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xanax to ativan?
  1. #1
    Toolooze is offline New Member
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    Default xanax to ativan?

    I have been taking xanax on and off for 20 years for panic disorder and it works well. I have been taking .25 as needed (usually once a day) to inhibit panic for the last couple of years. I had mitral valve surgery five months ago with amazing success. Recently however, I was diagnosed with congestive heart failure accompanied by shortness of breath. It seems that my heart function is half of what it was before the surgery although the surgery was successful. I started taking .5 xanax every 5 hours to control my anxiety (and potential panic) and ease the breathing difficulties. The shortness of breath is definitely related to anxiety at least partially, but none of the medical team is sure which causes which. The xanax also appears to mitigate the side effects of my hypertension meds, especially coreg, which are being evaluated at increasingly higher dosages.

    My doctor recommended that I try lorazepam (ativan) at the same .5mg dosage and five daily as needed intervals instead of xanax. She thinks the overlap between dosages (duration of ativan >> xanax) will be better and the anxiety control will be similar. I've read that ativan dosage is weaker than xanax, ie., you need a higher dosage of ativan to have the same effect. Does anyone have experience with these and how difficult was it to change over from one to the other? It is my choice which anti-anxiety drug to take; I have a Rx for both.

    Any advice will be greatly appreciated.

    At this point with my cardiac problems, addiction to anxiety meds is of less concern than is being able to breathe and sleep.

  2. #2
    tired2 is offline Senior Member
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    Quote Originally Posted by Toolooze View Post
    I have been taking xanax on and off for 20 years for panic disorder and it works well. I have been taking .25 as needed (usually once a day) to inhibit panic for the last couple of years. I had mitral valve surgery five months ago with amazing success. Recently however, I was diagnosed with congestive heart failure accompanied by shortness of breath. It seems that my heart function is half of what it was before the surgery although the surgery was successful. I started taking .5 xanax every 5 hours to control my anxiety (and potential panic) and ease the breathing difficulties. The shortness of breath is definitely related to anxiety at least partially, but none of the medical team is sure which causes which. The xanax also appears to mitigate the side effects of my hypertension meds, especially coreg, which are being evaluated at increasingly higher dosages.

    My doctor recommended that I try lorazepam (ativan) at the same .5mg dosage and five daily as needed intervals instead of xanax. She thinks the overlap between dosages (duration of ativan >> xanax) will be better and the anxiety control will be similar. I've read that ativan dosage is weaker than xanax, ie., you need a higher dosage of ativan to have the same effect. Does anyone have experience with these and how difficult was it to change over from one to the other? It is my choice which anti-anxiety drug to take; I have a Rx for both.

    Any advice will be greatly appreciated.

    At this point with my cardiac problems, addiction to anxiety meds is of less concern than is being able to breathe and sleep.
    Hi Toolooze,
    Xanax at .5mg would be the same as 1mg of Ativan.The Ativan (Lorazepam) has a slightly longer half life of 10-12 hrs while the Xanax half life is 6-12 hrs.
    Hope this helps!!
    Pam
    mardigras man 420 likes this.

  3. #3
    Toolooze is offline New Member
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    Default Thanks, Pam

    So I may need to take a higher dosage of Ativan but may not need it as often, correct? And to change over, I just need to wait 5 or 6 hours after taking xanax before trying the ativan and take it as if it is my normal xanax dose?

  4. #4
    tired2 is offline Senior Member
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    Quote Originally Posted by Toolooze View Post
    So I may need to take a higher dosage of Ativan but may not need it as often, correct? And to change over, I just need to wait 5 or 6 hours after taking xanax before trying the ativan and take it as if it is my normal xanax dose?
    Hi Toolooze,
    I would check with the doctor on how much he wants you to take and how often.Switching over should go smoothly as long as the dose of Ativan is equal to that of the Xanax.You can start with the next time you would normally have taken the Xanax.
    Pam

  5. #5
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    Quote Originally Posted by Toolooze View Post
    I have been taking xanax on and off for 20 years for panic disorder and it works well. I have been taking .25 as needed (usually once a day) to inhibit panic for the last couple of years. I had mitral valve surgery five months ago with amazing success. Recently however, I was diagnosed with congestive heart failure accompanied by shortness of breath. It seems that my heart function is half of what it was before the surgery although the surgery was successful. I started taking .5 xanax every 5 hours to control my anxiety (and potential panic) and ease the breathing difficulties. The shortness of breath is definitely related to anxiety at least partially, but none of the medical team is sure which causes which. The xanax also appears to mitigate the side effects of my hypertension meds, especially coreg, which are being evaluated at increasingly higher dosages.

    My doctor recommended that I try lorazepam (ativan) at the same .5mg dosage and five daily as needed intervals instead of xanax. She thinks the overlap between dosages (duration of ativan >> xanax) will be better and the anxiety control will be similar. I've read that ativan dosage is weaker than xanax, ie., you need a higher dosage of ativan to have the same effect. Does anyone have experience with these and how difficult was it to change over from one to the other? It is my choice which anti-anxiety drug to take; I have a Rx for both.

    Any advice will be greatly appreciated.

    At this point with my cardiac problems, addiction to anxiety meds is of less concern than is being able to breathe and sleep.
    Yea, lorazepam like Pam said lasts longer in your body. Additionally, Xanax drug level distribution is a lot worse so it is not recommended for most people (even though I am more than aware it is prescribed extremely often). Here's why: when you take a xanax you get high peak levels very quickly so you feel great and that is the good thing....HOWEVER, your drug level quickly drops off so you are left with feelings of withdrawal symptoms or anxiety often before the next time you were scheduled to take it even if it is "as needed" for some patients. Point being, there are better benzos (ativan and xanax are both benzos and there are many others) and ativan (lorazepam) is one of them because the drug level is more evenly distributed throughout the whole dosing interval so you should not have this dropoff toward the end of your dosing period. It should not be that difficult to switch over because they both work the EXACT SAME WAY (bind to the GABA receptor), it is just a matter of the right amount of each drug taken at the right time. You are not my patient so I'm sorry I can't give you a dosing schedule. Also, I am ONLY saying this as advice, NEVER take meds not as prescribed, but benzos are VERY difficult to have respiratory depression (breathing problems) as a side effect unless it is taken at insanely high doses versus barbiturates or other drugs that do have that problem. You mentioned breathing so I was not sure if that was a concern for you at all (some people are aware of this "side effect" and get worried, but it shouldn't be much of an issue at all if taken correctly. Good luck!!
    ---I answer questions to the best of my ability, but with always limited knowledge of the patient's situation and no ability to see your chart or full medical history my advice is limited and should also be confirmed with your own doctor/pharmacist/etc. Also, I do not promote following my advice without proper approval from your doctor either--

    Dr. B

  6. #6
    Toolooze is offline New Member
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    Default Thanks

    Thank you so much Pharmstud(ent) for your reply. It sounds like the ativan may be a better choice since there have been a couple of occasions where I have had to take a little xanax "boost" (maybe half of a .25 tab) an hour or two after my normal .5 dosage. When I switch, if the initial .5 ativan still leaves me anxious, it sounds like i can double the dose with no adverse affects except a little drowsiness, which would be ok. Although I am taking the benzos for actual anxiety/panic, my dose is much less than others take (at least initially) for recreation. For those of us with bona fide panic disorder, even taking anti-anxiety meds can cause panic, so your answer was especially helpful.

    In my case, the anxiety relief actually eases my breathing difficulties. I'm hoping that as I get accustomed to the increased dosages of coreg, my anxiety over shortness of breath should decrease.

    Thanks again so much for your response.

  7. #7
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    Quote Originally Posted by Toolooze View Post
    Thank you so much Pharmstud(ent) for your reply. It sounds like the ativan may be a better choice since there have been a couple of occasions where I have had to take a little xanax "boost" (maybe half of a .25 tab) an hour or two after my normal .5 dosage. When I switch, if the initial .5 ativan still leaves me anxious, it sounds like i can double the dose with no adverse affects except a little drowsiness, which would be ok. Although I am taking the benzos for actual anxiety/panic, my dose is much less than others take (at least initially) for recreation. For those of us with bona fide panic disorder, even taking anti-anxiety meds can cause panic, so your answer was especially helpful.

    In my case, the anxiety relief actually eases my breathing difficulties. I'm hoping that as I get accustomed to the increased dosages of coreg, my anxiety over shortness of breath should decrease.

    Thanks again so much for your response.
    You are most welcome. I had some time this morning and looked up the LD50 of xanax (LD50 means lethal dose 50% of the time), I had looked this up before but obviously couldn't remember the exact numbers, and it was somewhere in the range of 331 to 2171 mg PER kg (as low as 195 mg PER kg if IV) when tested in rats due to respiratory depression. A normal adult is roughly 70 kg so if you do the math that is an INSANELY large amount even for rec use. Bottom line, nobody would normally have or take that much xanax. So rest assured (if you weren't already), you should be okay. The MAX dose for ativan is 2mg per dose. As you probably know though try your best to use the smallest amount and as seldom as possible, this is very important. If you need to use it then by all means I understand and use it, but it is very important to do your best to not use it. Exercise and diet are SO important I can't even tell you. Get regular exercise everyday and that will help your anxiety immensely. Not only do you get endorphin release which will help you feel good, but if you think just common sense, if you run really hard and feel somewhat tired you won't have all this built up energy to be quite as anxious, that is the hope at least. Exercise is the biggest most important thing you can do, I know this can be very hard with CHF (heart failure) so don't push yourself too hard. I would DEFINITELY talk to your doctor before starting any exercise regimen in your case because of the CHF. If you need anything else, let me know!
    ---I answer questions to the best of my ability, but with always limited knowledge of the patient's situation and no ability to see your chart or full medical history my advice is limited and should also be confirmed with your own doctor/pharmacist/etc. Also, I do not promote following my advice without proper approval from your doctor either--

    Dr. B

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