Brief Answer: Please continue same dosage Detailed Answer: Hi XXXX, Thanks for sending in your query. Its great to hear that you are feeling improvement from you headaches which have been troubling you for last 3 months. Medications like Amitriptyline take a while to act in its full potency and it is too early to alter or increase the dosage pattern and strength of medication right now. I am sure it will help you through getting back to normal soon. Any such medications will take at least 2 to 4 weeks to show significant improvements. Taking amitriptyline and alcohol will increase the chance that you experience side-effects so please avoid alcohol for a while. MRI and CT being normal shows that you do not have any significant neurological condition. I hope this helps. Do write back in case of doubts. Dr.A.Rao Kavoor

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Brief Answer: Slow tapering is a good option. Detailed Answer: Hi, Thanks for writing again. In detoxification, in patients taking therapeutic dosage (i.e usually prescribed by doctors unlike high dosage taken in abuse of the drug) of benzodiazepines like lorazepam the dependence can be tackled by simply tapering the drug in a careful and step wise manner. It is usually reduced initially by 10-25% of the dosage and the response is evaluated. If you are tolerating it well then further similar dose is reduced. If at any point it is not tolerated then the duration of the tolerated dose is maintained for a few more days. With this, it is possible to stop the drug eventually. Only in cases of very high dose intake, the dosage is usually harmful to the body and hence has to be reduced right away, here, drugs like diazepam and clonazepam are used whose drug action lasts much longer than lorazepam (Ativan). You can discuss the slow taper of Ativan with your doctor. Regarding the Amitriptyline, as I said earlier, it is too early to change the dosage of the drug, you can expect more improvement with its regular use and it causes some sedation hence it is advisable to retain the dose at night as it is, till the drug is used. I hope this helps, Dr. A Rao Kavoor

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Brief Answer: It is advisable to continue 10mg of amitriptyline. Detailed Answer: Hi, Thanks for writing again. Lorazepam (Ativan) dependence with (a therapeutic dose) 1.5mg, if taken at night will give rise to insomnia as the prominent symptom on withdrawal of the drug. If it has been taken during the day one may feel restless or experience anxiety on stoppage. In case of the latter, buspirone (buspar) will help alleviate anxiety symptoms that are likely to arise on stoppage of lorazepam. But introduction of a new drug in your regime like buspirone, may also bring along few side effects of this drug. As in your case you said you experience worsening of headache. Gradual tapering is a very safe option. Amitriptyline is used for different conditions in different dosages. For pain syndromes like headache low dose of the drug is usually sufficient. It is always advisable to start with very low dosage because response is seen in different individuals with different dosages. If your headache is responding to 10 mg of the drug I see no reason in increasing it to 50mg right away. It is advisable you wait for at least two weeks to experience more improvement, these drugs act very slowly. 50 or 75mg may be the dose at which patients usually show response but it varies from person to person. As one increases the dosage one can also expect more side effects. I hope this helps, Dr. A Rao Kavoor

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