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Tapering Ativan


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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.
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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? 
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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.     
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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.

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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

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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?
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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.

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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!
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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. 
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  • 1 month later...
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? 
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I can hear your pain and frustration, I honestly don't know what to tell you, if you don't have a medical team willing to let you, the patient lead your taper I can only suggest you find another team.  Adding more drugs to the equation isn't typically the answer, tapering slowly so your body can recover as you taper has proved to be the best method, unfortunately, your team hasn't gotten this message.

 

I've read here that some nurse practioners can be more sympathetic to our plight, have you considered looking for a new provider?

 

How are you doing on the 1 mg a day, do you feel like you've been able to stabilize a bit?  I'm sorry you're feeling depressed, Professor Ashton had this to say about Buspar.

 

Other drugs. Several other drugs have been tested in clinical trials of benzodiazepine withdrawal to see if they could speed the process, prevent or alleviate withdrawal symptoms, or improve the long-term success rate. Many of these trials have involved what is considered here as over-rapid withdrawal. For example, a recent US study of benzodiazepine withdrawal in long-term users (Rickels, Schweizer et al. Psychopharmacology 141,1-5,1999) tested the effects of a sedative antidepressant (trazodone, Desyrel) and an anticonvulsant drug (sodium valproate, Depakote). Neither drug had any effect on the severity of withdrawal symptoms, but the rate of taper was 25% of the benzodiazepine dose each week - a rather fast withdrawal! Other drugs which have been found to be of little or no value in withdrawal trials over 4-6 weeks include buspirone (BuSpar, an anti-anxiety drug), carbamazepine (Tegretol, an anticonvulsant), clonidine (Catapres, an anti-anxiety drug sometimes used in alcohol detoxification), nifedipine (Adalat) and alpidem.

 

The Ashton Manual

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Actually I've been doing pretty good on the 1 mg.  Several times I've gone over the six hours between doses, sometimes 8 hours.  I almost have to believe the Buspar is helping with my anxiety or it's just not as bad anymore.  I had read that it wouldn't help with withdrawal symptoms also.

 

Would you recommend that I just keep tapering down myself on the Ativan?  I seem pretty stable right now and am ready to make a reduction.  I wanted to have shown some effort by my next appointment to show her that I can just maybe do this without other drugs.  I'm just using the dry taper method and just pinching or breaking a bit off a corner of the tablet.  This is after I cut two .5 mgs in half for my 24 hour dose.  I pinch either one corner or sometimes two and keep the left over powder in another pill bottle just in case I might need it later :)  I know this isn't exactly accurate.  Does it need to be?  Should I get a scale?  I succeeded in tapering from almost 3 mg to 1 mg just by breaking off corners.  Seems to be harder to do now that I'm down this low. 

 

Sorry, I've rambled enough but this is making me nuts.  I really hate to change doctors.  Not sure any of them listen to you anymore.  They really don't when you hit 67.  Ole folks are invisible.  I would like to show them all that I did this by myself with the help of benzo buddies. 

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Thanks for explaining your taper method and whatever works for you is perfect.  You don't need to use scales if you're doing fine without, sometimes its a difference in personalities, some people need to be more precise, it gives them the feeling they have some control over this, others do just fine with methods like yours, and really, as long as you're getting your required dose in a 24 hour period, it all evens out.

 

I would suggest not pushing the time limits though, your brain craves consistency and keeping steady blood serum levels of the drug in your body will help it get this.  Gradual and consistent reductions of the drug are best.  I think anytime you feel ready to make another reduction, this is what you should do, you know better than anyone how you're feeling.

 

I think your plan is perfect, if you show progress then that should be enough to reassure your doctor you don't need additional medications, you just need a steady supply of the one you're attempting to rid yourself of. 

 

I wouldn't mention BenzoBuddies, many doctors aren't thrilled with internet support groups but some have actually recommended us.  ;)

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I am also 67 years old and tapering off of Ativan after five years on it.  I was taking 2 mgs a day and I just recently made my 2nd cut.  I am now down to 1.25 mg per day.  I have not discussed this with my Doctor.  I see her at the end of the month.  The last two times I went to see her she suggested it was time to get off of it.  I told her I am not ready.  I am cutting every five weeks.  I am experiencing withdraw symptoms and they seem to last for three weeks and they go away.  I wish you much success. 
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Wow, sounds like you are making progress.  How much are you cutting each time?  What type of withdrawal symptoms do you have?  I think that's my biggest fear after ending up in the hospital already with withdrawal symptoms.  That's why I'm going to take it very slow this time tapering.  Talked with my doctor yesterday.  He's on board with a slow taper so hopefully everything will work out.  Best of luck to you also.
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Hi, actually I had an appointment with my psychiatrist today.  She's on board with a slow taper and not pushing an SSRI unless I find out I might need one.  She was glad I had gone back down to the 1 mg a day from the 1.5.  I had been pinching corners off but kind of stopped doing that.  My bad.  So she's leaving this month up to me to try to taper down some by myself.  She wants me to try and stretch the time between doses and get down to 3 times a day instead of 4.  Not sure if I can do that.  Sometimes it's hard to wait the six hours between.  Thank goodness I haven't been too anxious.  Withdrawal or tolerance symptoms haven't been too horrible.  I mostly get this weird feeling like I have to keep taking a deep breath when it's time for another dose.  Of course I've still been taking the .25 every six hours so I probably haven't experienced many withdrawal symptoms yet.  She says next month is her turn to be in charge.  So I have to make myself seriously start pinching corners, a corner, or trying to go longer between doses.  At least it sounds like she's willing to work with me. I'm still scared to death to do it but really. really want off of this stuff at the same time.  Thanks for checking in! 
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Yeah usually.  I don't have a set schedule.  So I just take it no sooner than 6 hours apart.  If I go longer between my schedule is always different.  Last night I went 7-1/2 hours between doses but was still up at 3:00 am taking the next one.  Of course when I wake up at night that's the first thing that pops into my head.  Do I need to take it?  Sometimes I can go back to sleep.  Most times not.  So I end up taking it. 
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Thanks for explaining your routine, I hate to see you wake up in the night to take a pill so I wonder if you could avoid this by sticking to a better dosing routine.  Our brain craves consistency so not having a set regimen could be contributing to your nighttime wakeups.

 

If you do decide to follow your doctors suggestion to whittle your doses down to 3 a day most members will do this gradually to limit the impact, they'll delay the doses a little each time. 

 

What really concerns me is your doctors threat for next month, a patient led, symptom based taper is in your best interest, not one dictated by someone else.  I hope you can show her a willingness to get off the medication but at the same time advocate for yourself that you're the one who has to suffer if her demands aren't achievable. 

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