Need help with elderly mother!

[[be...]]

My mother is 80 years old.  She's been taking benzos for 30+ years.  For many years it was Xanax.  While in FL she go so bad she almost died.  Couldn't walk, eat, do anything for herself.  She went through "detox" for 4 days in a hospital, then discharged to a rehab facility for physical rehab to be able to take care of herself again.  But obviously just the 4 days didn't work with respect to the benzo dependence, although it helped a little and she recovered enough strength to take care of herself again and function daily.  She did nothing else to address her benzo dependence and no counseling (CBT, EDMR, etc).  So while still struggling with withdrawal, she moved back home to Kentucky.  She went to a psychiatrist in KY with her symptoms and he prescribed Lorazapan (claiming he knew nothing of her history).  She was good, and happy for a period of time, because her body was getting the drug it wanted, but quickly gained tolerance and things went downhill.  By the way, all along she's been prescribed a smorgasbord of meds along with xanax/lorazapam (some other benzos and SSRIs and more).  She got to a breaking point again.  At this time she was taking 3mg of Lorazapam a day.  Dr tried to wean her off it, but did it too quickly (1/2 pill a week) and she couldn't take it/survive.  So Dr put her on Loreev XR (extended release version of Lorazapam), which is what she's still on today.  Still at breaking point and with suicidal ideations, she decided she can't continue to live like this and wanted to do something about it.  Tried to put her through a detox unit again in KY, but Dr there said because of her age and the duration she's been on it, they wouldn't accept her there saying it was too dangerous for her, and recommended going back to psychiatrist, getting back on Lorazapam, and doing a taper.  This was the first we even heard this was an option/possibility.  Her psychiatrist has been completely unhelpful (didn't know of any detox, rehab facilities that can help, or what else to do with her except pump more meds in her).  So now were exploring tapering options.  We haven't found any psychiatrists around her that even know about tapering for benzos, so we're left to do this on our own.  I found the Ashton Manual, schedule 8 (Lorazepam 3mg daily with diazepam subgstitution).  Should we just do that?  We just don't know where to go or what to do for sure. 

[[Co...]]

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

That's a distressing story. I am so sorry to hear what you mother has gone and is going through.

Please clarify: when your mother almost died, was this due to the detox, or was this before then, due to her use of benzodiazepines? Can you be a little more specific about what occurred so that we better understand.

Usually, doctors suggest that after extended use and at an advanced age, it is better to stay on benzodiazepines rather than attempting to withdraw. What precipitated the withdrawal/detox? And who suggested that she go to a detox facility? I am not sure if I've ever heard of someone of that age going through a benzodiazepine detox.

Going forward, it is vital that you do this with an engaged doctor on board. Yes, we can help you with devising a plan, and Ashton's tables are solid. But extra caution should be employed for someone of your mother's age. And if she does taper off, she might well need to do this more slowly than what's outlined in the Ashton schedule.

It is concerning to me that your mother is already experiencing withdrawal effects due to tolerance. This does bode well for a withdrawal (particularly, again, because of her age). There is one other possibility: your mother suffers from paradoxical effects. Reinstating benzodiazepines can be tricky. Sometimes, the patient finds they cannot stabilise at any dose and never feel as well as they did the first time (or the previous time) round.

If your mother feels worse a short time after her dose (an hour two, say), this is highly suggestive of paradoxical effects. Whereas, if she experiences relief in a similar timeframe, this is highly suggestive of more straightforward dependency and perhaps tolerance.

Again, it is vital that a doctor is involved in your mother's treatment and possible withdrawal (taper).

[[be...]]

She almost died due to her use of Xanax (and the withdrawal symptoms).  This happened before going to detox.  She built up such a tolerance over such a long time that even with a higher dosage, it was no longer working and she stopped eating, lost a lot of weight and strength, constant tremors, couldn't sit still, brain fog, confusion, and many more.  Got to the point she was bed bound.  Had to be helped up and mostly carried to bathroom.  Needed help wiping.  She was taken to hospital and then went through detox (only about 4 days). 

What precipitated the withdrawal/detox?  See above.  Xanax was no longer working.  Health deteriorated resulting in emergency room trip.  Admitted to hospital, then detox.  Then to physical rehab facility. 

BTW, she's currently on 1mg of Loreev XR (the lowest dosage).

[[Li...]]

Welcome to BenzoBuddies, @[be...]. Your mother’s situation is heart-breaking but she is indeed fortunate to have a loving and supportive son like you.

When you have time, would you please provide us with a list of the other medications your mother is taking?  It’s possible some of the ill-effects she’s experiencing may be due to drug interactions or adverse reactions to one (or more) of her other medications.

For example, per the FDA Drug Label for Loreev XR:

Quote

Concomitant Use with UDP-glucuronosyltransferase (UGT) Inhibitors

If an UGT inhibitor is initiated during treatment with LOREEV XR, discontinue LOREEV XR and switch to lorazepam tablets to reduce the dosage [see Dosage and Administration (2.4), Drug Interactions (7)].

LOREEV XR- lorazepam capsule, extended release
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=227734c1-bf01-9607-73ea-5a1f38a89bd9

FYI regarding the Ashton Method … in the interest of you and your mother being as informed as possible, you should be aware that many doctors in the US are reluctant to prescribe diazepam/Valium in general and especially to older adults — diazepam is a no-no per the American Geriatrics Society Beers Criteria.

Speaking of doctors, I checked the Benzodiazepine Information Coalition (BIC) database of ‘benzo cooperative’ prescribers.  There is one who is physically located in Kentucky (the other is a telehealth company based in California that sounds a tad sketchy to me).  Please note that the doctors on this list have indicated a willingness to help patients slowly taper off their benzodiazepine; however they are not necessarily experts in benzodiazepine withdrawal.  Per BIC: “They may suggest tapering too quickly, or adding unproven medications, and other treatments, so it’s important to understand what a safe taper involves and be ready to discuss it with them.”  Here’s the link:

Benzodiazepine Cooperative Providers
https://www.benzoinfo.com/doctors/#kentucky

 

[[An...]]

@[be...] said>>>>

Quote

 I found the Ashton Manual, schedule 8 (Lorazepam 3mg daily with diazepam subgstitution).  Should we just do that?  We just don't know where to go or what to do for sure. 

This was my 1st thought after reading your post. I agree that at your mother's age, detox must be approached very carefully while being monitored by a doctor (PCP and not a PDOC). What other meds is she on? Does she have other health conditions that might make benzo detox dangerous? I would definitely consider the valium substitution. It also sounds to me like she will need to find another prescriber which might be difficult at her age. If she was not tolerant and sick from the ativan, I would probably suggest just staying on for life at her age.