thepooka: tapering off lorazepam safely

[thepooka]

Hi Everyone,

 

I need help safely tapering slowly off Ativan (lorazepam) so I don't die in the process and don't retrigger severe akathisia I've had over this past year:

• I am about to slowly dry or water microtaper off of 2mg of Ativan (0.5mg 4x daily) that I was prescribed for dealing with severe akathisia that hospitalized me and that I had from January-August this year (2023).
• I have a histamine intolerance from tolerating? Ativan that has severely restricted my diet and my weight is currently 107-109lbs and I'm 5" 8'. I'm working to increase my weight and introduce foods.
• I've had akathisia for the past year and would like to avoid retriggering it during my taper
• I am interested in doing Brassmonkey's taper method
• I have a Gemini scale for tapering and a file
• Because of the histamine intolerance and akathisia risk, I am not switching over to Valium and can't tolerate the inactive ingredients in liquid ativan from a compounding pharmacy to do that either.
• I would like advice and help with 
  • calculating my taper schedule since I'm taking 4 doses of 0.5mg a day and want to avoid eliminating doses and causing interdose withdrawal
  • how to do a dry taper using brassmonkey's method (especially once the doses get small)?
  • how to communicate to my psychiatrist the rate of my taper (if I'm reducing my milligrams of weight and not dosage, how do I tell her what amount of dose I'm tapering each month?)

 

My background (Diagnosed with akathisia in May 2023)

2019-2022

• Previously on lexapro 10mg for anxiety, OCD, and reflux for 3 years (2019-December 2022)
• August - Acute severe akathisia from compazine in IV at hospital after minor car accident. Went away after 48 hours.
• September-October- Milder akathisia every time I took my Lexapro.
• October-December - Tapered off lexapro 10mg by skipping doses. Akathisia stopped at the time after this briefly.
• December - digestive issues, depression, anxiety

 

2023

• January 1-4 - attempted to get on 25mg Prozac for 4 days. Developed severe akathisia and stopped taking Prozac. 

January-May - Akathisia continued January-August because doctors thought initially it was anxiety and had me try numerous meds

• January-April - Back on lexapro 10mg and doctors added Zyprexa 2.5mg for weight loss and sleep from pacing and sweating with akathisia
• Late march - Zyprexa caused me liver issues. CT'd off it in 3 days. Akathisia worsened. Was hospitalized
• March 26-April 9 - Hospitalized. Rapid tapered off lexapro in first week. Started Ativan 1mg daily. Tried risperidone and seroquel once each but stopped due to side effects. 
• April 9-May 10 - Put in partial hospitalization program where I: 
  • tried and stopped buspar 30mg after 2 weeks (made akathisia worse)
  • tried and stopped gabapentin after 2 weeks (helped akathisia but gave me bad breathing issues)
  • tried to CT off the 1mg of Ativan I'd been on for 2 weeks (made akathisia worse and caused severe W/D symptoms). This included trying to cross over to Klonopin which made akathisia worse.
• May 10 - diagnosed with akathisia by neurologist. Got a new psychiatrist in partial hospitalization program. Put back on and increased Ativan to 2mg daily (0.5mg 4x a day) which I've been on ever since.
• Late May - June - Developed dry eye problems from histamine intolerance issues from Ativan. Akathisia worsened for a bit with new symptoms. Changed to low histamine diet which improved things significantly but also caused me to lose a lot of weight
• July - Developed more eye problems tried eye drops and antibacterial eyelid wipe treatments which triggered worse akathisia for two weeks.
• August - Stopped all medicinal eye treatments. Akathisia started to improve considerably.
• September-November - Akathisia continued to improve but started having benzo tolerance symptoms (short term memory, crying spells, some mild-moderate akathisia). For the past 4 weeks I've been sleeping till 11am which is unusual. My weight is 107-109lbs. I'm still having eye issues

 

Thanks everyone for your help in advance!

thePooka

 

[thepooka]

Given the information above anyone have advice for tapering the way I described?

• I would like to slowly dry or water microtaper off of 2mg of Ativan (0.5mg 4x daily) 
• I would like to avoid retriggering akathisia during my taper
• I am interested in doing Brassmonkey's taper method
• I have a Gemini scale for tapering and a file
• Because of the histamine intolerance and akathisia risk, I am not switching over to Valium and can't tolerate the inactive ingredients in liquid ativan from a compounding pharmacy to do that either.

 

I would like advice and help with 

• calculating my taper schedule since I'm taking 4 doses of 0.5mg a day and want to avoid eliminating doses and causing interdose withdrawal
• how to do a dry taper using brassmonkey's method (especially once the doses get small)?
• how to communicate to my psychiatrist the rate of my taper (if I'm reducing my milligrams of weight and not dosage, how do I tell her what amount of dose I'm tapering each month?)

 

[Onmyway]

Hi @thepooka, 

welcome to SA. 

At what times are you taking your doses? You would probably cut your from one of your mid day doses. The evening one would be needed for sleep and the morning one would be needed because there would be a longer gap between the evening and the morning dose usually. Perhaps cutting 2.5% from the 3rd dose first time, then 2.5% from the second dose, then again 2.5% from the 3rd dose, then 2.5% from the 2nd dose? Then hold 2 weeks. Then Take 2.5% from your 1st dose, then 2.5% from the 4th dose etc. 

 

Do you think what you are thinking of as benzo tolerance could be just withdrawal. In that case we would advise you to wait further. I am worried that the akathisia could come back if you lower too soon. In my understanding brain fog, short term memory issues etc are side effects rather than tolerance issues - tolerance would be more breakthrough anxiety. 

However, I want to warn you that SA is not specialised in benzo as other sites on the internet such as benzo buddies. You might get better advice there. 

 

Have a look at this post and see if it answers your questions. 

OMW

 

 

Edited November 6, 2023 by Onmyway

[LotusRising]

Hi @thepooka

 

Welcome to SA,

 

It looks like you've been given some good advice from @Onmyway. Ideally, we don't recommend tapering until symptoms are stable. Please see Stability for some excellent information on what it means to be stable.

 

As you may have already seen on the site, we recommend tapering by no more than 10% of your previous dose each month. Why taper by 10%

 

On 11/4/2023 at 11:36 AM, thepooka said:

September-November - Akathisia continued to improve but started having benzo tolerance symptoms (short term memory, crying spells, some mild-moderate akathisia). For the past 4 weeks I've been sleeping till 11am which is unusual.

 

How is your akathisia currently? Do you feel the ativan has helped?

 

As mentioned, these are likely side effects of the benzo, and not tolerance. 2mg is not a small dose of ativan, so it's not surprising to me that you're sleeping longer, and experiencing trouble with memory impairment and histamine. These are all well known side effects and I experienced them, even while taking ativan as needed. 

 

You have a couple options for tapering. As outlined already, you could remove the two middle doses first, but the other option would be to cut each dose consecutively ie. start with morning for 1st week (2.5%), then mid-morning 2nd week (2.5%), and so on, with the 2 week hold at the end of the 4th week. Alternatively, if you find that too aggressive, or are concerned about akathisia, you could reduce that to 1.25% each week. 

 

Personally, I found it easiest to keep my doses even until I was near the end. I tried eliminating the two middle doses, but it was confusing to keep it up long-term. I found by reducing consecutive doses, it reduced the margin of error in dosing. Some like to keep the evening dose biggest to help with sleep, while for me, it made no difference. It comes down to personal preference.

 

You can certainly ask over on benzobuddies, however, from personal experience, I found their tapering strategies a little more aggressive and I didn't like that I received conflicting advice.

 

Let us know if you have any more questions!  

[Onmyway]

Hi @thepooka, 

I would follow @LotusRising's suggestions over mine as she has personal experience with benzos while I only have general knowledge. Because of her experience she has also researched them more and been on Benzo Buddies which I have not been on. Since she has taken you on here, I would probably stick with the SA advice in that case. 

[thepooka]

Thanks Onmyway and LotusRising for responding!

 

Here's my reply to your feedback and questions

• The status of my akathisia and if the ativan helped
  • The Ativan definitely helped the akathisia and it has significantly improved to being mild to not there at all. It returned moderately in Aug-Sept because my ativan doses weren't spaced well from the get-go. But since spacing them evenly, things have been much better, with the akathisia being mild to almost not there and not every day. Plus I am able to sit even on the days I have it very mild now.
     
• Alternating cutting 2.5% on each dose 1 at a time for 4 weeks. Finding it easiest to keep doses until end with consecutive alternating cuts.
  • This was my exact thought recently. Or like mentioned, I could do it slower at 1.25% per week
     
• Waiting longer to taper till symptoms are stable because akathisia could come back if I lower my dose too soon
  • I'm concerned that I've been tolerating the Ativan because I had my akathisia return and worsen for weeks on end in August-September before I spaced my dosing better as previously mentioned. 
    • According to one article from the AkathisiaAlliance website, "people taking benzodiazepines can develop akathisia as each dose wears off (“interdose” or “end-of-dose” akathisia), which may become unrelenting when tolerance occurs." and that increasing the dose can alleviate the symptoms but only temporarily.
       
  • Spacing my doses more evenly in late September helped eliminate or reduce significantly the severity and quantity of symptoms I was having in August-September (including the akathisia I mentioned above). 
    • Symptoms before - severe, frequent crying spells (user mentioned having these), significant short term memory loss, brain fog, headaches, sleeping more, chest pain, nerve pain (arms, hands, head, feet), RLS in hands/feet/needs/fingers (probably akathisia).
    • Symptoms after spacing doses:
      • crying spells (less often, less severe) a 2-3 times a week, occasional brain fog once a week or less, some persistent or episodic mild anxiety/restlessness (possibly mild leftover akathisia) a few days a week, sleeping more (could be due to stress and me having eye problems).
         
  • My only options are to hold my dose, increase my dose, or start tapering slowly obviously. It's hard for me though to not see why tapering wouldn't be the best approach but I'd like to hear what you have to say about the info below. Thoughts?
    • I don't think holding my dose is going to help stabilize the akathisia or the symptoms I'm experiencing still. Especially given what happened with the akathisia returning because of bad dose spacing before. I'm worried waiting is just going to make the akathisia return/worsen like it did in August.
    • Increasing my dose might help but there are risks that at an even higher dose, it will worsen my histamine issues which have already caused me to lose a lot of weight (I'm 107-109lbs) and a cluster of eye problems I really don't want to worsen (dry eye/eye pain/corneal abrasions/blepharitis/etc.). Also increasing only one of my doses will cause uneven drug levels in my blood throughout the day which could cause interdose withdrawal or other problems that might trigger the akathisia or kindling. I suppose I could crush the extra pill and divid it among the 4 doses I take, but there would still be the risk of worse histamine and eye issues.
    • Tapering might be the way to go but obviously I don't want to risk triggering the akathisia like you mentioned. My goal was, if I did taper soon, to start tapering as small as possible for the first month (1.25% per week) and hold for two weeks and see how it goes.
       
• Most of my symptoms being benzo side effects and not withdrawal (brain fog, short term memory, excessive sleep/fatigue, histamine)
  • Perhaps. But the short term memory and excessive sleep didn't start till September/October. Months after starting the med in April.
     
• My thoughts on consulting Benzo Buddies etc
  • BB and Facebook groups pushed me to taper asap *shrugs*

[thepooka]

I feel like the longer I wait, the more I risk the akathisia returning and worsening again from tolerance. 

 

Given the info above, what is my best option?

 

Also, if I taper, I have several questions with regards to that:

It seems like there is conflicting info on the best approaches for tapering, in some cases particularly with Ativan. Which advice should I follow in each of the areas mentioned below? I'm inclined towards a dry micro taper because I've had dietary sensitivities to inactive ingredients in liquids but want to ensure I have accuracy especially at the end of my taper.

• Dry or liquid micro taper for Ativan? - I've seen posts where Brass Monkey seems to advocate for dry taper and then others (perhaps more recently) where he recommends a liquid taper because of accuracy issues with scales at the end of the taper measuring .004g.
  • For dry microtaper, wouldn't the end taper issue be solved by weighing a 10g or 5g weight with the .004g of ativan on top to force the scale to give an accurate weight because it will be in the middle range? Or is the .004g how much it fluctuates in general with weighing medication even at the start of taper?
  • Am I going to have issues like Mimi79 had with going down to .01mg of ativan doing the dry micro taper?
  • If I do a dry microtaper, should I switch to liquid at the end of the taper to avoid accuracy issues with the scale? or does my solution above fix the scale issue? or can I do the dividing piles method that Brassmonkey came up with? Or better yet, add more inactive ingredient [powdered caster sugar] to dilute things like mentioned on benzobuddies forum by one user?
     
• If I'm considering liquid taper options (using my own liquid and crushed pills), what is the safest one for me?
  • I've read some people say tapering Ativan with water and crushed pills works and others say you should do milk and others say that Ativan is not soluble in milk or water and you'll have accuracy issues at end of taper. And those folks only recommend dissolving ativan in vodka or propylene glycol and adding water. Which method is best for my case with tapering Ativan, especially given my sensitivity to ingredients and history of akathisia and histamine intolerance? Is water feasible? or am i forced to go the route of either vodka or propylene glycol to dissolve pills or mixing water with ativan intensol?  (Note - vodka and propylene glycol are both high in histamine or liberate histamine which is bad when you have a histamine intolerance. Propylene glycol is also the primary ingredient in ativan intensol)
  • Is olive oil a feasible option since it's a lipid and it's mentioned that Ativan is very soluble in lipids? How would I do that?
  • Is it true with liquid tapers you have to store the liquid in the fridge in a glass jar (because apparently lorazepam gets absorbed in plastic?), and toss the oral syringes when the plunger stops gliding smoothly to prevent infection with microbial growth? 
  • Will syringes work for oil? What about if I'm doing small doses of ativan and I'm at end of taper?
     
• How feasible is a dry taper with added inactive ingredient powder?
  • Especially at the end of taper where I mix it with some edible powdered ingredient to dilute it like it was posted on Benzo Buddies forum here (first post top of page 2)?
     
• Is it seriously going to take me 1 1/2 to 3 years to taper off 2mg ativan doing the brassmonkey method at a 10% or 5% reduction? Is my calculation correct? 
   

Thanks in advance!!!!

ThePooka

[LotusRising]

1 hour ago, thepooka said:

Given the info above, what is my best option?

 

You have to decide for you what the best option will be going forward. It sounds like you're inclined to start tapering. 

 

1 hour ago, thepooka said:

I feel like the longer I wait, the more I risk the akathisia returning and worsening again from tolerance. 

 

Are you certain you were in tolerance, and not just having interdose withdrawal? Tolerance is when you need more of the drug to get the same effects. Interdose withdrawal is when you get symptoms in between doses. It sounds like you might have been experiencing the latter if symptoms improved by spacing out doses. 

 

I don't know that I can answer all your questions, but I'll do my best.

 

1 hour ago, thepooka said:

Dry or liquid micro taper for Ativan?

 

Ideally, you would switch to a liquid through a compounding pharmacy. It's the most accurate way to measure and is easier at lower doses. If you have dietary restrictions, they should be able to accommodate them.

 

1 hour ago, thepooka said:

For dry microtaper, wouldn't the end taper issue be solved by weighing a 10g or 5g weight with the .004g of ativan on top to force the scale to give an accurate weight because it will be in the middle range? Or is the .004g how much it fluctuates in general with weighing medication even at the start of taper?

 

Perhaps @brassmonkey could weigh in here on the above.

 

1 hour ago, thepooka said:

• •  
• If I'm considering liquid taper options (using my own liquid and crushed pills), what is the safest one for me

 

At best, you're creating a suspension if you make your own liquid, as to my knowledge, ativan is not water soluble and has lower lipid solubility than other benzos - though the milk is denser than water, so it may work better. I can't comment on making a liquid with alcohol, as this is beyond my knowledge - you might try benzobuddies for this info.

 

1 hour ago, thepooka said:

Is olive oil a feasible option since it's a lipid and it's mentioned that Ativan is very soluble in lipids? How would I do that?

 

Again, it's my understanding that ativan has lower solubility in lipids than other benzos. Again, you could try benzobuddies.

 

As far as using a syringe, I suspect any liquid would be okay in the syringe. When I used a compounded liquid, I rinsed the syringe and let it dry and then reused it. I wasn't concerned about bacterial growth.

 

2 hours ago, thepooka said:

Especially at the end of taper where I mix it with some edible powdered ingredient to dilute it like it was posted on Benzo Buddies forum here (first post top of page 2)?

 

If this was a post on benzobuddies, I would follow-up with them.

 

 

[Onmyway]

@thepooka, given that these low doses are 2+ years away, I'd not worry about that now. It's also very possible that your histamine issues may resolve as you lower doses and you may be able to do conventional liquid. Let future you deal with those.  There are too many unknowns right now to even predict how things might end up in 2 years. Goal is to get and keep you stable NOW.

 

If you're intent on starting to taper now,  why don't you start extra carefully - cut 1.25% and hold for 2 weeks and we re-evaluate then.  

 

I also think you had interdose withdrawal rather than tolerance in August but it has traumatised you. 

 

What non-drug techniques to manage anxiety are you using?

 

Omw

 

Also,  can you please edit your signature so that we have info on what happened at each time period in a linear fashion? See mine if you want.  Think of it as a calendar of withdrawal if you wish - it should be obvious quickly what medicine and dose you were taking at each time as back as you can go (less accurate for older dates is OK). I thought you just randomly had akathisia until realising that you were on multiple drugs before.

 

Edited November 7, 2023 by Onmyway

[thepooka]

16 hours ago, LotusRising said:

You have to decide for you what the best option will be going forward. It sounds like you're inclined to start tapering. 

 

 

I'm trying to figure out what's my safest option to prevent the akathisia from returning when I start to taper down. Which option in you opinion will help me do that best? Also what symptoms or things in your opinion do I need to stabilize before tapering and how would I go about that? it just feels like holding my dose isn't going to stabilize things further, but I could be wrong and would like to hear your experience. Thanks!

 

16 hours ago, LotusRising said:

Ideally, you would switch to a liquid through a compounding pharmacy. It's the most accurate way to measure and is easier at lower doses. If you have dietary restrictions, they should be able to accommodate them.

 

If did talk to some compounding pharmacy's about their liquid form and the suspending agents they showed me, while free of the common allergens, contained at least 8 ingredients I've had reactions to and that was their best one. So I unfortunately can't go the compounding liquid route. There's a small chance I might be able to tolerate ativan intensol, but I'm inclined toward doing an end taper with that. Idk if that's a dumb idea or not, to start with a dry taper and then switch to intensol at the end? Thoughts based on your experience?

 

16 hours ago, LotusRising said:

I can't comment on making a liquid with alcohol, as this is beyond my knowledge

 

I'm pretty sure I saw @brassmonkey mention it before. Maybe he can chime in with regards to that and the dry microtaper given my situation with ingredient sensitivities.

 

16 hours ago, LotusRising said:

When I used a compounded liquid, I rinsed the syringe and let it dry and then reused it.

 

Curious what solvent did you use towards the end of you taper with the compounded liquid to get smaller doses?

 

16 hours ago, Onmyway said:

If you're intent on starting to taper now,  why don't you start extra carefully - cut 1.25% and hold for 2 weeks and we re-evaluate then.  

 

That's probably a good idea. I might just go that route. 
 

16 hours ago, Onmyway said:

What non-drug techniques to manage anxiety are you using?

 

 

Psychotherapy once a week, breathing, grounding techniques, some support from family and friends.
 

16 hours ago, Onmyway said:

Also,  can you please edit your signature so that we have info on what happened at each time period in a linear fashion? See mine if you want.  Think of it as a calendar of withdrawal if you wish - it should be obvious quickly what medicine and dose you were taking at each time as back as you can go (less accurate for older dates is OK). I thought you just randomly had akathisia until realising that you were on multiple drugs before.

 

Not sure what you mean here. I'm limited to 12 lines so it was rough squeezing in what I did. I also listed meds, dosages, and durations where applicable. As far as the akathisia goes, my signature mentions in the first two points of the timeline the meds that initially triggered it and what meds worsened it later. Does an edit like this make things clearer? (it makes my signature exceed 12 lines):
 

Quote

August-December 2022 - Had acute undiagnosed akathisia from being given compazine at ER after mild car accident. "Tapered off" lexapro 10mg that I'd been on for 3 years [no dose change eve] by skipping doses because it made the undiagnosed akathisia continue mildly for months whenever I took my dose.

January 1-4, 2023 - undiagnosed akathisia became severe after trying and stopping 25mg Prozac for 4 days

 

[thepooka]

I'm still wondering about the following. Hopefully brassmonkey or someone else can help. Just re-posting the remaining questions here:

 

The psychiatrist question is the most important one since I meeting with her to discuss how much I'm going taper and when and how this Thursday.

• how to communicate to my psychiatrist the rate of my taper (if I'm reducing my milligrams of weight and not dosage, how do I tell her what amount of dose I'm tapering each month?)
• Is it seriously going to take me 1 1/2 to 3 years to taper off 2mg ativan doing the brassmonkey method at a 10% or 5% reduction? Is my calculation correct?

Dry taper Qs

• For dry microtaper, wouldn't the end taper issue be solved by weighing a 10g or 5g weight with the .004g of ativan on top to force the scale to give an accurate weight because it will be in the middle range? Or is the .004g how much it fluctuates in general with weighing medication even at the start of taper?

• If I do a dry microtaper, should I switch to liquid at the end of the taper to avoid accuracy issues with the scale? or does my solution above fix the scale issue? or can I do the dividing piles method that Brassmonkey came up with

• how to do a dry taper using brassmonkey's method (especially once the doses get small)

Liquid taper Qs

• Is water feasible in the sense that has anyone as sensitive as me had success mico tapering off ativan using water? or am i forced to go the route of either vodka or propylene glycol to dissolve pills or mixing water with ativan intensol?
• Is it true with liquid tapers you have to store the liquid in the fridge in a glass jar (because apparently lorazepam gets absorbed in plastic?), and toss the oral syringes when the plunger stops gliding smoothly to prevent infection with microbial growth? 

 

With regards to the olive oil question:
 

16 hours ago, LotusRising said:

Again, it's my understanding that ativan has lower solubility in lipids than other benzos.

 

 Brass monkey mentions in the two sections below from this post that ativan is soluble in lipids [wouldn't olive oil work then?] 

 

On 5/10/2022 at 3:53 PM, brassmonkey said:

Lorazepam (Ativan)

Insoluble in water at 80 mg/L water ⁽⁶⁾

Note: solubility in water is .08mg/mL so 10mL of water is enough to dissolve a .5mg tablet.

 

Sparingly soluble in alcohol at 12mg/mL of 90 proof vodka. ⁽⁷⁾

 

Freely soluble in propylene glycol at 10 mg/mL ⁽⁸⁾

Highly soluble in lipids

 

On 5/10/2022 at 3:53 PM, brassmonkey said:

Fats and oils are grouped into a class called lipids. The fat in whole milk is the most popular one to use for homemade liquid preparations, but it is also possible to use many of the popular cooking oils. Oils such as corn oil, cottonseed oil, olive oil, peanut oil, safflower oil, sesame oil, soybean oil, hydrogenated vegetable oils, can be used in place of milk. For those who have problems with dairy products Almond or Soy Milk is a good alternative.

As we all know oil and water do not mix. Trying to dilute an emulsion, an oil-based preparation, by adding water will not work and in the case of Ativan, will cause the medication to crystalize, settle out and render the medication useless. It is possible to force the issue in some cases, but that is better left up to the chemists.

[LotusRising]

1 hour ago, thepooka said:

Which option in you opinion will help me do that best?

 

If it were me and I had a lot of sensitivities, I would stick to dry tapering. Another option, is to look into a jeweller's scale, which is more expensive, but would allow you to measure to another decimal place. I did this before switching to liquid and was able to find a cheaper, used one.

 

I would review our topic on Stability to gain clarity on when to start tapering. I can't tell you when to start tapering.

 

1 hour ago, thepooka said:

start with a dry taper and then switch to intensol at the end

 

I started with a dry taper and switched to compounded liquid. I found the liquid easier to measure and I didn't need to add anything to it at the end. The concentration was such that I could measure very small amounts. 

 

1 hour ago, thepooka said:

Not sure what you mean here

 

If you read through this post How to Create a Signature, it will give you info on the details we're looking for. It is a snapshot, if you will, of all medications you've been on, with corresponding timelines. We don't need symptoms listed here.

 

58 minutes ago, thepooka said:

Brass monkey mentions in the two sections below from this post that ativan is soluble in lipids [wouldn't olive oil work then?] 

 

Then yes, I would follow what brassmonkey says, over the limited knowledge that I have in preparing DYI liquids. What I know about DIY liquids

with milk/water/alcohol is that they seem accurate enough for many/most individuals, allowing them to successfully taper off lorazepam.

 

I would not get hung up on how long the taper will take. 

 

1 hour ago, thepooka said:

how to communicate to my psychiatrist the rate of my taper (if I'm reducing my milligrams of weight and not dosage, how do I tell her what amount of dose I'm tapering each month?)

 

 

I'm not sure what answer you're looking for here. I would tell your psychiatrist that you're planning to reduce your dose by 5% per month (if you're doing 1.25% per week), or 10% per month (if you're doing 2.5% per week). If you look back in your posts, @onmyway provided a link to a post for dosage calculations and spreadsheets.

 

 

[brassmonkey]

When you use a percentage basis, the reduction in dose weight and dose strength are the same. If you reduce 5% of the dose weight you automatically reduce 5% of the dose strength. We use dose strength when we are talking about how much we are taking, but we use dose weight to measure out what we are swallowing.

 

The calculation for a 10% reduction is Current dose weight (dose strength) X 0.9 = New dose weight (strength).

 

It takes a frustratingly long time to do a proper taper. The half-life of a 10% Brassmonkey slide is 9 months. So, if you are taking 2mgai now, in 9 months you will be taking 1mgai.

 

Lorazepam (Ativan)

Insoluble in water at 80 mg/L water ⁽⁶⁾

Note: solubility in water is .08mg/mL so 10mL of water is enough to dissolve a .5mg tablet.

 

If you are working with .5mgai tablets you can still use the water method. You will need to use 40mL of water and 4 tablets to make up each dose.

[thepooka]

A few more questions (anyone can answer these but definitely would like to hear what @brassmonkey has to say).

 

I'm doing a dry taper starting in a couple days. I plan on crushing the 0.5 mg lorazepam tablets into powder but I'm still unsure about a few things - my taper speed, getting accurate weights, how storage/environment affect weight, and how changes to the form of lorazepam will affect speed of it entering my system (e.g. causing delays compared to current tablet form).

 

Here are my specific questions

 

Taper Speed

•  Brassmonkey mentioned it taking 9 months to get to 1mg from 2mg with their method. I've only been on lorazepam for 8 months and 4weeks taper with 2 week hold is going to take me 4 years for 8% taper and 8 years for 5% taper. Should I go faster at the start once I know how symptoms will affect me? 

Weighing Pills on Scale

• Question - How am I supposed to taper this weigh if the mgpw reduction is already smaller (e.g. .0026) than the accuracy of the scales i have which fluctuate .001-.004g (i bought 3)?
• Background to Question - I'm tapering 2mg of lorazepam (in four 0.5mg tablets which weigh .240g total or .240mgpw or .060mgpw for each of the 4 pills) by 5% every 6 weeks [4 weeks of me reducing one more of my 4 tablets by 1.25%].
  • I do this by multiplying 0.240mgpw X .95 for 5% reduction which gives me 0.228mgpw
  • Then I divide that 0.228mgpw by the 4 pills so I get .057mgpw.
  • This is a .003 reduction per pill (.060-.057=.003)
  • The following month the reductions go in 4 decimal places (0.0029, 0.0027, 0.0026, 0.0024)
  • If I round up then that means 4 months of only reducing by .002mgpw, then .001 a year later, then .000 by my third year of an 8 year taper for 5%
• Question 2 - will moisture or humidity or cold affect the weight of older pill powder (like month or two old)?

Medicine release timing in body and withdrawals

• I want to minimize changes to when my dosage hits my system. After crushing my tablets into powder, will the following changes to forms of lorazepam changing the time it hits my system?
  • Using HPMC (hypromellose or vegetable cellulose) capsules or gelatin capsules? 
  • Pouring the reduced pill powder into water and immediately drinking it? 
  • Consuming just the plain powder of pill vs solid pill?

Capsules

• Won't i lose some pill powder getting stuck to the capsule, my mortar and pestle, or a glass jar if I'm storing the powder in it?
• Will the capsules I store the powder in absorb some of the Lorazepam like plastic containers do?
  • Or does this only apply if I'm storing the lorazepam as a liquid mixture?

Storage

• Will a plastic lid on a glass jar of lorazepam powder cause absorption or loss of the lorazepam?

[thepooka]

3 hours ago, thepooka said:

Question - How am I supposed to taper this weigh if the mgpw reduction is already smaller (e.g. .0026) than the accuracy of the scales i have which fluctuate .001-.004g (i bought 3)?

 

Just for clarification I'm talking about the reduction difference between current and previous tablet's weight here, NOT the overall weight of the dose.

 

For example - The weight of one of the pills might be .057g and the difference in reduction from the previous dose's weight of .058g is .001g.

[thepooka]

Can someone help me? @LotusRising @brassmonkey

 

I'm having a nervous breakdown trying to figure this out and it's the second day of tapering.

 

I've tried using a flat level surface, turning off ac, wearing a mask, adding 20g weight to get upper range for scale, tareing the 20g weight, and I'm still dealing with .001-.004g fluctuations.

 

Even if I add more weight to get the scales in the upper range I get those fluctuations.

 

In short, I can't reduce my dose weight 1.25% per tablet per week by filing or crushing the 0.5mg dose Ativan tablet and weighing it on the scale and trying to get it down to my first reduction from .060g to .058g (.002g difference) because all 3 scales I own fluctuate .001-.004g.  

 

Heck, I filed the tablet today and the scales now say it weighs either the same or even more. 

 

Please help. Would an analytical balance work better? Are there any other tricks or tips?

 

 

[LotusRising]

Hi @thepooka,

 

Have you reviewed this post on using a scale?

 

Personally, I ended up buying a secondhand analytic scale for accuracy, but many seem to make do with what they have. Are you weighing the pill in the same spot each time? I found the weights could vary depending on where my pill was, and I would usually weigh it out a few times. You might just use one scale, rather than 3. If you're using the same scale each time, it would be more consistent than weighing on three separate ones. Alternatively, after all the discussion about making a liquid, have you considered this? It's quite a bit easier to be accurate this way as well.

[thepooka]

I'm looking into getting an analytical balance @LotusRising  for now. Later in my taper I'll probably switch to a liquid route. 

 

I tried my best to follow the tips in that post but still had the fluctuation even with one scale.

 

My biggest concern other than accuracy with the scale is potentially having interdose withdrawal down the road since I'm taking a short acting benzo four times a day. My plan is to taper all four doses down as discussed but not sure if this will fix the problem later of potential akathisia or worse when each dosage is super low.

 

My final concern with switching to a longer acting benzo like Valium is that I have had reflux issues for years and I worry this will worsen them.

 

Thoughts? Thanks again for all the help ☺️

[LotusRising]

16 hours ago, thepooka said:

My plan is to taper all four doses down as discussed but not sure if this will fix the problem later of potential akathisia or worse when each dosage is super low.

 

How are you feeling currently on 4 doses a day?

 

16 hours ago, thepooka said:

My final concern with switching to a longer acting benzo like Valium is that I have had reflux issues for years and I worry this will worsen them.

 

Not everyone needs to switch to valium. I know Ashton did this, but given you have sensitivities, it might not be wise. The crossover itself is also time-consuming, and not everyone does well on valium. If you are doing okay on ativan and your body knows ativan, it might make the most sense to stay on it. If you're managing on 4 doses, then I wouldn't worry about interdose withdrawal right now. 

[Definez]

Wonder how this is going … I’m on this boat right now