Saffron Dosing for Anxiety
For anxiety treatment, saffron should be dosed at 50 mg twice daily (total 100 mg/day), which can be safely combined with your current regimen of lorazepam, nortriptyline, and propranolol. 1
Evidence-Based Dosing
The standard therapeutic dose is 50 mg of saffron extract (Crocus sativus L. stigma) taken twice daily, based on a 12-week randomized controlled trial that demonstrated significant reductions in both anxiety and depression scores compared to placebo 1
This dosing regimen showed statistically significant improvements on Beck Anxiety Inventory (BAI) scores at 12 weeks (p<0.001), with rare side effects reported 1
Safety with Your Current Medications
Lorazepam Interaction Considerations
Your lorazepam 0.5 mg daily can continue alongside saffron, as there are no documented pharmacokinetic interactions between saffron and benzodiazepines 1
However, be aware that lorazepam carries risks of tolerance, addiction, depression, and cognitive impairment with regular use, and paradoxical agitation occurs in approximately 10% of patients 2
Infrequent, low doses of short half-life benzodiazepines like lorazepam are least problematic when used as needed rather than daily 2
Propranolol Interaction Profile
Propranolol 10 mg twice daily is appropriate for somatic anxiety symptoms (physical manifestations like tremor, palpitations) but less effective for psychic anxiety (worry, rumination) 3
Propranolol has minimal interaction with lorazepam—it does not significantly affect lorazepam's half-life (13.2 vs 12.7 hours) or clearance 4
Be cautious of propranolol's mood effects: it can increase tension, depression, fatigue, and confusion, particularly at higher doses 5
Nortriptyline Considerations
Your nortriptyline 50 mg twice daily (100 mg total) exceeds the typical maximum of 40 mg/day recommended in geriatric guidelines 2
Nortriptyline is sedating and useful for agitated depression with insomnia, with a therapeutic blood level window of 50-150 ng/mL 2
No direct interactions between saffron and tricyclic antidepressants have been documented 1
Implementation Strategy
Start saffron at 50 mg twice daily immediately—no titration is needed based on the clinical trial protocol 1
Expect therapeutic effects within 12 weeks, with potential earlier benefits at 6 weeks 1
Monitor for the rare possibility of increased sedation when combining saffron with your existing CNS-active medications (lorazepam, nortriptyline), though this was not reported in trials 1
Critical Medication Review Needed
Consider tapering lorazepam to as-needed use only rather than daily dosing to minimize cognitive impairment and dependence risk 2
Verify your nortriptyline dosing with your prescriber, as 100 mg/day total exceeds standard recommendations and may increase anticholinergic burden 2
Evaluate whether propranolol is addressing somatic vs psychic anxiety symptoms, as it may be contributing to mood disturbance rather than helping 3, 5