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Dr_Anderson
Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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I ve been taking ativan for 1 month. the dosage every 6 hrs

Customer Question

I ve been taking ativan for 1 month. the dosage every 6 hrs (set by alarm) .50mg. meds taken-7am /1pm/7pm/1am
I contacted my doctor after I told him these bp/pulses & he said ok to reduce the 1pm pill to .25mg.
My question since i can't reach him, in your expert opinion, can I also reduce the 7pm pill to .25mg ( I am asking is it ok to decrease from 2mg in 24hr period to 1.5mg. READINGS after 1/2 pill (.25mg) 1pm 111/93 p55, 3pm 107/83 p78, 4:30pm 117/87 p61 should I take .50 mg at 7pm or .25mg
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr_Anderson replied 2 years ago.

Dr_Anderson :
Greetings, and thank you for your question! I see you are offline right now but will try to provide you with some information from which to start. First off, for most people Ativan does not alter blood pressure directly. It works on the GABA system in the brain, and the blood pressure systems are different (NE and EP, to be specific). Now, Ativan can relieve anxiety, as you have found out, and that lowered anxiety can translate to lowered blood pressure, but it ought not mean blood pressure that is too low. Typically, Ativan slows breathing rate and effort rather than blood pressure.


You can certainly wean off the Ativan, but given the length of time you have been off it, I'd do this under guidance of a physician. However, cutting out 0.25 - 0.5 mg at a time, or just spacing out the time between doses (which is effectively the same as not taking as much) is a very safe plan to avoid rebound anxiety and withdrawal symptoms.





For question 3, exercise in the long run usually lowers blood pressure (or keeps it close to normal), but during the actual exercise itself and for a short recovery period after the blood pressure and heart rate will be elevated - this is normal and desired.




Hope this gets you started! Please let m know if you have further questions or if I may be of further service!




Regards,




Dr. Anderson



 

Expert:  Dr_Anderson replied 2 years ago.
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Customer: replied 2 years ago.
my pulse have been around 55. should I be concerned?
Expert:  Dr_Anderson replied 2 years ago.
Greetings, and thank you for the question.

For most people, a pulse of 55 is not worrisome. As long as you are not having any symptoms, such as shortness of breath, chest pain, or dizziness, a pulse of 55 should be fine. In fact, many people who exercise have their pulses routinely in the 40's to 50's. So, to have it at that rate, as long as you feel fine, is probably ok.

Please let me know if I may be of further service!

Regards,

Dr. Anderson
Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience: Psychiatrist
Dr_Anderson and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

Dr Anderson:

At one point I was diagnosed as hypothyroid back in January 5.88 tsh

A month ago (May 19th ) I had anxiety from an adverse reaction to xanax and paxil

which I was on prior less than a week.

When I was in the hospital - they retook my thyroid.- tsh w free tr reflex it was 3.8

normal (range .270 to 4.20)

They put me on Ativan .50 every 6 hrs (which I take by alarm clock)

Yesterday I was told to cut my 1pm dose to .25mg

I had some chills and normal blood pressures but some pulses around mid 50's

by 8pm the pulse was 60 and 10pm 72.

Today I also at 1pm had only .25mg of the ativan

I went for a walk and was totally exhausted and fell asleep

I woke up 4:30pm 113/79 p 61

then after shower 105/84 p69

QUESTION 1 Are chills and tiredness from being hypothyroid again? or is this

drug withdrawal of ativan????

My appointment to see the thyroid doctor is one month away-can't get sooner

QUESTION 2 - Will Ativan hurt me if I am hypothyroid?

I was told to cut down only by .25mg per week as I am highly drug sensitive

So far had mild chest pains relieved when went for a walk. can deal with that.

QUESTION 3 - Does levothyroxine increase or decrease anxiety .

I am very holistic and hate being put on the ativan. It does help me sleep through the night and the old panic attacks are gone.

I think you really analyze all patient's info extremely well and trust your advice and help with these 3 questions. Thank you

Expert:  Dr_Anderson replied 2 years ago.
Greetings, and thank you for the follow-on questions. Let me answer each in turn:

(1) Hard to say, because it could be either or both! Although I'm more inclined to cite the Ativan withdrawal as the culprit. Why? It came on very suddenly, from how you describe it. If it were your thyroid, it would be a bit more insidious in onset. Still, it is good to get the TSH, free T4, and T3 rechecked to be on the safe side.

(2) Ativan will not hurt you if you are hypothyroid, although fatigue induced by it may look like hypothyroidism. Ativan, per se, does not have an impact directly either way.

(3) Levothyroxine can do either, depending upon the dose and clinical situation. For example, in a normal thyroid, if a large dose of levothyroxine is given, it may induce anxiety because it mimics hyperthyroidism. But, in a person who is anxious or depressed, a low dose of the medication may lead to improvement of symptoms, whether or not the thyroid is hypo. (Of course, if a person is hyperthyroid, levothyroxine will make a person feel worse!).

Glad to be of service, I hope this helps out. Please let me know if I may be of further service!

Regards,

Dr. Anderson
Customer: replied 2 years ago.

one final clarification, so withdrawal from Ativan can also bring on fatigue?

thanks again for your help

Expert:  Dr_Anderson replied 2 years ago.
Pleasure to assist!

Yes, ironically it can bring on fatigue. Other possible withdrawal symptoms can include tremors, irritability, sleep disturbance, and agitation.

Regards,

Dr. Anderson
Customer: replied 2 years ago.
can they cause chest pains above the breast? I heard magnesium at 400 is helpful. What do you suggest?
Expert:  Dr_Anderson replied 2 years ago.
Yes, it is possible to get muscle aches, including chest pains. Those could also be rebound anxiety symptoms.

Magnesium can be helpful. So does making sure your potassium intake and phosphorous are ok. For some of my patients, they try an herbal, Calms Forte, to assist with the anxiety symptoms, although the results have been mixed at best.

Regards,

Dr. Anderson
Customer: replied 2 years ago.

Pease advise -----I

QUESTION 1---Are the low blood pressure readings normal when you cut back ativan

or is it my body saying I can cut another dosage now.

QUESTION 2---I thought when the dosage decreases the blood pressure and pulse go up?

I have cut my 1pm dosage from.50mg to .25mg since sunday.(3 days)

my pulse has not been above 81 (once) just 60-77 range otherwise.

took this half tablet at 1pm

Next 7pm pill is scheduled for .50mg.

QUESTION 3-- Is this dizziness and low blood pressure part of cutting back PLSE ADVISE - you have been so helpful.

QUESTION 5 Now I am 121/87 p68- ?

QUESTION 6 Should I be cutting down next sunday - one full week later . I will be at 1.75g per day. Will cutting by another .25mg (being more than 10%) shock my system?

Question 7 does it get easier or harder as I cut to smaller dosages?

Expert:  Dr_Anderson replied 2 years ago.
(1) Typically, lowering of Ativan will lead to elevated blood pressure readings if there is rebound or withdrawal symptoms, so you ought to be able to cut another dose now.
(2) Blood pressure and pulse go up if it is rebound anxiety or withdrawal symptoms, true. With the pulse being good, this tells me you are having neither, so further cuts can safely and comfortably be made.
(3) Typically, low blood pressure is not due to cutting back, although dizziness can be a withdrawal symptom. I think, though, that some of the blood pressure issues (and dizziness as a result of that) are something else (vasovagal response and dehydration are two common causes, as well as blood pressure medicines or other medicines that lower blood pressure as another common cause).
(4) which is listed as (5) Normal SBP and pulse, DBP normal high.
(5) which is listed as (6) Cutting down a week later is ok, given you are not having withdrawal or rebound problems. You can go sooner than that, but going down weekly gives you some predictability in the taper off. It shouldn't shock your system, since it is on a controlled schedule of removal.
(6) which is listed as (7) Depends. Usually the very last bit (0.25 - 0.5 mg) is the hardest to come off of, if there is any difficulty art all.

Happy to help! :) Hang in there!
Customer: replied 2 years ago.

Hi Dr Anderson: Thank you for taking the patience and time to answer my questions.

I am not taking any other medications except the ativan. I do feel thirsty alot and know that is a withdrawal symptom. The readings I gave were after drinking OJ.

I am fearful of fainting yet don't want any difficulty in the tapering off.

I have some muscle pains in my hands, tense shoulders. Just don't want any of this to get worse.

My question is : it is day 3 that I cut back .25mg out of a total of 2gr lorazapen.

When will most of the withdrawal symptoms PEAKED? Can I expect it to get any easier or will they just remain the same for the balance of the next 4 days?

You are a gem...thanks in advance for your help.

Expert:  Dr_Anderson replied 2 years ago.
Glad to be of help! This is a tough time for you, so I'm glad to be of service.

Typically, withdrawal symptoms peak at the 3-5 day mark, but they may be present for as late as 2 weeks following a dose decrease. I encourage people to journal their symptoms, this way they can tell if they are feeling better or worse day by day. Sometimes a person may feel badly, only to note that how they feel is still better than the day before!

Given the various aches and pains you have, I'd hold on your current dose until they resolve or at least feel better before cutting back again. I think you are "in the thick of it" right now, although you ought to feel better over the next few days.

Hang in there!

Regards,

Dr. Anderson
Customer: replied 2 years ago.

Thank you again . I will hold on to this dose as you advised.

All day I cry and feel bad. Hope next decrease will be easier.

I've tried scrabble, tv and short walks.

QUESTION 1- Any other suggestions?

The thought of this for the next 2 months is really bothering me. QUESTION 2 - Plse tell me the truth is 2mg per day considered a average or high dose? I took that for 4 weeks and now am at 1.75mg.

QUESTION 3 Does it get easier for people at all?

QUESTION 4 Will adding salt to my diet prevent dehydration?

 

 

Customer: replied 2 years ago.
Thanks again. This should be what i need for now.Kiss
Expert:  Dr_Anderson replied 2 years ago.

QUESTION 1- Any other suggestions? The thought of this for the next 2 months is really bothering me.

 

Remember, that is a WORST case scenario, not the typical or best case one! Think optimistically, that you will be a typical or best case. Keep in mind that this has an end, and you will feel better on the other side of this rigamarole.

 

QUESTION 2 - Plse tell me the truth is 2mg per day considered a average or high dose? I took that for 4 weeks and now am at 1.75mg.

 

2 mg per day is average, I have seen folks on far higher doses before.

 

QUESTION 3 Does it get easier for people at all?

 

Yes! But the stormy waters are something that have to be passed through. BUT...you WILL pass through them! Anxiety is horrid, but it will not kill you. It is uncomfortable, yes, but treat it like a very protracted toothache or childbirth.

 

QUESTION 4 Will adding salt to my diet prevent dehydration?

 

No, but keeping up with your water intake will.

You are welcome! Please let me know if you have any further questions, and please leave feedback about our time together! Regards, XXXXX
Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience: Psychiatrist
Dr_Anderson and other Mental Health Specialists are ready to help you

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