Tapering off Ativan Support Thread

[[Ma...]]

Claw,

 

I understand the psychological element can get really difficult.  I have talked to people with OCD and while I think all of us going through this tend to obsess about it, and for good reason, there does seem to be a psychological condition that some people have that goes beyond normal worrying.  People have told me they had OCD even before they went on benzos.  One woman told me she needs to touch her laundry detergent bottle in a certain way when doing the laundry.  Yes, that can be real problematic to say the least.

 

That kind of thing, I have no idea how to fix.  Perhaps there is an anxiety board out there that deals with OCD.  They might have some suggestions.

 

I think the main thing I disagree with is the spreading the dose of ativan.  You stated elsewhere that she was taking the ativan every 3 hours at one point.  I understand your wanting to stop her from doing that.  For most people, taking it four times a day is the right thing to do because that is based on the duration of action of the drug.  It lasts 6 hours.  There are 24 hours in a day.  Anything more than that is unnecessary, but anything less than that, is likely to create interdose problems.  The reason it is normally not prescribed 4x a day is very simply this:  people are resistant to taking a drug multiple times a day.  So resistant, that even in bz withdrawal, it is hard to convince people of this fact!

 

Ok I say every six hours is normally sufficient.  But there are situations when people DO metabolize the drug faster, and it might be necessary for them to dose 5 or 6 times.  I don't know how common that is, but it is possible to be a fast metabolizer.  Ativan is easily metabolized, it is one of the easiest benzos to metabolize.  I think it has one inactive metabolite.  It is different from other benzos in that regard.

 

It is typical that mornings are difficult and it gets better as the day wears on.  Many many people report that.  I think it is because mornings are when the body's systems go into 'wake up and do stuff' mode, and there are chemicals that go into play in order to help us do that.  Cortisol is one of them.  And as the day wears on and night comes, these body chemicals decline, so that the impaired CNS is not having to deal with that chemical storm so much at night, and we calm down some.

 

Diet is quite a mine field.  Most processed food is so loaded with chemicals and junk that it is bad for anyone, not just benzo heads.

I lived on boiled meat and stew for months in acute.  Eating was a trial, every meal.  The soft meat was easier to get down, and I craved the protein.  I tried to drink "Boost" but it is so processed it always made me feel terrible.

 

The soy and berries in the shake, I am not sure about the berries but fruit is sugary and sugar is pretty difficult to deal with for most people in bz withdrawal.  My personal thought on soy is that is it a product that is being pushed on the world simply because it is profitable, but it is not really healthy.  Soybeans cannot be eaten raw, they are poisonous.  They have to be specially boiled to get the poisons out.  Ok then after that, they are processed six ways from Sunday into all kinds of other things.  Think about it, what kind of alchemy and hocus pocus goes on to turn a bean into something that looks like a burger?

 

Ok, I digress   Hopefully, she will even out and stabilize.  I suspect her shakiness and difficulty after taking the pill is simply because her blood levels have dropped significantly and then doesn't get better until the blood levels have risen and the pill has taken effect.  I could be wrong on that, but that is what it seems like to me.

[[Ma...]]

MM,

 

The best thing I found for myself was to eat unprocessed foods, and stew was a big staple for me.  The good thing about stew is that you can make a large batch and it will last a few days.  Do you know how to make pot roast?  All you have to do is sear the meat on all sides, and then boil the hell out of it.  Add some onion, celery, carrots and a few potatoes to the water.  Don't add meat bullion or powdered meat gravy, that most certainly will contain MSG.  The meat itself will flavor the water.

 

You can do this same thing with a chicken, and you don't have to sear the chicken   Just put a chicken in water, add the veggies, and you will have chicken soup.  Maybe throw some noodles in there instead of potatoes. (Take the chicken out of the water, put it in the refridgerator for about 45 minutes, so that it is cool enough for you to rip the chicken meat off and throw it back in the water).

 

I could write such and eloquent cookbook

 

A few people have mentioned a gluten free diet as being extremely helpful.  Lots of people are on this diet now, I think it is a reaction to all the processed junk out there.  All that processed stuff makes people sick eventually.  Then they wind up having to do this special diet that excludes gluten.  I forget the name of the condition that people develop.  I will try to remember it.  Oh, Celiac.  It is called the Celiac diet. 

[[cl...]]

Appreciate your patience with me Mairin.

 

Got you on the 6 hour thing. I am taking it to heart. At worst I will not go past 8 hours. As you mentioned, people do metabolize Ativan at different rates.

 

Hesitate to change anything right now given her agitated state. She is now sleeping (first time in weeks). Will watch her and listen and she how she is doing. Seeing her withdrawal symptoms and at the same time the fear she has when she believe if she takes the drug it will kill her is a real rock and a hard place to be.

 

Lots of information and misinformation about Soy. Dr Michael Gregor covers it extensively in his videos. The best controlled studies from the most prestiges journals show sow is very beneficial to ones health.

 

I am but a young grasshopper at this stuff ... but I am focused and giving it my all and learning all I can.

 

Thx again, keep coaching me.

[[cl...]]

Mairin,

 

Today may be a corner turning day. Wife is beginning to understand that her symptoms are withdrawal not poisoning. She may be more open to 6 hour doses.

 

Now I need to figure out how to convert. Presently she is taking 1mg every 7 hours. It is equivalent to 24/28 * 4mg = 3.43g daily. So, for four doses that would be .85g per dose. How do I do that?

[[Ma...]]

 

 

It is difficult to get amounts like that.  I tapered using 1 mg pills for a while (I was so high up I was tapering with 2 mg pills as well at one point).

 

When I got to 3 mgs I asked my doc for .5 pills.  They can be split pretty well into quarters, and each quarter is .125.  That is a pretty reasonable amount to eliminate.

 

Using .5 pills, you could cut them up to get a dose of .875.  That would be a .5 pill plus 3/4's of a .5 pill.  That is fairly close. 

 

You can also water titrate, which is a bit of a mess, but people do it, and you can get odd amounts that way.  Also, ativan does come in a commercially prepared liquid which is 2mg/ml, I believe.  That is super concentrated in my mind.  You can also get compounded liquid in any dilution you want, if you have a doc who will cooperate in giving you that.

 

Probably the easiest thing to do would be get .5's and cut them up to get .875.  That's not a huge uptick at this dose.  Then it would just be a lot easier to cut those .5's on the way down.

[[cl...]]

Would you do a straight switch over from 3 to 4 times a day or would you do the switch with a cut also.

 

Doing 4 x .75 doses would be 3 mg. That would be about a 11% cut from where we are now. I titch high but would it be doable given we are at 3.4mg currently?

 

Wife would like to get through her prescription which is good till mid Dec before she asks the doctor for .5mg dose.

[[cl...]]

My wife had a good night. Slept before her 1 am dose and then again afterwards. I believe she is past the fear of poisoning herself and dying.

 

She still has fear as her most common symptom. However, she seems to manage her symptoms better now. I believe she is beginning to accept that symptoms (on slow tapers) can't hurt her and are a sign of healing. I ask her to repeat to herself that "her feelings are a sign of healing".

 

Hard to tell how much is her body adjusting (it has been 5 days since her last cut) or her mind learning to cope (or both). Hoping for a better day today but must be ready for what ever comes.

 

Question, if a person is in tolerance withdrawal does that mean the symptoms are always present? How does a person in tolerance withdrawal know when to cut again (besides the guidance of %5-10% every 10/14 days)?

[[On...]]

Hi clawspeak, some bb members have done symptom based tapers meaning they wait.until they feel better or best they can. In this you can proceed at your own pace: cut less and/or wait longer depending on how your body is taking it.

 

 

I'm one of the ones who didn't do any sort of custom taper in the beginning because I didn't know any better. And now I'm trying to rectify this but am probably suffering more than I could have been by this point

[[Ma...]]

Claw whether to switch to 4 with a drop or just stay on the dose is a very tough call.

 

I think the better thing to do would be to keep the drug level the same when switching to 4 doses.  It seems people find doing this switch not as hard as they thought it might be, and in fact helpful.

 

It is very hard to make cuts to odd amounts because you are constrained by how the pills divide.

 

It's a little hard for me to wrap my head around this because what you are calling a cut seems to me more of just spreading the dose apart.

 

It's good your wife is accepting this better.  Hope she gains confidence once she is out of this crisis mode.

[[aw...]]

Mairin33:

 

Lorazepam oral solution comes from the druggist at 2 mg/mL in either ethanol or propylene glycol, plus some other cosmetics. Diluted 1:10 [or whatever you need] with the same solvent it's in and you've got a nice, 0.2 mg/mL working solution.

 

Aweigh

[[La...]]

My compounding pharmacy used some type of methylcellulose microbeads as a carrier to get lorazepam into suspension at 0.5 mg/ml. Due to the carrier's high viscosity, drug "settling" during dose extraction is never a problem for me. Of course, there are many carriers one could use, my pharmacist chose this one. And 0.5 mg/ml is low enough to get me all the way down to a jumping dose as the 1 ml syringe has 10 microliter graduations on it. And a 2 month shelf life (at 4°C) aint bad either.

[[Ma...]]

My compounding pharmacy used some type of methylcellulose microbeads as a carrier to get lorazepam into suspension at 0.5 mg/ml. Due to the carrier's high viscosity, drug "settling" during dose extraction is never a problem for me. Of course, there are many carriers one could use, my pharmacist chose this one. And 0.5 mg/ml is low enough to get me all the way down to a jumping dose as the 1 ml syringe has 10 microliter graduations on it. And a 2 month shelf life (at 4°C) aint bad either.

 

Bet you never thought you'd be talking about methylcellulose microbeads with such expertise a few months ago. 

[[La...]]

Ironically, I am a neuropharmacologist by profession. Though knowing about how this drug works hasn't made the wd/sx any easier.  My knowledge and experience in benzodiazapene pharmacology is almost exclusively pre-clinical (e.g. mechanism of action, molecular physiology), so the clinical ramifications of this benzo hell were an unpleasant surprise to me.

[[cl...]]

Would love to find a psycopharmacologist that is local to central OH. My wife's symptoms have become more than I can manage. I have an appointment for her at the New Beginning Detox (newbeginningsdetox.com) in Palm Beach Fl. on Monday. They are the only clinic that follow Ashton Protocol that I could find. They also take my insurance and all major insurance except Florida Blue Cross Blue Shield. They work on an outpatient basis and will require me to be there for the first 3 weeks as the conversion takes place. During the first three weeks it is 3 hours per day 5 days per week. After that it is 3 hours once per week.

[[Ma...]]

I hope that goes well Clawspeak.  You sound like you are at the end of your rope with this.

 

There is only so much you can do as her partner.  It seems she is totally hands off and leaving this all on your shoulders.  You really can't take charge of another person's life like that, even if you are her husband.  She has to be somehow involved in this.

[[cl...]]

Mairin, agree very much. Trying to get her there. Coaching her to manager her symptoms. Will not abandon her.

[[cl...]]

Mairin, today we are switching from 7 hours to 6 hour doses. Since she is currently every 7 hours we will go to the following.

 

6 AM and 6 PM will be 1mg

noon and midnight will be .75mg

 

Does that make sense? Given her anxiety is highest in the morning I thought it would make sense to have a 1mg dose to start the day then every other dose at .75mg.

 

So we will start cutting from 3.5mg daily. Given her 7 hour dose that equates to 3.43mg daily. Thus we will start about 2% high with the new doses schedule.

 

Given here symptoms are more intense than usual, I am hoping the new schedule will even her out.

 

 

[[cl...]]

Tolerance vs Toxicity:

 

Interesting way to distinguish between the two and the appropriate course of action:

 

"There seems to be a limited exception to the slow taper rule where people find that they have a "toxic" reaction to taking the benzodiazepine (see "paradoxical symptoms" above).  There is a tricky distinction between toxic symptoms and withdrawal symptoms.  The usual way to tell the difference is to try increasing your dose.  If the symptoms reduce or stay the same, your symptoms are likely attributable to withdrawal.  If your symptoms increase, you may be experiencing toxicity, and should probably consider a faster taper (6 to 8 weeks). However, do not make a hasty decision to taper fast.  Make certain that you are experiencing toxicity first.  Generally speaking, your symptoms are far more likely to be related to withdrawal than toxicity."

 

Initially I thought my wife to be experiencing toxicity thus I was looking for a faster cut schedule. I have come to learn my wife was experiencing tolerance withdrawal and a slower schedule is favored.

 

 

[[cl...]]

Upon additional searching, we found an MD in Chicago that specializes in benzo withdrawal using Ashton. Have an appointment set in a couple weeks from now. Logistically this is much easier than going to Florida (6.5 hours vs 16.5 hours).

[[Ma...]]

 

 

IT would be ideal if you could get all the doses even, but without the .5 pills that is hard to do.  So I guess see how that goes, it may be ok.  My doses are not all even all the time either as I cut down.

 

It is hard to say if she is experiencing paradoxical effects or if it is something else.  She was taking them every three hours but was that because she physically felt she needed to do that or because she was just terribly emotionally upset?  People do weird stuff when they are very stressed.

 

Even with taking it every three hours, I don't think that should have had much of a negative effect.  Because she was still getting 4 mgs a day.  Perhaps I am wrong about that.  But ideally it should be taken every 6 hours or 4 times a day.  It doesn't have to be every 6 hours on the dot for me, the whole point is really, it needs to be evenly spaced 4 times a day.  Because three is just not enough and is highly likely to create interdose feelings.

 

A big problem I see on here is that people are dosing ativan 1x or 2x a day, and then they think they are in tolerance, because they feel bad, but really that is interdose withdrawal.  It is commonly prescribed that way because many times it is prescribed for sleep at night, and also because studies show that the more doses people have to take a day, the less likely they are to take something.  It is not based on reason or science.  So Jimmy Joe takes his ativan at night, and that is ok for a while, but then he gets addicted and starts hurting cause he is basically going through withdrawal every day.

 

But my conclusion is, look at how long the drug works.  Then take it accordingly.  Seems simple but there is just so much resistance to doing that.  The problem of course with this is that once you get to the very end, then you have to start eliminating doses.  But hopefully by that time you have such a small amount of the drug inside that it won't hurt as much.

[[cl...]]

Things I learned from using time instead of a knife for tapering ones dose.

 

Thought I would share what I learned by using time instead of a knife to taper. What was attractive about using time what it was a far more accurate way to control the dose level. What was problematic is that Ativan has a short half life and short effective life. My wife's symptoms were at a peak in the hour before and after taking her 7 hour does.

 

Another negative effect was the unusual hours one would take a dose. Unlike every 6, 8 or 12 hours, time like 6.5 hours or 7 hours means you were taking the pill at a different time each day. Using a smartphone alarm helped but still could be confusing not to mention disruptive to ones routine.

 

Did my first cut. Measured .75mg by halving and halving again and taking a half a pill and a quarter of a pill. It is frustrating to cut as you can see the variance in the halves.

 

Are there any tricks to the trade to improve accuracy while cutting a dose?

[[La...]]

"Are there any tricks to the trade to improve accuracy while cutting a dose?"

 

Absolutely. Use an analytic balance. These are accurate down to the sub-milligram level.

[[Ma...]]

 

Laser,

 

I was told by my doc that pills are do not have the drug evenly distributed throughout the pill.  That there are "swirls".

 

So that cutting the pill, you don't really know how much you are getting.  Do you know anything about that?  This has not really been a problem for me, I cut anyway, just wondering what you know.

 

And how would you get a scale like that?

 

So you have chosen compounded liquid. You think this is best?

[[cl...]]

Mairin, if what you say is true, would it make sense to crush ones pill, mix up the powder then weight out a dose?

[[Ma...]]

 

Well you could do that Claw, but really, it is generally not necessary at the dose your wife is on.

 

I don't worry about the swirls in the pills.  Does not bother me at all. 

 

Going back to Ashton, her whole theory is really based on a slow steady decline in blood levels.

 

Cutting the pills, even if it is inexact, has been fine.  You don't have to be a lab practicioner to do this.

 

Trying to get exact cuts is going to drive anyone nuts.  I don't think that really becomes too necessary until you get down to very low levels.  Your wife's dose, and even my dose, is high enough as to no cause major concern about extreme exactness.