Liquid titration schedule Help??

[[Sh...]]

Hi I purchased liquid ativan from my compounding pharmacy and really need help on a good titration schedule. Please see my situation below. I have been holding in withdrawal for a few months at .35mg of ativan and now I have started my taper again with the liquid ativan at .33mg .08mg before bed, .1mg in the middle of the night when I wake up always, .1mg at about 11am in the morning and .05mg in the late afternoon.

 

Thoughts on how much to go down on each time, how quickly and spreading it out effectively.

 

Thank you so much for the help!!!

Sean

[[Be...]]

I think generally starting out reducing by 1%/day (of your total dose) works out well for most.  You can reduce from whichever dose you want but I always tried to alternate cutting doses so I could keep a more even blood level.  If you want to try that way, you could make your first reductions off your .1mg doses.  I'm sure there are others ways to accomplish the same thing; just go slowly until you see how you react.

[[Sh...]]

Thanks so much!! How do you do 1 percent of .35mg. I have a 1ML dropper that is .1mg per ML, so the lowest I can go is .01mg. What do you suggest and also how often do you go down 1%. How long would this take? I have not been stable at all at this dose (4 months here) so I wonder if I go down a touch quicker I will do better as I have read that the brain doesn't start to healing till we are completely off? What do you think?

 

[[Be...]]

Maybe you could ask your pharmacist how to figure it out? And maybe there's a syringe with smaller markings that would help for removing the liquid.  I don't think you will be able to do 1% with that dropper.  I usually know how to give instructions when a member is using a 100ml cylinder (removing 1ml is removing 1%) but don't really know how to approach doing it straight from the liquid Ativan.

 

As for how often to remove 1%, that depends on how fast you want to taper. Those who remove 1% the 1st day, 2% the 2nd day, 3% the third day and so on will be done in 100 days.  Removing more will make the taper shorter but I don't know if that's advisable given that you feel unstable already.  Does that mean you are steadily getting worse or just that you have a number of w/d symptoms?  I had w/d symptoms before I even made a reduction because I had become tolerant.  I had to just set up a schedule and stick to it which, for the most part, I did. ln case you are familiar with the concept of tolerance, here's a link to some more information:

 

http://www.benzobuddies.org/benzodiazepine-information/tolerance-addiction-dependency

[[Sh...]]

I have been feeling horrible since I tapered down to .35mg and have been stuck here for 4 1/2 months and I am not worse and maybe slightly better but still very horrible. I now have to just bite the bullet and start going down and not stop. I started 4 days ago going to .33mg using the liquid and thought I would go down about .02-.03mg a week as i don't have the other option right now and the dropper I have is already small as the liquid is quite concentrated. What are your thoughts on a taper like that since it still is pretty small changes and probably would take me about 100 days or more?

 

Thanks so much!!

[[Be...]]

If you were using the standard titration method, it would take 100 days so I imagine your plan will be fine. It is hard to taper while tolerant because you don't ever get to the symptom-free point until you are well off and healed, but it's the only way out imo.  Good luck. 

[[Me...]]

I had tolerance withdrawal with the clonazapan but I don't with the Valium when I crossed over, I had great releif at first.  I wonder if switching over could help, since you are at a low dose, the body sees the Valium, just slightly different. 

 

I don't like the different symptoms, but they are less miserable than the relative withdrawal I had with first drug. So maybe that could be something to try.  I am not happy to be amnesic and confused for another four months, but I could not imagine tolerating that nerve pain for four months and the interdose withdrawal, so overall, I think I made a good choice to cross over.  There is liquid valium.  Also I get the syringe and needles from harm reduction needle exchange for free.

 

The pharmacy didn't even give me a dropper with the liquid valium.  Are they idiots, did they think i was taking with a teaspoon?

 

I take 0.1 to 2.0 mls with the syringe plus the pills to keep my daily reductions very smooth.  I drop the drops into a 1/2 cup of hot cocoa, drink it and then add milk or water and drink the rinse to get every bit.

 

Just an idea?

[[sa...]]

Sean,

Have you considered crossing over to valium? Was it not an option? I was on ativan, granted a lower dose .5. I crossed over to valium 5 mg is the equivalent dose. I began tapering 6 mos ago, and my sx's are very tollerable. Of course everyone is different. If you already know this, please forgive me, but valium has a longer half life so it stays in your system longer making for an easier withdrawl process. It is also a benzo with a different makeup. Ativan half life is like 20 hours...

If you crossed over, and you will have to check the figures exactly but you could cross over to 3mlg val. maybe a bit more you are .33? You could take it in part pill part liquid or all liquid.

You might get a more comfortable taper from val. You can divide it up and take it throughout the day. I take mine all at night but that is what I did when iwas on ativan, too.

 

If you opt to stay on the ativan, since you asked our opinion, I would think you should stay the course of a taper. It's going to be uncomfortable, as you are likely experiencing interdose withdrawl. I have seen charts however that the post recovery pay off from coming off ativan is mildly shorter than the valium. I didn't think it was worth it. I'm glad I switched over, as I seriously have had mild symptoms.

 

You will get support here whatever you chose. Kudos for seeking advise and embarking on this all. Look forward to hearing how you are doing and what you decide.

 

Sarah~

Ps, Memories, me either on the dropper or syringe from the pharmacy. I said exactly what you did "WTH? they think I'm going to take this with a spoon???" I ended up getting my syringe at another pharmacy after asking everywhere I went. Next stop was an animal clinic.

[[Me...]]

What a great idea! The animal clinic to get syringes and large bore needles! The pharmacy seems limited in what they can  supply.

 

Now that I am on the liquid taper, I held a dose last night at 6.6 and got better sleep than usual. I'm still a bit reved up. How long does one hold, if they feel a need to hold?

I was hopeful that my window would stay open but i have to confront wd because additional stress of prednisone taper and bronchitis, new roommate, etc. Will holding help over all? Should I stick to my schedule?

[[sa...]]

Hey Memories,

 

I'm tapering differently but as a concept I would say, hold if you feel like it and monitor how you feel and then use that your future programs. For instance if you hold for like 1-5 days say start tapering again when you feel better 2 days in a row, and if you just don't feel better, do a reduction and see if that helps and if so, then stay the course, if its the same, just do your taper if your going to feel badly anyway.

 

I toyed with my taper a bit and came up with what works for me after reading what everyone else does. We all have about the same goal, fast and comfortable as possible. lol.

 

Maybe some other daily mircro taperers can chime in with what they do when they get sx. What have you done in the past?

 

You will figure it out. Good luck!

Sarah

[[Sh...]]

Hi Sarah, good advice on the taper. I did do a cross over awhile ago at a much higher does to valium, the exact Ashton one and slowly but the Valium didn't work for me, supposedly ativan has one different molecule and for some people that is enough for the withdrawals and effects to be bad.

 

I wonder if I should keep going down regardless because right now after 2 weeks of .02mg a week down (now .31mg) i am a mess (worse then the mess I was before these tiny tapers which was bad and for  5 months before I finally took this plunge) but I wonder whether I just keep doing this every week until I get off as I will never stabilize or be okay?

[[Me...]]

Sarah,

 

I went to the daily taper with liquid valium to get relief from the toxic effects, so that was helpful but I was a bit worried when it would catch up, which it did , but only the WD symptoms.  So I held two nights now.  Felt much better today, so I will hold steady tonight and then resume my 2% taper tomorrow.  It seems sensible to have two good days as a minimum.  If had not read your message, I was considering another taper tonight. 

 

I went to the phamacist and since I am tapering prednesone as well, the WD add up onto each other.  So the pharmacist suggested that I alternate, so that take a 3 day taper break when I do a cut in the prednisone. The prednisone is monitored by a lab and my symptoms so I wouldn't want to taper daily, because I want to get the most therapuetic benefit from the prendisone. The prednisone is actually more dangerous than the 6.6 mg Valium I currently take.

 

So a goal might be to step down, alternately the Valium and prednisone until I get to 5 mg Valium. Then hold the Valuim until I am done the taper of the prednisone to the therapuetic level.  Then continue on the liquid valium daily taper until I am done.

 

It sure does get complicated with the tapers. My Pdoc really doesn't care about my WD effects; he tells me to take more seroquel.  Why, if I could just work a comfortable taper schedule, why would I want to take more seroquel? It just just gives a bigger gut and then I have to take a another medication to handle the heartburn caused by the big gut! Both interfere with my sleep so I got run down and now have a bronchitis that will be protracted because I am taking prednisone.  So I am really having to figure it all out.  I went down in Valium 62% in 3 months, so I deserve a little break now that I am at safer dose of Valium!  (I was having serious toxic effects which seem to be minimal now, thus fast taper at the high doses was ok for me.)

 

And it will make more difficult for the physical rehab, just more work overall. It is freaking insane!  Pdoc just only cares about my benzo and can't see the bigger picture of my overall health.  It is not helpful for me to be in pain, which is one of the WD symptoms that I am trying to avoid, so that I can most benefit from the prednisone and physically rehab, but I can't rehab in pain (and if the pain is just a WD symptom and unnesseccary with the slow, daily taper with holds as needed.)

 

I am hopeful to get the pdoc to understand the concerns with the poly-pharmacy.  I asked the nursing center how long it would take to get a second opinion from there pain doctors and she said it can take several months.  My pdoc counts the pills and the mls (when previously the docs would give me armfuls of Cloazepam that I never even took!)  I don't have any cravings or desire to updose at all but he won't give me a very big supply.. he wants to be in control of my taper!

 

So thanks for the two day to 5 day advice (with 2 good days before resuming taper)... that seems very reasonable way to go!

 

[[sa...]]

Hi Memories,

 

Your situation sounds very complicated, but I'm so impressed how you have a handle on it and are maneuvering despite your control freak dr. We have to pacify them some to get what we need to get healthy. Its irritating how your dr and others had no problem giving us ooodles of these dangerous meds that made us sick, and so many of you are have to jump through crazy hoops to get cooperation to get "really well". I'm sorry for this  for you, but man am I impressed with the handle you have on it.

 

Glad my suggestion was another option to put in your bag of tricks. You sound very sensible, as does what you have decided to do. Can't go wrong when you put so much interest in it, you know?

 

Sean,

I have heard that some people can't tolerate valium. Since you asked our opinion, I would say just keep coming off despite your symptoms. It's just my opinion and I'm just another person working away at this and reading as much as I can, and I think you can hold too long and get interdose withdrawl (ok I think thats what it's called or protracted withdrawl) when the ativan is causing the problem, not the withdrawing of it. Your goal is to get off, so might as well continue to do that at a reasonable taper, not too fast and maybe not so slow. I can't think off the top of my head right now but I have tt some that have tapered directly off ativan. I'll keep my eyes open see if I can't get a look at their taper. I'm sure you are doing the same thing.

What did you decide?

 

Sarah~

[[Me...]]

I can attest that I didn't tolerate Valium at doses between 15 and 10 but it was still better than the Clonazepam.  Once I got down lower, I tolerate it better. 

 

I had the interdose wd and relative tolerance (withdrawal at sustained unchanging doses) you just have to get off or only other way of doing it is updosing and that is your choice.  Neither is a great choice, but it's your choice to make. The only thing I couldn't do was stay at a dose that is causing you interdose withdrawal.  Terrible place to be, like benzo purgatory!

 

I think the liquid valium is especially helpful when the Valium is not tolerated (having a toxic effect).  It is another tool for the toolbox of being benzo free.  It was how I was able to get down quickly and safely so now I can tolerate the Valium.  Anything higher than 10mg is likely to be difficult to tolerate my pharmacist said to me today and that is also why the switch is done gradually, to test tolerance.

 

I was so eager to get off the clonazepam (K) that I swiched over too fast (4 day intervals) so I got to a toxic level before it really hit my system but I only plan to do this once.  No one really knows how anyone persons reaction is to Valium! We are all different with different symptoms.

 

Thanks Sarah for the encouragement!  I have to work hard with 3 different conditions to deal with and different doctors agendas but I am pulling at all my resources from the Childrens services (for respite care and family support) to Pain Clinic to Mental Health, GP, pharmacist, homecare support and daycare, support groups, transportation for the disabled, massage and physio, bankrupct trustee (to get financially under control) and my friends who I try not to overwhelm, so it is great to have this forum to speak my diffficulties!  I making this happen because I want to be healthy again!  I guess I could considering practice to working as a health professional again in the future, because that is the most difficult aspect of my job, dealing with egotistical doctors!

[[Sh...]]

Hi Sarah, thanks for the advice. I have decided to keep going down at .o2mg a week but do you think that is to slow? I am in brutal withdrawal and it got alot worse just on these small cuts a week later...but do you think that I should speed up the detox because it will always be this bad or worse till I get off of it completely?

Thanks

 

Sean

[[sa...]]

Hi Sean,

 

Found this thread where you can find some answsers and people that are tapering from ativan

 

http://www.benzobuddies.org/forum/index.php?topic=44903.0

 

I can't really say about your dose as I tried to figure it out compared to val but I just couldn't do it, but then ativan reacts so differently than val, so your dosing throughout the day seems reasonable given it's short half life.

 

I do think you should get a taper plan to follow, holding for 3 mos seems too long. The goal is to get off and I have read that it is harder the lower we go. So I think being uncomfortable is to be expected. Since holding realling isnt giving you any relief, I would think continuing a sound taper would give you some progress even if it's uncomfortable.

 

I can't say for certain, but I doubt you will feel this bad or worse the entire time. Have you been applying some other coping ideas to help you? ie: some walking, and stretching, positive movies, comedies, self soothing..? I do think it's going to be hard, but I know you can do it. Many have done it before us and were glad they did and felt tremendously better.

 

I hope this helps, You can do this, Sean.!

 

Looking forward to seeing you move forward.

Sarah