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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by colin wallace on April 5, 2002, at 4:41:11
Could anyone recommend an alternative benzo. to diazepam? I only take between 2.5 and 5 mg for residual anxiety, and took .75 mg xanax prior to this, with good effect.I changed to diazepam(longer half-life)with the aim of ditching benzos completely, but as I'm faring quite well on such a low dose, I've changed my mind.(I previously suffered very severe depression- accompanying anxiety, necessitating 4mg xanax daily).
I believe I feel slightly groggier on diazepam than I did on xanax, and am contemplating switching back to a low dose xanax- but I'm not too familiar with the qualitative differences in benzos (other than what I've read, and I'd prefer personal insights as to how they 'feel'!)
I'm fairly familiar with their pharm. properties, in theory.(I sleep reasonably well too, so that's not an issue really).
Any suggestions welcome.Col.
Posted by Elizabeth on April 5, 2002, at 8:35:30
In reply to Benzo Preferences anyone??, posted by colin wallace on April 5, 2002, at 4:41:11
There really isn't much consistent qualitative difference between one benzo and another. For example, some people might find diazepam more sedating than lorazepam, others the reverse. Alprazolam usually has more antidepressant effect than the other benzos, that's the only thing I can think of (triazolam causes more amnesia than the other benzos, IMO, but that one's only used for sleep).
Duration of action is one characteristic that differs from one benzo to the next in a predictable way. Because of differences in volume of distribution, elimination half-life isn't a very good predictor of duration of action. (Diazepam, for example, is rapidly taken up into the CNS, then redistributed throughout the body.) Clonazepam is a good choice if you're looking for something long-acting.
Could you be a little more specific as to what you're looking for in a benzo?
-elizabeth
P.S. 4 mg/day of Xanax isn't a terribly unreasonable dose. I've heard of people taking as much as 10 mg/day (the high-end doses are mostly for panic disorder or anxiety + depression), and I typically need 2 mg at a time (I only take it on a prn basis).
Posted by Ritch on April 5, 2002, at 9:22:57
In reply to Benzo Preferences anyone??, posted by colin wallace on April 5, 2002, at 4:41:11
> Could anyone recommend an alternative benzo. to diazepam? I only take between 2.5 and 5 mg for residual anxiety, and took .75 mg xanax prior to this, with good effect.I changed to diazepam(longer half-life)with the aim of ditching benzos completely, but as I'm faring quite well on such a low dose, I've changed my mind.(I previously suffered very severe depression- accompanying anxiety, necessitating 4mg xanax daily).
> I believe I feel slightly groggier on diazepam than I did on xanax, and am contemplating switching back to a low dose xanax- but I'm not too familiar with the qualitative differences in benzos (other than what I've read, and I'd prefer personal insights as to how they 'feel'!)
> I'm fairly familiar with their pharm. properties, in theory.(I sleep reasonably well too, so that's not an issue really).
> Any suggestions welcome.
>
> Col.You might try a switch from diazepam to chlordiazepoxide (10-20mg/day). You won't get as much of a *drunk*, sedated feeling from it as you do the diazepam, and it also has a rather lengthy half-life. I have also heard someone here say that oxazepam was somewhat on the mild side.
Posted by colin wallace on April 5, 2002, at 10:06:03
In reply to Re: Benzo Preferences anyone??, posted by Elizabeth on April 5, 2002, at 8:35:30
Thanks Elizabeth/Ritch for the responses.
To clarify(qualitative differences), what I was concerned about was whether one benzo. may be more appropriate for low dose/long term administration than another, or have individual traits making (one) more or less desirable in these circumstances(Elizabeth, you have answered that for me)>In particular, whether one may be less likely to exacerbate depression with long-term use (although, at my low-end dose range, this probably won't be a big concern).
I have a GP. who is trying to badger me into discontinuance, but I'm standing my ground, not least because of the undoubted clinical improvement they (benzo's) have been able to provide in my case.I'll ditch them as and when I'm ready-if I want to!
Posted by Ritch on April 5, 2002, at 13:54:02
In reply to Re: Benzo Preferences anyone??, posted by colin wallace on April 5, 2002, at 10:06:03
> Thanks Elizabeth/Ritch for the responses.
>
> To clarify(qualitative differences), what I was concerned about was whether one benzo. may be more appropriate for low dose/long term administration than another, or have individual traits making (one) more or less desirable in these circumstances(Elizabeth, you have answered that for me)>In particular, whether one may be less likely to exacerbate depression with long-term use (although, at my low-end dose range, this probably won't be a big concern).
> I have a GP. who is trying to badger me into discontinuance, but I'm standing my ground, not least because of the undoubted clinical improvement they (benzo's) have been able to provide in my case.I'll ditch them as and when I'm ready-if I want to!Colin,
There was a discussion about long-term effects of taking benzos with relation to liver function. Someone's Dad had a bad liver and needed some anxiety med and I think Sunnelly mentioned that Ativan (lorazepam) isn't appreciably metabolized by the liver. Also, from what I remember the samples I got once mentioned anxiety associated with depression as an indication. It can make you pretty loopey though-you might need just a very small dose. I unwittingly stole a spice shaker out of a Pizza Hut once and didn't realize it till I was out of the building-holding it and looking at it.
Mitch
Posted by colin wallace on April 5, 2002, at 15:09:40
In reply to Re: Benzo Preferences anyone?? » colin wallace, posted by Ritch on April 5, 2002, at 13:54:02
I have to say that I like the sound of that-I could get into Pizza-Hut shaker racketeering, and have the perfect legal defence...
Posted by andyboy on April 5, 2002, at 16:20:29
In reply to Benzo Preferences anyone??, posted by colin wallace on April 5, 2002, at 4:41:11
colin
klonopin (2mg/day) has done wonders for me if you are seeking another benzo. we all react differently obviously to different meds, but my life is back-and i owe it all to the benefits this med has provided me with. its been about a year and the theraputic effects are still 100%, although the side effects (sleepiness, ataxia, slurred speech, etc.) lasted only a month or so. I actually kind of miss feeling that disinhibited as it was the first time i had felt that carefree in years.
as always, good luck
andy
Posted by pharmer on April 6, 2002, at 1:43:19
In reply to Benzo Preferences anyone??, posted by colin wallace on April 5, 2002, at 4:41:11
Hi Collin,I've been taking clonazepam 0.5mgtid for 11 yrs.with great results and no side effects at all. I find that it has an excellent ability to "block" panic attacks ,which inturn,has helped myself to cope with my chronic anxiety. At one time-many moons ago,I was taking 2mgtid along with 150mg of clomipramine. I felt extremely aggitated and gradually reduced down to my current dose. I also was able to wean myself off of it with minimal withdrawl. I'm currently taking effexor 150mg with the clonazepam as I find it to be a great mood stabilzer. I tried zanax and ativan but didn't like the "up and down" feeling I felt. Hope this helps. Rick.
Posted by andyboy on April 6, 2002, at 12:16:01
In reply to Re: Benzo Preferences anyone??, posted by pharmer on April 6, 2002, at 1:43:19
rick
its comforting to hear about someone who has had long-term success with klonopin (11 yrs.) I too have found it extremely theraputic and i was tired of hearing all the anti-benzos say it will stop working!" I suffered so with with the panic/anxiety and its comforting to know that i should be good for the long haul.
thanx
andy
Posted by colin wallace on April 6, 2002, at 14:03:40
In reply to Re: Benzo Preferences anyone?? » pharmer, posted by andyboy on April 6, 2002, at 12:16:01
Thanks for the input guys- appreciate it.I'll probably give Klonopin a whirl myself, as it seems to fit what I'm after.
Col.
Posted by geno on April 6, 2002, at 19:36:17
In reply to Re: Benzo Preferences anyone?? » pharmer, posted by andyboy on April 6, 2002, at 12:16:01
From what i gather, .5mg of xanax is equal to 1mg of klonopin or 10mg of valium. The other difference is xanax hits you quicker, klonopin takes longer and last longer. Valium last the longest and is the most sedating, while klonopin is in the middle, and xanax the least sedative.
Also, klonopin may have some 5ht properties, thus depressed persons will do better on klonopin.Geno
Posted by mike21 on April 7, 2002, at 8:39:59
In reply to Re: Benzo Preferences anyone??, posted by geno on April 6, 2002, at 19:36:17
> Also, klonopin may have some 5ht properties, thus depressed persons will do better on klonopin.
Geno,
I've heard the same thing regarding klonopin and 5ht but have been unable to find data to substantiate this. Can you refer me to any studies, etc. that back this up?
Mike
Posted by Elizabeth on April 7, 2002, at 23:06:34
In reply to Re: Benzo Preferences anyone?? » colin wallace, posted by Ritch on April 5, 2002, at 13:54:02
Ativan is the preferred benzo for people with liver disease. To the best of my knowledge, people with healthy livers don't need to be concerned. Benzos are pretty safe, in the long term as well as the short term.
Some people do find that Ativan causes more amnesia than most other benzos do (I personally never had a problem with it). Interestingly, Ativan and Halcion both have an extra chlorine atom in the same place. This might just be a coincidence, but Halcion is another benzo known for causing memory problems.
Sometimes you'll hear of somebody saying that benzos made them depressed. I'm not convinced that this is all that common; but anyway, Xanax is probably the best benzo to take if you have a history of getting depressed on benzos.
Klonopin is nice and long-acting, which makes it more convenient than most benzos. Valium isn't very long-acting for the reasons I mentioned, even though it's metabolized into nordiazepam, which is very long-lived.
For panic disorder and generalized social phobia, the high-potency benzos are preferred: Xanax, Klonopin, Ativan. I'm not sure if they're superior in other conditions.
-elizabeth
Posted by mike21 on April 8, 2002, at 19:32:12
In reply to Re: Benzo Preferences anyone??, posted by Elizabeth on April 7, 2002, at 23:06:34
>
> Klonopin is nice and long-acting, which makes it more convenient than most benzos. Valium isn't very long-acting for the reasons I mentioned, even though it's metabolized into nordiazepam, which is very long-lived.
>
Elizabeth,When you say valium isn't long-acting for reasons mentioned, I assume you are referring to the previous post where you said it is rapidly taken up into the CNS then redistributed.
Is nordiazepam just another type of benzo with varying effects for various people? Does it have any specific properties which make it different from other benzos?
You'll recall from a recent post that I have had success with benzos- specifically it has been valium for me. I've tried xanax but for me a benzo has to be long acting, or the fluctuation in blood levels is unpleasant. I am thinking that "if it ain't broke, don't fix it," but I am interested in the number of raves about klonopin on this board. Also, it is maybe 10 times(?) more potent than valium, so I'm thinking over the long haul, it would be a better choice- less for my liver to metabolize.
This next question probably falls under "YMMV" but would you expect valium or klonopin to have a longer therapeutic half-life? I've heard valium is 20-200 hours half-life, which based on your previous statement must include its metabolites. I've heard for a young person this number is probably closer to 24 hours. I've heard klonopin is in the 18-30 hours range. Sounds like for someone with fairly high metabolism their effective half-lives could be pretty close.
Do you have any thoughts?
Mike
Posted by Elizabeth on April 10, 2002, at 12:35:58
In reply to Re: Benzo Preferences anyone?? » Elizabeth, posted by mike21 on April 8, 2002, at 19:32:12
> Is nordiazepam just another type of benzo with varying effects for various people?
Yes. Librium and Tranxene, as well as Valium (and many benzos that aren't in clinical use), are metabolized to nordiazepam. In fact, Tranxene basically *is* nordiazepam -- it's metabolized in the stomach.
> ...I am thinking that "if it ain't broke, don't fix it," but I am interested in the number of raves about klonopin on this board. Also, it is maybe 10 times(?) more potent than valium, so I'm thinking over the long haul, it would be a better choice- less for my liver to metabolize.
I don't know how much of a difference that makes -- that'd be a good question to ask your doctor. Still, I think it'd be perfectly fine to follow your "if it ain't broke..." reasoning. (Consider that I take 375 mg/day of Effexor and 1200 of Trileptal with no liver problems.)
> This next question probably falls under "YMMV" but would you expect valium or klonopin to have a longer therapeutic half-life?
You mean duration of action? Klonopin. Valium generally doesn't last nearly as long as you'd expect it to based only on its half-life. An elimination half-life is based on the assumption that the concentration is the same everywhere in the body. Klonopin is distributed very differently from Valium and the like, and the result is that it lasts longer. (Other benzos that resemble Klonopin in their volumes of distribution include flunitrazepam (Rohypnol) and nitrazepam (Mogadon).)
-elizabeth
Posted by mike21 on April 13, 2002, at 9:17:11
In reply to Re: Benzo Preferences anyone?? » mike21, posted by Elizabeth on April 10, 2002, at 12:35:58
>Klonopin is distributed very differently from Valium and the like, and the result is that it lasts longer. (Other benzos that resemble Klonopin in their volumes of distribution include flunitrazepam (Rohypnol) and nitrazepam (Mogadon).)
>
> -elizabethI was unaware that benzos had different ways of being distributed. I will be researching it now. If you know of any good resources about that, online or otherwise, please let me know. I might have more questions for you in the future. As always, I appreciate your info.
Mike
Posted by troutslayer on February 14, 2005, at 17:16:22
In reply to Re: Benzo Preferences anyone?? » mike21, posted by Elizabeth on April 10, 2002, at 12:35:58
Any first time or infequent users of benzos have any experience with Rohypnol without alcohol ?
What kind of hangover or morning residual can I expect ? I don't want to feel dopey or unable to function. I'm talking 1 or 2 mg.
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