Tapering Ativan

[[Buddie]]

I recently had to go up a little on my Ativan after an ER visit.  I'm up to 1.5 mgs in 24 hours.  I had tapered down from almost 3 mg to 1 mg and was tapering down from that.  Which has taken almost 2 years.  I have to go very, very slowly.  It's only been a week or so since I've gone back up to 1.5.  I still almost feel like I have tolerance and inter dose withdrawal symptoms.  Do I need to take more to balance out for a while or should I go ahead and start tapering down again? I take my doses every six hours.  Thank you for any advice.

[[Buddie]]

Are your symptoms manageable at the moment, what has guided your taper thus far, is it by your symptoms or are you on a fixed schedule? 

[[Buddie]]

I'm on a fixed schedule I guess, every six hours.  Sometimes I go over a bit.  If I sleep through dose time during the night etc.   Symptoms aren't horrifying but definitely annoying and noticeable.  Of course my anxiety kicks in with any symptom and makes everything worse.  Right now I'm terrified of tapering after ending up in the ER, but I can't just keep sitting here doing nothing.  Need to go down.  My doctor still isn't much help at all.  He's waiting for me to talk to a psychiatrist again to see what she recommends.  It was my last psychiatrist that kept me on Ativan for 10 years then dumped me when I turned 65.  I'm also taking Buspar which my last psychiatrist gave me to take to help taper the Ativan.     

[[Buddie]]

I'm sorry I wasn't more specific about your schedule, I was referring to your taper schedule, how often do you reduce and by how much?  It would help us help you if you put your medication history and taper details in your signature, that way members can see at a glance what you've been doing so they can offer suggestions.  Here are the instructions but if you need help, you can put the information here and a team member can input it for you. Add your history/signature 

Can you talk more about why you ended up in the ER, this seems key to figuring out what you need to do now.

[[Buddie]]

maybe try dosing every 4 hours  0.25mg   it will keep your blood concentration levels from falling 

8am 0.25mg
12pm 0.25mg
4pm 0.25mg
8pm 0.25mg
12pm 0.5mg

[[Buddie]]

I ended up in the ER after an unsuccessful oral liquid Lorazepam taper gone bad.  My doctor switched me over to the liquid from pills and reduced 20%.  I lasted about 4 days then ended up in the ER thinking I was having a heart attack.  Chest pains, trouble breathing, sweating, high blood pressure & racing heart.  They of course gave me extra Ativan to get things settled down.  Had heart tests done and heart is ok.  They said this wasn't a cardiac issue.  I ended up having to stay overnight for tests and they gave me a couple extra .5 mg to calm me down.  So when I tried going back to taking my usual .25 every six hours I was really struggling with symptoms about every 3 hours.  In between doses and before time for a dose.  So to keep from ending up back in the hospital I upped myself with an extra .125.  This is barely working but I really don't want to go up any higher if I can keep from it.  I also take Buspar 10 mgs three times a day.  I promised my doctor I would try to cut myself back down to 1 mg but I'm still struggling with the dose I'm on.  Would it be better to dose every 4 hours?  Or just go ahead and start to taper down a little?

[[Buddie]]

I'm so dismayed to hear your doctor did this to you!  Making the switch to liquid will often produce noticeable symptoms so we advise holding your same dose for about a week.  But to hear your doctor wanted a 20% reduction on top of the switch is horrible, I'm so sorry!  Is there any way you can educate this person, a patient led symptom based taper is best.  Would your doctor be willing to read this? Colorado Consortium Benzodiazepine Deprescribing Guidelines

My feeling is it would be a good idea to either go up in dose a bit or hold your current, reducing at this time isn't a good idea because you're so unstable.  As for how often to dose, you may need to do it more often if you're suffering so much in between.

[[Buddie]]

Ok I will try to stay on my current dose for now.  I did pretty well yesterday.  I definitely will print out the Guidelines and take them to my doctor.  I think he might be willing to work with me even though I'm not sure he knows how to.  He's just a PA so the one causing problems is his advising doctor.  She pretty much wants me off the Ativan right now or was threatening they would no longer see me as a patient.  She requested a psychiatrist visit, so I have that scheduled.  I'm trying to do what they want me to do so I can keep seeing my doctor & obviously keep getting Ativan so I can slowly taper off.  I'm not sure they realize how much more stress and anxiety they are actually causing this 67 year old     Thanks for your help!

[[Buddie]]

Please keep us posted about your situation, more and more doctors are cutting off their patients and it's incredibly irresponsible especially when these patients are seeking their help to do a taper.  I hope both the PA and the doctor will be receptive to a patient led, symptom based taper. 

[[Buddie]]

Me again.  I did see a new psychiatrist on May 9th.  She told me to go back down to 1 mg total of Ativan a day.  She told me to up my Buspar to 45 mgs a day.  I was at a little under 30 mgs.  She also tried to start me on Viibryd, which I really didn't want to take.  Told her I had bad experiences with SSSI's in the past years.  Evidently my insurance wouldn't cover it unless I had tried a couple other SSRI's that failed first.  So she called in Remeron. I took one pill and stayed up most of the night feeling like I had to keep moving my arms & legs.  Called her the next day and was told to stop taking it.  Now she has called back in the prescription for Viibryd.  I feel like a guinea pig.  I don't want to take a SSRI or any antidepressant med at all.  Don't think she is hearing me.  Meanwhile I am currently on the 1 mg ativan taking .25 every six hours.  I'm actually up to about 40 mgs of the Buspar but I think it's making me feel depressed.  Please any advice would be greatly appreciated.  I just want to taper off of the ativan slowly & without adding another med.  Why keep prescribing me someing that I can't take?