Advice on possible cross over and taper plan

[[Buddie]]

Hi,

I would really welcome some advice on creating a possible cross over and taper plan for myself. I am medication sensitive (suspected MCAS) and already have fragile mental and physical health. I have very severe ME and am 100% bed bound.

I have been on total of 2.5mg Ativan daily (in 6 divided doses over 24 hour period) since August 2021. It was initially prescribed for debilitating anxiety and panic attacks and so far this has kept things relatively stable.

My situation is that now my GP is pushing for me to come off Ativan as he is concerned about long term use. I am hoping to discuss a very slow taper plan next time we speak but really need some help with this.

I have a few initial questions I don't know if anyone can answer - I know there might not be any straight answers, but I would appreciate any advice on them:
1. Is a smooth taper possible with Ativan given it is a short acting benzo? How would I do this? what are the potential problems?
2. Is it better to cross over to a longer acting benzo? Which is best? and what would a slow cross over plan potentially look like?  I have some concerns about Diazepam due to the fact that I read it is a DOA blocker (histamine issues). I also had a bad reaction to Klonapin in August when I trialled a straight switch (possibly because it was a straight switch)

Thank for your much appreciated help

[[Buddie]]

Hi [...],

1. A direct taper from Ativan is possible but given you're already dosing 6 times a day I can see where this could be challenging for you, you're already dealing with interdose so tapering could exacerbate this situation.

2.  For you, given your sensitivity I would suggest a crossover, Diazepam of course is the gold standard but I'm not sure if its the right fit for you given your histamine issues, have you ever taken it before?
 
2.1  I'd like to ask about your attempt to cross over to Klonopin, since it's twice as strong as Ativan, I'm wondering what you mean about "straight switch"?

[[Buddie]]

Thanks for answering [...]

No, I haven't tried Diazepam before.
For the Klonopin 'straight switch - I mean there was no taper in the cross over. Stopped Ativan for 1mg Klonopin almost overnight. It messed me up too much (more anxiety), so I stopped the Klonopin and went back to the Ativan.

[[Buddie]]

I'm sure it was a shock to your system to switch to Klonopin, even though it's a benzo it has much different properties, I wonder if a tapered crossover would be better for you?  You must have to wake up in the middle of the night to take all of your doses, so you do this?

I'm thinking it might be a good idea to talk to the members in the  Valium Support Group about histamine issues, they might be able to tell you if they've encountered problems.

[[Buddie]]

Unfortunately I do wake up 2 x night to take the Ativan, not ideal.

Thanks for the suggestion, will check out the Valium Support Group.

About the Klonopin - are you able to expand on what you mean when you say it has different properties? Sorry for the bother, and thank you.

[[Buddie]]

Oh dear, waking up to take a pill, that's not ideal and when you taper you'll eventually have to start giving up those doses, a crossover sounds like a good idea.

As for different properties, they're all benzo's but each have a different method of action because of their different ingredients, so each will make you feel differently.  Most will acclimate to it and can begin their tapers, others find the change too disturbing and go back to their original benzo. 

[[Buddie]]

Thanks [...]

[[Buddie]]

Just fyi, I crossed over from Ativan (1.5 mgs) to valium (15 mgs). I was dosing Ativan 4 x a day and it still wasn't enough. I felt like I was losing my mind. When I got crossed over to valium (I followed Ashton's c/o schedule) I dosed 3 x a day, then 2 x, then once. I felt a lot better. It worked out pretty well . . . except that I went too fast at the end. My bad.

Ashton's manual is here:

https://benzo.org.uk/manual/bzsched.htm

Look for Schedule 3.

Best wishes,

[...]

[[Buddie]]

Thank you so much [...], that's really encouraging for me to hear. Much appreciated.