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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 banxious on August 30, 2002, at 22:21:44
Hello everyone,
I posted previously about anxiety spiraling out of control while taking bromazepam (not available in US), and asked for suggestions/advice. I have now ended up on Xanax. My pdoc has prescribed 1mg tid. I still find I am having breakthrough anxiety related to lifechanging events coming up in the very short term. I have only been taking benzos regularaly for about 3-4 weeks. Previously it was all very occasional prn usage. My questions are:
1) What else can I do? Increase the dose temporaraily until this upcoming anxiety trigger subsides?
2) I am unsure of the amount of time I should be spacing my doses - as in how many hours between each of the three doses? or should I split my daily dose into qid dosing?Other meds: Remeron 30mg qhs, Gabapentin 1200mg tid
Thanks for any insights
Posted by alan on August 30, 2002, at 23:04:22
In reply to Xanax Dosage, posted by banxious on August 30, 2002, at 22:21:44
> Hello everyone,
> I posted previously about anxiety spiraling out of control while taking bromazepam (not available in US), and asked for suggestions/advice. I have now ended up on Xanax. My pdoc has prescribed 1mg tid. I still find I am having breakthrough anxiety related to lifechanging events coming up in the very short term. I have only been taking benzos regularaly for about 3-4 weeks. Previously it was all very occasional prn usage. My questions are:
> 1) What else can I do? Increase the dose temporaraily until this upcoming anxiety trigger subsides?
> 2) I am unsure of the amount of time I should be spacing my doses - as in how many hours between each of the three doses? or should I split my daily dose into qid dosing?
>
> Other meds: Remeron 30mg qhs, Gabapentin 1200mg tid
> Thanks for any insights
----------------------------------------------
Anxiety levels wax and wane for me and my dosage traces that fluctuation. This is normal from all I've read and been told.It sounds like you either need to dose closer together or increase each dose. I do that in those circumstances and just take the medicine when I feel the anxiety. There is no rigid preset time to take each dose - otherwise you're just following an arbitrary schedule that does not take into account your personal rhythms and circumstances.
Of course you should bounce this off your doctor first.
You may want to read first:
http://panicdisorder.about.com/library/weekly/aa031997.htm
Best to you,
Alan
Posted by missliz on August 31, 2002, at 3:10:47
In reply to Re: Xanax Dosage » banxious, posted by alan on August 30, 2002, at 23:04:22
This really is a doctor question- xanax lasts about six hours, and if it isn't working then you may need a doseage adjustment. Moving the doses closer together just exacerbates tolerance and dependency risks. Maybe you need to go to therapy? Just running ones mouth about anxiety producing stuff will blow off a lot of steam and help you get along 'till this trauma passes. Xanax is a real bitch to get off of, so you don't want to take more than you need.
Perhaps a longer half life benzo like Klonopin or Valium would work better. Xanax wears off at the worst possible moment, and a longer action could make things smoother.Miss Liz
Posted by alan on August 31, 2002, at 12:03:53
In reply to Re: Xanax Dosage, posted by missliz on August 31, 2002, at 3:10:47
> This really is a doctor question- xanax lasts about six hours, and if it isn't working then you may need a doseage adjustment. Moving the doses closer together just exacerbates tolerance and dependency risks. Maybe you need to go to therapy? Just running ones mouth about anxiety producing stuff will blow off a lot of steam and help you get along 'till this trauma passes. Xanax is a real bitch to get off of, so you don't want to take more than you need.
> Perhaps a longer half life benzo like Klonopin or Valium would work better. Xanax wears off at the worst possible moment, and a longer action could make things smoother.
>
> Miss Liz
------------------------------------------
While going to a good therapist is always recommended before or during xanax therapy, finding the theraputic dose does not necessarily mean sticking to an arbitrarily set time schedule for dosing. Nor does increasing the frequency of the dose pose any risk of someone becoming "addicted" (please read link in my prior post).Finding a theraputic dose for one's existing level of anxiety is what confuses a lot of people and some doctors. An individual's metabolism will determine the effective (theraputic) half-life of any drug - especially the shorter half-life versions. This could be anywhere between 4 - 8 hours in the case of xanax.
Rapidly escallating doses are extremely rare and would be obvious to the individual and doctor. There is a hypersensitivity to ANY dose increase arbitrarily set by a doctor who might be either misinformed or inexperienced with the routines of the panic population. It is OK for the dose to be adjusted upwards to find the theraputic dose. For the panic population, it is by far more common to start at a higher dose and eventually adjust downwards over time. This is certainly true in my case with ativan.
As far as withdrawl, there is always a way out. Slowly tapering the xanax while augmenting with klonopin or sometimes valium in the proper proportions and proper rate makes the taper relatively more comfortable.
Bzds have different theraputic effects for each individual. Therefore, xanax may be much more effective for some than ativan, valium, or klonopin. That's why many times it is not as simple as trying a longer acting version.
Sure, it would be easier to dose less frequently with longer acting versions, but perhaps the shorter acting ones are much more effective in an individual case. Prescribing practices seem to suggest to me that there is no standard to which to refer.
Alan
Posted by judy1 on August 31, 2002, at 18:31:39
In reply to Xanax Dosage, posted by banxious on August 30, 2002, at 22:21:44
since you're on the roller coaster ride of xanax (which i happen to think is the best benzo for panic disorder), you may want to try (like the other posters suggested) klonopin and then take xanax prn- i always take it sub-ling so (despite the nasty taste) it starts working in 5-10 minutes. i also agree that panic waxes and wanes and that's why i don't mess with my klonopin dose but do increase and decrease the xanax when appropriate. take care and good luck- judy
Posted by banxious on August 31, 2002, at 20:51:02
In reply to Re: Xanax Dosage » banxious, posted by judy1 on August 31, 2002, at 18:31:39
Actually, the benzo is for GAD/SP.
I found Klonopin (Rivotril here in Canada) to be like a heavy sedative, no anxiolytic effect.
Having tried bromazepam and having a bad reaction to lorazepam, and knowing that the longer half life benzos (ie. Valium/Tranxene) are not particularly effective for SP, I have gone to Xanax as a last resort.
I finally figured out that instead of worrying about dependency and taking much smaller doses than prescribed, I should just go to the full mg TID and set a date in 2-3 weeks time to do a little taper with a benzo with a longer half life.
My pdoc doesn't seem to have a problem keeping me on the Xanax long term (he gave me 600 0.5 mg tabs at once), but I am concerned about the long term effects of cognition and memory.Brian
> since you're on the roller coaster ride of xanax (which i happen to think is the best benzo for panic disorder), you may want to try (like the other posters suggested) klonopin and then take xanax prn- i always take it sub-ling so (despite the nasty taste) it starts working in 5-10 minutes. i also agree that panic waxes and wanes and that's why i don't mess with my klonopin dose but do increase and decrease the xanax when appropriate. take care and good luck- judy
Posted by judy1 on September 1, 2002, at 13:37:38
In reply to Re: Xanax Dosage, posted by banxious on August 31, 2002, at 20:51:02
you seem very typical of my pdoc's patients, for some reason they hate the thought of taking their meds, or at least the full dose. i never found xanax a problem with memory (and i've tried all the benzos), but i do have problems with klonopin and memory. i guess the ability (for me) to leave my house alone and to be able to drive, far outweigh any possible side-effects. i wish you the best- judy
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