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Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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ANSWER BY DR ANDERSEN ONLYDr Andersen: Please address this

Customer Question

ANSWER BY DR ANDERSEN ONLY Dr Andersen: Please address this email- not the others...thank you I need to clarify because my last email was not clear because things have changed greatly MY HISTORY with Lorazapem: 1. From 5/19/12 to 6/9/12- I was taking Lorazapem pills of .50mg (4x daily)- total 2.00mg 2. From 6/10/12 to 6/14/12- the Lorazapem pill dosage was changed to .50mg (3x daily) and .25mg mg (1 x daily)- total 1.75mg 3. From 6/15/12- 6/21/12- the Lorazapem pill dosagewas changed to .50mg (2x daily) and .25mg (2 x daily)- total 1.50mg 4. From 6/22 to 6/28/12 - the Lorazapem pills were changed to ORAL ATIVAN .with 1ml liquid =.25mg to be taken 3 times daily AND one Lorazapem pill .50mg once a day (total 1.25mg)After my first dose, I got severe shakes. It didn't go well. Should of realized then it might be problematic.After I got alot of eye twitches, numbness in legs, mild hypertension, and had real trouble at night. I feel the ATIVAN is too strong and different. Last week I was dehydrated, had mild hypertension, anxiety. There is an intensity of this drug that is difficult for me. Q1- I am switching back at least the 7AM oral dosage back to .25mg pill LORAzAPEM as I woke up shaking intensely. Will going back to LORAZAPEM pills instead of all ORAL DOSAGES minimize these stronger side effects? Are there side effects of mixing one generic and the other not- one lorazapem and the other ativan. Q2- CURRENTLY is this ALSO the result of going too fast from 2.00 gr to 1.25gr in 3 wks only giving me these side effects? Q3- If I change back to pills will symptoms be less severe Q4 Can I change the .50mg that I take down to .25mg next week.(this will be a change to one dosage (the 1am only) of the 4 dosages- not to overall amt taken) should I wait to see what happens next week? Q5- I feel something is wrong - the effects are much stronger and harder for me . This time I had terrible trouble sleeping on day 2. I went to bed at 3am woke with the shakes and the following at 6:45am: 125/113 p 93 6:30am 132/95 p62 7:15am -AFTER PILL 126/88 p 65- this shaking scares me. I don't want to risk seizures, and or other problems.. Plse tell me your recommendations. Q6 What are the signs of going too fast? Q7- My concern is going forward that I do the proper tapering process. Is my tapering from 2gr to 1 gr in ONE MONTH - too severe being that I make changes to ONE DOSAGE LEVEL rather than overall to all 4 dosage levels? Please let me know Q8- last night was my first taper to the ONE dosage level at 7pm. After my 1AM pill of .50mg ---I had the following interim withdrawals 4am woke up - hot - only 97.2 (if therm correct?) but from 4am to 4:45am 102/91 pulse 90 106/89 p 82 put ice direct on chest 115/94 p76 110/87 p68 112/98 p 70 117/88 p 60 at 5:00 went back to sleep ....WILL THERE BE MORE INTENSE OF THIS MILD HYPERTENSION? i DON'T WANT TO PUT MYSELF INTO ANY DANGER. THERE WAS NO CHEST PAIN INVOLVED. Q9- My FEAR is that the withdrawal symptoms have NOT peaked yet being day 2...I am fearful that they may be more severe and dangerous. Your reassurance and help in monitoring me is greatly appreciated. I trust and think you check these things thoroughly. I know this is alot of questions and information and will compensate accordingly. Thanks again. Margo

Submitted: 3 years ago.
Category: Mental Health
Expert:  Camille-Mod replied 3 years ago.
Hi, I am a Moderator for this topic. I sent your requested Professional a message to follow up with you here, when they are back online. If I can help further, please let me know. Thank you for your continued patience.
Expert:  Dr_Anderson replied 3 years ago.

This question finally opened up, so let me answer each question in turn:
(1) Given that the liquid version was a bit too potent for you, switching back to the pill version seems very logical to do. There should be no difference between generic and brand name lorazepam, HOWEVER, I do have a number of patients that tell me they feel there is a difference between the two. There is no way to predict for whom this will be the case, so if you take a generic and then a brand (or vice versa) and feel withdrawal or side effects that seem ill-timed or disproportionate, it may be because there is a difference for you, too.

(2) Since you are having withdrawal effects that are more severe now than perhaps last week, it may be the switch from pill to liquid rather than a taper that is too fast. The last bit of medication is usually the toughest to come off of, though, so that plays a role, too.

(3) Given the liquid does not seem to be a good fit for you, the pills are a reasonable switch to make.

(4) I would wait to let things settle a bit before dropping to a lower dose. Now, if you feel better, that the withdrawal effects have improved, then a decrease in the dose next week would be a good idea.

(5) Remember, the switch to liquid PLUS it being the last 1.5-1.75 mg of dosing is probably to blame. for things feeling worse. BUT, this feeling will pass, in spite of it being miserable. That being said, I'd probably hold at your current dose and let the withdrawal effects ease up a bit before moving on to the next dose cut.

(6) Shakes, sleep and mood disturbance are all signs of withdrawal, but really the only worrisome ones that would indicate too fast a withdrawal would be hallucinations, delirium, or uncontrollable shaking.

(7) I think the tapering schedule you have is ok - really the taper is a custom and individual one. The general guidelines that you have been following are a good place to start, but then it is customized to your specific needs. Every person is different. Some people can taper off in a few days, others may take weeks or even months to do so. In your case, we are looking for the ideal taper - not quite there, but certainly closer than when we started!

(8) Those blood pressures are typical for withdrawal. As long as they go back to normal (which many of them are), and are not accompanied by other concerning signs such as chest pain, shortness of breath, or dizziness, then they are transitional in nature. If any of those things happen, or if your blood pressure remains elevated, then it would be wise to consult with your doctor.

(9) The last bit is the hardest to come off of. So, I think holding at the current dose is wise, and then when things settle (as evidenced by normal blood pressures and few if any withdrawal symptoms) then another small cut (by 0.25 mg) would be in order. I know you want to be off it as soon as possible, and we'll get there, but we also want it to continue to be safe and as little discomfort involved as possible.

Thank you for the questions! Very happy to help out. Please let me know if I may be of further service.


Dr. Anderson
Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience: Psychiatrist
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