10% Weekly Ativan Taper Schedule for 2mg Four Times Weekly
For a patient taking 2mg of Ativan (lorazepam) 4 times per week, a gradual 10% weekly reduction is recommended to minimize withdrawal symptoms and optimize patient outcomes.
Initial Assessment and Calculation
First, let's calculate the current weekly dose:
- Current dose: 2mg × 4 times/week = 8mg total weekly dose
10% Weekly Reduction Schedule
| Week | Weekly Dose | Individual Dose | Frequency |
|---|---|---|---|
| 1 (Current) | 8mg | 2mg | 4 times/week |
| 2 | 7.2mg | 1.8mg | 4 times/week |
| 3 | 6.5mg | ~1.6mg | 4 times/week |
| 4 | 5.9mg | ~1.5mg | 4 times/week |
| 5 | 5.3mg | ~1.3mg | 4 times/week |
| 6 | 4.8mg | 1.2mg | 4 times/week |
| 7 | 4.3mg | ~1.1mg | 4 times/week |
| 8 | 3.9mg | ~1.0mg | 4 times/week |
| 9 | 3.5mg | ~0.9mg | 4 times/week |
| 10 | 3.1mg | ~0.8mg | 4 times/week |
| 11 | 2.8mg | 0.7mg | 4 times/week |
| 12 | 2.5mg | ~0.6mg | 4 times/week |
| 13 | 2.3mg | ~0.6mg | 4 times/week |
| 14 | 2.1mg | ~0.5mg | 4 times/week |
| 15 | 1.9mg | ~0.5mg | 4 times/week |
| 16 | 1.7mg | ~0.4mg | 4 times/week |
| 17 | 1.5mg | ~0.4mg | 4 times/week |
| 18 | 1.4mg | ~0.3mg | 4 times/week |
| 19 | 1.2mg | 0.3mg | 4 times/week |
| 20 | 1.1mg | ~0.3mg | 4 times/week |
| 21 | 1.0mg | 0.25mg | 4 times/week |
| 22 | 0.9mg | ~0.2mg | 4 times/week |
| 23 | 0.8mg | 0.2mg | 4 times/week |
| 24 | 0.7mg | ~0.2mg | 4 times/week |
| 25 | 0.6mg | 0.15mg | 4 times/week |
| 26 | 0.5mg | ~0.1mg | 4 times/week |
| 27 | 0.5mg | ~0.1mg | 4 times/week |
| 28 | 0.4mg | 0.1mg | 4 times/week |
| 29 | 0.4mg | 0.1mg | 4 times/week |
| 30 | 0.3mg | ~0.1mg | 3 times/week |
| 31 | 0.3mg | 0.1mg | 3 times/week |
| 32 | 0.2mg | ~0.1mg | 2 times/week |
| 33 | 0.2mg | 0.1mg | 2 times/week |
| 34 | 0.1mg | 0.1mg | 1 time/week |
| 35 | Discontinue | - | - |
Practical Implementation Tips
Dose Preparation:
- For doses that aren't commercially available, use the liquid formulation of lorazepam which allows for precise dosing 1
- Mix with liquid or semi-solid food as directed in the FDA label
Monitoring for Withdrawal Symptoms:
Adjustments:
- If withdrawal symptoms are severe, slow the taper to 5% weekly reductions
- For doses below 1mg, consider slowing to 5% reductions to minimize withdrawal symptoms
Important Considerations
- This gradual taper is consistent with FDA recommendations to reduce the risk of withdrawal reactions 1
- The 10% weekly reduction is supported by guidelines for benzodiazepine tapering 3
- For practical purposes, some doses may need rounding to the nearest available formulation
- Slower tapers (5-10% reduction) are generally better tolerated than more rapid tapers 3
Potential Pitfalls and Cautions
- Avoid abrupt discontinuation which can lead to severe withdrawal symptoms including seizures
- Be aware that withdrawal symptoms may be delayed, especially with longer-acting benzodiazepines 3
- If the patient has been taking lorazepam for many years, an even slower taper (5% every 2-4 weeks) may be warranted
- Consider adjunctive treatments for managing withdrawal symptoms if needed
This tapering schedule provides a structured approach to safely discontinue lorazepam while minimizing withdrawal symptoms and optimizing patient outcomes.