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Last November my Dr prescribed Ativan to me due to GAD. I was taking 1mg per day for 6days and 0.5 for 10 days and stopped without typing. Because Dr. Said it's ok. 10 days after I started to take sertraline, Dr. adviced to take Ativan 0.5mg twice per day untill sertraline kicked in. but I only took 0.25 or 0.5mg per day as needed total for 13days in

Dec,  sometimes I took everyday, sometimes 3 or 4 days without taking. In January, I felt sertraline finally kicked in, I didn't take Ativan for 1week. After this week, my anxiety back, I started to take it again.  I still take 0.25mg per day most times. Only two days I took 0.5mg and 0.75mg. but unfortunately 0.25mg is not effective as before. I don't want to increase the dose, but struggling every day for the physical symptoms .After search online, I read so many horrible stories, I am so regret to take this medication in the first place, I want to typing it as soon as possible. but don't know if I can handle the physical symptoms (chest pain and tight, palpitations). Do I need increase dose to stabe my condition then typing or just power through this and typing. I am so scared. Any suggestions will be really appreciate. I am apologizing for my English writing. Thank you everyone!!

 

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It looks like your body is dependent on the Ativan so its time to figure out a plan.  First and foremost, will you have enough Ativan to do a slow taper? 

 

Secondly, now that you know your body is dependent, its important to determine what your daily dose is.  Try to pick a dose that allows you to perform your daily tasks but not feeling great, this is our definition of stable and its important to begin a taper from a position of stability.  Do you know what your daily dose might be?

 

I’ll do a search on the forum about sublingual Ativan, it seems like its been done. 

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Thank you very much for replying. I am currently taking 0.25 mg per day. I think 0.5mg should keep me stable.

How long  should I stay on 0.5mg then start typing? I do have enough Ativan.  I am taking low dose for not long time. Do I still need very slowly typing? Is that ok I reduce 10% per week or it's too fast?

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We typically suggest those who have been on the drug for a short time taper a bit faster but this needs to depend on your symptoms.  If they’re unmanageable then it might be wise to taper a bit slower, its all about finding what works for you and unfortunately that requires experimentation on your part.

 

If you feel .5 mg will get you where you need to be then I’d increase and stay there for about a week.  What size are your pills and how many times a day do you dose?  Many of our Ativan users will dose up to 3 times a day to avoid interdose withdrawal, have you experienced that yet?

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Re: your question about using the sublingual formulation of lorazepam to make a do-it-yourself liquid …

 

As Pamster has wisely observed, the only way to know if this will work for you is via experimentation.

 

If you do decide to try this, please be aware that you may experience differences in onset of action, time to peak plasma, effectiveness, etc. The sublingual lorazepam formulation is designed to be rapidly and directly absorbed into the bloodstream.  When lorazepam is taken orally (i.e. swallowed), it must pass through the gastrointestinal system and then the liver before it enters the bloodstream.

 

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Thank you Pamster

Really appreciate your help. My Ativan tablets are very tiny blue one. So it very hard for dry cut,

So I want to use water titration. But I heard some people said when they used water titration, the effective of the drug is not good as tablets.  I only take one time per day.  I may experience some interdose withdrawal, I am not sure.

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Is switching from the sublingual formulation to a regular tablet an option?  Your prescriber might need to increase your dose plus you might need to dose multiple times a day.

 

Is a commercially manufactured oral solution of lorazepam available in your country? 

 

Is a professionally compounded liquid an option?

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I am in Canada, no liquid ativan. Regarding the oral tablets, the absorption may different with sublingual. I will ask my doctor. But he doesn't believe slow typing. Thank you!

 

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That’s unfortunate that a commercial lorazepam liquid is not available in your country.  Yes, the pharmacokinetics (e.g. absorption, metabolism) of the sublingual lorazepam formulation may indeed be different than those of regular tablets.  This is why I suggested you may need a different dose or dosing schedule if you switch dosage forms.

 

If you find yourself in need of a different prescriber, one of our other Canadian members recently posted about RAAM clinics at:

 

http://www.benzobuddies.org/forum/index.php?topic=275250.msg3436239#msg3436239

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Hi, Pamster and Libertas

  you two have been very supportive - I appreciate it so much.I think recently my symptoms getting worse due to interdose withdrawal. Since yesterday I started to take twice 0.25mg Ativan(morning and evening) but still not effective as before I only took 0.25mg or 0.5mg by once per day. today I am going to take 3 times 0.25mg. I have already taken morning and afternoon doses, but still not feeling well.  I am so scared that I am also getting tolenenc as well. Normally how long does it take to stablelize? Do I need to switch to another long half life drug which I really don't want to. All of this make me really panic. Thank you!  Also I went to ER of mental hospital another day, the Psychiatrist didn't believe all my symptoms was caused by Ativan interdose withdrawal. It's so desperate to feel hopness.  Sorry for my English

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Your English is just fine, no worries, okay?

 

It’s very common to encounter those in the medical profession who don’t acknowledge our situation, try not to take it personally or be discouraged, this is why we’re here.  Most will use their doctors as prescribers only, they get the medication from the doctor but they taper on their own.

 

We have many members tapering directly from Ativan but some have had to make the cross to Valium or Clonazepam.  it’s challenging to cross to another benzo but interdose withdrawal makes it just too difficult to taper.  I’d give the 3 times a day dosing a few days to see if you can level out before giving up.

 

Our of curiosity, do you have a doctor who would be willing to cross you to a longer acting benzo?

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Thank you for your reply. I have a  Psychiatrist, but I need to wait 3 weeks to see him. He doesn't believe typing. I don't know if he is willing to change the drug. Even he does, I don't know if he can give good cross typing schedule.He told me as soon as I felt better, I can stop right way. I have already increased my dose from 0.25mg once per day to 3 times per day. but didn't feel much  effective.  The tolerance is mean I need to increase dose again? If I do need to increase,  Do I risk kindling?  I have learned so many from the forum. By the way , which drug you will recommend? Thank!
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If your doctor doesn’t think tapering is necessary then I doubt he’ll be willing to cross you over to a longer acting benzo like Valium/Diazepam or Klonopin/Clonazepam.

 

How bad are your symptoms, are you functional, are you able to perform your daily tasks? This is our definition of stable, it doesn’t mean feeling good, it means functional.  The reason I ask is because you may be at the point we say you’re stable enough to begin your taper.  You may not be stable but I thought I’d mention it.

 

It concerns me you’re increasing your dose, will your doctor keep filling your prescription if you’re taking more than he instructed?

 

I’m not worried about kindling, it applies to those who have completely ceased benzo’s then start taking them again.

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Hi, Pamster

Thank you for your reply. The past week my symptoms is bad, couldn't sleep, constantly had palpitations and chest pain. Currently I am not working, but still feel pretty tough every day.  The psychiatrist prescribed enough pills for me and asked me to take it 0.5mg twice per day until sertraline kicked in and I can stop without typing. He told me not to worry about dependence because the low dose and short period using and I believed him(biggest mistake in my life).  I only take 0.25mg -0.5mg per day.( During past 2 months, I didn't take every day, some time without taking it for 3-7days ).

 

3 weeks ago,  sertraline kicked in, I felt much better, then I stopped taking Ativan for 7 days without any problems. After that I started to feel intense physical symptoms creeping back and I started to take Ativan again. Still 0.25-0.5mg per day. But condition is getting worse. I started to suspect my Ativan using.  I went to ER to see another Psychiatrist, I was told it's nothing to do with Ativan, it's my anxiety.

 

I was so desperate to search answers online, finally I found BB. org and your guys are very kind and knowledgeable . Now I realized I have interdose withdrawal. I changed my dose from 0.25mg or 0.5mg once per day to twice 0.25mg per day Wednesday and yesterday 0.25mg 3 times per day. Last night  I could sleep. This morning I feel a little better. I hope the condition is more stable, then I can start to typering. I feel so bad to dragged my family down and scar unknown future.

 

Regarding the kindling, because I took Ativan so irregular, sometimes without taking for 7or 10, I am afraid which could cause kindling.

 

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It sounds like 0.25mg three times a day may be a good starting point for your taper.  I suggest you hold at that dose and dosing schedule for several days to allow time for blood serum concentration to reach steady state.  According to StatPearls (link below), lorazepam has an elimination half-life of 14±5 hours.  This means it can take from 3 to 5 days to reach steady state.

 

Will your current prescriber support you in stabilizing at this dose and dosing schedule?  Will your prescriber support you in implementing a gradual, symptom-based taper?

 

If not, is working with a RAAM clinic an option?

 

Link:

Lorazepam

https://www.statpearls.com/ArticleLibrary/viewarticle/24422

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Thank you Libertas

  I don't think I will get any support from any Dr here. I just spoke to my family doctor, he told me I don't need typing due to low dose and short term using. He told me take 0.5mg at night every another day for 1-2 weeks, then I can stop. I am so disappointed those drs. I think I have to do it by my own.

My main problem is that the sublingual is so tiny to cut, I don't know if I can switch to oral tablets. I am very sensitive to medication, I afraid the different form may affect the effective.

I have contact RAAM clinic , still waiting them to make appointment

 

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Hi, Libertas and Pamster

I need your help. I am planning when my condition is stable  then I may consider to do the linear typing. I don't know if  it's good idea of not. Because I am taking the sublingual, it's so hard to dry cut. I may do titration schedule when the dose is getting very low.

Thank you!

 

My plan is

Week 1  0.5mg ×2 days.    0.75mg× 5 days

Week 2  0.5mg × 3 days.    0.75mg× 4 days

Week 3.  0.5mg ×4 days.    0.75mg× 3 days

Week 4  0.5mg × 5 days.    0.75mg× 2 days

Week 4  0.5mg × 6 days.    0.75mg× 1 days 

Week 5  I will follow same schedule alternating 0.5mg and 0.25mg until

Reduce to 0.125mg. then take 0.125 mg every other day for 1week, twice for 1week,

, once for 1 week, then jump.

 

 

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We don’t typically recommend alternating doses like you have outlined, its important to keep blood serum levels constant to avoid a whiplash effect of symptoms but I like the fact that you’ve come up with a plan.

 

Have you designed your plan this way because of the difficulty in cutting the pills and what size did you say they were? 

 

If you could do us a favor it would help us help you.  Your signature should contain your medication history and any other pertinent information that is helpful, this way we can see at a glance what your situation is rather than going back through your posts.  Here are the instructions.  Add your history/signature

 

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If you’ll click on this link, it will take you to the instructions.  If you can’t accomplish this, you can put the information here and someone from the team can add it.  Add your history/signature

 

What is the dose size of your pills, .5 mg, .25 mg?

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