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Re: why isn't Valium prescribed more??? » sdb

Posted by yxibow on August 27, 2006, at 5:50:50

In reply to Re: why isn't Valium prescribed more???, posted by sdb on August 25, 2006, at 18:15:04

> I don't understand why there's no prazepam or ketazolam available in the US. Ketazolam has proven to be better than diazepam. The substance ketazolam itself has a longer half-life than diazepam, some ketazolam is metabolized in diazepam and at the end there are the active nordiazepam metabolites. Ketazolam could be a very good drug to come off from all benzos. Diazepam included. In would be a good maintenance treatment also. Ketazolam has very flat plasma-levels.
>
> Prazepam is said to possess even antidepressant properties itself. Plasma-levels are flat because of slow resorption.
>
> Benzodiazepines are actually very useful drugs. I don't understand all the discussions of addiction.
> Benzos are used everyday in hospital. I don't think benzos cause much physical dependency (increased dopamine transmission in some areas in the brain, changes in plasticity).
>
> IMO every drug will cause dependency if the substance works. Furthermore one should differentiate of physical or mental dependency.
>
> There was a discussion recently of great concern relating SSRI dependency in the news. I was only laughing.
>
> It's a shame that somebody must have a bad conscience using a benzo if he only treats a problem.
>
> Many docs treat panic attacks with imipramine. Imipramine is a good deal more dangerous for the body than a low dosage treatment with benzodiazepines.
>
> It was no astonishment for me that I saw a woman with total noncompliance under imipramine, clomipramin coming in to the hospital every second week again and again.
>
> The problem is that if a constant anxiety patient with failure of other treatments or pychotherapy has taken benzos, the patient will no more abandon because of its relieving effects.
>
> But nevertheless there should be a clear diagnosis (!) before prescribing benzos.
>
> Clonazepam is an effective drug for anxiety, panic attacks. But it makes absolutely no sense to prefer clonazepam over diazepam on principle only because of some studies done in Durham, N.C.
>
> Opinions may vary.


Some of the more esoteric benzodiazepines were not bothered to be marketed here -- there are literally more than 2 dozen and some have been discontinued for years because the market is full with plentiful 1,4 benzodiazepines since they since they were first discovered in 1958.


Some are not here for good reason -- they discovered liver problems early on and were withdrawn from the US market or most likely entirely worldwide.


All benzodiazepines, with the exception of the esoteric clobazam (Canada and other countries), are 1,4 benzodiazepine derivatives. Clobazam is a 1,5 benzodiazepine and binds slightly differently to parts of GABA.


Its basically a marketing issue and general trends in prescribing that have determined what benzodiazepines (including some older, more esoteric ones) have remained on the US market. (And this is generic trends largely since the 80s with the exception of Xanax XR).

 

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