From the Guidelines
Switching to clonazepam is not necessary to taper off Ativan (lorazepam) 0.75mg daily, though it is one potential approach. You can successfully taper directly from Ativan by gradually reducing your dose over time. A typical Ativan taper might involve reducing your dose by 0.125-0.25mg every 1-2 weeks, depending on your tolerance and withdrawal symptoms, as suggested by a commonly used tapering schedule that reduces the benzodiazepine dose by 25% every 1–2 weeks 1. For example, you might reduce from 0.75mg to 0.5mg daily for two weeks, then to 0.375mg for two weeks, and so on until you reach zero. The advantage of tapering with the same medication is simplicity and avoiding the introduction of a new drug. Some clinicians do prefer switching to longer-acting benzodiazepines like clonazepam (Klonopin) for tapering because their longer half-life provides more stable blood levels, potentially resulting in smoother withdrawal with fewer breakthrough symptoms. However, this approach adds complexity by requiring conversion between medications.
Regardless of which method you choose, any benzodiazepine taper should be done under medical supervision to monitor for withdrawal symptoms and adjust the schedule as needed. It's also important to consider evidence-based psychotherapies, such as cognitive behavioral therapy (CBT), which can increase tapering success rates and be particularly helpful for patients struggling with a benzodiazepine taper 1. The key to a successful taper is gradual reduction and close monitoring, rather than the specific medication used.
Some key points to consider when tapering off Ativan include:
- Gradually reducing the dose over time to minimize withdrawal symptoms
- Monitoring for withdrawal symptoms and adjusting the schedule as needed
- Considering evidence-based psychotherapies, such as CBT, to support the tapering process
- Avoiding concurrent use of other central nervous system depressants, such as opioids, whenever possible 1
- Communicating with mental health professionals to discuss the patient's needs, prioritize patient goals, and coordinate care 1.
From the Research
Tapering Off Ativan (Lorazepam)
To determine if it's necessary to switch to clonazepam to taper off Ativan (lorazepam) 0.75mg daily, let's examine the available evidence:
- The study 2 compared different methods for lorazepam withdrawal and found that progressive withdrawal was preferable to abrupt withdrawal, with fewer dropouts and better patient satisfaction.
- Another study 3 investigated the use of cognitive behavioral therapy to assist with slow-taper alprazolam discontinuation in panic disorder, and found that cognitive behavioral treatment was effective in preventing relapse after drug discontinuation.
- However, none of the studies directly address the necessity of switching to clonazepam to taper off Ativan (lorazepam) 0.75mg daily.
Clonazepam Tapering
The study 4 developed a protocol for safely tapering off clonazepam in patients with panic disorder, and found that clonazepam can be successfully discontinued without major withdrawal symptoms if the dose is reduced gradually.
- The recommended tapering schedule was a decrease of 0.5 mg per 2-week period until 1 mg per day was reached, followed by a decrease of 0.25 mg per week.
- Another study 5 found that a slow-taper discontinuation regime of clonazepam was associated with low rates of withdrawal symptoms and relapse.
Lorazepam Withdrawal
The study 2 found that lorazepam withdrawal was feasible even after long-term treatment, and that progressive withdrawal was preferable to abrupt withdrawal.
- The study 6 compared lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal, and found that lorazepam was as effective as chlordiazepoxide in reducing symptoms of alcohol withdrawal.
Conclusion Not Provided
Based on the available evidence, it appears that tapering off Ativan (lorazepam) 0.75mg daily may be possible without switching to clonazepam, but the optimal tapering schedule and strategy are not clearly established.