Ativan Low dose and intermittent , taper help needed

[[ma...]]

Hello, I am new here. I have been prescribed Ativan 0.5mg , 5 years ago to take for insomnia and anxiety . I knew it was not the best drug so I took 0.25mg about every 3 days. I thought I had it under control.(?!) Last year or so I started taking it more regularly, some weeks daily, sometimes 2 weeks without it. Never more than 0.5mg a day. I have developed physical dependence and very uncomfortable symptoms. I don’t know if these are withdrawals or side effects of the drug. I want to taper however since my usage is so chaotic I am not sure how to do it and what to do. My symptoms that are constant are high muscle tension, body pains ( jaw, neck, teeth etc) and occasional ( few days a week)  inner restlessness which is hard to describe ,  sleep issues, exhaustion, de realization , headaches, dizziness. Overall I am miserable in my own skin. If you have any advice on how to effectively taper lower dose ( going back to more regular use and then lowering etc) or confirming any of these symptoms. I will ask for switch to diazepam although last time my dr was not too accommodating. Thanks and wish you all safe and comfortable taper 

Edited Tuesday at 03:14 by [ma...]
Spelling :)

[[...]]

Hello, @[ma...], welcome to BenzoBuddies! We're glad you've found us.

The symptoms you're describing remind me of my own condition when i was in interdose withdrawal. I'm off and feel a lot better but my taper was rather hard. There are more experienced and knowledgeable in this regard buddies here who, i'm sure, will join in and help you. I think, considering your way of use, tapering in a proper way must allow you to make the process of coming off the drug feel quite satisfactory.

Good luck!)

[[Re...]]

Hello @[ma...], Welcome to BenzoBuddies, 

I am really sorry you have been experiencing these very uncomfortable symptoms, I believe these might be the signs of benzodiazepine tolerance as well. 

After long term use, we generally recommend a 5-10 % reduction of your previous dose every two or three weeks, some people need to reduce even slower. There are multiple ways to do this, please see the website of the Benzodiazepine Information Coalition. We have members who can help you with the method you choose. 

It would be also wise to choose a stabile daily dose and even distribution, so that you can start this reduction systematically. 

We are glad you joined the Forum!

[[Ta...]]

I just got off of lorazepam six weeks ago, after 20 years of use. If it were me, I would try to stabilize before going down. This will make the taper easier in the long run.

Maybe try taking .5 mg daily, and divide the dose in 2 or 3 equal parts since lorazepam has such a short half life. Try to stay on that dose until you feel better and symptoms subside.

Then you can plan your taper from a more comfortable and stable place. 5-10 percent each cut is a solid guideline in my experience. But it's really up to you. Whatever feels right for your health and comfort. I wish you all the best 🌷

[[Tr...]]

On 24/08/2024 at 14:11, [[R...] said:

Hi @[th...],

     Sure.  I'd be happy to give you my thoughts.  My taper of 1 mg clonazepam lasted about 19 months.  For your reference, I have my taper schedule laid out on my About Me tab of my Profile.

     I remained functional and stable throughout the process.  "Stabilization" means, for me, a condition where symptoms are manageable and not changing.  It doesn't mean zero symptoms.  There were times that I felt discomfort during my taper, but it remained straightforward and I could forge ahead.

     I followed the general guideline of a 5 - 10% taper and generally stretched each hold period to 14 days, even if, as I often experienced, a long period of leveling off of any symptoms.  The main bothersome symptom I had was bloating of my G.I. system.  I also had increased food sensitivities, especially involving broccoli and tomato-based foods.  I had hyperacusis and would be startled by such noises like an automatic garage door going up or down.  I had tinnitus in both ears.  Now almost 9 months off, I still have those, but they have diminished and are even more manageable.  I still battle with fatigue, though.

     I did a dry, cut-and-hold taper to .024 mg.  I tried to be as precise as possible with my weighing.  Although sometimes tedious, I looked at my taper as a challenge.  I put my metal nail file to good use on every cut.  I slowed down a little closer to the end, even though I hadn't sensed any increased symptoms or symptom intensity at lower dosages.  Going to zero before jumping was never my goal.

    In addition, I did moderate exercise.  I didn't want to take chances with a vigorous routine as I was afraid it might ramp up anxiety, something I was able to keep at a low degree throughout my taper.

     Look at tapering Clonazepam like you would landing a plane.  Unless there's short use, paradoxical reactions, or unbearable side effects, every step during a taper can be done gradually.  Since you have fortunately reduced your dosage, don't be afraid to slow down.  The 5 - 10% recommendation for cuts is not written in stone.  At .5 mg of the drug, I did a one-time reduction of 3%, as I had never in my 7 years of using clonazepam gone below .5 mg.  It was uncharted territory.  I also kept my a.m. and p.m. doses equal.

  Hopefully, I have answered your questions.  I wish you much luck in your taper.  While the mantra goes "we're all different," I spent a lot of time on BB, checking to see what worked and what didn't work for others, and helping out when I could.  Keep pushing on!

Hello @[ma...] little Olive,

I am so sorry that you are experiencing these symptoms. As already mentioned by other buddies, you need to stabilize at a certain dose before starting your taper. If you switch to Diazepam, you should also wait some time to get used to it and stabilize on it. 

If you have two doses, always taper off both doses simultaneously to avoid interdose withdrawal. I found this the hard way. 

Imho the buddies who have developed dependancy should start their taper with a reduction of 5% per 14 days and if needed adjust to a slower or faster rate depending on the wd sxs. 

I am quoting some useful information here. 
 

Feel free to check my History for more helpful stuff like references of books, etc. The Maudsley deprescribing guidelines can be of great help.

I hope and pray that you will stabilize quickly and will have a smooth taper.
 

 

Edited Wednesday at 21:32 by [Tr...]

[[Tr...]]

On 26/08/2024 at 13:55, [[C...] said:

As @[Ro...] suggested, it is best to use a .001 g scale. When using this scale, your taper is based on pill weight. When you start, you first need to determine the average pill weight of 10 of your pills. I am tapering using .5 mg Clonazepam pills, and my average pill weight is .175 g. For my taper, I reduce by 5% so here is how I calculate the pill weight for my first reduction — .175g X .95 = .166 g (pill weight). I use a nail file to reduce my pill to this weight and hold at this weight for 2 weeks. After that, I calculate using my current pill weight — .166g X .95 = .158 g (pill weight). I hold at this pill weight for 2 weeks. With each hold, I journal my symptoms and adjust my taper rate as necessary.

Since reductions are based on pill weight in grams, I calculate my current dosage of active ingredient as follows. 
0.5 mg/0.175g = x/0.158g

x = 0.5/0.175 X 0.158 = 0.45 mg active ingredient 

Best wishes on your taper, @[Sa...]

Please check my calculations, @[Ro...].

Hello @[ma...], 

I have quoted some additional very useful information. 
 

Good luck!