Looking at changing the way I dose. Anyone else try this?

[[Di...]]

I have also posted this on another board but wanted to post here also.  I am doing a DLMT.

 

I am having a really hard time with my taper.  I have tapered from 1.5 mg to .489 mg ativan and my symptoms are rough.  The doctor that prescribed the ativan told me to dose my largest dose at bedtime so I could get good sleep but I never had a problem sleeping prior to benzos.  I sleep good but feel horrible from the time I get up in the morning until early evening almost everyday.  I dose 6 am 11 am 4 pm and 9 pm.  My question is what are some thoughts or experiences if I switch my largest dose to the first dose of the day say at 8:30 am.  Then take my smaller doses 12 pm 4 pm and 8:30 pm?

 

Appreciate any suggestions.

Thank you,

Diane

[[Li...]]

Hello, Dianedeedee.

 

Congratulations on tapering to 0.489mg per day from 1.5mg.  That’s quite an accomplishment!

 

How many milligrams of lorazepam/Ativan do you currently take for each of your daily doses:

 

6am

11am

4pm

9pm

 

What time is ‘early evening’?  5pm? 6pm? Other?

[[Di...]]

Hi Libertas,

Thank you!

 

2 mg/ml

I pull 1 ml L and mix with 299 ml water and take my daily doses from that mixture

 

6 am  14.8

11 am 14.8

4 pm    14.6

9 pm    28.6

 

Early evening is 6 pm

 

[[Li...]]

You’re welcome! Thank you for providing this additional information.

 

To help myself and others quickly grasp the amount of lorazepam you are taking, I have converted your daily doses from milliliters of liquid to milligrams of lorzepam as follows:

 

6am    0.0987mg

11am  0.0987mg

4pm.  0.0972mg

9pm.  0.1907mg

 

After doing so, the first thing I noticed was that your daytime doses are very low.  I wonder if they might be so low you are not deriving much of a therapeutic effect from them?  If so, then below is one possible explanation for what you are experiencing.  Please note: I am not a pharmacologist and have zippo experience with using lorazepam so this is pure speculation on my part. 

 

- Based on a quick tour of the Internet, I’ve gleaned that lorazepam reaches peak plasma in about 2 hours after oral administration and has a half-life of about 12 hours.

- There are 9 hours in between your 9pm and 6am dose.

- By 6am, close to half of your nighttime dose has been eliminated.

- Your first two daytime doses are very low so may not be sufficient to ‘bump’ your serum blood level back up into a therapeutic range. Consequently, you feel unwell during the day.

- Your daytime doses accumulate so when your 4pm dose ‘kicks in’ around 6pm, your serum blood level approaches the therapeutic range.  Consequently, you feel a little better.

 

If the above scenario is in play, then moving some of your 9pm dose to your 6am dose might indeed help (assuming it does not harm your sleep).

 

Another option to consider is to ‘even out’ your doses by splitting the ‘excess’ from your  9pm dose equally across your 3 other daily doses (so you end up with 4 equal doses). This approach would reduce the peaks and troughs in blood serum level caused by taking unequal daily doses.

 

Given that it is not uncommon for members to report issues when they change dosing amounts and/or times, please consider (1) making any such changes gradually and (2) keeping careful notes.

 

I hope the above helps at least somewhat.  I also hope other members will contribute their thoughts, experiences, and suggestions.

[[Di...]]

Hi Libertas,

Thank you so much!  That all makes so much sense.  I am going to soak all this in.  I appreciate you taking the time to research and explaining it all so well.  I'll let you know how it goes.

 

Thank you again,

Dianedeedee

[[Ha...]]

Libertas, you are a marvel of research, it’s so good to know we help each other like this.

 

Diane, hope this strategy help you big time.