Need Help Tapering Ativan

[Alurai]

Hi everyone,

I've been on 1 mg of Ativan for about 9 weeks, suffered for about a week with a c/t, then reinstated to 2 mg and bumped down to 1 after about a week (b/c I still had no idea what I was doing).  I don't think I've ever stablized from the c/t or the 2->1 mg bump, but I really really don't want to go back up on my dose b/c I'm worried it'll prolong the problem.  I tried switching to Valium one night, but that didn't work, and every time I cut my nightly dose (even just a tiny bit), I wake up shakier than normal.  I'm thinking water titration (sp?) might be the way to go, but I'm not sure how fast I can do it...

Is cutting 10% every week okay?
Is water titrating directly from Ativan too hard??  I've been reading a lot of posts on this site and it seems like Ativan's one of the wosrt ones to get off of.  =/

[coasterer]

Is cutting 10% every week okay?

It's recommended that you not taper faster than 10% every two weeks.  Please read the site's newer information on water titration.  There are guidelines and indicators included in the spreadsheet section:
http://benzowithdrawal.com/forum/index.php?topic=11.0

[RUNVS]

There is no obvious reason why about 10% of the people have problems with
diazepam tapering, but it is sometimes due to one or more of the following:

1) Incorrect equivalent dose – the values quoted by Ashton, et. al.
are those found to be effective in benzodiazepine withdrawal
and should in principle compensate for any difference in
binding of the benzodiazepines to either the same or different
benzodiazepine receptors. There values are not necessarily the
same as therapeutically effective doses, but sometimes are.

2) Poorly planned or too short a period for the exchange from
another benzodiazepine to diazepam. Mild daytime sedation at
the end of a 2-3 weeks exchange suggests the equivalent dose is
correct.

3) Failure to maximize accumulation of diazepam used and its
metabolites – it takes about four weeks to achieve 90% accumulation,
i.e. four weeks after exchange.

4) Tapering too fast. Each person should find the rate suitable to
themselves. A good starting guide is 2 ½ % of the initial dose/week.
The rate for the last 1/3 of the taper should be reduced to ½ of that for
the first 2/3.


by Dr. Reg Peart Victims of Tranquilizers

[lasseter334]

Given your history, I'd suggest that you consider one of 2 approaches:
1) Go up on your dose a little until you feel good. This doesn't always work after a  CT or overly rapid taper, but sometimes it does. The fact that you were on Ativan for a fairly short time may increase the probability that you can get stable by briefly updosing a little. Once stable, rest a few days and then begin tapering using water titration. 10% every 2 weeks is probably a good guideline since you had difficulty with the 2:1 jump earlier.
OR
2) Begin water titration from your current dose, cutting about 10% every 2 weeks. Since you won't be starting from a position of stability, you may not ever get stable during your taper, but you might. The good news is your short duration of use makes it probable you will recover fully fairly quickly after the drugs are out of your system. If during this process you start feeling really good, you can always speed up a little to get it over with faster.

Another option would be to be a little more agressive in your taper, (e.g. 10% a week). This would probably be more uncomfortable but you would be drug-free faster. The only reason this might make sense is because you were on ativan for a fairly short period of time, increasing your chances of a fast recovery.

Finally, you mentioned your brief experience with valium. You can't judge the viability of a crossover to a different benzo in a single day. It would take several days to complete a crossover, and several additional days to adjust to the different benzo after that before you could determine whether it feels better for you than ativan. If you don't do a crossover, I would definitely use the water titration method on the ativan.

[Alurai]

Well that would definitely explain my crappy reaction to day 1 of the Valium crossover.    I'm sooo glad you guys are here to help people like me...  I'm a totall n00b at this stuff.  Unless you guys don't think I should, I'm going to try to get off this stuff by water titration, 10% per week, since I don't see myself stablizing anytime soon and I'm really anxious to get off this stuff and let my brain heal.  I've been holding stead with 1 mg for about a week now.  My depression/anxiety is a little better, but the visual symptoms are the same.  Do you think going that fast will make my withdrawal symptoms worse?

RUN- Did you have a hard time tapering directly from Ativan?

[coasterer]

Well that would definitely explain my crappy reaction to day 1 of the Valium crossover.    I'm sooo glad you guys are here to help people like me...  I'm a totall n00b at this stuff.  Unless you guys don't think I should, I'm going to try to get off this stuff by water titration, 10% per week, since I don't see myself stablizing anytime soon and I'm really anxious to get off this stuff and let my brain heal.  I've been holding stead with 1 mg for about a week now.  My depression/anxiety is a little better, but the visual symptoms are the same.  Do you think going that fast will make my withdrawal symptoms worse?

RUN- Did you have a hard time tapering directly from Ativan?

Remember - Your brain heals as you taper.  It's not a situation where you don't heal until you're completely off.  The purpose of a taper is to make the discontinuation of the medicine as comfortable as possible, and to allow your brain time to get used to the gradual reductions.

[Alurai]

True...  I guess it's hard to make the idea sink into my benzo brain that it'll take even longer to taper off this stuff than I've been on it.

I was looking at the water titration method and I just have a quick q about these steps:

7. Click inside cell C6 enter the dry amount of benzo you will be taking (the amount taken in pill form)
8. Click inside cell C7 and enter the amount of benzo you will be dissolving in water (titrating)

Can I dissolve the whole thing, or do I keep part of the pill solid?

[coasterer]

I was looking at the water titration method and I just have a quick q about these steps:

7. Click inside cell C6 enter the dry amount of benzo you will be taking (the amount taken in pill form)
8. Click inside cell C7 and enter the amount of benzo you will be dissolving in water (titrating)

Can I dissolve the whole thing, or do I keep part of the pill solid?

You can dissolve the whole thing.  In my case, I was on 3 mg of Klonopin so my amount in C6 was 2mg and the amount in C7 was 1mg.  I am attacking one dose (1 mg) at a time.

The reason for these entries is so that the spreadsheet can fill out the subsequent sheets for the remainder of your taper (if you are on multiple pills per day).  If you are only taking 1 pill per day your amounts in C6 and C7 will be the same, and the spreadsheet would only populate data in sheet number one.

[Alurai]

Awesome, thanks!  I'm starting tonight!   

[coasterer]

Awesome, thanks!  I'm starting tonight!  

Great news!  Keep in touch to let us know how things are going.  Also, if you go into your profile, you can input your signature line so everyone knows where you started and where you are (like below my posts).

Feel free to ask any other questions that may come up.

[mike59]

Awesome, thanks!  I'm starting tonight!   

Great! I am thrilled you're starting!!

[Alurai]

Welp, I'm day 2 into my direct taper, and I think I'm doing okay.  I keep tossing over the idea of switching to Valium because every morning after the Ativan runs its course (after about 8 hours), my arms and legs feel jittery and I'm anxious for 2/3 of the day until I take my dose again at night.  I think I could deal with it for the next 2 months if I had to (as long as it doesn't get worse), but it's pretty annoying. 

How long would it take to switch 1 mg of Ativan to Valium?

[Alurai]

I think I'd like to do a Valium switch over.  The anxiety is getting worse in the mornings, and lasting pretty much all day.  Would you guys help me with a crossover plan?  How should I split it up?  I know 10 mg Valium = 1 mg Ativan, so for my first day, should I take .75 Ativan and 2.5 mg of Valium, or is that too fast?

• Downloads
• Benzo Equivalence Table
• Water Titration Instructions