Tapering off Ativan Support Thread

[[La...]]

mrmteo:

 

If I understand that table of lorazepam then c/o diazepam correctl, Table 3, stage 26 and onward prescribes a progressive 1 mg reduction in diazepam (after the crossover from lorazepam) each stage which is listed as 1-2 weeks all the way to zero. This sounds like a much higher % cut each week than the recommended 10% (of current). For examle, going from Table 3, stage 32 to stage 33 entails a drop from 4 mg to 3 mg. That is a 25% cut. Stage 33 to stage 34 advises to go from 3mg to 2 mg; a 33% cut. Then 2mg to 1mg (50% cut). After 1 mg, stopping is advised though in some of Ashtons text, I read that she recommmended jumping not from 1 mg diaz, but from 0.5.

 

The dogma on BB seems to be a maximum cut of 10% with reference to Ashton regarding this guidance. Am I misunderstanding this table? It seems to be at odds with the recomended taper rate? I am on a lorazepam taper and draw inference from the diazepam using a 10:1 equiavalency (as per Ashton, Table 4 in "The Diagnosis and Management of Benzodiazepene Dependence"). Can someone please explain this apparent discrepancy to me?

 

Notwithstanding the different half-lives of lorazepam and diazepam (and associated different propensity for IDW), the prescribed 1 mg cuts of diazepam in Table 3 referenced above would equate to 0.1 mg cuts in lorazepam which I discovered were way too painful at doses lower than 0.5 mg lorazepam.

 

This healing/taper process is most certainly non-linear as others repeatedly state. Amazingly, I had a continuous 7 day window. Just amazing, didn't know they could last so long. But yesterday that window started closing, don't know why, I was 7 days into a 13% cut, whose first 7 days were easy going. No additional cut made, but on the 8th day, IDW started ramping up and got slammed with the rebound insomnia. This is one extrordinarily unsettling rollercoaster guide. But with everyone's support here, I hope to make it through! Thanks BB.

[[mr...]]

Hi Lazer,

It is just a rough protocol that Dr Ashton came up with and I don't agree with the aggressive reductions, but this gives people a starting point.

Anyone can customize it to a 5-10% reduction or less if they want.

I tried using this protocol with my mom and it was too aggressive, so I modified it according to my mom's comfort which .05 morning dose and .05 on nightly doses every 8 days.

I believe bart's protocol is the closest I've seen to something that could minimize w/d's dramatically.

I rounded up his .0025mg per day to .0033 to fit the days in a month evenly as .10mg per month because I am not able to do that low a mg dosing daily.

 

If someone wants to revise her protocols with a 10% reduction rate, this would be great, so that we have something to send a link for to those looking for help.

 

[[La...]]

mrmteo:

 

Are the cuts you describe in your last post for lorazepam or diazepam?

[[mr...]]

mrmteo:

 

Are the cuts you describe in your last post for lorazepam or diazepam?

The cuts i'm doing for my mom is using valium.

I can only assume it would be the same for any benzo.

 

[[Ma...]]

Laser,

 

I do believe Ashton did the best she could.  The basis of Ashton is really a slow steady decline in blood levels. 

 

Starting off at a no more than 10% drop is a good idea.  Lots of people cut 25% or 50% because that is what their docs tell them to do, and then they suffer from that because that is too much of a shock for people to handle. 

 

The BB site has a page that shows a reduction schedule that does not adhere to the 10% rule.  At some point in the game, we are all going to have to make cuts bigger than 10%, it is just mathematically impossible to make 10% cuts all the way down.  At some point, everyone is going to make a 100% cut.  The lower you go, the higher the percentages are going to get.

 

Some people feel Ashton is too aggressive.  Valium takes 3 weeks to clear the body, not two.  I think that accounts for some of the trouble people have with tapering valium.  The information is just not accurate.  However, ativan is a different story.  Ativan will clear the body in about 4-5 days.  Ashton believes all benzos are equal, that it is just a matter of finding equivalencies.  Yes they are all benzos but their properties are different.

 

We all need to find a rate and a cut that works for each of us.  Ashton also quoted the Quakers, "Proceed as the way openeth."  She said that because it is important that people be allowed to control their own taper, what feels best for them.  I don't think Ashton meant for people to get really hung up on percentages.  I do think some people take that to extremes out of fear and it takes them years to get off.

[[Ma...]]

I think getting down from a building is a good analogy.

 

Say you are at the top of a 6 story building.  You jump off.  You are not going to be in any kind of good shape when you get to the bottom.  That is why C/T doesn't work.  It delivers a very severe shock to the body, body cannot withstand that without extreme damage.

 

Your are at the top of a 6 story building.  You go to the stairwell, and jump from one landing to the next one down.  Will that kill you?  No.  But it is still going to be a shock to your body, you are going to be hurt.  Even if you decide at this point to take the stairs, you have probably broken your leg or jarred yourself so bad that now going down the stairs is going to be difficult.

 

The most reasonable method is to, of course, take the stairs.  If you would have started with the stairs in the first place, you would not be all damaged and hurting.  A lot of times that is what is going on in BB, people have already jumped down too far, and they are hurt.  So when you are already hurt, you have to be extra careful going down the stairs, because now taking the stairs hurts.

[[Bi...]]

I think getting down from a building is a good analogy.

 

Say you are at the top of a 6 story building.  You jump off.  You are not going to be in any kind of good shape when you get to the bottom.  That is why C/T doesn't work.  It delivers a very severe shock to the body, body cannot withstand that without extreme damage.

 

Your are at the top of a 6 story building.  You go to the stairwell, and jump from one landing to the next one down.  Will that kill you?  No.  But it is still going to be a shock to your body, you are going to be hurt.  Even if you decide at this point to take the stairs, you have probably broken your leg or jarred yourself so bad that now going down the stairs is going to be difficult.

 

The most reasonable method is to, of course, take the stairs.  If you would have started with the stairs in the first place, you would not be all damaged and hurting.  A lot of times that is what is going on in BB, people have already jumped down too far, and they are hurt.  So when you are already hurt, you have to be extra careful going down the stairs, because now taking the stairs hurts.

 

Hi mairin, that story sound like what happened to me for sure

[[On...]]

Very nice analogy, the building and stairs!  I'm pretty beat up from jumping down a few flights too many, but holding now  and will start a very slow taper again soon. I hope the bruises are healing and that I didn't break too many major bones. 

 

I am not tapering directly from Ativan, having switched to Valium, but I found this case study about a young med student who was prescribed Ativan and his quest to try different things to relieve his symptoms. When he finally found what worked for him, it REALLY worked!  He was even able to accelerate his taper. I thought I'd post it here if anyone wants to read it. He went on to finish med school, btw. Johnathan Prousky is the ND who reported the case. It also talks about the upregulation of GABA receptors. 

 

http://www.jonathanprouskynd.com/uploads/Nicotinamide___Anxiety_-_Case_Report.pdf

 

[[Ch...]]

I have been on 8 mgs a day for about 20 years. I started to taper off Sept 26. I am now down to 5mgs a day, trying to adjust. During my first week down to 7mgs, I experienced a few moments of absolute fear. But I was in my living room and not in any real danger. So I told myself, it was just chemicals in my brain and there really was no threat.Going down to 6mgs ( after a two week period) I had a moment where I thought a squid had leaked its ink inside my head. I layed down for an hour and it was gone. Now, at 5 mgs I know I have to stabilize first before my next drop. But I have become very forgetful. After getting back from the grocery store I unknowingly forgot to shut the engine off. It was only by chance that I found it still running, an hour later. So that's my story for now. Good luck to your tappering.

[[La...]]

Very nice analogy, the building and stairs!  I'm pretty beat up from jumping down a few flights too many, but holding now  and will start a very slow taper again soon. I hope the bruises are healing and that I didn't break too many major bones. 

 

I am not tapering directly from Ativan, having switched to Valium, but I found this case study about a young med student who was prescribed Ativan and his quest to try different things to relieve his symptoms. When he finally found what worked for him, it REALLY worked!  He was even able to accelerate his taper. I thought I'd post it here if anyone wants to read it. He went on to finish med school, btw. Johnathan Prousky is the ND who reported the case. It also talks about the upregulation of GABA receptors. 

 

http://www.jonathanprouskynd.com/uploads/Nicotinamide___Anxiety_-_Case_Report.pdf

 

OneLove: Thank you for the Prousky citation. Very interesting article. i also went on to read his other articles and find him to be very credible. The potential efficacy of nicotinamide for easing benzo wd sxs is intriguing enough for me to investigate empirically, though there are some potential problems with the megadoses recommended. I may try a gradual dose escalation of nicotinamide to evaluate any potential benefit. Reviewing the scientific and clinical peer-reviewed literature produced a dearth of information, but this may be due to the bias that PubMed has for orthomolecular and alternative medicines (e.g. they refuse to index these journals).

[[An...]]

Oooh, Charlie,

Take it easy, I am concerned that you are going too fast ..I think the idea is to drop maybe .125 mgs every 2 weeks, with a hold to see how your body is reacting, before dropping again.

 

Mairin33 has been tapering a large amount of Ativan. Please read her tapering story, as it will help you. She is on the  page before your post ..Below her signature, click on her buddies blog, or plog to read her story ..

 

Cedardree, a buddie here,  has a schedule that you can follow .. I will see if I can find it for you ..

Meantime hold for a while ..

Love, Anu

[[Bi...]]

Very nice analogy, the building and stairs!  I'm pretty beat up from jumping down a few flights too many, but holding now  and will start a very slow taper again soon. I hope the bruises are healing and that I didn't break too many major bones. 

 

I am not tapering directly from Ativan, having switched to Valium, but I found this case study about a young med student who was prescribed Ativan and his quest to try different things to relieve his symptoms. When he finally found what worked for him, it REALLY worked!  He was even able to accelerate his taper. I thought I'd post it here if anyone wants to read it. He went on to finish med school, btw. Johnathan Prousky is the ND who reported the case. It also talks about the upregulation of GABA receptors. 

 

http://www.jonathanprouskynd.com/uploads/Nicotinamide___Anxiety_-_Case_Report.pdf

 

OneLove: Thank you for the Prousky citation. Very interesting article. i also went on to read his other articles and find him to be very credible. The potential efficacy of nicotinamide for easing benzo wd sxs is intriguing enough for me to investigate empirically, though there are some potential problems with the megadoses recommended. I may try a gradual dose escalation of nicotinamide to evaluate any potential benefit. Reviewing the scientific and clinical peer-reviewed literature produced a dearth of information, but this may be due to the bias that PubMed has for orthomolecular and alternative medicines (e.g. they refuse to index these journals).

 

Interesting

[[je...]]

I am confused! My doctor wants to put me on Klonopin to kick Ativan. If you can directly cross over to Klonopin, why can't you cross directly to Valium? Also, if I switch, how long would I have to wait to taper off Klonpin? I don't want to be on it a long time.

[[mr...]]

I am confused! My doctor wants to put me on Klonopin to kick Ativan. If you can directly cross over to Klonopin, why can't you cross directly to Valium? Also, if I switch, how long would I have to wait to taper off Klonpin? I don't want to be on it a long time.

I would stay away from klonopin.

I think klonopin is the very worst of the benzo's.

Valium is a true longer acting benzo and seems to have far less issues than the shorter acting.

Klonopin is not a true long acting benzo.

 

[[An...]]

I am confused! My doctor wants to put me on Klonopin to kick Ativan. If you can directly cross over to Klonopin, why can't you cross directly to Valium? Also, if I switch, how long would I have to wait to taper off Klonpin? I don't want to be on it a long time.

 

Hi Jen, this is why we just take the script, and manage our own tapers.

There should be careful and slow cross over to K as it is to V. There is a Klonopin thread here, worth checking out.

Thinking of you Jen ..

Anu

[[je...]]

Thank you!

[[...]]

I would stay away from klonopin.

I think klonopin is the very worst of the benzo's.

Valium is a true longer acting benzo and seems to have far less issues than the shorter acting.

Klonopin is not a true long acting benzo.

 

Everyone is entitled to their own opinion and I disagree with this one.  Klonopin somehow gets a bad rap.  It is fine to taper and in some respects it is better than valium.  I crossed to valium because I was advised to, but as I learned more I wish I never had.  Two or three doses a day is not that bad in my mind and is about the same as valium anyway.  One thing that detracts from valium is the longer acting time made it take too long for problems to appear - sometimes days - so recognizing them and jumping on them quickly was not as easy.

[[Ch...]]

Anu,

Thank you very much for your reply/post. After 5 days at 5 mgs I hit a wall, an internal pressure began, pulse racing, B.P. rising. Had to updose to 6 mgs. Guess I wasn't ready for the change. 4 years ago I had to be hospitalized when I tried to c/t. At first, they told me I had had a heart attack ( this is a teaching hospital), then they changed it to a stroke. Later in the evening I mentioned my c/t and they gave me some Ativan. Felt much better and left the hospital the next morning.So I have been scared about tapering off ever since, for fear it might happen again. But , you're right,with smaller cuts I may have a better chance to eliminate. And Thanks for suggesting that I read Mairin33"s story. What an ordeal ! His blog and plog, were very informative. I , also, read the article OneLove suggested about niacinamide. On the technical side, how does one create a blog or plog? Your response was very much appreciated. Thanks ,again.

Charlie

 

[[Ju...]]

On the technical side, how does one create a blog or plog? Your response was very much appreciated. Thanks ,again.

 

Hi Charlie,

 

Your buddy Anu PM'd me that you were interested in possibly starting a Progress Log and/or a Buddie Blog.

 

A Progress Log is great because it's an online diary where you can write about your journey, but no one can respond to what you have written.  Here is the Progress Log board.  All you need to do is start a new topic and you're good to go.

 

http://www.benzobuddies.org/forum/index.php?board=87.0

 

A Buddie Blog is a space where you can journal your progress, make friends and ect.  When you start a Buddie Blog, you can receive replies to your posts.  Here is the Buddie Blog section.  Just start a new topic and you've created your Buddie Blog.  Here is the link to the board:

 

http://www.benzobuddies.org/forum/index.php?board=88.0

 

Good luck and welcome to Benzo Buddies.

 

Juliea

 

 

[[Ma...]]

Hi Charlie,

 

Yes I think you are trying to cut too much too fast.  You've already cut down 2 whole milligrams of ativan.  If you can stabelize at 6 mgs that would be good.  I would wait before you cut anymore.  You just reduced your dose a whole lot.  Don't keep cutting like that, by 1 mg amounts.  That is just too much.  I cut down by .25 mg every two weeks from about 6 mgs to 3 mgs.  You need time to adjust to each cut. 

 

How often do you take it a day?  It may be helpful to split your dose in to 4 doses.  At 6 mgs that would be 1.5 mgs 4x a day.  If you are not already doing that, this can help a lot because ativan generally last about 6 hours, so taking it more often can reduce interdose withdrawals, which occur when the drug levels drop to low.

 

It was very hard for me because I was on an extremely high dose of benzo, starting with klonopin, and that dose was effectively cut in half in about 4 months.  That really put my body into shock and made it a lot harder to taper.  What you want to avoid is doing that, do not cut too much in the beginning and send your body into shock.  That just makes everything worse.  The best way to do this is cutting small amounts over a very long period of time.  It has taken me about a year and a half to go from 8 mgs ativan to .5626, where I am at now.  This is going to take time.  You have been on it for a very long time.  It's not a good idea to rush off.  The only really sane way to get off benzos is by gradually cutting down over a long period of time.

 

Seriously, I would wait two or three weeks now without cutting anymore.  See how you feel at 6 mgs.  Let your body adjust to that.  Then consider cutting a much smaller amount, like .25.

[[La...]]

Hi:

 

Each day i re-assess my ativan taper strategy and consider all the advice on this board. One recurring comment I hear is that an Ativan taper is difficult, and part of the reason is due to its short hald life, leading to more significant IDW.

 

I agree that my Ativan taper is difficult, but I am finding that my difficulties lie predominantly in the cuts i make (using the cut and hold approach), whereas IDW for me actually seems pretty manageable (though by no means comfortable). I only dose once at 11pm and I do notice IDW coming on early evening, but I can usually glide to that 11pm dose and quickly after dosing, the IDW wanes to zero. Given my response thus far (tapering from 1 mg daily now down to 0.29mg) might it be reasonable to complete the taper on Ativan?

 

I don't know what the future holds in this process, but one of the advantages, I think of an Ativan taper (as opposed to a longer duration benzo) is that I get pretty quick feedback from the drug, if I begin tapering too fast.

 

Many folks here talk about the last few mgs of a valium taper being the most difficult, is this also true for the last few tenths of a mg of Ativan? In some Ativan tapers, I have seen a departure from the 10% cut guidance as one gets to 0.1 mg and below (e.g. much higher % drops). But I have not observed this nearly as much in the valium tapers, those last mg or two seem to stick to the slow and steady schedule. Does this reflect a difference in the inherent properties of the 2 drugs, or just an inacurrate set of observations I made on general taper strategies between the two?

 

I realize there may not be an answer to my question, perhaps I am just looking for reassurance that the future that lies ahead for me will not be as hard and that my dose reduction of the last 0.1 mg will not need to be drawn out forever (e.g. the shape of the curve [of drug dose vs. time] will not be an asymptote as many valium tapers seem to be).

 

Thoughts? Reassurance? Am I dead wrong?

 

[[...]]

Hi Laser

I've noticed that a lot of Ativan and Klonopin taperers seem to have a little easier time of it at the very end than us Valium slobs. I tapered Ativan initially and then crossed over from one nightly dose of Ativan to Valium as per Ashton and then tapered off Valium. If I had it to do over again, I would have tried harder on the Ativan taper and only crossed to Valium if I was badly stuck.

Bart

[[ce...]]

The end of my Ativan taper was the very hardest part.  It seems to be different for everyone, but the lower I got the worse I became until I was off for a long time.  Things to take into account are, duration of benzo use, mgs, abuse, stopping/starting, other psych drugs, rate of taper, etc.

[[aw...]]

Laserjet:

 

I took 6 mg of Ativan as a single dose for many years, and I'd have to say that my sx got nothing but worse until I changed to 3X/day dosing. You might be able to 'tough it out', but you're fighting your own body and the pharmacokinetics of the drug itself. IMO, it's a set up for failure and quite unnecessary.

 

Aweigh

[[mo...]]

I have been following cedartree's taper to a T so far . It seems that the lower I get the better I feel, knock on wood . So far at the lower doses my wd sx are fairly mild . Valium may be the way to go in the long run but in the end game I think us Ativan folks might have it a little easier because of the short life of the drug . The compound doses so far have worked out for pretty well for me . I will find out next week when I start my 0.0312 mg doses . I also dose 5 mg of propranolol 4 times a day with each of my 4 doses of Ativan . A little trick I learned that I think helps with the anxiety symptoms .