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Direct switch from single daily dose ativan to single daily dose diazepam


[CH...]

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Spoke with my psychiatrist and he prescribed me 15mg valium and to do a direct switch, stop my 1.47mg ativan at bedtime and start 15mg valium before bed. He said since im only taking the ativan once a day its fine to directly switch over. Have others been fine with this switch??

 

Definitely suffering from interdose withdrawals big time from the single ativan dose. So looking forward to getting stablized and continuing my taper.

 

Planning to start tonight. He said if tomorrow im too sedated to back off 2mg and go to 13mg,  but if I still have withdrawals than add 1-2 mg. Does this sound about right?

 

Ive heard that diazepam can be initially very sedating but that it gets better after a week or so. Im a bit confused now, if im oversedated tomorrow and go down to 13mg and stay at that dose, once my body adjusts (after a week) will I go into withdrawal?  He told me that theres no going up once tappered.

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Generally Valium takes longer to build up in the blood than other shorter acting benzo's so you may have a rough night in store, I'm not sure why your Dr wouldn't allow you to build up to the cross in order to give you the greatest chance for success?

 

As for going down and up in dose, Professor Ashton suggested always going in a downward path, yoyo-ing isn't a good way to go.  Again, I wonder why your Dr wouldn't allow you to stabilize on the Valium before starting your taper?

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[1e...]
I did a direct switch. I would just go with the 15 mg. Diazepam has long half-life but short duration of action. For me sedation never lasted longer than four hours after taking it. Then after you stabilize you can drop 2 mg per week, until you reach 11 mg, then drop 1 mg per every two weeks until you reach 5 mg, then drop 0.5 mg per every two-three weeks until you're off.
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Help, what should I do?

So I did my direct cross-over last night, no Ativan and took 15mg of Diazepam before bed. Around 2am I was still awake and heart racing, along with some withdrawals like arm tingling and muscle twitches. Since my psych advised if I still had withdrawal symptoms after the dose I could take an additional 2mg total 17mg. Which I did at 2:30am. Still no sleep and heart racing. I can’t say I felt much from the diazepam last night. My insomnia hasn’t been that bad in a long time. Usually my Ativan puts me to sleep. I do have bad underlying insomnia.

Any thoughts on What should I do now?  I’m surprised I didn’t sleep, the diazepam dose I took seems pretty big?

 

 

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[1e...]
Strange, as diazepam should be more sedating than lorazepam. You shouldn't increase the dose. Maybe diazepam is not working for you. It happens that some people have trouble switching benzos (maybe the issues with metabolisation of the drug, diazepam is heavily dependant on its metabolites for its action).
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Professor Ashton tapered in the Valium for a reason, it takes time to build up for most people so while I agree with pacenik about not increasing your Valium dose, I don't feel you need to give up this soon if you can make use of your Ativan while crossing

 

This chart shows you how she crossed her patients over to Valium and then once crossed, how she tapered them.  https://www.benzo.org.uk/manual/bzsched.htm#s8

 

Take a look at the chart and let us know if you think you're interested doing a modified version of this, with your Dr's support of course,

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[1e...]
It takes time to build up in blood to avoid interdose withdrawals, but sedative effect should be immediate. When I took a rescue dose of diazepam last time I did not even need to wait 2 hours (its onset of action time) for it to put me to sleep, my head was falling in 15 minutes.
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When I started the switch from 30mg of temazepam to 15mg of temazepam + 7.5 mg of diazepam, I DEFINITELY experienced withdrawal symptoms. It was hell for the first few days. The first night I didn't sleep at all. However the second night I did sleep better. It took me 9 days to feel normal again but I did eventually stabilize on the 15mg T + 7.5 mg V and my interdose withdrawal SX from the temazepam went away. So that was a relief. I asked my psychiatrist why I experienced withdrawals from just switching from one benzo to another and she said my body was adjusting to a new molecular structure. Now I am on to stage 2 of the transition (7.5 T + 12 V). This second stage has also been hard but not nearly as hard as the first. I guess I just want to give you hope that although the c/o was very hard for me initially, that eventually my body has begun to adapt to the V and possibly yours will too.
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Thanks for the input. I spoke with my doctor and she said she is not going to change anything to add back in any Ativan for a slower crossover because the psychiatrist said my Diazepam dose was equivalent to my Ativan. She did say I should continue 17mg Diazepam until I spoke to the psychiatrist in a week. Basically she said it’s expected that there may be some challenges with starting a new drug and gave empathy for the difficulty I’m having. So that’s it. I have to tough it through the withdrawal symptoms from the direct cross over.

I was only taking one dose of Ativan a day (bedtime). I looked at the Ashton charts for cross over and they are generally for multiple daily doses. I guess this is why they directly crossed me over?

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[1e...]

You have keepers there, usually doctors shortchange by 2 mg, you got 2 mg overshoot.  :)

Hopefully it's the same problem Grace5 had and it'll start working out for you any day now. Good luck!

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CHo85, I definitely feel for you. I get what you're going through. I am believing that things will get better for you. You will get through this!
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Thanks Grace5.

 

I slept well last night, day 2 if direct crossover from A to V. I woke for an hour or so in the middle, anxious thoughts and heart rate started to pick up but I was able to calm myself down and get back to sleep. I did go back to 15mg of V (did 17 for the first day) didn’t think it made much difference so didn’t want to be going up when the trajectory needs to be down as recommended by others here.

My psychiatrist did say I could even go down further to 13 or 14mg if I felt the V was too sedating. 

I am feeling more optimistic about this crossover today, thank goodness I slept and now can get a clearer picture how my body is doing in this crossover. Yesterday I was a wreck from no sleep and so many fears and worries.

 

How long should I stay at 15mg before I go down? If my withdrawals are mild should I try to go to 14.5mg and hold there till I get more stabilized? Or just stick with 15mg and stabilize there? I’ve heard some people are able to cut off a couple mg with the transition. I’d love to be able to do that, but also a bit worried that the drop could hit me hard in a few days and lay me out a while. I’ve been in terrible withdrawals for weeks basically already cause of the Ativan. If I can make headway in reducing I would love to, but not sure how to tell if it’s ok or not with the V. Ativan I would feel it the next day. V I’m not sure what to expect. Thanks

 

 

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I'm happy to hear you got some sleep, it really helps doesn't it?  You're wise to stick to the lower mg, downward trajectory is what we're aiming for. 

 

This is the time when you take control of your taper and do what feels right to you.  I understand it's scary and because Valium takes longer to eliminate, you worry the withdrawals will hit when it leaves your body.  My feeling is this and mind you, I have no experience with tapering or with taking Valium but since you've only been on the Valium for a couple of days, I feel you can make a cut if you're feeling okay.  This is based on my feeling that since the Valium hasn't had enough time to build up in your system, you're looking at a sweet spot here.  You have enough Valium in you to compensate for the loss of the Ativan but your body hasn't fully realized the 15 mgs yet.

 

This is the beauty of a peer support system, if someone (me) gives you faulty advice (entirely possible) then someone with experience can stop by and offer a different way to go.  ;)

 

Let us know what you think and hopefully others will stop by with suggestions. 

 

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[1e...]
Everyone is different, some people microtaper and feel every cut, others can cut a milligram per week, even in sub-5 mg range and feel no increase in withdrawal symptoms. My personal recommendation is to go slow and steady. It's not a race. I know you probably want to be off the drug as soon as possible, but cutting too fast can blow in your face. It's better to go slow, than go too fast and then have to updose or take rescue doses, which, as I can attest leads to worsening of withdrawal symptoms. I would stabilize on 15 mg, which is sure'n'safe dose, then cut 1 mg every week until 10 mg is reached. Then I would cut 1 mg every two weeks until 5 mg is reached. Then I would cut 0.5 mg every two-three weeks until the end. Of course you can go even slower if you hit a rough patch. If you want super-fast taper, you can just cut 1 mg per week, but it is a risky move if you don't know how you're gonna respond.
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I wish I could give you advice on that, but I am asking myself the same kind of questions. Right now I am on 12mg of V and it is so sedating.. But I don't know if I should decrease my V yet because I haven't completed my cross over yet. I am still taking 7.5 mg of temazepam. So I am wondering if I should complete the c/o first and then make decisions about cutting, like you are. I'm glad things are getting better for you!
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Thank you pacenik and pamster. So two different opinions, anyone else able to weigh in?

I did 15mg last night, day two of the direct A to D crossover. Slept pretty well last night and today was the first day in weeks I felt pretty functional! I was a bit sleepy/sedated till about noon but I wouldn’t say over sedated by any means.  Didn’t feel much withdrawals, just some residual anxiety and mild muscle tremor, mostly anxiety induced, go away when I meditate or relax myself. Actually as the day goes on I am getting a slight increase in muscle tremor. Should I try to cut a a 0.5 or 1mg off and take advantage of the the initial days after crossing over, or just stay put. How long to wait before I start some tapering?  On days when you feel good it’s easy to wanna go down but I don’t want to overdo it at the same time and get laid out for days again. Thanks!

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Just wanted to update that the direct crossover went quite well and I felt loads better by the second day. I stayed at 15 mg for 5 days and cut to 14 days 2 days ago. Still feeling pretty good! Main issues is my insomnia at night I get about 3-5 hours broken sleep due to anxiety, and feeling anxious in the mornings and evenings which is triggered by my very active and strong willed toddlers lol. Mom life...

 

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I'm happy to hear the crossover went well and you've already reduced 1 mg!  Life doesn't stop while we're doing this does it, we have to keep going for ourselves and our families but I know it's rough.  Slow down if you need to, no need to rush to the end, there's still more healing to be done then so you might as well make the ride down as smooth as possible.
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