Lorazepam to clonazepam: opinions appreciated please 💊➡️💊

[[...]]

I started taking lorazepam .5 mg three times a day (sometimes less) on 8/30/21 while undergoing cancer treatment. It was prescribed for nausea as needed. Because of the side effects, I decided to go off it last week not knowing I should taper. Within a day, I had diarrhea, high anxiety, sweats, no appetite etc…

Yesterday, my pcp switched me to clonazepam .25 mg twice a day and Zoloft 25mg once a day. Does this look like a good game plan? I’m so new to this and suffering a bit from information overload.

 

 

[[sl...]]

Hi SLS,

In brief, no, I don't like the game plan that your doctor has prescribed.

 

First, I think they under-prescribed your clonazepam dosage based on your previous lorazepam dosage per Ashton-equivalents; I would want 0.75mg/day of clonazepam to stabilize after being dependent on 1.5mg/day of lorazepam. At 0.5mg/day of K you've perhaps gone from a cold turkey cessation to a 33% reduction; still a very large reduction for many buddies and this may cause a prolonged period of symptomatic intensity while your body makes repairs. Alternatively, you may want to ask your doctor for 0.75mg/day and hold there instead.

 

Second, it can take a week or longer for regular clonazepam doses to get to full potency (overlapped half-lives); it's a different drug than lorazepam in this way and you would likely continue to experience withdrawal symptoms while waiting for this build-up, even if your doctor had given you an Ashton-equivalent dose.

 

It might be less frightening if you are aware that this is happening; many buddies get scared that the new, longer-acting benzo is "not working", but it usually just needs more time and doctors don't often mention this "little" detail. This is also why step-wise crossover (a slow, week by week substitution-based transition) are safer and more comfortable, but I think you will survive this if you can nurse your nerves while the clonazepam is accumulating.

 

Personally, I would NOT take Zoloft if I was trying to get off of psyche medications. SSRIs notoriously cause increased anxiety when started, have their own often difficult withdrawal symptoms, and can cause all sorts of other problems during use which may be difficult to distinguish from the benzo withdrawal symptoms and any issues you have tolerating clonazepam. I would NOT want to be trialing two new psyche drugs simultaneously, while trying to recover from the neurological fallout caused by a third psyche drug that I quit cold turkey; I think this would be a recipe for confusion and poor decision-making.

 

Everyone is different. You may well-tolerate the abrupt switch to clonazepam and the 33% decrease in Ashton-equivalent benzo dosage. Clonazepam is a more taper-friendly drug in my experience having using both lorazepam and clonazepam at different times. I am tapering clonazepam presently and while it has it's challenges, the half-life is favorable. Unless you need an anti-depressant, I suggest not taking Zoloft or any other drugs. I also suggest learning about and avoiding other GABA agonists like alcohol, ashwaganda, and similar while you recover.

 

I am sorry for the bad news; this is a difficult situation we're all in and yes, information overload is a huge problem for most of us. Let us know how we can help. 

[[...]]

Hi SLS,

In brief, no, I don't like the game plan that your doctor has prescribed.

 

First, I think they under-prescribed your clonazepam dosage based on your previous lorazepam dosage per Ashton-equivalents; I would want 0.75mg/day of clonazepam to stabilize after being dependent on 1.5mg/day of lorazepam. At 0.5mg/day of K you've perhaps gone from a cold turkey cessation to a 33% reduction; still a very large reduction for many buddies and this may cause a prolonged period of symptomatic intensity while your body makes repairs. Alternatively, you may want to ask your doctor for 0.75mg/day and hold there instead.

 

Second, it can take a week or longer for regular clonazepam doses to get to full potency (overlapped half-lives); it's a different drug than lorazepam in this way and you would likely continue to experience withdrawal symptoms while waiting for this build-up, even if your doctor had given you an Ashton-equivalent dose.

 

It might be less frightening if you are aware that this is happening; many buddies get scared that the new, longer-acting benzo is "not working", but it usually just needs more time and doctors don't often mention this "little" detail. This is also why step-wise crossover (a slow, week by week substitution-based transition) are safer and more comfortable, but I think you will survive this if you can nurse your nerves while the clonazepam is accumulating.

 

Personally, I would NOT take Zoloft if I was trying to get off of psyche medications. SSRIs notoriously cause increased anxiety when started, have their own often difficult withdrawal symptoms, and can cause all sorts of other problems during use which may be difficult to distinguish from the benzo withdrawal symptoms and any issues you have tolerating clonazepam. I would NOT want to be trialing two new psyche drugs simultaneously, while trying to recover from the neurological fallout caused by a third psyche drug that I quit cold turkey; I think this would be a recipe for confusion and poor decision-making.

 

Everyone is different. You may well-tolerate the abrupt switch to clonazepam and the 33% decrease in Ashton-equivalent benzo dosage. Clonazepam is a more taper-friendly drug in my experience having using both lorazepam and clonazepam at different times. I am tapering clonazepam presently and while it has it's challenges, the half-life is favorable. Unless you need an anti-depressant, I suggest not taking Zoloft or any other drugs. I also suggest learning about and avoiding other GABA agonists like alcohol, ashwaganda, and similar while you recover.

 

I am sorry for the bad news; this is a difficult situation we're all in and yes, information overload is a huge problem for most of us. Let us know how we can help. 

 

 

 

Thanks so much for such a detailed reply, it’s appreciated. I just went through my dosing records so I’ll edit my post.  So my prescription was for 3 times a day, as needed. Sometimes I took it 3 times a day, some 2 and occasionally once (over the course of two months), depending on how much nausea I had that day. Does this change your thoughts or opinion?

 

Thanks also for your thoughts on Zoloft. I have reservations about starting it because of the facts you mentioned. I’m 52 years old and have never been on benzos or antidepressants until now. I feel like if I can just get through this Ativan withdrawal, I can deal with anything!

 

 

[[sl...]]

Thanks so much for such a detailed reply, it’s appreciated. I just went through my dosing records so I’ll edit my post.  So my prescription was for 3 times a day, as needed. Sometimes I took it 3 times a day, some 2 and occasionally once (over the course of two months), depending on how much nausea I had that day. Does this change your thoughts or opinion?

 

Thanks also for your thoughts on Zoloft. I have reservations about starting it because of the facts you mentioned. I’m 52 years old and have never been on benzos or antidepressants until now. I feel like if I can just get through this Ativan withdrawal, I can deal with anything!

 

Hi SLS,

I understand now that your lorazepam dosing was sometimes less than 1.5mg/day. Since you mention dosing records you could add up the last few weeks of doses and divide this by the number of days. This average dose per day of lorazepam is what I would use to determine an Ashton-equivalent dose of clonazepam.

 

Average Per Day Dosage

(total of milligrams consumed) / (number of days) = (avg. dose per day)

ex. 27mg / 21 = 1.285mg

 

Ashton-Equivalent Lorazepam -> Clonazepam

(milligrams of lorazepam) / 2 = (Ashton-equivalent milligrams of clonazepam)

ex. 1.285mg / 2 = 0.643mg

 

IMO a slight updose on a sudden cross is favorable to a reduction. In the above example, for 0.643mg K I would consider crossing to 0.75mg because this dose is easy to produce with a pill splitter and 0.5mg tablets. I find that my generic 0.5mg clonazepam tablets can be reliably split into 1/4s with an aluminum pill splitter so that gives me tablet dosage intervals of 0.125mg.

 

I have the EqualSplit brand aluminum splitter from Amazon. Here's how I use it...

 

Yes, I'm confident you can get through this and anything else you put your mind to! I suggest being gentle to yourself though; the most functional tapers seem to be had by people willing to let their body guide their steps.