Quick answer needed re Ativan (lorazepam) withdrawal

Factual Questions
1

How severe and how common are withdrawal effects from Ativan (lorazepam)? I’ve googled up withdrawal information and it sounds like it can be pretty bad, but I’m not finding any info on how common the severe problems are.

YANM Doctor or Pharmacist, etc. We’re working to get medical help with this, I’m just trying to figure out how critically fast we need to move.

Is someone going cold turkey from Ativan likely to drop the next day or would it take a few days? Are severe withdrawal effects common or rare? Which are the most dangerous that should be watched for? What symptoms would rate a trip to the ER?

Would any of the other sedative drugs help control any problems? There’s someone who has either Xanax (alprazolam) or Valium (diazepam) (can’t remember which at the moment) who’s offered some if that will help until a new doc is found.

My friend’s 90 year old mother has been taking Ativan twice a day (1 mg, I think) for some time now. When she doesn’t take it, she gets very, very anxious and easily upset. She’s fairly healthy but has had a few problems, including something like a temporary stroke. (I don’t remember what they called it, the mental effect was very much like a stroke, but it was not and was mostly temporary.)

Recently her worthless grandkid was over for lunch and stole her Ativan. She discovered the loss, called his parents, and he returned what little was left. That made her come up 10 days short for the month.

Yesterday she went to her doctor (visit was already scheduled) and asked about replacements. The doctor not only wouldn’t replace the stolen drugs (I can understand that might be a problem with all the fed regulations these days) but also refused to extend her prescription at all, ever again. Because anything he prescribes will “just get stolen again”. The doc referred the patient to a psychiatrist for any further anxiety meds, but couldn’t find a psych to take her. The doctor seems to have simply washed his hands of the whole situation and decided it’s not his problem.

Aside from being completely flabbergasted at the doc’s reaction (this is a patient he’s been seeing for THIRTY FUCKING YEARS who was taking Ativan on his insistence and fought the idea tooth & nail for a long time - not exactly a “drug-seeker”), my friend is extremely worried about mother’s health until this can be resolved. Part of the problem is that she’s only got Medicare and there are very, very few docs around here who will see Medicare patients that don’t have supplemental insurance.

Thanks much for any info.

2

My academic background is in psychopharmacology and I have a prescription for lorazepam as well although I rarely take it because I am scared of dependency. The three main classes of drugs that are the most difficult and dangerous to detox from are alcohol, barbiturates, and benzodiazipenes like lorazepam. That are all related in their effects and mode of action. My grandfather died from heart failure at age 55 during unintentional Valium withdrawal for example. The doctor’s behavior, as you describe it, seems like severe malpractice to me. That situation can be very medically dangerous.

Any of the benzodizapines have overlapping effects but that still won’t take care of a greater problem if there are only a few doses. The main problem is if major withdrawal symptoms start, they won’t go away for a few days at the least. Look for extreme irritability and then (hopefully not) mild seizures. If any of that happens, just go straight to the best ER you know of. That shouldn’t be just a temporary fix. A good ER with lots of resources should be about to get her a psychiatrist both in the hospital and after she is out.

3

Yeah, that’s what I thought. My mom had seizures from Valium withdrawal when I was a kid. It’s a very scary thought when you’re talking a 90 year old woman.

She took her last pill yesterday, so hopefully we can get something done before any problems start. If we can find a doctor to see her.

I’d thought of the ER, that may be the way it has to go.

4

Have you spoken with her pharamacist about an emergency supply?

5

I suggested that last week (before the doc visit) but they moved up the appointment instead. This little old lady is SO WORRIED about taking these pills that she insisted on going back to the doctor. (I’m not sure why, but you can’t really argue with little old ladies.) Dunno if anyone’s thought of it again, I’ll suggest it.

6

Ativan is a controlled substance. I don’t think pharmacists can give an emergency refill for it but that may vary by location.

7

Pharmacists are not authorized to give out “emergency” supplies if the medication is a controlled substance. If she begins to sweat, vomit, or have tremors, take her to the ER asap.

8

My 80-year old mother in law had to quit taking benzodiazepines when her old doc retired and she got a new young female doctor who wanted to wean the patients of their depencency habits.

What happened was that my MIL got in a self-induced stress spiral (I NEED my medicines!) where she gave herself heart palpitations, panicked over those heart palpitations, thought she had a heart attack, and called an ambulance that whisked her away with sirens blazing.
In the end, it turned out to be just the stress I mentioned above. Her heart was fine. She stayed a couple of days in the hospital though, which reassured her as she went through the worst of her withdrawal symptoms.

She got home, and her son bought her OTC valerian tablets, which are basically herbal placebo’s. To amplify the placebo effect, her son warned his mom: “Not to take these too often, as they are quite strong”. :slight_smile:

Granted that only worked because his mom is not the kind of woman to look up info about medicines. But it worked fine, and his mom is still healthy an off her daily benzodiazepines seven years later.

9

Right, I wouldn’t be so concerned (not to mentioned pissed!) if the doc had offered to WEAN her off the drugs. That’s the appropriate method to use. It was the “nope, no more, you can just cold turkey it” bullshit that torqued me up.

Current update: she’s doing OK so far. Waiting on a call back from the doctor’s office after my friend “had words” with them again this morning, including the info we’d looked up on withdrawal effects.

Plan is to go to the ER if needed. Kids are checking on her frequently. Of course, she’s always shaky and nauseated, so that makes it a bit tricky. I think they’ve done a couple things to try and reduce the likelihood of stress/panic attack also.

Thanks much for the info, guys!