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Lorazepam


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Hi

 

I am trying to find a way to taper directly off Lorazepam.  Is that possible?  I've discussed a valium taper with my DR but he will not support it.

 

I am currently taking 2x 1 mg Lorazepam at night.  I don't know what the valium equivalent would be, does anybody know?

 

Although, since my DR won't support a valium taper it would be just easier I hope to taper directly off the Lorazepam.  He wants me to just stop taking it.  >:(

 

juleswife

 

 

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Hi, Juleswife,

 

Your doctor is not acting properly in telling you to just stop tapering the benzo. Sudden withdrawal from a benzo can cause seizures. They're supposed to taper. Grr.

 

Have you tried a taper yourself already, just by cutting tablets? Although I suppose that's hard because those pills are so small.

 

Yes, a direct taper from Ativan is possible, though it will probably involve more work than one from Valium. You would have to make your own liquid Ativan using homogenized milk. You will need a 100ml cylinder to do this. Instructions are here: http://www.benzobuddies.org/forum/titration-tapers/titration-instructions!/0/. We can help you do the calculations when you're ready.

 

The Valium equivalent of 2 mg Ativan is 20 mg Valium.

 

Will your doc continue to prescribe you the Ativan, seeing as he just wants you to stop it cold turkey?

 

Therese

 

Reason for edit: forgot to add URL

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Hi Juleswife,

 

  Stupid incompetent Drs. like yours make me SOOOOO angry! :pokey:

 

  As Therese says, you are on the equivalent of 20 mg of Valium!!!  How long have you been taking it? 

 

  If you stop cold turkey you Might be in one heck of a mess.  You Might or might Not have a seizure, and you Might or might Not have very painful withdrawal once the benzos clear out of your system.  But WHY take that chance?!! 

 

  Get on the internet and go look up benzo.uk.org.  It will take you to the Ashton manual, which is considered considered the "Bible" in benzo withdrawal/tapering.  Print that out and take it to your stupid Dr. 

 

  If he still won't listen, then Therese, Colin and everyone here who knows, will help you. 

 

  Good luck! ;)

 

  XXXXXChristine/BlueMoth

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Hello Therese and Bluemoth:

 

I have already presented my DR with the Ashton manual and a withdrawal schedule.  He insists that I can go directly off the Lorazepam with no problem.

 

So I have done my research, and became interested in the tritration method I see here.

 

I seem to understand the first part of the taper (tapering the first pill out of the two) but don't understand why

quote You will be titrating one tablet at a time. When you have finished titrating with one tablet from your daily dose, you will start titration of your next tablet, with fresh calculations.unquote.

 

So rather than fight with the DR., I will simply commence the reduction via tritration as outlined and if I understand it, then it wiwll take 100 days to reduce the first 1 mg tablet?  But then I don't understand why the calculations would change again, when I'm ready to tritrate the 2nd tablet.

 

Also........since I take both tablets at night, would it benefit me in any way to start taking one in the morning and one at night? 

 

I started taking the lorzepam last Dec. 2/-6  in response to a traumatic event.  My sister committed suicide and I was so traumatized, and in a white hot rage for over a month,  both the DR and I were afraid I would have a stroke.  And yes it did accomplish what I needed at the time.

 

However, lately I am noticing, I feel like my skin is crawling,  lots of intestinal problems,  and the anxiety is very high anyway, especially at night. .  So I began looking around for a means to withdraw from the lorazepam.

 

I will go and buy a 100 ml graduated cylinder, and a 10 l syringe, tomorrow and get started.

 

Is there any benefit to splitting the doses though, when I've been accumstomed to taking both at night.

 

juleswife

 

 

 

 

 

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Hi Juleswife,

 

All we are trying to do by stating that you will be titrating one pill at a time, is to get across that just one pill is initially used in the liquid (and some of this liquid is disposed of to create a cut of this pill), and your other tablets are taken full. Once you have reduced the titrated tablet down to zero, you move onto the next pill. We reduce one tablet incrementally and then move onto the next for titration.

 

The method involves making up a liquid from one pill, and then making the necessary reduction to this pill (by disposing of the appropriate amount of liquid. At this stage, you then add the other pills to the liquid (as per the instructions), as you have already made the reduction to the first pill. This means that you have a liquid containing your full daily taper dose and it can be easily split up into two or more doses over the day.

 

I hope that helps.

 

Also, before we can calculate the amount of liquid you need to use, we need to determin what rate of withdrawal you wish to go with. If you have not already made any cuts to your benzos to base any guess of what would be good rate of withdrawal for you, then a cut of about 10% over two weeks would probably be a good start. Enough to make difference, but small enough to reasonably certain that you will not suffer unduly.

 

So, can you tell us what taper rate you would like to start at, and we can then check the maths for you.

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Thanks for your response.  I was assuming that 100 ml of liquid, and reducing my .01 per day via the syringe was the plan.  Unless I misunderstood.  I tried a couple of times to take one tablet at night instead of two but this never lasts more than a couple of nights, and the anxiety get bad.

 

So how much liquid do I use?  I thought I just filled the 100 ml graduated thingy and reduced with the syringe.

 

juleswife

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Hi,

 

No, the method involves you initially deciding a sensible taper rate for you to try; we then make a calculation to determin the volume of liquid. Usually, you will be reducing the volume of liquid by 1ml per day. If your initial volume is 24ml, then you will taper off that one tablet in 24 days. This is why we need to make the calcution, as we need to determin how many days will equal the reductions your aiming for. This is also affected by how many tablets you are taking, because 1ml from 24ml is actually 1ml from 48ml if you take two tablets per day.

 

The reason we do it like this is to make the procedure simple - we are normally reducing 1ml of liquid every day. Also, it is very similar to splitting pills, except we use a liquid and we can now split pills pretty much as small as we wish.

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Ok what I thought sounded simple is now getting complicated in my head.  Please just tell me what amount of liquid according to a sensible taper rate.  24 days sounds good to me when I was thinking in terms of 100 days per pill because I was reading it that way. .  I would love to be able to do that.(24 days)

 

I will go and buy the equipment today, and watch for an answer.  Sometimes I just need to be told.  DO THIS.

 

And I will do it.   wow, once again 24 days per the first pill sounds good.  I take two tablets per day, at night.

 

juleswife

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Hi

I don't think Colin meant for you to drop a whole 1 mg of Ativan in 24 days, I think he was just using those #'s as an example, They usually suggest no more than a 10% reduction per week, and by doing it in 24 days that would equal a 100% in just over 3 weeks. I wont confuse you with #'s but the goal would be to figure out what reduction rate would equal 10% per week in 7 days. Wait for more info, but go ahead and by your stuff.

Good luck

Bobers

 

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They usually suggest no more than a 10% reduction per week,

but the goal would be to figure out what reduction rate would equal 10% per week in 7 days. Wait for more info, but go ahead and by your stuff.

Good luck

Bobers

 

 

thanks again.  seems I can't find a 100 ml cylinder at any of the places I've called so far.

 

I am aware that 10% reduction is the norm and best solution per cut.  but I can't quite grasp how 10% of 1 tablet would work into a  per  centage of volume of liquid?  :idiot:

 

I want to cut 10% , per cut.  So how does that pan out?  Working at cutting one tablet at a time?  how do I cut 10% of a 1 mg tablet of Lorazepam?

 

juleswife

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Well I dont want to bog you down with the math, Colin has a whole section somewhere with examples or if you have difficulties they might set you up, but... as an example, if you dissolved 1 mg in 70ml of liquid 10% of 70 would be 7 mls so if you reduced by 1ml per day it would = 7ml or 10% in 1 week 0r 7 days , but wait for someone to check this. As for 100ml measurers try a gourmet cooking store. Take care

 

Bobers

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Hi Juleswife,

 

Assuming that you take two 1mg tablets of Ativan (2mg total per day), and that you wish to cut by a rate of 10% of your dose per week, the calculation is as follows:

 

14 days

2 tablets

10% = 0.1 (as a decimal)

 

(days/tablets)/rate = volume of liquid

 

(14/2)/0.1 = Volume

 

7/0.1 = Volume

 

70ml = Volume

 

So, you make up a liquid of 70ml, and you dispose of one additional ml each day. So, on the first day, you would crush one tablet, make up 70ml of liquid with one of you pills, then dispose of 1ml of the liquid. At this point you will add the second (whole) crushed benzo tablet to the liquid. This means that we are just cutting form the first tablet. The second the procedure is exactly the same, apart from you dispose of 2ml instead.

 

A full explanation can be found here: http://www.benzobuddies.org/forum/titration-tapers/titration-instructions!/msg55024/#msg55024

 

Earlier, when I mentioned 24ml, it was only meant as an example. The amount of liquid you will make is dependant upon what taper rate you decide upon. If it is not 10% over 14 days, you can recalculate, or we can do it for you.

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Thank you so much for the clear directions.  I still don't grasp the math but the directions are clear.

 

Except, why can't I just gulp the 2nd pill strait up?  That's a joke.  :laugh:

 

Now if I can just find some equipment.  I phoned all over the place today to all sorts of drug stores, and nobody seems to have a graduated cylinder.  I will check the cooking stores for a measuring cup.

 

Or there's always Ebay I suppose.

 

thanks again for the help.

 

juleswife

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The reason we don't recommend people take the tablet part of their dose in a normal way (rather than crushing it and adding it to the benzo liquid) is because that would make it impossible for you to have two equal doses per day. For example, once you've cut half of your tablet using titration (that is, once you've gotten down to 35 ml of liquid), you would be taking only .5 mg Ativan in the morning but a whole 1 mg Ativan in the evening--so the amount of drug in your bloodstream would not be constant. It is very important to keep a constant, even supply of benzo in your bloodstream during a taper because it really helps symptoms. So in answer to one of your earlier questions, yes, we would recommend that you take your Ativan twice a day. Its half-life is not very long.

 

If you have any more questions, just post again. The math is hard to get your mind around--it was for me, anyway! Basically, Colin devised a method to make different strengths of solution depending on your dose so that your determined cut will always be 1 ml of liquid. This means you don't have to be measuring messy amounts with a syringe. We recommend using a syringe just for fine-tuning the amount of liquid in the cylinder.

 

By the way, you can also find graduated cylinders on the internet.

 

Therese

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. . . And your pharmacist should be able to order a cylinder - it should not be expensive!

 

I'd recommend taking Ativan three times a day, as its half-life (the time it takes for half of the Ativan present in your bloodstream to be metabolised) is 10-20 hours. Twice maybe often enough though.

 

You can take your other tablets whole, so long as they are in amount that makes it easy to split evenly. It's probably easier to just be in the habit of adding them to the daily liquid though.

 

The reason our method came about was to do away with the whole idea of working with ratio and particular strengths of liquid, and then needing (as Therese pointed out) to use a syringe and to make very precise readings. It really isn't necessary to obtain a slow controlled taper. Our method can be simply thought of as fine pill-splitting. If your total liquid (before discarding of the amount to be cut) is 70ml, we are splitting the one tablet into seventy equal parts. This cannot be achieved by normal dry pill-splitting.

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i DO NOT recommend takings your ativan 3x a day if you were only taking it at night.  your body is fine during the day and doesn's seem to crave the drug.  i, on the other hand, did take my ativan 3x a day and eventually the interdose withdrawals were horrendous.  why make a good thing worse.  you might only end up bad insomnia which everyone coming off benzos seems to get.

 

joan

 

 

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Hi Pleasentville,

 

You may be right, but gradually switching the daily dose from once-a-day, to a regimen that covers the whole day, is usually helps during withdrawal. This topic came about because we were discussing why the remaining tablets should be added to the liquid after the daily reduction is carried out to the first 'titrated' tablet. Therese wrote that we would recommend that Juleswife take the Ativan twice a day - I then wrote that I recommend taking it thrice daily. Although what Therese and I wrote were our 'recommendations', and do not pretend to have all the answers around here, we should have been a little more careful about how we phrased it - especially to a new member and particularly because we carry the labels of Moderator and Admin respectively! From our experience, during a taper, people tend to benefit from even blood levels of benzo over the day. So, splitting the dose into several parts makes sense. However, everyone is different, and Juleswife could certainly stick to the once-a-day routine and see how it goes. If you, Juleswife, do decide to switch to taking your Ativan two or three times a day, you should move just a small part of your dose at a time, leaving several days (at least) between each change.

 

To repeat, Pleasentville may be right - there are few hard-and-fast rules about quitting benzos. A sensible approach is probably one of caution, changing as little as possible with your routine, and reassessing the situation as and when the need arises. I didn't mean to push you into changes that may not be necessary for you.

 

Edited for typos and clarity.

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Colin is quite right, there are no hard and fast rules about quitting benzos! It's all based on how you're feeling during the taper. If things start getting tough, try splitting the dose into two or three parts during the day and see if you feel any better. If it doesn't change anything for you, then you can just stay with once a day and saver yourself the hassle.
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