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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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I am trying to taper off my Ativan that I have been on since

Customer Question

I am trying to taper off my Ativan that I have been on since April. Many months ago I took up to 2 mg a day for just a few days. Otherwise I dropped it down to a .5mg b.id. and now have been at .25mg at 6 AM and noon for a couple of months. I am now, with my MD's ok, starting to taper off of the noon dose and eventually the AM dose to just prn. I was told that I was on a very minimal dose and that I should not have rebound/withdrawal. Yesterday and today I have not taken the noon dose. I notice that my pulse is faster (which is one thing I have always gotten with my panic disorder, up to 160's, and the EKG's showed sinus tachycardia with panic). So, now I am wondering if I am getting withdrawals from the decrease in ativan or is it just psychological because I am worried about the possibility of rebound/withdrawal?
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 3 years ago.
Hello. I believe I can be of help to you with this issue.

You are likely experiencing BOTH some withdrawal symptoms and fear/anxiety reaction due to withdrawal 'expectancies' you have. Here is my favorite site for assistance with tapering off of the benzos such as Ativan (lorazepam)

http://www.benzobuddies.org/

What you will want to do is try to increase your exercise level (aerobic activity) significantly during this time period of tapering. Realize that withdrawal symptoms from most drugs are roughly the 'opposite' symptoms of your use effects e.g., sedative effects associated with use are then consistent with anxiety and arousal effects during withdrawal. If you can get a partner or helper to sort of baby sit with you for a few days off and on, hang out with you and exercise to help manage your withdrawal and anxiety-like symptoms, you should be o.k. Also, if you go to your local pharmacy, for a few bucks you can buy a pill cutter, which will help you accurately cut your pill size/dose. Just do the tapering slowing, don't rush it, keep exericising during this period e.g., a couple times per day if necessary, and you should do just fine. Use the above website for assistance.

I hope this information is helpful to you. Please let me know if I have overlooked any aspect of your original question. Also, be sure to hit the green Accept button at the bottom of the screen. Thanks.
Customer: replied 3 years ago.
Do you think I am at any risk for any bad reactions? Like seizures and stuff like that for people who have been on high dosages?
Expert:  Dr. Michael replied 3 years ago.
No, your doseage is low to begin and thus, your risk of such reactions is very low. Also, if you taper slowly, the risk of reactions and side effects beyond those observed with normal, simple withdrawal, are very minimal. You need to reassure yourself that you can take this slowly, you'll experience a bit of distress, but can mange it with patience and a little hand-holding; you can increase your dose upward a bit if you need to. But the more you can tolerate the withdrawal symptoms and your own anxieties about doing this, the better off you will be. Even with your low dosage, you are probably talking about several weeks of tapering, to do this more or less painlessly----you can go faster if you can put up with the normal withdrawal symptoms.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
The pharmacist that I spoke to said I could discontinue my .25mg of ativan at noon and do that for several days. Then I could discontinue my 6 AM dose of .25mg. He felt that was safe and that I should be ok. Do you think that is safe? I was going to stay at the .25mg dose at 6 AM for a week or two without the noon dose before I discontinued the AM dose. I have .5mg tabs and I do have a pill splitter that I have been using for a couple of months to just use the .25mg dose. Do you think I should be splitting the .25mg dose also to 12.5mg? I think that would be difficult to do accurately as even splitting the .5mg tabs aren't always exactly the .25mg.
Expert:  Dr. Michael replied 3 years ago.
I think I would try the schedule suggested by your pharmacist. If you find it to be too distressing, you can try to even out your blood levels of the medication by cutting the .25 mg dose in half, and taking it in the a.m. and p.m. Your pill splitter will do a close, 'good enough' job of approximating these dose levels. What I'm suggesting here is that you can try one thing, and then if you cannot tolerate the symptoms, make an adjustment, preplanned in advance. You will probably have to experiment just a bit, starting out. Give it a go and get back to me if you want more information or suggestions.

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