Advice needed for Lora taper

[[Ma...]]

Hi @[El...],

nice to hear from you again! 
Listening to my body, I think that’s one of the things I really have to learn. Today I think: another microcut for the next 5 days is possible. But: I don’t know what ‘lag time’ each cut has. I guess I’m a bit slow in reacting to each normal cut (looking back at my taperingprocess since Feb 1st).

I hear people getting symptoms at day 4 and getting better around day 12. Well, I’m getting symptoms at day 6 and only get better after 3-4 weeks. Not in the ‘expected range’ with a short acting benzo like Lora?

Anyway. Thanks for sharing your experience! Going to decide if I’m going to do 1 more microcut next 5 days of choosing to hold for 3 more days. 

Will keep updating!

[[Dr...]]

On 15/05/2024 at 19:38, [[E...] said:

I am so glad your microtaper seems to be working!

It has been my experience that, yes, your body needs a period to “catch up” from a cumulative series of cuts. This would suggest, that after 20 days of microtapering and the recent increase in your symptoms, that your body is telling you that it does need to “catch up”. The problem you are facing, and one which we all face, is that we are both the chief investigator and the subject of this experiment, which is tapering. I am not in your place. But, I have found that I must schedule in regular holds, even if I am feeling well. For me, it only takes one day to go from feeling “OK” to feeling “rotten”. When I last replied to your thread, I was scheduling regular holds of 3 days after every 5 days of tapering. I have now been able to extend it to holding for 3 days after every 10 days of tapering. That is what is working for me NOW. I might be able to extend it to 12 days, or I might need to go back to holding every 5 or 6 or 7 or 8 days. I just have to listen to my body very closely and not gaze too keenly into the future (lest I become depressed about the length of the taper). For me, I think getting off this medication in “relative comfort “ is more important that getting off it 3-6 months earlier that I had hoped and planned.

Best wishes to you!

Hi Ellie, hi Marly, 

I hope it's okay for me to 'jump' into this thread with a short question of my own? 

Ellie, when you mention you taper for 5 days or 10 days and then hold, does that mean you reduce the amount of medication each day for 5 or 10 days and then hold? Maybe a silly question, but I just wanted to understand it correctly. 

I'm also tapering Lora and I'm a fellow Dutchie, Marly. 

Hope all works out with the micro taper and you are getting more and more of the good days! 

 

[[El...]]

@[Dr...] Yes, I currently make small cuts for 10 days consecutively, then hold for 3 days. For example, I recently did 0.25%-0.30% cuts consecutively for 10 days (always calculating from the preceding dose) to reduce from 0.5858 mg to 0.5685 mg, which is about 3% overall. I am on the third day of my hold. Tomorrow I will cut to 0.5669 mg (a 0.28% reduction). For me, if I had done the entire 3% at once, I would probably have had to hold for at least 2 weeks to regain functionality. Using small daily cuts I am able to reduce at least 6% every 4 weeks (which was my goal), accomplish all my daily tasks, as well as walk or swim everyday. It has been a real life-saver for me. I have also found that if I dose 3/day and keep my doses fairly uniform, I do not suffer from interdose withdrawal. I did try to eliminate my afternoon dose, but the 12 hour gap between doses seemed too long for me (although it probably works for benzos with a longer half-life). Do note, that I still have some pretty bad days, but overall I can continue to make progress and generally feel “quite” well.

[[Dr...]]

9 hours ago, [[E...] said:

@[Dr...] Yes, I currently make small cuts for 10 days consecutively, then hold for 3 days. For example, I recently did 0.25%-0.30% cuts consecutively for 10 days (always calculating from the preceding dose) to reduce from 0.5858 mg to 0.5685 mg, which is about 3% overall. I am on the third day of my hold. Tomorrow I will cut to 0.5669 mg (a 0.28% reduction). For me, if I had done the entire 3% at once, I would probably have had to hold for at least 2 weeks to regain functionality. Using small daily cuts I am able to reduce at least 6% every 4 weeks (which was my goal), accomplish all my daily tasks, as well as walk or swim everyday. It has been a real life-saver for me. I have also found that if I dose 3/day and keep my doses fairly uniform, I do not suffer from interdose withdrawal. I did try to eliminate my afternoon dose, but the 12 hour gap between doses seemed too long for me (although it probably works for benzos with a longer half-life). Do note, that I still have some pretty bad days, but overall I can continue to make progress and generally feel “quite” well.

That's very helpful to know, Ellie! Thanks for sharing. How do you make these cuts, if I may ask? I am using tapering strips and taper per dose, which went okay till halfway through recently. I stabilised for 2 weeks, started tapering again last Monday and am still trying to find the balance again. 

[[El...]]

@[Dr...] I am very unclear as to how tapering strips work, but I can tell you what I do. I am prescribed 0.5 mg Ativan pills. Each time I refill my prescription, I find the average weight of 10 pills. I then use that weight to figure how much I need to weigh out for each of my three doses. This morning I weighed out 0.0227 grams for my afternoon dose, 0.0228 grams for my evening dose and 0.0227 grams for tomorrow's early morning dose. I use a pill splitter, a razor blade and a metal nail file to cut and shave the pills to the correct weight. When calculated, using the average weight of my pills, this translates to 0.5669 mg of active ingredient (a 0.28% reduction). Since I seem to be very sensitive to very small variations in dose weights, I did purchase a 0.0001 gram scale (from eBay) that has a +/-0.0001 gram accuracy and repeatability. (For others out there reading this post, I am not advocating for the purchase of such a scale. I recognize that, for some, attempting this accuracy may seem like overkill and stress-inducing, but it seems to work better for me.)

I started this method in September 2023 after a period of great instability and fairly debilitating withdrawal symptoms. I had tried both a less accurate scale and a “home-brewed “ liquid titration. My insurance does not cover a liquid formation from a pharmacy, so I needed to find some method that would work for me. After an initial few weeks of holding, I became quite stable and was able to resume normal everyday activities and exercise. I think the combination of microtapering, a greater degree of accuracy in doses, and having 3 fairly equal and evenly spaced out doses (to prevent peaks and valleys in my blood serum levels) made a huge difference for me. Again, I still experience some uncomfortable days, but overall I am doing so much better.  And again, this works for me.  We are all different and a "one size fits all" tapering strategy is probably impossible.

Hope this answers your questions. And I hope you are feeling well today!

 

Edited May 18 by [El...]
Correction

[[Dr...]]

14 hours ago, [[E...] said:

@[Dr...] I am very unclear as to how tapering strips work, but I can tell you what I do. I am prescribed 0.5 mg Ativan pills. Each time I refill my prescription, I find the average weight of 10 pills. I then use that weight to figure how much I need to weigh out for each of my three doses. This morning I weighed out 0.0227 grams for my afternoon dose, 0.0228 grams for my evening dose and 0.0227 grams for tomorrow's early morning dose. I use a pill splitter, a razor blade and a metal nail file to cut and shave the pills to the correct weight. When calculated, using the average weight of my pills, this translates to 0.5669 mg of active ingredient (a 0.28% reduction). Since I seem to be very sensitive to very small variations in dose weights, I did purchase a 0.0001 gram scale (from eBay) that has a +/-0.0001 gram accuracy and repeatability. (For others out there reading this post, I am not advocating for the purchase of such a scale. I recognize that, for some, attempting this accuracy may seem like overkill and stress-inducing, but it seems to work better for me.)

I started this method in September 2023 after a period of great instability and fairly debilitating withdrawal symptoms. I had tried both a less accurate scale and a “home-brewed “ liquid titration. My insurance does not cover a liquid formation from a pharmacy, so I needed to find some method that would work for me. After an initial few weeks of holding, I became quite stable and was able to resume normal everyday activities and exercise. I think the combination of microtapering, a greater degree of accuracy in doses, and having 3 fairly equal and evenly spaced out doses (to prevent peaks and valleys in my blood serum levels) made a huge difference for me. Again, I still experience some uncomfortable days, but overall I am doing so much better.  And again, this works for me.  We are all different and a "one size fits all" tapering strategy is probably impossible.

Hope this answers your questions. And I hope you are feeling well today!

Thanks for sharing your experiences @[El...]. That's very insightful. I had a couple of rough days but started feeling better again yesterday evening. True, we are all different and I don't think I've really experienced interdosis withdrawal although I sometimes thought I did as some symptoms would get worse in the afternoon. But looking back, that also happened when I hadn't even started tapering yet and I've also had many days where my symptoms would be worse in the morning and better in the afternoon and evening. So, not really a pattern there. I was considering switching to Diazepam for the last dose, but am now not sure again. It all depends on how the next steps and then the jump from my morning dose will go. 

Thanks again for sharing and sending you lots of love from Holland 

 

[[Ma...]]

Hi @[El...] and @[Dr...],

I was signed out for some weeks to get a bit of distance, hoping for a little more rest in my mind. I had!

I had two rounds/months of microtapering (0,5% every 5 days, times 4, followed by 10 days of stabilising). That went better then doing a 2% cut and hold. 

2,5 weeks ago I got my Paroxetine from a different compounding pharmacist. Never had issues with that before.

Last 3 weeks I gently crossed over from Lorazepam tablets to compounded liquid.

Since 2/3 days I’m on a slide downhill, so it feels. Feeling worse, more symptoms. Really don’t know why. Feels a bit different than prior ‘waves’. It scares me (thinking back to march ‘23 when I crashed due to tapering Paroxetine… symptoms kept getting worse an no one believed me). I’m over-analyzing what could be the cause of this, but I have no clue.

Maybe someone has a smart idea? Or just comforting words? 

I’m currently on day 3 of my next round of microtaper (it doesn’t feel like this step is the cause of my worsening). Should I postpone the next few steps ‘till I feel betted? 

 

 

[[El...]]

@[Ma...] You are making such good progress during your first rounds of microtapering!

I guess I would like to know how you felt during your transition to the liquid.  Did you hold your dose constant during that time?  Some people have said they do experience difficulties transitioning to a liquid formulation.  If you did feel stable during the transition and you are now feeling symptoms on day 3, I would probably hold for a period of time until you feel better.  There is no set number of steps in your microtaper.  Rather, it each day evaluating your symptoms and making a judgement as to whether you are feeling able to make a cut (even though it may be ever-so-small).  Sometimes I can make 10-12 consecutive daily reductions.  Lately, it has only been 4-5 consecutive days.  My goal is to get off Ativan as painlessly as possible...so I always evaluate my symptoms each day and make a determination whether or not I should reduce and, if so, whether I should go forward with the percentage cut I planned or reduce that percentage for that day.  So, I guess my advice is that if you feeling something, you should probably listen.  There is really no reason to rush!