Let me pick your brain.

I dry cut ativan, i am now on three quarter tablets or .125 a day. What do i do now? I have no way to get the liquid from the doctor cause he is a stubborn mean person. Should i just drop to twice a day then once a day or should i just jump at .375 i cant get the pills any smaller. If im going to have inter-dose why not just jump is my thinking.

Hi Alb1nom00se,

 

as Ativan is 10 times more potent, your current dose would be equivalent to 3.75mg. Valium. I think there would be consensus no one should jump from that dose.

 

I hope others will pitch in on your case, but I'll share what I believe could be your options:

 

1) Switching to water titration (I think that would save you the hassle of a crossover)

2) Crossover to around 3.75mg. Valium

 

Best of luck,

Naf1983

 

I dry cut ativan, i am now on three quarter tablets or .125 a day. What do i do now? I have no way to get the liquid from the doctor cause he is a stubborn mean person. Should i just drop to twice a day then once a day or should i just jump at .375 i cant get the pills any smaller. If im going to have inter-dose why not just jump is my thinking.

Hi,

 

you can find info on water titration on BenzoBuddies (can someone add a link?) and there are videos on YouTube.

 

Basically it means disolving your pills in water or milk and using a seringe to get a specific dose. I'm afraid I have no experience with it.

 

Best of luck,

Naf1983

 

Doctor wont let me crossover, and wont prescribe liquid. Im not sure what water tritiation means

I def would not jump at this point…. Are you shaving and weighing the pills and now it’s too tiny? Any way you can see if another Dr in your area will work with you on switching to liquid Ativan and tapering down further?

I dry cut ativan, i am now on three quarter tablets or .125 a day. What do i do now? I have no way to get the liquid from the doctor cause he is a stubborn mean person. Should i just drop to twice a day then once a day or should i just jump at .375 i cant get the pills any smaller. If im going to have inter-dose why not just jump is my thinking.

 

Hi Alb1nom00se

 

It sounds like you’re in a real pickle with your prescriber…

 

I certainly wouldn’t advise jumping from your daily dose, and so if you’re in a situation where you have no other choice, I would probably look at this video Naf1983 mentioned and look at possibly doing a water taper. My biggest concern is water tapering one of your daily doses away at a time and ending up with interdose withdrawals from one remaining dose at the end, but doing this water taper is a far cry better than jumping from where you are or even jumping from one of your daily 0.125mg doses at a time. Anyway, have a look through the video, and maybe we can figure out a way of minimising interdose withdrawals as you taper. We just wouldn’t want you to end up dosing such a potent short half life benzo only once a day. Maybe you could just start by gradually water tapering one dose to begin with, and then begin tapering the others soon after, rather than tapering away one at a time. If you decide to do this water taper, make sure you stay at the full dose for a week or so before you begin to taper to give your body time to acclimate to a different delivery system before the dose begins to lower.

 

Another option if you don't want to mess with liquid titration is crushing or shaving your pills into powder and putting the powder into capsules, which can be bought on Ebay or, I believe, on Amazon.

Rocknroll also offers a valid option.

 

Here’s a link to a dry taper process by Bob7 using a filler and capsules. You’ll just need to purchase a cheap jewellers scale.

 

https://benzodrytapermath.com/

Hi Alb1nom00se

 

Just a few things to consider before you jump into this…

 

Micro tapering can be tricky and you will have to watch your symptoms very closely, as daily reductions can pile up on each other all of a sudden. Micro tapering doesn’t necessarily mean you can just keep tapering without holding at times. The idea is to get you off the medication with the least amount of suffering, as this will potentially make your acute withdrawal phase (after your last dose) less turbulent. Your brain needs time to recover from your reductions on the way down so it doesn’t have to make them all once you jump.

 

I’m not sure about the math, as my brain is not functioning too well at the moment, but maybe someone else can go over your measurements and confirm they are correct, just to be safe. I would urge you to not go too fast to begin with. Best to dip your toe in first, remembering that those micro reductions can catch up and hit you suddenly. If you sense things getting difficult, hold your dose, don’t keep pushing through because in all likelihood, whatever symptoms you feel on one particular day, will most likely increase in the days to come, even if you’re holding, because symptoms from your most recent daily reductions will still have to surface and run their natural course. Please don’t let impatience be your guide, as impatience has been the downfall of many of us here. The more sensibly you taper, the less intensely symptomatic your recovery.

So i am going to dissolve a .5 tablet into 100 ml making 1 ml .005. I can then remove 25ml every 3-4 weeks or i can remove 1ml a day stating at 25ml (because i want to be at .375) and that would be a monthly reduction of .25 just would be cutting daily instead of dropping and holding.

 

Hello, Alb1nom00se.

 

Two observations about the above plan:

 

(1) When you add water to a regular lorazepam tablet, the tablet disperses (as in disintegrates).  The active drug substance (i.e. the lorazepam) in the tablet does not dissolve (as in go into solution).  This means the do-it-youself liquid is a suspension not a solution and should be treated as such (e.g., shake the liquid well to distribute the particles of active drug substance as evenly as possible throughout the liquid before you measure, measure reductions as quickly as possible before particles settle out of suspension).

 

(2) If I’m understanding correctly, your plan is to make fixed amount reductions of 0.125mg (0.005mg/mL x 25mL) every 3-4 weeks.  A downside of this approach is that the percent reduction in dose will increase over time.  For example, a reduction from 0.5mg to 0.375 is a 25% reduction in dose.  A reduction from 0.25mg to 0.125mg is a 50% reduction in dose. 

 

Do you have a sense of what percent reduction in dose you can tolerate?* If so, I encourage you to use that to guide your reduction amounts.

 

*As a general rule of thumb, we suggest reductions in the range of 5 to 10%, calculated using the current — not the original — total daily dose.

 

 

So i am going to dissolve a .5 tablet into 100 ml making 1 ml .005. I can then remove 25ml every 3-4 weeks or i can remove 1ml a day stating at 25ml (because i want to be at .375) and that would be a monthly reduction of .25 just would be cutting daily instead of dropping and holding.

 

Hello, Alb1nom00se.

 

Two observations about the above plan:

 

(1) When you add water to a regular lorazepam tablet, the tablet disperses (as in disintegrates).  The active drug substance (i.e. the lorazepam) in the tablet does not dissolve (as in go into solution).  This means the do-it-youself liquid is a suspension not a solution and should be treated as such (e.g., shake the liquid well to distribute the particles of active drug substance as evenly as possible throughout the liquid before you measure, measure reductions as quickly as possible before particles settle out of suspension).

 

(2) If I’m understanding correctly, your plan is to make fixed amount reductions of 0.125mg (0.005mg/mL x 25mL) every 3-4 weeks.  A downside of this approach is that the percent reduction in dose will increase over time.  For example, a reduction from 0.5mg to 0.375 is a 25% reduction in dose.  A reduction from 0.25mg to 0.125mg is a 50% reduction in dose. 

 

Do you have a sense of what percent reduction in dose you can tolerate?* If so, I encourage you to use that to guide your reduction amounts.

 

*As a general rule of thumb, we suggest reductions in the range of 5 to 10%, calculated using the current — not the original — total daily dose.

 

Thanks so much for jumping in and providing that important information, Lib. It’s much appreciated.

 

I think Alb1nom00se actually intends to micro taper daily, at least, that’s what I got from the last line of the post… However, I could be wrong there.

 

 

You’re welcome, WS. 

 

My observation about the percent reduction in dose increasing over time applies to both ‘reduce and hold’ and daily microtapering. 

 

PS I agree with your observation that one of the disadvantages of daily microtapering is that ‘cuts can pile up on one another’ especially when tapering benzodiazepines with longer half-lives.  If you read posts from members who say they are daily microtapering, it’s not uncommon to discover they include periodic holds in their tapers.

Absolutely, Lib

 

I was just explaining to another member that the brain doesn’t actually experience each 0.5mg reduction as simply another 0.5mg reduction.… it experiences it in terms of its percentage of the current total daily dose, and yes, the water taper is no different… the size of the reduction remains the same, but the percentage (in terms of the current total daily dose) is climbing with each reduction. 

May just continue with .125 cuts and deal with it. I may get lucky.

 

I hope you do get lucky. Just keep in mind that the lower you go, often the more difficult symptoms become. Your doctor clearly has no idea about benzodiazepines, withdrawal, or benzodiazepine induced neurological disorder. No one who understands the long term effect these medications can have would ever advise a patient to go to a detox centre. Detox centres are for other medications and drugs, not benzodiazepines. Because of how fast they detox you, the real acute withdrawal phase doesn’t even begin until they’ve sent you home and wiped their hands of you. They are terribly uneducated about these medications. It’s criminal.

 

Just be careful and please don’t underestimate the potential for withdrawal symptoms to develop to a point which you could never have imagined. I’m not saying this to scare you, but many of us here have unfortunately been thrust (by doctors or our own impatience) into unimaginable suffering by a c/t or tapering too much, too fast. Just trust your own intuition, not your doctors advise. He’s never been through it, and he’s not the one who has to go through the potential suffering.

Well said, as for me I struggled with guilt of taking the pills because i was abusing them when i first got benzo wise. I have always had benzos pretty readily available and still do. one nice thing now is i no longer fear my script running out. but even when my taper got slow and I just sat at 1 mg i was taking it at 4 hr intervals so if i stayed up later i would take anther .25 so i wasn't very strict on my taper and finally god or something thrust me into what i guess is tolerance, this past august and I'm grateful for it i can move forward and no longer give the doctors that power over me. Im not sure if I'll get off my ssris but I'm starting to think I may be good to get off it all. i went on them for sort of depression and dp dr after a traumatic sinus infection but back then i didnt have the knowledge i do now.

 

Keep us updated with how you’re travelling, we’re here to help you through this