What is the recommended tapering schedule for Ativan (lorazepam) 8mg, taken 2mg, 4 nights per week?

From the Guidelines

I strongly recommend consulting with a healthcare provider before attempting to wean off Ativan (lorazepam), especially at a dose of 8mg, as benzodiazepine withdrawal can be dangerous and potentially life-threatening if not properly managed.

Tapering Schedule

A typical tapering schedule might involve reducing your dose by about 10% every 1-2 weeks, but this must be individualized 1. For your specific situation of 2mg taken 4 nights per week, your doctor might suggest first establishing a consistent daily dose, then gradually reducing by 0.5mg every 1-2 weeks depending on how you tolerate the reduction. The entire process could take several months to complete safely.

Risks of Tapering

Tapering too quickly can lead to withdrawal symptoms including anxiety, insomnia, tremors, and in severe cases, seizures 1.

Additional Support

During the tapering process, you may benefit from additional support such as cognitive behavioral therapy for insomnia and anxiety management techniques 1. Some people also find it helpful to switch to a longer-acting benzodiazepine like diazepam for the tapering process, as it provides more stable blood levels and smoother withdrawal.

Key Considerations

• Tapering should be done under the guidance of a healthcare provider
• The tapering schedule should be individualized based on the patient's needs and tolerance
• Additional support, such as cognitive behavioral therapy, may be beneficial during the tapering process
• Switching to a longer-acting benzodiazepine like diazepam may be helpful for some patients 1.

From the FDA Drug Label

To reduce the risk of withdrawal reactions, use a gradual taper to discontinue lorazepam or reduce the dosage If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. Subsequently decrease the dosage more slowly

The patient is taking 8mg of Ativan (lorazepam) per week, divided into 2mg doses, 4 nights per week. To wean this patient, a gradual taper should be used to reduce the risk of withdrawal reactions.

• The taper should be patient-specific and gradual.
• If the patient develops withdrawal reactions, the taper should be paused or the dosage should be increased to the previous level, and then decreased more slowly.
• The evening dose should be increased before the daytime doses when a higher dosage is indicated.
• It is recommended to start by reducing the dose by a small amount (e.g., 0.5mg or 1mg) and monitor the patient's response before making further reductions.
• The patient should be closely monitored for signs and symptoms of withdrawal reactions, such as seizures, and respiratory depression. 2 2

From the Research

Weening Off Ativan

To ween off Ativan 8mg, taken 2mg 4 nights per week, it is essential to consider the following steps:

• Gradually reduce the dosage to minimize withdrawal symptoms
• Consider alternative treatments for insomnia, such as Cognitive Behavioral Therapy for Insomnia (CBT-i) 3, 4, 5, 6
• CBT-i has been shown to be an effective treatment for chronic insomnia, with clinically meaningful effect sizes 6

Alternative Treatments

Alternative treatments for insomnia include:

• Cognitive Behavioral Therapy (CBT) 4, 7
• Acceptance and Commitment Therapy (ACT) 4
• Sleep hygiene practices 3, 5
• Relaxation techniques 3, 5

Considerations

When weening off Ativan, consider the following:

• The risk of addiction and withdrawal symptoms associated with long-term benzodiazepine use 4
• The importance of addressing underlying sleep disorders and anxiety disorders 4, 7
• The potential benefits of CBT-i in improving sleep quality and reducing symptoms of insomnia and anxiety 3, 5, 6