How to taper off Lorazepam (Ativan) 0.5mg?

Lorazepam Tapering Protocol

A gradual taper is essential when discontinuing lorazepam 0.5mg to minimize withdrawal symptoms and ensure patient safety. The recommended approach is to reduce the dose by 25% every 1-2 weeks until complete discontinuation.

Risks of Abrupt Discontinuation

• Abrupt discontinuation of lorazepam can lead to serious withdrawal reactions including seizures and, rarely, death 1
• Benzodiazepine withdrawal carries greater risks than opioid withdrawal and should always be conducted gradually 2
• Withdrawal symptoms may include anxiety, blurred vision, depersonalization, depression, dizziness, fatigue, gastrointestinal issues, headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain, panic attacks, photophobia, restlessness, tachycardia, and tremor 1
• More severe withdrawal symptoms can include catatonia, convulsions, delirium tremens, hallucinations, mania, psychosis, and suicidality 1

Recommended Tapering Schedule for Lorazepam 0.5mg

• Begin with a 25% reduction of the daily dose every 1-2 weeks 3, 2

• For lorazepam 0.5mg daily, a sample tapering schedule would be:

  Weeks	Daily Dose
  1-2	0.375 mg
  3-4	0.25 mg
  5-6	0.125 mg
  7-8	0 mg
  3, 4

• If withdrawal symptoms become problematic, slow the taper by extending the time at each dose reduction 3

• For patients who have been on lorazepam for extended periods, an even slower taper may be necessary, potentially extending over several months 5

Monitoring During Tapering

• Assess for withdrawal symptoms at each follow-up visit 3
• Watch for both acute withdrawal symptoms (which occur immediately) and protracted withdrawal syndrome (which can persist for weeks to months) 1
• Monitor for signs of depression or suicidal ideation, which may emerge or worsen during benzodiazepine discontinuation 1
• Be alert for rebound anxiety, which may be mistaken for recurrence of the original anxiety disorder 5

Adjunctive Treatments to Support Tapering

• Consider cognitive-behavioral therapy (CBT) during the taper, which has been shown to increase success rates 2
• Non-pharmacological interventions such as relaxation techniques and physical activity may help manage anxiety during the taper 3
• For patients experiencing significant withdrawal symptoms, adjunctive medications may be considered:
  • Buspirone may help manage anxiety symptoms during the taper process 3, 6
  • Avoid starting other CNS depressants during the tapering period 2

Special Considerations

• If the patient is also taking opioids, prioritize benzodiazepine tapering due to the higher risks associated with benzodiazepine withdrawal 2
• For patients who have been on lorazepam for many years, tapering to doses lower than the standard minimum therapeutic dose before complete discontinuation may be beneficial 5
• Patients with a history of seizures or who have previously experienced severe withdrawal symptoms may require a more gradual taper and closer monitoring 1

Common Pitfalls to Avoid

• Avoid tapering too quickly, which increases the risk of withdrawal symptoms 3, 4
• Don't mistake withdrawal symptoms for recurrence of the original condition, which could lead to unnecessary resumption of medication 5
• Recognize that protracted withdrawal syndrome can last for weeks to more than 12 months after discontinuation 1
• Avoid concurrent use of other CNS depressants during the taper period, which can complicate withdrawal 2