Tapering off of Lorazepam and taking Effexor

[AmZ]

Hi everyone,

So, I went to my psychiatrist this morning.

As I have been taking the Lorazepam for over 2 months now on a daily basis, I said that I'd like to start to taper off of it. Hopefully this will work alongside taking the Effexor and the Effexor will take over enough so that I won't need the Lorazepam/Benzos in the future.

I asked about a tapering plan and he just said to come off of it within a 'week or two'. So I asked if he could be more specific. (I take 1mg at bedtime and 0.5mg in the morning and maybe 3 days out of the week, 0.5mg in the afternoon). He said that if I take 1mg at bedtime, then take 0.5mg at bedtime for a week and I can then stop completely. He said that the 0.5mg in the morning doesn't need to be tapered off, that I can just stop it tomorrow if I wanted and it would be OK.

Have I missed something here or is he right in suggesting this? It's different to what I have read.

So he's given me 20 Lorazepam of 1mg each and said that is enough in order to taper off now. Luckily I have 22 left over from before, so I have 42 total - Plenty to work with!

I am basically going to do more than he said to do, because there is no harm in it, (coming off it it slower).

I think I'll do 0.5mg at bedtime instead of 1mg for a week and then even 0.25mg for a further week and finish there with that.

With the 0.5mg in the morning, I guess do a week of 0.25mg and then finish it?

I asked for 0.5mg tablets so that I can easily break them in half and get 0.25mg, his response to that was "when you come off of it, you don't need to take anything less than 0.25mg, 0.5mg is a low enough amount to finish on".

Concerning the Effexor, I've been on 75mg for a month now and can't say it's raised my mood or helped really.. But difficult to tell, because 3 good days here, 1 bad day there etc and haven't been able to see enough over time if there are cycles of how I feel or whether it is the medication helping. He said that I should go to 150mg from today. I asked if maybe I could go to 112.5mg (1 1/2 tablets) for a week or two and see how I feel on that. He said that I can if I wanted. He said that if I had no side effects at all from the 75mg (which I didn't), then I will most likely need the 150mg, so recommends I just do that. Is that true? It would be a sign that if someone had no side effects on the 75mg then it shows they need a higher dosage?

So, got some decisions to make here.... Please, any advice would be superb.

Thanks in advance. :2thumbs:

---------- Post added at 06:04 PM ---------- Previous post was at 11:31 AM ----------

And meeting with the new (and long-awaited!) psychologist next Monday....

 

[Retired]

He said that if I had no side effects at all from the 75mg (which I didn't), then I will most likely need the 150mg,

My understanding of therapeutic success is when symptoms for which the treatment is prescribed are relieved, for a significant period of time. Symptom relief is usually the goal and the what determines success.

According to the manufacturer's literature supporting Effexor (venlafaxine) most people achieve symptomatic relief at the 75 mg per day dose, while others whose symptoms are not relieved, might be increased to 150 mg per day. 300 mg per day is usually reserved for the most resistant cases.

As I mentioned in another post, the literature indicates that adverse effects do not appear to increase in a linear fashion with this medication, so when the pshysican determines an increased dose is required for added symptom relief side effects are not expected to increase in proportion to the dose.

I am not familiar with using side effects as a measure of theraputic success or failure, so you would want to pursue that conversation with your doctor.

As for tapering your lorazepam, if you are taking it twice a day, then consider tapering over a ten day to two week period. Reduce the dose by half the first few days, then take one tablet a day for a few days, then one tablet every other day then one half a tablet the last few "every second day". By the time to get down to 0.5 mg every second day, you should be pretty well tapered off, but for your own satisfaction, keep a 0.5 mg tablet on hand just in case you might feel a little uneasy, after a two day withdrawl.

Bsed on my understanding of the kinetics of this medication, for the length of time you have been taking it, the above schedule should serve you well.

You may wish to verify the withdrawal schedule you plan to use with your doctor and/or pharmacist to be absolutely sure they concur.

As you know, I am not a medical professional, although I have received some training in these matters related to my professional career.

 

[David Baxter PhD]

According to the manufacturer's literature supporting Effexor (venlafaxine) most people achieve symptomatic relief at the 75 mg per day dose, while others whose symptoms are not relieved, might be increased to 150 mg per day. 300 mg per day is usually reserved for the most resistant cases.

Again, though, the best dose should be determined on an individual basis and I have seen individuals who required 300 mg who were not necessarily treatment resistant but rather simply did better on the higher dose. As Daniel previously noted, individuals with OCD symptoms do often require higher doses than those with General Anxiety Disorder.

Whether or not the patient is prescribed Effexor or Effexor-XR is probably also a factor.

 

[AmZ]

Thanks for the replies.

Symptom relief is usually the goal and the what determines success.

I think I need more time to see about this. I'll be honest, like I said in the first post about this, I'm not even too hot on knowing how I am actually feeling. I can generally see that the last 4-5 days have been a lot better, but I wouldn't be able to say if this was due to the Effexor or due to me just having a few good days which I've had before (a week in fact) and then I had a bad few days which were the worst days I ever had throughout this! If, like we were saying in the past, as Dr Baxter rightly said, I am in a cycle of anxiety etc... Then I need to wait to see another week or so how I am feeling, as it has appeared to come in cycles... like 3 good days, 1 bad, 2 good, 1 bad, etc... But this is the 'longest period' of not having a bad day as such. I still can't say though that my mood has lifted as such etc, it's just that I haven't had very bad days.

I did take 112.5mg today so will continue with this for the next week I guess and see what happens in-between now and then. If after another week, I am still feeling better, then I'll stick to the 112.5mg and again see how another week goes. The psychiatrist said to take 150mg, I said 112.5mg, he said OK and get on with it basically and see him in another months time!

As Daniel previously noted, individuals with OCD symptoms do often require higher doses than those with General Anxiety Disorder.

Taking that in to account, and from what I have read also, this is why I decided also to go to the 112.5mg at least, and then do like I said above and increase it by another half a tablet if needs be in another week or two.

As for tapering your lorazepam, if you are taking it twice a day, then consider tapering over a ten day to two week period. Reduce the dose by half the first few days, then take one tablet a day for a few days, then one tablet every other day then one half a tablet the last few "every second day". By the time to get down to 0.5 mg every second day, you should be pretty well tapered off, but for your own satisfaction, keep a 0.5 mg tablet on hand just in case you might feel a little uneasy, after a two day withdrawl.

OK, sorry, trying to get my head around this one!!! So, it goes a little something like this, according to what you think would be a good idea...
First 3/4 days: Instead of 1mg at night, 0.5mg and instead of 0.5mg in the morning, 0.25mg. Total: 0.75mg
Next few days: One tablet a day. (1mg) But then I am taking more than in the previous few days? How about 0.25mg at night and 0.25mg in the morning, so 0.5mg total?
Next few days: ??
EDIT: Something I actually need to take in to account here is that I don't really know if I can start to taper the morning dose right now from 0.5mg. I feel like I still need this dose. I do still wake up feeling anxious and once I take the Lorazepam it helps a lot, and I need it... I guess that is a sign that the Effexor isn't enough also!!

As you know, I am not a medical professional, although I have received some training in these matters related to my professional career.

Totally. And I really appreciate your advice. Don't worry, I am not taking this like a final answer here, I'm just discussing it and know that you know a bit about it. My psychiatrist doesn't seem to want to take the time to work it out like this, so thank you for the assistance in my thought process also!

Thanks guys.

 

[AmZ]

If I may just finish off on this quickly...?

Is it important to finish off the last few days having one day off the lowest dose and one day on? i.e. taking 0.25mg on Monday, nothing Tuesday, 0.25mg Wednesday, nothing Thursday.
Rather than to for example take 0.5mg 5 days in a row and then 0.25mg 5 days in a row and stop the next day and cut it off completely.

I hope that makes sense. Sorry, my brain isn't working so good today!

Thanks.

 

[David Baxter PhD]

The short answer is it really isn't that critical. The whole purpose of tapering is to allow your body time to adapt to lower doses before adapting to no dose, i.e., to prevent or minimize withdrazwal in the case of drugs like lorazepam.

Do what ever is comfortable and works for you. There are no hard and fast rules.

 

[AmZ]

Fine. Done deal. As long as I know that's the case.

In the meantime, I'm still taking the 0.5mg in the morning (need that!) and will go down to 0.5mg at night from 1mg for the next 5 days or so and then stop the night dose... (or another few days of 0.25mg to finish that off).

Does that work?

 

[David Baxter PhD]

Whatever works for you. If it were me, I'd keep the night dose and skip the day dose, since the effects of the night dose will carry over until the following day.

 

[AmZ]

Thx for the advice.

Not sure. Wake up feeling pretty shaky and anxious in the morning after taking the 1mg at 10pm or so the night before... So, at least it seems that 10 hours later or so, it's not only doing much for me in the morning, but if I'd skip the morning dose, then I'm pretty screwed by lunchtime and for the afternoon. Feel like the 0.5mg in the morning works very well after 30mins-1hour and I'm good to go. But also only take the Effexor in the morning at the same time, so maybe, I don't know, that is the thing that's helping me in the morning also...

I think for the time being, I will change the night to 0.5mg and stick to the morning 0.5mg and when I feel that the Effexor is working better, then come off the Lorazepam. I'm just fretting because I've been on the Benzos for 2 months, but really, I still need to take it at least 0.5mg in the morning... So will give it another week or so and see how I feel then. I'm taking 112.5mg of Effexor now also so will see how this goes in the next week also. If I have another one of those days like I had today, then it's up to 150mg for me, no messing around (!) and see how that goes.

Patience is a virtue

Thx again for talking it over with me.

---------- Post added at 11:36 PM ---------- Previous post was at 11:20 PM ----------

BTW, just wanted to say... I wasn't asking these questions and expecting someone to tell me to take that dosage at that time for those amount of days etc... I know I need to do what works for me, as of course, you all can't know how I am feeling and other details. Just wanted to make sure I had the basics here, as the psychiatrist didn't offer me any advice whatsoever. Like I was asking before about if it's OK to just take less and stop completely one day or to have a few days on and off of it at a lower dosage.

But all clear now, so I'm good to go...

Thanks.