Need HELP with lorazepam taper plan, please!

[[Ro...]]

Hi Twindubs,

 

So wonderful to hear that you are having such a successful taper. That's really awesome! Slownsteady is simply amazing...his help through these early days has made ALL the difference in helping me get stabilized and figuring out a solid taper plan. I'm currently at 0.25 and holding.

 

It's great to hear from another Ativan taper-er. Thank you for commenting! I agree, working with a mental health professional is everything. I just started working with one and am ready to work hard! And yes, not resisting withdrawals but instead inviting them in, is EVERYTHING. That way of thinking has kept me sane through this process.

 

A couple of quick questions for you if you don't mind...I'm curious how often you are dosing (and how much per dose you take) to avoid inter-dose withdrawal and stay functional during the day? Are you fairly comfortable, symptom-wise, most days at your current taper rate of 2% every 3 days or is it a major struggle? Is sleep easy to come by?

 

I've only recently stabilized at 0.25 mg and haven't tapered further yet so I'm eager to know what other Ativan-er's experiences have been like who are further along than me. Thank you in advance!

[[Ro...]]

Hi slownsteady,

 

Agreed! Let's celebrate today. Small milestones are more important than the destination at this stage for sure. 

 

I'm running short on tablets but I am going to go step-wise to liquid with the ones I have remaining, hold, and see how I do. Fingers crossed. Thank you for letting me know about that!

 

Also, thank you so much for the links and clearing up the 2 mg/ml lorazepam oral concentrate confusion. Yes, that first pharmacist was very confused! Now I understand (and will be educating those behind the counter as needed).

 

I did go to 2 other compounding pharmacies after visiting that first one and they said that for compounding a suspension, Suspendit would work well and they are familiar with it. I couldn't find any research to support the use of lorazepam in Suspendit so it would be new territory.

 

Both of these pharmacies wanted to put pure lorazepam into PCCA Suspendit. No flavorings or other ingredients at all. It would be a 0.1 mg/1 mL suspension supplied in a plastic bottle containing 140 mL of the suspension along with 1 mL syringes that measures to .02 gradations, so not perfect but I can get pretty close on dosing. Both pharmacists are assuring me that by using fresh Suspendit and fresh lorazepam, the suspension will last in the fridge for weeks. 140 mL would get me through a chunk of my taper. Cost was $25-$30. No diluting would be required. I would take my 4 daily doses right from the bottle with a syringe AFTER a good few shakes each day. What are the red flags you see with this approach? My thought is to try it and I'll know pretty soon how well it's going to work (or not). I already have the script for it and my doc seems keen on me trying it first so I'm thinking it'll be my first shot. I feel a little more confident about it after talking to these 2 other pharmacists than I did after my first pharmacy visit.

 

Otherwise, the Intensol oral lorazepam concentrate looks like a good bet and should be easy to get, if my doc will write for it. Diluting each day wouldn't be bad once I got the hang of it, I think. I'm so worried I'm going to make a mistake with it for some reason. If the compounded route doesn't work out, I'll go with the Intensol or make daily small-batch homebrews of lorazepam at-home from dry pills/ethanol and then doing a water suspension.

 

It's all a learning game and I just hope I don't mess up too badly. Thank you for your support!!! <3

 

 

[[Li...]]

Another tip of the hat for your thoughtful and thorough approach to taper planning, RoadtoHealing.

 

If you decide to try the compounded liquid, here are some suggestions for you to consider:

 

(1) Verify that the compounding pharmacy will be use a PCCA standardized formula for the suspension and that the drug source will be the pure active drug powder (aka Active Pharmaceutical Ingredient or API) not commercial product (i.e. crushed regular tablets).

 

(2) Ask the compounding pharmacist if s/he will provide adapter caps.  See link below.

 

(3) Ask the compounding pharmacist if s/he would be willing to order 1mL oral syringes with 0.01mL gradations so you can make reductions in the range of 0.001mg if needed (0.01mL of a liquid with a concentration of 0.1mg/mL = 0.001mg). Medisca and BD (Becton, Dickinson and Company) are two high-quality brands that are used by compounding pharmacists.

 

(4) If possible, crossover to the liquid gradually.  For example, take one of your daily doses in tablet form and the other in liquid form.

 

(5) Do not make any other changes as you transition to liquid.  For example, do not make a reduction in dose, do not change your dosing amount or schedule, do not start taking new medications or supplements. 

 

(6) Do not be surprised if the liquid “feels” differently than regular tablets. The bioavailability of the liquid may be different from the tablets you’ve been taking. Some members suggest increasing the dose slightly to compensate for this, but others just wait until their bodies adapt to the change in format.

 

(7) Give yourself time to adjust.  For example, when I first started my compounded suspension, I hated the taste and thought I would never get used to it.  After just a few days, I did. 

 

(8 ) Keep a daily taper journal (if you are not already doing so).  See link below.

 

PS Here’s what I’ve been able to find about SuspendIt:

 

“SuspendIt has special thixotropic properties that allow it to thicken when standing in order to minimize the settling of particles and become thinner when shaken so the medication can be accurately administered. It is also sugar-free, paraben-free, dye-free and gluten-free.”

 

“PCCA members with Clinical Services have access to over 150 standardized formulas for SuspendIt oral liquids, many with beyond-use-dates (BUDs) superior to those pre-established by the United States Pharmacopeia (USP).”  See link below.

 

Links:

 

Adapter Caps | The Withdrawal Project

https://withdrawal.theinnercompass.org/taper/adapter-caps

 

Setting Up a Taper Journal | The Withdrawal Project

https://withdrawal.theinnercompass.org/taper/step-19-setting-taper-journal

 

THE PCCA BLOG | 8 Academic, Peer-Reviewed Stability Studies on SuspendIt

https://www.pccarx.com/Blog/8-academic-peer-reviewed-stability-studies-on-suspendit

[[Tw...]]

I actually only dose once a day at 9pm before bed. I only ever took Ativan to help me sleep and for me figured since it was all I was used to I would stick to once a day. Maybe looking back a lot of my tougher days were due to interdose withdrawal but I just assumed it to be part of the journey.

 

For me I have to be functional during the day no matter how I feel. I have 3 kids under the age of 5 and am the sole income earner in our house so its non-negotiable to be laid up in bed. I had a few tough days on no sleep where I don't know how I did it but I did. I would say like most my symptoms come in waves. For instance I had a few weeks twice where I had tinnitus that was driving me crazy but it finally went away. My anxiety still runs high and I feel it in my chest so I try and do a lot of meditating and breathing exercises to get through it.

 

For sleep I have had many nights where I had no sleep, or 1-3 hours. The next day is honestly the worst. Lately however my sleep is averaging 5-6 hours a night which I am very thankful for. I do take 4-5 drops of THC oil at 8pm a few hours before bed that has helped my sleep. I also have a routine of wind-down before bed where I spend at least an hour doing yoga and meditating in a mostly dark room before bed. I also listen to the calm app sleep stories while I'm falling asleep and I find they help me fall asleep.

 

Also for sleep, I do 30-40 minutes of intense exercising everyday no matter how I feel. I had times where I felt I was having a heart attack (its how my anxiety shows up) and I would still work out. I would tell myself I'm totally healthy and I've been checked out many times where I have no heart problems so I would just keep exercising. I sleep much better the days I work out.

 

One last thing. I looked into the compounding pharmacy for liquid ativan but they wanted to take the prescription and I actually didn't trust them to make the right dose. I knew if I was making it myself I was totally in control. For you I think if you take it even slower than me. You could drop 0.01 every 5 days or so and be done in 4-5 months. My taper will take about 8 months from 1mg. I might take the last 0.3 a bit slower but as of now I'm dropping about .10-.15 a month.

 

I hope this helps!

 

[[sl...]]

Hi RoadtoHealing,

I'm so glad you're getting so much help and feedback on this thread. I'm also happy to hear you're going to do a step-wise transition to liquid while holding your daily dosage.

 

I think starting with a compounded suspension of pure lorazepam is a great option for moving to all liquid dosing. I'm glad you found better services for compounding than earlier. I agree with Libertas' concerns and suggestions for using a pharmacy compounded suspension. 1ml syringes with 100 gradations are a couple dollars each on Amazon (linked in my previous post) but I think it's worth asking your pharmacy to supply one with your order.

 

Libertas mentions the Adapt-a-Cap type syringe adapter, but I personally prefer the press-in syringe adapters for ease of dosing. I find Adapt-a-Cap doesn't make as secure a seal with my 1ml syringes as the press-in does. If you don't know already, I'd consider asking the pharmacy which option they supply. Either will work, I just like the press-in type.

 

I like Suspendit, as I said before, from what little I know about it. I'm glad that option is available to you. I especially like that it's paraben-free, unlike Ora-Plus and some other common vehicles.

 

I agree there is some risk to diluting, especially while struggling with any symptoms. Homebrew, especially daily batch making, I consider to be inferior to pharmacy compounding in most cases. I really like the order that you're trialing liquids: compounding suspension to manufactured solution to homebrew (or possibly a custom compounded solution, which may be an option with a flexible pharmacist). Tapering can be easy; I think it's just about finding the right balance of risks, labor and cost; you're definitely on your way to that balance!

 

Let us know how the trial goes! Or if you need more help planning the transition.

We're all rooting for you. 

[[Li...]]

Libertas mentions the Adapt-a-Cap type syringe adapter, but I personally prefer the press-in syringe adapters for ease of dosing. I find Adapt-a-Cap doesn't make as secure a seal with my 1ml syringes as the press-in does. If you don't know already, I'd consider asking the pharmacy which option they supply. Either will work, I just like the press-in type.

 

A point of clarification ... the link for Adapter Caps provides an overview (with pictures) of three types of adapter caps:

 

Press-in

Screw-on

Universal

 

My compounding pharmacist uses the press-in type.  (I tried using the universal-type adapter cap with liquid pet medication a while back but found it less than satisfactory.)

 

Link:

 

Adapter Caps | The Withdrawal Project

https://withdrawal.theinnercompass.org/taper/adapter-caps

 

 

[[sl...]]

Libertas mentions the Adapt-a-Cap type syringe adapter, but I personally prefer the press-in syringe adapters for ease of dosing. I find Adapt-a-Cap doesn't make as secure a seal with my 1ml syringes as the press-in does. If you don't know already, I'd consider asking the pharmacy which option they supply. Either will work, I just like the press-in type.

 

A point of clarification ... the link for Adapter Caps provides an overview (with pictures) of three types of adapter caps:

 

Press-in

Screw-on

Universal

 

My compounding pharmacist uses the press-in type.

 

Thanks for clarifying your phrasing Libertas. I understand now that you're just repeating the naming convention used by the Inner Compass Initiative. I think that asking for an "adapter cap" from a pharmacist would lead them to think I was asking for one of the external adapter types. I find this use of the term "adapter cap" misleading when referring to internal adapters as they do not function to cap the bottle; I've seen them called "plug", "press-in" or "push-in" syringe adapters. I think any pharmacist would know these as a "press-in syringe adapter".

 

Press-in adapter caps

These push into the neck of a bottle and fit snugly. They are not reusable, so a new one is needed for each bottle of the drug.

(https://withdrawal.theinnercompass.org/taper/adapter-caps)

Also to the contrary, I've found that press-in syringe adapters are indeed reusable. 

[[Ro...]]

Hi slownsteady,

 

Yes, the help on this thread from everyone is beyond wonderful! I'm so, so, so beyond grateful. <3

 

I did order the 1ml syringes with 100 gradations that you linked previously. Thank you! Will talk to the pharmacy about supplying more also.

 

Trying to get together a plan for rate of taper now, for when I stabilize on the liquid. Sleep is still quite hard to come by and still feeling pretty amped most of the time. My initial taper (per psychiatrist) from 1 mg was far too fast and although I stabilized after 11 days once I went back up to 0.25 mg per day (stabilized as in I no longer felt completely dysfunctional and like I had lost ALL my marbles), I don't seem to have fully stabilized as many of you have. I'm still dealing with a lot of inner anxiety, intrusive thoughts and physical/emotional/mental burn-out. This would be helped a lot by sleep but I'm just not getting much even. Lots of sleep hygiene stuff happening around here though and I'm reading through the insomnia threads here. My CNS is still just struggling to cope. Is it like this for everyone? I'm trying to do all the things to stay calm and centered....lots of meditation, daily walks, journaling, positive talks to myself, etc.

 

But yes, not sure what to do as far as rate of tapering. I've been back at 0.25 mg since 8/26/21 so not sure how long I hold there after the adjustment to the liquid or if it's better to continue cutting down. Thoughts? My goal is to have a successful taper where I essentially walk off easily with no lasting issues so I want to be smart now about rate of taper...and feel somewhat ok while doing it.

 

After reading your instruction guide, I've been trying to set-up a plan in http://benzo.alwaysdata.net/titration/titrationForm.php. From 0.25 mg, going 10% every 14 days would have me tapered in 7 months. 5% every 14 days would be more like 5 months. I've only been on Ativan since the last week of June and low doses. Not sure that makes a difference or not as far as pace of tapering can go. I'm guessing it's all very individual?

 

 

 

 

[[sl...]]

I'm so glad we all can be of help to you RoadtoHealing.

 

After reading your instruction guide, I've been trying to set-up a plan in http://benzo.alwaysdata.net/titration/titrationForm.php. From 0.25 mg, going 10% every 14 days would have me tapered in 7 months. 5% every 14 days would be more like 5 months. I've only been on Ativan since the last week of June and low doses. Not sure that makes a difference or not as far as pace of tapering can go. I'm guessing it's all very individual?

 

The 10%/14 day timeline is accurate to my knowledge. The 5%/14 day timeline, however, is not; 5% takes a total 440 days or 1 years 2 months 14 days to reach 0.05mg. Maybe you meant 15%/14 days? I don't suggest using a rate above 10%/14 days until you've had some time tapering between 5-10%. It's easy to speed up if progress is easy, but IME if the rate is too high things can be start and stop and very uncomfortable waiting to stabilize again.

 

As you guessed, tapering is VERY individual. I think it's safe to trust your symptoms; sleep is so important for healing and if you're not getting enough I think more time holding might offer improvements. Short-term use isn't something I find offers ANY guarantee of fast tapering or low symptoms. Symptom-based slow tapering means you're largely in control of how much you suffer, but NOT in control of how much time your body needs to adapt to reductions.

 

I suggest setting some functionality goals before doing anything else at this point.

 

How many hours of sleep do you need to be functional? How important is having a strong appetite and digestion? What minimum of exercise is important to you? What work or social or homecare performance do you need to maintain to support your lifestyle? These are all very personal questions and only you will know the answers, but I suggest having some kind of foundational functionality goals that are your anchor of well-being and alarm bells to let you know if and when your body can't keep up with reductions.

 

My functionality goals include 8hrs of sleep per day, a short car ride per day, a walk per day, basic social interactions with my wife and family, appetite and digestion of four medium-size meals per day, and some creative outlets. If I can't meet these goals it's not the end of the world, but I know that something is up with my taper or my lifestyle (usually both) and I need to be paying attention and likely slow down.

 

I suggest once you have some functionality goals, then hold a little longer to see if you can meet them. If your doctor or some other condition is forcing you to rush and keep tapering I understand, but otherwise it sounds like your body made a BIG adjustment already just getting to 0.25 and needs more time. Further tapering without regaining quality sleep or other important functions might actually take longer overall than waiting to recover more at this time.

 

Just my two cents worth. 

[[Ro...]]

Hi Twindubs,

 

Thank you so much for sharing your journey! You are truly a superman and your progress is amazing. It does help me so much to hear how others are tackling the benzo beast, what it's been like, things that been helpful along the way, etc.

 

I'm going to start out pretty slow on my taper and see how it goes. Can always speed up if things are going well. Thank you again for replying...I feel less alone knowing there are other Ativan-ers out there with me who are saying no more and getting off!

[[Ro...]]

Hi Libertas,

 

As always, thank you for all the info!

 

I did get a press-in adapter and 1mL oral syringes with 0.01mL gradations syringes from the pharmacist and ordered some more that slownsteady recommended from Amazon.

 

It'll be a week tomorrow since I started crossing over to the liquid. I didn't have many tablets left but did have enough for 3 days and did as you recommended previously. I did liquid in the morning, pill at night. Cumulative daily dose the same at 0.25 mg. And then I went to my new daily dosing schedule of all liquid, 4 doses a day at 0.0625 mg each (0.625 mL per dose) for a total daily of 0.25 mg. I crossed over to my new dosing schedule before a week was up because I was feeling better but now I'm wishing I had waited out a full week.

 

Because that's the one thing I noticed right away, even after the first day, that I'm a little concerned about is how much better I feel. I called the pharmacist to verify the concentration of the suspension, amount of drug that went in, etc. and it is all as it should be. With the exception of the using pure lorazepam. He was like "oh yes, forgot to tell you at pick-up that I didn't have enough without having to order more so I just used tablets". Ugh!!!! But otherwise, it's 0.1mg/1mL. 14, 1 mg lorazepam tablets went in to the 140 mL PCCA standardized formula suspension (SuspendIt). And I shake like crazy before dosing for even dispersal.

 

Anyway, now I'm worried about how much I'm actually getting in each dose. Previously, with the tablets I was only dosing twice a day due to how small I could cut them and I was having terrible inter-dose withdrawal, on the edge of my seat and amped up most of the day. I have none of that now and I don't know if it's because of the liquid being off, more frequent dosing or my body's reaction to the liquid.

 

Thoughts? I so hope I haven't up-dosed myself accidentally. :'( What would be a wise way to proceed? I haven't started tapering yet, just holding at 0.25 mg. I don't want to end up in tolerance either way.

 

P.S. I did call DrugCrafters out in Frisco, TX to see if they ship to GA and they do, but not controlled substances. It's a shame, because they seem like such a great compounding company. They seem to really know what they are doing, unlike some of the compounding pharmacies around here.

 

Edited to add: so I'm all amped up today after feeling good the last several days. I got myself all worked up and worried about the liquid. It's been almost a week so I'm guessing everything is still settling out. I just don't know. 

[[Ro...]]

Hi slownsteady,

 

It was on http://benzo.alwaysdata.net/titration/titrationForm.php, that I found "Recommendations: Reduce the daily dose between 5% and 10% every 10-14 days"  in red towards the bottom of the form. Is this inaccurate? I may just be confused! I'm definitely planning on starting out slow. Like you say, it's always easy to move along more quickly if things are going well.

 

Definitely setting some functionality goals is in order for me. I need at least 8 hours a night and getting by on 2-4 isn't cutting it. Thank you for sharing yours. It gives me a good idea of how I should be planning this out. One more question...how do you feel most days? Do you feel like you're pretty even keel with few symptoms or is the withdrawal feeling always there? My hope is to go so slow that's not very perceptible, my anxiety is well under control and I can live a reasonably normal life.

 

Also, I've found myself in a bit of a predicament regarding my compounded liquid. Ugh!!!! I just hope all is well and I haven't messed up. Such a newbie to all this. I put all the details in my last reply to Libertas. Any thoughts you have as well would be very much appreciated. I'm so sorry to keep reaching out. I'll get the hang of this, I promise!

 

 

[[Li...]]

Greetings, RoadtoHealing.

 

Thank you for letting us know how you are doing with your compounded liquid. If I were in your shoes, I would try my best not to over-think this.  Instead, I would focus on what my symptoms are telling me.  In your case, your symptoms are telling you that you are responding well to the new dosage form and schedule. This is good news!

 

Given lorazepam’s relatively short half-life (10-20 hours per Ashton), after one week of holding, you may have reached steady state in terms of blood serum concentration. So, it’s your call as to whether or not you feel ready to make a reduction.

 

It’s disappointing your compounding pharmacist did not use the pure active drug substance (aka API) for the drug source as promised. However, given that you have responded well to a formulation prepared using regular tablets, I suggest you consider continuing to use it if your compounding pharmacist will (1) assure you he will make future batches using exactly the same tablets he used for the first batch (same manufacturer, same lot number, same strength) and (2) take additional steps to ensure consistency across batches (e.g. same suspension vehicle, same preparation procedure, same equipment, same technician).

 

Tip of the hat for contacting Drug Crafters (DC). My understanding is that shipping controlled substances across state lines is subject to multiple rules and regulations at both the federal and state levels. I wonder if DC would be willing to share its formulation with compounding pharmacists in other states?

 

[[Tw...]]

You've got this! Also nice to know there are other Ativan-ers out there as well . I will be following your journey and peeking in from time to time. Now onto my nightly wind-down routine. Take care talk soon!

[[Ro...]]

Hi Libertas,

 

Yes, I think not over-thinking this is key. I do seem to be responding well to the new dosage and schedule and that is indeed a good thing! Thank you for the reassurance. I'm just hoping it's as well suspended as I think it is after shaking so that I'm indeed getting the right amount per dose. I just feel so great that it's a little weird. Among those who using compounded formulations, have you heard of others using SuspendIt (or similar suspension vehicles) and had great success? I'm guessing it's kind of hard to be getting too much if I'm measuring each dose very carefully.

 

I will talk to the pharmacist about the points you mentioned below. Indeed very important to maintain consistency across batches!

 

I will also reach out to DC and see if they are willing to share their formulation.

 

Thank you again for your assistance! You've been so amazing and I'm so thankful. 

[[Ro...]]

Hi slownsteady,

 

Yes, I was indeed mistaken on the 5%/14 day timeline being 5 months. Sheesh. You are correct, it would indeed a total 440 days or 1 years 2 months 14 days to reach 0.05mg. Sorry, my mistake!

 

I seem to be adjusting very well to the compounded liquid. I feel SO much better! It's been a little wild to go from such severe inter-dose W/D to feeling a whole lot more like my old self. Going to hang at my current dose a little while longer to stabilize, get sleep back in order and set some functionality goals before starting to reduce but wanted to start getting a taper plan in place now for when the time comes.

 

I'm thinking 5% every 10-14 days is probably the best place to start? If I'm doing a DMT, how easy is it course-correct if going too fast? Even if I know lorazepam's half-life, with daily little cuts how will I know what day to slow down before things get dicey? This kind of thing seems harder to know with this method than with the cut-and-hold method but I like the idea of DMT more because it's tiny cuts daily vs. guessing at bigger cuts and possibly suffering. Just wondering if you've run into this and how you've dealt with it?

 

Hope all is well on your end! 

[[sl...]]

I seem to be adjusting very well to the compounded liquid. I feel SO much better! It's been a little wild to go from such severe inter-dose W/D to feeling a whole lot more like my old self. Going to hang at my current dose a little while longer to stabilize, get sleep back in order and set some functionality goals before starting to reduce but wanted to start getting a taper plan in place now for when the time comes.

 

I'm thinking 5% every 10-14 days is probably the best place to start? If I'm doing a DMT, how easy is it course-correct if going too fast? Even if I know lorazepam's half-life, with daily little cuts how will I know what day to slow down before things get dicey? This kind of thing seems harder to know with this method than with the cut-and-hold method but I like the idea of DMT more because it's tiny cuts daily vs. guessing at bigger cuts and possibly suffering. Just wondering if you've run into this and how you've dealt with it?

 

Hope all is well on your end! 

 

Hi RoadtoHealing,

I'm so happy to hear you're adjusting to your new compounded liquid! I like your plan to hold here a little longer to continue stabilizing and meet your functionality goals, especially around sleep.

 

I like the idea of starting at 5%/14 days. The way I like to think about percent-based reductions is that 5%/14 days cuts my dose in half every ~6 months. I think time is a small price to pay for better living AND lower medicine. You might want to consider speeding up if your symptoms are unnoticeable after several weeks of continuous cutting, and I suggest doing a rate increase slowly and patiently if possible. I expect there will be a limit to how fast you can taper comfortably, and I think paying close attention with symptom monitoring and your tapering journal will go a long way to minimizing symptom severity.

 

Regarding a DMT, I think you're fortunate with lorazepam because the short half-life of the drug should give a quick response to your DMT. By this I mean, I expect you will feel both the full effect of your rate of reduction and a recovery from new symptom severity rather quickly when holding. It could be one to two days both for reductions to peak and for holds to stabilize you; this seems to be common from what I hear about alprazolam DMTs as well, a drug which has a similar half-life. But everyone is different! Trial and discovery will teach you about how your DMT is effecting you and I think this is the best information for you to rely on. I think you'll feel increasingly more confident as you learn the ropes by tapering.

 

I am tapering clonazepam so my DMT is far less responsive than I expect yours will be. I'm working with a half-life that is something like 3x as long as that of lorazepam; this means roughly 3x longer to feel reductions and roughly 3x longer to recover by holding. I have to be especially patient to find out how a reduction is hitting me (3-5 days but usually 9 for full effects), and if things have really gone sideways I could be holding for 3-5 days minimum to recover. Fortunately I am getting better and better at noticing my symptoms, and lately I did a one day hold when symptoms start to get difficult and that seemed to be enough to make a difference.

 

Just as a side note, the problems I have doing a DMT of clonazepam is why I do not recommend a DMT for diazepam. Diazepam's half-life is another 3+ times that of clonazepam; instead of smoothing out the taper, I think a daily reduction schedule for diazepam would actually make it very hard to fine tune the rate and result in many many uncomfortable days holding to recover if functionality becomes significantly impaired.

 

I hope this makes sense. I think you're in a great place to do a DMT. I expect you're planning to keep all your daily doses throughout the bulk of your taper, as this seems to be extremely beneficial for short-acting benzo tapering.

 

Would you mind updating your signature to summarize your current dose, tapering method, and dosing schedule? This would be a good reminder for me, because I'm pretty forgetful. Thanks!

 

Again, so happy for you! I'm sure this is only going to get easier with experience. 

[[Ro...]]

Hi slownsteady,

 

Thank you so much for answering my questions....and giving me some confidence that tapering will indeed get easier as I ease into it and adjust. I really, really needed to hear that so thank you! I am continuing to hold at 0.25 mg until I fully stabilize and meet some functionality goals I created for myself. Especially when it comes to sleep as it still remains fairly elusive. And appetite. I have zero appetite right now but am eating regular meals daily + snacks to keep up my nutrition. It's really weird to have NO appetite for anything at all but I know it'll be back eventually. Have you had this experience (or have heard of it?) I think coming down so fast (just a few short weeks!) from 1 mg on my old psychiatrist's taper plan wrecked some havoc on my CNS so it's taking some time to recover. Sigh. But it will recover! I'm letting my body be my guide as far when to start tapering. I'm just not ready yet.

 

I think 5%/14 days is indeed a wise place for me to start though when the time comes. Nice and slow. Speed up if it seems right but otherwise I may be very well be tapering for a year-ish. I just can't go back to weeks and weeks of terrible WD like I had before I got my compounded suspension and started my new dosing schedule.

 

Given the short half-life of lorazepam, it is reassuring to know that I'll get symptom feedback pretty quickly doing DMT. I am planning to keep all 4 daily doses throughout the taper. If possible, would love to be able to drop the 2:30 am dose as I regain more functionality. Fingers crossed! I did update my signature and will be better about keeping it current. Thank you for the reminder!

 

 

 

 

[[sl...]]

Hi RoadtoHealing,

I'm so glad that was helpful for you. Yes I also lose my appetite when I'm neurologically unstable; it's one of my early warning signs that I use to determine when to hold on my DMT. I'm relieved that you're still able to eat; I understand this can be uncomfortable.

 

I went through a period of time before clonazepam where my brain was flooded with glutamate and it took a number of tricks and a force of will to keep myself eating. I couldn't afford to lose any more weight at the time, and it was a serious challenge. One thing that helped me was using apple cider vinegar to spark my digestion; sometimes a sip or two, but other times just a smell right as I was sitting down to eat would get things moving. Lemon juice might work as well, but ACV worked for me during those dark days.

 

Yes, you will definitely recover. I think this is an important message to tell your whole body. I like to think of myself as the message center for all my cells, and when things get tough I think it's especially important to send messages to my cells that encourage them to rally and believe in a positive outcome. Sometimes I'm like a general, mustering the troops before a charge; other times I'm like a mother, soothing her nervous babes. I get good results when I take responsibility for the messages I'm sending throughout my body with my thoughts.

 

I appreciate that you're willing to start at 5%. I think this is a wise decision. Slow tapering can really be so beneficial, letting time do the heavy lifting.

 

Four lorazepam doses per day all the way makes perfect sense to me, but you might want to consider carving out an 8 hour period between doses so that you can get a solid night of sleep. I took clonazepam doses ever 6 hours for months when I started, and it was rough waking at 2am in the middle of restorative sleep to dose and lie awake instead. I think an ideal schedule with 4 doses would be every 5-6 hours, leaving an 8 hour chunk of time between doses when you're liable to get the most sleep; for me this is 8pm - 4am, but for you it might be different times.

 

An example 4 dose schedule with an 8 hour sleep period would be:

5am dose

10am dose

4pm dose

9pm dose

 

You could rotate these numbers around the clock to get different sleep and wake up times that work better for you. The trick is just 2x 5-hour gaps between doses and 1x 6-hour gap creates four doses and leaves an 8-hour period for sleep.

 

Thanks for updating your signature! You're doing great! Keep us posted if you can. 

Let us know if you need any more help.

[[Ro...]]

Hi slownsteady,

 

Yes, eating has been quite hard but I've been managing. Definitely going to try out the tricks you mention below. Especially the ACV. Thank you!

 

I think tinkering with my dosage schedule to allow for 8 hours for sleep is a really good idea. Severe insomnia is my #1 issue right now. This past week I'm averaging 1-2 hours a night. :'( I need 8-9 to function normally. I'm getting these wild cortisol surges at night that wake me up, usually in the 2:00 - 5:00 am timeframe. I think my body is still recovering from the fast crash down from 1 mg to 0.125 mg and then back to 0.25 mg to stabilize and that's why eating and sleep have been so hard. I feel like these are some of my darkest days. :'( But on the plus side, I'm not on the edge of my seat ALL the time anymore since beginning the compounded suspension and more frequent dosing so that's major improvement. And I KNOW it will ALL get better! I love the body messaging you mentioned below. I need to remember to do that often throughout the day. Flood every cell with love, compassion, empathy and joy.

 

Today marks a month since I went back up to 0.25 mg to try and stabilize. I used tablets until I started my compounded suspension on 9/10/21. Would it be wise to hang out here at 0.25 mg until sleep and eating are much better? It's been 4 weeks and I'm not sure about tolerance. If advisable, holding here seems wise if growing tolerance won't likely be an issue. Thoughts on that? I do seem to have a little rebound between doses but it's hard to tell since I'm also so sleep-deprived. Not sure whether it's better to stay at the same dose (in possible tolerance) to allow the CNS more time to recover or to start my 5%/14 days DMT tapering. I've been researching this but am getting mixed viewpoints. So I'm just not sure. Hmmm.

 

Unfortunately, I wasn't benzo-wise when I was being rapid-tapered by my psychiatrist. By the time I found BB, I was already in terrible inter-dose WD and trying to stabilize before further tapering. I think that's why eating and sleep are still so messed up. If I could do it all over again, I would have researched safe tapering heavily and done it on my own, but I just didn't know at the time. Ugh. I would love to have been stable BEFORE starting the tapering journey. Shame. I was not knowledgeable. BUT I am now and I *hope* I can still get back on track with reasonable sleep and eating at 0.25 mg before tapering further. Time heals everything. I just have to keep that front and center.

[[sl...]]

Hi RoadtoHealing,

I hear that you are still struggling with important functions like sleep, but seeing other improvements. I think that sometimes small improvements are all that we have to celebrate, but celebrating them is so important.

 

I think your sleep will improve. Paradoxically in my own journey to better sleep, worrying less about sleep and focusing on day-to-day, round-the-clock restfulness strategies helped me, eventually, to get better sleep. From this experience I believe that you will see significant sleep improvements if you can be patient and generally restful.

 

It sounds like your rapid taper was a very big destabilizing event; making a full recover from this could take a while. It also sounds to me like you are doing many successful strategies for stabilizing, and the other biggest factor that I consider a powerful aid is time. You said it well yourself, "Time heals everything".

 

If I was experiencing the significant loss of functionality that you are describing after such a rapid reduction I would be expecting and maintaining a long hold. A further updose would cross my mind, but I would reserve that approach for if I began to experience cascading failures in functionality; I do not hear that happening in your situation. I would be hopeful that because my current dose is so low compared to my previously stable dose that tolerance will not be an issue while I'm stabilizing. I would set basic functionality goals to meet before making any further reductions, including regular, sufficient sleep and appetite. And I would endeavor to stabilize, and thus earn my functionality at this new dosage, by the use of non-medication methods and steady daily benzo dosing.

 

I have great faith that you can stabilize here and experience the functionality you need to progress in your taper. You have the right attitude, and while currently you are experiencing great difficulty, I expect you will continue to see improvements.

 

Let us know if there's more we can do to help. 

[[Ro...]]

Hi slownsteady,

 

Thank you, as always, for your words of wisdom and encouragement. I really needed to hear that this can indeed be done and that I'm on the right track. Your kindness to me and time spent replying just means the world to me. Thank you, again. 

 

Yes, I think celebrating the small improvements is indeed important and I need to remember to do that daily. I am definitely in a much better place than I was previously!

 

Less worry about sleep and incorporating more restfulness during the day is what I need to be doing for sure. I tend to worry and this is not the time for it. Focus on forward and positive thinking :-)

 

Was very helpful to read your thoughts on tolerance. I was all worried that it's something that happens quickly but that's not necessarily the case. Separating between 1) the feelings of being in "tolerance" to the benzo and 2) my own anxious feelings in general is tricky for me. But hopefully I'll get the hang of it! I will definitely be maintaining a long hold until sleep and appetite are stabilized and daily functionality goals are met. It's so reassuring to hear that even after a rapid taper down from 1 mg, that I CAN indeed stabilize at 0.25 mg! It'll just take a little more time and I need to be patient. I see that now. After all, it's only been a month that I've been at this dosage and it could my system a bit longer to recover. Definitely want to get the mind and body soothed before trying to taper further.   Have you seen others here in a similar situation as mine where they tapered too quickly at first and it took quite a while to stabilize?

 

I want to avoid future episodes of akathisia (feeling of wanting to jump out of my skin/edge of my seat, wanting to keep moving, major inner restlessness/panic) and other benzo W/D symptoms. By going real slow, allowing my body to be the guide, is the only real way I see to hopefully avoid all that. Crashing down quickly on a taper as my psych had me do at first, I'm afraid would have proved to be terribly disastrous at the end. Now, thanks to you and others here, I'm on a much better path. 

[[sl...]]

Hi RoadtoHealing!

I'm so glad I could offer you some reassurance. My own journey to neurological stability was plagued with doubt and fears, so I understand how difficult this can be.

 

Some people don't get the opportunity that you have to hold at 25% their original dose; they're rushed off, quit C/T, or rapid taper compeltely for lack of support or understanding. I feel confident that you are in a good place for stability and eventual slow tapering.

 

Have you seen others here in a similar situation as mine where they tapered too quickly at first and it took quite a while to stabilize?

 

Yes, many buddies have had to recover from formulaic, doctor-led reduction schedules. I was so disabled from a doctor-led 25%/14 day reduction that I needed to return to and stabilize on my original dose but other buddies, for various reasons, have held at their lower doses and eventually stabilized. If you want to connect with others who might be or have been in similar situations, I suggest starting a topic on the Withdrawal Support board about stabilizing after a rapid reduction.

 

I believe in your healing. 

[[Ro...]]

Hi slownsteady,

 

Yes, being plagued with doubt and fear has been hard for me to overcome but I'm getting there. Slowly. I have general anxiety and OCD also so mix those 2 things with coming off lorazepam and it's the perfect storm of worry and intrusive thinking. Ugh. Trying to stay busy with other things to occupy my mind and have at least 2 long meditations each day. I'll get through this. I just know I will!

 

My goodness, your doctor-led reduction sounds as horrible as mine was, if not worse. I'm so sorry you went through that. So glad you are doing better now.

 

Yeah, my hope is to hang in there and continue to stabilize at 0.25 mg. It may take a while. Good idea about starting a thread on the Withdrawal Support board about stabilizing after a rapid reduction! I'll do that.

 

Thanks again and I'll keep you posted on how it goes. Appetite is back today which is so encouraging!

[[sl...]]

Yay for appetite!