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What is the ideal dosage of Ativan for an alcoholic patient?

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Posted on Wed, 6 Apr 2016
Question: I was given 2mg of Ativan to withdraw from alcohol, and it doesn't seem to be affecting me at all. I am 6'4' tall and weith 265 lbs. Would it be ok for me to use 4mg at a time. I only have a three day prescription.
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Answered by Dr. Matt Wachsman (28 minutes later)
Brief Answer:
several points.

Detailed Answer:
First the general information. Alcohol, ativan, some anti-epileptic medications get the brain used to being damped down and it over corrects into even potentially fatal OVER activity when they are abruptly stopped. Tapering down a bit gradually for a few days prevents this. This is more likely the more medicine, the more alcohol, the more brain damage, the worst medical history someone has. Ideally, the bare minimum medicine to damp down brain activity for a few days after stopping alcohol would be the best idea. Ideally, someone will feel no sedation whatsoever from the seizure prevention medication.

"doesn't seem to be affecting me at all" can mean it is working perfectly or that someone is near a seizure and needs immediate hospitalization or anywhere in between. Signs of definitely needing hospitalization are those of overstimulation. These include but are not limited to body overstimulation: rapid pulse > 110, elevated blood pressure, sweats, shakes. or mind overstimulation no sleep > 24 hrs, hallucinations/paranoia, severe panic. If taking 2 mg ativan and having even a FEW of these signs (ok, probably ANY ONE of these signs) it probably means observed treatment in hospital for about 24 hrs. So....it's pretty doubtful 4 mg ativan is ever going to be the simple solution. Either 2 mg is fine and there's very very low risk of problems or 2 mg isn't fine and observed and medically supervised treatment (currently in the US that implies hospital; it would be a medical facility NOT a hospital in many other countries).
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 3945 Questions

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What is the ideal dosage of Ativan for an alcoholic patient?

Brief Answer: several points. Detailed Answer: First the general information. Alcohol, ativan, some anti-epileptic medications get the brain used to being damped down and it over corrects into even potentially fatal OVER activity when they are abruptly stopped. Tapering down a bit gradually for a few days prevents this. This is more likely the more medicine, the more alcohol, the more brain damage, the worst medical history someone has. Ideally, the bare minimum medicine to damp down brain activity for a few days after stopping alcohol would be the best idea. Ideally, someone will feel no sedation whatsoever from the seizure prevention medication. "doesn't seem to be affecting me at all" can mean it is working perfectly or that someone is near a seizure and needs immediate hospitalization or anywhere in between. Signs of definitely needing hospitalization are those of overstimulation. These include but are not limited to body overstimulation: rapid pulse > 110, elevated blood pressure, sweats, shakes. or mind overstimulation no sleep > 24 hrs, hallucinations/paranoia, severe panic. If taking 2 mg ativan and having even a FEW of these signs (ok, probably ANY ONE of these signs) it probably means observed treatment in hospital for about 24 hrs. So....it's pretty doubtful 4 mg ativan is ever going to be the simple solution. Either 2 mg is fine and there's very very low risk of problems or 2 mg isn't fine and observed and medically supervised treatment (currently in the US that implies hospital; it would be a medical facility NOT a hospital in many other countries).