Tapering off Ativan Support Thread

[[Jo...]]

How do you cut the pills that small?

[[br...]]

Hi Joy,

 

My tablets are .5 mgs.....and I used a pill cutter to cut them into four .125 mg pieces.  Cutting them that small is sometimes difficult....sometimes they tend to crumble a little......that's why, at my next appt., I want to discuss with my dr. switching over to liquid titration....that way I can make very small cuts easily.

 

My taper has not been smooth at all......horrible w/d x/s.....I hope you're one of the lucky ones and your taper goes better than mine has.

[[Jo...]]

Thanks for answering. How do you liquid titrate? I thought you could use water but someone told me you can.t I'm getting really confused and frustrated. Sorry you're having a rough time I"ll definitely pray for you.

 

Joy

[[br...]]

Hi Joy,

 

I asked the same question.....I use Lorazepam (the generic version of Ativan)......my understanding is that you can liquid titrate with water ...but it's better to get a compounding liquid from a compounding pharmacy b/c the crushed tablet does not mix as well with water and the med may settle at the bottom instead of being disbursed more evenly throughout the liquid.........one of the other BB's (LaserJet)...gave me the following information.

 

your doctor would call in or fax your lorazepam prescription to the compounding pharmacy exactly as he/she would with a prescription for lorazepam tablets to any other pharmacy. For the suspension they will need to indicate concentration and volume. Given where my current dose level is and how anal I am about getting my dosing exact, I recommended that the concentration be 0.5 mg/ml. With regard to volume, you will need to figure out how much you will need and tell this to your doctor so they can communicate that to the pharmacy. To figure out how much you will need, you must know the shelf life of the liquid suspension and have a projected taper plan. so, for example, if you know the shelf life is 2 months from the date of preparation, and you would be dosing 0.5 mg in the first two weeks, then 0.5 mg/day x 0.5 mg/ml = 1 ml / day x 14 days = 14 ml. So for the first 2 weeks, you would need 14 ml. Based on your planned cuts for the next 6 weeks, you would calculate (as above), how many ml of the lorazepam suspension you would need. Once you figure out this volume, then increase it by some conservative %, as you can never truly get every last bit of the liquid out of the bottle (unlike tablets). Since my lorazepam is suspended in a methylcellulose carrier, it tends to be very viscous and I am only able to recover 75% of the total volume in the bottle, due to it sticking to the outside of the syringe during each nightly draw/dosing.

 

My pharmacist uses methylcellulose and for this specific formulation in this specific bottle the shelf life is 2 months at 4°C. But there are other formulations available to pharmacists that may have different a shelf life.

 

It is really amazing how precise I can dial in a dose or dose cut with this method as the 1 ml syringe I have, has 0.01 ml gradations on it!

 

By the way, just because I can dial in precise and small dose cuts, does not mean this whole taper ordeal is a cake walk for me. Quite the contrary, yesterday, my wd sxs were through the roof!

 

Hope this info helps. Let me know how things turn out.

 

 

I hope the above information that LaserJet shared with me is of help to you.  Best wishes for a smooth taper.....

 

[[br...]]

Hi All,

 

Hit with another awful x/s :'( .............this time, when I first laid down to go to sleep last night, some of the muscles in my arms and legs were twitching and I had a horrible kind of painful buzzing feeling in my nerves and my body wouldn't relax so I could sleep.....it was another one of those terrifying feelings that feels like you're dying.  I take my evening dose when I go to bed, so about 3 to 4 hrs later, it finally relaxed enough that I could sleep a little.....but I only half way slept......kinda like sleeping with one eye open, no REM sleep.  Was scared to get up for fear that awful feeling would come back.  I haven't changed my dose at all.......so is it possible that I tapered too fast and now my body has caught up with where I am currently at in dosage?.......Has anyone else had this x/s?  Right now, I take my morning dose at 10:00 am and my evening dose at 10:00 pm.......I'm considering adding a afternoon dose again to see if this helps at all.............however, I don't want to take a step backwards but in the same token, I am afraid there may be horrific consequences if I try to force myself through this x/s.  Any suggestions would be appreciated.

 

Thanks. :smitten:     

[[mr...]]

Hi All,

 

Hit with another awful x/s :'( .............this time, when I first laid down to go to sleep last night, some of the muscles in my arms and legs were twitching and I had a horrible kind of painful buzzing feeling in my nerves and my body wouldn't relax so I could sleep.....it was another one of those terrifying feelings that feels like you're dying.  I take my evening dose when I go to bed, so about 3 to 4 hrs later, it finally relaxed enough that I could sleep a little.....but I only half way slept......kinda like sleeping with one eye open, no REM sleep.  Was scared to get up for fear that awful feeling would come back.  I haven't changed my dose at all.......so is it possible that I tapered too fast and now my body has caught up with where I am currently at in dosage?.......Has anyone else had this x/s?  Right now, I take my morning dose at 10:00 am and my evening dose at 10:00 pm.......I'm considering adding a afternoon dose again to see if this helps at all.............however, I don't want to take a step backwards but in the same token, I am afraid there may be horrific consequences if I try to force myself through this x/s.  Any suggestions would be appreciated.

 

Thanks. :smitten:     

Hi brunet,

I can only compare lorazepam to valium.

.125mg lorazepam = 1.25mg valium.

2x's per day would be = 2.5mg valium.

My mom's symptoms would be bad with better days inbetween at 2.5mg valium.

Her symptoms didn't start to ease up some until going below 1.6mg valium (.16mg lorazepam) and she was 6 months into the taper.

I'm not sure if this helps, but I believe most of my mom's symptoms are underlying lorazepam symptoms.

I don't know if anyone here is doing a microtaper with ativan, but I am having good results with this on my mom with valium.

Are u titrating?

[[La...]]

Hi All,

 

Hit with another awful x/s :'( .............this time, when I first laid down to go to sleep last night, some of the muscles in my arms and legs were twitching and I had a horrible kind of painful buzzing feeling in my nerves and my body wouldn't relax so I could sleep.....it was another one of those terrifying feelings that feels like you're dying.  I take my evening dose when I go to bed, so about 3 to 4 hrs later, it finally relaxed enough that I could sleep a little.....but I only half way slept......kinda like sleeping with one eye open, no REM sleep.  Was scared to get up for fear that awful feeling would come back.  I haven't changed my dose at all.......so is it possible that I tapered too fast and now my body has caught up with where I am currently at in dosage?.......Has anyone else had this x/s?  Right now, I take my morning dose at 10:00 am and my evening dose at 10:00 pm.......I'm considering adding a afternoon dose again to see if this helps at all.............however, I don't want to take a step backwards but in the same token, I am afraid there may be horrific consequences if I try to force myself through this x/s.  Any suggestions would be appreciated.

 

Thanks. :smitten:   

 

Last week when a I cut 0.03 mg (down to 0.105mg total daily dose), I was relatively symptom-free for 6 out of 7 of the subsequent hold days, with the 7th day having moderate sxs; overall a really good week. This week, however, when I again, cut 0.03mg (down to 0.075mg daily dose), I have had sxs for 3 out of 3 days, specifically, what you mention above, "buzzing feeling in my nerves and my body." After a really good week last week, I was expecting this same cut to give a good result but alas, recovery is nonlinear it seems.

 

These last few nights when I lay down to bed, the buziing feeling makes it hard to go to sleep. At this stage, it is not so severe that I feel like I am dying (though earlier in my taper this is exactly how it felt (dying). Despite the less severe buzzing, it is still hard to get to sleep, but I found that mindful meditation right before bed really helps me to get to sleep under these conditions/sxs. Deep regular breathing, eyes shut, body stillness, disconnecting from both past and future thoughts, focusing on the breath, maintaining this focus; repeat. The more I have practiced this, the better I am getting. Of course, the more severe the wd sxs, the higher the threshold for relaxing but the principle is still the same. 

[[br...]]

Thanks, mrtmeo and LaserJet. 

 

Not sure what's happening.....but it's not getting better.  I took my morning dose, did some craft painting to try to distract myself for awhile and then tried to take a nap this afternoon since I didn't sleep well last night......and the same thing happened.....that horrible buzzing nerve feeling ....so still can't relax to sleep......it's been 3 hours since I took my dose and the buzzing is not letting up and I feel really sick.  I'm considering taking another dose to see if I feel any better....at least long enough to sleep a little. ....ugh :'( :'( :'(

[[Rr...]]

Hi everybody!

 

I'm tapering with the water titration method.

 

Does anyone know how long the ativan/water mix stays good at room temperature (76 degrees F)?

 

Thank you!

 

Rriver

 

[[Ma...]]

Something new I am trying is using an x-acto blade to cut up the pills.  The compounded pills are 40 dollars for 90 pills.  My regular .5's are only like 7 dollars.  So, I got the x-acto blade and I am cutting the .5 pill into 1/8ths now.

 

Half of .5 is .25.

 

Half of .25 is .125.

 

Half of .125 is .0625. 

 

I know it is not exactly exact (even with the x-acto haha) but I think it is good enough.  The blade cuts well, is very sharp.

[[Jo...]]

Great minds think alike, I got two x acto knives at Wal Mart today.

[[Ma...]]

Hi Joy,

 

If you are still wondering what to do, this is what I would do:

 

Hopefully, you have .5 pills.  I would cut them up and take .25 at even intervals 4x a day.  Then I would start cutting out .0625 every 10-14 days.  That is a very gradual reduction.

 

It seems long but the days turn into weeks, and the weeks turn into months, and pretty soon you will be off

 

Slow, steady reduction is really the best way off.

[[aw...]]

Rriver: Why not keep it in the fridge?

 

Aweigh

[[Rr...]]

Hi Aweigh!

 

I forgot to put it in the fridge. It sat on the kitchen counter for 6 hours.

 

I mixed up a new batch, just to be safe. There's a lot going on this week, can't risk with any more s/x.

 

River

[[Ks...]]

Hi, sorry to intrude but it seems the topic has come up about evenly cutting the pills?  I am having a hard time with this.  1) The 0.5 pills do crumble, and 2) I can't get an exact cut, and this is assumingly important since I am trying to get 1/8 off of a tiny 0.5 pill.  The liquid titration seems complicated and expensive, I have already spent so much $ on my health problems...  I don't even know if I could find a pharmacy that could compound it, or whatever the process is (still very uneducated about this).  I have gotten exactly nowhere so far, in fact gotten worse because the one day cut I made was apparently too much (o.125 from a 2mg nightly dose) and am still paying for it two days later.

[[An...]]

Hi Ks,

I am sorry that you are going through a bad time

I too got in trouble with my first cut being a .125 cut. I held for 4 weeks, and then cut again 0.625 mgs, which is half the .125mgs. Unfortunately the second cut proved too big for me too. So I am holding again.

Ks, a good thing to do, is to spread your doses to 4 or even 5 a day. This prevents Interdose Withdrawal, and you do not get symptoms between doses.

I dry cut the 0.5 tablets with a pill cutter from the drugstore. It does a good job cutting. If you decide to continue dry cutting, you will need a gram scale to weigh your tablets accurately.

Please read Mairin's post above, to see how to make your cuts.

Wishing you success .. Keep posting if unsure, and keep asking questions.

Love, Anu

[[Ks...]]

Thanks, I couldn't even hold the cut for a day though.  I tried cutting 1/8 of .5 last night but I think the messed up cut of my 2mg pill basically made up the difference so there was no actual cut at all.  This is not working.

 

I am afraid that I will get some sort of withdrawal from spreading my dose during the day and lowering the dose at night time.  I know I probably get interdose withdrawal already, but I'm afraid because of the bad reaction I already had, to half my night dose and take the other half in the morning...

 

Where do you get a gram scale?  Are they expensive?  They measure micrograms too?

 

Thank you...

[[Ma...]]

KS,

 

I don't think exact doses are that extremely important.  Whether you ingest .124 or .128 or .122 I don't think matters a whole lot.

 

You can try Summermeadow's method, of taking the 1/4 pill, crushing it and just separating it into piles.  The human eye is pretty good at judging amounts, you can pretty much divide the pile evenly into 1/2, 1/3 etc. 

 

However, a 2 mg pill is hard to cut down to small amounts.  Really the best pill size to use for tapering is the .5 size.  I tapered with the 2 mg pill but I was on an enormous dose, 8 mgs a day.  I tapered with the 2 mg pill for a while, then I got the 1 mg size, and finally I am using the .5 size, but my doctor has been very cooperative in this process.  But really when you think about it, it is no big deal for them to do this, give you an easy to cut pill.

 

How much are you on?  It's a little confusing because you say you are using a 2 mg pill.  A signature helps to have that information so people can help.

 

Yes lots of people get gram scales and dry cut using that, weighing.  You would have to figure out the actual weight of the pill and how much by weight to cut, and weight miligrams and drug content mgs are different.

 

 

[[Ks...]]

Hi Mairin,

Thanks for the reply...

I am cutting the 2mg in half because my psych only gave me one month's supply of 0.5, aka 28, so I have to get that straightened out I guess.  I am in between psychiatrists and see the next one in four days so I guess I will just have to get it from him.  I don't even know if he will work with me if all I want to do is get OFF all my meds and not take any new ones.  I am taking 2mg.  That is a good point, I completely forgot the pill size is not actually 2mg, but anyway, where do you buy a milligram/microgram scale?

[[Ma...]]

You can get a gram scale on Amazon.

 

If you are on two milligrams, why did he give you 28 .5's?

 

If I were you, I would cut down by .125 every two weeks.  It will take a long time, but that is what I would do.  It's better to go slow than cut too much at once.  Slow gradual decline is really the best way.

 

I cut out 2 mgs from January to August.  So it took me eight months to do that, cutting by .125 every two weeks.

[[aw...]]

Rriver: Thanks for the reply. My semi-educated guess would be that the solution's OK to use for roughly 3-6 hours at room temp. and 3-5 days in the 'fridge [40 deg. F]. Those are the limits I use for a solution of Ativan in 75% ethyl alcohol, which should be at least as stable as a water suspension.

 

Aweigh

[[Ks...]]

You can get a gram scale on Amazon.

 

If you are on two milligrams, why did he give you 28 .5's?

 

If I were you, I would cut down by .125 every two weeks.  It will take a long time, but that is what I would do.  It's better to go slow than cut too much at once.  Slow gradual decline is really the best way.

 

I cut out 2 mgs from January to August.  So it took me eight months to do that, cutting by .125 every two weeks.

 

My psychiatrist is stupid is why, I really can't give an explanation...like I said I'm seeing a new one in a few days...but I can't make a 0.125 drop at once...I don't know how I would do a 1/8 of a tiny 0.5 pill but that is the only way I can do it.  I don't know if I could do that every week, or if I'd have to every other week, but my CNS/endocrine system is so, so, so screwed up at this point from all the meds that I've been on and drastic weight changes...

 

I have looked up the gram scales on Amazon but I'm also aware that they are expensive, and the cheaper ones are not as accurate which definitely is a big no-no in this case, so I feel stuck in that way too...There has to be some way to do this...Do you think calling the pharmacy would help...?  I don't know...

[[Rr...]]

Rriver: Thanks for the reply. My semi-educated guess would be that the solution's OK to use for roughly 3-6 hours at room temp. and 3-5 days in the 'fridge [40 deg. F]. Those are the limits I use for a solution of Ativan in 75% ethyl alcohol, which should be at least as stable as a water suspension.

 

Aweigh

 

Thanks, Aweigh. Good thing I played it safe and mixed up a fresh dose. It was sitting out for 6 hours.

 

I will keep these guidelines in mind.

 

Rriver

 

 

[[La...]]

From a lot of reports on this board about how difficult the last 2mg of Valium is to cut out, I have been very worried about the last 0.2 mg of Ativan. But from 0.2mg down 0.105 mg I was feeling pretty good, then I dropped 0.03 mg down to 0.075 mg Ativan and felt pretty bad the first 3 days after the cut. I was really hoping things would be better as I feel like I am in the home stretch, but alas, things got worse. Sever panic and wd sxs set in, the king like we experience at higher doses. Even at 0.075mg things can really suck! I decided to updose a bit to 0.085mg last night and things feel a bit better. I think I will hold at 0.085 until I stabilize. But my liquid suspension expires Jan 5, 2014, I don't have much left, and I was hoping (and planning to jump at that date). I am also not sure that my doctor will prescribe any more for me as she thought I could taper 1mg in a total of 1 week. To further complicate matters, she is now on pregnanct leave and I don't know what that would mean. To go in to the office and request a prescription for the equivalent of 1 pill (2 ml of 0.5 mg/ml suspension) seems ludicrous, not only to me, but probably would also seem that way to whomever is filling in for her.

 

I am just so shocked that my body is so sensitive, even at these low doses, that it can perceive the difference between 0.075mg and 0.085 mg. In units of milliliters, it was only an extra 0.01ml! I just want this whole miserable ordeal to be over with and being at 0.085 mg, seems so close, but when I am spiraling out of control with wd sxs, it seems light years away.

 

I was hoping to take Ativan all the way down to 0.015mg by Jan 5, 2014 and jump. Then with wanting to avoid wd sxs during the holidays, I was thinking of holding a bit longer during Dec, then jumping on Jan 5, 2014, at the slightly higher 0.03 mg. Now with this big set back in wd sxs, I may only be able to get down to 0.05mg before my planned jump on Jan 5, 2014.  If a 0.03mg cut earlier this week had big teeth as it did, I just really fear what jumping from 0.05mg would do to me.

 

Cooper, weren't you making 0.03125mg cuts down near the end before your jump?

 

I know many of you here are at higher Ativan doses, but if anyone can chime in with a word of reason or reassurance, it would greatly be appreciated.

 

Laser

[[br...]]

Hi LaserJet,

 

You seemed to be doing so well that I thought for sure you would sail right through the end of your taper.  You have answered so many questions/concerns that I have posted that I wanted to respond to your post by saying that I am so sorry to hear that you have had a setback.  You have been a true source of hope and inspiration to me in my dark times and although I can't offer any solutions or suggestions, you are in my thoughts and prayers.  It's so frustrating and scary how unpredictable w/d x/s can be even at low doses.  I know you'll push on and fight the good fight.....that's pretty much all any of us can do.  Hang in there, sweetie. 

 

Much love and hugs 

 

Brunette