LotusRising: Buspar, Ativan

[LotusRising]

@Frogie

So, it is 1245 right now and I took my morning dose at 700. I am only just now feeling better from its effects. I felt really awful and I’m nervous about taking the next half dose at 200. Even more concerned about taking the full .25mg at 800 this evening. The clonazepam seems to prevent me from sleeping at all. I can’t even seem to nap.  What do you think? I feel like I’m already setting myself up for a night with no sleep again and I haven’t slept for two weeks. 

[Altostrata]

@MedRN what is your dosing plan for today?

[LotusRising]

@Altostrata as per discussions with @Frogie, I have not been able to sleep over even nap. Yesterday, I took .25mg at 600am/100pm/700pm. The goal was to move forward the 2nd and 3rd doses today, so I took .25mg at 0700, we decided on a half dose (due to morning dose causing a whole host of symptoms until 1245) of the .25mg at 200pm and will do .25mg at 800pm. The problem seems to be that the evening dose is kicking in when I need to sleep, hence being awake the entire night, and also exacerbated by the increased doses my pharmacist recommended on the weekend. As I was approaching the 200pm dose today, I had a very large wave of anxiety that seemed to subside when the dose started working.

[Altostrata]

Is your schedule:

 

7:00 a.m. 0.25mg clonazepam

2:00 p.m. 0.25mg

8:0 0p.m. 0.25mg

 

You got a wave today before the 2 p.m. dose? When did it start, how long did it last?

 

You've made a drug change and schedule changes lately, some of these symptoms may be blips on the way to steady-state, which for clonazepam will take about 3 days. Is this the second day you've taken 0.75mg total/day?

 

Switching benzos can take some experimenting to find the right dosage equivalents. Too much clonazepam can cause the sleepless symptoms you've described. 

 

As @Frogie noted, from earlier, larger doses, you probably have a higher blood level of clonazapam in you than will settle out at 0.75mg per day. Hang in, your symptom pattern should smooth out. 

[LotusRising]

@Altostrata

 

Yes this is my schedule today, but I would like it to be 6/12/6 so the evening dose has kicked in and mostly worn off, as the clonazepam has been causing restlessness and an uptick in anxiety (whether this will pass I don't know). I got a slow wave today starting at about 200 that slowly gained momentum and then tapered off within an hour of taking the half dose, but is now increasing again. I should mention that I was able to sleep for the first time ever from 100pm-200pm today

 

Today will be the second day at .75mg, except for my 200pm dose, which we halved due to the drugged feeling and other uncomfortable symptoms I had until 1200pm. 

 

I wonder if it would make sense to move my evening dose up to 6pm today, in light of taking a half dose at 200pm? Or, what do you think?

Edited October 25, 2021 by MedRN
added content

[Altostrata]

54 minutes ago, MedRN said:

the clonazepam has been causing restlessness and an uptick in anxiety

 

This indicates the overall daily clonazepam dosage is too high. BUT your symptom pattern is confounded by the week's drug changes, these symptoms may be a legacy of the larger doses you took a few days ago.

 

What you could do is consistently take 0.15mg at 6/12/6 starting tonight.

 

But still, you may not get exactly the results you want, the change may be bumpy and will take some days to settle out, and every change you make will cause a ripple effect.

 

What we want you to do is get settled on a regular schedule of consistent dosing, so we can see your symptom baseline.

 

It is possible that when 0.15mg at 6/12/6 gets to steady-state in 5-20 days, you might find it too low a dose. Then we can ratchet it up. But maybe not, because clonazepam is stronger than lorazepam and equivalent dosages are approximate.

[LotusRising]

@Altostrata @Frogie I only have a kitchen scale that measures grams, so I have no way to measure out 0.15mg. Until I have a scale, what are my options? I was also able to have a short nap today from 100pm to 200pm. Does this potentially mean the levels were coming down. I have had several waves of anxiety (panic) since taking the half dose (0.125mg approx) this afternoon, so it maybe too small? Does it seem like a big jump to go from .75mg/day to only .45mg/day when I was previously taking ativan 1.5, sometimes up to 2mg?

 

Also, when I was trying to schedule the ativan initially, it didn't feel like it was quite enough and I was always chasing the anxiety. So maybe the .75mg is the right amount? Or would .125mg/.125mg/.25mg work? 

 

Sorry I know that's lots of questions.

Edited October 25, 2021 by MedRN
added content

[Altostrata]

28 minutes ago, MedRN said:

I was also able to have a short nap today from 100pm to 200pm. Does this potentially mean the levels were coming down.

 

Yes, let's not change anything for a while. How about a week?

 

29 minutes ago, MedRN said:

I have had several waves of anxiety (panic) since taking the half dose (0.125mg approx) this afternoon, so it maybe too small? 

 

No, your overall drug blood level is still too high.

 

29 minutes ago, MedRN said:

Also, when I was trying to schedule the ativan initially, it didn't feel like it was quite enough and I was always chasing the anxiety.

 

Ativan half-life is much shorter, you probably were getting interdose withdrawal. 

 

You're interpreting all the adverse effects as a need for more drug. As I've said, benzos have a way of whispering to you that you should be taking more.

 

@Frogie should making a liquid be considered here?

[LotusRising]

@Altostrata yes, everything you're saying is making sense. I'm a little stressed out about the whole thing and really need to sleep, as I haven't in many days, except for my small 1 hr nap. I also found out I have an initial psychiatric appointment in 2 weeks, so was hoping to have this figured out so I could go in with a plan. I'm also starting to get burning in my scalp, tinnitus and ear pain right now, so it definitely makes it harder to work all this through, but I certainly don't want to take too much tonight. Nor do I want to be in a panic all night either like I was last night.

I thought I remembered reading somewhere on the site that changing from pill to liquid can be hard on some people? I do have the ability to obtain a scale tomorrow if need be. 

[Frogie]

I think at this point you just need to stabilize. Since you took those huge doses that the pharmacist told you to take. I’d wait a week or so to see if you settle down. At this point I don’t think it’s a good idea to start liquid because that’s just one more change to the way to dose is distributed through your body. I’d give it a few more days and see how you’re doing. Have you tried melatonin? You might try a very small amount, only 0.3 mg and see if that might help. Shut off any computer, phone, tv a couple hours before bed and maybe read or meditate. Do a crossword or word search before bed. That may help also.

[LotusRising]

@FrogieSo take the .25mg tonight? If I feel drugged and gross again tonight, then I would know if it was too much wouldn’t I? And that I would need a smaller dose tomorrow? Or should I just take .125mg again, use Ativan for breakthrough (I know not usually recommended)

[LotusRising]

And is it dangerous for the levels to be too high?

[Frogie]

No, you’re not in danger because you stopped it before you became dependent on that dose. I would take the .25 mg tonight and for the next few night and see how you do. It’s going to take a little time for your body to even out since you took such large amounts in the beginning.

[LotusRising]

@Frogie Ok, I'll stick with the .25mg 3x/day for now, as you said, and continue with my notes. The 6/12/6 schedule is ok?

[Frogie]

That schedule works fine. It has to work for you.

 

Lets see how you do in the next few days and go from there.

[LotusRising]

@Altostrata @Frogie

So just to confirm, if I am experiencing an increase in anxiety, chest tightness and restlessness approximately 3hrs after taking the .25mg, the dose is likely too high - is that correct? This is happening again this evening - same as yesterday. Can I take a small dose of Ativan to alleviate it the chest tightness if it gets to the point I’m having difficulty controlling it?

 

What is the easiest way for me to decrease my dosages tomorrow? I can get a scale but I won’t have it for the morning dose. 

[Altostrata]

No, taking additional benzo is going to make a paradoxical reaction worse. "Paradoxical" means it does the opposite of what it's supposed to. Instead of relaxing, too much benzo will make those symptoms worse.

 

Stay calm, those symptoms will gradually go away.

 

Can you halve those 0.25mg doses? I understand this may not be exact.

 

@Frogie I think it might be a good idea for @MedRN to use a liquid for smaller doses ASAP.

[LotusRising]

@Altostratayes I can try. I don’t feel like I’m coping very well. 

[Frogie]

You can make a solution with vodka as it does not dissolve in water. I’m going to tag @brassmonkeyto see if he can tell me if I’m correctIn the meantime, 1/2 your dose.

 

Hope you feel better soon. I know it’s tough but we will get this figured out for you.

Edited October 26, 2021 by Frogie

[LotusRising]

@Altostrata @Frogie

Sorry for the panic last night. I had a particularly long and hard panic attack and unfortunately, I have been up all night.  
 

So, I have a pill cutter to cut the .25mg tablets, which will obviously not be accurate, but I’m hoping to have a scale by end of day. The pharmacist already cut the pill in four, so I just need to make the one cut. Please let me know what kind of schedule I’ll be looking at. I’m hoping to start by 6 if possible, but I do realize this is not your full-time job. I do appreciate all the help and commitment you’re providing. 

[Frogie]

Just now, MedRN said:

@Altostrata @Frogie

Sorry for the panic last night. I had a particularly long and hard panic attack and unfortunately, I have been up all night.  
 

So, I have a pill cutter to cut the .25mg tablets, which will obviously not be accurate, but I’m hoping to have a scale by end of day. The pharmacist already cut the pill in four, so I just need to make the one cut. Please let me know what kind of schedule I’ll be looking at. I’m hoping to start by 6 if possible, but I do realize this is not your full-time job. I do appreciate all the help and commitment you’re providing. 

If you’re taking it every 6 hours, then you might try one extra dose of the smaller one and take it every four hours to see if that might help. If you get breakthrough anxiety then you could take it every 3 hours to get in a couple extra doses. It’s ok to feel panic when going through this. I’ve been there many times. But we will get it figured out. Hang in there.

[LotusRising]

@Frogie oops, I think we were both replying at the same time. Would a scale be just as effective if I can get my hands on one today? Halving my total dose will not put me into withdrawal will it? And still 3 times/day?

[LotusRising]

@Frogie ok, so just to confirm, I can take .125mg up to every 3hrs in the 12hr dosing window, depending on breakthrough anxiety, or move to the 4 or 6 hour intervals?

[Frogie]

Is there anyway you could get the dr to prescribe liquid? Then you wouldn’t have to make your own liquid. I would order a scale and some “00” gel caps then you can crush and weigh them to get it as exact as possible. I think still dosing 3 times a day is best as it will keep the medication steady in your system.

[Frogie]

1 minute ago, MedRN said:

@Frogie ok, so just to confirm, I can take .125mg up to every 3hrs in the 12hr dosing window, depending on breakthrough anxiety, or move to the 4 or 6 hour intervals?

You can take it every 3 hours, you’re getting the same dosage just smaller increments. If you take .125 mg every 4 hours you might do better with that as you’re not getting the full .75 mg per day. I think you’re on too high of a dose. I would try every 4 hours and see how you do. We can always go to every 6 hours if it’s still too much. 

[LotusRising]

@Frogie I don’t speak with my doctor for two more days and I’m not sure if she will prescribe the liquid or not, as I will be transferring to a psychiatrist in two weeks. 
Do you mean dosing .125mg 3 times per day?

4 minutes ago, Frogie said:I think still dosing 3 times a day is best as it will keep the medication steady in your

[LotusRising]

@Frogie ok now I’m confused. So If I start with the 4hr dosing, what amount am I taking every 4 hrs? And without a scale as yet, this will be a rough estimate. It’s easy to half the pills with a cutter, but I can’t necessarily do much more. 

[LotusRising]

7 minutes ago, Frogie said:

If you take .125 mg every 4 hours you might do better with that as you’re not getting the full .75 mg per day. I think you’re on too high of a dose. I would try every 4 hours and see how you do. 

Got it. 

[Frogie]

Hi:

 

Did we get everything  straightened out so you understand? I think we were both replying at the same time, like we did earlier. I hope the psychiatrist will prescribe liquid for you. It makes it so much easier. Just please, if you can help it, don’t let them taper you off. 
 

Take care,

 Frogie xx

Edited October 26, 2021 by Frogie

[LotusRising]

@Frogie

Yes, I believe we did. Start at .125mg every 4 hrs, switch to every 3hrs if lots of breakthrough anxiety. 
 

What length of time do you recommend to stabilize before tapering?

[Frogie]

It’s going to take a good long time before you stabilize. I would guess we can revisit that in at least a month or so.

 

Hopefully the psychiatrist will prescribe the liquid. That would make it so much easier. 
 

But we will get you there😊

[Altostrata]

@MedRN, if you get panicky feelings AFTER you take a dose, your overall benzo intake is too high.

 

Breakthrough symptoms occur BEFORE you take a scheduled dose. Like you had before, when you said you felt you needed to take a dose earlier than scheduled.

[LotusRising]

@Altostrata yes, this definitely makes sense. So, I’ve been fine all day with the schedule that @Frogie came up with (.125mg every 4hrs, last dose at 6pm) and suddenly I am having breakthrough anxiety. Do I wait now until my next dose of clonazepam at 600am, or do I take a breakthrough dose now. 
 

Is it possible we brought my levels down too quickly?

[ChessieCat]

9 minutes ago, MedRN said:

and suddenly I am having breakthrough anxiety.

 

Please state the time.  Thank you.

[LotusRising]

@ChessieCat it is 1040pm. My last dose was at 600pm. I felt sleepy for the first time in days and fell asleep right away, but woke straight up with anxiety. It’s like my body wants to sleep but when it starts to fall asleep, it wakes with a start seeking oxygen. It’s a very strange feeling. 

[Frogie]

It was over 4 hours when you had the anxiety after your last dose. I think you would be ok to take another .125 mg dose. I would try that if it happens again tonight.

 

Im glad the new dosing and schedule seems to be working.

 

Give it a few days to regulate and I bet we’ve got it figured out😊

 

Please update with your notes.

 

Take care,

 Frogie xx