How much Ativan is really necessary?

March 2, 2009 7:23 PM

How much Ativan to take for a plane flight?

I'm afraid of flying, and I'm going on a trans-Atlantic flight soon. The flight has three legs on both the departure and return trip. The first leg is 2 hours, the second around 8 hours, and the third around 1 hour.

I asked my doctor to prescribe me some anti-anxiety medication, and he gave me generic Ativan. I've been reading up about the drug, and I'm scared of the side effects/dependency. He prescribed me .25 mg pills.

My intent is to take one pill at the gate for the second leg, then take another while I'm in the air. Would this be enough to calm me/knock me out? I'd like to take medicine for all of the legs, but I don't think that's realistic.

I'm taking distractions like a NDS and an MP3 player, but the last flight I took I cried all during take-off and landing.

Coping tips are appreciated (I read the other recent thread) but I'm especially concerned about the Atvian dosing.

Also, the old adage that, "Planes are safer than driving! You should be more afraid of getting in your car, yadda yadda," doesn't work for me. I don't like cars either.

Here is my throwaway address: [e-mail]

posted by anonymous to health & fitness (18 comments total)

Don't worry about dependence if you're taking Ativan in a context-specific situation. I have some that I only take if I have job-threatening insomnia. It's not like it's such a fun drug you'll be dying to take more of it unless you suffer from a wide range of social anxiety or addiction behaviors generally. My deal with me is don't take it two days in a row and don't take it more than twice in a week. I got fifteen pills prescribed sometime last summer and I still have a few. My pills are .5 mg and I've taken two at once, once. usually I take one and it's fine, calming without being nkock-out drops. The only side effect I personally have experiences was weird dreams the day after I took it but I don't have a big sample size of times I've taken it.

The bigger deal is that if you're taking Ativan you really shouldn't do other things you might be inclined to do, specifically drinking or anything else that might have a sedative effect. I had a friend who told me how he took Ativan for flying nerves and then had a drink on the plane and practically had to be carried off. So, don't do that.

I don't know how long the drug lasts so I'm not a good person to give advice there (I'd ask the doc personally or see if your health insurance has one of those "call a nurse" numbers, or ask your pharmacist).

The big deal about flying is that there are a lot of things that are pretty "normal" for flying that can freak someone out who doesn't fly much, things like

- the big CLUNK when the wheels come down before landing
- the way the plane can get really noisy when it's landing
- turbulence generally is normal, esp when changing altitudes, watch the flight attendants for cues

I don't mind flying terribly, but I do fly a lot; things that generally make a trip nicer are good things to do to be kind to yourself - have a fascinating book to read that you can get caught up in as the plane prepares for takeoff to take your mind off of being nervous, wear earplugs to make the general level of noise go down some, wear clothes you like, etc. Good luck!
posted by jessamyn at 7:32 PM on March 2

Oh man, I love Ativan. I used to take .5 mg in the morning and night and it makes a world of difference. It won't knock you out or make you feel drunk. In fact, you probably won't notice any physical differences when it takes effect. What you will feel is your brain finally shutting up. However, it won't magically fix your flying phobia. It will take the edge off so that you may focus on relaxation techniques.
When I would wake up in the night after taking an Ativan, I did see tracers when I moved my hand in front of my face which supplied me with a bit of entertainment as I sat on the toilet. Great fun.
Don't you dare drink anything for 24 hours after your last dose. Driving is also a bad idea until you get used to the meds. You aren't going to get addicted to them after only a few doses, so don't worry about that.
posted by idiotfactory at 7:35 PM on March 2

IANAD and IANYD. I'd recommend asking your doctor and/or pharmacist before you head off on your trip. But I can relay my own experience with flying and benzos.

0.25 of ativan is a tiny amount of that drug. It affected me much less than 0.25 of xanax, which would be considered a rough equivalent. When I fly transatlantic, I take 5mg of valium an hour before my flight, then 0.25 of xanax every 1hr-1.5hr after that to a maximum of 2.5mg of xanax in total. It does not knock me out, though I get drowsy and like to nap when I land in Europe. I am female, 5'5" and 120 lbs.

Your body may react completely differently than mine and a small amount could knock you out. But my biggest tip - take one ativan before your first flight. You don't want to get worked up before you even start the transatlantic leg. And no alcohol! Good luck!
posted by meerkatty at 7:39 PM on March 2

Ask your pharmacist re: the best way to take ativan. .25 is a very minimal dose. I would strongly suggest you stash away your fears regarding tolerance and dependence if you are only planning only using this to manage your anxiety before and during your flights--unless you are planning on daily flights for a weekor two. The other advise is good--decide on either Ativan or alcohol and do not mix--make sure the dose is adequate to the need. If you have a history of either alcohol or substance abuse make sure your physician is aware. Benzodiazapines are usually contraindicated with a history of abuse or dependence. Be sure and discuss with your pharmacist--if you are going to use it--and there is little reason why you shouldn't--make sure you are using enough and taking advantage of its uptake parameters and 1/2 life.
posted by rmhsinc at 7:50 PM on March 2

My psychiatrist gave me the .50 mg version. For my recent transatlantic (LAX to LHR, then LGW to EDI), I would take 2 pills an hour before the flight and another dose about halfway through the flight. In the meantime, I'd keep myself entertained with a book or whatever good movies were on the IFE.

Bear in mind that each person has different limits and resistance. I experimented how I was affected by the different doses (1 .50 pill vs. 2 pills) before leaving. I found that at .50 mg, I was calm and relaxed, but still VERY aware of my surroundings. 1 mg would put me just at that place where I was so relaxed hardly anything bothered me. Thus, I settled on that for the transatlantic while using just .50 for the shorthaul flights between the the UK and Ireland.

As everyone else said, don't drink while you're on the meds. Besides essentially doubling whatever sedation you're already under, it could very well kill you. Also, realize that this stuff has a tendency to make you forget what happened while you were sedated.
posted by arishaun at 7:52 PM on March 2

P.S.- I forgot to reference my flight times. LAX to Heathrow was about 10 hours and 45 minutes. Gatwick to Edinburgh about 45 minutes. Between UK and Dublin was about an hour each.

I found the half-life of the pill to be about 4-6 hours for me, depending on how much I ate and drank water (also important to do). I strongly suggest testing the dosages before you leave so you can best gauge how many "boosters" you would need on a case by case basis.
posted by arishaun at 7:55 PM on March 2

Your weight is important for the dosage. On my last flight (when I was about 340lbs), I took .25mg at the gate and another .25mg once seated (15 minutes apart). By the time we took off, I was giddy. One great coping tool: put a rubber band around your wrist. When you start to get scared, snap it. Hard. It's a great way to shock yourself out of the fear.
posted by Cat Pie Hurts at 7:56 PM on March 2

My last flight I was given 1mg dosage. I combined that with a couple of glasses of wine between flight delay and on the plane. Previous dosages were probably smaller and I didn't have a problem combining the two.

My seat was in coach, and I was fine for a while but woke-up in business class with a doctor keeping a watch over me. Paramedics checked me out at the destination. So, be careful if you like a drink or two, but .25mg you'll probably be fine, it will probably just take the edge off.
posted by hungrysquirrels at 7:58 PM on March 2

To clarify that before I get flamed, yes, don't mix alcohol with ativan or it's class of meds. Bad idea. I've done it a few times, but be very careful about the dosage, and how much is drunk.
posted by hungrysquirrels at 8:05 PM on March 2

My wife has anxiety issues with planes, too. On the last trip, she took 1 mg and was pretty doped out, but made it through the flight. She slept for a while, then woke up enough to read. She keeps her Ativan for emergencies only, and has other medication for daily usage.
posted by filthy light thief at 8:11 PM on March 2

I am a believer in sleeping through my flying panic. I'd take a sleeping pill and one cold beer. Ask the flight attendant to wake you when you land. Anything else and you are struggling with your fears. Sleep and you are not thinking about it.

If I am awake, I really like to look out of the window. I also try to say hello to the pilot on the way into the plane. Putting a face to the driver of the bus really helps. Sometimes I have told the pilot I am not really comfortable with the whole up in the air thing and they have been very reassuring and sent me drinks a few times. I like when I fly on United and they let you listen to the pilot talking to the control towers. You know a few seconds in advance if there is a turn coming up or a change in altitude.
posted by JohnnyGunn at 8:12 PM on March 2

I take 2 mg of Ativan every single night, and when I don't take it, I experience no ill effects (other than the insomnia I take it for in the first place). I have been taking it for years. I think you'll be just fine and I wouldn't give any thought to dependence for taking a few pills.

At 2 mg, it helps me sleep. I find that it lasts about 4 to 6 hours. But definitely try taking it before hand to see how it affects you personally.
posted by crankylex at 8:14 PM on March 2

According to Medscape, the minimum adult dosage is .5 mg, the maximum is 10.0 mg. The most common dosages for anxiety are 1 or 2 mg, 2 to 3 times per day. If you are not used to taking it, a smaller dose will have a bigger effect.

IANAD but you really don't have to worry about dependency if you only take it on the rare airplane trip. Furthermore, whatever dosage your doctor recommended is likely to be relatively small so I would suggest that you take it as directed with the first dose 45 minutes before take-off and then followed directions to maintain it in your system until you land. There really is no reason to skimp. it is easier to stay calm than to try to calm back down.
posted by metahawk at 8:24 PM on March 2

.25mg of Ativan does not equal, even roughly .25 mg of xanax- not by a long shot.

Anyhow, .5 should do you just fine, and may even knock you out. Jessamyn's adivce is spot on, too.
posted by captainsohler at 8:51 PM on March 2

I take Ativan/lorazepam for flight anxiety. My prescription is for 0.5mg. I take it 30-60 minutes before takeoff, which is for me the most anxiety-inducing part of the flight. I take it almost every time I fly, and definitely for cross-country flights, and have not experienced any dependency problems or side effects. I wouldn't worry so much about dependency unless you have a history of dependency or addiction, and if so, that's worth talking to your doctor about, to see if your doctor might recommend something else.

My flight anxiety was getting out of hand before I started taking Ativan, and the medication has transformed my flying experience. I highly recommend it as one coping mechanism for anxiety. It does make me sleepy, but I don't mind sleeping on the plane. It usually seems to have worn off by the time I land on the other coast, 5-6 hours later.

It has also helped me re-train myself to be less anxious about flying. For the flights when I couldn't take it (short flights and had to drive or work at the other end) I've been able to talk myself through the anxiety better than I could before I started taking the ativan.
posted by gingerbeer at 9:21 PM on March 2

I took one .5 mg Ativan before getting on the plane the last time I flew Boston-Heathrow. My doctor told me I could take a second one while on the flight, but the one was enough to take away the heart-pounding terror of flying. I was still mentally afraid of flying and couldn't quite turn my brain off, but my body was more relaxed than usual. It made me kind of hyper and talky, so maybe the second pill would have brought me down to total calm (or maybe I was just hyper because I was excited about going on vacation?).

I, too, was worried about side-effects and whatnot, but I can tell you that I got four pills for one round trip and I still have two of them leftover sitting in my bathroom almost a year later. I didn't even bother taking them for a Boston-California flight a few months after the first trip.
posted by banjo_and_the_pork at 3:47 AM on March 3

FWIW, my 9-month old, 12 pound baby was prescribed .30mg of Ativan liquid every 6-8 hours, increased from .15 when she was slightly smaller. So, .25mg is a really, really small dose.

Did the doctor tell you how many you can take at a time? For example, I am prescribed to .25mg Xanax tablets right now, and I can take up to three of them at a time. So, with the doc's approval, when I am having an anxiety/panic attack (about the loss of said baby), I can take one, and if it doesn't help, take another one a little bit later.

Sometimes, just KNOWING I can take another one if I need to is enough to make the first one work. Before I knew that, one never worked (hence calling the doc to see if I could take more than one at a time).

I know this is an indirect answer and probably not much help, but that's my three cents.
posted by bunnycup at 5:37 AM on March 3

IANAD, but I do take ativan for anxiety.

Note that an oral dose of ativan takes about 2 hours to reach it's maximum effect (though you will feel it after about 15 minutes), and has a half life of something like 6-12 hours. Though like previous posters, I find it has a 4-6 hour window where it is at optimal strength.

Ativan calms you down, but it doesn't knock you out. It will just smooth over the rough edges for flying. Since it effects people differently, you might try taking a 0.25 prior to the trip, and see how it affects you. You might find that if you are extemely anxious on planes, .5 or even 1.0 might be a more effective dose. Even 1mg is considered a low dose.

(to give you an idea, ativan is used to calm down agitated/unruly patients in a medical setting. If someone is really freaking out, they may give him something upwards of 4 mg of ativan via intravenously, which is WAAAAY stronger than an oral dose)

Don't worry about dependancy so much. 0.25 is an extremely low dose, and you're not taking it reguarly. You would have to take a much higher amount, and for weeks, in order to put yourself at risk for dependancy.
posted by HabeasCorpus at 7:21 AM on March 3