Tapering Ativan when you can’t do the cutting work (bedbound)

I am currently on 2.5mg Ativan and am bedbound from a range of chronic illnesses and a bad vaccine reaction. I physically cannot cut and weigh stuff and my carer is already overburdened. How can I begin a micro taper . I am extremely med sensitive.

 

Can I get a small portion of it in liquid form that would be easier to reduce in small amounts? What are my options.

 

In a difficult place, really appreciate any advice.

 

Another option is to cross to vallium and go from there but I don’t know how my body will react to vallium. I know something long acting will be needed eventually but I’m not sure if I should try reduce first. Scared of depressive effects.

 

Currently have my bad days but not sure it’s interdose withdrawal. Varies by day more than by hour?

Hey I'm currently tapering from 6mg Ativan a day. I'm at 3mg

 

I dont know much about microtapering but I just want to wish you well.

 

I would suggest maybe leaving out one of your smaller doses that you take throughout the day. That might help jumpstart something. See how you react after that

 

Good luck to you my friend

Hi Montreal, good to have you onboard. I’m so sorry that you have so many difficulties, I feel for you. I managed to taper directly from Ativan so it is possible, especially if you are med sensitive.

Are your pills 1mg? 2mg?

Best healing wishes.

Are you going to taper on your own or with your doctor's support?  Ativan comes in a liquid concentrate - 1mg/1ml which might be easier for you to use.

Thanks all. My pills are 0.5. I have an appointment with my psychiatrist Monday but I don’t know what he will support yet.

 

I think he would support liquid if I asked. But 1mg/ml seems hard to taper too. I would want to be going down by like 0.125 a month I think.

 

I take six doses a day because of IDW so I definitely can’t just remove a dose…

We have members who dilute the lorazepam concentrate with water to achieve a liquid with a concentration of 0.1mg/mL (or even lower).  Are you in the US?  If not, have you searched your country’s database of approved drugs to determine what dosage forms are available?  If the lorazepam concentrate is not one of them, we have formulations for compounded liquids we can share.

I’m in Canada. So it’s definitely water soluble? I wonder if they have issues with distribution in the solution.

 

My carers think I should ask for a vallium prescription and just switch over. I’m just scared of how I’ll react to it. How long does it take to know it’s tolerated?

Valium is slow to build up, this is why Professor Ashton suggested a slow crossover, have you seen her suggested schedules?  This is one for Ativan, a higher dose than yours but it's just an example to show you how it works.  https://www.benzo.org.uk/manual/bzsched.htm#s8

 

Introducing a new medication comes with challenges, Valium is known for its sedative and depressive qualities as you mentioned but I'm told once you acclimate to it, its a smoother taper for those on shorter acting benzodiazepines.  Some members don't seem to do well on it and go back to their original medication, but many are glad they made the switch.

We have members who dilute the lorazepam concentrate with water to achieve a liquid with a concentration of 0.1mg/mL (or even lower).  Are you in the US?  If not, have you searched your country’s database of approved drugs to determine what dosage forms are available?  If the lorazepam concentrate is not one of them, we have formulations for compounded liquids we can share.

 

Yes please share the formulations thank you

Below are examples of formulations.  A knowledgeable and experienced compounding pharmacist will have access to other formulations and/or will know if it’s possible to modify the ones below to achieve different concentrations.

 

1mg/1mL lorazepam oral solution

Vossen, A.C. & Velde, I. & Smeets, O.S.N.M. & Postma, D.J. & Eckhardt, M. & Vermes, A. & Koch, Birgit & Vulto, Arnold & Hanff, L.M.. (2017). Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug. European Journal of Pharmaceutical Sciences, pp. 205-210. Accessed online at: https://www.sciencedirect.com/science/article/pii/S0928098717300490

 

0.4mg/mL lorazepam oral suspension

http://inphonet.albertahealthservices.ca/pharmacy/ahs_recipes/viewrecipe.asp?id=75

 

1mg/mL lorazepam oral suspension

https://www.medisca.net/pdf/shortage-support/en-us/oral/F%20001%20270v2%20Lorazepam%201%20mg%20per%20mL%20Oral%20Liquid.pdf

 

1mg/mL lorazepam oral suspension

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/lorazepam--low--oral.ashx