Ativan Taper Help Please

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Hello!  I’ve been trying to taper off of Ativan and it’s been rough (hospitalizatized for withdrawal symptoms where they only encouraged me to take it again).  
 

I’ve been taking anywhere from .5 to 1 mg since November (8 months) most recently I’ve been tracking: 

7/4 .5

7/5 .25

7/6 .25 

7/7  .125

7/8 .125 

7/9 missed ( felt terrible) 

7/10 .125 

7/11 .125 

my new psychiatrist wants me To go to Valium of 2.5 to complete my taper and completely replace Ativan with that dose.  But I decided to not do that I don’t want to have to go through all of this again with Valium. 
 

My question is I only take .125 should I make a smaller cut ? If so when ? Should I stay here at .125 for a week or more ?

If I should cut more what would the remaining taper look like in terms of dosages and timing?  I can’t imagine cutting my pills any smaller (I have been cutting up .5mg pills)

 My symptoms are severe panic and dread in the morning and sort of heightened anxiety all day and some nausea that I’m not sure is from this or something else. 
 

Thank you in advance I appreciate any guidance ! 

 

[[El...]]

I saw your questions on another thread, but will attempt to address then here. I do not have experience tapering at very low doses, but I do have a few questions and ideas that may help you clarify what might be your next steps going forward.

You state that you have been on Ativan for 8 months. During that 8 months were you taking daily doses of 0.5-1 mg or only taking as needed? Did you ever try to taper within those 8 months? I ask because if you were taking 0.5-1 mg for 8 months fairly consistently, it might indicate a greater degree of physical dependency than if you have been taking it intermittently or only as needed. It has been generally found (but certainly not in every case) that longer and consistent use may require a lengthier taper.

If this is your only attempt at tapering and if you have began tapering from 0.5 mg on July 4, that is a very rapid taper of 75% from your original dose. Since the recommended taper rate is a 5-10% reduction every 1-3 weeks (based upon your symptoms), I can understand why you may be experiencing withdrawal symptoms at this point. Are night panic attachs your main concerning symptom? To what degree do you experience panic and nausea during the day? Are you functional during the day….can carry out regular tasks, exercise, eat? If you are non-functional, it would certainly indicate that you should hold longer than a week at 0.125 mg to reach a degree of stability before attempting any further reductions. It might also indicate that you consider dividing your doses by cutting and weighing your pills or by switching to a liquid version of Ativan. Using a liquid formulation or cutting and weighing your pills would allow you to split your doses so you can address any interdose withdrawal you may be experiencing in the 24 hour gap between doses. And, while I understand why your doctor might be recommending a longer acting benzo (so as to relieve your panic), my “gut” feeling is that switching to a longer acting benzo at this point seems like a fairly drastic action to take when you are so close to cessation. If you are feeling like you need to extend your taper, I think a better approach would be a attempting to further cut your pills or switching to a liquid formulation. Introducing a new benzo can introduce a while new set of difficulties…and why suffer through that if it can be avoided?

So, I guess if it were me, I would consider the answers to those questions. But in the meantime, I would also consider taking the Ativan at a set time each day…perhaps at the same time each night right before you go to bed. If after holding for 1-3 weeks and dosing at the same time each day and you are then still experiencing panic at night or are having intolerable symptoms during the day, you might consider either buying a scale so that you can cut and weigh your pills or moving to a liquid formulation. Cutting and weighing your pills or using a liquid formulation will allow you to dose precisely each day* or divide your dose if interdose withdrawal is an issue and then also allow you to reduce your dose in a systematic fashion.  If you should desire to do a more systematic taper, I would happily help you with any asociated calculations.

You are so close to the end, it seems prudent to consider your next steps carefully so as to not either needlessly extend your taper or too abruptly end your taper.

*”Eyeballing” splitting your pill into 4 sections is unlikely to be giving you precisely 0.125 mg. For example, my 0.5 mg Ativan pills have an average weight of 0.06 grams. Even after cutting then with a pill splitter, 1/2 of a pill may weigh up to 0.038 grams or as little as 0.025 grams (instead of the expected 0.03 grams if it were precisely split). This is an error of between 17-27%.  If you are anywhere near that error (and insuspect you are) you are probably exascerbating the peaks and valleys of your blood serum levels.

Let me knowbwhat you decidecand if I can help you further!

 

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@[El...] thank you so much for your response, I was taking .5 consistently every night for those 8 months then towards the end of that time I got a medical diagnosis that  I’m still grappling with that made me have lots of anxiety so I started “needing” more, so I began taking an additional .5 as needed.  Then I realized I was experiencing a need for more and i recognized my body had developed a dependence.   That was at the end of June, and that is when I began experiencing some severe side effects from taking away the .5 dose that was as needed and just taking the night time dose - then lowering it.  
 

I had no idea what I was doing by reducing so much.  I’d say it sent me over the edge.  I would like to not switch to Valium, as you mentioned it seems problematic to solve one problem with creating another. 
 

I’ve been at .125 and it’s very very hard for me in the mornings I have my withdrawal symptoms then, fast heart rate, dread anxiety, tremors and nausea ( that’s all day). I also have anxiety all day but am able to function somewhat.  I’m make myself get up, shower and pretend I’m ok. 

I would like to do a slower taper and would love your advice on metrics for the remaining .125 so my body isn’t experiencing those peaks and valleys.  I can ask my doctor for liquid Ativan but if she is unwilling I’ll need to do the pill weight approach - both are confusing to me, so I truly appreciate your input and help. 
 

thank you so much !🤍

Edited July 12 by [...]

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[[Pa...]]

I'm not in favor of you switching to Valium at this juncture, but it seems like you need a little more consistency in your dosing, I believe liquid titration is your best option.  This would allow you to take consistent doses to help with interdose and make very small reductions.  I know this type of taper is confusing, but we have smart people who can help you (and me ) figure this out.  I can reach out to someone now if you're interested. 

[[...]]

12 minutes ago, [[P...] said:

I'm not in favor of you switching to Valium at this juncture, but it seems like you need a little more consistency in your dosing, I believe liquid titration is your best option.  This would allow you to take consistent doses to help with interdose and make very small reductions.  I know this type of taper is confusing, but we have smart people who can help you (and me ) figure this out.  I can reach out to someone now if you're interested. 

Thank you @[Pa...] I am very interested and agree although my family is pressuring me I feel Valium is not a good option either i SO appreciate your help.  This forum is life saving 🤍

[[El...]]

I would agree with @[Pa...]. Upon looking over my last post, I do think that since you are at such a low dose, it might prove difficult to cut and weigh pills. A liquid titration would enable you to limit your interdose withdrawaI and as well as make small reductions once you are stable. It would be my hope that your doctor would be amenable to switching you to a liquid formulation. Since Ativan is only very sparingly soluable in water, it is somewhat difficult to be precise with a “home-brewed” formulation.

When do you talk to your doctor next and do you think you might find him agreeable to your plan?

 

 

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@[El...] thank you - I spoke with her today and she is not amenable and she is insisting on the Valium crossover 

[[Pa...]]

[[...]]

34 minutes ago, [[P...] said:

How much Ativan do you have left?

Hi @[Pa...] 10 .5 mg pills left 

[[Pa...]]

[[...]]

3 minutes ago, [[P...] said:

Thanks, I'm reaching out to another member, he's good with math. 

@[Pa...] thank you 

[[Pa...]]

Hi @[...], the member I've been communicating with can only access the forum with his phone at the moment, so he's not comfortable jumping into this thread but he said 10 pills isn't enough to do a gradual taper, you may have to cross over to the Valium.   It makes no sense to me to do this at such a low dose. 

[[...]]

12 minutes ago, [[P...] said:

Hi @[...], the member I've been communicating with can only access the forum with his phone at the moment, so he's not comfortable jumping into this thread but he said 10 pills isn't enough to do a gradual taper, you may have to cross over to the Valium.   It makes no sense to me to do this at such a low dose. 

@[Pa...] ok thank you for trying - I’ve been prescribed 2.5 Valium at night wondering if that is equal to .125 Ativan ? I think it’s more maybe I should do 1.25 instead ? What do you think ? 

[[Pa...]]

[[El...]]

@[...] So sorry you are being "forced" to switch to Valium.  Please don't fret too much. Many, many people have succesfully tapered from Valium without developing additional "dependencies" or difficulties.

I was wondering if your doctor would be willing to prescribe the liquid formulation of Valium?  It is my understanding that it comes in a concentration of 5 mg/5 ml (1mg/ml).  This might be easier to dispense your dose as, I believe, the smallest pills available are 2 mg.  2 mg pills might be difficult to cut accurately at your low dose and as you taper to smaller doses.

Please keep us informed how you are getting along!

[[...]]

10 minutes ago, [[E...] said:

@[...] So sorry you are being "forced" to switch to Valium.  Please don't fret too much. Many, many people have succesfully tapered from Valium without developing additional "dependencies" or difficulties.

I was wondering if your doctor would be willing to prescribe the liquid formulation of Valium?  It is my understanding that it comes in a concentration of 5 mg/5 ml (1mg/ml).  This might be easier to dispense your dose as, I believe, the smallest pills available are 2 mg.  2 mg pills might be difficult to cut accurately at your low dose and as you taper to smaller doses.

Please keep us informed how you are getting along!

@[El...]thank you I am scared of a bad  reaction and dependency - she recommend 2.5 but I’m going to start at 1.25 that seems more in line with the lorazepam at .125.  She gave me 5mg so I’m halving and halving again.  I’ll find out if she’s willing to do liquid.  Thank you for the support, it means a lot to me I feel less alone and scared. 

[[...]]

@[je...] hi sorry about the multiple taper posts crossing over to valium from Ativan because of severe morning anxiety I’d be going to 1.25 then hold for a week if feeling ok then begin taper - is it crazy to do ? My and anxiety with Ativan is rough for me right now in the mornings - it gets better later in the day but mornings are impossible 

[[je...]]

No need to apologise. If I had a choice I would not cross over as I mentioned in the other thread and it seems you got the same advice on this thread as well. But it sounds like you don’t have a choice.

1.25mg is the better conversion. At such a low dose I’m not sure how you would go about doing a cross over.  I don’t think you should plan yet how long you want to hold. I think you need to take it day by day and see how you adjust to the Valium. Hopefully you’ll do just fine. So let’s see how things progress. 

[[...]]

7 minutes ago, [[j...] said:

No need to apologise. If I had a choice I would not cross over as I mentioned in the other thread and it seems you got the same advice on this thread as well. But it sounds like you don’t have a choice.

1.25mg is the better conversion. At such a low dose I’m not sure how you would go about doing a cross over.  I don’t think you should plan yet how long you want to hold. I think you need to take it day by day and see how you adjust to the Valium. Hopefully you’ll do just fine. So let’s see how things progress. 

@[je...] thank you / do you mean you don’t know how I would go about the taper - the cross over is from Ativan .125 to diazepam 1.5 - tonight’s my first night - I’m scared ! 

[[je...]]

No, once you’re stable on the Valium, then you can slowly taper. You’ve received a lot of great input already. I understand that every time we change things up it is scary. It is normal to feel that way. Whatever happens you will be okay. Your biggest positive at this stage is that you’re at such a low dose. That will definitely work in your favour. Ashton said at around 1mg Valium there is barely any therapeutic effect from the medication. You’ve done most of the hard work already. You will be okay.

[[...]]

On 13/07/2024 at 21:27, [[j...] said:

No, once you’re stable on the Valium, then you can slowly taper. You’ve received a lot of great input already. I understand that every time we change things up it is scary. It is normal to feel that way. Whatever happens you will be okay. Your biggest positive at this stage is that you’re at such a low dose. That will definitely work in your favour. Ashton said at around 1mg Valium there is barely any therapeutic effect from the medication. You’ve done most of the hard work already. You will be okay.

@[je...]@[El...] @[Pa...] one night on diazepam 1.25 down I’m hoping to do 6 more then taker.  I have a few questions I’m hoping someone could help - I take my dose at bedtime/ any idea why morning is so hard but the anxiety decreases as the day goes on? The other question is what should my next dose be? Ashton goes from 2-1 , if I’m at 1.25 should I go to 1, then jump? Or 1 to .5 then jump?  Also because the half life is so long do people get unbearable withdrawal symptoms a week or two after they jump typically or if they go to 1 or .5 is the tough part done ?  Thank you in advance for any insight.  
 

[[Pa...]]

Most members talk about high cortisol levels in the morning making them and the early half of the day miserable, I would imagine that's what you're dealing with too.

I'm glad you're planning to stay at your current dose of Valium for a week, I'm not sure how much you should reduce, your dose is so low I'm not sure how its going to go.  But when in doubt, proceeding with caution is always the right approach so maybe reduce to 1 mg, hold, then go to .5.  Try not to make plans past your first reduction, they could end up getting changed when you see how its going. 

[[...]]

42 minutes ago, [[P...] said:

Most members talk about high cortisol levels in the morning making them and the early half of the day miserable, I would imagine that's what you're dealing with too.

I'm glad you're planning to stay at your current dose of Valium for a week, I'm not sure how much you should reduce, your dose is so low I'm not sure how its going to go.  But when in doubt, proceeding with caution is always the right approach so maybe reduce to 1 mg, hold, then go to .5.  Try not to make plans past your first reduction, they could end up getting changed when you see how its going. 

@[Pa...]thank you for your feedback it is so greatly appreciated 🙏🏻

[[...]]

Hello All 

I was trying to decide whether to go to an inpatient facility that does the Ashton Taper or do it at home- I really want to do it at home, partly because I will be at the facility for a long long time and don’t want to be away from my family (I have an only child and a checked out husband).  The facility did say they would not perscribe additional medication while I was there which was encouraging.  But … I want to do it at home -  conservatively - as I went from .5 to .25 to .125 on Ativan too quickly and had such a hard time -  then I found a doctor that knew the Ashton taper method and switched me to Valium and put me up at 2.5.  She said once I’m stable we can start tapering.  It’s been 2 days on 2.5 I’m very uncomfortable for most of the day, with symptoms easing at night - right before my next dose. 
 

can someone help me do the math for dosing? 

Im at 2.5 if I follow Ashton I would be here for 2 weeks 

then 1.5 for two weeks 

.5 for two weeks then jump 

BUT they seems too aggressive for me - what do folks recommend ? 10% reduction every 2 weeks or is that too slow ? 
 

I’d love to have a rough schedule to guide me -and can tell you math is not my strong suit.  
 

Thank you to anyone who may be able to help  make the plan -

 

My taper history

 

Ativan - 8 months .5 nightly + intermittent fasting.5 daytime dose 

Ativan: 

7/3 .5 

7/4 .5

7/5 .25

7/6 .25 

7/7  .125

7/8 .125 

7/9  missed 

7/10 .125 

7/11 .125 

7/12 .125

7/13 .125

SWITCH to VALIUM - I take at bedtime around 10 pm 

7/14 1.25 Valium - racing heart - high anxiety all day, laid on couch to keep heart rate down 

7/15 2.5 Valium - racing heart,sweats , insomnia, morning and dread and body pain, symptoms easing around 5pm

7/16 2.5 Valium - racing  heart,sweats , insomnia, morning and dread and body pain , symptoms easing around 5pm

thank you In advance !