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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by John on February 19, 2000, at 12:29:48
Although the mechanisms are all similar, there are substantive differences that I invite feedback over:
1. diazepam: Has a definitive onset of action, but the effect lasts shorter than others, although because of active metabolites, there is still sedating drug flowing: e.g. have a beer after a few days of 15mg/day and though perhaps 5 or more hours after the last pill, the accumulation is definite!
2. chlordiazepoxide: As I recall less 'effect' but equally anxiolitic, and less (half) as long lingering in the system (un-noted) until some other substance activates.. And so cheap.
3. clorazepate: This is something I have little recollection of but have read of its potentially incredible accumulative properties
4. clonazepam: Seems ideal for lack of rapid (flush) onset and questionable accumulation as established by at least No. 1 above.
5. alprazolam: So popular but why?
6. lorazepam: slow onset, but rapidly out and... by FAR THE WORST 'withdrawal' of any and after very short course of therapy. What is it about this one that is so MISERABLE (in the end)
7. bromazepam seems like another ideal one as clonaz but no US.
Posted by Cam W. on February 19, 2000, at 13:11:16
In reply to Comparing benzos - your experiences please.., posted by John on February 19, 2000, at 12:29:48
> Although the mechanisms are all similar, there are substantive differences that I invite feedback over:
>
> 1. diazepam: Has a definitive onset of action, but the effect lasts shorter than others, although because of active metabolites, there is still sedating drug flowing: e.g. have a beer after a few days of 15mg/day and though perhaps 5 or more hours after the last pill, the accumulation is definite!
>
> 2. chlordiazepoxide: As I recall less 'effect' but equally anxiolitic, and less (half) as long lingering in the system (un-noted) until some other substance activates.. And so cheap.
>
> 3. clorazepate: This is something I have little recollection of but have read of its potentially incredible accumulative properties
>
> 4. clonazepam: Seems ideal for lack of rapid (flush) onset and questionable accumulation as established by at least No. 1 above.
>
> 5. alprazolam: So popular but why?
>
> 6. lorazepam: slow onset, but rapidly out and... by FAR THE WORST 'withdrawal' of any and after very short course of therapy. What is it about this one that is so MISERABLE (in the end)
>
> 7. bromazepam seems like another ideal one as clonaz but no US.John - Just to start out, the worst withdrawl from long-term benzodiazepine use is Halcion (triazolam). All Benzodiazepines (BZDs) have different pharmacokinetics (absorption, metabolism, distribution and excretion). It is the differences between these factors that account for the differences in each BZD's activity in the body.They all do exactly the same thing to the GABA receptor. They bind to the GABA receptor and better facilitate GABA's binding (GABA now binds easier to the receptor, thus facilitating its inhibitory control over other neurons.) - Cam W.
Posted by Alan on February 19, 2000, at 13:18:26
In reply to Comparing benzos - your experiences please.., posted by John on February 19, 2000, at 12:29:48
> Although the mechanisms are all similar, there are substantive differences that I invite feedback over:
>
> 1. diazepam: Has a definitive onset of action, but the effect lasts shorter than others, although because of active metabolites, there is still sedating drug flowing: e.g. have a beer after a few days of 15mg/day and though perhaps 5 or more hours after the last pill, the accumulation is definite!
>
> 2. chlordiazepoxide: As I recall less 'effect' but equally anxiolitic, and less (half) as long lingering in the system (un-noted) until some other substance activates.. And so cheap.
>
> 3. clorazepate: This is something I have little recollection of but have read of its potentially incredible accumulative properties
>
> 4. clonazepam: Seems ideal for lack of rapid (flush) onset and questionable accumulation as established by at least No. 1 above.
>
> 5. alprazolam: So popular but why?
>
> 6. lorazepam: slow onset, but rapidly out and... by FAR THE WORST 'withdrawal' of any and after very short course of therapy. What is it about this one that is so MISERABLE (in the end)
>
> 7. bromazepam seems like another ideal one as clonaz but no US.***********************************************
Yeah, the Ativan if not properly managed has a withdrawl like Xanax but it is by far the least sedating for me and in my job that's essential. I've tried all of the others but they also make me clumsy. It really is an individual thing.As far as Ativan being the worst for withdrawl, I've heard reports on this board of withdrawl that's just as bad on long acting Klonopin for some people. How about reports of withdrawl from Paxil, Effexor, etc? Don't ever hear that these are addicting drugs...but people are certainly dealing with withdrawl symptoms.
After long (or short)term treatment with the shorter half life benzos, smaller doses of Neurontin (a mood stabilizer with a low side effect profile) can ease the tapering down period.
Ativan has a very rapid onset for me (15 - 20 min) and even faster if held under the tongue or taken with a carbonated beverage on an empty stomach.
Alan
***********************************************
Posted by judy on February 19, 2000, at 16:56:02
In reply to Re: Comparing benzos - Ativan (loraz.), posted by Alan on February 19, 2000, at 13:18:26
Hi,
Xanax had the worst withdrawal for me, but had the quickest onset. Ativan was somewhere in the middle, but klonopin worked best for panic attacks and some mood stabilization. Despite numerous attempts, I've never been able to stop klonopin w/o significant withdrawal- despite slow tapering outpatient or in hospital (with clonidine). What are you taking a benzo for? Sometimes the relief it supplies especially for panic attacks outweighs any negatives. Take care.
Posted by Alan on February 19, 2000, at 18:16:28
In reply to Re: Comparing benzos - Ativan (loraz.), posted by judy on February 19, 2000, at 16:56:02
> Hi,
> Xanax had the worst withdrawal for me, but had the quickest onset. Ativan was somewhere in the middle, but klonopin worked best for panic attacks and some mood stabilization. Despite numerous attempts, I've never been able to stop klonopin w/o significant withdrawal- despite slow tapering outpatient or in hospital (with clonidine). What are you taking a benzo for? Sometimes the relief it supplies especially for panic attacks outweighs any negatives. Take care.*********************************************
I'm taking for social phobia. Works wonderfully for me....just have to manage carefully. I augment with a little Neurontin to alleviate the symptoms of the ativan going in and out of my system when situations aren't presenting themselves (away from work environment). The Neurontin stabilzes my mood during those periods. Also ativan for specific phobia.
Alan
**********************************************
Posted by Jan on February 19, 2000, at 20:34:37
In reply to Comparing benzos - your experiences please.., posted by John on February 19, 2000, at 12:29:48
Although the mechanisms are all similar, there are substantive differences that I invite feedback over:
1. diazepam: Has a definitive onset of action, but the effect lasts shorter than others, although because of active metabolites, there is still sedating drug flowing: e.g. have a beer after a few days of 15mg/day and though perhaps 5 or more hours after the last pill, the accumulation is definite!**I've never tried this benzo, which I belive is Valium.
2. chlordiazepoxide: As I recall less 'effect' but equally anxiolitic, and less (half) as long lingering in the system (un-noted) until some other substance activates.. And so cheap.
**Nor this one, and don't even know the brand name, although I suspect it is Librium.
3. clorazepate: This is something I have little recollection of but have read of its potentially incredible accumulative properties**Believe this is Tranxene. I tried that for several months, but it really didn't do much for me except make me want to try a more potent benzo ... it had little more than a placebo effect on anxiety and social phobia. My understanding is that it works similarly to Valium.
4. clonazepam: Seems ideal for lack of rapid (flush) onset and questionable accumulation as established by at least No. 1 above.**I took this for 6 months. I had depressive side effects from this drug, but it worked great on anxiety, panic, and social phobia. It wasn't as long-lasting (at least in my body) as I had been led to believe or hope. I did have a few memory problems while taking it, and often felt like my brain was functioning in a fog. I was able to go off of it by taking a similar strength of Xanax. I'm thinking of trying it again.
5. alprazolam: So popular but why?
**I take this now. It works quickly, and lasts for me about 4 hours. It gets the job done with no sedation or memory problems, and works well on anxiety, panic, and social anxiety, but not as well as Klonopin. Does anybody know if and when the USA will ever approve Xanax XR??? If so, I would be the first to sign up to try it.
6. lorazepam: slow onset, but rapidly out and... by FAR THE WORST 'withdrawal' of any and after very short course of therapy. What is it about this one that is so MISERABLE (in the end)
**For some reason, my pdoc refuses to let me try this benzo. He said it's not made for panic, and doesn't work as well as Xanax on anxiety. Maybe if I begged him he'd let me try it, but for now I won't bug him about it. Actually, I've heard the opposite about Ativan ... that the withdrawal is easier than for Xanax. Although I have weaned off Xanax, it was not a fun experience.
7. bromazepam seems like another ideal one as clonaz but no US.**Never heard of it.
Posted by Sef on February 19, 2000, at 21:37:29
In reply to Comparing benzos - your experiences please.., posted by John on February 19, 2000, at 12:29:48
> 6. lorazepam: slow onset, but rapidly out and... by FAR THE WORST 'withdrawal' of any and after very short course of therapy. What is it about this one that is so MISERABLE (in the end)
This one, I took (Ativan) with prozac for anxiety. It helped my anxiety and had a side effect of diminishing my craving for cigarettes. I told my pdoc about this and he let me take it 3x a day for 3 weeks, then tapered me off of it. I had no adverse withdrawal from the ativan and remained cigarette free for 5 months after discontinuing the Ativan....but then started smoking again. I still had an old RX of Ativan so I tried to do it again...but for some reason now the Ativan only makes me sleep. Maybe because my RX is over 1 year old? For what it's worth, that was my experience.
This is the end of the thread.
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