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Re: Xanax

Posted by sukarno on March 17, 2010, at 0:27:14

In reply to Re: Xanax » floatingbridge, posted by Phillipa on March 16, 2010, at 23:56:46

Yeah, lorazepam (Ativan) is short-acting, but intermediate in its onset. Everyone is different though, but when I took Ativan for sleep I remember nothing happening until almost an hour later so I took another one. I slept like a baby when it finally kicked in and when I woke up I could almost hear music playing in my head (very foggy headed).

The advantage of lorazepam, as Phillipa pointed out, is there are no drug interactions. Lorazepam does not interact with the P450 liver enzyme system. It can be given to those with liver problems without fear of accumulation.

Alprazolam (Xanax) is metabolised by CYP3A4 and interacts with many medications (those that are also metabolised by CYP3A4), such as fluvoxamine (Luvox) and even grapefruit juice. Kava-kava should never be taken whilst on Xanax. There were a few reports of folks passed out who took Xanax along with Kava-kava or who added Kava-kava to their existing Xanax regimen.

Alprazolam binds very tightly to the GABA receptor complex relative to other BZDs. It is thought, although perhaps controversial, that it might target a subset of GABA receptors that diazepam does not. Thus, diazepam seems not to have full cross tolerance with alprazolam. This is controversial though. Some say that diazepam will suppress all withdrawal symptoms and will switch their patients directly to diazepam from alprazolam. Other physicians will perform a cross taper.

I'm not sure whether lorazepam has the same or worse withdrawal than Xanax. They are both very potent BZDs, although Xanax is approximately twice as potent (roughly 1mg alprazolam = 2mg lorazepam, although this can vary from patient to patient).

Halcion (triazolam) supposedly has the worst withdrawal syndrome if abused and taken regularly. Some patients would take it throughout the day instead of using it as a sleep aid. One patient abused it to the tune of 14mg/day and discontinued it abruptly. The patient was given IV chlordiazepoxide (Librium), but still experienced a seizure despite coverage from Librium. I can't remember whether this patient died or not.

Death from discontinuation of BZDs, even Xanax, is rare in the medical literature, despite the seizure risk. However, there was a female patient who had taken [xxx]mg Xanax for one week and went through acute withdrawal in the ER, presenting with all the symptoms of withdrawal and high fever.

This patient was not adequately treated by the hospital and unfortunately died due to a series of epileptic fits.

[xxx]mg is an extreme amount (almost [xxx]mg/day!).

In the literature, there are a few reports of deaths due to status epilepticus from abrupt withdrawal (and one report of seizure during tapering).

With diazepam I believe this is unheard of. Seizures can happen with diazepam withdrawal, but much less so than with alprazolam.

I was forgetful one night and skipped one of my Xanax doses. I couldn't understand why I was hyperventilating and feeling like I was going to "lose my mind" until I looked at the clock and realised it had been 2 or 3 hours since I was supposed to take my medication.

I would rather take Xanax XR instead as a friend of mine told me it is less sedating and has far less peaks and valleys, but the price is exorbitant. I think it is almost USD$2 per tablet. I would have to take two 2mg XR tablets, which would cost me $4/day. :-(


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URL: http://www.dr-bob.org/babble/20100305/msgs/939771.html