Snow's Titration

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Hi -  OK, thinking about titration .... I have just dry cut my .5mg Lorazepam tabs to 2.5 tabs - 1.25 mg (started at 2mg). This is day one at the new dose.

 

If I want to start a titration once I have stabilized here, and want to be at 0 in 112 days, I would use 100ml water and 2.25 tabs (1.25mg) every day, removing .9 ml the first day, 1.8 the second day....and so forth?  Would that be right?

 

Snow

[[Co...]]

Hi,

 

You are correct in your method, but measuring fractions of a ml is impossible in 100ml cylinder - and totally unnecessary overkill.

 

I can draw up a schedule for you. The method we use means titrating one whole pill - this is more accurate than splitting pills. To get a half tablet dose, you would simply drink 50ml from the 100ml benzo liquid (that contains a whole pill) - this will be included in the schedule, so no calculations for you to make. Once you have discarded the 50ml (or whatever the amount might be for that day), you might then crush the two remaining tablets for the day and add them to the remaining liquid. This means that you can more easily spread your dose over the day into equal amounts.

 

If you look at some of the schedules posted on this board, you will see that they include the number of whole pills taken in addition to the titrated pill. I promise, it is much more straightforward than I make it sound!

 

Just let me know your start date (and end date), and your starting dose (in mgs and number of pills), and I'll draw up a plan. The plan will include all the dates of when your dose changes, so this makes it pretty much foolproof.

 

Good luck.

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I appreciate your generous participation in this.  I will have a start date soon, and will post then. 

 

I was thinking you would use a syringe to draw up the fraction to be tossed and go from there, but sounds like your method is easier and/or more complicated!  There's my numbers brain in action.

 

Thanks, Colin.

 

Snow

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One more question this morning -  I take my whole lorazepam dose at bedtime.  Can I continue to do that with the titration method?  It looks like some people have divided it throughout the day...?

 

 

[[Be...]]

One more question this morning -  I take my whole lorazepam dose at bedtime.  Can I continue to do that with the titration method?  It looks like some people have divided it throughout the day...?

 

 

I'm surprised that you don't have interdose withdrawal symptoms taking such a short-acting benzo only 1x/day, but, yes, you can continue to take it at bedtime.

[[Co...]]

Hi Snow,

 

The majority of our members seem to benefit from spreading their dose evenly over the day, but some do need to take most or all of their dose to help with sleep or for morning anxiety, etc. Beeper alluded to the fact that you might benefit from spreading your dose more evenly, and if you are suffering from interdose withdrawal, you should perhaps consider gradually altering your regimen. However, if you feel fine with your present regimen, then it might be better to stick with what works for you. There are few hard and fast rules when withdrawing from benzos - do what's best for you.

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Hi Beeper and Colin -

 

Well, hmmm.  I don't know.  Lorazepam was prescribed for sleep - I DO have symptoms all the time, but they don't seem to be related to the time of the dose - I have strings of good days and strings of bad days.  I'm terrible in the mornings, take a "nap" (I don't really sleep) after breakfast for an hour  - and when I get up and get moving, I'm either okay for the rest of the day or I'm not.  Once in a rare while I'll come around in the afternoon after a bad morning. 

  I'm also on Doxepin and ambien at night - the lorazepam was added when I switched to Doxepin from Seroquel because that's when I really lost the ability for any kind of decent sleep. I know these other medications are awful too, and complicate the picture. I have no idea what are truly symptoms of withdrawal and what are symptoms of sleep deprivation.  My sleep is a matter of not good to way bad.  My psychiatrist thought getting off the lorazepam would be the first thing to do.

  Thoughts?

 

Snow

[[Co...]]

Hi Snow,

 

Ambien (generally referred to as a 'z-drug'), although not technically a benzo, operates almost identically to benzos. We make little or no distinction between benzos and z-drugs.

 

The problem with Ambien is that it has a very short half-life (about 2 hours), whereas Lorazepam has a half-life of 10-20 hours. Most of our members benefit withdrawing first from the shorter half-life benzo (or z-drug), and then the longer half-life drug. But, of course, you will need to discuss this with your psychiatrist. Since you appear to not suffer from interdose withdrawal symptoms, it might make little difference to you which drug you quit first. Are you intending to quit Ambien too?

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I am intending to quit Ambien too.  But I've already started with Lorazepam, down to 1.25 mg from 2 over the past 2 months. Would it make sense to hold at 1.25 and get rid of the ambien before I continue?  Wish I'd found BB sooner.

Really get bouts of anger re: MD's.

 

Snow

 

 

[[Co...]]

Would it make sense to hold at 1.25 and get rid of the ambien before I continue?

 

This is the conventional wisdom around here (quit the shorter half-life benzo first), but as I said, you should discuss this with your doctor.

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Hi Colin -

 

After thinking it and asking for other's experiences, I am planning to go ahead with my lorazepam taper before tackling ambien.  I am not yet sure of the exact date I will want to start - how much lead time do you need to help with a titration schedule?

 

Hannah

[[Co...]]

Hi,

 

Just be sure to include the information I request in this post: http://www.benzobuddies.org/forum/index.php?topic=11093.0, and I should have the schedule drawn up for you within 48 hours.

 

 

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OK - I'll get back to you.

Snow

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I have 100ml cylinders marked at 1ml - but the lowest mark is ata 10ml.  Will that work?

 

I am currently trying to get my hs dose into two equal am and pm doses.  Don't know how long that will take.

 

Snow       

[[Co...]]

Hi,

 

Yes, you can use that. You would pour and/or spoon out the amount you require when below below 10ml. So, if you require 9ml, you know that you have 9ml when there is 91ml remaining in the cylinder. Though most people obtain 10ml syringe bodies for convenience.

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Oh - of course! Food. ( Not a great day for brainwork here.)  I've got syringes.  Thanks, Colin.

 

Snow

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That was supposed to be "Good," not Food. 

[[Co...]]

That was supposed to be "Good," not Food.   

 

For future reference, above each post you make, there is a 'modify' button for editing out such typos and mistakes. I use it a lot!

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Why, so there is! What a good idea (duh).

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Colin - or anyone -

 

couple more questions re:titration

 

Can you mix at hs and keep the am dose overnight?

 

It sounds like I would be able to move small increments of the dose from am to pm easily - right?  And if I do this, I imagine I would want to hold at the current total dose for a couple days before continuing with the titration - ?  Are there any downsides to doing this?

I am better with a small a.m. dose, but might want to see if I feel more better with a slight increase.

 

Snow

[[Be...]]

Colin - or anyone -

 

couple more questions re:titration

 

Can you mix at hs and keep the am dose overnight?

 

It sounds like I would be able to move small increments of the dose from am to pm easily - right?  And if I do this, I imagine I would want to hold at the current total dose for a couple days before continuing with the titration - ?  Are there any downsides to doing this?

I am better with a small a.m. dose, but might want to see if I feel more better with a slight increase.

 

Snow

 

I'm not sure what you mean by the bolded statement. If you are asking if you can mix up your solution one day and drink it the next, the answer is yes.

Also, you are right that you can move some or all of your dose from am to pm using titration.  You can go so slow it can take you months to shift what you want so my suggestion is to set up a schedule for shifting the dose that doesn't take longer than roughly 1 week.  If I understand your signature box, though, you are currently taking 0.125 mg in the am and 1 mg in the pm so I'm wondering if you are looking to dose just at night?  I would think you'd need to go in the other direction to even out your blood level since lorazepam is so short-acting.  I didn't go back and re-read all your posts, though, so if you've already explained why you want to shift to 1x/day at night, no need to restate it here.

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Beeper -

You interpreted the bolded question right.  Thank you.

I will be taking 2 doses, am and pm, using just enough in am to even me out as I need the larger dose for sleep.  Currently .125 is working, emphasis on the "currently."

 

Snow

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MORE QUESTIONS re: Titration

 

1.  I've been practicing with a chunk of calcium citrate.  The pill crusher I am using leaves little chunks.  I have a large mortar and pestle which works better, but there is still a little dust-like residue that doesn't get totally into the mix.  How much margin for error is there in this process?

 

2.  For now I want to leave the am dose at .125mg because it is working for me and I need the larger dose for sleep.  It seems like it would be simpler to understand what I'm doing if I continued to dry cut that dose until it needs to be changed, and just mixed the pm dose (knowing that the titration is still based on the total daily dose).

 

I am sorry I am so dense, but I am.

 

Snow

 

 

[[Be...]]

MORE QUESTIONS re: Titration

 

1.  I've been practicing with a chunk of calcium citrate.  The pill crusher I am using leaves little chunks.  I have a large mortar and pestle which works better, but there is still a little dust-like residue that doesn't get totally into the mix.  How much margin for error is there in this process?

  It seems to depend on how exact you want to be.  When I was cutting my pills in 1/4s, I knew there was a lot of variability between the pieces but I decided not to worry about it.  One thing you can do to get more of the powder that's left is to take some of your 100ml of milk and pour it in the mortar/bowl, swish it around a little and pour it back with the rest of the solution before you divide up your doses for the day.  I'm not an expert on titration but that makes sense to me.

2.  For now I want to leave the am dose at .125mg because it is working for me and I need the larger dose for sleep.  It seems like it would be simpler to understand what I'm doing if I continued to dry cut that dose until it needs to be changed, and just mixed the pm dose (knowing that the titration is still based on the total daily dose).

 

I am sorry I am so dense, but I am.

 

Snow

 

I think that makes a lot of sense, Snow.  Are you planning on keeping the .125mg in the am until you get down to .125mg in the pm via titration?  And you certainly are not dense.  This is all kind of abstract to you right now but once you are underway with the process, I am confident that you will gain confidence as well.   

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Frankly, I think I'm perseverating on this a little too much.  I started fussing with it late in the day - you'd think I'd know better.  Today I figured out a way to do it, and besides discovered my little lorazepam crushes and goes into a suspension much more easily than calcium citrate. 

 

Am adjusting am and bedtime dose a little - hoping to send the info for a titration schedule on Sunday. 

 

Snow