Cycling ultram and ativan

Aiken · Post by **Aiken** » Sat Mar 31, 2007 1:52 am

Due to other issues that I babble on at length about in another thread, I'm currently only able to tolerate Ultram, and more recently Ativan, to deal with RLS and sleeping. Of late, I've only been on the Ativan, about 1.5mg per evening.

My sleep doctor says that the dose of Ativan that I'm on should be okay, but it's best to cycle it with something else. I'm considering taking the Ultram on weekends, and the Ativan on weekdays.

However, I've seen a couple of horror stories about coming down off of an extended course of Ativan. Now, I'm not taking very much in comparison to those people, and my doctor didn't make any worried noises when I suggested the weekend theory to him, but still, I want to know if anyone here would caution me against this 5-on 2-off cycle. I normally take 0.5mg in the evening and then 1mg 3-4h later, near bedtime. I don't know if the weekend dose should just be the Ultram, or if I should take the evening 0.5mg Ativan as well to avoid rebound anxiety. I don't know if that would make the mini-holiday pointless.

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Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Neco · Post by **Neco** » Sat Mar 31, 2007 2:19 am

Well, if the goal is to balance how much you're needing, etc.. I would suggest alternating 2-2-2-2 etc.. 2 days on, 2 days off. I would think that would establish a steady level for both drugs.. and with the Ultram it will really work well because 2 days or more off of it, and the required amount can drop significantly

Post by **ViewsAskew** » Sat Mar 31, 2007 4:36 am

Boy, I wish I knew if that was enough. . .just not sure. I do know that in terms of a nasty time stopping it, the amount being taken is not as important as your personal physiology. Some of us just get easily dependent on the benzo and have a horrid time getting off of them. I wasn't on a high dose of clonazapam, nor on it all that long (7 months), yet it took me longer to get off of it than I was on it and I had vomiting, weight-loss, hot flashes, etc. Not fun. But, other people can be on them for years and high doses and just stop them without effect. . .

You might get better info about the benzos on another board - definitely NOT the UK based benzo.org (they are busy helping all of those who are having a horrid time and don't advocate anyone taking them for any reason), but maybe a board about them that can give you some accurate info about what point you can create physical tolerance. I know that a month on require two weeks off, but not sure of this shorter time frame. If know one here knows, please come back and post what you find out.

Aiken · Post by **Aiken** » Sat Mar 31, 2007 6:24 am

Ann--

You weren't kidding about the UK benzo site.

It's a good read, though. Not much scarier than I had already expected, but definitely worth it to know the details. I feel validated in my paranoia about taking as little as I can get away with while stuck with these limited options.

Zach--

I was thinking about weekends because it's easier to keep track of, but you might be right about the shorter cycles.

---

I may just have to experiment carefully and see what I can get away with. I'm very self-aware when it comes to anxiety; I can always feel it start to grow (which, alas, makes it worse). Likewise with insomnia, physical symptoms, and so on. I can probably assume I'll recognize withdrawal in time to get back on the drug so I can start a taper.

But not until I do some more reading.

Thanks...

_________________
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

tashton · Post by **tashton** » Sat Mar 31, 2007 9:49 pm

Aiken...
I was taking Ativan for three or four years. Increased the dose to 2 mg. before bedtime. When I quit taking it I didn't notice any withdrawal symptoms except that my body was so used to having it to sleep that without it I couldn't sleep. I would lie in bed with my eyes wide open all night. It took a couple weeks to be able to sleep without it. So what I am trying to say is, if your body gets used to needing ativan to sleep, the nights you don't take it might be a problem unless the Ultram makes you sleepy enough to overcome the need. I switched to hydrocodone for my RLS and it controled the RLS but didn't make me sleepy enough until my body withdrew from the ativan.

Post by **ViewsAskew** » Sun Apr 01, 2007 4:52 am

Yeah, benzo.org can be scary and very one sided. They didn't seem to understand that I HAD to have something for the RLS, so I just didn't talk about that, lol. But, they knew their stuff and I was really glad they were there when I was going through withdrawal.

Did you find any info anywhere on alternating? You could post a letter to Dr Buchfurer on RLShelp.org. He might know.

Aiken · Post by **Aiken** » Sun Apr 01, 2007 7:13 am

Ann--

I didn't run across anything specific to alternating Ativan and Ultram, but I have to admit I didn't do a whole lot more looking. I've had a couple of good days for the first time in a while and, honestly, I wanted to avoid obsessive googling related to my health.

From what I hear, if you're going to have Ativan withdrawal symptoms, you're going to get them pretty much right away. Ativan is pretty strong and has a pretty short half-life. In fact, I suspect taking it only in the evening would produce daily withdrawal in many people, depending on physiology. I'm testing the waters tonight. Luckily, I can afford a sleepless night on a Saturday night.

Really, I hope, and suspect, that I'm just being over-cautious and that this will work just fine.

_________________
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Aiken · Post by **Aiken** » Tue Apr 03, 2007 7:10 am

tashton wrote:So what I am trying to say is, if your body gets used to needing ativan to sleep, the nights you don't take it might be a problem unless the Ultram makes you sleepy enough to overcome the need.

Yeah, that was pretty much the story. I simply stayed up an extra four hours or so, rather than lie and stare at the darkness, but even with the extra exhaustion, sleep was poor and short.

The next night, last night, was a work night and I wanted to be sure I'd sleep, so I went back to the Ativan. That brought to light that, even though the Ultram was crappy for sleep, at least I hadn't gotten any PLMs or other symptoms. I had forgotten that, with the Ativan, I got the PLMs. So, I ended up trading about 90 aggravating minutes of twitching legs before going to bed for a solid night's sleep after going to bed. It was a rather iffy tradeoff.

I'm trying the Ultram again tonight. It's a really hard call, and it's probably going to depend on how I feel each night, but I bet most of the time I'm going to prefer so-so sleep over PLMs.

I guess I never realized how annoying the PLM *buildup* is. It always sounded annoying, sure, to have legs twitching of their own volition, but I never knew that the buildup was like when your limb has fallen asleep and is now waking up and nobody better bloody touch it. So very, very aggravating.

_________________
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.