Ativan / Zoloft

[[Mt...]]

Hello Community, 

Long story short, I am suffering a Zoloft withdrawal / reinstatement at the moment and I am using 1mg of Ativan in the mornings to cope. I've been on for 9 days now and don't plan on extending that out past another couple weeks until the reinstatement kicks in. That said, would I need to taper Ativan after 3-4 weeks of use at 1mg per day? If so, are there any strategies here on a short term use taper? Thank you!

[[Bu...]]

Hello @[Mt...],

Welcome to BenzoBuddies.

Three to four weeks of everyday use is right on the edge of developing dependency for most people.  I think a short taper might be in order in your situation.  The trick here will be to balance getting off safely with not prolonging the taper so much that it causes further dependency.

The details of tapers are not my strength but I am sure that other people will be along shortly to help you set up a good plan.  You can also do a search at the top right of the page for short term use tapers.

I'm glad you found us and we'll do our best to help you with this.

[[Mt...]]

Thank you!! I am coming up on week 2 and don't plan to going past week 3-4... Would need advice on tapering at that point. 

[[Mt...]]

Hello community..

I have been taking Ativan for about 28 days now to deal with AD withdrawal, the first 2 weeks were administered at 1mg per day, then a fast taper, cutting the dose in half every 5 days. I'm currently at 0.125mg (second day). Everytime I drop the dose, I have days of insomnia and hypnic adrenal surges that disrupt sleep, eventually stablizing after the 3rd or 4th day on that dose. 

 

However I am at 0.125mg now and the symptoms of insomnia are worse. Am I tapering too fast? I thought I was being prudent here considering the short amount of time I was on the Ativan but I've seem to develop a depenancy quickly. 

 

Any advice would be appreciated 

[[Al...]]

Just a thought, but the Zoloft reinstatement could also be influencing your symptoms. What symptoms of the AD withdrawal was the Ativan originally prescribed for? Ativan has a short half-life and as you are taking it in the morning, it might not be that effective for insomnia.

[[Mt...]]

I was taking Ativan for anxiety as the sole symptom. I can tell it's the Ativan giving me trouble since tfhe insomnia and withdrawal flares up with each dosage decrease. Those symptoms are buzzing, lightheadedness, agitation feeling. It's a different animal to the AD. The Zoloft reinstatement has helped with the overall anxiety. 

 

I take the Ativan at night. And the symptoms flare up at night 

 

[[Al...]]

Okay, I see. In your original post you mentioned using Ativan in the mornings, so I thought that was still the case. 

As this is only your second day at 0.125 mg, do you think you could handle holding for a bit longer to see if you stabilize?

[[Mt...]]

I think so.. I haven't slept much anyways but the physical sensations have ramped up. Telling me that my body is pretty pissed. The only other option is to go back to 0.25mg let the symptoms subside, then do a slower taper from there. 

[[Al...]]

Yes, you could hold for another couple of days and if the symptoms don't improve go back to 0.25 mg and do a slower taper. Tapering generally gets harder the lower you go so that might be what is happening here. Hopefully some other buddies will chime in with their thoughts as well.

[[Mt...]]

Thanks for your insight. 

[[Mt...]]

Also, are there any resources on this site with instructions on how to taper with low dosages? I.e. Crushing and measuring tablets etc. 

[[Al...]]

To measure really low doses you would need a jeweler's scale, but I'm not sure that's necessary for you as you have only been taking Ativan short term.

@[El...] Would you be able to offer @[Mt...] some advice on a short term Ativan taper? As explained in this thread, they have been taking Ativan for 28 days and are down to 0.125 mg.

[[Mt...]]

Thanks @[Al...]

[[El...]]

@[Mt...] I am sorry you are experiencing difficulties trying to eliminate Ativan. Unfortunately, one of the sad realities of benzo use is, for some, a fairly rapid physical dependence.

It was suggested by @[Al...] that I might help you plan a taper. Although I have been on a benzo (unfortunatey!) for many years, and thus do not have experience with short term use, I would be happy to help in any way I can.

First, though, I would urge you to consider whether you can “push through” on 0.125 mg. That will be dependent on your level of discomfort and, as you mentioned, insomnia. If you can stay at this dose, when stable, you can consider a fairly rapid taper from that dosage. If you wish to move off of Ativan a little less painfully, this taper would probably (but dosen’t have to) entail a few more steps than merely trying to halve your dose to 0.0625 mg in 1 step. If you wish to updose, once stable, it is also possible to have a “fairly” rapid taper. In any case, I would be happy to assist. This would involve using a scale and cutting, and then shaving and weighing pills. Or you could transfer to a liquid formulation that would involve dilution of the liquid to achieve the desired dose. Would your doctor consider prescribing a liquid rather than pills? I know all this may sound overwhelming. I don’t mean it to sound so. I just want you to know what you may be facing so you can decide how you wish to proceed. I am certainly very happy to help you with the asociated mathmatical calculations for either method.

Two things that did come to mind though. One is your method of splitting pills. Since the pills are not scored, it is extremely difficult to accurately cut them in half, much less in quarters, with any precision. If you are not weighing each dose, I would suspect that you doses are shifting fairly erractically in weight.  Secondly, you are only dosing once a day. Ativan has a half life of approximately 12 hours. If you are only dosing every 24 hours, I would suspect you are experiencing peaks and valleys in your blood serum levels which might result in any other physical symptoms you are experiencing.

Please let me know how you wish to proceed and if I can be of any help!

 

[[mo...]]

10 hours ago, [[A...] said:

 

Just a thought, but the Zoloft reinstatement could also be influencing your symptoms.

 

I think this is something to consider. I did a medication switch in January and added Zoloft. Although I had gone on it in the past with no problem, I had a lot of difficulty this time. Dizziness, nausea, EXTREME anxiety, especially upon waking up. It was extensive enough to interfere with my job. I’ve been on many ADs in the past and this was among the most extreme reactions I’ve ever had. Just reiterating that it’s something to consider!

[[Mt...]]

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

@[Mt...] I am sorry you are experiencing difficulties trying to eliminate Ativan. Unfortunately, one of the sad realities of benzo use is, for some, a fairly rapid physical dependence.

It was suggested by @[Al...] that I might help you plan a taper. Although I have been on a benzo (unfortunatey!) for many years, and thus do not have experience with short term use, I would be happy to help in any way I can.

First, though, I would urge you to consider whether you can “push through” on 0.125 mg. That will be dependent on your level of discomfort and, as you mentioned, insomnia. If you can stay at this dose, when stable, you can consider a fairly rapid taper from that dosage. If you wish to move off of Ativan a little less painfully, this taper would probably (but dosen’t have to) entail a few more steps than merely trying to halve your dose to 0.0625 mg in 1 step. If you wish to updose, once stable, it is also possible to have a “fairly” rapid taper. In any case, I would be happy to assist. This would involve using a scale and cutting, and then shaving and weighing pills. Or you could transfer to a liquid formulation that would involve dilution of the liquid to achieve the desired dose. Would your doctor consider prescribing a liquid rather than pills? I know all this may sound overwhelming. I don’t mean it to sound so. I just want you to know what you may be facing so you can decide how you wish to proceed. I am certainly very happy to help you with the asociated mathmatical calculations for either method.

Two things that did come to mind though. One is your method of splitting pills. Since the pills are not scored, it is extremely difficult to accurately cut them in half, much less in quarters, with any precision. If you are not weighing each dose, I would suspect that you doses are shifting fairly erractically in weight.  Secondly, you are only dosing once a day. Ativan has a half life of approximately 12 hours. If you are only dosing every 24 hours, I would suspect you are experiencing peaks and valleys in your blood serum levels which might result in any other physical symptoms you are experiencing.

Please let me know how you wish to proceed and if I can. 

Thanks so much @[El...] for the informative and concise reply. For now I'm going to lean on the 0.125mg dose and see where that takes me. In order to not waste your time now, I will post back and let you know which direction I'm going and then hopefully you can help me sort out a plan at that juncture.

My doctor thinks I'm making too many changes too quickly, which I agree with. He suggested I go back up to 0.5mg and stabilize for while, which would certainly ease things up. However I'd be kicking the can down the road in that regard, probably lining myself up for a way longer taper later on. Eeesh. 

I just ordered a scale from a Amazon so I can more accurately dose my cuts.

Quick question: to measure the dosage more accurately with a scale, would I simply weigh 1mg of Ativan, then take the weight of that single pill, divide that by 8 to get my 0.125mg dosage weight? 

[[El...]]

@[Mt...] The best way to ensure that you are taking 0.125 mg daily is to find the average weight of your pill. You would do this by weighing 10 pills and then dividing that weight by 10. Then always use that average weight to cut and shave your pill.  So for example, let's assume you weighed 10 pills and they weighed 1.200 grams.  One pill, then, has an average weight of 0.120 grams.  To find how much you should weigh for your daily dose, simply multiply the average weight of 1 pill (0.120 grams) times the dose that you want (0.125 mg):

.120 × 0.125 = 0.015 grams (remember, the 0.120 is only for this example…your pills might weigh more or might weigh less)

So, no matter the weight of the pill (and you will find they vary extradinarily!), you need to always weigh out 0.015 grams to get your dose of 0.125 mg (in this example).

Do you have a pill splitter, single-edged razer blade and nail file? These usually come in handy to achieve the weight you want. I use the pill splitter to cut my pill in half. Then I use the razer blade to cut off a “chunk” that I “eyeball” close to the correct weight. Then I use the nail file to file down any last tiny bits. If I file too far I use the small chucks to add back to the weight, keep repeating until I get the correct weight….it does take patience!

Hope this helps!

 

[[Mt...]]

Thanks so much @[El...] - going to try this now and use this method going forward. I'll let you know where I land.

 

 

[[Al...]]

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

It was suggested by @[Al...] that I might help you plan a taper. Although I have been on a benzo (unfortunatey!) for many years, and thus do not have experience with short term use, I would be happy to help in any way I can.

Thank you so much @[El...] I'd seen you giving advice in some of the other Ativan threads, so I thought you would be the best person to ask!

[[Mt...]]

Thanks @[Al...] for the referral.

@[El...] your math was perfect, down to the dosage. I just split up my dosages now with the scale. Thanks! 

 

[[Mt...]]

8 hours ago, [[m...] said:

I think this is something to consider. I did a medication switch in January and added Zoloft. Although I had gone on it in the past with no problem, I had a lot of difficulty this time. Dizziness, nausea, EXTREME anxiety, especially upon waking up. It was extensive enough to interfere with my job. I’ve been on many ADs in the past and this was among the most extreme reactions I’ve ever had. Just reiterating that it’s something to consider!

@[mo...]

Thanks for your comment. Did you come off the Zoloft after those side effects or did they dissipate? 

[[mo...]]

45 minutes ago, [[M...] said:

@[mo...]

Thanks for your comment. Did you come off the Zoloft after those side effects or did they dissipate? 

I stayed on the Zoloft and the symptoms did dissipate over a couple months. I am currently on it now. Best of luck!

[[Mt...]]

Hello @[El...]

OK I've decide to keep tapering from the 0.125mg dosage. My current schedule of 50% reduction every 5 days is proving to be too fast due to the several days of withdrawal effects and insomnia that follow. 

Tonight will mark 4 days at 0.125mg. 

Something a little slower would be preferred. Would you have a recommendation that gets me from 0.125mg to 0mg as quickly as possible yet with a softer landing?

I have the scale now and ready to go. 

Thanks!

[[El...]]

@[Mt...] So, how are you feeling today?  Have your symptoms faded somewhat?  How is your insomnia?  I ask, because, for me, I only like to make a reduction from a position of relative stability.  Reducing while unstable seems to just increase my instability and draw out the process.  If you are not stable, would you consider holding at 0.125 mg for at least a week?  If you are then feeling stable (or are currently relatively stable), perhaps trial a 10% reduction to 0.103 mg.  You could then hold that for 5-7 days.  Then evaluate how you feel, and make another 10% cut or hold longer if needed.  If your first 10% reduction seemed to steep, try a 5% reduction next time.  Or, if you were OK at 10%, try 15%.  The best you can do is to be conscious of your symptoms (or lack thereof) and make accomodations as you go along.  I say this, knowing full well that this is never going to be a completely symptom-free journey.  But, it can be "relatively" comfortable if you are mindful of your symptoms.  Unfortunately, this will mean taking your focus off the calender, as well (something which I struggle with daily!). The best each of us can do is to determine when and if we feel well enough and able enough to make another reduction.  This method, I believe, will give you the softest journey and the softest landing.

Now having said that you should take your focus away from the calender, a series of 10% cuts and holding 5-7 days after each reduction, would take you about 9-10 weeks to get to the recommended 0.05 mg "jump off" dose.  I know that is out of the ballpark of your original plan.  But, remember,  it is flexible depending on your symptoms.  Is that agreeable to you...to at least trial an initial 10% reduction?  If not, let me know.  

Hope you are feeling well!

[[Mt...]]

Thanks @[El...]! Appreciate your time and insight.

I feel like the Ativan withdrawal effects subside after a few days following the drop. That is after a 50% drop. Yes I feel like I should hold on this dosage atleast for another week before the next drop. 

10% drop does sound slow. I feel like I can deal with some level of discomfort in favor of going faster since I've only been on for 30 days. I don't feel the need to watch the calendar with this, but I also feel like I have my short term use in my favor.

Would a 15-20% drop be doable if I can handle the symptoms? I could always reduce the cut on the subsequent drop if things get problematic? 

Thanks!