Help with tapering low dose lorazepam

[[pp...]]

 

In 2016 or 2017 I had a season where I would wake up at 3am, having slept 4 hours or so and I couldn't get back to sleep. I told my doctor about it and he prescribed me lorazepam. That problem subsided on its own but every once in a while when I went back to the doctor for some other reason I would ask him for a prescription for the days I was having trouble sleeping. With 1 mg I got to sleep well and except for the first part of the morning, the next day I was fine. Years of sporadic use passed, sometimes more regular, let's say the average was between 2 and 3 pills a week depending on the season, and when I ran out of lorazepam, and until the next time I went to the doctor, I had no symptoms of dependence or withdrawal. 

Around May of this year I started to notice some symptoms that at first I did not attribute to lorazepam, as I thought that taking 1mg was like taking a beer, and the most I had ever taken was 2mg in one shot and I had rarely taken it more than 3 days in a row. 

Long story short, between late August and early September I became aware that what I had was a dependence on lorazepam, needing at least 1mg a day to not have withdrawal symptoms, and even then, depending on the day, at 16 or 18 hours I could get, mainly anxiety and at times almost panic, being bothered by noises, crowded places and things like that. 

 

I started reading up on everything and decided to do a taper, going down first to 0.75 mg, which I carried well, and then to 0.50 mg, which was perhaps too fast. The main problem I see is interdose anxiety. Normally I try to take the dose once every 24 hours, but the anxiety is much worse outside the house, so depending on what I have to do I can take the dose before 24 hours, and on other days when I am at home I try to extend it so as not to take more than a dose of 0.5 mg a day. 

I have an appointment with a drug psychiatrist in two weeks, but until then I doubt if I should take two doses of 0.25 every 12 hours, or if I should continue as I am, because I doubt if the 0.25 dose will be effective to avoid anxiety when I have to leave the house, being used to a 0.50 dose. Maybe since I'm going to see the psychiatrist I don't need to lower the dose until then, or sometimes I think I do, that I could take advantage of tapering to 0.45 this week and 0.40 next week while waiting for the psychiatrist's appointment to arrive.

The psychiatrist thing is because he seems to be a reputable drug specialist from where I live, not because I think I have any psychological problem that is causing my anxiety. I started taking it to sleep and now I have developed a dependency that I want to get rid of. 

 

 

[[Co...]]

Hello @[pp...]. Welcome to BenzoBuddies.

Yes, a creeping up of usage, resulting in dependency is very common or even usual from 'as needed' use. I am not convinced there is much utility in splitting your dose into two doses of 0.25mg lorazepam since it seems that you intend to taper off in the shorter term. The smallest dose available is 0.5mg (I assume this what you have) - the best you will probably manage is to quarter those pills into doses of roughly 0.125mg. And since you intend to taper off, starting from two doses of 0.125mg means that you probably will be back to a single dose per day in the fairly near future anyway.

But if you find interdose withdrawal unmanageable, it might still be a good option for you. But you should discuss any changes to your your usage with your doctor.

I am assuming that you intend to continue your taper from 0.5mg per day. If that is not enough, and you intend to reverse a recent cut, try to keep to the minimum required for you function reasonably. When did you reduce your daily dose to 0.75mg; and when did you cut to 0.5mg per day? And what dose do you take now?

It is possible to make other reductions to dose, either by a compounded dose, or perhaps even through home methods of further dividing your dose (though, they can be unreliable).

Your psychiatrist sounds like a good/useful find. Good luck with the appointment; please let us know how it goes.

[[pp...]]

Hello Colin,

Thank you very much for your reply and for the forum, as I can see you are the founder. I started taking notes on September and I can see the first day I lowered the dose to 0.75 (from 1 mg) was September 19. I didn't notice much change. When I took it I felt good and the next day from 16 hours of the last shot I could feel anxiety.

On September 25 I lowered it to 0.5 mg and that's why I've said before that I think it was too fast, less than a week since the last drop and with a 33% dose reduction. Here I did notice more the change negatively, more stronger symptoms and start earlier than average but for now I have endured. I discovered the forum and the Ashton method later. I also doubt if I could go back up to about 0.75 in two shots until I see the doctor. 

And btw I have 1mg pills, not 0.5 ones.

[[Co...]]

If you can manage on 0.5mg/day, there is nothing to be gained by going back up to 0.75mg/day only taper off again.

Be sure to ask about 0.5mg pills when you see the psychiatrist. They will help you manage your taper.

[[pp...]]

 

Today a curious thing happened to me, and it is that when I break the tablet it does not remain homogeneous, always falls a little powder or a tiny piece, and I put almost half of the tablet and what falls wrapped in a silver paper. Today it had been 25 hours since the last intake, I started to feel slightly anxious and when I opened the silver paper the powder and small pieces fell on the floor, so what I have taken will be equivalent to 0.40 or 0.45 mg of lorazepam or so. And I feel well. 

I had decided not to continue lowering the dose until I saw the psychiatrist but because of this accident I think I will take a little less than half the pill. It's not very accurate but I bought a scale and it's not accurate enough. It only measures to 0.01 grams, not 0.001 which would be ideal. I might buy another one. 

 

[[he...]]

35 minutes ago, [[p...] said:

It's not very accurate but I bought a scale and it's not accurate enough. It only measures to 0.01 grams, not 0.001 which would be ideal. I might buy another one. 

It's more accurate than your current method.  It's possible you're just not that sensitive, which means you can probably go faster than a lot of us, but be careful when cutting your dose and make sure you don't cut too much and get yourself in trouble. Wish you all the best, @[pp...]!

[[pp...]]

21 minutes ago, [[h...] said:

It's more accurate than your current method.  It's possible you're just not that sensitive, which means you can probably go faster than a lot of us, but be careful when cutting your dose and make sure you don't cut too much and get yourself in trouble. Wish you all the best, @[pp...]!

Well, I don't think it is more accurate. A 1-milligram tablet weighs 0.08. If I split it in half and put the powder in it, it is 0.04. If I remove the powder it can be 0.04 or 0.03, depending. If 0,04 is 0,5 milligram and 0,03 is 0,375 milligram, it means that in reality when it marks 0,03 it can be weighing between 0,4375 and 0,3125 mg of lorazepam because of the margin of error of the unit of measurement. The only way for it to be closer to 0.43 than the low range is to do it by eye and I don't see it much different than just doing it by eye without using the scale, which is usually going to consist of not using the powder or the tiny bits that fall off when I break it in half. 

[[he...]]

But your scale should be able to measure to .001 g, and even if the tolerance or margin of error is +/- .002, that's still quite a bit more accurate than splitting and eyeballing.

[[pp...]]

On 06/10/2023 at 20:40, [[h...] said:

But your scale should be able to measure to .001 g, and even if the tolerance or margin of error is +/- .002, that's still quite a bit more accurate than splitting and eyeballing.

It just measures to .01g, so it's useless.

After a few days with the 0.5 lorazepam dose there was one night when I met up for a few beers. I haven't usually mixed lorazepam with alcohol, but I had taken the 0.5 of lorazepam at about 10 a.m., so I figured there wouldn't be much interaction. The evening went well, alcohol consumption was not excessive, about 4 beers in 2 and a half to 3 hours but the next day I had a panic attack shortly after waking up. I guess it had something to do with dropping the dose so quickly to 0.5 and hangover anxiety. 

I took 0.5 of lorazepam as soon as I noticed the first symptoms, but after a short while, as I noticed that it was a strong panic, I took another 0.5 and took a cab to a health center near me, where they examined me and everything was normal, so it was a simple panic attack. As that day I had taken a total of 1 mg, the next day just in case I did it too, and from then on I went down to 0.8 approximately, which is the dose I am going to keep until I see the doctor next week.

I will keep you updated with what the doctor says and my progress.

 

[[he...]]

If it were me, I would drink zero alcohol due to the cross tolerance and because alcohol plays with your GABA(a) receptors, which you ideally want to leave alone as much as possible while you're tryin to heal from this. I haven't had more than a sip since I started taking clonazepam, and I don't dare drink any now that I'm off and trying to heal.

You can get a scale that measures .001 g from Amazon for not a lot of money.

Please keep us updated, @[pp...].

[[pp...]]

Hi @hereforhelp, thanks for the reply. I'll try to keep it down to a minimum but I won't avoid it during social events. The other day I was at a dinner party, had a couple of glasses like everyone else and the next day I was fine. It's something that the Ashton manual even mentions, that you can have a glass of wine, or coffee.

I went to the specialist and surprisingly for the idea I had, he ended up prescribing me an antidepressant, escitalopram, which despite the name is also treated for anxiety disorders. 

The plan he proposed to me is to take it for two weeks and maintain a dose of 1 mg of lorazepam daily. After two weeks escitalopram starts to make effect, and then I can lower the dose but doing so with minimal reductions, according to him, is not so important. I could lower it in the faster version to 0.75, 0.50, 0.25 and 0 in 4 weeks, depending on how I am feeling. Minimum one week between downgrades, maximum two. He has also told me not to worry about filing the pills and weighing on scales to get downgrades to 0.9, 0.8 etc. If I see that with the drop to 0.75 I have some symptoms I can take 1 mg one day and the next day 0.75, the next day 1 mg and so on, so that the blood level would be that of the 0.875 dose. 

After asking me about my history, he explained to me that what he believes is that I have an underlying anxiety problem, although it is not due to a specific cause, but more related to my personality and moment in life, and that what will take it away will be the treatment with the antidepressant, which will last 9 months. He says he has treated many people with similar problems with the same treatment and it works very well.

The truth is that he gave me confidence, you can tell he knows what he is talking about.

Whether the treatment works for me or not, I will post updates. 

 

 

[[Co...]]

3 hours ago, [[p...] said:

Whether the treatment works for me or not, I will post updates.

Please do, @[pp...].

[[pp...]]

 

Well, I am going to update, as I recently had the second visit with the psychiatrist. After the first visit I was still experiencing interdose anxiety. It is something that I did not specify with the psychiatrist, and in the end what I did is to go from 1 mg of lorazepam a day to two doses of 0.75 mg every 12 hours, to finally raise it to 1 mg twice a day, for a little anxiety and for convenience because the pills break well. 

He has told me that he thought it was fine but that if I have any brief doubts of that style I don't need to wait for the next visit, I can send a Whatsapp to the clinic to forward it to him, it can be an audio, and he will answer me. 

Long story short, about 5 days ago I started noticing the first positive, mild, symptoms of escitalopram. He has told me not to get obsessed with reducing the lorazepam fast, he has recommended me to wait at least one more week to see how the effects of escitalopram evolve and from there start reducing as I feel comfortable: I can reduce 0,25 every 1 or 2 weeks or 0,50. He says he has had several cases with the same problem as mine taking more than 5 mg of lorazepam daily and when the escitalopram took full effect they were able to taper 0.5 a week without problems and without PAWS. But there is individual variability in this and we will adapt to how it evolves. 

I will continue to report. 

 

[[Co...]]

That sounds pretty positive @[pp...]. And it all sounds very sensible to me.

In all likelihood, you will experience no significant problems when it is time to taper off the lorazepam. And since your psychiatrist seems very flexible in approach, this bides well for you.

Good luck.

[[Ch...]]

Can I ask if Lexapro is a ok to take while tapering. 

[[pp...]]

This week I have noticed a clear improvement, so I am going to start tapering off the lorazepam. I guess I will start this evening cutting from 1 mg to 0.75.

[[pp...]]

So, I've taken two days the lowered 0.75 lorazepam dose in the evening and I am just fine. Escilatopram seems to be working indeed. If I keep like that, next week I'll lower the morning dose to 0.75 also.

[[Co...]]

On 19/11/2023 at 15:01, [[p...] said:

This week I have noticed a clear improvement, so I am going to start tapering off the lorazepam. I guess I will start this evening cutting from 1 mg to 0.75.

On 20/11/2023 at 19:21, [[p...] said:

So, I've taken two days the lowered 0.75 lorazepam dose in the evening and I am just fine. Escilatopram seems to be working indeed. If I keep like that, next week I'll lower the morning dose to 0.75 also.

That's great, @[pp...]. Here's hoping that the rest of your taper goes as smoothly.

[[Co...]]

On 15/11/2023 at 01:28, [[C...] said:

Can I ask if Lexapro is a ok to take while tapering. 

Many members take Lexapro while tapering off benzodiazepines (or z-drugs). If it is your intention to taper off Lexapro at some stage, we generally recommend - in the absence of an overriding medical concern - to taper off one medicine at a time. Whereas if you taper two or medicines at the same time, it can be difficult to determine the cause of any problems you might experience. And in any case, tapering off more than one medicine at a time is very likely to take a greater toll.

And further to the above, some members report that taking antidepressant helps with benzodiazepine withdrawal. Certanly, Prof. Ashton thought that - for some people - it helps to take an antidepressant during withdrawal of benzodiazepines.

From the Ashton Manual - Chapter II:

Quote

(5) Antidepressants. Many people taking benzodiazepines long-term have also been prescribed antidepressant drugs because of developing depression, either during chronic use or during withdrawal. Antidepressant drugs should also be tapered slowly since they too can cause a withdrawal reaction (euphemistically labelled "antidepressant discontinuation reaction" by psychiatrists). If you are taking an antidepressant drug as well as a benzodiazepine it is best to complete the benzodiazepine withdrawal before starting to taper the antidepressant. A list of antidepressant drugs and brief advice on how to taper them is given in Schedule 13 of this chapter. Some antidepressant withdrawal ("discontinuation") symptoms are shown in Chapter III (Table 2).

from the Ashton Manual - Chapter III:

Quote

 

Depression, aggression, obsessions. Depressive symptoms are common both during long-term benzodiazepine use and in withdrawal. It is not surprising that some patients feel depressed considering the amalgam of other psychological and physical symptoms that may assail them. Sometimes the depression becomes severe enough to qualify as a "major depressive disorder", to use the psychiatric term. This disorder includes the risk of suicide and may require treatment with psychotherapy and/or antidepressant drugs.

Severe depression may result from biochemical changes in the brain induced by benzodiazepines. Benzodiazepines are known to decrease the activity of serotonin and norepinephrine (noradrenaline), neurotransmitters believed to be closely involved in depression. Antidepressant drugs including the selective serotonin reuptake inhibitors (SSRIs such as Prozac) are thought to act by increasing the activity of such neurotransmitters.

Depression in withdrawal may become protracted (see section on protracted symptoms) and if it does not lift within a few weeks and is unresponsive to simple reassurance and encouragement, it is worth seeking a medical opinion and possibly taking an antidepressant drug (see section on adjuvant medication). Depression in withdrawal responds to antidepressant drugs in the same way as depressive disorders where benzodiazepines are not involved. If, as in many cases, an antidepressant drug is already being taken along with the benzodiazepine, it is important to continue the antidepressant until after benzodiazepine withdrawal is complete. Withdrawal from the antidepressant can be considered separately at a later stage (See Chapter II, Schedule 13).

 

The point of the above is to not scare anyone here about depression. It is just to demonstrate that using an antidepressant during benzodiazepine withdrawal is generally not contraindicated. And even might be - for some people - beneficial.

[[pp...]]

 

Hello,

Things have been going so well that I forgot to come here to update. 

Everything on schedule, I first made cuts of 0.25 a week (sometimes less, like 5 days) and when I got to 0.5 a day the cut was made directly from 0.5 to 0. No anxiety, no PAWS.

So, when I see people on the forum say they have lowered the daily dose from 0.25 to 0.237 or from 1 mg diazepam to 0.9 and they have terrible symptoms I think there is an underlying condition they are not addressing. Best to consult a professional.

Kind regards

 

[[Co...]]

7 hours ago, [[p...] said:

Hello,

Things have been going so well that I forgot to come here to update. 

Everything on schedule, I first made cuts of 0.25 a week (sometimes less, like 5 days) and when I got to 0.5 a day the cut was made directly from 0.5 to 0. No anxiety, no PAWS.

So, when I see people on the forum say they have lowered the daily dose from 0.25 to 0.237 or from 1 mg diazepam to 0.9 and they have terrible symptoms I think there is an underlying condition they are not addressing. Best to consult a professional.

Kind regards

Well, there might be something to that in some cases. But there is great variability in how individuals respond to benzodiazepine use and withdrawal. Some (and very many around here) develop a very deep dependency and this affects how fast they can taper within tolerable limits.

What is surely true in some cases is that members who suffer from an underlying anxiety condition might feel more fearful of withdrawal than someone who was prescribed benzodiazepines for another reason (as a muscle relaxant, for example). But this does not mean that are tapering off more slowly than what is tolerable for them.

I mostly disagree with you. But where I do agree with you - to some degree - is that some can become too wrapped up in exactitudes of dose which are completely swamped by variables outside of their control (such as the true dose of the pill they are subdividing). I have written about this quite a lot, but some years back another benzodiazepine withdrawal support community promoted (rather, pushed) withdrawal schedules which would subdivide a 2mg diazepam pills into hundredths of a pill. They would promote this as some kind of withdrawal panacea for benzodiazepine and even applied for a patent! Ridiculous stuff.

I would not criticise anyone aiming for exactness in their taper. But such obsessiveness can be counterproductive for others. There is a lot more I could write about this, but I'll stop there - I'm sure many here do not me to go through it all again.

[[pp...]]

5 hours ago, [[C...] said:

 

I mostly disagree with you. But where I do agree with you - to some degree - is that some can become too wrapped up in exactitudes of dose which are completely swamped by variables outside of their control (such as the true dose of the pill they are subdividing). I have written about this quite a lot, but some years back another benzodiazepine withdrawal support community promoted (rather, pushed) withdrawal schedules which would subdivide a 2mg diazepam pills into hundredths of a pill. They would promote this as some kind of withdrawal panacea for benzodiazepine and even applied for a patent! Ridiculous stuff.

I would not criticise anyone aiming for exactness in their taper. 

Well, I think we are goint to agree to disagree then. 

 

You tell me about your experience of the forum and I tell you about my experience and that of my psychiatrist.

Do you know why I made the last cut from 0.5 to 0 directly? Because I was taking two doses of 0.5 and when I lowered the 0.25 in the morning I didn't notice anything when I took it. I doubt it's even an active dose. Where I live the minimum you can buy is 0.5 and doctors hardly prescribe it, with the 1 mg being the starting dose. Same for diazepam, the minimum sold is 2mg. I doubt 1mg is even an active dose. 

So for someone to say they have terrible symptoms when they cut 10% off a non-active dose is like someone saying they have terrible symptoms when they cut 10% off half a shot of whiskey they take a day, or 10% off half a 2mg nicotine chewing gum.

And on the other hand my psychiatrist says that he always prescribes lorazepam tapering at 0.5 mg each cut, as I commented earlier in the thread, every week or two. He has extensive experience and not always the patient has underlying anxiety that requires antidepressant treatment.

The example you give of the other support group would be laughable if it weren't for the seriousness of how bad it is for people who use benzos and try to taper.

 

 

[[Co...]]

1 hour ago, [[p...] said:

The example you give of the other support group would be laughable if it weren't for the seriousness of how bad it is for people who use benzos and try to taper.

As I said, this was for 2mg tablets of Valium, which is one of the least potent benzodiazepines, and with a longer half-life than most other benzos. So these next to impossible to achieve exactitudes in pill division, even if achievable (which they are not, because they swamped by other factors affecting dose outside of our control) cannot even achieve a practical advantage because diazepam's long half-life means that reductions to dose are only reflected in blood levels gradually. Within reasonable limits, tapering from diazepam has in-built smoothing!

To be clear, I am not against pill-division beyond halving and quartering of tablets. And I think you under-estimate how badly others can be effected (where smaller reductions might be truly beneficial). But I do like to keep things in perspective.

* That group (and the patent) even suggested halving the cuts to one part in two-hundred at lower doses. I once calculated how long it would take to withdraw from a fairly moderate doses of diazepam using their patented 'protocols' - five, seven, or ten years!