Long-acting benzo to taper off short-acting benzo

[[bl...]]

Hi, I was told recently that it's almost impossible to taper off Ativan because it's a short acting benzo and to ask my doctor to switch me to a long-acting benzo like Valium. I've been using Ativan for 5 years for sleep so I'm wondering if this would work or create another dependency? I've tried Seroquel for tapering after being told I couldn't become dependent on it but I did and it took me two months to get off of it.

Have some of you used Valium to taper off Ativan or another short-acting benzo and did it work? Thanks! 

[[pi...]]

Hello @[bl...]

Many people are able to do a direct taper from Ativan. Yes, it is short acting, that was my first benzo. I was put on it for a supposed middle ear issue. I did feel a lot of inter dose symptoms while on it. After a long a convoluted journey I did end up on Valium for my taper, it did work for me. 

If you choose to cross over you are not necessary creating a new dependency. The crossover should be done gradually to allow the body to adjust and then a slow taper can be implemented.

Seroquel is not a good choice for tapering benzos. It’s an entire different type of drug. 

I would suggest you start a thread on the Taper Strategy forum. Members can share their direct taper and crossover experience with you. This is doable and we’ll be happy to guide and help you.

[[or...]]

@[bl...] I crossed over to Valium from Ativan as the interdose wds were making me very agitated and anxious. No way could I have tapered it successfully. I followed Professor Ashton's crossover protocol and her withdrawal schedule for tapering valium. It worked out quite quite well. The Ashton Manual is here:

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

Look for Schedule 2.

This might be good info for you. It was  for me.

  

[[bl...]]

Thank you pianogirl and oregonkatz. I have trouble tapering off Ativan because if I lower my dosage, I can't sleep so I go back up to my regular dosage. Does Valium replace Ativan for sleep?

I ask this because I know some people take benzos during the day for anxiety and not for sleep. That's why I was told to take Seroquel because it makes you sleepy. It does, initially until you have to increase the dosage after 2 weeks. Then at the 50mg dosage, I felt like an old woman mentally and physically.

Thanks for the link oregonkatz. :-)

[[An...]]

Hello @[bl...], welcome to BB.

I agree with @[or...] wrote to you.

Many ppl find the short-acting, high potency benzos like Xanax and Ativan almost impossible to direct taper from.

How much ativan are you currently on?

[[bl...]]

Hi AntiBenzo7. 

I'm on 2mg of Ativan. None of the doctors I saw ever told me to switch to a long-acting benzo. But then again, I was told so many different things over the years.

[[or...]]

@[bl...] I was on 1.5 mgs of Ativan and crossed (slowly as per Ashton) to 15 mgs of valium. Eventually, after trial and error, I  took my valium in 2 doses -- one in the am am and one pm. I did this so the evening dose would help me sleep, which it did. You might well end up doing something similar. Just fyi, valium is very sedating . . .another reason I split up my dose. I had/still have to work, and I found myself pretty dozey in the daytime. Some ppl divide their doses unevenly and take the bigger part at night. If you decide to do a switch, you'll just see how it goes. By the way, is your doc/drug prescriber on board with you switching benzos? You say none of your docs ever suggested this. Neither did my drug prescriber, but I showed her the Ashton Manual and was firm about wanting to switch. As well, I was having such a miserable time on Ativan that she admitted that a switch made sense. Best to you. 

Edited May 23 by [or...]

[[El...]]

@[bl...] I also am on Ativan. After an initial very rocky start, I am down from 3 mg to 0.55 mg. I dose 3/day with 3 equal doses. So far, no interdose withdrawal. I am hoping to successfully complete my taper without switching to another benzo. “Better the devil I know” mentality. I do periodically suffer from insomnia. It seems to come in waves when I only get about 2-3 hours of very interrupted sleep lasting for about a week. Then I go back up to 6 hours per night for a couple of weeks. I find that when I am in a wave, I do better if I just get up and read or watch a mindless movie, rather than tossing and turning and worrying about not sleeping. I also remind myself that biologically our body has to sleep. We cannot survive without it. So, at some point, I will sleep. I just have to be patient, remind myself that this is part and parcel of the withdrawal process and I will get back to a regular sleep rhythm.

[[je...]]

6 hours ago, [[b...] said:

I have trouble tapering off Ativan because if I lower my dosage, I can't sleep so I go back up to my regular dosage. Does Valium replace Ativan for sleep?

Hi @[bl...]. I’m sorry you’re having trouble with taper. Please just know that no benzo is going to solve your insomnia. Whichever one you choose to taper from you are very likely to still struggle with insomnia as you cut. 

[[re...]]

Ativan is from the bowels of hell. Do everything you can to taper of off a longer acting medicine. Even Klonopin is possible. It doesn't always gotta be Valium. 

[[or...]]

@[bl...] I sure hear you about insomnia. Many of us struggled with it on and after our tapers. But if you start a thread asking for non-prescription insomnia-fighting  "ideas" I bet you'll get plenty! I've probably tried them all . . . and some of them even work/worked! 

[[Cr...]]

@[bl...] my sister did a direct taper off of ativan due to her doctor not wanting to switch her to valium believing it to be addictive (go figure).

It was hard but she managed to do it even with her heart problems (Severe Long QT).

If you can crossover to Valium (1mg of Ativan = 10mg Valium) then that may help you out. I have never been on Valium but some people say it is more sedating than other benzos but also more likely to cause depression. But that is just anecdotal. There is a small chance your body may not react well to Valium but overall it is seen as the best route as per Ashton Manual.

[[bl...]]

58 minutes ago, [[o...] said:

@[bl...] I sure hear you about insomnia. Many of us struggled with it on and after our tapers. But if you start a thread asking for non-prescription insomnia-fighting  "ideas" I bet you'll get plenty! I've probably tried them all . . . and some of them even work/worked! 

oregonkatz, can you please tell me which natural supplements/therapies you used for insomnia that worked? Thanks. 

[[Hu...]]

Tapering ativan is not difficult if you have enough doses per day (min 3) and not have a lot of tolerance. For people who use it for a short time there may be no problem to taper easily.

If tolerance and not enough doses per day... forget it. It will feel like a rollercoaster of daily withdrawal. And in the Ashton manual that is almost exactly what Dr. Ashton wrote. She was not a fan of Ativan for benzo withdrawal for this reason. 

Quote

(2) Switching to a long-acting benzodiazepine. With relatively short-acting benzodiazepines such as alprazolam (Xanax) and lorazepam (Ativan) (Table 1, Chapter I), it is not possible to achieve a smooth decline in blood and tissue concentrations. These drugs are eliminated fairly rapidly with the result that concentrations fluctuate with peaks and troughs between each dose. It is necessary to take the tablets several times a day and many people experience a "mini-withdrawal", sometimes a craving, between each dose.

 

Edited May 23 by [Hu...]

[[bl...]]

Hugodrax, how can I take several doses per day if I take all the Ativan before bedtime? Should I start taking three doses instead of just one? Will it still work for sleep?

[[Hu...]]

18 minutes ago, [[b...] said:

Hugodrax, how can I take several doses per day if I take all the Ativan before bedtime? Should I start taking three doses instead of just one? Will it still work for sleep?

Just splitting your doses will not work because your baseline for relief or sleep is now 2mg. 

What you could do is cut your dose a bit and move that particular part to a daytime dose. And end up with 3x0.66 mg. That however will take a long time.

Might be better to just crossover to diazepam. Somebody here said that even clonazepam would be better than lorazepam. In terms of duration of action yes, but those small tablets create a problem with weighing doses. If diazepam is not an option, it could be still better than lorazepam.

But that is what I had in mind, maybe others have better ideas?

Edited May 24 by [Hu...]