Switching from Lorazapam (Ativan) to Diazapam (Valium) for the taper

[[Buddie]]

Hello, I haven't been on in a while. I am still tapering Ativan and having a hard time getting past 1mg. I have tapered down from 2mg over the past 9 months. Whenever I get close to 1mg (daily - divided into 4 doses every 6 hours), my withdrawal symptoms get bad - I get what seems like the stomach flu and then I wind up going back up SLIGHTLY in the dose and things level back out. Spoke to my doctor and he recommended switching to Valium for the rest of the taper since it stays in the system longer and I would have fewer inter-dose withdrawal symptoms as I taper the Valium.

My question is, is it better to gradually swap one dose at a time (as I have read online many places) or to just swap out equivalent amounts and go forward? The Ashton Manual recommends subbing out one of the 4 doses once a week until you are fully switched over. Then starting the Valium taper from there. Does anyone have experience with this? Did you feel weird? Withdrawal symptoms?

I keep getting mixed reviews on this. Some say just swap it out and others say swap gradually, and still others say don't take two different Benzos at the same time!

Confused and scared to take this next step!

Any tips and experience is gratefully appreciated! Thanks!

Also!! I tried to move this message to the Substitutions forum, but I cannot figure out how so I reposted it there as well!

[[Buddie]]

Hi Free
I tapered Ativan for 2.5 months going from 3mg to .375mg per day and had horrible interdose wd. When I got to 1 mg it got very hard like your experience
II was dosing 3 times a day but still suffered a lot
I crossed over to Valium in a step wise fashion like Ashton recommends
Here is what my crossover looked like
.125A. 9am.  .125A 3pm.   .125A 9pm
Week  1 .125A. 9am.  .125A 3pm.   1.25V9pm
Week 2.  1.25V 9am.  .125A 3pm.  1.25V 9pm
Week 3.  1.25V 9am.   1.00V 3pm.  1.25V  9pm

Depending on how you feel you can hold each crossover dose for more weeks but mine worked fine this way. I also held for 2 months after completely crossing only because my daughter came to visit

The conversion ratio that Ashton uses is a guide if you feel too sedated and want to substitute less you can try it. That’s why my mid day dose was only 1V.
During the crossover it gives you a chance to see how you are responding to the Valium and can decide if you can use a lower conversion dose
Valium is a lot better to taper with the long half life
Hope this helps, you can do something similar
Let us know if you need help developing a crossover schedule
[...]

[[Buddie]]

I don't really have any personal experience here but I would think a step wise crossover to valium like [...] said would be less of a brain shock than abruptly stopping the ativan and replacing with an equivalent amount of valium. A gradual cross allows the valium to get in and slowly start building up. I have never been on ativan long-term, but I have taken it short-term (max 4 days in a row), but I was on xanax long-term (8 years) so I know exactly what the interdose withdrawals feel like. It is a horrid feeling.

Hang in there [...]. I do think a cross to valium would be better for you after reading what you wrote. I am happy to hear you have a doctor who is open to putting you on valium bc valium has a bad reputation. IDK why, but many doctors consider valium much worse than the newer, shorter acting, more potent benzos like xanax and ativan....makes no sense. They are all bad news, but valium seems to be a little easier to taper due to long half-life. Don't get me wrong tho....valium is no cakewalk either.

[[Buddie]]

[...] - Thank you SO much for your response! And yes I would love help developing a crossover schedule.
I am at slightly over 1mg a day (had to move up a little due to the awful withdrawals) split the dose 4 times a day.

So approximately:
.30 A 9 am  .30 A 3 pm  .30 A 9 pm .30 A 3 am (yes 3 AM EVERY NIGHT)

I found that 4x a day kept w/d away as Ativan wears off in 6-8 hours. I am hoping to drop that 3 am dose as soon as I am fully on the Valium.

Your response and Anti enzo7's response have helped put me at ease this evening tremendously. Thank you again.

Hi Free
I tapered Ativan for 2.5 months going from 3mg to .375mg per day and had horrible interdose wd. When I got to 1 mg it got very hard like your experience
II was dosing 3 times a day but still suffered a lot
I crossed over to Valium in a step wise fashion like Ashton recommends

[[Buddie]]

Your welcome Free, how are you dosing, are you using liquid? or cutting and weighing or some other method? how are you getting accuracy?

So here is a schedule for consideration. Note that each step can be extended into another week depending on stability. You want to be somewhat stable before the next substitution. Valium takes time to build up so you want to make sure that it has enough time before changing another one of your doses. So you can hold for another week if necessary to stabilize. Also when the crossover is complete consider holding another week or 2 to ensure stability. Also the Ashton equivalents are estimates based on her clinic experience, you will find many tables on line that vary from 5-1, to hers which is 10-1. Going with her's is a good rule of thumb.  but note that some people on the forum have found that the they are more sedated on the 10-1 and can adjust on less valium as they cross over. So doing the crossover gives you a chance to see how your body adjusts to the valium and you can adjust the amount if it is too sedating. I would suggest being conservative and not making alot of changes at the same time.
Sorry if all this information is a bit much to digest. Pls post any questions and we will do our best to answer you.


Here's 2 options, the second option is more conservative splitting each dose based on how Ashton does it in her withdraw schedule table for 3mg Ativan, I just changed it to reflect your lower dose of 1.2mg Ativan;  but it will take a longer period. The first option is shorter, but may produce more wd. I did the shorter option with 3 doses but i was on a lower dose than you. Your dose is still fairly low so you may be ok with the first option. I think your decision to combine doses after is a good one. Pls ask if you have questions, again THESE ARE JUST RECOMMENDATIONS. Recommend looking at the Ashton table and consult with your doctor, hopefully he is benzo wise, if not you will have to make the call as many of us have had to do.

 Current:  .30 A 9 am  .30 A 3 pm  .30 A 9 pm .30 A 3 am
Week 1   .30 A 9 am  .30 A 3 pm  .30 A 9 pm   3V 3 am
Week 2    .30 A 9 am  .30 A 3 pm   3V 9 pm   3V 3 am
Week 3     3V 9 am    .30A 3 pm   3V 9 pm   3V 3 am
Week 4     3V 9 am     3V 3 pm   3V 9 pm   3V 3 am

Current:  .30 A 9 am             .30 A 3 pm             .30 A 9 pm           .30 A 3 am
Week 1   .30 A 9 am              .30 A 3 pm           . 30 A 9 pm     .15A 1.5V 3 am
Week 2   .30 A 9 am              .30 A 3 pm     .15A 1.5V  9 pm     .15A 1.5V 3 am
Week 3   .15A 1.5V 9 am        .30 A 3 pm   .15A 1.5V  9 pm      .15A 1.5V 3 am 
Week 4   .15A 1.5V 9 am   .15A 1.5V 3 pm  .15A 1.5V  9 pm      .15A 1.5V 3 am
Week 5  .15A 1.5V 9 am   .15A 1.5V 3 pm   .15A 1.5V  9 pm      3V 3 am
Week 6  .15A 1.5V 9 am   .15A 1.5V 3 pm              3V 9 pm      3V 3 am 
Week 7            3V 9 am    .15A 1.5V 3 pm              3V 9 pm      3V 3 am 
Week 8            3V 9 am             3V 3 pm              3V 9 pm      3V 3 am 

[[Buddie]]

Thanks for this! I have been dry-cutting with a scale. Each 1/2 mg pill weighs .050 gm. so I began tapering by cutting .001 off of the pills for each cut, x 4 pills per day. At this rate, it took me 9 months to get where I am. So I am now at .032 grams in weight of a pill, (4x a day) knowing that to be down to a 1mg per day dose I would have to be taking .025 4x a day. The lowest I have been able to go was .029 and then got really sick. Literally didn't know if it was a stomach virus or withdrawal since other people I know had similar symptoms and they are not withdrawing from anything! As a result, though, I re-upped my dose slightly up to .032 to see if it was the cut, and I did level out, but now for some reason, and only in the morning I have terrible symptoms of anxiety and heart-pounding around 7 am every day. It eventually passes. Don't know what this is or why this is happening all of a sudden. Ugh.

My question is - what will I feel when I start making this crossover? Will I have any symptoms? Weird thoughts? Nausea or diarrhea? I am super sensitive to ALL drugs, so I am afraid to make this change even though I know it is either this or CT which I don't want to do!

This all began in 2020 with a trip to the ER with a panic attack; doc gave me SIX Ativan and sent me home. I spread them out, so even then I was getting inter-dose withdrawals and had to go to a GP to get more. Been tapering ever since.

So ONE WEEK of Ativan has led me to 18 total months of tapering, in total!
 

[[Buddie]]

Sorry about your situation, cold turkey at this point is not a recommended option although that’s entirely up to you. If you search the forum you will find that it typically does not go well.
To answer your question there’s no way to predict what symptoms you will have since we are all different. Typically the one symptom that many buddies have e reported and I experienced is a sedated more depressive feeling. It does tend to subside free crossing over, it did for me. But you won’t know until you try. I was nervous and apprehensive also when I did my crossover but the wd on the Ativan was so bad I had to try and I was down to .375A total per day. Ativan is a very strong benzo much stronger than Valium and the Ativan short half life made it very difficult to taper. I suffered immensely in the Ativan. Valium is still a benZo and it won’t be easy but it will be much easier than Ativan. Unfortunately you have to make a choice on which one to taper.
Many buddies taper Ativan successfully so you can try to continue that, since you already know what to expect for the most part. I say that because as I tapered my symptoms changed as I lowered my dose. Benzo wd can be unpredictable in that way. Sorry I don’t have a better answer for you.
[...]

[[Buddie]]

Yes I agree, I can't seem to get past the spot I'm at with the Ativan and still function so I am definitely going to try the Valium route. Wish I had done it sooner, but I was too scared! Looking forward to a smoother taper and even more looking forward to being OFF comepletely!

Thanks so much for your replies! They are really helping me feel LESS alone and LESS anxious!