Titrate lorazopam

[[jo...]]

I want to reduce my daily dosage of 2.0 mg Lorazopam taken at night using the titration method and would appreciate some advice. Plan to begin reduce dose by .125 mg over a 3 week (that is taking 1.875 mg each day for these 3 weeks) and  assuming I am ok with that bringing it down by another .125 taking  mg each 1. 75 mg each day for the next three weeks. And so on using even smaller increment reductions for the further reductions. I have pills of .5 mg and . 25mg (I had the .25  pills compounded by a pharmacist At the beginning I am thinking of dissolving one .5 mg int a 100 milliometer of milk and each night  taking 1.75 mg of pills plus  drinking 25 millometers of milk to get the .125 reduction.  is this Ok ? Are the reductions too prolonged . Are the increments too small? Any suggestions or comments would be greatly appreciated. Ive been on this drug for 15 years . Am 72 yeqrs old. Thanks

[[pr...]]

I think that especially with your age and the length of time on the drug, the increments are definitely not too small and the three-week hold between cuts is definitely not too long.  I think it's a good plan for starting with, and if you find yourself feeling really crappy and not getting better, you can try smaller cuts and longer holds. 

 

The point is to have some quality of life while you taper and to stay as healthy and well as possible throughout the taper.  And to come off at the end feeling okay, rather than in intense withdrawal for many months.

 

This usually means a much slower taper than we would like.

 

At our older ages I don't think we can risk the kind of crazy kamikaze approach the younger folks can get away with.  The brain does change and heal at every age, but like everything else with our bodies, it's slower when we're older and we don't bounce back as fast.

 

Also try to arrange your life so as to minimize stress, including good stress (like lots of activity and travel) during your taper, at least at first until you see how it goes.  And keep good health habits--moderate to gentle exercise, and healthy diet, no junk food, minimal sugar and processed foods, no caffeine, minimal or no alcohol.

[[...]]

I think that especially with your age and the length of time on the drug, the increments are definitely not too small and the three-week hold between cuts is definitely not too long.  I think it's a good plan for starting with, and if you find yourself feeling really crappy and not getting better, you can try smaller cuts and longer holds.  

 

The point is to have some quality of life while you taper and to stay as healthy and well as possible throughout the taper.  And to come off at the end feeling okay, rather than in intense withdrawal for many months.

 

This usually means a much slower taper than we would like.

 

At our older ages I don't think we can risk the kind of crazy kamikaze approach the younger folks can get away with.  The brain does change and heal at every age, but like everything else with our bodies, it's slower when we're older and we don't bounce back as fast.

 

Also try to arrange your life so as to minimize stress, including good stress (like lots of activity and travel) during your taper, at least at first until you see how it goes.  And keep good health habits--moderate to gentle exercise, and healthy diet, no junk food, minimal sugar and processed foods, no caffeine, minimal or no alcohol.

 

Joshua,

 

I totally agree with phriannon.  Will you be able to make one "daily batch" using the entire 2mg's in your liquid?  This would simplify things for you.

 

I have heard that cutting in increments is preferred by people who are titrating ativan as opposed to cutting 1% or 1ml per day, but not sure if this is true.   I just have a few small suggestions for you in addition to what phriannon wrote:

 

1.  Don't cut more than 5% increments at the start.  5% of 2mg would be .1mg if I am correct.  

 

2.  If you can, put the entire 2mg's in with the 100ml of whatever liquid you choose to use after crushing it good with a mortar and pestle.  If you remove 5ml from your liquid, this would be the equivalent of .1mg or 5%.  Obviously each ml would be 1% of 2mg.

 

3.  Watch the video I made in my signature if you have not done so already.  It may help make things a little easier for you.  The only thing I do different now, than I did in the video, is I crush the benzo DRY in the mortar and pestle, then tap the bottom of the bowl firmly and put the benzo powder in the jar BEFORE adding any liquid.  Then I add from the 100ml liquid into the little bowl to get all the excess benzo powder out by using my finger to remove all the residue from inside the little bowl.  This will make more sense if you see the video.  I also heard that water may work better with ativan.  Not sure if this is true, and I'm not sure why.  Maybe someone else can step in and explain that.

 

4.  I don't think it makes any sense to put a time frame on your cuts.  This makes it impossible for us to follow our symptoms.  Even fast acting benzos give us "delayed" withdrawal reactions, so it is still way too easy to cut too much making time tables in my opinion.

 

I hope for your success on your titration journey!

 

Kian

[[jo...]]

Prhiannon and Klan: Many thanks for the excellent  general counsel and very helpful specific suggestions. Just one needed clarification  ; what is the difference between cutting in increments and cutting 1% per day? Also what happens to the tiny amount you remove assuming you make 2mg mixture? Did try a .25 reduction earlier in the Summer and after a week was in  trouble so went back to 2mg. But was this right ?. Should i have tried to stabilize around a smaller reduction, say .10, rather than going back to the original dosage? Thanks again. Josh  PS Do you think it's a good idea to be around family and friends grandchildren etc while withdrawing ?

[[...]]

Prhiannon and Klan: Many thanks for the excellent  general counsel and very helpful specific suggestions. Just one needed clarification  ; what is the difference between cutting in increments and cutting 1% per day? Also what happens to the tiny amount you remove assuming you make 2mg mixture? Did try a .25 reduction earlier in the Summer and after a week was in  trouble so went back to 2mg. But was this right ?. Should i have tried to stabilize around a smaller reduction, say .10, rather than going back to the original dosage? Thanks again. Josh   PS Do you think it's a good idea to be around family and friends grandchildren etc while withdrawing ?

 

Joshua,

 

I just discard the removal.  I don't save it.

 

Forgive me, I worded that wrong.  Whether you cut 1% per day or 5% every however many days/weeks, they are all increments.  If you cut daily, the amount would be much much smaller, but if you wish to wait longer between cuts, then you would make slightly bigger cuts.  The idea is to start out slow so you can learn how to monitor your symptoms and also learn what size of cuts to make.  Since the daily cuts are so small, and there is a "delayed withdrawal" effect, it is a good idea to make single cuts and wait enough time to see how you will be able to take each cut.  When you cut daily in small increments, it makes it a little harder to avoid cutting too much since it usually takes more than a day to feel the effects of the cut.

 

If you have stabilized on 2mg's, then that is a good starting point.  What is done is done.  No need to worry about that.  This process will take a long time no matter where you start.

 

.25 was, indeed, a huge cut, but no doubt you will do much much better when abiding by a wise and slow titration as you learn to monitor yourself.

 

As far as the last question about family and friends, I would post that question as a new topic here:

 

http://www.benzobuddies.org/forum/index.php?board=55.0

 

Please take good care of yourself and take it nice and slow.   

 

Kian

[[jo...]]

Kian ;Thanks for the clarification and additional advice. I also found your video very helpful. Regarding which can you comment on this; let's say I crush .5 mg of Lorazopan and then intermingle it with 100 milimeters of whole milk. Could I  achieve a .125 mg reduction of my current dose of 2.0mg, by taking 25 millimeters of the solution plus 1.75 mg of pills.? (If i mixed 1mg with the 100 millimeters , I would only need to add 12.5 millimeters to the 1.75 mg of pills to get the desired reduction, Is that right?). Sorry to ask these basic questions but my math skills have deteriorated badly recently and I want to be sure i am not making a stupid mistake. I entirely agree with creating a larger batch but many of my lorAzopam pills are in capsule form and the powder cannot be seperated easily from the capsule. Any help you can provide on the math would be greatly appreciated.  josh

[[...]]

Kian ;Thanks for the clarification and additional advice. I also found your video very helpful. Regarding which can you comment on this; let's say I crush .5 mg of Lorazopan and then intermingle it with 100 milimeters of whole milk. Could I  achieve a .125 mg reduction of my current dose of 2.0mg, by taking 25 millimeters of the solution plus 1.75 mg of pills.? (If i mixed 1mg with the 100 millimeters , I would only need to add 12.5 millimeters to the 1.75 mg of pills to get the desired reduction, Is that right?). Sorry to ask these basic questions but my math skills have deteriorated badly recently and I want to be sure i am not making a stupid mistake. I entirely agree with creating a larger batch but many of my lorAzopam pills are in capsule form and the powder cannot be seperated easily from the capsule. Any help you can provide on the math would be greatly appreciated.  josh

 

Josh,

 

Your math is correct.  I checked it with a calculator.  I hope you can get the solid pills when the time comes.

 

You also might be surprised at the support you get here when posting things regarding family, friends, grandchildren.  By communicating with those who have gone through your particular set of circumstances, you may get some good advice on how to deal with things like that.  I hope you do.  I have no children, or grandchildren.  I've been having to rely on family for over two years now because of this.  It's hard no matter what because no one could possibly understand this for what it is unless they go though it.  It is teaching me the real meaning of love.  For me, it's like a totally different life that I have to learn how to live.  All the best to you and your family.

 

Kian

[[pr...]]

Kian ;Thanks for the clarification and additional advice. I also found your video very helpful. Regarding which can you comment on this; let's say I crush .5 mg of Lorazopan and then intermingle it with 100 milimeters of whole milk. Could I  achieve a .125 mg reduction of my current dose of 2.0mg, by taking 25 millimeters of the solution plus 1.75 mg of pills.? (If i mixed 1mg with the 100 millimeters , I would only need to add 12.5 millimeters to the 1.75 mg of pills to get the desired reduction, Is that right?). Sorry to ask these basic questions but my math skills have deteriorated badly recently and I want to be sure i am not making a stupid mistake. I entirely agree with creating a larger batch but many of my lorAzopam pills are in capsule form and the powder cannot be seperated easily from the capsule. Any help you can provide on the math would be greatly appreciated.  josh

 

 

Josh,

 

Your math is correct.  I checked it with a calculator.  I hope you can get the solid pills when the time comes.

 

You also might be surprised at the support you get here when posting things regarding family, friends, grandchildren.  By communicating with those who have gone through your particular set of circumstances, you may get some good advice on how to deal with things like that.  I hope you do.  I have no children, or grandchildren.  I've been having to rely on family for over two years now because of this.  It's hard no matter what because no one could possibly understand this for what it is unless they go though it.  It is teaching me the real meaning of love.  For me, it's like a totally different life that I have to learn how to live.  All the best to you and your family.

 

Kian

 

Hi again!

 

About the math: You've got the math right, but how do you plan to get that 1.75 of pills? If you have actual tablets that come in those strengths that's fine, but don't try to cut the pills.  It's impossible to get accurate enough cuts for the kind of titration you need to do.  (These are very potent pills.)

 

I do my titration a bit differently (I just measure out my dose for the day, rather than measuring out the part I'm removing, but I work in a lab and am comfortable using pipettes for measuring so this works well for me.)  So I won't comment further on the math part, since Kian's got that covered so well.

 

However, I'd like to pitch in with some tips about the chemistry.

 

There's no advantage to mixing lorazepam with milk as it doesn't have a special affinity for the fat globules in the milk the way diazepam does.  And there are disadvantages:  milk spoils so it's harder to transport and keep (and with lorazepam you need multiple daily doses so this is a big disadvantage); and milk makes it impossible to see if you have a good even suspension or not, which is key, because the evenness of the suspension is what makes it possible to get consistent dosing.

 

Do you need me to explain what a suspension is, versus a solution? I won't bore you with it if you already understand it.

 

I also recommend not using the mortar and pestle as this is rarely (never?) necessary (if you're dissolving your pills/powders in water) and makes the dosing less precise and predictable.  Any time you manipulate the pills-- any time they touch a new surface, and especially if there is friction or pressure involved--you are going to lose microscopic (or even visible) amounts of the powder.  According to a pharmaceutical pamphlet about compounding solutions, they recommend an overage of 10% for the amount lost to mortar and pestle and getting that into the compound.

 

These "new" benzos are so potent that this will cause a variability in dosing that can affect your taper.  Since the pills and powders usually disperse just fine in plain water if you let them sit long enough, you can skip the whole mortar and pestle thing (and blender too if the instructions you're using include using a blender).  I'm tapering five different meds and they all dissolve just fine in plain water. 

 

Now, when I say "dissolve", I mean the tablet/fillers dissolve.  The drug itself doesn't actually dissolve.  (Not even the ones that mix well in milk actually dissolve; that's a misconception.  There are no benzos that actually dissolve in anything you can drink, although a few of them partially dissolve in ethanol, which is drinking alcohol.  But you don't want to be taking alcohol with benzos.)

 

It doesn't matter that the drug itself doesn't dissolve, though, because if you keep it well stirred while you measure, you can get a smooth enough suspension to get consistent dosing.

 

ALSO: something I always remind people who are starting liquid titration is, your transition from solid tablet to liquid is going to be a cut in itself, because you are manipulating the tablets and they are touching various surfaces and small amounts will be adhering to those surfaces.  So when you go to liquid titration, start out with your FULL dose.  Do NOT cut at first.  Just start with taking your full dose, and consider it your first cut, and treat it as a cut, holding and waiting to see how your body reacts and taking time to let the withdrawal symptoms subside before cutting again.

 

Okay, this is probably tons of information, so I'll stop now.  Let me know if you have any questions.

[[pe...]]

prhiannon,

 

Thank you!  I am planning to titrate lorazapam, so this information is very helpful.

 

Peace

[[jo...]]

Kian : Many thanks for checking my math and I take to heart your comments about the importance of relationships

in the effort to free oneself from dependence on these drugs.

Prhiannon: I am going to take your advice regarding mortar/pestle and milk--not to use either. (Kian also suggested water rather than milk for lorazopam.)I have always taken lorazopam (2.mg)only once at night (my 1990s doctor prescribed it as a sleeping pill) I've never experienced withdrawal symptoms throughout the day,even in the early hours of the morning if I am still up: it is just that I cannot now sleep without it. But your comment that one "needs multiple daily doses" of the drug suggests that i might be in a lot of trouble if I try and just reduce the once nightly dose. (I know that the drug is short acting and was unable to persuade my current doctor to do a substitute taper with Valium)May be i should begin a pattern of several doses throughout a day ..say .5 in the morning/.375 at midday/then .5 in late afternoon/finally .5 at bedtime. What do you think? Any way thanks so much for your many helpful suggestions.

My 1.75mg all are pills (the .25 was specially prepared by a compound pharmacist)

Joshua

[[jo...]]

Just one more question: should the mixture of the Lorazopam and water (an 8 day supply)be kept in the refrigerator or is room temperature OK?

Thanks,

Joshua

[[...]]

Just one more question: should the mixture of the Lorazopam and water (an 8 day supply)be kept in the refrigerator or is room temperature OK?

Thanks,

Joshua

 

I'm not positive, but if it were me, I would put it in the refrigerator for 8 days worth.  Just speculation.  This would keep the water from getting too stale.

 

Kian

[[pr...]]

Eight days, definitely refrigerate, since I really don't know what happens to these meds chemically in water over time--if they degrade, lose effectiveness, etc.  Refrigerated they will be less active chemically.

 

I make up my meds once every 24 hours or at the most 48 so I have no experience with keeping them longer, with one exception--for a while I was making up a solution of Valium which I would keep in the fridge and dose from a bit at a time.  I think the longest I kept that was about a week. 

 

Keep an eye on the solutions and if the color starts to change or anything, dump it and make up a new one.

 

Your plan for multiple daily dosing sounds good.  Everyone I know who has successfully tapered directly off a short-acting benzo (lorazepam or alprazolam) has used multiple daily dosing and liquid titration.  You can experiment and see what works best for you as far as times and doses.  The plan you have described sounds good for starters and you can tweak it if you run into trouble with breakthrough symptoms.

 

Also, by the way, benzos cause tolerance really quickly (like within a couple of weeks).  After that they really don't do much for us.  They no longer do whatever we originally took them for.  After that first few weeks, pretty much all benzos do is prevent withdrawal.  The reason we think they're helping us is because they DO help withdrawal, and we think that the symptoms they are helping are "just us" when actually they are caused by the addictive drug.

 

So probably the reason you need Ativan to sleep isn't because it's helping you sleep, it's because if you don't take it you experience the withdrawal symptom of insomnia.  You may find that when you spread out your doses so that the level of the drug in your bloodstream is staying even and smooth throughout a 24 hour period, you won't need it as much to help you fall asleep.  Although you may need to take a dose during the night. 

 

I like your plan so far, go for it.  As long as you go very slowly you should be able to tweak it as necessary with good results.

[[jo...]]

Kian and Phriannon :The mixture is going to remain in the refrigerator as advised.

Phriannon : Thanks for more of your very helpful insights.

I do face a problem in switching from one dose of  in a 24 hr period to several smaller doses over that same period. I began my taper 3 days ago and I am now taking 1.875 mg of Lorazopam having reduced my long-standing dose of 2.00mg by .125mg. (Following on your advice and that of Kian regarding taking it slow I am going continue with this dose for 33 days and then move on to the next .125 mg reduction.) The problem with switch  is that initially it causes a large overdose of the drug:

. For example on Day 1, the day before the transition,  I take 1.875 mg . By the late afternoon of the next day I will have taken 3 additional doses amounting  to 1.375 mg ; in other words , by that time I will have 3.250mg

of the drug swirling around in my bloodstream ( 1.375mg plus the previous night's dose of 1.875mg). I cannot begin the switch by initially further reducing my once nightly dose since this has already been reduced and to reduce it further (to prevent a load-up of the drug the next day) would seem to be playing with fire. What do you think? I would be very grateful for your comments on this dilemma.    joshua

 

[[pr...]]

Kian and Phriannon :The mixture is going to remain in the refrigerator as advised.

Phriannon : Thanks for more of your very helpful insights.

I do face a problem in switching from one dose of  in a 24 hr period to several smaller doses over that same period. I began my taper 3 days ago and I am now taking 1.875 mg of Lorazopam having reduced my long-standing dose of 2.00mg by .125mg. (Following on your advice and that of Kian regarding taking it slow I am going continue with this dose for 33 days and then move on to the next .125 mg reduction.) The problem with switch  is that initially it causes a large overdose of the drug:

. For example on Day 1, the day before the transition,  I take 1.875 mg . By the late afternoon of the next day I will have taken 3 additional doses amounting  to 1.375 mg ; in other words , by that time I will have 3.250mg

of the drug swirling around in my bloodstream ( 1.375mg plus the previous night's dose of 1.875mg). I cannot begin the switch by initially further reducing my once nightly dose since this has already been reduced and to reduce it further (to prevent a load-up of the drug the next day) would seem to be playing with fire. What do you think? I would be very grateful for your comments on this dilemma.    joshua

 

 

I guess you could take the 1.875 at bedtime and then break the next day's dose into only two increments, and do that a couple of days, and then go to however many increments you're going to end up with, to spread the process out over time more gradually.

 

But the whole point of multiple doses is because Ativan clears out of your body pretty fast.  At your age that will be slower than average, but it's still fast enough that you will never at any one point have that total amount in your bloodstream.

 

Personally I would say, just do it, it's just for that one day, if I'm understanding you correctly, and even if at some point you have a total of, say, 2.5 to 2.8 or even 3 mg of Ativan in your system at once, that's not a dangerous dose as far as overdosing.  Just be aware that you might be a little sedated--if you're planning to operate heavy machinery or a chainsaw that might not be the day to do it.

 

[[jo...]]

Phriannon: I am going to take a crack at spreading the dosages along the lines that you suggest.

Now that I have spent a week preparing and taking a mixture of water and  .125 of lorazopam  i can appreciate some of the errors that arise in measuring these doses (You referred to these errors in an earlier post). Cleaning out a 10 ml syringe after using it (to ensure no liquid remains in it ) requires multiple (8 to 10) attempts. And even then the next day I find a few drops remain in the syringe. And things become more complicated when you have to remove 12.5ml. (Having an additional 5 mil syringe solved this problem ).Making sure that when removing the dose, particles of lorazopam are evenly dispersed in the solution seems easier said than done. When you have 4 ounces of fluid in a 6 ounce jar this seems less of a problem but when there is only ounce or less left in the jar, it is more difficult. After stirring or shaking the jar you can see that the particles of Lorazopam immediately begin sinking to the bottom. (I am unable simultaneously stir and extract the fluid) To extract a 10 ml dose from  a jar with less that half an inch of fluid requires you to angle the jar so the syringe remains below the liquid surface and given the tendency of the particles to instantly settle, the result may well be that you are extracting too many or too few particles. My hunch is that the last dose remaining in the jar will have a higher concentration of particles than previous doses.

Thanks so much again for your thoughtful advice.  joshua