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Vakul Aren
Vakul Aren, Doctor
Category: Health
Satisfied Customers: 4106
Experience:  MBBS,DTM&H( Univ of Liverpool),34yrs experience in practice
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How to switch from Xanax to Lorazepam?

Resolved Question:

I'd like to find out how to switch from xanax to lorazepam? is it a tapering or just swiching cold turkey, for ex I was taking 2mg xanax. now the doc gave me lorazepam 1m 4-6 hours as needed. i experience all kind of side effects for the last 3 weeks since I stopped xanax and i take 4.5 mg lorazepam (1mg in morning 3 halves during the day and 2 at bed time). my question is how long will take for lorazepam to get stable and to not feel xanax withdrawl symptomps. i took xanax for 10 years but lower dosage (0.25). in the last year i increased more due to changes in my life.
Submitted: 6 years ago.
Category: Health
Expert:  Vakul Aren replied 6 years ago.

There seems to be a problem in many patients who switch from Alprazolam/Xanax to Lorazepam/Ativan.Lorazepam 1 mgm is considered equal to 0.5 mgm Alzalopram.

Though there is a similar anxiolytic effect,some patients find that there is a antidepressant like effect with the alprazolam which is missing with the lorazepam.Further the halflife of lorazepam is 10-20hours whereas the alprazolam has a half life of 6-12 hours and is a more speedy/ with a high.

The addiction potential of alprazolam is much more than that of lorazepam,it would take some time to adjust to the switch.There is more tiredness while taking the lorazepam.There appears to be a strong psychological dependence on alprazolam which often gives symptoms of withdrawal even though bioequivalent doses of other benzodiazepines may be given.

Benzodiazepines are not proper drugs for lomg term use due to their strong dependence/addiction potential and should ideally not be used formore than 2-4 weeks when treating anxiety .Further,0.5 mgm of alprazolam is a bioequivalent of 10 mgm of diazepam.Hence ,the 3 mgm of xanax you were taking is equivalent of 60 mgm of Diazepam which is quite a high dose.

Further,the effect of almost all benzodiazepines tends to wear off in a couple of hours on long term use.With repeated daily dosing,there is accumalation of the drug in the blood ands also in the fatty tissue of the body leading to fairly high levels.Ideally complete withdrawal from benzodiazepines using a very gradual tapering dose over a long time would be best done under the supervision of a psychiatrist as these drugs are addictive in nature.

Customer: replied 6 years ago.

thanks for your very informative response. so coming back to my problem since I took xanax for 10 years even if in small dosage and switched 3 weeks ago to lorazepam without any tapering from xanax, how long should I expect to have horable symptoms until my body forgets xanax and gets stable with your opinion and experience? my intention is to wean off lorazepam but now that I have a therapist she told me that it'll take some time until I'm ready for weaning off. I'm taking now 4-4.5 mg lorazepam to cover the xanax i used to take 3 weeks ago (almost 2 -2.5mg).

Expert:  Vakul Aren replied 6 years ago.
This normally takes 2-4 weeks.In your case,since the time you have been on alpazolam is very long,it may be longer by another 4-6 weeks.Taking a mean ,I would expect between 6-10weeks if not longer to be the time taken for the body to adjust to the switch.There may still be a feeling of discomfort /something not quite right but most uncomfortable symptoms should settle down by that time.
Customer: replied 6 years ago.
thanks so much....the most unconfortable for me is nausea, lack of appetite and nervesness sometimes...if you have any advice in this regard, it'd be much appreciated....and with a bonus:)
Expert:  Vakul Aren replied 6 years ago.
Just give it time as addition of further drugs would increase the side effects.
Customer: replied 6 years ago.
sorry, i don't understand "addition of further drugs would increase the side effects. " you mean addition of lorazepam, the new one that I'm taking? can you please elaborate your last response? thanks
Expert:  Vakul Aren replied 6 years ago.
I meant addition of drugs for the nausea and nervousness apart from the lorazepam would cause further sedation and other problems.
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Customer: replied 6 years ago.

i feel that it's getting better in the last 2 days with the nausea and appetite. i also saw a nutritionist to help me with the sluggish stomach and GERD. Two things that I knew how to handle since I don't eat spicy food, drink coffee, alcohol or other stuff that's not good for GERD but it's true that sometimes I overeat, which is not what you think of overeating but for my stomach it is. so giving all of these and this transition period from xanax to lorazepam, what would you suggest as a long term plan for me b/.c I don't want to treat my anxiety with lorazepam. I got a therapist and we need to have a long term plan when to start weaning off this benzo and i don't want either to switch to something else again and wean off that one.

How long should I stay on lorazepam (when it gets stable and have no rebound from xanax) and in the meantime work with hte therapist to learn how to deal with this anxiety, my friend. When should I start thinking of weaning off lorazepam? pls share with me your opinion based on your experience and knowledge and what's best for me giving all the other circumstances. Keep in mind that I have a job so we need to count this in.

Expert:  Vakul Aren replied 6 years ago.
Weaning off benzodiazepines is a long process,you need psychological support and a positive spirit,apart from a good medical professional to guideyou through the withdrawal. .The first thing which comes to mind is that use of longer acting benzos like Diazepam will help in a smoother transition than short acting drugs like Lorazepam/ativan and Clonazepam.Secondly ,the availability of Diazepam in scored 2 mgm tablet helps in easier dose control of 1mgm of the drug. It is thought that if you are on about 5mgms of lorazepam,it would be prudent to decrease it very gradually,say about 1mgm of diazepam worth weekly or every 10-15 days ,assuming that 1mgm of lorazepam is equivalent of 10 mgm of diazepam.Since all benzos act differently it would further be prudent to introduce the diazepam gradually in place of lorazepam.The bedtime dose may be changed to 1 mgm of ativan and 8 mgm of dizepam instead of the 2 mgm of ativan.The body will find this easier to accept then changing over the bedtime dose completely.If th e total dose of ativan is the equivalent of 60 mgm of diazepam,it would take about 30 -40 weeks to halve the dose.The slow ,smooth reduction is essential as the healing of the mind is a very slow process.You may need 10-15 months to withdraw, but please go slow as directed by your doctor/PCP. Gradually all ativan will be reduced to equivalent daily divided doses of Diazepam which can then be slowly cut back.AS diazepam is a longer acting drug,it can be used in two divided doses and then cut back very gradually.You may stand still at a dose if you feel uncomfortable and delay reducing further for 2-3 weeks if necessary.It would be important to plan and design the withdrawal with your doctor/psychiatrist. The lorazepam may be stabilised for about 3-4 weeks before shifting onto diazepam.Avoid use of alcohol,cannabis,Zolpidem or other such sedative or recreational drugs.The last few milligrams will be difficult and may take a much longer than expected time.If you are on a antidepressant also,you may need to taper off that too.But taper off that after you have finished tapering of and withdrawing the benzodiazipine.Your doctor/Therapist can guide you further.
Customer: replied 6 years ago.

thanks much for your elaborate response. no, i don't take any anti depressant so one problem less. so to understand better what your suggestion is:

1. wait until I'm stable on Lorazepam - this might take to wait for the transition to finish and then to get stable so i'm looking at another 4 weeks for the transition (i am in the 4th week now) plus another 4 weeks of stabilizing before I start working with this right? this is just for me to work with my doc and therapist. sometimes docs here pushes you to move permanentely on the something long term that is also adictive (but long term) and this is something I dont want....

pls let me know if i understand correctly....

Customer: replied 6 years ago.
one more I have to go through diazepam and cannot do it directly slowly from slow as possible that it's bearable...
Expert:  Vakul Aren replied 6 years ago.
Diazepam will be preferred as it is a long acting agent,it is available in 2mgm scored tablets,hence 1mg stregnth is available for easy titration,can be used in twice a day doses,covers the effects of most benzos.If a taper of lorazepam is tried,the withdrawal is not smooth due to short half life of the drug leaving a gap which is uncovered by the drug.Also the lowest drug dose available is 1mgm which is the bioequivalent of 10mgm of diazepam which makes it difficult to titrate.
Customer: replied 6 years ago.

sorry for the delay in my preference would be to not try or go through other medicine like this case, how do you see the withdrawl plan and how slow should it go? I am not concerned about timing but the success of the plan and less unconfortable symptoms.


Expert:  Vakul Aren replied 6 years ago.

The problems arising from lorazepam withdrawal have already been mentioned.The problem arise due to the shorter half life,actual effects of drug wearing off within 2-3 hours of the dose causing withdrawal side effects arising,difficultly in titration because availability of lower doses are not available.

Customer: replied 6 years ago.
i am confused with this 'difficultly in titration because availability of lower doses are not available". Can they be cut in smaller dosage? today i felt so nauseated and don't know why. I introduced the peanut butter (at the nutritionist's idea) with crackers and this might have been the culprit...don't know.....but I am so so tired of the transition period and my eating....only mached vegie, now i cut in small pieces some chicken, eggs, ensure....sometimes i feel all of sudden a normal hunger and I;m so happy but cannot eat much...but still feel happy....gas in anoying as well and feeling tired....oh, I;m just crying like a child.....if you have more ideas how to go through this time please share them with'll be much appreciated. Thanks
Expert:  Vakul Aren replied 6 years ago.

The symptoms of withdrawal include nausea,bloating,dysphagia,abdominal cramps,anxety,nervousness,sudden mood swings,body aches,flu like syptoms including fatigue,body ache and joint pains,agitation,irritability,twitching of eyes ,tremors,breathlessness and other symptoms.

These occur because fractionating the doses of lorazepam is difficult and withdrawal symtoms often occur on reducing or stoping the drug. is a site of interest.

Customer: replied 6 years ago.

Here I am in the 5th week since I stopped xanax and swiched to Lorazepam. I have days when I can eat better and no nausea but I still have many days when I am experiencing this's the most annoying thing for me. Is there any natural stuff I can use to alleviate this nausea? should I try to not eat later than 6 or 6:30pm? I stay basically on cream of wheat in the morning, boiled eggs, cottage cheese, I introduced peanut butter with marmalade, matched potatoes with carrots, zucchini, fish. all these are in small portion and as bread, I'm using now the german zweiback (double baked fine dry bread), lots of water, sometimes cammomile tea or decaf green tea....but what else can i do? appreciate your opinion.

Customer: replied 6 years ago.

mostly the nausea is in the is I take this lorazepam:

1mg - 7am

1mg - noon

0.5 - 5:30 - 6pm

2mg - bedtime

i think that's not smart to try to go down with the dosage now, while I;m not stable yet, what do you think?

Expert:  Vakul Aren replied 6 years ago.

The nausea is associated with prolonged use of benzodiazepines.Your dosage of 4.5 mgm is fairly high and is the equivalent of 45 mgm of diazepam.The re is a cumulative effect of such high doses and may in fact lead to tolerance,anxiety despite high doses of antianxiety medication.paradoxical effects like excitement ,agoraphobia may also occur.The answer lies in reducing and gradually stopping the drug. is a site which will be of interest. Lorazepam is used as an adjunct in treating vomiting.Paradoxical nausea may be seen on prolonged use.

Customer: replied 6 years ago.

From your response, i understand that I should lower the dosage of lorazepam but we thought that this nausea is more form the xanax withdrawal which I stopped it abruptly 5 weeks ago. so my question is again....should I lower the dosage of lorazepam now when I not stable yet. Lowering the dosage would trigger more nausea? I'm confused.....

Expert:  Vakul Aren replied 6 years ago.
Benzodiazepines like lorazepam,Xanax are short acting drugs which should not be used for more than a few weeks.longer usage leads to dependence and addiction.Essentially lowering the dose of the drug being used is required.this needs to be done under the supervision of a qualified mental health professional/psychiatrist.Gradual tapering of drugs is practical when longer acting drugs are used so that the withdrawal is smooth.Your psychiatrist /Therapist can guide you further.You arre alrerady on a high dose of lorazepam and stabilisation may not occur even on this dose due too development of tolerance of the body and the brain..
Customer: replied 6 years ago.

i stopped xanax a month ago. how do you know that I'm not experience the withdrawal symptoms from xanax?

Expert:  Vakul Aren replied 6 years ago.
Alprazolam and lorazepam act essentially in a similar way.As I said withdrawal can occur even on high doses of Xanax/Ativan due to tolerance to the drug.The withdrawal may be from lorazepam/Xanax but the symptoms and management will remain essentially the same.
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