Q. What are the ways to reduce dosage of Ativan?

Answered by
Dr. Suresh Kumar G D
and medically reviewed by Dr. Divya Banu M
Published on Oct 02, 2019 and last reviewed on: Oct 05, 2019

Hi doctor,

I have taken Ativan for the past three years and really feel like I am addicted to it. I currently take 1.5 mg daily but used to (last year) take 2 mg daily. I usually wake up with anxiety, headache, neck pain, back pain, nose numbness and some eye pressure. I take .75 mg around 8:30 AM and by 9 AM most of my symptoms are gone. I take my second dose of .75 mg at around 3 PM and usually feel like my symptoms from the morning are coming back. That is what usually reminds me that it is time to take my afternoon dose.

I have a very stressful life and have been told that stress can eventually lead to experiencing real pain as a result. Ativan seems to help me with this pain, but now I feel I am addicted to it and I do not know what my next step should be. I have tried tapering, but perhaps I am doing it incorrectly.

Dr. Suresh Kumar G D

Child Health Paediatrics Psychiatry
#

Hello,

Welcome to icliniq.com.

It is good that you are trying taper off Ativan (Lorazepam) as long term use is not advisable due to physical and psychological dependence. You have already managed to cut down from 2 mg daily to 1.5 mg daily which is a positive step forward. Did you have any withdrawal symptoms at that time?

You can try to taper very gradually to minimize withdrawal symptoms. For example, try taking 0.75 mg in the morning and 0.5 mg in the afternoon for about a month. If there are any significant withdrawal symptoms at any stage, go back to the original dose. If you are able to tolerate, then cut down to 0.5 mg twice daily for a month. Then cut down to 0.5 mg in the morning and 0.25 mg in the afternoon for a month and so on. In this manner you should be able to wean off completely by 5 to 6 months. If it is not possible to taper down safely, you may need rehabilitation therapy and medically assisted detox.

Practise relaxation techniques like progressive muscle relaxation for atleast 15 minutes daily to manage stress. Consult your doctor for review of your mental health. If there are significant anxiety symptoms, other medication like SSRIs can be considered which will be safer for long term use.

Hi Doctor,

No major withdrawal symptoms I recall when tapering from 2mg to 1.5mg, but I can't get lower for some reason - I tried taking a .5mg yesterday afternoon instead of .75mg and it was very unpleasant.

I wanted to also mention that I've gone to an ENT, Neurologist, Neurosurgeon, pain management specialist, chiropractor, physical therapist and have tried pain (steroid) shots and various other things and nothing has really helped - which is why I feel that my addiction to Ativan is really the underlying cause here.

Finally, I'm also taking 20mg Duloxetine daily as per my general doctor's suggestion, but don't see anything different with it.

My question is like this, is it dangerous to stop taking 1.5mg Ativan daily? Meaning to say, if I have some withdrawal symptoms from slowly lowing the dose, should I just deal with them and try to power through it, or do you think I should have a medical professional monitor the entire process? I'm worried all these pains are coming from other things, but all the medical specialists I mentioned earlier ruled these things out - with the exception being the Neurologist and Neurosurgeon agreeing that I have some bulging discs in my neck that are likely causing pain there.

The bottom line is that every medical professional I speak to tells me Ativan is bad, and I should work I getting off of that first before anything else - so it will be easier to work with my medical issues while my body is in it's natural "un-medicated" state - so perhaps we should focus on that. But you're the professional, so I leave this in your capable hands.


Thank you.

Dr. Suresh Kumar G D

Child Health Paediatrics Psychiatry
# Hello John
- When you say it was unpleasant when you dropped Ativan from 0.75 mg to 0.5 mgs, what symptoms did you experience ?
- Regarding your question about danger , stopping Ativan without planned withdrawal can be potentially dangerous because in addition to the psychological symptoms , some people can also experience symptoms like increased heart rate, high BP, headache, tremors, feeling of confusion, rarely seizures, etc. So it is advisable to have your doctor/psychiatrist to monitor your detox and support you accordingly.
-I have to say that not everyone experiences these symptoms. Some have very mild withdrawal symptoms but there are some who cannot manage without medical support. In your case, it is good that the Ativan dose is not too high but you have used it for three years so your body needs time to adjust without Ativan in the system. It will take atleast few weeks for your body to adjust to the lowered dose each time you taper.
-Some people also experience protracted withdrawal symptoms like anxiety, mood problems for a longer period. This can be managed better when you are withdrawing under medical guidance.
- Can I ask why you were prescribed Ativan 3 years ago ? Were you experiencing any anxiety, panic symptoms ? If so, the underlying condition needs to be managed appropriately.
-Duloxetine which has been prescribed by your general doctor can be helpful in managing depressive and anxiety symptoms. You are on a lower dose. Dose may need to be optimised or alternative medication needs to be considered to manage any underlying anxiety or mood issues.
- It is good to know that most of the medical professionals you have consulted already have ruled out any significant causes for your pain. You can follow up with your neuro doctors regarding managing bulging discs.
- I agree with all other professionals that you will be better off after complete withdrawal from Ativan. With medical supervision,it can be done gradually and in a safe manner so that the unpleasantness of withdrawal can be minimised
Hope this helps. You can contact again for any further advice/guidance as needed
Hi Doctor,

Some of my statements at the beginning here may be repeated in my answers to your questions below, because you had asked specific questions, but the bottom line is I always wake up with some anxiety, muscle tremors, some face numbness (usually nose), headache, jaw pain, neck pain and sometimes back pain as well. However, after I’ve taken my morning Ativan, most of the pain goes away and I can go about my day. Around 3pm the symptoms start returning and I know it’s time for my afternoon dose.

It’s crazy to wake up feeling like this. When you have a cut, for example, there seems to be an organized way to handle it. You stop the bleeding – you put on a band aid and first aid cream - and you will start to heal, and every day you can see the progress and the pain and wound itself lessens. However, what I experience happens daily and it sometimes feels like I need to go to the ER, but I take the Ativan and it’s once again for the most part under control.

Sometimes I run to specialists, but the answer is always the same – I am 100% healthy. You can see why this is so frustrating for me. Every day the same and the symptoms just “reset” the next day – like I am living the same say over and over again.

I mentioned I take two doses during the day – one in the morning and one in the afternoon. What if I stay up late and my afternoon dose wears off – like tonight when I am up late providing all these details to you? Well, for one, my nose feels numb now, even though I am not cold. My eyes feel dry and painful when I blink, but I’m used to it by now. There’s also a feeling of a lump in my throat and I feel like I need to move my head down from side to side (ear to shoulder) to “crack it” and get a feeling like I’m loosening it up – otherwise it feels too stiff.

All this has been going on for quite some time and I’ve just gone along with it, but this is no way to live. I used to have very bad anxiety and panic attacks, but I haven’t had one in a while. Now I feel like I just take the Ativan so I don’t have to deal with the withdrawal symptoms of not taking it.
Do you think if my doctor increases my Duloxetine dose I will have an easier time tapering from the Ativan?

Here’s answers to some of your questions:

- When you say it was unpleasant when you dropped Ativan from 0.75 mg to 0.5 mgs, what symptoms did you experience ?

My answer: I would have headaches, muscle termers, neck pain and just a feeling like I won’t be able to handle it if I don’t take the correct dose.

- Regarding your question about danger , stopping Ativan without planned withdrawal can be potentially dangerous because in addition to the psychological symptoms , some people can also experience symptoms like increased heart rate, high BP, headache, tremors, feeling of confusion, rarely seizures, etc. So it is advisable to have your doctor/psychiatrist to monitor your detox and support you accordingly.

My answer: I understand, and this is one of the reasons I am hesitant to withdrawal on my own. At times when I would try and taper the symptoms would get so bad they caused me to lose my job and even my health insurance at the most-recent time - so I wasn't able to see my psychiatrist anymore and now he stopped practicing. I've stuck with my regular dose since they and have a new job and am working on getting back health insurance so I can see a new psychiatrist. Meanwhile my regular doctor has been supplying my Ativan because he knows what I’ve been through and that ultimately, I am willing to go back to a psychiatrist once I can afford one again.

- Can I ask why you were prescribed Ativan 3 years ago ? Were you experiencing any anxiety, panic symptoms ? If so, the underlying condition needs to be managed appropriately.

My answer: My wife was taking Ativan 3 years ago for stress. One day when I was very stressed out, I used one of her pills and felt much better. Then I used to start getting panic attacks and anxiety where I couldn’t breath – so my doctor gave me some of my own “as needed” Since then however, I kept getting refills from my doctor because I guess I’m dependent on the Ativan because I’ve taken it so long and worry about withdrawal symptoms – does this sound correct to you?

The bottom line Doctor is that I would like your assistance in helping to guide me towards the correct treatment and plan of action. I’ve been stuck taking .75mg Ativan twice a day for a long time and I am having a hard time going lower. Yesterday I took .50mg in the afternoon instead of the usual .75mg, and I felt like my headache wouldn’t go away, like my jaw pain was too much to handle – so I took the remaining .25mg and felt “as usual” again.

Doctor – does all this sound like what typically happens to someone if they take Ativan on a regular basis for too long? Have you dealt with a case like mine before? I just want to feel like myself again and I’m willing to do whatever it takes to get there. I just want to make sure I am doing the right thing. It’s like when you get a shot with a needle – you’re told there will be a “pinch of pain” and it will soon go away. This is what I need to hear – I need to know the correct steps to get rid of taking the Ativan with the minimum withdrawal as possible – so I can go to work and continue to provide for my family.

I know I wrote A LOT and I appreciate if you read the whole thing. This whole situation has been scary at times, so I wanted to provide as much detail as possible so you can help guide me. I know I am healthy and there’s nothing “wrong” with me and I’m certainly not a “drug addict”. I’m simply one of many that started using Ativan to help take the “edge off” when life got tough, but ending up making it part of my daily routine and need help.

Thank you!

Dr. Suresh Kumar G D

Child Health Paediatrics Psychiatry
# Hello John
- I can understand the rationale behind your questions and the circumstances leading to your long term use of Ativan. You are not alone and I have come across people in similar situations like you eventually coming off Ativan successfully with monitoring and support.
- It looks like you are experiencing both physical and psychological dependence to Ativan which is contributing to withdrawal difficulties. You need not be unduly scared as these symptoms are common in people who have been on long term Ativan.
-Regarding your query about duloxetine, optimising the dose can help with managing any underlying anxiety and mood symptoms. But it is less likely to mitigate withdrawal symptoms on its own.
- Having psychological support like counselling/CBT helps. Also regular exercise will be benficial.
- You have mentioned in detail that prior attempt at tapering below 0.75 mgs twice daily caused signficant withdrawal symptoms which affected your normal functioning and you lost your job. In such a scenario, the safest option will be to stick to the current dose till you are able to see a new psychiatrist locally who can monitor your tapering , support you in managing the withdrawal symptoms and also treat any emergent mental health issues following withdrawal.
-You will need an individualised , safe and effective withdrawal plan which will involve examining and monitoring you in person.Discuss with your regular doctor whether he can guide you in accessing psychiatric input locally considering your circumstances.
You can contact us again if any further advice or clarification is needed
Thank you so much for all the helpful advice doctor - do you happen to know of any psychiatrist colleagues in the Los Angeles area you may be able to refer me to? I have a very low income...

Dr. Suresh Kumar G D

Child Health Paediatrics Psychiatry
# Hello John
- Sorry I do not have any professional contacts in the Los Angeles area.
- Best option will be to discuss with your general doctor who will have a better knowledge of the local mental health resources available that will be appropriate for you.
- You can also look at the following links which I found online when I searched for non-profit mental health support at LA . You can have a look and contact relevant agencies for guidance.
https://www.namiurbanla.org/resources
https://dmh.lacounty.gov/
https://www.guidestar.org/nonprofit-directory/health/addiction-substance-abuse/1.aspx
Hope this information is helpful.
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