Experience switching to longer half-life benzo for long taper

[[Ob...]]

Hello,

I am very interested to hear your experience with switching from a short half-life to a long half-life benzo for tapering.  What method/schedule was used to switch from the one benzo to the other?  And what were your withdrawal symptoms throughout (either during the switch or throughout the switch and withdrawal)?

Thank you, I've included context below as to why I am asking.

 

Current Dose and tapering:
Currently at 3.125mg/day of Ativan (3x/day, 1.25mg dose midday, 1mg morning and night), dry cutting 0.125mg every 2 weeks (holding, if needed)
Total 5 years daily at 2mg/day (1mg, 2x/day). In Nov 2023, upped to 3.5mg/day at the start of the current medical crisis.  In Jan 2024, advised by psych to cut by 0.25mg every 3-4 weeks to taper off Ativan.  Cut to 3.25mg was fine but cutting to 3mg caused a massive headache and went back to 3.25mg.
Tried daily water taper, 0.01mg cut daily but the method was causing heartburn so switched back to dry cutting.
 

Context:

I'm the caregiver for my wife who is currently tapering Ativan.  Before learning it was the Ativan causing her issues she struggled with dysphagia, GI issues, tingling sensations, and ringing in the ear, also had adverse reactions to any medicine given to try to treat her symptoms.  Once tests ruled out GI and neurological disorders, and that nothing is inhibiting her from being able to swallow solid foods, it was clear it was the Ativan and she was going through tolerance withdrawal.  Since January when we learned it was the Ativan, we've been trying to educate ourselves about tolerance withdrawal and everything else with getting off this type of medicine, because the doctors and psychiatrists never educated us.  Through her current taper, she thinks she's experiencing interdose withdrawal and considering switching to a longer half-life benzo, which brings me to why I am posing this question to the forum.

Any comments or information are truly appreciated.

Thank you.

 

[[Hu...]]

It is good that you take action now. 

Ativan is notorious for causing a rollercoaster of interdose withdrawal. 5 years is a long time. 

Have you read the Ashton manual? It probably has all the answers you are looking for. 

https://www.benzoinfo.com/ashtonmanual/

 

[[Ob...]]

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

It is good that you take action now. 

Ativan is notorious for causing a rollercoaster of interdose withdrawal. 5 years is a long time. 

Have you read the Ashton manual? It probably has all the answers you are looking for. 

https://www.benzoinfo.com/ashtonmanual/

Thank you.  I have read the Ashton manual, but while I'm on board with its method, it's ultimately my wife's decision what she wants to do since she is the one going through it.  Considering her difficulty with other meds, and now with the Ativan, she's apprehensive to try switching.  I made the post in hopes of getting a perspective from those who have gone through it, to see if it's worth bringing up the option of switching to a longer benzo.

[[ns...]]

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

Thank you.  I have read the Ashton manual, but while I'm on board with its method, it's ultimately my wife's decision what she wants to do since she is the one going through it.  Considering her difficulty with other meds, and now with the Ativan, she's apprehensive to try switching.  I made the post in hopes of getting a perspective from those who have gone through it, to see if it's worth bringing up the option of switching to a longer benzo.

Hi obvi, I am tapering Ativan and it has been a roller coaster ride for sure. I'm sorry your going thru this, your wife definitely sounds like she's in withdrawal. 

I was in 4mg per lorazepam, forced off into protracted withdrawal but didn't know for 2.5 yrs I was in withdrawal. 

After 3 yrs went back on by my precious doctor.

They worked for about 3 months, then a paradoxical affect happened and I had to begin taper. You can't really do a liquid, Ativan doesn't really dissolve properly. 

I tried valuim for the 1st 2 mg and it was a nightmare! Clonazepam the same but I cut too fast I think but I can't tolerate any medications. 

Hopefully your wife will be able to switch, many do and have great success some withdrawal is very difficult but everyone is different. 

I'm sure someone will chime in here and assist u and will begin with questions so be prepared for thar ok.

I sincerely hope for a easy transition for your wife and a successful taper.

Take care

Ns

[[Pa...]]

Hi @[Ob...], hopefully those with experience will stop by but I'll tell you what I've observed and I have a few questions.   

First issue is some doctors won't prescribe Valium, and others are hesitant to prescribe more than one benzodiazepine for crossing purposes, is hers willing?

Members have noticed Valium can cause depression and sedation, most will acclimate to the drug but some have to go back to their original, that can take time and will be quite uncomfortable.

You indicated she's using tablets now, how much is she reducing each time and how long between reductions?

Would you be willing to share the details of her water taper, what your method was for preparation and how long she tried it? 

[[Ob...]]

2 hours ago, [[P...] said:

Hi @[Ob...], hopefully those with experience will stop by but I'll tell you what I've observed and I have a few questions.   

First issue is some doctors won't prescribe Valium, and others are hesitant to prescribe more than one benzodiazepine for crossing purposes, is hers willing?

Members have noticed Valium can cause depression and sedation, most will acclimate to the drug but some have to go back to their original, that can take time and will be quite uncomfortable.

You indicated she's using tablets now, how much is she reducing each time and how long between reductions?

Would you be willing to share the details of her water taper, what your method was for preparation and how long she tried it? 

Her psych mentioned switching to Valium, but I think it was more in the sense of tapering down on Ativan and then getting on Valium, which didn't make sense to us - which is why I'm curious about others' experience considering the psych made it sound like no one gives two benzos at once, but then again they didn't know about the Ashton manual, either. 

We have since moved to a psych who presents themself as helping to taper benzos specifically and they proposed tapering 0.25mg every 3-4 weeks.  My wife tried and went from 3.5 to 3.25 without issue, but after 3 weeks when she tapered to 3, she got a massive headache.  She went back to 3.25.  Now she split the cut to 0.125 every two weeks.  She is at 3.125 and will consider cutting next week to 3, if ready.

We tried reducing by 0.01mg daily with the water taper, but only got as far as 3.23 (3 days) until she held there.  She was getting heartburn so we stopped and went to just doing a tiny slice off the pill until she started the current taper she's on.  I had bought ora-blend to try but she didn't feel comfortable trying ora-blend.

 

 

[[Hu...]]

Well, the massive headache sounds like tension headaches. Those are caused by withdrawal, maybe because certain muscles in the neck and around the scalp are contracting a lot. I had the same on ativan. Once I took the pill.... after 2 hours it was good as gone. So there you know it.

Switching to a different benzo can be hard for some. I can only assume from having done a DNA gene test myself that there must be a lot of different people that don't produce the required liver enzymes for metabolizing Diazepam as well, since it is a far more "dirty" or primitive drug than lorazepam.

I've tapered lorazepam quite successfully in the beginning of taking it, the first year. Like you describe, just cutting .25 was hard, but doable. Extra anxiety yes, all the extra depressed feelings. But once you hit tolerance...forget it. Then it's just torturing yourself by cutting the smallest piece of a pill. This is where cross tapers come into play. Helpful, can make life a lot better, but not blissful.

I'm having a hard time with the cross taper as well. My body doesn't like diazepam. 

[[Pa...]]

It sounds like you're running into what others have, doctors not willing to use Valium so unless you can find one, are we looking at trying to make the Ativan work for her?  Many members have found nurse practitioners can be a little more sympathetic so if you're still interested in a cross, you might need to go that route. 

I'm glad she's making smaller reductions, I like that her new doctor is allowing 3-4 weeks but the amount they suggested is awfully large.  One thing members have found is that they have to slow down when they get lower in dose, so I hope she'll pay attention to her symptoms.  Are you documenting her symptoms and their severity, this can be useful when deciding when to reduce again.

What size are her tablets, are you cutting them?

 

 

[[Ob...]]

On 27/02/2024 at 18:42, [[P...] said:

It sounds like you're running into what others have, doctors not willing to use Valium so unless you can find one, are we looking at trying to make the Ativan work for her?  Many members have found nurse practitioners can be a little more sympathetic so if you're still interested in a cross, you might need to go that route. 

I'm glad she's making smaller reductions, I like that her new doctor is allowing 3-4 weeks but the amount they suggested is awfully large.  One thing members have found is that they have to slow down when they get lower in dose, so I hope she'll pay attention to her symptoms.  Are you documenting her symptoms and their severity, this can be useful when deciding when to reduce again.

What size are her tablets, are you cutting them?

They're 1mg tablets that we are cutting.  I liked the idea of the water taper and suspensions that could allow for a more controlled dosing, but since it gave her heartburn we're cutting a small 1mg tablet into 8 pieces.  I suppose I could get a scale with 0.1mg readability, if reasonably priced, to at least get the pill cut as close to 0.125mg.

I'm documenting her symptoms and my observations throughout the day - she's off of work and I'm working remote to care for her so I'm around her all day.  She has been diagnosed with anxiety and ptsd due to past medical crises, so often it's hard to determine which is causing her symptoms, but we try our best and I write down everything. 

I feel there's improvement from the start of tapering at the start of January, likely because there's a more set schedule and she can gauge how she feels compared to previous days (a lot of doubting and anxiety at the start).  I just wanted to see if it's significantly better switching over to longer lasting, because she does feel so bad when she hears that Ativan is one of the worst benzos to come off of - subjective, but sometimes these small comments can get to her which is why I try to do all the research and posing questions to forums in hopes of lowering her doubt and anxiousness.

[[Pa...]]

I've many successful tapers from Ativan but I understand the stories can lead to doubt and fear, this is why its so important to trust the process you've chosen.

Scales are a good way to go, we have many members using them but I've noticed there are two types of people, those who are comfortable with good enough and those who need to be as exact as possible.  Both groups are successful at the method they've chosen, its mostly a matter of finding out which type you are and finding the method that works for you, or her in this case.

You mentioned your wife wasn't comfortable trying PG, we have members who use whole milk, I don't know if that would help with the heartburn but thought I'd mention it.  Is heartburn a common symptom for her, even before this experience?  I've noticed this process attacks us at our weakest point.