Shelton: withdrawal from short term amitriptyline and nortriptyline use, Celexa previously

[Shelton]

9 minutes ago, Altostrata said:

Do you feel better or worse after you take Ativan? How often do you feel this increased heart rate? Please include this in your daily notes.

It doesn’t help. It just makes me even more sleepy, tired and depressed. Insomnia at night so I’m sure that contributes to it but Ativan makes it worse for sure. When I take it at 5:30am, I notice it makes my heart race and heightened anxiety for like 30 minutes. 

 

22 minutes ago, Altostrata said:

Your recent drug history has so many changes, we can't tell what's going on. You're going to have to ride out one-off weird symptoms, like the doom you felt last night. You've still got some Valium in you, you've been taking Ativan inconsistently, and it's unclear what Celexa is doing, if anything.

Should I wait out the Celexa a little longer then? Ativan is now .125mg 5:30am, 1:30pm and 9:30pm (finally got a schedule).

 

I know!!!! I can’t tell what’s going on either or what is causing what. PGAD has calmed down some so if I need to hold on Celexa, I can if you think that’s best.

 

I know my brain needs the least amount of change right now but it’s so hard when you’re feeling terrible. I know you both understand. Last night was terrifying. 

 

About to post my notes for today. 

[Shelton]

Wednesday 09/16 continued...
3:00-5:00pm - rested, couldn’t sleep, anxiety calmed

 

6:00pm-9:00pm - had dinner at in laws - felt terrible. Feels like I’m poisoned? - could not handle a lot of talking and chaos/loud noises around me - nauseous, brain burning, brain zaps, body weakness, internal agitation and slight anxiety, shortness of breath/heavy chest - PGAD 2/10

 

10:00pm - 4:30am - didn’t sleep at all, severe insomnia, internal anxiety, intrusive thoughts, fear/scared, brain burning and zaps, feel physically horrible

 

4:30am-6:30am - slept

 

6:30-7:45am - woke up with anxiety/fear, overall feeling terrible/tired/depressed

 

6:30am - .125mg ativan - increased anxiety/heart rate for a little then stopped.

 

8:00am-11:30am - feeling physically terrible, feel like I have the flu, not much anxiety but feeling very down, inner restlessness/akathesia? Shortness of breath/heavy chest and definitely down/depressed

 

9:30am - Celexa .5mg

 

12:00pm - ate turkey sandwich

1:30pm - .125mg ativan - makes me sleepy and “down”

 

2:00pm - still feeling rough physically and “down”

 

3:00pm-6:00pm - felt sleepy, down but had a wave of feeling okay mentally. Have moments of anxiety and intrusive thoughts but is not long lasting - try to ignore thoughts. 

 

7:00pm- feeling rough again physically - Tired but feel wired so can’t nap. Feel down

 

NOTE: I never feel any different after I take Celexa dose

 

@Altostrata

[Shelton]

4 hours ago, manymoretodays said:

And then ......stay steady.    Meticulous observations.  Sheesh, you are not different from most, shortly after arrival.  I tinkered and monkeyed around for a couple of weeks......could barely put words together, etc.   And then it all kind of fell together, and it took awhile, but the cognition and organization all improved.   AND......the worst of the waves too.  I was pacing and clutching pillows some nights and even days. 

 

I thought it was going to all clear up in a couple of weeks.  Frankly, I was glad to hear that may not be the case, for me, and cut myself some slack in expectations of myself.

The hospital is going to be the hospital....... you can do this!!!!

Thank you so so much for this motivation. You have no idea how much it means to me to see positive affirmation and not feeling so alone. Nobody understands why I’m just not going to the hospital to get help because I’m so sick. That’s hard for me too - my whole life has been stopped over this and I just want to enjoy my son 😭

[Altostrata]

18 hours ago, Shelton said:

I know!!!! I can’t tell what’s going on either or what is causing what. PGAD has calmed down some so if I need to hold on Celexa, I can if you think that’s best.

 

All we can do is go by how you feel. If your symptoms are reducing, that's a sign you're going in the right direction. You need to give any change some time to see what the trend might be.

 

It looks to me like you're taking too Ativan, you're getting a paradoxical reaction. @Shep @Frogie , please advise.

[Frogie]

Hi Shelton:

 

I'm really sorry to read what you are going through.

This sometimes seems like the most difficult thing you will ever do in your life. But there is light at the end of the tunnel. 

I didn't read your entire thread, but it looks like you have a baby boy? How old, if I may ask? How precious!

If you could tell me what times you take the Ativan, maybe we can help you feel a slight bit better. I know when I took my Xanax at the EXACT same time every day, it did get better. Benzo's are notorious for giving you paradoxical reactions. You have to take them consistently, i.e. the exact same time and dose everyday.

Perhaps we could get you on a schedule with your Ativan, if you aren't already on one?

I saw in your signature you were taking Valium also, however, you only took it a couple of times. If you can refrain from taking that anymore that would be wonderful!

Let me know.

Take care,

Frogie xx

[Shelton]

31 minutes ago, Altostrata said:

All we can do is go by how you feel. If your symptoms are reducing, that's a sign you're going in the right direction. You need to give any change some time to see what the trend might be.

I slept better last night and was able to nap today. Flu like symptoms have calmed down although nowhere near 100%. I have random bouts of anxiety that overcome me, when I think about going somewhere or doing something I get so anxious/scared! Although PGAD keeps flaring, I think I’ll stay at Celexa and see if there’s a trend. I know medication is very much frowned upon right now but if PGAD continues to flare or get worse, I may have to see about adding or changing something. I will talk to you before I do to get your thoughts, trust me!

[Shelton]

6 minutes ago, Frogie said:

I'm really sorry to read what you are going through.

This sometimes seems like the most difficult thing you will ever do in your life. But there is light at the end of the tunnel. 

I didn't read your entire thread, but it looks like you have a baby boy? How old, if I may ask? How precious!

Thank you so much! He is 4 months old and my strength through this all!

 

7 minutes ago, Frogie said:

If you could tell me what times you take the Ativan, maybe we can help you feel a slight bit better. I know when I took my Xanax at the EXACT same time every day, it did get better. Benzo's are notorious for giving you paradoxical reactions. You have to take them consistently, i.e. the exact same time and dose everyday.

Perhaps we could get you on a schedule with your Ativan, if you aren't already on one?

I just started a schedule that I think needs a little tweaking. I was doing 5:30am, 1:30pm and 9:30pm but I’m having a hard time doing the 5:30am one. 
 

Can I change it to 8:30am, 4:30pm and 12:30am (usually up with the baby at 12:30)? I take .125mg 3 times a day. I HATE taking the Ativan - I don’t feel like I need it and they make me so sleepy. I’m assuming I still need to hold on them though? I’m very fearful about withdrawal from them so would love not to be on them long term.

 

9 minutes ago, Frogie said:

saw in your signature you were taking Valium also, however, you only took it a couple of times. If you can refrain from taking that anymore that would be wonderful!

Let me know.

Take care,

Frogie xx

Yes! I did 2 vaginal Valium’s within the last couple of months for PGAD. I was told it was topical and not addictive *rolls eyes*. I haven’t touched them since I found out otherwise!

 

Thank you so much!

[Frogie]

47 minutes ago, Shelton said:

Thank you so much! He is 4 months old and my strength through this all!

 

That is so wonderful that you have a bundle of joy to help you through this. 

 

49 minutes ago, Shelton said:

I just started a schedule that I think needs a little tweaking. I was doing 5:30am, 1:30pm and 9:30pm but I’m having a hard time doing the 5:30am one. 
 

Can I change it to 8:30am, 4:30pm and 12:30am (usually up with the baby at 12:30)? I take .125mg 3 times a day. I HATE taking the Ativan - I don’t feel like I need it and they make me so sleepy. I’m assuming I still need to hold on them though? I’m very fearful about withdrawal from them so would love not to be on them long term.

Once you take the Ativan for approximately 3 weeks you become dependent on it. So please do not stop it. If you want to change the times you take it you will need to move the times by 1 hour everyday until you get to the times you wish to stay at. Then unfortunately you will have to taper off of it. But it can be done. I take my last dose of Xanax tonight! Just hold tight and it will work out for you

 

51 minutes ago, Shelton said:

Yes! I did 2 vaginal Valium’s within the last couple of months for PGAD. I was told it was topical and not addictive *rolls eyes*. I haven’t touched them since I found out otherwise!

 

Glad you aren't touching this again. 

 

You are very welcome. Let me how you are doing.

 

 

[Shelton]

7 minutes ago, Frogie said:

Once you take the Ativan for approximately 3 weeks you become dependent on it. So please do not stop it. If you want to change the times you take it you will need to move the times by 1 hour everyday until you get to the times you wish to stay at. Then unfortunately you will have to taper off of it. But it can be done.

I know. So sad that no doctor ever told me this. When do you suggest starting to taper? @Altostrata @Frogie

 

9 minutes ago, Frogie said:

I take my last dose of Xanax tonight! Just hold tight and it will work out for you

That is AWESOME! How was withdrawal for you?

 

[Frogie]

Just now, Shelton said:

I know. So sad that no doctor ever told me this. When do you suggest starting to taper?

I wouldn't touch it for quite a while. You need to stabilize and get on the schedule that best fits you. And you need to stabilize on the Celexa. You don't want to taper anything while you are unstable.

 

1 minute ago, Shelton said:

That is AWESOME! How was withdrawal for you?

 

I take my last dose tonight, then the wd will really start. It hasn't been too bad. It is tolerable. My main symptoms are RLS, creepy crawly feeling in my arms and insomnia. 

 

But like you, I will heal!!

 

Take care,

Frogie xx

[Altostrata]

7 hours ago, Shelton said:

I slept better last night and was able to nap today. Flu like symptoms have calmed down although nowhere near 100%. I have random bouts of anxiety that overcome me, when I think about going somewhere or doing something I get so anxious/scared! Although PGAD keeps flaring, I think I’ll stay at Celexa and see if there’s a trend. I know medication is very much frowned upon right now but if PGAD continues to flare or get worse, I may have to see about adding or changing something. I will talk to you before I do to get your thoughts, trust me!

 

You have been making a fuss at every twist and turn. You need to give a change some time to see what happens. Most likely, your nervous system is settling down now from all the changes you've made since August.

 

You cannot keep on changing drugs and expecting immediate resolution of your symptoms. You need to take them regularly, at the same times each day, including Ativan. You'll be able to taper it when you need to.

 

Please do not report a symptom without daily symptom report over at least 24 hours. In other words, stop freaking out about your symptoms. They cannot be interpreted out of context.

 

If you keep on changing your drugs, we can't help you here.

[manymoretodays]

Hey sweetie,

Try a 24 hour note with just medications, by name and dose first......if that works best for you.

Then next one, the next 24, keep going with times on the left, and symptoms added.

It's going to be so, so, very helpful to see, for some further guidance, on managing your Ativan.

 

I know it's all very confusing now for you.  And I am so very sorry that you are in the soup of it all now.

 

Please don't stress it, if you can only do the big ones, the greater than 14 font size.  I'll swing round and edit it, if need be.

 

And what kind of scale do you have at present, I know you mentioned having one, awhile back?

Other options for Ativan controlled dosing exist as well.  Let's just get some days of notes, one at a time, 24 hour segments going, for several days.  We can run through those options soon enough.

 

Just repeating some of what I put in the PM.

And sending plenty of hope, patience, kindness, and hugs today!

 

Baby boy, huh?  So sweet.  Mine is your age now!!!  And I still parent.  It's very different, of course.  Quite.

Cherish the few moments you get in the day.......there must be a few, that are calm inside.

 

L, P, H, and G,

mmt

 

 

Edited September 20, 2020 by manymoretodays

[Shelton]

@Altostrata, @manymoretodays, @Frogie

 

Friday 09/18

*Slept better last night – flu like symptoms calmed down. Random anxiety overcomes me – usually when I think about going somewhere or doing something, I get anxious/scared.
*PGAD is random flares – sometimes 2/10 – sometimes 7/10

 

(Slept through usual 5:30am dose of Ativan)
8:00am – woke up feeling not so hungover and sleepy/anxious – actually felt a bit refreshed
8:30am – took .125mg Ativan – made me sleepy/down/depressed feeling
9:30am - .25ml Celexa
9:45am – Nap for about 45 minutes - Felt more refreshed – not so physically terrible and not so sleepy. Still weak and had random moments of anxiety
11:00am-1:00pm – showered, got some stuff done around the house. Not severely weak and felt better physically. No intrusive thoughts – mostly random anxious thoughts

(Do not feel like I need this Ativan but staying on schedule)
1:30pm - .125mg Ativan (tried to get back on track with timing)

2:00pm – 9:00pm - Felt sleepy, started feeling some anxiety but worked through it. Still feel weak and “off” – cannot tell if Ativan is the culprit since it makes me so tired

(Do not feel like I need this Ativan but staying on schedule)
9:30pm - .125mg Ativan

10:00pm-5:30am – slept on and off. If I woke up, I was able to go back to sleep fairly quickly

 

Saturday 09/19

(Do not feel like I need this Ativan but staying on schedule)
5:30am – .125mg Ativan

8:00am – woke up feeling hungover, tired, weak

9:30am - .25ml Celexa – feel no differently after

9:30am-12:30pm – felt “off,” weak, sleepy, random moments of anxiety but worked through it. Headache!

(Do not feel like I need this Ativan but staying on schedule)
1:30pm- .125mg Ativan

2:00pm – 9:00pm – about the same – weak, sleepy, random bouts of anxiety and a headache – was able to watch a movie and focus on the movie

(Do not feel like I need this Ativan but staying on schedule)
9:30pm - .125mg Ativan

Sunday 09/20

Slept okay throughout the night – accidentally slept through the 5:30am dose of Ativan
8:00am – woke up anxious and felt like I needed the Ativan. Almost like my body could feel that I missed it. DID NOT feel hungover and felt okay waking up otherwise.

8:30am – took .125mg Ativan – made me sleepy, hungover feeling, calmed down slight anxiety

9:30am - .25ml Celexa – no difference after taking it

10:00am-1:00pm – random bouts of anxiety but working through it. Sleepy/kind of hungover feeling/weak and headache

1:30pm - .125mg Ativan – felt no different after taking it

3:00pm – heightened anxiety

[Shelton]

18 hours ago, manymoretodays said:

And what kind of scale do you have at present, I know you mentioned having one, awhile back?

Other options for Ativan controlled dosing exist as well.  Let's just get some days of notes, one at a time, 24 hour segments going, for several days.  We can run through those options soon enough.

 

@manymoretodays @Frogie

Well, it's broken. Not sure what happened. I am currently cutting the .5mg Ativan in fourths. I actually need a refill of the Ativan. I meet with my doctor Tuesday - I was going to see if I could get the liquid from my local compound pharmacy. Bad idea? I was going to tell her it's because the pills are hard to cut. I looked up how to do the liquid titrate but that seriously overwhelmed me.

 

Couple questions:

1. With my symptoms now, does it seem I am stabilizing or "stable?"

2. NOT rushing things, just curious - when it's time to taper the Ativan, how long will my taper take? I tried to come up with a week by week schedule on my own, lowering 10% each week and it was very confusing. Do I need to go ahead and get a scale for this or if I can get liquid compound, would that be better?

 

Thank you so much!

[Frogie]

Hi:

 

I would get a scale and some “0” or “00” gel capsules. You can get them on Amazon. Most people use the Gemini 20 scale. That’s what I used and it worked well. You’ll want to crush and weigh the Ativan as you don’t get a consistent dose cutting them.

 

It took me 15 months to taper off 1 mg Xanax, and that was a fast taper. Here is a spreadsheet you can use. There are other ones on the site also if you want to search for one.

 

https://docs.google.com/spreadsheets/d/1pw4tjImAJ92OIVyRvZoZYjqxiKMk7wvp-ljiIi1olRo/edit?usp=sharing

 

It sounds like you are doing relatively well. I think that you are starting to stabilize because you’re taking the Ativan at the same time everyday. Glad to hear that!

 

 

Edited September 20, 2020 by Frogie
Added spreadsheet

[Altostrata]

@Shelton, it appears 2 doses of Ativan are enough, which is good. Two 0.125mg doses would bring your daily dose dowh to .25mg/day. It would be better if you took each 0.125mg dose 12 hours apart, one earlier in the day, but not at the same time you take Celexa, and one at night before you go to sleep. What time do you go to sleep?

 

Can you keep to a drug schedule of

9:30 a.m. - .5mg Celexa (please refer to dosages in milligrams)

11:00 a.m. - .125mg Ativan

11:00 p.m. - .125mg Ativan

 

 

Yes, a compounded liquid would be easier for you to manage.

 

7 hours ago, Shelton said:

1. With my symptoms now, does it seem I am stabilizing or "stable?"

 

How long have you been on this drug schedule? 5 whole days? Please stop expecting instant results.

 

As you can see, just sticking to a consistent drug schedule has benefits. Please continue to let us know how you're doing on a schedule with only 2 Ativan doses a day, 12 hours apart.

[manymoretodays]

17 hours ago, Shelton said:

 

@manymoretodays @Frogie

Well, it's broken. Not sure what happened. I am currently cutting the .5mg Ativan in fourths. I actually need a refill of the Ativan. I meet with my doctor Tuesday - I was going to see if I could get the liquid from my local compound pharmacy. Bad idea? I was going to tell her it's because the pills are hard to cut. I looked up how to do the liquid titrate but that seriously overwhelmed me.

 

Couple questions:

1. With my symptoms now, does it seem I am stabilizing or "stable?"

2. NOT rushing things, just curious - when it's time to taper the Ativan, how long will my taper take? I tried to come up with a week by week schedule on my own, lowering 10% each week and it was very confusing. Do I need to go ahead and get a scale for this or if I can get liquid compound, would that be better?

 

Thank you so much!

 

Hi Shelton,

I think a compounded liquid solution, would be great for your purposes Shelton.

Ativan/lorazepam is complicated however when it comes to dilutions, as it's poorly water soluble.

Call ahead to the compounding pharmacy, today, to get some idea on what they can do.

 

Tell them you will be working with 0.125 mg doses and then eventually less than that, and see what they can come up with, in a liquid formulation, that allows for ease of measuring tiny doses.

See if it's going to be an affordable option for you.

 

Be sure get some more 0.5 mg tablets. 

As you may want to continue with your current method of splitting them,  for dosing, for at least the next week.

 

I don't want you to make too many changes all at once.

 

Especially with benzo's, and even with AD's,  you don't want to just shift formulations, from solid to liquid, without doing some form of cross-over.

And I would not suggest a cross-over while also doing a timing and total daily dose change.  Each little change deserves to get some adjustment time of it's own.

 

We can go over this more.

 

Your sleep looks better, your notes look great!  Keep them coming. 

 

L, P, H, and G,

mmt

 

 

 

 

 

Edited September 21, 2020 by manymoretodays

[manymoretodays]

Hey Shelton and in addition to the above,

******  Do attend to Alto's post above mine too, and see what you think about that.  Frogie or I can help you get the doses shifted, yet we'll still need you to do the dailies or notes to help with this all.

 

You may even decide to go with weighing for the long haul.

The Gemini 20 scales are available from Amazon, fairly cheap.

 

For today:

Talk with compounding pharmacy

Find out more about having them compound a liquid from the tablets:

Questions I would ask:

Can they do a reasonable concentration, so that you can measure doses of .125 mg and less?

How long will it keep, refrigerated, and protected from light?

How much will it cost?

 

For tomorrow when you see doctor/prescriber:

Get a months or more supply of your Ativan/Lorazepam, same form that it has always been......the 0.5 mg tablets.

You may also need to supply the compounding pharmacy with a script from your doctor before they compound.

Do your best to share what you learn today from the compounding pharmacist.

 

Just that is a great start for now.

And do not do a direct switch to any new formulation just yet.  If you go with liquid, please don't do it all at once.  Let us guide you in crossing over from the solid form to the liquid.  This will help eliminate further instability to your nervous system.

[Shelton]

16 hours ago, Altostrata said:

 

@Shelton, it appears 2 doses of Ativan are enough, which is good. Two 0.125mg doses would bring your daily dose dowh to .25mg/day. It would be better if you took each 0.125mg dose 12 hours apart, one earlier in the day, but not at the same time you take Celexa, and one at night before you go to sleep. What time do you go to sleep?

 

Can you keep to a drug schedule of

9:30 a.m. - .5mg Celexa (please refer to dosages in milligrams)

11:00 a.m. - .125mg Ativan

11:00 p.m. - .125mg Ativan

 

 

Yes, a compounded liquid would be easier for you to manage

 

I try to go to bed around 9. Can I change my schedule to:

8:00am - .125mg Ativan

9:30am - .5mg Celexa

8:00pm - .125mg Ativan

 

@manymoretodays my compounded pharmacy has 2mg/1ml liquid Ativan for $30 - they have to order it once my doc calls it in. Room temperature and it will last “a long time.” I still have five .5mg tablets left.
 

So .125mg of liquid would be .0625ml. How would I do this with a syringe? 
 

I’m wondering since I haven’t been on it very long if I could do a faster taper (when it is time).

 

4 hours ago, manymoretodays said:

You may even decide to go with weighing for the long haul.

The Gemini 20 scales are available from Amazon, fairly cheap.

The weighing system overwhelms me. Once I determine how much one .5mg tablet weighs, I then divide that by 4. That will give me the weight of .125mg. Then I taper based off of weight and not mg, correct? And I prepare the capsules at the beginning of each week?

 

Another thing, last night I took my .125mg ativan at 9:30pm. 2 hours later, I woke up with a severe panic attack and chest pain! It lasted about 3 hours - me just laying there trying to breathe and stay calm until I finally fell back asleep. That’s the first time it’s been that severe of a panic attack - any insight if that’s withdrawals or Ativan reaction?

 

16 hours ago, Altostrata said:

How long have you been on this drug schedule? 5 whole days? Please stop expecting instant results.

 

As you can see, just sticking to a consistent drug schedule has benefits. Please continue to let us know how you're doing on a schedule with only 2 Ativan doses a day, 12 hours apart.

I’m sorry @Altostrata, I am not expecting instant results. This is just all so overwhelming and scary. I am sticking to the schedule - I will let you know how I feel with the 2 ativan 12 hours apart!

[Shelton]

Sunday 09/20  continued...

From 4:00pm-8:00pm, just dealt with sleepiness and some heightened anxiety. Also new symptom- bad headache!!

 

8:00pm - was able to eat chicken sandwich and enjoyed it!

 

9:30pm - took .125mg Ativan

 

11:30pm - woke up with massive panic attack and BAD chest pain. Never experienced a panic attack like this. Laid in bed for 4 hours staying calm, listening to meditation app until I fell back asleep

Monday 09/21

 

5:30am - .125mg Ativan - no change in anxiety, allowed me to fall back asleep

 

8:30am - woke up feeling hungover, sleepy, headache

 

9:30am - .5mg Celexa - no change

 

10:30-12:00pm - no appetite, forced myself to eat. Slight anxiety and just feeling “off”

 

12:00-1:00pm - able to take a small 30 minute nap - woke up with heightened anxiety

 

1:30pm - .125mg ativan

 

2:00-3:00pm - bad headache!!! Sleepy/tired - not much anxiety

[Altostrata]

Could be that your inconsistent Ativan dosing has yet again caught up with you. Still, if you can get by with only the 2 doses, it will be better for you in the long run.

 

If this is your new schedule, could you please follow it? Taking Ativan when you feel like it is going to cause you big problems again.

 

1 hour ago, Shelton said:

8:00am - .125mg Ativan

9:30am - .5mg Celexa

8:00pm - .125mg Ativan

 

[Shelton]

30 minutes ago, Altostrata said:

Could be that your inconsistent Ativan dosing has yet again caught up with you. Still, if you can get by with only the 2 doses, it will be better for you in the long run.

 

If this is your new schedule, could you please follow it? Taking Ativan when you feel like it is going to cause you big problems again.

 

 

Yes! I will take 8:00pm dose of Ativan tonight and 8:00am dose of Ativan in the morning and start that way. I’ll make notes!

[manymoretodays]

1 hour ago, Shelton said:

I try to go to bed around 9. Can I change my schedule to:

8:00am - .125mg Ativan

9:30am - .5mg Celexa

8:00pm - .125mg Ativan

 

@manymoretodays my compounded pharmacy has 2mg/1ml liquid Ativan for $30 - they have to order it once my doc calls it in. Room temperature and it will last “a long time.” I still have five .5mg tablets left.
 

So .125mg of liquid would be .0625ml. How would I do this with a syringe? 

 

You will be getting the Lorazepam Intensol Oral Concentrate then.

https://www.pdr.net/drug-summary/Lorazepam-Intensol-Oral-Concentrate-lorazepam-2668

They aren't going to compound directly from your tablets.

And from that link:

Oral Liquid Formulations

Concentrated Oral Solution (2 mg/mL)
Measure dosage using a calibrated oral syringe/dropper.
Dilute the oral concentrate in water, juice, soda, or semi-solid food (e.g., applesauce, pudding) prior to administration. Administer immediately; do not store for future use.
Storage: Protect from light. Store refrigerated at 36 to 46 degrees F. Discard opened bottle after 90 days,

 

You will be doing any further dilution, just directly before taking your dose, when you try the liquid.

And yes, that's correct.  .125 mg of the Concentrate is going to be .0625 mL. 

You are going to have to get a 1 mL or even .5 mL syringe to work with, and then even still, may have to round up or down with the the mL amount.  General rule of thumb, round up if your number 3 spots to the left of the decimal points, is > 5, round down if it is < 5.

Using an oral syringe and other tapering techniques

 

 

Your often leaving out the whole picture by not getting the whole 24 hours in, with notes. 

I am assuming that you've done 3 doses now each day, since 9/13 or 9/15.  Making today either day 8 or 6.

 

Since you will be reducing your dose already, from .375 mg total daily dose for ? 6 days, back down to .25 mg total daily dose......you don't really need to worry about any "faster taper" right now.

 

The rule of 3KIS: ;Keep it simple, keep it slow, keep it stable

Read ^

If I were you, I would hold on the switch to liquid for now.  At least for the next 2 weeks to 1 months time.

While you work on a nice steady approach to every 12 hour dosing.  0.125 mg every 12 hours.

 

For tomorrow, Tuesday, September 21.

Yes, fine.  Morning dose of Ativan .125 mg(1/4 tablet) at 8 am

Celexa 0.5 mg at 9:30 am

No mid-day dose of Ativan at all!  If you haven't taken todays midday dose yet.....skip it!

9 pm- Ativan .125 mg

 

Get it all in your notes, post the whole day, the next day.

On Wednesday, September 21, you can move the 9 pm Ativan to 8 pm.

 

Then stay with that schedule, which will be:

8 am- Ativan .125 mg (quartered tablet)

9:30 am Celexa .5 mg (.25 mL)

8 pm- Ativan .125 mg (quartered tablet)

 

Always keep the Ativan spaced from the Celexa by at least 1 and 1/2 hour.

 

Okay.  Best.

L, P, H, and Growth, groan, greener pastures soon.......

mmt

 

 

[Frogie]

@Shelton

 

Hi:

 

You are getting Ativan liquid? That will make the taper a lot easier.

 

Please read @manymoretodays notes so you can move the Ativan doses to new times and post notes. 
 

After you stabilize then we can work on tapering you off😊

 

Take care,

 Frogie xx

Edited September 21, 2020 by Frogie
Added text/deleted text

[Shelton]

1 hour ago, manymoretodays said:

You will be doing any further dilution, just directly before taking your dose, when you try the liquid.

And yes, that's correct.  .125 mg of the Concentrate is going to be .0625 mL. 

I can’t find a .5ml syringe. Lowest is 1ml syringe. With that, the lowest dose is .05 (half of the .1 - pic attached). Will that work for the liquid taper (when time is right?) @Frogie

 

1 hour ago, manymoretodays said:

Your often leaving out the whole picture by not getting the whole 24 hours in, with notes. 

I am assuming that you've done 3 doses now each day, since 9/13 or 9/15.  Making today either day 8 or 6.

 

Since you will be reducing your dose already, from .375 mg total daily dose for ? 6 days, back down to .25 mg total daily dose......you don't really need to worry about any "faster taper" right now.

I get what you’re saying now! I’m posting too soon. I’ll make sure to wait until I have the full 24 hour picture. 
 

1 hour ago, manymoretodays said:

If I were you, I would hold on the switch to liquid for now.  At least for the next 2 weeks to 1 months time.

While you work on a nice steady approach to every 12 hour dosing.  0.125 mg every 12 hours.

Okay, I will ask for tablets for now and then let her know I’ll possibly want liquid to taper later?

 

1 hour ago, manymoretodays said:

For tomorrow, Tuesday, September 21.

Yes, fine.  Morning dose of Ativan .125 mg(1/4 tablet) at 8 am

Celexa 0.5 mg at 9:30 am

No mid-day dose of Ativan at all!  If you haven't taken todays midday dose yet.....skip it!

9 pm- Ativan .125 mg

 

Get it all in your notes, post the whole day, the next day.

On Wednesday, September 21, you can move the 9 pm Ativan to 8 pm.

 

Then stay with that schedule, which will be:

8 am- Ativan .125 mg (quartered tablet)

9:30 am Celexa .5 mg (.25 mL)

8 pm- Ativan .125 mg (quartered tablet)

 

Always keep the Ativan spaced from the Celexa by at least 1 and 1/2 hour.

Got it! When should I post an update once this has settled? Maybe Wednesday so you get the full picture? 
 

 

[manymoretodays]

Perfect syringe Shelton.  You should be able to get .062 or .064 when the time comes to carefully cross over from solid to liquid without any dose change.

Get several.

 

Notes everyday are great!  With the full 24 hour picture. In words.  With times on the left and drugs by name and dose in mg on the right.  Times on the left, symptoms, sleep, supplements, what and when you are eating on the right.

 

Try and post all of todays, tomorrow.

It's easier to follow them if you can start in the am, when you wake up, go all through the night and early morning with each day.

 

Then all of tomorrows, on Wednesday.

 

Narratives around your doc visit and other worries, you can post separately.

 

Nice syringe picture too, by the way!

 

13 hours ago, Shelton said:

Okay, I will ask for tablets for now and then let her know I’ll possibly want liquid to taper later?

 

Yes.  No question mark needed.  You can tell her you want to cross over to Ativan/Lexapro Lorazepam liquid when you have your doses stable and steady, at the same time every day for awhile.   And when you are somewhat less dysregulated.  Could be awhile.  Post the notes please.  Try not to let the doctor rush you into anything right now. 

 

 

Edited September 22, 2020 by manymoretodays
oops on Lorazepam, called it Lexapro..... :-0, and in black

[Frogie]

13 hours ago, Shelton said:

I can’t find a .5ml syringe. Lowest is 1ml syringe. With that, the lowest dose is .05 (half of the .1 - pic attached). Will that work for the liquid taper (when time is right?) @Frogie

Those are perfect! That's what I used during my taper of Lexapro and you can get really low with them. I loved the picture. Then we can see exactly what you are dealing with. Good job!

I do know that I was able to get (2) .5 ml syringes from my vet and she didn't charge me. If you want to go lower you might check with a vet.

 

I would ask the dr for a couple months of Ativan/Lorazepam tablets so you have extra to get through the stabilization and then the crossover to the liquid.

 

Then, post notes so we can get everything in order and you can taper off of this when the time is right.

 

You are doing wonderful. It feels good to stabilize somewhat, doesn't it

 

Take care,

Frogie xx

[Shelton]

@manymoretodays @Frogie

 

Appointment did not go well. I am slightly panicking. She wants to do a faster taper off of Ativan. She said start with removing my middle of the day dose. She is only giving me 30, .5mg tablets. I cannot get a prescription elsewhere as all of my doctors fall under the same company with system showing last refill. 
 

Can we come up with a plan to taper so I don’t have even more issues when I run out?

 

Should I order a new scale and should I create a schedule to be proactive?

 

I’m hoping and praying I do not have a bad reaction. Is there any hope since I haven’t been on them for years and years like the Celexa?

 

She also said she’ll prescribe Gabapentin next Monday to get me off ativan and help sleep. I told her I would do magnesium and possibly melatonin (If needed) for sleep.

[manymoretodays]

Oh Shelton,

Absolutely nothing has changed.  You are dropping the middle dose anyway.    I told you it was a bit of a "fast taper" already, which is going to have a few bumps.

See previous posts please,  and you are working towards the schedule that is bolded. 

23 hours ago, manymoretodays said:

For tomorrow, Tuesday, September 21.

Yes, fine.  Morning dose of Ativan .125 mg(1/4 tablet) at 8 am

Celexa 0.5 mg at 9:30 am

No mid-day dose of Ativan at all!  If you haven't taken todays midday dose yet.....skip it!

9 pm- Ativan .125 mg

 

Get it all in your notes, post the whole day, the next day.

On Wednesday, September 21, you can move the 9 pm Ativan to 8 pm.

 

Then stay with that schedule, which will be:

8 am- Ativan .125 mg (quartered tablet)

9:30 am Celexa .5 mg (.25 mL)

8 pm- Ativan .125 mg (quartered tablet)

 

Always keep the Ativan spaced from the Celexa by at least 1 and 1/2 hour.

 

You have enough Ativan/Lorazepam now for 2 months time at this schedule.  Nothing to panic about. 

You were on the Lexapro for years and years, not the Celexa. 

 

Yes, a scale would be very helpful for getting accurate doses right now.   Meantime, you were going to continue with quartering your .5 mg tablets of Ativan/Lorazepam for each of your doses of .125 mg.  Exactly 2 a day now.

 

It's going to be a little bumpy, this next week, as you start to adjust to the lowered dose, but should not be insurmountable.  You were hating the 3rd dose anyway and a bit overmedicated.

 

A day at a time, Shelton.  Consistency with the present dosing and schedule.

 

Doctors can be hard to communicate with, for most of us.  Sounds like she wants you off benzos and we'd like to see that happening too.   Only difference is we'd be happier if you could do it without adding in another drug.  Next week is next week......just stay in today.

 

Yesterdays notes, and then todays notes when you've got them.  They'll help keep you on track with dosing too, I would think.  And then we can see how it's going, in relation to the drugs and timing more clearly.  I expect that you will show some improvement, if you can just stay with a consistent schedule for awhile.  Please add in anything that helps with the anxiety as well.

 

I hope the rest of your day goes well.  Try some music, or meditative you-tubes.......and just breathe........breathing is wonderful.  Take the baby for a walk in the stroller.

 

And best, L, P, H, and G.....mmt

 

 

 

[manymoretodays]

You may find something helpful here:

The first link has a whole indexed list of: non-drug coping for emotional symptoms

Right in the first post.  Scroll on down for some guided meditations, if you like those.

Just try and come back to the present time and place right now........and breathe.

[Frogie]

It’s going to be ok.

If you got 30 .5mg you have enough to do a fast taper. That will give you 120 doses if you quarter them.

Just remember like manymoretodays said it will be bumpy, but you can do it.

We can do a fast taper, every 5-10 days like I did. And I was on for 20 years!

Just breath and know you’re going to be fine😊
Take care,

 Frogie xx

Edited September 22, 2020 by Frogie
Added text

[Shelton]

22 hours ago, manymoretodays said:

You have enough Ativan/Lorazepam now for 2 months time at this schedule.  Nothing to panic about. 

You were on the Lexapro for years and years, not the Celexa. 

 

Yes, a scale would be very helpful for getting accurate doses right now.   Meantime, you were going to continue with quartering your .5 mg tablets of Ativan/Lorazepam for each of your doses of .125 mg.  Exactly 2 a day now.

 

It's going to be a little bumpy, this next week, as you start to adjust to the lowered dose, but should not be insurmountable.  You were hating the 3rd dose anyway and a bit overmedicated.

Well, I picked up my prescription for ativan. It is only 15 TABLETS. Doctors are stating this is plenty for tapering since I haven’t been on them long and they will not prescribe more. I ordered a scale, it will be here Friday. 

 

20 hours ago, Frogie said:

We can do a fast taper, every 5-10 days like I did. And I was on for 20 years!

Frogie, you give me so much hope. This is so scary. I have accepted the fact that I’m still trying to stabilize from the Celexa nightmare and now having to deal with a fast taper of Ativan, I just want to be okay. I know my brain is constantly healing and that’s the peace I have in all of this. I just want to be better for my baby, my husband and my family. I am only 28 years old and my life has been flipped upside down. 
 

22 hours ago, manymoretodays said:

Doctors can be hard to communicate with, for most of us.  Sounds like she wants you off benzos and we'd like to see that happening too.   Only difference is we'd be happier if you could do it without adding in another drug.  Next week is next week......just stay in today.

Amen! Doctors are difficult where I’m at too - they all use the same system so same notes, etc. She thinks ativan is making everything worse which, she’s probably right but I don’t want to make anything worse. So you definitely don’t agree with Gabapentin? I have no idea what that drug even is. I can’t wait to be med free and HEALED.

 

@Frogie @manymoretodays

I am about to post my update! 
 

Hey, can food affect anxiety/how I’m feeling? I ate pizza one night, felt awful. Today, I had a sub, felt terrible. I’m wondering if bread and dairy are hurting me?

[Shelton]

Tuesday 09/22

Total of maybe 5 hours sleep? Up a lot throughout the night (son not sleeping well either so that contributes to it)

7:45am - woke up with anxiety/unsettled/uneasiness

8:00am - Ativan .125mg 

9:30am - Celexa .5mg

10:00am-11:00am - internal uneasiness/anxiety 

12:00pm-5:00pm - extremely irritable - sounds make me so anxious and angry - this had been an issue since C/T Celexa but has gotten a little harder (not like me at all, I’m SO patient and kind) - some restless legs when laying down

6:00pm-8:00pm - irritability calmed down a tad but was distracted with friends that stopped by

8:00pm - Ativan .125mg - slept

11:00pm-12:30am - wide awake with slight anxiety

 

Wednesday 09/23

12:30am-7:00am - slept off and on - woke up with some anxiety/restlessness

7:00am - shower - slight nausea/irritability/anxiety

8:00am - Ativan - .125mg - just sleepy after

9:30am - Celexa .5mg

10:00am-12:00pm - heightened anxiety/shortness of breath/nausea/dry mouth/very irritable

1:00pm - went to sub shop and was waiting on my sandwich - SO ANXIOUS - almost panicked!

1:15pm - ate sub - felt pretty terrible after this (so irritable, anxious, short of breath, felt physically terrible - did sub make me feel worse? Maybe I need to avoid bread/dairy?)

2:00pm - took 100mg L-theanine

2:45pm - still feeling how I did after eating sub

3:00pm-4:00pm - overwhelming sense of calm/sleepiness - laying down - did L-theanine calm me down? Possibly try again tomorrow at the same time?

 

(Posting this at 4:00pm so will continue today’s notes at a later date. Plan tonight is .125mg ativan at 8:00pm as scheduled - if I wake up in the middle of the night, may take 50mg Doctor’s best magnesium)

[Shelton]

5 hours ago, Shelton said:

Posting this at 4:00pm so will continue today’s notes at a later date. Plan tonight is .125mg ativan at 8:00pm as scheduled - if I wake up in the middle of the night, may take 50mg Doctor’s best magnesium)

Continued....

5:00pm - very irritable/shortness of breath/physical anxiety

 

6:00pm-7:00pm - chest pain/shortness of breath, irritability/restlessness, achey legs, no appetite but forced myself to eat

 

8:00pm - Ativan .125mg

 

8:30pm - restlessness/irritability calmed down - legs sore like muscle aches after exercising?, sleepy

 

@Frogie @manymoretodays - is this interdose withdrawal? 

[Shelton]

@Frogie @manymoretodays

 

Update: it’s 3:30am and I haven’t slept at all. I am just now starting to get the slightest bit sleepy. I have been dealing with severe leg aches/pains and insomnia tonight. I took 50mg Magnesium, it didn’t touch this. It didn’t make it worse though so maybe I could increase?

 

I am staying calm but really worried about withdrawal from Ativan. I think I’ll feel better once I have my scale and a schedule for tapering.

 

Any suggestions? Should I stick out these withdrawal symptoms? Or possibly divide the .25mg daily dose into 3 doses?

[manymoretodays]

Just keep HOLDING with the current schedule.  You're doing fine.

Edited September 24, 2020 by manymoretodays