KathyLoop: 30+ years of drugs

[KathyLoop]

Do you know whether Ativan dust and bits lose their potency after sitting chopped up for a while? It might be my imagination, but it seems like when I use the bits or the dust leftover from days previous, I get more withdrawal. And it tastes bad too, so I'm thinking maybe it degrades somehow with more exposure to air? I'm always reluctant to throw any away, but is it maybe best to start with a fresh pill every day? Or is this just my imagination?

[Shep]

Are the tablets expired? Also, how are you chopping up your Ativan? Are you using a mortar and pestle and crushing them up completely? The reason I'm asking is because if you're not crushing them up really well, you may have some chunks of tablet that contain more filler than active ingredient and that could cause your doses to vary with how much of the active ingredient you're taking. 

[KathyLoop]

No, not expired. I've just been using a knife to cut bits off the pill. I should be crushing them and weighing the powder then?

[KathyLoop]

I tried crushing it. My 1mg ended up weighing only .73 when crushed, so clearly my scale isn't very accurate. I guess I'll continue doing what I've been doing (just cutting off bits) and try not to worry about it. I don't know how people do this when their minds and emotions aren't working properly. It's so frustrating. This damn taper is becoming my whole life at times, worrying about every little grain of dust... am I taking too much? am I taking enough? I'm so angry that I ever got myself into this mess.

 

Sorry to rant. I know it's not your fault and you're doing your best to help me. I will carry on as best I can. Like you said, I'm likely overthinking all of it and just have to go through it.

[KathyLoop]

No need to respond. I'll carry on as I have been and try to worry less.

[Shep]

21 hours ago, KathyLoop said:

No, not expired. I've just been using a knife to cut bits off the pill. I should be crushing them and weighing the powder then?

 

11 hours ago, KathyLoop said:

No need to respond. I'll carry on as I have been and try to worry less.

 

I feel the need to respond. Please indulge me because this isn't about worrying. It's likely some of your symptoms are coming from the way you're tapering, so let's work on making this a more comfortable ride for you.

 

 Yes, I would crush them and weigh them. Otherwise, you really don't know what you're taking, especially since you're taking very specific amounts (listed in your signature as .18/.16/.46). I'm not sure how you can get to those amounts using a knife. It would be well worth crushing the pills and using a scale for better accuracy. Bouncing around on doses confuses the nervous system and can cause all sorts of additional symptoms. 

 

20 hours ago, KathyLoop said:

My 1mg ended up weighing only .73 when crushed, so clearly my scale isn't very accurate.

 

Please let us know what kind of scale you're using. There are videos out on YouTube that can show you how to work these scales, including how to recalibrate it. 

 

Also, what units was the .73 in? 

 

Another option would be to get a prescription for Ativan liquid, if it's available in your area. 

[KathyLoop]

I've got the Gemini 20 scale. I have been weighing everything, just haven't been crushing the pills. I cut off a small chunk, trying to approximate the dose I need, then make adjustments as needed... adding or cutting off a few bits. It's working ok, but I worry it's not always that accurate... the measurement seems to jump around at times. Weighing the same dose repeatedly and getting different weights stresses me out. I think it's just anxiety over the whole process. I try to remember it doesn't have to be perfect and just do my best with what I've got.

 

The whole 1mg ativan pill weighs .102, so I don't worry about the math and just go by the display on the scale.... like if I'm going for .18, I want the scale to show me .018. 

 

Sorry my .73 was a typo... should've said .073 when I weighed the crushed powder. I'm not sure what happened there, if I lost powder in the crushing process or my scale was less sensitive to the powder as opposed to bigger pieces, but it alarmed me. I may just continue what I'm doing for now, as I have trouble making changes in the middle of all this. But I'll keep it in mind, crushing the powder, especially as I get to smaller doses. I didn't realize from the start that I should've been crushing the pills.

 

Thank you for all your help. I really do appreciate it. I have extreme anxiety and crazy emotions at times... and that's not from withdrawal as much as it is just from life... it's been a decade of real hell and the two decades before that weren't great either. I have trouble functioning in all areas. So this tapering is a challenge for sure.

[Shep]

You may want to recalibrate your scale, if you haven't already done so. Please see this video for more information, starting at around 3:30 minutes:

 

Smart Weigh GEM20 Digital Jewelry Scale Review

 

Alto wrote a great post listing tips for using a scale:

 

 More tips

 

Since you're down to the small amounts, especially splitting the dose into three, you may want to use the ten gram weight, as Alto mentioned in tip number 7 of that list. 

[KathyLoop]

Thanks for all of that. Would it maybe make sense to combine the two day-time doses, and take it all at 10am? So I'm just dosing twice a day, 10am and 10pm?

 

And do you know if they can make liquid ativan so that I can easily measure to .01 of a mg? Might make it all simpler and less stressful. Or are there issues with liquid ativan too?

[Shep]

18 hours ago, KathyLoop said:

Would it maybe make sense to combine the two day-time doses, and take it all at 10am? So I'm just dosing twice a day, 10am and 10pm?

 

You'll be the best judge of this, since it depends on your individual metabolism. Some people go into interdose withdrawal if they don't have that middle dose. We recommend only moving a dose an hour a day. This is gentlest on your nervous system. 

 

If you were to move the mid-day dose to the evening, do you think you would sleep better? That's another option, especially if you feel you could handle any upticks in interdose withdrawal during the day with non-drug coping skills. The payoff of better sleep might be worth it. 

 

18 hours ago, KathyLoop said:

And do you know if they can make liquid ativan so that I can easily measure to .01 of a mg? Might make it all simpler and less stressful. Or are there issues with liquid ativan too?

 

We recommend switching from tablet to liquid gradually, say 25% in liquid, 75% tablet and then a 50/50 split and then 75% liquid, 25% tablet, and then finally 100% in liquid. You would hold for a few days with each interval.  This allows your nervous system to adjust to the liquid formula. 

 

Please don't reduce the dose until you've completely switched over to the liquid. One change at a time. 

 

[KathyLoop]

I'm wondering about interdose withdrawal with the clonidine. I notice that I start feeling hot/sick/head ringing early afternoon, about 5 hours after taking it. And I'm also waking in the night and having trouble getting back to sleep, again about 5 hours after taking it. I'm considering going off it to see if this improves my state any. I wonder if all the hot discomfort I was having when it was prescribed was due to coming off the ativan/zopiclone way too fast. And I recall you advising me not to start a new drug, but I was already on it and didn't listen. I assumed it was menopausal symptoms and didn't realize clonidine could be harmful during my taper until I was already taking it. I'm thinking it's a fairly small dose and maybe there wouldn't be lengthy withdrawal effects from it, since I've only been on it about 2-3 months. And maybe I'd be better off without it.

 

(Or maybe it's just the ativan taper which I'm doing rather quickly, mainly because I feel so unwell, exhausted, etc., and I should just carry on.)

 

Just thought I'd run this by you. Thoughts?

[Shep]

Here is the prescribing label for Clonidine:

 

Catapres® (clonidine hydrochloride, USP)

 

Per that PDF: The plasma level of clonidine peaks in approximately 3 to 5 hours and the plasma half-life ranges from 12 to 16 hours.

 

So you could be waking up after the peak plasma level hits and then decreases the amount of the drug in your blood. But the half-life is long. 

 

14 hours ago, KathyLoop said:

I assumed it was menopausal symptoms and didn't realize clonidine could be harmful during my taper until I was already taking it.

 

Are you waking up with hot flashes? If so, that may be menopause, especially if hot flashes weren't withdrawal symptoms for you earlier. 

 

14 hours ago, KathyLoop said:

(Or maybe it's just the ativan taper which I'm doing rather quickly, mainly because I feel so unwell, exhausted, etc., and I should just carry on.)

 

This is from your signature:  July 19 .9mg (.19/.19/.52), July 26 .85mg (.18/.18/.49), Aug 8 .8mg (.18/.16/.46), Aug 18 .75mg (.18/.14/.43)

 

From July 19 -> August 18, you've gone from .9 mg to .75 mg, which is a 16.7% decrease. 

 

If your symptoms are severe, you may want to updose the Ativan back to .75 mg, which is were you were 5 days ago. I wouldn't count on removing the clonidine to take care of too rapid a benzo taper. You'll likely be destabilized even more. 

 

[KathyLoop]

Thanks for that. I'll stay the course. Holding at .75mg ativan.

 

I guess my problem is that my life is so sh*tty, even without all the withdrawal. So I'm desperately looking for some kind of "fix" to improve things and there simply isn't one. I keep thinking I need to be off these drugs so that my brain can heal, but who knows if it ever will... and if I rush it, I probably make things worse. It's just hard to live as I am, yet I'm in a state that makes it difficult to change or improve anything.

 

So I'll just keep going and hope that somehow, with everything I'm doing, things will slowly improve.

 

I appreciate you answering my repeated questions.

[KathyLoop]

I'm having a lot of symptoms... hot, heart pounding, head burning/ringing, emotionally fragile, angry, irritable, trouble sleeping... just completely stressed out and having difficulty coping with the physical symptoms. Laying in bed most of the time. I don't know if it's withdrawal or menopause or tolerance or some interaction between the clonidine and ativan or all of the above.

 

Haven't reduced ativan in 10 days. I'm not getting much, if any relief when I take my doses the past few days.

 

Any suggestions?

[KathyLoop]

Not sure if you're busy or missed my last post. Apologies if you're busy... don't mean to be a pain.

 

I'm now 2 weeks since my last ativan reduction. Still having a lot of symptoms, as I described. Should I just keep holding until I feel better? I'm still not getting any relief when I take the ativan, particularly during the day. I did get more sleep last night though. Having a lot of life stress... relationship, car accident, etc. 

[ChessieCat]

I've let the other mods know that you need assistance.

[Altostrata]

@Frogie, could you kindly assist?

[Frogie]

Hi @KathyLoop

 

I’m sorry you’re feeling so rotten. I just wondered if you’re taking .17 mg at 8 am? That’s what I got off your signature. And you dropped the 23rd of September? If that’s the case, you could try tapering a little more (.01 mg like you have been) and see if that helps. Just know it can take 4-7 days to feel any difference.

 

Let me know how you feel about that and if I can help anymore .

 

Hang in there, it will get better.

 

Take care,

 Frogie xx

[KathyLoop]

I'm unsure about which dose to reduce from going forward. I was originally trying to take more at night, to help with sleep. But should I be gradually bringing the 3 doses to the same amount, to maintain a more steady level of drug in my system? So should I mainly be reducing from my night-time dose soon? Or is it only necessary to get some drug in my system during the day and not necessarily the same amount as at night?

 

If you could advise me about how to move forward with small dose reductions, that would be helpful. Thank you.

[Shep]

@KathyLoop I'm going to repeat some earlier advice because it's something we've discussed before. Please work on getting a game plan in place before making any more reductions. Earlier this year, you were experimenting in finding the right timing at the right doses and it's possible that bouncing doses around experimenting caused some nervous system destabilization, so this would be the same advice as before: 

 

On 7/20/2021 at 7:03 AM, Shep said:

This is highly individual. If you need to take the bulk of the Ativan at night for sleep, you may want to only taper the daytime doses and use non-drug coping techniques to help with any interdose withdrawal during the day, knowing you'll get some sleep at night. 

 

Some people like to target the middle dose first because they feel like having a nighttime dose for sleep and a morning dose for interdose withdrawal is enough to get them through the day. The half-life of Ativan is 10 - 20 hours, so depending on how quickly you metabolize it, you may be fine with just a morning and evening dose. A lot of the individual aspects have to do with the speed each of us metabolize these drugs. 

 

Other people like to taper all three doses at the same time in order to keep a consistent amount of the drug in their system. 

 

There's no right or wrong way. 

 

I would set up a game plan and then stick with it. 

 

The more consistent you can be with timing, the better. 

 

Please post your thoughts.

[KathyLoop]

Yes, I recall that earlier advice. Essentially, you're telling me to decide for myself. I'm not getting consistent sleep. I'm not getting much sleep at all. I don't feel like the ativan is doing much for me anymore. Every reduction is awful, even just the last 1/100th of a milligram... which scares the hell out of me. But it's all my own fault, for taking it in the first place.

 

Seems like I have so far to go yet. And it's so difficult already. So I was just looking for some guidance, some reassurance. But that's likely not what you're here for.

 

I joined a benzo group on facebook and they suggested I equalize my doses, so I was just checking to see if that's good advice. But you're right, you've already advised me on this. And there's no great way to do it.

 

I don't think I've been bouncing around. But it has been very difficult and the anxiety is very high. I'm trying to listen to my body, to my symptoms, to all the external stressors, and adjust my taper accordingly. Seems like you're saying to make a plan and stick with it no matter what. I just had major things happen in my life... relationship fell apart, boyfriend called the police on me, totalled my car, getting physio for the injuries, staying with my parents, need to shop for a new car, can't even think straight never mind handle any of this. I tried to slow my reductions because of all the stress, but I guess there's no good time to taper.

 

I feel pretty alone with this. But I guess that's the reality of it. I'll carry on. 

[Shep]

On 10/22/2021 at 9:43 AM, KathyLoop said:

Seems like you're saying to make a plan and stick with it no matter what. I just had major things happen in my life... relationship fell apart, boyfriend called the police on me, totalled my car, getting physio for the injuries, staying with my parents, need to shop for a new car, can't even think straight never mind handle any of this. I tried to slow my reductions because of all the stress, but I guess there's no good time to taper.

 

Wow, that's a lot to happen. Kathy, please don't rush your taper. If you feel you need to hold, then hold. You're right that there's no good time to taper, but there's always a good time to hold. Take care of yourself. 

[KathyLoop]

Thanks, Shep. I'm managing to knock off a .01 or .02 here and there still. I just want to keep things moving. I appreciate your support.

[Shep]

On 10/22/2021 at 9:43 AM, KathyLoop said:

But it's all my own fault, for taking it in the first place.

 

Forgot to touch on this in my earlier post. This sentence is not true. We go to doctors and pay a high price (or our insurance does) because of their expertise. When people have illnesses such as cancer or heart disease and they don't follow the doctor's orders, we say it's their own fault if their condition gets worse because it's assumed that the doctor knows what he or she is doing. 

 

You followed your doctor's instructions. The guilt lies with the doctor, not with you.

 

Just a thought. No need to carry more baggage during withdrawal than you have to. 

[KathyLoop]

Thanks for that, Shep. I tried to express my anger to my doctor yesterday, but he mostly just defended psychiatry... said they had no way of knowing how sensitive I am, said I should avoid staying in anger, look to the future, got the speech on "the practice" of staying present, letting the emotions flow by, blahblah. Of course, never an apology on behalf of psychiatry. I just got very triggered and very angry. Might be best not to have phone calls with him... he doesn't really help me much.

[KathyLoop]

I had to try coming off the Clonidine. I was having 30-50 hot flashes a day so it was clearly not working as intended. And I kept thinking back to what you said about paradoxical reactions. I reduced by 1/4 every 3-4 days, taking the last dose 6 days ago. Hot flashes are mostly gone. But I'm having a lot of anxiety and just generally feeling unstable and unwell inside. Carrying on with the slow ativan taper... reducing .02 every 9-10 days, so that I'm hitting the 10% a month mark. Assuming the clonidine withdrawal has upset my system, any idea how long to stabilize? 

[KathyLoop]

You can ignore that last question. I know you can't tell me how long to stabilize. I guess I just wanted to share an update. If you have any thoughts on it all, great. And if not, I'll just carry on. Hope you're well, Shep.

[KathyLoop]

Just checking in. Things settled down after the clonidine taper... pretty much zero hot flashes now, so that whole ordeal was pointless. I think I've finally learned my lesson about taking any drug just because it's been prescribed. It only took 35 years, lol! Hopefully, no more drugs ever again.

 

Every ativan reduction continues to be very difficult, but I'm getting through it. Continuing with therapy twice a week and trying to get up out of bed more often for some movement. Sleep meditations and good sleep hygiene have improved my sleep. I've also been having some windows... some brighter moods for short periods... much less suicidality. The physical symptoms of withdrawal, especially extreme fatigue and body soreness are proving to be most difficult. The awful depression comes and goes with each cut, but is more manageable. 0.45mg to go!

[Shep]

18 hours ago, KathyLoop said:

I've also been having some windows... some brighter moods for short periods... much less suicidality. The physical symptoms of withdrawal, especially extreme fatigue and body soreness are proving to be most difficult. The awful depression comes and goes with each cut, but is more manageable. 0.45mg to go!

 

This is a great update, Kathy. I know there's still a lot of struggle in the mix, but some improvements, too. 

[KathyLoop]

I'm thinking of switching to micro-tapering. Reducing by .002mg daily until I hit my 10% reduction, then holding. Or maybe alternating between .002 and .001 daily until my dose is lower, and eventually, sticking with .001mg reductions. I thought it might help to smooth out the bumpy ride. I have no way to measure less than .001mg to even it all out accurately over the month. Any advice? Or reasons why I maybe shouldn't try this? 

[Shep]

Some people are able to do daily mico-tapering and it work well. Be careful you don't go over the 10% reduction per month in total, though. 

 

You may find that weekly reductions work well. This is the Brassmonkey Slide:

 

The Brassmonkey Slide Method of Micro-tapering

 

 

[KathyLoop]

I did 5 days of microtapering .002mg each night, for a total of .01mg reduction ending 4 days ago. Increased symptoms set in after 3 days of the microtaper and maybe I should've stopped but pushed on for two more days. The microtapering seemed no gentler than my previous reductions of .02mg all at once, and I only managed to cut half that. I'm having a very hard time staying calm and facing this. Everything hurts, head and heart pound, the world seems very strange, can't believe this is all real, that I have to go on like this... I can't find a stable place within... I go into panic and hysterics over the state of existence. This has been going on so long and now it seems there's not even an end anywhere in sight because I won't even be able to maintain a 10% reduction pace. I'm terrified of making another cut.

 

So I'm holding for now... hoping things will settle somewhat... but this is really getting unbearable and hopeless. I am barely living... literally in a bedroom, in a bed most of the time. Just feels like I lose more and more of my mind... any progress I make is squashed and then some by the next reduction. I was better in the summer... getting out for walks regularly, making some progress, I thought.

 

Still doing Jungian psychotherapy twice a week, physical therapy for the car accident twice a week, but neither are really helping much. I do the physio exercises but everything hurts so much, I wonder if that's harming more than helping. My neck is so tight and sore 24/7. Yet laying here in bed all day can't be good either. My 80-year-old mother is taking care of me, driving me to appointments, cooking my meals.

 

Any suggestions? Have I kindled myself worse somehow by doing so many tiny reductions? Am I developing tolerance?

 

I realize you're just a volunteer stranger on the internet and probably can't offer much to help, but I'm open to hearing anything at this point.

[Shep]

On 1/26/2022 at 12:19 PM, KathyLoop said:

So I'm holding for now... hoping things will settle somewhat... but this is really getting unbearable and hopeless. I am barely living... literally in a bedroom, in a bed most of the time. Just feels like I lose more and more of my mind... any progress I make is squashed and then some by the next reduction. I was better in the summer... getting out for walks regularly, making some progress, I thought.

 

Have you had your vitamin D levels checked? You mention being better in the summer and I'm wondering if there may be something to do with sunlight and vitamin D. Some people find this supplement causes upticks in symptoms such as insomnia, so if that's the case, you may want to stop tapering until spring and then see if it goes better then. 

 

Winter can be brutal for many of us. 

[KathyLoop]

No, I haven't had my Vitamin D level checked. I asked my doctor at one point and he said the blood test available did not give an accurate reading. I have literally spent decades mostly indoors, not liking the sun, plus I live in Canada... but I've also been supplementing for years, at least 1000mg daily, sometimes more. I'm currently taking 1000mg but after seeing your comment, I'm not sure if I should take more or stop altogether?

 

I'm reluctant to hold the taper for a long period because my current state is not good, barely manageable, and I worry that I won't start to heal until I'm completely off this crap. Maybe the ativan I'm still taking is the problem? But I will consider holding longer, particularly if these symptoms start to settle down soon. And I guess pushing ahead with tapering while in a barely manageable state is not wise.

 

Would it make any sense to try switching to Valium at this point? I know I've brought this up in the past and you said it comes with its own issues and wasn't a good idea.

 

As always, thanks for your input.

[Shep]

9 hours ago, KathyLoop said:

No, I haven't had my Vitamin D level checked. I asked my doctor at one point and he said the blood test available did not give an accurate reading. I have literally spent decades mostly indoors, not liking the sun, plus I live in Canada... but I've also been supplementing for years, at least 1000mg daily, sometimes more. I'm currently taking 1000mg but after seeing your comment, I'm not sure if I should take more or stop altogether?

 

The best advice I can give without knowing the levels is to make sure you're being consistent with the dosing. If you're changing up the dose with this and / or other supplements, that can definitely cause problems. 

 

A lot of doctors aren't able to give supplement advice so if this is an area of interest, you may want to seek out a functional or holistic practitioner. That may be difficult right now, so you may just want to concentrate on making sure you're dosing supplements consistently until the time comes when you can see a specialist who knows how to run the right tests. 

 

9 hours ago, KathyLoop said:

Would it make any sense to try switching to Valium at this point? I know I've brought this up in the past and you said it comes with its own issues and wasn't a good idea.

 

Most crossovers do not go well for people who are already destabilized. Crossing over to a new benzo means going into withdrawal from your current benzo. The valium may or may not cover that withdrawal. It's very risky. 

 

9 hours ago, KathyLoop said:

I'm reluctant to hold the taper for a long period because my current state is not good, barely manageable, and I worry that I won't start to heal until I'm completely off this crap. Maybe the ativan I'm still taking is the problem? But I will consider holding longer, particularly if these symptoms start to settle down soon. And I guess pushing ahead with tapering while in a barely manageable state is not wise.

 

Since winter seems to be particularly difficult, why not hold until the beginning of April? Spring weather may provide some comfort and get you out of the house to sit in the sun and get some fresh air and some gentle walking. Spring is only a few weeks away. 

[KathyLoop]

Doing better. The last reduction of .02 wasn't so horrible. I'm back to having some short windows. It seems my monthly cycle is really in play. I did the last cut right after my period ended.... and then 2 weeks in, the hormones hit with a week of hot flashes and feeling just awful. Moods, rage, irritability gets really crazy following the cut and during the hormonal stuff. So I'm now thinking I need to stick to once-a-month cuts, right after my period or right after the hormonal symptoms ease if no period comes ('cause I'm 54!) 

 

So I'm currently at 0.4mg. Thinking I might try a 10% cut and then hold for a month. Also thinking I'd even out doses so that I'm taking the same amount every 8 hours... 0.12mg at 6:30am, 2:30pm and 10:30pm. Currently at .12/.11/.17.

 

Any thoughts? I figure it's worth a try, but also suspect it's going to be a big hit the first week. The smaller more frequent cuts seemed to make sense to me, but my experience was that every cut was difficult and I never really got any relief.

 

If it's too hard, I guess I go smaller next month.