Tapering on compounded Ativan - considering daily tapering

[[NW...]]

Hello BBs,

 

I've been on these boards since September after getting hooked on 1 mg Ativan after being prescribed it for sleep issues following a concussion.  Wish I'd never taken it.

 

Fast forward five months and I'm down to .82 mg/day, spit into four doses and using compounded liquid Ativan (0.1mg/ml) I get from a local pharmacy.  I'm doing the cut and hold method and having decent but very slow success.  I'm also stable right now after holding for 2.5 weeks since my last small cut/move.  However, I am sensitive to cuts and am experiencing BP spikes (among  other symptoms) with even small 3% cuts.  As a result, I've recently been considering trying daily cuts and was interested in getting opinions and tips from those who have done daily tapering off of Ativan (and other benzos).  I've read posts by extremely helpful BB members like builder and bart on their positive experiences, and I have a couple questions:

 

- During daily tapering, do you continue tapering every day until you feel symptoms, or cut for five days, take two days off, etc?  Any tips, suggestions are much appreciated. 

- Does it get unwieldy to keep track of the different cuts every day vs. just having to think about a change every two weeks or so?

 

I may continue with cut and hold, but want to get as much information as possible.

 

Thanks in advance,

 

NW Guy

 

 

 

 

[[bu...]]

 

 

- During daily tapering, do you continue tapering every day until you feel symptoms, or cut for five days, take two days off, etc?  Any tips, suggestions are much appreciated. 

- Does it get unwieldy to keep track of the different cuts every day vs. just having to think about a change every two weeks or so?

 

I may continue with cut and hold, but want to get as much information as possible.

 

Thanks in advance,

 

NW Guy

 

If you are at the right cut rate, you may not have to hold at all.  As long as your sxs are mild and tolerable, just keep moving.  If you feel your sxs ramping up, you can hold,

 

You don't have to keep track of different cuts every day.  Choose a cut rate and stay on it unless you begin to get symptomatic.

 

You didn't say what size cuts you were making, but for example, if you were cutting .1mg every to days, you could just do .01 every day.  At the end of 10 days, its still the same, but 10 tiny cuts will definitely be easier than one big cut.

[[NW...]]

Thanks builder,

 

I've read a number of your posts over the months, and I so appreciate how willing you are  to help those of us who are trying to find our way through the maze of benzo withdrawal.

 

I am going very slowly right now, making .025 mg cuts every 10 -14 days (I wish I could do .1 mg cuts).  So, given your math, I would want to start with cuts of .002 mg/ml per day and see how it goes, correct? 

 

And because my doses are spread out across the day, I'm assuming that I would cut .002 mg from my morning dose on day 1, .002 from my afternoon dose on day 2, and so on.  Is this correct?

 

I notice that it takes 3-6 days for my symptoms to really kick in after a cut.  On a daily cutting schedule, I'm guessing that with this delay it's possible to get ahead of yourself and not notice that you're cutting too fast until a few days down the road.  Has this been your experience?

 

Thanks again for your input.

 

 

[[bu...]]

Thanks builder,

 

I've read a number of your posts over the months, and I so appreciate how willing you are  to help those of us who are trying to find our way through the maze of benzo withdrawal.

 

I am going very slowly right now, making .025 mg cuts every 10 -14 days (I wish I could do .1 mg cuts).  So, given your math, I would want to start with cuts of .002 mg/ml per day and see how it goes, correct? 

Yes, you could start there.

 

And because my doses are spread out across the day, I'm assuming that I would cut .002 mg from my morning dose on day 1, .002 from my afternoon dose on day 2, and so on.  Is this correct?

 

That's the way I would do it.

 

I notice that it takes 3-6 days for my symptoms to really kick in after a cut.  On a daily cutting schedule, I'm guessing that with this delay it's possible to get ahead of yourself and not notice that you're cutting too fast until a few days down the road.  Has this been your experience?

Except the a daily taper, your sxs typically don't "kick in".  If you're tapering too fast, your sxs will gradually ramp up, so you can respond before the full impact would develop.

Thanks again for your input.

[[NW...]]

Thank you for the follow up. 

 

Aside from potentially taking longer and being more complex, what are the downsides of daily tapering?  Why do some people try it and decide against it?  It seems to me to have a lot of positives and not a lot of negatives compared with C&H.

[[La...]]

Thank you for the follow up. 

 

Aside from potentially taking longer and being more complex, what are the downsides of daily tapering?  Why do some people try it and decide against it?  It seems to me to have a lot of positives and not a lot of negatives compared with C&H.

 

Hey NW, I did the cut and hold method of withdrawing off ativan using compounded liquid like yourself. For me, the drawbacks of doing daily tapering were:

 

1) despite being a pharmacologist by trade, the idea of having to recalculate a different dose volume every day, while my brain felt totally scrambled and baked on benzos, was somewhat onerous. More probability for error due to having to recalculate 7 times per week as opposed to once. Yes, the calculations are very simple, a 3rd grader can do it, but my mind was so twisted on benzos, i just wanted the simplicity of reproducing yesterdays dose on any given day. Furthermore, my fear was out of control, especially when cutting. Each cut brought overwhelming worry and anxiety. In cut and hold, I had to deal with this monster only once per week, rather than 7 times.

 

2) I already had a scrip for a compounded liquid ativan suspension whose concentration supported projected weekly cut %s. Daily cut %s would be much smaller and I would have to ask for a new (less concentrated scrip). Sure, one could argue that I could have used a micropipetter to draw up microliter volumes from my current scrip for a daily tapering, but due to suspension viscosity, adequate accuracy of such small volumes would be compromised.

 

3) Fear of change. My cut and hold strategy, while excruciatingly painful, was in fact working. I was numerically progressing lower and lower towards zero. Didnt want to rock the boat, take a chance on a new method. Could daily tapering have been easier on me? Maybe, I'll never know.

 

That said, I have no preference for or against daily tapering. The conceptual arguments for it, sound compelling, but then again, a slower cut and hold taper should also make the journey easier.

 

Good luck. Just make sure you get to zero, however you do it! 

 

laser

[[NW...]]

Thanks LaserJ,

 

I appreciate the perspective.  I'm learning that I'm not able to taper very fast while remaining somewhat functional (which I need to be for work/family/etc.), although I sometimes wish I could taper as quickly as you apparently did. So it will be a slow C&H or slow microtaper for me moving forward. 

 

As far as accuracy is concerned, I would be getting close with each cut but not totally precise, due to the 1mg/ml suspension and a 1 ml syringe. I seems doable, but definitely more of a hassle to keep track of.  Were your doses spread out 3-4x day?

 

During your taper, did your fear around each cut ever subside?  I too feel that apprehension each time but am trying to think of the pain and discomfort as good since it is helping my brain to heal and helping me slowly get off this drug.

 

NWG

 

 

 

[[bu...]]

Thank you for the follow up. 

 

Aside from potentially taking longer and being more complex, what are the downsides of daily tapering?  Why do some people try it and decide against it?  It seems to me to have a lot of positives and not a lot of negatives compared with C&H.

 

Why would it take longer?  Whether someone cuts 1mg every 10 days, or cuts .1mg each day, at the end of 10 days, you have dropped 1mg either way.  Since most folks find daily liquid more tolerable, some folks are actually able to taper more quickly.

 

More complex than what?  It certainly is less complex and fiddly than the scale method.

 

[[NW...]]

It makes sense that daily tapering wouldn't necessarily take longer.  As far as complexity is concerned, I mean just the need to keep track of different amounts each day of the week/month as you taper down.  This sounds like one of the reasons that LaserJet opted not do daily tapering.

 

From my perspective, I see mostly positives in the daily tapering approach.

[[bu...]]

Once you choose a taper rate, it would probably take 5 minutes to write out a 30 day schedule.  Less if you have spreadsheet skills.

 

For example, lets say your at 5mg and want cut .025/day.  On most basic calculators, you can enter 5-.025 then hit = and it will display 4.975.  Now just keep hitting =, and it will just keep subtracting .025 each time you hit =.

 

It just took me 30 seconds to go from 5 down to 4 in .025 steps.  I'm sure I could have written each number down in less than 6 minutes.

 

Whether folks actually mean to or not, they come up with lots of reasons why "...I can't do this", or "this is too hard...too complicated", etc.

 

If some one decides they don't want to do a liquid taper, a daily taper, or whatever, that's fine.  I just hate to see folks reject what might be a good idea for a bad reason.

[[NW...]]

builder,

 

I'm at .82 mg/day, split as follows across the day:

 

9:00 AM -  .155 mg

1:30 PM -  .15 mg

6:00 PM -  .14 mg

10:30 PM - .375 mg

 

Let's say I want to work on the night-time dose only for the next 10 days.  My reductions would look like this at .002 mg/day, correct?

 

2/6 - .373 mg

2/7 - .371 mg

2/8 - .369 mg

2/9 - .367 mg

2/10  .365 mg

2/11  .363 mg

2/12  .361 mg

2/13  .359 mg

2/14  .357 mg

2/15  .355 mg

 

Because I have a .1mg/ml suspension, measuring precisely at .002 mg is doable but a little tough to be totally accurate.  Would I be better off going to a more diluted suspension?

 

Thanks - NW Guy

 

 

 

[[bu...]]

builder,

 

I'm at .82 mg/day, split as follows across the day:

 

9:00 AM -  .155 mg

1:30 PM -  .15 mg

6:00 PM -  .14 mg

10:30 PM - .375 mg

 

Let's say I want to work on the night-time dose only for the next 10 days.  My reductions would look like this at .002 mg/day, correct?

2/6 - .373 mg

2/7 - .371 mg

2/8 - .369 mg

2/9 - .367 mg

2/10  .365 mg

2/11  .363 mg

2/12  .361 mg

2/13  .359 mg

2/14  .357 mg

2/15  .355 mg

 

Correct!

 

Because I have a .1mg/ml suspension, measuring precisely at .002 mg is doan accuracyble but a little tough to be totally accurate. Would I be better off going to a more diluted suspension?

 

It doesn't matter.  Consistency is much more important than acccuracy.  If you start at .375, make a cut every day, and 10 days later you're at .355, that's good enough.

 

Thanks - NW Guy

[[NW...]]

Thanks builder,

 

As far as knowing when to stop/slow down, I have a feeling that will be obvious.  When you were doing a daily taper would you stop and hold when starting to feel withdrawals, or would you step back a day or two in dosage?  And did you simply hold until you made it back to baseline or wait a specific amount of time before resuming?

 

NW Guy

[[bu...]]

Yes, you will  know when to slow down or hold.  But...don't assume that every little ripple in your life, every time you have a bad night, every time you have a headache, etc, that your feeling WD sxs.  Not everything is benzo related. 

 

If you do experience what are clearly WD sxs emerging, I would 1) hold for 10 days or so, and if they don't resolve then 2) go back to the last dose you felt OK at.

 

 

[[NW...]]

Thanks builder.  I'll keep you posted of my progress.

[[NW...]]

Builder,

 

Wanted to provide an update after doing the daily taper approach for the past 10 days.  I made it seven days (.014 mg - down to 8.06 mg total) and am now pausing due to anxiety, some elevated BP and sleep-related issues.    I also stepped down my Gabapentin dose a small amount at the same time, which is contributing to my sxs. 

 

Overall I like the daily taper approach, and am planning to continue it for the foreseeable future.  Thanks very much for your help and insights.

 

NW Guy

[[bu...]]

Builder,

 

 

 

Overall I like the daily taper approach, and am planning to continue it for the foreseeable future.  Thanks very much for your help and insights.

 

NW Guy

  I can't promise your taper will be trouble-free, but I can almost guarantee a daily taper will be more tolerable than a C&H.

[[NW...]]

builder,

 

I've been on hold on my taper for over a month and am going to resume again this week.  When it comes to DLMT across 4 different doses of Ativan, would you recommend focusing on tapering one dose at a time or trimming a little bit off of each dose on each successive day?  So, I could either trim off the morning dose for a series of days, or take .002 off the morning, then the afternoon, then the evening and then the nighttime.

 

I'm sure I could do it either way, but I'm curious if people have had better luck doing it one way vs. the other.

 

Thanks in advance,

 

NW Guy

 

 

[[bu...]]

Because Ativan pretty short acting, I would keep the doses "balanced", meaning they don't have to perfectly matched, but I would taper them somewhat evenly.

 

Instead of trying to measure out several individual doses, pull up your total dose for the day and divide it into 4 smaller doses.  Eyeballing it is close enough.

[[NW...]]

Thanks builder,

 

So right now I take four doses as follows:

 

9:00 AM - .155 mg

1:30 PM - .150 mg

6:00 PM -  .140 mg

10:30 PM - .358 mg

 

For a total of .803 mg right now.  I'll first be trimming the night time down to .350 in .002 increments and then start chipping away at all doses little by little.

 

NW Guy

 

[[NW...]]

Builder - wanted to thank you again for the advice on Microtapering earlier this spring.  I have made it down to .71 mg/day from .82, and have felt pretty decent the whole way, and have been cutting almost every day for the past month+.  It's going to take a while, but I'm able to work, be a parent, and take part in normal life - which is something I could not say earlier this winter/spring.

 

Thanks!!

[[...]]

NW - that's great that MT is working so well for you.  Why did you hold for a month? for sx's or something else?

I'm am sensitive to 3% cuts as well.

I'm thinking to switch to MT as well and wanted to get your input - any tips?

I'm mostly concerned about knowing when to hold or decrease my rate.  I'm scared I won't "catch" sx's in time. - any advice on this?

 

Thank you!

[[NW...]]

NW - that's great that MT is working so well for you.  Why did you hold for a month? for sx's or something else?

I'm am sensitive to 3% cuts as well.

I'm thinking to switch to MT as well and wanted to get your input - any tips?

I'm mostly concerned about knowing when to hold or decrease my rate.  I'm scared I won't "catch" sx's in time. - any advice on this?

 

Thank you!

 

Libr,

 

Thanks for the note.  I held for a month back in February/March due to sxs from dropping my Gabapentin dose too quickly.  The sxs were extremely unpleasant, and took over a month to subside.  Wish I had never started taking Gabapentin, but I'm going to wait to taper it until I am off the Ativan. 

 

As far as switching to microtapering is concerned, since I was already using liquid the switch was very straightforward.  I started with a very conservative daily cut - .002 mg Ativan, which was roughly equivalent to the .025 cut I had been doing every two weeks.  I was inconsistent at first as I gauged how I was feeling,  but eventually I hit a groove in late April/early May and have been reducing consistently ever since.  I've paused a couple times for a few days at a time due to come lingering concussion issues and a head cold, but so far my body/brain seems to be dealing well with this slow taper rate.  I may try cutting a bit faster during the coming month, but most likely I'll stick with my current cut rate since it's working!

 

I take doses 4x day, so I reduce one dose at a time by .002 mg, starting with the morning one day, then the afternoon the next day, then the evening next day and then finally the bedtime dose.

 

Let me know if you have other questions.  I'm happy to help!

 

NW Guy

 

 

 

 

[[bu...]]

Builder - wanted to thank you again for the advice on Microtapering earlier this spring.  I have made it down to .71 mg/day from .82, and have felt pretty decent the whole way, and have been cutting almost every day for the past month+.  It's going to take a while, but I'm able to work, be a parent, and take part in normal life - which is something I could not say earlier this winter/spring.

 

Thanks!!

 

DLMT works!!  :thumbsup:

[[NW...]]

Builder - not sure if you'll see this post, but wanted to provide you an update and ask about your experience tapering below 4.5 mg of Valium.  I'm currently at .46 of Ativan after microtapering this past year from .82.  I'm nearly half-way there, and have had some bumps in the road due to some concussion symptoms that preceded my Ativan dependency. 

 

I see that you slowed down a bit during your taper after getting below 4 mg and am curious if you simply reduced your taper amount or did longer holds along the way.  I find myself getting impatient at times, but am realizing that this is going to take as long as it takes.  I can't hurry up the process.

 

Thanks in advance for any words of wisdom you have about tapering below 4 mg.

 

Thanks,

 

NW Guy