Taper schedule

[[jc...]]

Hi,

Looking for a taper schedule for 1 mg Ativan twice a day and 1 mg Ambien at night for 22 years. My new primary care physician is more than willing to help me thru this.

Thanks very much.

[[Cr...]]

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

Hi,

Looking for a taper schedule for 1 mg Ativan twice a day and 1 mg Ambien at night for 22 years. My new primary care physician is more than willing to help me thru this.

Thanks very much.

Hello @[jc...], welcome to BenzoBuddies.

We would be glad to help you come up with a taper plan suited to your needs. We typically use the guidelines laid out in the Ashton Manual as a basis for a taper. Generally it is recommended to do cuts of about 10% around every 2 weeks.

The first thing is to decide is how you would like to taper off of your benzo. Below is a link describing the typical withdrawal methods.

https://benzobuddies.org/benzodiazepine-withdrawal-methods/overview/

Are you currently experiencing any type of symptoms in between your 2 daily doses?

[[jc...]]

No symptoms at this time. My new Dr. thinks possibly we should deal with the Ativan first. Then a break of about a month and taper the Ambien. She is open to ideas and is very supportive. My biggest concern is the length of time I was on these drugs (22 years). So glad I found your site. Thanks for your fast response. Best to everyone going thru this.

Take care

 

[[Li...]]

Welcome to BenzoBuddies, @[jc...].  Given that your new primary care physician is open to ideas, you might ask her if she is familiar with this new textbook about deprescribing:

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (Horowitz & Taylor, 2024)

The book includes step-by-step guidance for safely stopping Ativan and Ambien, including examples of fast, moderate, and slow tapering schedules for each drug.  

However, the most important point made by the authors is that patients should never be expected to adhere strictly to any tapering schedule.  Instead, the patient’s experience of withdrawal should guide the taper  — the schedule should be modified as needed to ensure that the patient’s withdrawal symptoms remain tolerable.

[[Pa...]]

I'd also like to welcome you @[jc...], is there a reason your doctor suggested reducing the Ativan first?  Let me ask you, is the Ambien allowing you to sleep through the night or are you waking up after a few hours?

I'm glad @[Li...] shared the wisdom of letting the patient decide taper rate, when I saw your doctor mentioned only allowing about a month between the Ativan taper and tackling the Ambien, I was concerned. 

[[jc...]]

I cut the Ambien in half. I take the first half at 11 pm. I sleep until about 2:30 am. I then take the second half and sleep until about 6:00 am. If I take the whole tablet at 11:00 pm, I wake up at about 1:00 am. and have a hard time getting much sleep after that. Strange how that works.

Thanks

[[jc...]]

Libertas,

Thanks for the book reference. I doubt that she has it. If not, I will get a copy for her. After looking at your earlier reference I would like to switch over to diazepam for the taper. Sincerely appreciate all your help. Thanks very much!

[[Li...]]

11 hours ago, [[j...] said:

Thanks for the book reference. I doubt that she has it. If not, I will get a copy for her. After looking at your earlier reference I would like to switch over to diazepam for the taper.

You’re welcome @[jc...].  Tip of the hat for getting a copy of The Maudsley Deprescribing Guidelines (MDG) for your PCP!  I encourage you to read it as well.  (Although the primary audience for MDG is clinicians, it’s a straightforward read.)

Your PCP’s comment that you would only need a month break between tapering Ativan and Ambien is a caution flag that she may not fully understand how to taper benzodiazepines and z-drugs safely.  Reading MDG will drive home the point that expecting patient’s to adhere to a set taper timeline or schedule has the potential to cause harm. Patient-reported symptoms must be prioritized and adjustments should be made as needed to prevent harm and minimize withdrawal symptoms.

Re: crossing over to diazepam …

Although Heather Ashton (the author of The Ashton Manual referenced earlier) did indeed use this approach, please be aware that:

1. There are mixed views about switching to diazepam. It works for some individuals but not for others.
2. Many clinicians do not know how to implement a proper crossover.
3. A substantial number of US-based clinicians are reluctant to prescribe diazepam (see Note). 

Unless you are experiencing intractable interdose withdrawal on the Ativan, you might consider ‘dancing with the devil you know’ and at least try tapering from it.

Note: Your PCP may suggest clonazepam as an alternative to diazepam.  If she does, please be aware that it is one of the more difficult benzodiazepines to taper because of its potency and limited dosage forms and strengths.

[[Oc...]]

@[jc...]

I wanted to make sure you take only 1 mg Ambien? I thought you don't need any taper from such a small dose.

[[jc...]]

Yes,only one. Problem may be the lenght of time. Aprox. 20 years.

Thanks

[[Pa...]]

23 hours ago, [[C...] said:

1 mg Ambien at night for 22 years.

How do you get such a small dose of Ambien, I believe it comes in 5 and 10 mgs tablets, do you cut up the 5 mg?  

It sounds like your body is tolerant to your dose, but I'm glad you can get back to sleep by taking the other half.