Tapering off Ativan Support Thread

[[Ho...]]

Concerned, yes microtapering seems really complicated to me too, but it is at least an option to look into. 

 

Holding up good so far, thanks for asking.  To the day, my jump off has been the same as the cuts I made during my taper.  Today the headaches kicked in (ugh), but the dizziness seems to be lightening up a bit (yeah!).  Fatigue is still crushing but I always know that is the last to go.  The really telling thing will be how I feel in about a week from now, because I never held a cut for more than 10 days or so.

 

I know the heart racing thing is so nervewracking, but according to my PCP and my Pdoc it is completely normal when you come off of a sedative.  Unless you get really lightheaded with it, pain, or some other kind of symptom, it is probably just your body adjusting.  I don't get the heart racing, but more the pounding.      Hang in there!!!

[[Ma...]]

Hi Hoosierfan,

 

I'm glad you are doing ok so far.  You mentioned you have gotten off benzos before.  I just wanted to tell you, there is such a thing as kindling. 

 

Please look it up.  Just saying this in hopes you don't go back on benzos.

[[co...]]

hoosierfan,

 

I hope you feel better as time goes on. Yes, i think next next week will tell you more how you are doing as it is still early on. Did you generally feel better from the 6th to the 10th day, when you cut again? Did you dry cut or use liquid ativan?

 

Is it normal to start to feel a cut from the first dose or does it indicate that the other cuts are catching up?

I seem to wake up with my heart racing/or pounding. Not sure how to describe it except that i feel very anxious. It seems to come and go through the day and to quiet down after the evening dose.

 

I hope this symptom will go away after a few days and is related to the cut. I can manage for another few days of this however i would not want this to be the new baseline that i feel on a lower dose. i am going to assume it is rebound anxiety from lowering the dose and will pass as part of the withdrawal and body adjusting to the lower dose as you mentioned.

 

I am curious about micro tapering if it eliminates withdrawal or reduces it significantly, however if it is really complicated or hard to measure accurate dosing, i am not sure i can manage it. i thought about a cross over to valium however that will most likely make me very sleepy and i will not be able to work that way which i can not afford to do. i guess i will just keep going for the time being and how my body can adjust to the cuts, or i will have to keep making smaller cuts...

 

 

 

[[be...]]

Thanks, everybody!!!  The kindness of strangers is overwhelming to me.    You are all the "fingerprints of God." 

 

Concerned, I absolutely felt like the cuts caught up with me as time went on, and it took me a longer time to recover from each cut (even when my cut was a smaller amount).  In the beginning, I had about 3-4 days of yuck and then came out of it.  By the end, I never quite stabilized before I was cutting again (i.e. 7-8 days).

 

The only experience I can compare it to was when I've gotten of Klonopin in the past.  I took bigger straight cuts (i.e. from .75 mg, .25 mg each time), but did it every 4-6 weeks.  That taper was SOOOOO much easier...could have been the long half life of Klonopin, or the fact that I gave my body 3-5 weeks of rest (i.e. feeling stabilized) before I cut again.  I would think the latter was more of an effect.  All that is to say, if you can give the time, give your body time stabilized before you cut again.  I think most everyone will tell you that while it means a really slow taper, it is best for your body psychologically and physically.

 

Hopefully BDL will chime in shortly, because I know awhile back he had to hold for several weeks (I think around 5 or so) to stabilize after a certain cut, but doing so made all the difference in the world and seemed to get him feeling so great that his cuts are now easier.

 

Night, night, sleep tight everyone. 

 

Hi everyone! I'm sorry I've been away but I've been busy as heck and honestly feeling pretty good.

I have found a taper rate that is working well for me so far. I am currently at .27mg a day split into 4 doses. I moved to a liquid suspension a couple months ago to make this possible. I am coming down roughly 2 to 3 percent every 3 days. This has worked from .36 to .27 with very little problems.

I would not say I am symptom free but the symptoms are very manageable so far. Exercise helps tremendously, staying very busy with projects, remaining social etc. I will confirm what Hoosier said about having gone through a rough spot aka "hitting a wall" and holding for 5 weeks. That's when my priority shifted from getting off of benzos to just feelIng better. I slowed way down after that. From my experience, a micro taper where you come down in teeny tiny amounts more frequently is the way to go. My body just couldn't handle the bigger drops. Im not in the clear yet but steady as she goes.  I'll keep you posted. I hope you all have a great day!

[[co...]]

BDL,

When i get to around 1mg which should be later in less then a month, i am going to consider switching to a liquid suspension. Can you help me figure out what i should ask my pharmacist to order for me? How do you figure out what 2-3% is and divide that through 4 doses a day for 3 days? It sounds complicated to me. Do i need special equipment? My pharmacist said he could make me a suspension that did not require refrigeration however we did not discuss measurements as he preferred i use compounded capsules so i can have more accurate dosing that is measured properly.

 

Also, what would be the difference between my going down at 5%-6% every 7 days or 10 days to micro tapering at 3 % every 3 days which ends up being about 12% in 2 weeks? What percentage were you cutting before? Are you less symptomatic at 3% every 3 days as that can also catch up with you?

 

Perhaps you can walk me through the micro tapering so i can plan ahead and speak to my doctor and pharmacist about what i would need and buy whatever equipment it involves, if any?  It is hard for me to wrap my head around this so your help would be most appreciated!

[[Ma...]]

Bzd, I've been doing some reading and I am getting very interested in micro taper.

 

I've been reading Jana Hills stuff.  I've been told it can reverse the symptoms.  Seems a bit paradoxical, to cut more frequently, but people say it works.

 

I've spoken to one BB member who switched to this method and they said it has changed their life amazingly, they are now functioning well.  I think I really need to try this method.

[[Ho...]]

Concerned, I always used the liquid from 1.0 mg / day down.  I usually felt my w/d starting at the second or third dose cut (i.e if I cut on a Tues and always took my doses at 6 a.m., 11 am, 4 pm and 9 pm, I would start feeling w/d sometime Tuesday afternoon).

 

Yeah, BDL!!!  I was hoping you were away b/c you were doing so well.  :thumbsup:

 

Mairin, thanks for the kindling info.  I think that really explains why Ativan w/d is so tough for everyone-- because if you think about it, with a 6 hour half life, unless you are taking it 4-5 times a day, your brain is going through kindling w/d EVERY morning (i.e. there was 9 hours between my night dose and my first morning dose).  Just more evidence and theory as to why the longer acting benzos are easier to get off of, and my experience bears that out -- Klonopin was so much easier than Ativan.  And, I'm not touching benzos again!!!!

 

Today is a little better than yesterday so although the improvement is small, I see it coming.  One thing I will note is that my w/d sx seem to "wave" at the times when I used to take my dose -- i.e. I about fell over in Lowe's this morning from dizziness at about 10:45, and I always had a dose at 11.  Crazy how precise the brain can be.

 

(((hugs))) to everybody....have a great weekend!!!  Cheers!

[[co...]]

Hoosierfan, As you always used the liquid and started at 1mg, how would I order it? What should I ask my pharmacist for? Amount in ml?

How do you measure the percentage you want and divide it into doses? As you did it, I would imagine it would be a similar process to microtaper. Did you need to buy any special equipment?

My pharmacist said that he could make one up that did not require refrigeration, however he did not think I would be able to reduce at 1% daily....He is less experienced with liquid and encourages me to stick with the compounded capsules for better control and accuracy.

 

Also, when you had heart pounding, how long did it take for that symptom to pass? I hope this is not going to be the way I always feel on a lower dose. I think it is withdrawal and rebound anxiety....I am now on 1.17 and when I started a month ago I was at 1.50, so that is a big drop.

 

Going forward I will do smaller cuts, however it is finding the right balance between smaller cuts and prolonging the process...

 

You must feel so happy to be done with this!

[[Ma...]]

I'm no expert on kindling, I've just been warned about it.

 

I've heard that, that ativan may run out of your system.  BUT, 6 hours is just the half life, so really its in your system for 10-12 hours, from what I've read.

 

But yes, it probably does add to the difficulty of withdrawing.

 

All benzos have different effects.  They all present their own problems.

[[Ho...]]

Concerned, the way my compounding pharmacy worked, they needed a specific script from my PDoc.  So, she and I worked out a "convenient" concentration that I could work with over the month, and then we did the math.

 

Ok, example:  The month that I was on .85 mg / day (total), .7 and .55, she wrote a script for a .85 mg / ml concentration, and 30 ml.  So, for the first week I took .25 ml with each dose (.85 mg / ml x 1 ml = total dose for day .85 mg.  Divide 1 ml / 4 doses = .25 ml per dose).  Second week I took .205 ml with each dose (.7 mg /  ml x .82 ml = total dose for day .7 mg.  Divide .82 ml / 4 doses = .205 per dose).    And so on.......I had both my Pdoc and the pharmacist confirm my daily dose based on the concentration I was taking, just to make sure I got the math right!!!

 

My pharmacist gave me 1 ml syringes that had 100 demarcations on them.  So, yes, it would probably be pretty difficult to get the really small cuts UNLESS you hav them make up the compounded liquid at a low concentration -- i.e. if you have .25 mg / ml liquid, every 100 of the demarcations is .0025 mg.  If you have 1 mg / ml liquid, every 100 demarcations would be .01.    So, maybe if you want to make really small cuts, ask your doc to write the script for a low concentration liquid, and just a lot more ML.

 

Does that help?

 

On the symptoms, here's what I always stick to -- if it wasn't something I experienced pre-benzo, its a side effect or w/d and IT WILL go away!!!

[[aw...]]

Concerned, I always used the liquid from 1.0 mg / day down.  I usually felt my w/d starting at the second or third dose cut (i.e if I cut on a Tues and always took my doses at 6 a.m., 11 am, 4 pm and 9 pm, I would start feeling w/d sometime Tuesday afternoon).

 

Yeah, BDL!!!  I was hoping you were away b/c you were doing so well.  :thumbsup:

 

Mairin, thanks for the kindling info.  I think that really explains why Ativan w/d is so tough for everyone-- because if you think about it, with a 6 hour half life, unless you are taking it 4-5 times a day, your brain is going through kindling w/d EVERY morning (i.e. there was 9 hours between my night dose and my first morning dose).  Just more evidence and theory as to why the longer acting benzos are easier to get off of, and my experience bears that out -- Klonopin was so much easier than Ativan.   And, I'm not touching benzos again!!!!

 

Today is a little better than yesterday so although the improvement is small, I see it coming.  One thing I will note is that my w/d sx seem to "wave" at the times when I used to take my dose -- i.e. I about fell over in Lowe's this morning from dizziness at about 10:45, and I always had a dose at 11.  Crazy how precise the brain can be.

 

(((hugs))) to everybody....have a great weekend!!!  Cheers!

Hoosierfans:

I'd be very interested to know what you experienced that made K so much easier than A to taper from. I thought I was going to be tapering off A, but the more I learn the more it it looks like I'll be tapering off K, and I believe this is what is often recommended.

From what I've read, the half life of Ativan can vary quite a bit with age, kidney health, and other factors. It can even vary somewhat within a single individual over time. What I've seen agrees fairly well on ~12 hours being the elimination half life for Ativan in healthy adults. The confusion may come from the fact that A's duration of action (how long there is still enough A in the blood to have a significant effect) is around 6 hours. And to make it more confusing, the half live and duration of action are not related in a simple, intuitive, linear way. Oh, well.

Just saw your most recent post with all the numbers. No wonder some folks are intimidated by titration methods! The post makes sense to me. Perhaps you also have the options of having the pharmacist dilute the concentrated solution or... DIY!

 

Aweigh

[[be...]]

Concerned, you shouldn't have to figure all of the math out. Your doc or pharmacist should do that. I'm not sure of the exact concentration of my liquid but it's something my pharmacist came up with. I'm just coming down one mark on a syringe every 3 days. Its not exactly 3percent. That's just rough.

My taper is something I came up with. Which is what you should do. The key is just small frequent cuts. Mine isn't proven or anything. It's just working for me right now. I'm not there yet. Just whatever you can do to avoid larger drops in dose the better you will feel. It's that simple.

[[co...]]

Hoosierfans, 

 

Thank you for taking the time to explain what you did in such detail. Although you explained it very well it still seems complicated to me as i am challenged in math. The relationship between 85mg/30 ml. is what confuses me. In the second week you had .7/82mg. Is that because you had less from the first week?

 

Also, when the doses are .205 or very specific is it hard to measure it out with the syringe? Did your solution have to be refrigerated? I suppose it was a suspension?

 

Did you find that using the liquid caused any less withdrawal then when you used the dry cut or was it just more convenient?

 

As you went down quickly and every week, were you in continuous withdrawal or did you have periods of adjustment before the next cut?

 

If i go this route i would have to speak to my pharmacist and doctor and perhaps they can explain it to me or show me specifically how to measure and what to do.

 

This is the reason i am taking the compounded capsules as they are pre-measured for me. Once my pharmacist returns in September, i can then adjust the percentage each week based on my symptoms but for now i am stuck with the next 2 cuts which will be 6 and 7% each for two weeks each cut after this 6% cut i recently began and will be completing now in August 8th.

 

I also hope to learn more about micro tapering by then and liquid suspension options and explore those as alternatives with my pharmacist and doctor.

 

 

[[co...]]

BDL,

I just read your post after i replied to Hoosierfans. When you say you go down one mark every 3 days, how would i split my doses those days into 4 doses a day?  Is this self explanatory when the pharmacist shows it to you? Is yours refrigerated? I guess i am so used to pills and now capsules that i am having trouble visualizing this new method.

 

When you say small but frequent cuts. Would 5% every 7 days do the trick or 6% every 10 days? Does it have to be 2-3% every 3 days to avoid withdrawal as micro tapering is supposed to somehow bypass the strong withdrawal process. How many days would be the longest i can hold a cut based on micro tapering and can i go as high as 5% or it is best to keep it at lower amounts?

 

Before you did this how much were you cutting at a time? it sounds like you are not having much withdrawal using this method. if so, that is great. Thanks for chiming in on this as i would like to learn all i can about this now and prepare myself if a change is indicated. I can"t imagine continuing to feel this way continuously for 6-8 months more. There has to be an easier way to do this.

[[Ho...]]

Aweigh,  you are right about the half life v. the effective time.  With Klonopin, my highest dose ever (about 3 yrs ago) was .75 mg.  Along with my Pdoc, we agreed on a taper of .25 every 4-6 weeks.  The only side effects I had was some insomnia for the first couple of nights.

 

Ativan has been SOOOOO different; the side effects from being ON it were so much worse for me (constantly fatigued, dizzy like I'd been drinking, bad brain fog, horrible headaches, muscle aches, depression) than Klonopin, which I tolerated quite well.  In fact, Ativan made me so sick that I had to stop working.  Probably the same mechanisms that made the Ativan intolerable for me also made the withdrawal so much worse (chemical compound, effective time, short half life).

 

Concerned, yes the liquid was refrigerated suspension.  The liquid and the dry cutting caused the same amount of withdrawal for me.  Early on I had times of "stability" before I cut again, by the end I would say I was in continuous withdrawal. 

 

Let me try and explain the math again.    The measurements don't change as the amount of liquid goes down because the concentration is consistent throughout the suspension.  So, it doesn't matter how much liquid you have (i.e. 20 ml, 30 ml, or x ml), it just matters what the concentration is, and then you figure out your measurements from there. 

 

So let's say you have a .85 mg / 1 ml suspension.  And you want to take a daily total of .7 mg.  Here's how you do the math:

 

Step1.    .85 mg / 1 ml = .7 mg / X ml

Step 2.  Solve for X by multiplying across.  .85 mg x X ml = .7 mg x 1 ml;  .85 mg x X ml = .7 mg / ml; Get X by dividing .7 mg / ml by .85 mg.

Step 3.  So .7 / .85 = .82 ML (the total amount of ml of your concentration you want to take during the day)

Step 4.  Divide your total by the # of doses;  if 4, .82 / 4 = .205 ml per dose

 

Here's another example.  Let say same concentration, but you now want to take .6 mg per day.

 

1.  .85 mg / 1 ml = .6 mg / X ml

2.  .85 mg x X ml = .6 mg x 1 ml

3.  .85 mg x X ml = .6 mg / ml;  X = .6 / .85; X = .705 ML

4.  .705 ML / 4 doses = .176 ml per dose

 

It's not hard to keep track of -- I would suggest you have the pharmacist confirm your math based on the dose you want to take, and then put it on a calendar!!!  On my calendar I put my total dose for the day and then underneath it the amount in ML I needed to take with each dose.  Made things pretty easy!

 

[[co...]]

Hoosierfans,

 

Thanks for your patience with me. I think i understood it better this time. Is it easy to measure out .205 and .176 on the syringe or doses that are that specific? Is it that accurate?

 

If i do micro tapering, as you indicated then i would probably need a different formula to handle smaller cuts as you mentioned,  however i can discuss that with my pharmacist.

 

i think micro tapering has to be very small cuts like 1, 2 or 3 % every day or every few days for it to not cause withdrawal. I don't know if 5% every 7 or 10 days would have the same effect? If so, i can have smaller percentages such as 5% compounded every week, or through a suspension. I thought if i did 5-6% every 10 days i should not feel very much withdrawal however that does not seem to be the case this time, unless this particular cut of 6% is hard because i cut 24% through this whole month from when i started to taper and it caught up with me.

 

You tapered at more then 20% every week to 2 weeks, which must have been very difficult. if you did so much better on Klonopin, why did you not cross over? My doctor originally suggested i cross over to klonopin however that made me very sleepy during the  day and ativan does not. This is the reason i did not cross over to valium as well.

 

In any case, i appreciate the math lesson and it is giving me information and some new options to think about.

 

[[aw...]]

Aweigh,  you are right about the half life v. the effective time.  With Klonopin, my highest dose ever (about 3 yrs ago) was .75 mg.  Along with my Pdoc, we agreed on a taper of .25 every 4-6 weeks.  The only side effects I had was some insomnia for the first couple of nights.

 

Ativan has been SOOOOO different; the side effects from being ON it were so much worse for me (constantly fatigued, dizzy like I'd been drinking, bad brain fog, horrible headaches, muscle aches, depression) than Klonopin, which I tolerated quite well.  In fact, Ativan made me so sick that I had to stop working.  Probably the same mechanisms that made the Ativan intolerable for me also made the withdrawal so much worse (chemical compound, effective time, short half life).

HF: So you did a microtaper this time, from Ativan like your sig says, without c/o to K, and it was much worse than 3 years ago when you tapered from K? Just want to make sure I'm on the same page with you.

Aweigh

[[zo...]]

And to make it more confusing, the half live and duration of action are not related in a simple, intuitive, linear way.

Hello Aweigh. I wonder if you have seen this summary about selecting benzos at http://www.ncbi.nlm.nih.gov/pubmed/1980860 ......

 

Although the time to peak plasma levels provides a rough guide' date=' it is not equivalent to the time to clinical onset of effect. Two half-lives can be described: the alpha half-life, the rate of decline in plasma concentrations due to the process of drug redistribution from the central to the peripheral compartment, and the beta half-life, the rate of decline due to the process of drug elimination due to metabolism. The frequent classification of benzodiazepines into long, intermediate, and short-"acting" categories based on their terminal beta half-lives is unfounded; the duration of action is much more dependent on the alpha half-life.[/color']

 

-Zoner

[[Ti...]]

Just wanted to let you guys know that today I am officially Ativan free--but NOT benzo free.  I am still on 1.25 mg. Valium.  I could only crossover halfway from Ativan to Valium last February--I could not complete the cross over since the Ativan w/d were too strong.  Ativan had dug its claws in deep.

 

It took me 4 months to taper from .09 to 0 mg. Ativan.  I wish I was benzo free-but at least I am Ativan free.  Now I have to taper the 1.25 mg. of Valium that I have been on since February.  Ugh. 

 

If I had only tapered the Ativan slowly from day 1 and not tried going to fast, doing abrupt cross-overs, etc., I would be Ativan free today.  I hope others can learn from my mistake (well, I listened to "advice" from 3 doctors--so actually not my mistake).  If I had only listened to my body and not doctors, I would be benzo free today.

 

I tapered Ativan using a compounded suspension .25 mg/5 mL.  The pharmacist used fixed oil, stevia and the crushed Ativan pills.  I drew out directly from the bottle.  Shake it well!

 

Good luck to all of you.  I am now going to begin leg 2 of this journey and begin tapering using liquid Valium in the next week or so.  I hope to be off of everything in about 6 months.  Slow, slow, excruciatingly slow--but for me, it has been the only way...

 

Tina

[[co...]]

Tinca,

Congratulations on getting off of Ativan. You are are almost free from Valium as well.

 

As i am considering crossover to valium or micro tapering ativan or just reducing my cuts and using liquid ativan... so i wanted to ask you some questions to help me decide what route to take based on your experience.

 

I am hesitant to cross over to Valium as i know it makes me sleepy and i can't imagine being able to work and function normally on it. It sounds like it did not work for you?

 

Can you let me know how often you cut and at what percentages? Did you have strong withdrawal or milder withdrawal? How many times a day were you dosing? Did the formula you use take you all the way down to 0?

 

Although i am reducing the  amount i cut each time and holding for 2 weeks, it does not seem to be working as this last cut of only 6% has been very difficult and my anxiety symptoms are ongoing for the first time since i started this taper. It is my 5Th day today so i hope it will pass however i am looking into alternate and easier ways to go about this as i will be on this for another 6 months or more..

 

i am interested in learning from your journey. I also want to thank you for starting this thread as it has been very helpful to me...

 

[[aw...]]

Zoner:

No, I haven't seen that one. Thanks for the link, it's very interesting. I'm leaning toward a c/o to Valium or Klonopin for the taper. Ativan has difficult metabolism.

 

Aweigh

[[Ma...]]

Congratulations Tina!  Try to relax and take it slow on the V.

[[be...]]

Just wanted to let you guys know that today I am officially Ativan free--but NOT benzo free.  I am still on 1.25 mg. Valium.  I could only crossover halfway from Ativan to Valium last February--I could not complete the cross over since the Ativan w/d were too strong.  Ativan had dug its claws in deep.

 

It took me 4 months to taper from .09 to 0 mg. Ativan.  I wish I was benzo free-but at least I am Ativan free.  Now I have to taper the 1.25 mg. of Valium that I have been on since February.  Ugh. 

 

If I had only tapered the Ativan slowly from day 1 and not tried going to fast, doing abrupt cross-overs, etc., I would be Ativan free today.  I hope others can learn from my mistake (well, I listened to "advice" from 3 doctors--so actually not my mistake).  If I had only listened to my body and not doctors, I would be benzo free today.

 

I tapered Ativan using a compounded suspension .25 mg/5 mL.  The pharmacist used fixed oil, stevia and the crushed Ativan pills.  I drew out directly from the bottle.  Shake it well!

 

Good luck to all of you.  I am now going to begin leg 2 of this journey and begin tapering using liquid Valium in the next week or so.  I hope to be off of everything in about 6 months.  Slow, slow, excruciatingly slow--but for me, it has been the only way...

 

Tina

 

 

Tina! So awesome that you are off of the Ativan! that's such a big deal. I have a feeling things will gradually get easier for you from here on out. Are you microtapering the v now? Good luck and great job on you perserviernce.

[[co...]]

This question is for BDL,

I am looking into liquid suspensions for Ativan and a few pharmacist said it would not be possible to make a suspension for my dose which will be around 1.15 or 1mg when i begin at 4 times a day where i would be able to go down between 1-3% every few days.

 

It would be helpful if you shared what formula you used in mg/ml? Also, how many times a day you dosed and from what amount you started the liquid formula? Perhaps it was at a much lower dose. i assume it needed to be refrigerated? if not, what did they use in the suspension?

 

Thanks in advance. I know you are doing much better with this method so i would like to begin researching how to go about using this and find a compounding pharmacy who could do this for me.

[[be...]]

I started liquid at .75 I think. But I think you should start whenever. My solution is .4 mg per 1ml of solution. I don't know why they did it that way but that's what it is. But I would suggest 1mg per 1ml of solution. This makes the math very easy. If you are at 1mg then you would divide that into .25 ml 4 times a day. And then just take away 1/100 of a ml everyday. This will take 100 days aka 3 months give or take.

 

If they will not make you this solution then make it yourself with whole milk and crushed pills. As I understand it, this seems to be working for others.

 

Hope this helps.

 

 

BDL