPY' patient always gets their meds on time, something to ponder,,,,,.

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