Seeking help with lorazepam tolerance withdrawal/med issues

[[ge...]]

Hello everyone,

I am feeling really stressed and confused about my situation and how to proceed.

Basically I’ve been maintaining my lorazepam sublingual dose (3x per day) for 12+ months after beginning too rapid of a taper. I also had another rapid reduction in the winter that set me back. Trying to find my path forward, I ran into some issues along the way…discovered that sublinguals aren’t the best to use for tapering because you can’t get small, accurate cuts. The plan with my doctor has been to slowly switch from the sublinguals to oral tablets so I can slowly cut the dose down….but I have been too afraid to begin it yet.

I am definitely in tolerance, I have little windows and lots of waves, I know my general symptomology and struggles. I’ve been taking the medication for 5 years.

2 weeks ago I refilled both strengths of my medication, and over the last week I started experiencing bouts at night that felt like withdrawal, that intensified each night. The pills felt a little odd (like harder, stale maybe) but the pharm said the expiry was in 2 years. I had my doctor request that I return that supply to the pharm and have them dispense a different lot number (he said that maybe the potency is off). Today I have begun them and I still feel very affected and not sure if it's related to the pills specifically, or intense tolerance withdrawal, or what.

I am wondering if anyone has experienced sensitivities to their medication like these, had batch issues, or anything?

I already know that being in tolerance to the medication can cause a type of withdrawal, and that holding this dose for a prolonged time is not helping my situation. But this week’s symptoms were more like when I did a rapid decrease and got very very sick, rather than my usual- I’ve just been so backwards and unwell this week.

I also feel very nervous to proceed with my doctor’s plan to switch the formula, because of all the issues I’ve got going on I’m scared to add more, but I also know that remaining the same will not help. Is it a good idea to give this a few days to hopefully stabilize and then start the switch?

Also curious if anyone has been through the sublingual to regular switch recently and how the experience was?

Thank you.

[[Br...]]

I'm sorry you're going through such a difficult time.  We do see members report sensitivity to brand changes of their med.  It sounds like that may very well be a piece of what you're experiencing along with reaching tolerance.  Whatever the situation is, if I were in your shoes I would hold at your current daily dose for a couple of weeks to let your system adjust to the new pills.  It's important to take them regularly at the same time each day.  Hopefully you will stabilize at least to the extent that you feel more functional.  And then you can begin to taper again.

Do you think there's a possibility you're experiencing interdose withdrawal? Interdose withdrawal occurs when withdrawal symptoms emerge in between scheduled doses. It often occurs with short acting benzos like Ativan.  If you think it may be a possibility we can talk about ways to address this.

Generally we recommend cuts of no more than 5-10% of your total daily dose every two weeks or so, but it's best to let the severity your symptoms guide your taper. We encourage you to remain flexible and hold longer  or make smaller cuts if your symptoms are rough.  This helps you manage your withdrawal symptoms so you're able to function as well as possible. I know this is a challenging process but we will support you.  You're going to get through this.

[[ge...]]

Hi @[Br...] thank you for your reply.
I think I may have been unclear in explaining my situation...I have not yet been able to switch from sublingual to oral. I have been taking the sublinguals all along, and through some attempts to taper those and having gone into intense withdrawals, I learned that this is an incompatible pill for slow tapering because you're not supposed to split them up (no accuracy of what dose you get). Recently when I refilled my script, I started getting withdrawals without any change to the dose or forumla/brand. I had it switched yesterday to another batch/lot number of sublinguals, same manufacturer and I am hoping that within a few days I may feel a bit better. 
I don't know for sure that it is an issue with the batch I had...I am hoping so because otherwise my question becomes, can I go into full-on withdrawals even if I continue taking my usual dose? The onset of these issues were within the last 2 weeks of using this new script I filled so I am hoping it was just a bad batch (but that does unlock new fear of this occuring again).
And even if this was a batch issue, maybe a potency issue, I have no way of knowing how much of a lack of dose I had. This increases my fear of making any changes to the meds. I keep trying to get my mind on track to taper off this drug because I know it is ruining my life and I'm suffering so much...however, every single time I've attempted a change recently it seems like my body just goes full on and I'm terrified of experiencing it again. I immediately feel a desperation to reinstate the previous dose, or in this case (since I'm unsure what caused this) even increase the dose- but I know that is also not good. I've also not been able to find others taking lorazepam specifically to relate to the struggles and challenges with coming off this medication. 
I also feel that if I can get my body to stabilize within a few weeks, that I need to really start trying to switch over to the oral version that I can actually taper. Continuing to stay on these sublinguals and maintain the dose indefinitely without a taper plan, and starting it is just hurting me more. It's really painful knowing that I'm not even able to start the taper and I'm already dealing with so much, it feels so daunting and impossible to fathom moving ahead with it!
On the topic of interdose withdrawals...normally while maintaining this dose over the last 6 months, I haven't noticed too much interdose issues. But this past week with the sudden onset of symptoms, I definitely felt it, however it was so bad overall that even taking the dose wasn't helping. Overall, I'm hoping that things will improve with this new batch of pills and that I can continue on doing things extremely slowly and gradually.

Thank you so much for getting back to me. If you have any more insights based on my clarifications, I would so appreciate it.

[[Br...]]

I'm going to ask a team member with more tapering expertise than I have to step it.  Hang on - we'll get some answers for you.

[[Br...]]

Hi geminidivine - sorry it's taking a while - the team has been very busy working out bugs as we get the new site up and running.  I haven't forgotten about you, just want to get you some good input.

[[Pa...]]

Hi geminidivine, I don't have taper experience but I feel you would benefit from starting a thread on the Withdrawal & Recovery Support - BenzoBuddies Community Forum with your question about sublingual's or whatever your biggest concern is in the subject title.  There is more traffic there and hopefully you'll connect with someone who has faced your issue. 

I do know some members who have tapered using sublingual, they'll typically crush then weigh them to achieve uniformity but switching to oral tablets is common too, especially if you can get the lower dose tablets so you can continue to cut them longer. 

I hope the new batch will get you back on track but that still leaves you with a big task, beginning a taper you're petrified to embark on, I don't blame you a bit.  I agree with Brighterday that getting stable is your number one priority right now, I hope you can without having to go up in dose.