1mg/day Lorazepam - problem?

[TanmasterDan]

As related to me by a friend seeking advice:

While tapering off suboxone (which is my real issue), I've been using Lorazepam. Although I do occasionally miss a day, I normally take 1mg each evening.

I know this is a fairly minor dose, but will I need to taper off 1mg and will I experience withdrawal, or will I be able to just "stop" from 1mg with no risk?

Thanks!

[HandyMan81]

Lorazepam Withdrawal


Some withdrawal symptoms from abrupt withdrawal from lorazepam can be serious and potentially life threatening, including seizures and psychosis. Many people decide to withdraw from lorazepam after long term use due to the adverse effects on physical and particularly mental health from long term use.Long term use of lorazepam can cause an increase in anxiety, muscular problems, sensorary problems, agorophobia and cognitive deficits. Lorazepam is a short acting benzodiazepine drug with a half life of 10 - 20 hours and the available doses are all potent doses and thus small reductions cannot be made and the blood level of the drug cannot be kept stable. For this reason it is advised to cross over to an equivalent dose of the long acting benzodiazepine drug called diazepam, or as it is sometimes better known Valium. There are many benzodiazepine medications, which all share the same mechanism of action. Some common benzodiazepine drugs include lorazepam, alprazolam and clonazepam.

Lorazepam works similar to alcohol, on the GABA receptors in the brain and thus can cause an addiction and withdrawal syndrome similar to that seen in alcohol. The withdrawal syndrome from alcohol is similar to that seen in withdrawal from lorazepam and other sedative hypnotic drugs. Lorazepam also carries the risk of overdose especially in cases of drug abuse. The risk of overdose increases with the size of the dose, tolerance level to the drug and when lorazepam is taken in combination with other drugs, especially opiates and or alcohol. Lorazepam is not recommended during pregnancy and is classed as category D, which means that it can harm the unborn baby. Lorazepam has been found to cause an increased risk of birth defects and also can result in the baby being born addicted to lorazepam and suffering complications after birth including floppy infant syndrome and benzodiazepine withdrawal symptoms.

How to Withdraw From Lorazepam

Withdrawing from lorazepam can be made easier as explained above by a slow reduction regime preferably using diazepam. The slower the withdrawal rate from lorazepam the less severe the withdrawal side effects. Withdrawing too fast from benzodiazepines such as lorazepam can result is serious adverse effects. The most serious withdrawal symptom is seizures as these can be life threatening. However seizures do not occur when withdrawal is slow so those embarking on a sensible withdrawal rate can rest assure that they will not experience such serious withdrawal effects.

The first thing a person who is addicted to lorazepam should do is to stabalise their dosage of lorazepam. This means taking lorazepam in devided doses throughout the day. So for example if someone taking 2 mg of lorazepam at night, they should space this out to 0.5 mg 4 times a day. It may take the body a few weeks to get used to this change in dosing regime of their medication.

Once a person has stabalised their use of lorazepam in equally spaced doses the next step is to gradually switch over to diazepam. An example of how to switch from lorazepam to diazepam is given here... http://www.drugs-forum.com/forum/showthread.php?t=16708

Below link is a suggested withdrawal schedule. The withdrawal rate suggested below can be changed according to how the individual responds to dose cuts and the withdrawal rate should be determined by the individual. The below table uses the example of how to withdraw from 4 mg of lorazepam. If you are taking a different dose simply ammend the table to suit your current dose level.

NOTE: Some people find it difficult in the final stages of withdrawal from 5 mg of diazepam to zero. If you are one of these people it may be of value asking your doctor to provide you with the 2 mg per 5 ml diazepam oral, liquid suspension, and obtaining a 1 ml syringe from your local pharmacy/drug store/chemist. Users can then obtain smaller dose reductions than the 0.5 mg sized cuts obtained using the 2 mg sized diazepam tablet.

Hope this helped....

Reputation Comments on this post:

great informative post

[Bluedrip]

1 mg. of Ativan sounds small, but it's still equivelant to 10mg. of valium (per Ashton estimates), so it's not insignficant. Depending on how long SWIY has already been taking 1mg./day, SWIY might find that he can get by taking less than that. SWIY could try skipping a day to see what happens, or SWIy could try taking a lower dose to see what happens (e.g. 0.5mg./day). Tolerance/dependance build at very different rates in different individuals. The longer SWIY takes 1mg. a day the greater the chances that SWIY's tolerance threshold will be close to 1mg./day (rather than less).

If SWIY has not been taking Lorazepam longer than a few weeks, SWIM would attempt dose reductions now (e.g. 0.25mg every 3-4 days) to see if it can be done without significant withdrawal. If it can, great. If it can't, SWIY should not force it. If it's too late to get off of Ativan quickly, SWIM would take minimum dose needed to stay out of withdrawal until ready to do a truly gradual taper using water titration method or valium substitution method.

[ganjahero420]

eh, not to be picky here but 1mg lorazepam is more like 5mg diazepam than 10 according to msot benzodiazopeine equivalent charts. whta the OP said about cutting back .25mg a day every other day or so is probably your best bet to avoid withdrawl as much as possible.

[radiometer]

Professor Ashton's site is full of great information (btw you may not directly link to it, handyman, because that site includes a discussion forum).

But I must point out that it completely informed by an explicitly anti-benzodiazepine philosophy, and when one reads something which is informed by a heavy bias, one must be sure to be critical of everything they read and to back it up by finding another, unbiased reference.

[Bluedrip]

Equivelancy estimates do vary, which is why I gave the source for the one I used. Her bias is to give an equivelancy that is large enough to actually cover symptoms if there is an actual crossover. They are different drugs, so all estimates are just that: estimates.

In my experience Ashton's charts seem to be pretty close to the mark for most people crossing to diazepam. There are exceptions: I have seen people who have been able to get stable on a lesser dose of diazepam than she suggests (most often when someone is crossing from clonazepam to diazepam). I have *never* seen anyone with an Ativan dependancy get stable on diazepam at a 1mg: 5mg level. There's probably someone out there who has done so, but my experience tells me that 1mg: 10mg. is probably pretty close for Ativan: Diazepam.

Just my .02

[KNOWLEDGE_IS_POWER]

SWIM used to have that same problem bro, using lorazepam to help cope

with stress and help with insomnia. SWIM's best advice to you is to do

what the others have said and jsut taper down your dosage, spreading it

out... SWIM went from 6 a day then moved down to 4 a day for a few

weeks, no withdrawls or nothing, then down to 3, for a few weeks, still

nothing, when SWIY gets down to 1-2 a day SWIY will feel it but jsut a

little bit. SWIM noticed though that once he was down to once a day for

about a month, SWIM jsut went cold turkey... not as bad as SWIM

expected at all, the only thing that WILL get to you (dont know if anyone

else had this on benzo withdrawl) the most disturbing nightmares ive ever

had every single night for about a week. The daytime wasnt bad but

SWIM seriously dreaded going to sleep because of those damn night

terrors. Who wouldve thought those little tiny pills could be such a pain to

get off of? anyone else experience these kinds of withdrawls? Also, if

SWIY really doent want to stop that bad he could always get a

prescription for it for his anxiety this way you could use responsibly and

not have to spend ure time and effort trying to find some.

[radiometer]

Originally Posted by Bluedrip

Equivelancy estimates do vary, which is why I gave the source for the one I used. Her bias is to give an equivelancy that is large enough to actually cover symptoms if there is an actual crossover. They are different drugs, so all estimates are just that: estimates.

I believe you mistook the intent of my post. I meant to validate Prof. Ashton's information, while pointing out that people perusing her site should do so with awareness of the site's explicit bias. In my experience those who are choosing to use benzodiazepines despite the risks can feel unfairly disempowered by the sort of rhetoric used there. I certainly made no comment WRT the equivalency tables found there - I use them as a reference myself.

[Uncle Getafix]

Hey man,

Yep be glad you aren't taking more than 1mg/day Lorazepam.

SWIM had crazy nightmares off the stuff too, coming off larger doses.

Try halfing the dose to 0.5 mg for a few days. If there is no kickback, get rid of them. If SWIY feels a kickback, a taper may well be in order.(re Ashton schedule)

Dude(or dudess), Lorazepam is a sneaky drug so take care and be well.

Smoking a bit of pot before bed can be very helpful for the sleep, if SWIY is an experienced smoker. Otherwise pot may increase anxiety. For SWIM a cone or two works a treat, much better than Benzos for insomnia!!

[tyranny4u]

I know this is a fairly minor dose, but will I need to taper off 1mg and will I experience withdrawal, or will I be able to just "stop" from 1mg with no risk?

though the thread was started quite long ago and many good and reasonable
answers were given, tt would like to point out that benzodiazepines will cause
so called "low dose dependancy". means: even if only the therapeutical dose
is taken for a longer period of time, chances are given that someone got
physical addicted to the substance. lorazepam is such a "candidate" as it is
a very potent benzodiazepine derivative. after using 1 mg per day for a few
weeks won't make any problems. but consuming 1 mg of it for a year, it then
has to be tapered off instead of stop using it abrupt.
the tyrant doesn't know about the thread starters situation today, the added
text was meant as info for all readers, anyway.