Ativan tolerance?

[Peanut]

I have a question about ativan. I have a rx for daily use but I was wondering about how to use it without it becoming less effective. Specifically, I have something coming up that I want to use it for, but during the days leading up to event I am becoming increasingly nervous about it. So, I am wondering if it would be most effective to take it on the days leading up to the event and also during the event, or if that would decrease the effectiveness of the medication during the event and/or require me to increase the dosage during the event. This is a weekly occurrence so this will be an ongoing concern. Generally, how long does it take tolerance to build? Also, I was wondering if the best time to take it is an hour prior to the event?

Any input is greatly appreciated! Thanks!

 

[ThatLady]

A couple of questions, Arose:

Is Ativan a new medication for you, or have you been taking it for awhile?

If you've been taking it, what dose are you taking and how do you react to it? Does it make you sleepy or interfere with concentration?

Answers to those questions will help us to help you.

 

[Peanut]

Is Ativan a new medication for you, or have you been taking it for awhile?

I have had it for awhile.

If you've been taking it, what dose are you taking and how do you react to it?

1mg, depending on the situation, if it is a high stress situation then sometimes it doesn't seem like it is enough, if it is a low stress situation then I get tired. After several hours I start to feel fatigued (usually after the high stress situation is over).

Does it make you sleepy or interfere with concentration

Only after the high stress situation is over

Thanks for asking. I know it is a delicate balance and that is why I am concerned about getting it just right for this situation.
Thanks!

 

[Retired]

Arose,

What is the daily dosage of Ativan (lorazepam) that was prescribed for you?

Ativan is a short acting minor tranquilizer in the benzodiazepine class of medications.

Other meds in this class include Serax Librium, Valium and Xanaz to mention a few.

There is a great deal of difference among the various benzodiazepines in the way they are absorbed, distributed and metabolized in the body.

The study of the way medications react in the body is called pharmacokinetics, and much has been written about the pharmacokinetics of benzodiazepines.

Ativan has a short half life of 8 hours, which is moderately short when compared to compounds such as Valium and Librium which have half lifes of four to five days.

The significance of the half life is that if you take one tablet at bedtime or preferably a couple of hours before bedtime, Ativan will help you fall asleep and will be out of your body by the time you wake up the next morning.

That's if you use the medication on an "as required" basis.

However if you plan to take your Ativan as the doctor prescribed, that is once a day, then the medication will reach steady state in about three days, that is to say in three days if you continue taking one tablet a day, the blood levels will be constant.

Rapid steady state is a two edged sword, which means if steady state occurs quickly, it will diminish quickly when the medication is stopped.

Ordinarily this is not a problem if, when you are ready to stop the Ativan you do it in conjunction with your doctor's instructions, where you will taper the dose gradually over a week or two rather than stop abruptly.

Stopping abruptly can cause some unpleasant withdrawl type side effects in some people, depending on the dose and the length of time they were taking Ativan.

The other aspect of Ativan is that there are no active metabolites, which interfere with dosing changes, or interact with many other medications.

This is a more technical aspect of what is a positive characteristic of Ativan, but suffice to say there is less chance of unwanted drug interactions with Ativan than with some other benzodiazepines.

To my knowledge of the literature, and I stand to be corrected because my reviews of the literature on benzodiazepines is a bit dated, I am not aware of studies showing significant tolerance to Ativan.

I believe there may be some, but the amount would be marginal, as one becomes acclimated to the effect of the Ativan.

Taken in the usual prescribed does over a moderate period of time does not generally produce unwanted adverse effects based on the work I did which involved a detailed understanding of this medication.

Speak to your doctor about what type of dosing schedule would work best for you.

If you feel you need relief because of a recurring weekly event, ask you doctor if your dosing schedule could be changed to a PRN (as needed) schedule.

If the event in question occurs, let's say in the afternoon,every Wednesday, then your doctor could prescribe one tablet 2 hours before bedtime on Tuesday and another tablet at 10 am on Wednesday morning.

This schedule would get you through the night with good quality sleep, and the second dose would carry you through the event.

Using this dosing schedule and if you are not taking this or any other psychotropic medication, I would hesitate to take a third dose and let the two doses carry you through.

I would also counsel you to avoid alcohol as Ativan or any other benzodiazepine potentiates or increases the potency of alcohol which may certainly work against you, especially if you are working to make a good impression. Ativan plus one drink can react like you had two or more drinks

Ativan enters the bloodstream about 45 minutes after swallowing and crosses the blood brain barrier in about an hour to an hour and a half. It's peak effectiveness is between the second and third hour but taken as I proposed, should carry you through an eight hour period.

You might also want to know that Ativan can be taken under the tongue instead of drinking with water. If held under the tongue and not swallowing for two minutes, the absorption into the bloodstream will be a little quicker, so if you forget to take your 10 am dose, you can take it sublingually.

Please bear in mind I am not a physician, and the only one who can advise you on how to take Ativan or any other medication is your own physician.:doctor:

I offer you this information based on some knowledge I have about this compound, but your doctor is the only one who can change your prescription :rxr the dosing schedule you have been given.

Please keep us posted on how you make out

 

[Peanut]

Thank you so so so much. That is extremely helpful. That is exactly what I was wondering, it sounds like I was actually not doing the right thing by not taking one every day as the rx indicated because I do want the steady amount in my bloodstream.

So, just to reiterate, even if I take one at night and it only has a half life of 8 hours, taking it everyday will override that and I will still have the anti-anxiety effects during the day?

***The other point, I wanted to clarify with your example about the event time, do you rec. taking it more than 1 hour ahead of time for optimal effectiveness?*** This would be nice because I do get really nervous prior to the one hour beforehand. The actual event lasts for 1.5 hours but the beginning is the hardest part.

Thank you Steve! I will never, and I mean, never never forget this. This event is soooo important. It very well might be the scariest thing I've ever done! I seriously can't thank you enough. You are so cool!

 

[Retired]

You are most welcome, but I would strongly advise checking back with your doctor who prescribed Ativan to discuss any modifications in the dosing schedule.

even if I take one at night and it only has a half life of 8 hours, taking it everyday will override that and I will still have the anti-anxiety effects during the day?

I neglected to elaborate on how daily continuous schedules generally work.

Because the biologic half life of this med is 8 hours, it's usually prescribed to be taken twice or even three times a day depending on the persons condition and their response to the medication.

I wanted to clarify with your example about the event time, do you rec. taking it more than 1 hour ahead of time for optimal effectiveness?***

Based on my understanding of the kinetics of Ativan, peak effectiveness is achieved between the second and third hour after initial ingestion.

So, again, based on my understanding, you would take your pre-event dose about two and a half hours before the beginning of the event.

If you and your doctor agree to this type of dosing schedule, I would suggest taking it through a dry run before the actual event.

If you have never taken this type of medication before, the first time you do, you may feel a bit drowsy.

In that case you may wish to report back to your doctor and ask if it would be appropriate to reduce the dose.

1 and 2 mg tablets are scored so they can be broken in half. If your doctor prescribed sublingual tablets, they cannot be broken as they are not scored.

As I said earlier, oral tablets can be taken sublingually, though there may be a little powder left under the tongue due to the tablet binding material.

 

[ThatLady]

Oral Ativan reaches peak serum levels in about 30 to 45 minutes (can be up to two hours), so if you want to take it to reduce anxiety for a specific event, that would be when to take it for that purpose. To achieve a steady blood level takes about three days if liver function is normal.

If I were you, I'd talk to my prescribing physician about the event in question and ask him/her what their recommendation would be as to dosage prior to the event.

 

[Peanut]

Thank you both soooo much! I will never be able to thank you enough for the help. It is so hard to figure these things out. I think I have a game plan now of taking it a little bit earlier than I had originally planned on, perhaps 1.5 hours beforehand + one the night before, which I think will help me b/c it will help the nerves ahead of time, and usually once you get up there and going it's not as bad anyway as the anticipation. I will consider asking my doctor but I really appreciate your guys' help since the "event" is coming up this week (eek!!). Usually I don't have time to go to the doctor so I have to make the most of my own medical knowledge (I know that is scary!).

Thanks again, as I am about to embark on the scariest thing I've ever done in my whole entire life and I will never, ever forget this you guys, thank you a million times over again!!

 

[David Baxter PhD]

One more point: Ativan is produced in a faster acting sublingual version as well as the standard tablet. Which one you have will determine absorption time as well as peak blood concentration time so you may need to factor that into your decisions.

 

[Peanut]

Ok, so noted. I am taking the non-disolving, non-sublingual kind. Therefore, I am thinking that taking one the night before and then one 1.5 hours prior to the 90 minute function would be the best route. If somebody thinks something else would be more ideal please say so! If not...wish me luck!! I know I can do it--the first time is always the hardest!

Thanks guys!!

 

[Retired]

Arose,

Do keep us posted on how it goes with your presentation. You know, if this is a recurring event, you may find that once you get over the initial stage fright, you may want to go through the event with no medicinal support.

Many performers have a routine they do before a stressful performance that includes seclusion for aan hour or two before the event, breathing exercises and verbalizing the presentation to yourself while in seclusion.

Will be looking forward to hearing about your experience.

Break a keg!

 

[AidanMC]

I think it's worth mentioning here that Ativan is extremely addictive if taken over a long period of time (more than a few weeks). 1mg Ativan is equivalent to 30mg Diazepam. It is potentially very risky to PRN on any benzodiazepine for a long period of time.

The withdrawal from benzodiazepines is one of the scariest there is. I'm not trying to frighten anybody, but those are the facts.

 

[David Baxter PhD]

I'm not sure where you're getting your information, Aidan, but it doesn't correspond with my experience.

 

[AidanMC]

Benzodiazepines are probably one of the worst meds to withdraw from, and tapering dosage can take a year or more. In some cases withdrawal effects such as panic, paranoia, tinnitus can continue for a long period of time following full withdrawal. There's a wealth of evidence on here

http://www.benzo.org.uk/manual/index.htm

This site also has a forum, comprised of people either trying to come off Benzodiazepines or who have been successful in getting clean. Their experiences are frightening. The site is based in the UK. A lot of it's members are American, too.

Aidan

 

[David Baxter PhD]

I don't doubt that the site has a lot of horror stories - you can find similar sites regarding any medication, all with anectdotal personal stories ad nauseum about how terrible {insert medication du jour here} is.

What's missing from that pseudo-evidence are the stories of the millions of people who have been successfully treated for anxiety disordern using these medications and who have little or no trouble tapering off the medications when the time comes to do so. What's missing is also the reality that, used correctly, benzodiazepenes are still the most effective treament for many anxiety disorders.

As for your claim about the potency of Ativan, I think you've been misled. 1 mg of Ativan (lorazepam) is a mild dose.

 

[sister-ray]

I've used Valium for quite a while now. Its the only drug that helps when my aniexty gets bad. i dont take it all the time Infact go months without it, then take it for a week or two just to help, its the only drug that doesnt give me side effects. I use it wisely and according to my GPs instructions and I dont have any problems with it. You can get withdrawal symptoms from giving up most things like Coffee or nicotine. I think for me coming of nicotine was more scary then any tablet Ive ever come off.

 

[Daniel E.]

The withdrawal from benzodiazepines is one of the scariest there is. I'm not trying to frighten anybody, but those are the facts.

Compared to antipsychotic drugs like liver-unfriendly Depakote, Ativan is almost a placebo regarding side effects and withdrawal. My sibling and I were both on Ativan/lorazepam and we didn't have any withdrawal effects. I didn't drive as well when I started taking Ativan but that was expected.

But your post is a good reminder that one should taper down when discontinuing any benzo.

 

[Retired]

Based on published comparison charts, 1 mg of lorazepam is equivialnt in effect to 5 mg diazepam. The difference pharmacologically is that diazepam also delivers active metabolites with half lifes that can range from 36 to 54 hours.

The result is that with multiple doses of diazepam, there is the potential for unexpected side effects such as excessive drowsiness and others. It's difficult to titrate diazepam until steady state has been attained which can take a couple of weeks.

Lorazepam on the other hand, has no active metabolites and has a relatively short half life, resulting in a steady state in three days.

The down side of a rapid steady state medication is the potential for withdrawl symptoms on discontinuation of medication, which is why patients are advised to follow their doctor or pharmacist's advice on tapering.

Whether benzodiazepines are addictive in the sense of altering body chemistry in the way classic addictive medications do I don't believe has been established, but I stand to be corrected as I have not followed the literature in recent years.

However it is understood that benzodiazepines can result in habituation in some people, and the potential for habituation increases proportionately with dose and duration of use.

 

[AidanMC]

I too, hold the view that Benzodiazepines, when needed, are excellent for the treatment of anxiety related ilness. But only when used over a short period of time.

Long term use most definitely creates dependence and subsequent withdrawal symptoms. The severity of the withdrawal is directly related to dosage and length of time using.

Even the PI sheets with these meds warn that they should only be prescribed short term. I just feel it's important for people to know that.

Aidan

 

[Peanut]

I agree with the person who said that when compared to other medications, the side effects of Ativan really are mild. I also agree with the statement that they are one of the most effective treatments for anxiety.

Furthermore--I WOULD LIKE TO SHARE THE NEWS THAT I DID IT!!!!!!! I ran the group for 1.5 hours for the first time today and only lost control of it once or twice!!!!!!!!! Plus it was a pretty big group!!! It wasn't perfect, but I wasn't a nervous wreck either. I came right out and told people that I had a fear of public speaking but a real love for group therapy and support groups and that I was overcoming a fear to follow a dream! One person sneered at me (partly due to hostility for other reasons), but overall it was totally awesome!! Above all, I did what I thought was the scariest thing in the entire world Wow!

And you are right TSOW, one day I hope I won't need any medication at all, and I firmly believe that that will someday be the case. But WOW I am WIPED out now!!!

Thank you all so much for the great advice...I ended up taking it about 1 hour 45 minutes prior and it was just about exactly right!!!!