Is the Ativan working?

[Alien Navel Cord]

I recently got my prescription changed from clonazepam 1mg to Lorazepam .5 mg and was told by the pharmacist (and per pdoc instructions) to take 1, then 15 minutes later if I need to, take another one. I've done this, and also I have taken 2 at the same time... and... nothing. No obvious relief, no effects, no sleepiness or calming effect, nothing.

Should I call my pdoc and see if he can authorize me to take 2mg since 1mg doesn't do anything for me? Should I, in your opinion, be taking them on an empty stomach, or a full stomach, or anything like that? I need them to work, real bad, not sure why they aren't doing anything for me. Sigh.

[Wooster]

For more immediate relief, sometimes people will dissolve them under the tongue ("sublingual"). This is the fastest way to absorb the ativan short of getting a shot of it, I believe.

Always a good idea to consult with your health care provider if your medication isn't working as intended.

[Alien Navel Cord]

At my next appointment soon I will mention it and see if a higher dose can be given. Yesterday, desperate for relief I took 2mg and that worked really well.

[chimpmaster]

Some people just need a bigger benzo dose than others. This can also be related to a particular time in your life - perhaps when the anxiety and /or panic is worse, or just related to your brain chemistry and/or metabolism.

A few years ago I was prescribed 40mg/diazepam(valium) per day. Now I am only on 10mg prn. Usually its enough, but sometimes I find myself needing 15mg.

Its not unusual for someone to be on 2mg of lorazepam (atvian). Keep in mind that the drowsiness will likely go away pretty quickly if you use the med daily/regualrly. The therapeutic effect (for anxiety/panic) should keep working.

[colin]

"I recently got my prescription changed from clonazepam 1mg to Lorazepam .5 mg"

Well my response would be-why the lower dose-1 mg clonazepam is equivalent to 2 mg lorazepam AFAIK-thus your Lorazepam should be about 2 mg.

[crtclms]

Colin, you cannot make that kind of comparison, they are two different meds, even though they are in the same family. They work differently.

Plus, many of those equivalency charts are designed to assist with titrating off of benzos, not to demonstrate which benzos work better for anxiety.

[crtclms]

Also, once again, I am going to have to ask you to please refrain from playing doctor. You don't determine dosages. That is what pdocs are for.

[colin]

http://www.benzo.org.uk/bzequiv.htm benzo equivalence chart shows clonazepam twice as potent as lorazepam

I think it is perfectly appropriate to question a doctor-that is all i was doing. Patient rights-yes we do have that right if your living in America. Perhaps it didn't come across that way and for that I apologize. so in the future i will be certain to clarify what I thought was pretty obvious.

BTW I have taken both drugs many times. Clon for long term and Loraz for PRN. And they are definitely not equivalent-clon being stronger mg. to mg. than Loraz in my body-no question about that so if its true for me and many others i have read here and on crazy meds than it may be true for the OP, but again bottom line is always discuss these things with your doctor of course.

[Alien Navel Cord]

I actually forgot to bring it up the last time I saw the pdoc. I've been taking 3 sometimes 4 .5 mg at a time instead of 2, and that seems to work better. Next time I see the pdoc I will bring it up and see if he can prescribe me a higher dose so that I can feel adequate relief. I am not sure why he only prescribed me .5 if I was taking 1mg clon previously. I had asked him about xanax when switching off the clons, but he said xanax is too addicting and I'd be better off on a daily basis taking the ativan.

[crtclms]

Colin, "AFAIK" does not mean "I was just asking the doctor a question." Again, you cannot equate medications that are used for different purposes, just because they are in the same class. Klonopin is not of any use, no matter how strong *you* feel it is, if it is being used to stop a seizure or a panic attack, because it is too long acting to be of help.

Also, you can post as many different equivalency charts as you would like, comparing meds used for different reasons is useless.

Oh, and newsflash: You are not the only person posting in this thread who has tried multiple benzos.

2Spirals, is it possible that the reason you are on .5-1 mg is that you are using it for a slightly different purpose than the klonopin? Usually with ativan, you are not trying to maintain a blood level, but instead are trying to nip something in the bud.

My husband takes 2mg of ativan to try to prevent tonic-clonic seizures, and we found out that is also the exact amount the paramedics give him if he has a seizure and is picked up by them. When I tell the doctors in the ER that he might be on 4mg, because he often has time to pop one of his own, they are usually astonished that he is on so much ativan. Even his neurosurgeon considers 2mg of ativan at once a wallop.

It could be you need that much, but it isn't a little.

Anyway, even if you forgot at your appointment, if you feel that your symptom is not being covered by the amount of benzo you are currently taking, it is worth calling your pdoc.

Also, I know this is entirely up to your pdoc, but just because you *can* become addicted to something doesn't mean you *will* become addicted. I have been using Xanax for 7 years with no rise in dose (i.e., no addiction). I also drink alcohol, and have not become an alcoholic. Sorry, this is just a HUGE pet peeve.

[Alien Navel Cord]

2Spirals, is it possible that the reason you are on .5-1 mg is that you are using it for a slightly different purpose than the klonopin? Usually with ativan, you are not trying to maintain a blood level, but instead are trying to nip something in the bud.

The first pdoc who prescribed me the klonopin originally intended it to be used to help me sleep when I was first diagnosed as bipolar. Over the past few years it was prescribed by different doctors as prn for anxiety. But I found it was not particularly helpful with panic attacks and extreme anxiety attacks because it took a while to 'kick in'. So this new pdoc I have prescribed the Ativan, for a more quick-acting benzo to control attacks and also they are supposed to be used on a daily basis to control my general anxiety.

[crtclms]

Oh, I already asked you someplace else if you were using the ativan for "daily maintenance." I am on Xanax, which isn't supposed to be as good as Klonopin for daily control of symptoms, but I had a bad side effect with Klonopin. But ativan has an even shorter half-life, which is what I said elsewhere.

Of course, you can build up a blood level of almost anything if you take it twice a day.

It seems like I have heard a couple of people saying they are using klonopin for sleep in the last week or so. I didn't realize it was generally used for that.

[chasetinsley]

In response, nobody is a doctor, and it seems as if some of the posters barking at others for this are doing the same thing the "offender" was doing.

You do need to talk to you doctor. My advice would be to switch back to the Klonopin, though I believe it is too addicting as well. Tranxene has a rapid onset of action, while having lower abuse and tolerance potential. If you'd like, ask your doctor about Tranxene, though it can be hard, since it is an older benzodiazepine and rarely prescribed these days, so some doctors are reluctant. 7.5/mg 2x a day could, emphasis on could, be a good option for you.

[crtclms]

Your advice is inappropriate. You cannot give medical advice, it is illegal for people on this forum to do so.

If you would like to discuss *your* experiences with different meds, feel free. But stop pretending that all benzos are equivalent, and stop telling people how much of a particular med they should take; you can't prescribe meds.

[so_very_lifelike]

"I recently got my prescription changed from clonazepam 1mg to Lorazepam .5 mg"

Well my response would be-why the lower dose-1 mg clonazepam is equivalent to 2 mg lorazepam AFAIK-thus your Lorazepam should be about 2 mg.

And you are correct.The half-life of Ativan is unfortunate...bad enough that we're all on these meds that no-one (insurance, medicare, medicaid, etc.) wants to cover. Some get the prescription, but cannot possibly afford it. Benzodiazepines are tossed at us like candy, then the Doctors that prescribe want nothing more to do with them. These "drugs" need to be re-classified. If the 2 mg~s work for you, that's a good thing. Everyone is different and, if we've suffered for decades, we know our bodies and what works best.

[sonicwhite]

I would recommend maybe trying a different benzo other then klonopin or Ativan but it maybe all in your head. Because if you have to ask the pharmist is this going to work your already setting yourself up for failure. Thats the mistake I made with klonopin and xanax. I siked myself to where they didn't even work. Now I just deal with my OCD with ERP>

[december_brigette]

I would recommend maybe trying a different benzo other then klonopin or Ativan but it maybe all in your head. Because if you have to ask the pharmist is this going to work your already setting yourself up for failure. Thats the mistake I made with klonopin and xanax. I siked myself to where they didn't even work. Now I just deal with my OCD with ERP>

Its all in our heads. If asking the pharmacist a question about a med = doom to fail? Well, its just a little sad. Sometimes my pharmacy makes me talk to the pharmacist. Failure.

Db

[minouette]

I used to take 1mg Klonopin to sleep. My new pdoc switched me to .5mg Lorazepam to take only as needed for anxiety and only prescribes 15 pills at a time since he says it's highly addictive. I've noticed that the Lorazepam has an almost immediate calming effect on me at .5mg but that may be because I've been off Klonopin for some time now.

[Alien Navel Cord]

At my last appt with the pdoc I asked him about prescribing 2mg to me in a quantity of 30 instead of .5 in the quantity of 60, because .5 and even 1mg didn't do anything to help me. Instead, he prescribed me 1mg pills in the quantity of 60 so that I can take 1 or 2 depending on the severity. Now that I have this dose that is more helpful to me, I feel it is working and alleviating the anxiety appropriately. Yay!

[crtclms]

Great news!

[Trent Locke]

First, 2spirals... w00t! Glad that combo("1mg pills in the quantity of 60 so that I can take 1 or 2 depending on the severity" twice daily for me though) is working for you. I have general anxiety disorder, insomnia, and panic disorder. My doctor had me on the same combo for a few months and it worked well enough for quick relief of panic attacks when used sublingually until I started developing a tolerance, which is easy to do with ativan taken on a regular daily basis. I still have left over ativan I can take if I have a horrible panic attack and really need it, but now I'm on Klonopin twice daily... which is more preventitive.

***DISCLAIMER*** I am not a medical doctor(MD), nor am I a PsyD(which is a Psychologist who is allowed to prescribe medication in several states) nor am I a doctor of osteopathic medicine(DO), nor can I write prescriptions. However I do work within the medical field(not in mental health) and have a degree in mental health, and am in school to further supplement my abilities as a medical professional, thus I tend to know what I'm talking about as far as biochemistry, pharmacology, psychology, and chemistry in general goes. So, speaking as someone with knowledge of biochemistry, pharmacology, psychology, and chemistry and not as a medical professional, I will give you all some facts. This is not advice, but information instead. As I am not treating you it would be illegal for me to give you medical advice, but any intelligent individual should be able to gather their own conclusions from a few simple facts. ***END OF DISCLAIMER***

Facts:

• First and foremost.. Everyone's biochemistry is different and thus everyone reacts differently to different substances. Though their *is* an average on people's reactions to substances, which is generally followed; otherwise doctors would never know what to prescribe for what.
  
• Ativan is also known as Lorazepam
  
• Ativan is usually prescribed(when it comes to anxiety disorders) for panic disorder, on an as needed (PRN) basis for fast relief of an anxiety attack, as it works fairly quickly(especially sublingually) and has a short half life(meaning it stops affecting you withing 4 to 6 hours and leaves your body more quickly.
  
• Ativan is also sometimes prescribed for social anxiety, though more often than not Xanax is prescribed by a doctor for social anxiety as it is faster acting and stronger per mg than Ativan (and most other benzodiazepenes typically prescribed for anxiety disorders)
  
• The addicition potential of Ativan is also lower than Xanax, which may be prescribed for the same reasons as Ativan would be.
  
• .05mg of Ativan PRN is the recommended dosage(Physicians desk reference- manual) for children suffering from panic disorder.
  
• 1mg of Ativan is equivalent in strength(mg for mg) to .05mg of Klonopin, but Ativan has a short half life, as I mentioned, where as Klonopin has a long half life.
  

(sidenote/observations~not necessarily fact): some doctors will also use .05mg Ativan as a starting dosage to test the waters with a new patient for varying reasons, if you are an underweight adult, or just to be cautious for varying reasons.

• Klonopin is also known as Clonazepam
  
• Klonopin is usually prescribed(as far as anxiety disorders go) for Generalized Anxiety Disorder and/or to help prevent the anxiety attacks from panic disorder.
  
• Klonopin is usually prescribed(as far as anxiety disorders go) to be taken BID(twice daily)
  
• Out of the four benzodiazepenes typically prescribed for anxiety disorders(Ativan, Xanax, Valium, and Klonopin) Klonopin has the longest half life and thus affects you the longest and stays in your body the longest.
  
• Due to the statement directly above and due to taking it on a daily basis, often twice or sometimes even three times daily(TID), Klonopin has a very high addiction potential, and thus patients who discontinue use for whatever reason need to be weaned off it over time rather than dropping it entirely and immediately.(going cold turkey)
  

At the moment I forget the P.D.R. recommended dosages for children and adults for Klonopin, though as far as I know there is no recommended dosage for children because it isn't often recommended to be prescribed to children.

***END OF FACTS***

Now, last but not least. Not to be confrontational but, the moderator on this forum that is active in this thread,

crtclms

needs to chill out.

While being somewhat helpful at times, and I'm sure trying to enforce board rules and local/federal laws, has been for the most part very abrasive, and at times flat out rude to multiple posters.. at times very nearly flaming(which I'm sure you all know in board speak means unnecessarily mean and confrontational, including personal verbal attacks on other board members). I point this out because it bothered me enough to join this board to say something about it and the incorrect information that said moderator is perpetuating, such as "Klonopin is not of any use, no matter how strong *you* feel it is, if it is being used to stop a seizure or a panic attack, because it is too long acting to be of help." for example. Klonopin is REGULARLY prescribed to be used as an anti-convulsant, as well as a sleep aid. There are other minor falsities you've said.. but I think you had the right idea behind what you were saying and just assumed everyone knows as much as you and thus didn't include enough information for the every day person and thus wrote what you wrote misleadingly.... and without enough specificity. But I won't mention those instances exactly because I have no intention of starting a flame war, especially with a moderator... but as a moderator, try to be more tolerant, explanatory, and kinder please... otherwise all you do is make people NOT want to listen to you, not want to post, and you may even possibly derail threads. I've moderated many a forum, and many online groups and their discussions. Take a breath and calm down, or medicate yourself(but only as your presciption indicates) if you find anxiety and anger creeping up on you reading poster's posts before posting back something abrasive, derogatory, or insulting. It'll do you, and this forum, and this forum's members... a world of good. Less drama is always good. Hope you don't hate me now.

Sincerely,

Moi

[humanoid]

You seriously joined CB just to whine about crtclms? I find it really weird that you join up a board JUST to tell a moderator who puts her time and effort (for free, and for very little appreciation, as shown here) how she should do things. It doesn't seem you read the rules. And telling her to medicate herself? What the fuck. Honestly.

[Trent Locke]

Yes, obviously, I only joined to whine about a moderator handling moderation incorrectly, regardless of her help being free or not. *rolls eyes* Thats why my post contained all that other information and thats why I tried to be as kind and helpful as possible when posting that last part about the moderator. Yes, obviously that's the only reason. Obviously. Did you even read my whole post.. or did you just see me tell the moderator to chill out. Did you also see the part where I mention NOT starting a flame war or derailing the thread. and yes, I told her to medicate herself with the medication she said she was prescribed and I told her to follow her perscriptions instructions while doing so. Did you not notice she mentioned what medication she's on from her doctor..?

You're dismissed, go be angry somewhere else. On a more serious note, just cause you volunteer(you know, for free) for something doesn't mean you get to do it badly. and it was done badly at points in this thread.. which is my only point of reference.. and thus I pointed it out. If it's against the rules to tell a mod when they are being unnecessarily abrasive.. then heaven forbid... I guess I'll be banned.

*shrug*

[Wooster]

Trent, I don't believe I've EVER seen crtclms say this:

"Klonopin is not of any use, no matter how strong *you* feel it is, if it is being used to stop a seizure or a panic attack, because it is too long acting to be of help."

Unless I've missed something somewhere.

If you desire less drama, please PM crtclms personally instead of calling it out on a public thread.

Also, not having an understanding of the culture of CB, and the incessant shit we deal with on benzo issues, I would further add that while your experience is relevant and helpful, perhaps the opinions should be placed elsewhere.

Also, saying this

You're dismissed, go be angry somewhere else.

is just plain rude.

Please stop.

[Wooster]

What point were you hoping to clarify with your facts?

[humanoid]

...I point this out because it bothered me enough to join this board to say something...

Quoting you directly...you said yourself her apparently bad moderating is what prompted you to join our forums. You add the info at the top, sure, but you say exactly that the only reason you joined was to be a dick. You might have done it in "polite" terms (though telling someone what they should and shouldn't do and how to act is not all that polite) and claim you don't want a flame war, but you are still being a dick.

Yes, we all pretty much mention what medications we take here. That doesn't really mean you get to tell someone to go medicate themselves because you don't approve of what they say or how they say it.

And I mention that she moderates for free because a lot of people here (particularly new members...) take what they do for granted and expect them to be perfect at all times. We are all mentally ill here, perfection is just not going to happen. Specifically, I know crtclms is having a really difficult time right now, but I guess you wouldn't considering you just joined to post in this thread. Personally, I'm grateful that there are people that want to dedicate their time to moderating CB and making it a better and more supportive place for all. I guess if you want to nitpick everything a moderator says and turn it around, whatever.

I'm not angry at all. I am just genuinely bewildered and find your motives strange. If you think what I'm saying is flaming, you are mistaken. How about you dismiss yourself to another forum if you don't like how things are run here?

Edit: Lol cute signature. You're not an egotistical dick at all!

[Trent Locke]

1.) Trent, I don't believe I've EVER seen crtclms say this:

"Klonopin is not of any use, no matter how strong *you* feel it is, if it is being used to stop a seizure or a panic attack, because it is too long acting to be of help."

2.) Unless I've missed something somewhere.

3.) If you desire less drama, please PM crtclms personally instead of calling it out on a public thread.

4.) Also, not having an understanding of the culture of CB, and the incessant shit we deal with on benzo issues, I would further add that while your experience is relevant and helpful, perhaps the opinions should be placed elsewhere.

5.) Also, saying this

You're dismissed, go be angry somewhere else.

is just plain rude.

6.) Please stop.

1.) and 2.) It's on the first page of this thread... near-ish the top. You must have missed it. Please check again.

3.) Fair enough.

4.) not quite sure what you mean unless you're basically repeating #3, in which case.. I agree

5.) So was the post directed at me immediately before that. I responded in kind. We are all human, after all. and respect is deserved.. not given freely... so is disrespect.

6.) I will stop, as long as other posters do the same. I'm not the only one in the wrong, even though... I was one of the people in the wrong in that instance.

[Velvet Elvis]

I'm closing this.

[Wooster]

1 and 2) I did just re-read. I didn't see that she said that about klonipin. I did see she was referencing ativan/lorazepam as useful for her partner who has seizures.

3) Thank you for being reasonable.

4) Am not repeating #3... its a cultural thing. If you peruse the benzo threads or hang out here for a while you will start to see how many people don't understand the difference between physiological dependence, tolerance, and psychological addiction, in addition to gloating about misusing benzos and trying to minimize such, and/or come up with new strategies to get docs to prescribe more.

5) I stand by my original comment. Civility costs nothing but often yields great rewards.

6) Please respect the original poster (OP) and their question by keeping this topic on track.

What was it that you were hoping to clarify with your long list of highly disclaimer-ed facts?

ETA: Ooops... looks like VE beat me to the wire.

[crtclms]

I listen to a podcast, and I miss everything.