Nixy: Considering crossover from Ativan to Valium, on interesting cocktail

[nixy]

Hi,

Been diagnosed with bipolar disorder in 2001 when I was put into mental hospital  post a serious trauma. I tend ot be more depressed, although the depression started before the trauma that landed me in the hospital.

 

This is the basic rundown of meds since then....

 

Lamictal 50mg(after close relative died)
Zoloft 100mg(after close relative died)
Tegretol 100mg

Withdrawal history:
2001-2014 Tegretol 100mg, Prozac 20mg,
2010 - Added Lamictal, other two still, force (after close relative died) Took myself off it no real probs. Lamictal sporadically was ok (seemingly)

2014- Reintroduced Lamitcal (after relative died)
2017 Withdrew Prozac for Paxil and Paxil to Zoloft,other two still in force
2017 Brief reintroduction of Zoloft to Prozac, other two still in force 
Nov 2018 Back to Zoloft, Tegretol, Lamitcal, Added Ativan .75mg (after close relative died)

Dec 2018 -started withdrawal from Ativan now on .25 Ativan

 

For me I did not like the meds but I seemed to be  relatively stable on the orginal Prozac/ Tegretol combo......ten years in began to experience sleep problems, recurring sinusitis and hidden acid reflux. Just felt it was sinusitis alone and subjected to repeated antibiotics. Now that Ativan is added to the mix, it seems like all hell broke really broke loose. Tried to go from .75 mg  Ativan Nov 17, .5 Ativan December 7  and now holding at .25mg Ativan since December 17. Hell y'all.

 

Considering seriously rehab becuase partner works long hours or staying my butt home and C/o to Valium 2.5 mg because liquid Ativan not available where I am and neither is compounding an option. ( The other choices given to me by addiction doc were C/T and raising Zoloft, one day one day off, hospitalization - ALL NOT GOOD OPTIONS) Really scary right now. Been down and depressed for months. Advice anyone?

 

Edited February 17, 2018 by ChessieCat
increased font size

[ChessieCat]

Hi nixy and welcome to SA,

 

We ask all members to create a drug signature.  Please use the preferred format:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Link to Account Settings – Create or Edit a signature.

 

Please put ALL the drugs you are currently taking in the Drug Interactions Checker and copy and paste the results in a post here in your Intro topic (ie not in your signature).

 

Please check out these topics as they will help you understand SA's recommendations:

 

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

 

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

important-topics-in-the-tapering-forum-and-faq

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

Windows and Waves Pattern of Stabilization

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

 

This is your own Introduction topic where you can ask questions and journal your progress.  We encourage members to visit members' Intro topics and connect with other members of the community.

[Altostrata]

Welcome, nixy.

 

Please stop tapering Ativan for the time being while we sort this out.

 

What times of day do you take each drug, and at what dosages?

 

What are the symptoms you get? Do they follow any daily pattern?

[nixy]

Hi Altostrata,

 

Zoloft 100mg, Tegretol 200mg, Lamitcal 50mg - morning;   Tegretol 200mg, Lamicyal 50 mg - 6-7pm ;   Ativan 8.30-9pm; Doxyaline succinate- 9:30-10:pm

Symptoms - primary ones - increased depression in the afternoon to evening,  impaired memory and concentration.,weight loss of 35lbs

Variable:  depersonalization, palpitations, vision issue,restless leg syndrome, dry mouth, muscle spasms, increased and then decreased acid refkx

[nixy]

Hi Chessie Cat,

 

Drug interactions are as follows. I read the majority of that list already. Been doing my research.

 

carbamazepine  lorazepam

 

Using carBAMazepine together with LORazepam may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

sertraline  lamotrigine

Applies to: Zoloft (sertraline), Lamictal (lamotrigine)

Using sertraline together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

lorazepam  lamotrigine

Applies to: Ativan (lorazepam), Lamictal (lamotrigine)

Using LORazepam together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

carbamazepine  lamotrigine

Applies to: Tegretol (carbamazepine), Lamictal (lamotrigine)

Before using carBAMazepine, tell your doctor if you also use lamoTRIgine. This combination may cause restlessness, seizures, tremors, slurred speech, staggering walk, and feeling light-headed or fainting. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or special tests in order to safely take both medications together. Avoid driving until you know how the medications will affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

sertraline  doxylamine

Applies to: Zoloft (sertraline), doxylamine

Using sertraline together with doxylamine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

lorazepam  doxylamine

Applies to: Ativan (lorazepam), doxylamine

Using LORazepam together with doxylamine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

carbamazepine  doxylamine

Applies to: Tegretol (carbamazepine), doxylamine

Using carBAMazepine together with doxylamine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

lorazepam  sertraline

Applies to: Ativan (lorazepam), Zoloft (sertraline)

Using LORazepam together with sertraline may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

carbamazepine  sertraline

Applies to: Tegretol (carbamazepine), Zoloft (sertraline)

CarBAMazepine may decrease the blood levels and effects of sertraline. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your symptoms worsen or your condition changes during treatment with these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

doxylamine  lamotrigine

Applies to: doxylamine, Lamictal (lamotrigine)

Using doxylamine together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

 

Drug and food interactions

Moderate

carbamazepine  food

Applies to: Tegretol (carbamazepine)

You should preferably avoid the regular consumption of grapefruits and grapefruit juice while taking carBAMazepine. This can cause carBAMazepine levels to increase. You should report signs of carBAMazepine side effects such as nausea, visual disturbances, dizziness, or muscle weakness to your doctor. You should avoid or limit the use of alcohol while being treated with carBAMazepine. Alcohol can increase the nervous system side effects of carBAMazepine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

 

sertraline  food

Applies to: Zoloft (sertraline)

You should avoid or limit the use of alcohol while being treated with sertraline. Alcohol can increase the nervous system side effects of sertraline such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

doxylamine  food

Applies to: doxylamine

Alcohol can increase the nervous system side effects of doxylamine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with doxylamine. Do not use more than the recommended dose of doxylamine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

lamotrigine  food

Applies to: Lamictal (lamotrigine)

Alcohol can increase the nervous system side effects of lamoTRIgine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Do not use more than the recommended dose of lamoTRIgine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

• lorazepam (active ingredient in Ativan (lorazepam))
• lamotrigine (active ingredient in Lamictal (lamotrigine))
• carbamazepine (active ingredient in Tegretol (carbamazepine))
• sertraline (active ingredient in Zoloft (sertraline))

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

Edited February 19, 2018 by ChessieCat
reduced font size

[Altostrata]

What dosage of Ativan and doxylamine do you take at night?

 

What do you think of those potential drug interactions? Do you think they're affecting you?

 

See side effects of doxylamine here https://www.drugs.com/cdi/doxylamine.html

 

When did you add doxylamine? How long have you been taking it? What does it do for you?

 

It sounds like you had intended to go off Ativan, why did you decide to do that?

[nixy]

.25mg Ativan at night and  12.5mg doxylamine. I have been taking it for two months. 

 

Yes I think it is affecting me. I was on the Zoloft , Tegretol, Lamitcal combo with no undue mental side effects. This time around when the Aitvan was added was when it went downhill. 

 

I was aware of its addictive potential was given it by a substitue pdoc who would not allow me to go off it when I requested so I began to drop on my own. When my regular pdoc came out, he also wanted me off it as well. Taking it since November 1, 2017 - nearly four months now.

[nixy]

Oh and Alotstrea. The doxylamine just gives me a good night's sleep. The dosage of Ativan I am on is not working to give me that anymore.

[ChessieCat]

Hi nixy,

 

I've received your PM.  Please ask questions here in your Intro topic.  This way your history is in one place and other people can see your questions and make suggestions.

[nixy]

Hi people,

 

Getting a little antsy here. Seeing my pdoc  in two days and he gave me the following decisions to get off the Ativan .25mg

 

1) Cold Turkey .25 mg Ativan and raise my Zoloft dosage

2) Crossover to 2.5mg Valium and taper from there...his initial percentage was 20%

3) Taper Ativan one day on, one day off

4) Hospitalization for detox.

 

Where I am liquid ativan is not imported and I have sensitivity to alcohol. It stimulates me.

 

I really am nervous becuase at this point meds and doctor's patience are both gonna run out soon.

 

[ChessieCat]

Hi Nixy,

 

I've asked the other mods for their thoughts/suggestions.

[ChessieCat]

12 minutes ago, nixy said:

Seeing my pdoc  in two days and he gave me the following decisions to get off the Ativan .25mg

 

Is he refusing to continue prescribing Ativan?

[nixy]

He very well may.

[Altostrata]

Why does your psychiatrist believe you cannot further taper Ativan? Why does he insist on the crossover to Valium?

 

Is he aware you are experiencing withdrawal symptoms from decreasing Ativan?

 

You don't have to use alcohol to make a liquid from Ativan.

 

In the U.S., any doctor can prescribe a psychiatric drug. Do you see any other doctors who might be sympathetic to your tapering your drugs? Are you legally required to be treated by a psychiatrist?

 

When did you add doxylamine? How long have you been taking it? When did your sleep problems start?

[nixy]

It is that they believe I cannot dry cut anymore. Yes he is aware. I am in the public health system. I was told sent by my regular psychaitrist to the addiction specialist.  Yes, I am required to be treatd by a psychiatrist in this case. No GP would treat me here for that. The doxylamine started on the regular as in nightly around Nov/Dec, Had sleep issues over years but would only use it before occasionally.

[Altostrata]

See

 

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=711b60a3-028d-41d4-aa17-8f976e6df23e

 

https://www.webmd.com/drugs/2/drug-14588/lorazepam-intensol-oral/details

 

FDA pdf Lorazepam Oral Concentrate, USP 2 mg per mL

[nixy]

In my country, the only form of Lorazepam offered is in tablet form. You cannot import it.

[nixy]

Sorry, you can't import the liquid form and available most likely in 1mg tablets.

[Altostrata]

Does your doctor object to you making your own liquid?

 

Have you discussed not tapering Ativan for a while, or updosing a little?

 

[nixy]

I have not discussed it no. To the doctors here, the only way to do reductions for psychotropic meds is to is to dry cut. As to not tapering Ativan for a while, I have been holding at .25mg since December 17...

[Altostrata]

nixy, if you're forced to be under this psychiatrist's care, you need to participate in your treatment by telling the doctor how you would prefer to proceed.

 

We can only make suggestions for you to consider, we can't do anything about your real-life situation.