Tapering off Ativan Support Thread

[[Ma...]]

The only reason I am asking Laser about it is out of curiosity.  I am not going to be using that anytime soon.

 

I don't know, maybe it is because I was on the mother of all doses at one time, but I don't worry about exactness.  I do notice other people do.  It has just not been an issue for me.  Maybe because I was in pretty bad withdrawal for a long time, that I just don't obsess about exactness.  I am infinitely better than I was a year ago, even with cutting inexactly.  I still got my dose down.

[[cl...]]

Mairin, your taper is very impressive. It is apparent you have learned the core mindset of Ashton : confidence, patience and chart your own path.

 

Have you noticed any reduction in symptoms as you have reached lower doses?

[[Bi...]]

A great trick I learned the hard way is to take more of my Ativan dose at bed time.

I put my daily scale weighed dose in water with a pinch of xanthan gum to thicken it.

Then pour it into 4 medicine bottles just eyeballing them. I use an eye dropper to get the levels perfect.  Notice that 3 bottles are the same level and one is double that level?  That third bottle with double the water/med level is the night dose. The last bottle I drink at 5AM when I wake up to pee, then back to bed for a few hours.  I am sleeping very well and cutting too.  My brain like's this trick.

 

I'm dosing every 6 hours. 11AM-5PM-11PM (the big one) and 5AM

http://i1296.photobucket.com/albums/ag4/birdman22222/bottles_zpsa55dd184.jpg

[[Ma...]]

Hi Claw,

 

Yes I did get better on the way down.  But, my situation was different from your wife.  I was on a high dose of klonopin, and got completely off klonopin by switching to ativan.  I went into a very long and acute withdrawal from that.  I think a lot of what I was going through, now that I look back on it, was recovering from the removal of klonopin.  So, very different from your wife's situation.

 

But I found this, and this may be what is going on with your wife:

 

Paradoxical effects: In some cases, paradoxical effects can occur with benzodiazepines, such as increased hostility, aggression, angry outbursts, and psychomotor agitation. These effects are seen as more common with lorazepam than other benzodiazepines.[46] Paradoxical effects are more likely to occur with higher doses, in patients with pre-existing personality disorders and those with a psychiatric illness. Frustrating stimuli may trigger such reactions, though the drug may have been prescribed to help the patient cope with such stress and frustration in the first place. As paradoxical effects appear to be dose-related, they usually subside on dose reduction or on complete withdrawal of lorazepam.[47][48][49][12][50][51]

 

So maybe these severe reaction will decrease when she gets down in dose.

 

Bird, ok I see you have medicine bottles now   No more pudding   Good idea though.

[[Bi...]]

Bird, ok I see you have medicine bottles now   No more pudding   Good idea though.

 

Mairin;  I tried pudding but I can't get my spoon in the bottle.

[[cl...]]

Mairin, my wife does have a bit of drama queen in her personality. It is amplified as she withdraws.

 

She is a bit better today. I think I am also getting better at managing her symptoms. Learning that keeping her calm helps. She can't yet be convinced she will be OK yet she welcomes endless affirmations that she will be, and I do mean endless.

 

Glad to hear you say that your symptoms improved as your dose lowered. We are approaching the 6 PM dose. We have not yet decided if it will be the .75mg dose or a 1mg dose.

 

If she choses .75mg dose she will be at 3.25mg daily, if she choses 1mg she will be at 3.5mg daily. Will update my signature based on her choice.

[[so...]]

I appreciate in advance insights and support that can help me to successfully get off .5mgs of Ativan and 7.5mgs of Immovane.  I take these to help me sleep.  When i missed a dose of Ativan the other night, the next day (mid-day) i felt confused and had clammy, sweaty hands. I have taken Ativan at night (.5mgs) for 11 months and Immovane 7 months. I am at a loss for how to proceed. Should I try to taper off these two simultaneously?  Do i need to cross over to Valium equivanlents for each seperately or together? The Valium equivalent is 10mgs in total. The Ativan tablet is sublingual and very small.  thank you very much for your help. 

 

If i proceed first with Ativan, I have this proposed plan that includes Valium cross-over:

 

              Night time Daily DiazepamEquivalent

Starting dosage Ativan .5mg 5mg

Stage 1

(1 week-2 weeks) Ativan .25mg

                            diazepam 2.5mg 5mg

Stage 2

(1 week-2 weeks) Ativan .125

                            diazepam 3.75mg 5mg

Stage 3

(1 week) Stop Ativan

                            diazepam 5mg 5mg

Stage 4(1-2 weeks) diazepam 4mg 4mg

Stage 5 (1-2 weeks) diazepam 3mg 3mg

Stage 6 (1-2 weeks) diazepam 2mg 2mg

Stage 7(1-2 weeks) diazepam 1mg 1mg

 

[[La...]]

Mairin:

 

I don't know if the drug substance is evenly distributed throughout the pill, or not (e.g. swirls). If one assumes the worst, and it is in swirls, crushing the pills and weighing the powder would circumvent any uneven distribution in dosing only a portion of a pill. But that requires a scale/balance. I tend to doubt that drug is NOT uniformlay distributed throughout the pill, but I am just guessing. There are some really accurate digital scales out there, but the most accurate, an analytic balance is cost prohibitive. I merely mentioned it as a tool, in the event one has access to such a device (you can weigh a single granule of salt on it).

 

For me, the compounded liquid has been the best. When I realized that dry cutting pills was not accurate and this would cause fluctuations in my daily dose, I knw I needed an alternative approach. Furthermore, trying to cut pills into 1/8s, even with a razor blade was very inaccurate. The compounded liquid gives me the opportunity to dial in any dose, no matter how small the % increae or decrease is from the previous day with exacting precision. Pharmacologically speaking, it is no different from the dry pill. I am not advocating this for any one person but merely stating what my approach was and the rationale behind it. At some point in my taper I will go from 0.15 mg daily to 0.07 mg.There would be no possible way to do this with a tablet.

 

I should also note, that my wd/sx are getting much better as my dose goes lower. It seems that a 10% drop in drug leads to, not a 10% drop in symptoms, but a much much bigger drop. I feel SOOO much better with each 10% drop.

 

Yesterday I met with a Psychiatrist (for the first time) and discussed my tapering plan which is based on the Ashton guidance. He was familiar with it but thought it was excessively slow and generally guides his patients to do 10% dose cuts each week, using 10% off the STARTING (not current) dose. Which for a taper from 1 mg A, would look like, 1.0, 0.9, 0.8,...you get the idea. I am not advocating this to anyone but just reiterating what his position was. Of course he stated that if that is too fast for someone, they can slow it down. It was an extremely expensive DR visit, but given my situation, I am willing to do anything to get back to normal (drug free with no insomnia).

[[Ma...]]

 

HI SoulPilot,

 

Your plan looks perfect and it is just what Ashton would recommend. 

 

However, it might be advantageous to try cutting the ativan down first, and see how that goes, before switching to valium.  .5 is not a very high dose.  Ashton's patients had already tried to cut their own drug and failed, which is why she suggested valium.  But, really that is not always necessary to do.  Most people can get off just fine from their starting drug.  In fact, that is what BB recommends. If you look at the posts by Colin and the reduction tables on this website, it is recommened to just cut your own pills.

 

The advantage to at least trying to cut ativan first is that you will avoid any possible complications that may come from switching to valium.  Switching from one drug to another can turn out to be problematic for some.  Valium has far more metabolites than ativan.  Ativan only has one inactive metabolite, whereas valium has many active metabolites, and the metabolites in valium accumulate in the body.

 

You've been on it less than a year.  This may not be too hard for you.  It might just be better for you to get ativan in liquid form from a compounding pharmacy, and reduce it every week or two by a small amount.  Maybe like, .5 > .45 > .4 > .35 > .3, etc.

 

A big problem I see over and over is that people get prescribed ativan and told to take it once a day at night, for sleep.  That works fine for a while until a person's body gets dependent on it, and then taking it only once a day starts causing withdrawal because ativan only effectively lasts 6 hours.  So breaking up the dose into 2, 3 or 4 doses a day is often helpful.

[[La...]]

"A big problem I see over and over is that people get prescribed ativan and told to take it once a day at night, for sleep.  That works fine for a while until a person's body gets dependent on it, and then taking it only once a day starts causing withdrawal because ativan only effectively lasts 6 hours.  So breaking up the dose into 2, 3 or 4 doses a day is often helpful."

 

I was prescribed ativan once per day to be taken at bedtime. When I became dependent on it (only took several weeks), I started noticing an interdose withdrawal. But to be honest, it only appeared in the evening (between 8 and 10 pm) a few hours before I was scheduled to take my normal evening dose (11 pm). And for me, it was very minor wd/sx as compared to the whopping sx/wd I would get from a 25% dose cut in the beginning of my taper. This is just my story. I realize that some folks can get bad IDW, for me though, it seems minor and easily manageable. Whether I was getting IDW at 1 mg daily, or now at 0.555mg daily.

 

 

[[Ma...]]

 

 

Yes, not everybody has to go to 4 doses a day.  Two doses may be just enough for you.  This is something that seems to get worse over long periods of time on the drug, and also at higher doses.

 

The 6 hour duration of action is going to vary from person to person, and also I think, that is effected by length of time on the drug as well.  I used to take 1 mg once a day and that was fine for me for a very long time.  Years.  No way could I do that now.

 

 

[[cl...]]

Day one of my wife on 3.25mg Ativan per day. Less than a 5% cut after a week at 3.42mg daily.

 

Doses are as follows

6AM - 1mg

Noon - .75mg

6PM - .75mg

Midnight - .75mg

 

We will hold this for a week and see if she is ready to go to 3.0mg daily.

[[Bi...]]

"A big problem I see over and over is that people get prescribed ativan and told to take it once a day at night, for sleep.  That works fine for a while until a person's body gets dependent on it, and then taking it only once a day starts causing withdrawal because ativan only effectively lasts 6 hours.  So breaking up the dose into 2, 3 or 4 doses a day is often helpful."

 

I was prescribed ativan once per day to be taken at bedtime. When I became dependent on it (only took several weeks), I started noticing an interdose withdrawal. But to be honest, it only appeared in the evening (between 8 and 10 pm) a few hours before I was scheduled to take my normal evening dose (11 pm). And for me, it was very minor wd/sx as compared to the whopping sx/wd I would get from a 25% dose cut in the beginning of my taper. This is just my story. I realize that some folks can get bad IDW, for me though, it seems minor and easily manageable. Whether I was getting IDW at 1 mg daily, or now at 0.555mg daily.

 

 

 

Yes my worst time is always in the evening between 8 and 10 pm too and I dose 4 times a day :'(

The pattern is hard to stop after 5 years.

[[cl...]]

Day 2 of Wife's Conversion to 4 times per day.

 

My wife has become more "even". Her fear is constant but less severe. She still is very OCD though but to a lessor degree. It takes much coaching and hours or time to get her to complete a task.

 

Mairin's guidance on the 4 dose per day it right on the money. Hoping to see additional improvement until we see the doctor in 2 weeks from tomorrow (Sat appointment).

 

[[La...]]

 

[[cl...]]

Green Smoothie Recipe - Has helped my wife with sleep, calming, stomach upset and stabilized weight

- 2 cups organic soy milk (rich in animo acids,

- slice of ginger (calms the stomach)

- 10 dates (high in potassium, will not spike the blood sugar)

- handfull of almonds (protein, high in magnesium and contains melatonin, protects heart)

- 2TBS Flaxseed (high in Omega-3)

- 2tsp Amla Powder (Indian Gooseberry, highest antioxidant food on the planet)

- 3 or 4 small frozen broccoli spears (very powerful aid to detox the liver)

- dozen or so spinach leaves (greens help minimize depression, rich in phytonutrients)

- 1 cup blueberries (high in antioxidants)

- 1 cup mixed berries (high in antioxidants)

 

Blend in Vitamix, Blentec or other powerful blender. Rich in fiber which helps with intentional upset.

 

Very healthy drink for detoxing. Nutritional information not based on antidotal evidence but peer reviewed journals (double blind cross-over studies). Check out nutritionfacts.org. Dr Michael Gregor dedicates his life to making known scientific nutritional information for all.

 

My wife drinks her green smoothies three times a day. Odd thing is, before tolerance withdrawal she would not drink a smoothie. Now she is living on them.

[[aw...]]

 

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.

 

Hi, Mairin: And how would you get a scale like that?

 

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

 

Hi, Mairin:  That (presumabely all) pills have "swirls" and so cannot be divided evenly is such an outrageous and harmful thing to tell a patient, I'm shocked down to my sox.  Perhaps the good doctor was referring to sustained released tables, some of which do have swirls, and someone got confused. Let's hope so. I worked in a lab whose PI sat on the Federal panel that deals with exactly these questions--is the tablet homogeneous within the doseage unit, and are the tablets identical within the batch? I've no doubt plenty of regulators are in bed with Big Pharma, but I'd sure hate to be the company QC officer who tried to pull a fast one on Dr. B. He'd make beef jerkey out of you. Also, tabs are made in 1000 kilo batches, so they tend to come out the same just because of the order of scale of the synthesis. I'm more concerned with the properties of the drug itself [how well was it tested?] than how carefully they manufactured it.

 

I'm not certain that even the $1,500 required for an analytical balance would ensure really high-accuracy dry cutting. There's various weird problems at microgram levels, like static electricity effects, plus the question of pill homogeneity becomes more significant. I really think liquid is the way to go at this very small weight level.

 

Aweigh

[[On...]]

Hi mairin, I was wondering Iknow you said something a while back about valium and it having a klonopin metabollite?

Just curious if that's what you said because I can't quite remember

 

Thanks oneday

[[Ma...]]

Ok Aweigh, that is interesting, so you are saying the pills are homogeneous with the drug all the way through?  Well that would be good then.

 

 

Yes OneDay, my doc said that klonopin or clonazepam is a metabolite of valium.  I have tried before to look up the metabolites of valium, the only thing I found was that it has three main ones and several other ones, but I could never find a list that spelled it out or listed them all clearly.

 

You could google "metabolites of valium or diazepam" and see what you find.  It seems to be very hard to find very specific information.  I have read that ativan has 1 metabolite that is inactive, whereas valium's metabolites are active.

 

Hugs.

[[Ma...]]

Ok so the three main metabolites of diazepam are nordiazepam, oxazepam and temezepam.

 

Really I have tried to find a list of the other metabolites of valium, but that seems to be specialized clinical information that is just not out there on the web.  It is frustrating.  I found a very scientifically worded article that was talking about identifiying the major metabolites, and there is implied in that the suggestion that there are other metabolites.  But, really I cannot find any information on what exactly they are.  My doc told me k is a metabolite of valium.  Ok so it may be quite minor, I really don't know.  So I guess nobody should freak out about k being in valium lol.

 

The three main ones I listed.  Those are drugs in and of themselves and they are part of what makes valium stay so long in the body. 

 

I am kind of sorry I said that, about K being a metabolite.  I just repeated what my doc told me after I asked him why he does not like valium.  Maybe he was trying to scare me away from it because he knows I am afraid of K.  who knows lol

 

[[La...]]

"I'm not certain that even the $1,500 required for an analytical balance would ensure really high-accuracy dry cutting. There's various weird problems at microgram levels, like static electricity effects, plus the question of pill homogeneity becomes more significant. I really think liquid is the way to go at this very small weight level."

 

Aweigh: First, let me agree with you that liquid is the way to go at small weight/dose levels. But I will disagree with you that an analytic balance does not ensure high accuracy dosing. I formulate drugs for a living for the purpose of dosing. I use an analytic balance to deliver ridiculously small doses and HPLC analysis of my formulations confirms that they are accurate to a very high degree. Unlike some other compounds, static electricity is not a problem for Ativan, but even if it were, one could discharge the static before weighing thus eliminating fly away during weighing. Finally, inhomogeneity of drug throughout the pill is not a concern if one weighs the crushed powder as at that point, drug is distributed uniformly.

 

Also, none of us really needs to weigh microgram levels of drug. since the drug substance is blended with excipient we are really weighing milligram levels of drug. Unless we are talking about weighing out a single dose of LSD....

 

[[Ma...]]

 

 

I see a lot of anxiety over exact dosages on here.  I've been cutting for a year and a half, and I am totally sure it was not accurate to the nth degree

 

I dont' think its really necessary, and particularly when you are eliminating the drug and going down on it, to get anal about nano-milligrams.  Really not.

 

I may be singing a different tune when I get below .25 or something, but at the higher levels, it just really does not seem to make a difference, whether you get .75 or .71 for a single dose, especially if you are dosing .75 4x a day.  You will get slightly different doses each time, but not significant variation.

[[Bi...]]

 

 

I see a lot of anxiety over exact dosages on here.  I've been cutting for a year and a half, and I am totally sure it was not accurate to the nth degree

 

I dont' think its really necessary, and particularly when you are eliminating the drug and going down on it, to get anal about nano-milligrams.  Really not.

 

I may be singing a different tune when I get below .25 or something, but at the higher levels, it just really does not seem to make a difference, whether you get .75 or .71 for a single dose, especially if you are dosing .75 4x a day.  You will get slightly different doses each time, but not significant variation.

 

Hi mairin,  You could be right.  There are so many other variables too that can kill 30% of a dose like grease.  About 2 months ago I ate greasy deep fried fish and chips and it sat in my stomach like a brick of lead!  I took my night dose and it had NO EFFECT.  I think it sat in the grease.  It took me 48 hours to get right again.  If what we eat and when we eat has this much effect I wonder why we are so fanatical about accuracy some times.  If a person is going to worry about being so accurate then a person should also dose two hours before or after eating and no heavy foods with oils, fats, grease or butter or all the accuracy in the world is not going to work very well anyhow.  Benzo's stick to fats and oils like glue.

[[cl...]]

My wife had a better day today. While she says her symptoms were about the same, her ability to manage them improved. She is coming to accept where she is and that it will take time to heal ... and most importantly, that she will heal!

 

I don't see the psychological symptoms controlling her today. Instead I see my wife attempting to manage her symptoms. Hope this is a turning point for her.

 

This is her 5th day at 3.25mg of Ativan. On Thursday she goes to 3mg. We will hold there until we see the Benzo Wize doctor is less than two weeks.

[[...]]

Hi Bird

I also think there is some  variation in absorption and bioavailability depending on diet and the state of our GI tract at the time of dosing. Maybe just another factor contributing to our symptom variation from day to day.

Bart