Posted by ed_uk2010 on January 6, 2014, at 15:31:58
In reply to lorazepam » ed_uk2010, posted by sukarno on January 5, 2014, at 16:04:13
I dislike lorazepam. It causes less drowsiness than diazepam but I just find it pointless. It takes far too long to work to be effective for a panic attack. I do not have an hour to spare in this situation. And when it does work, it's crap, fuzzy head but still panicking, and no relief of muscle tension. Sublingual absorption is no more rapid than oral absorption - the alleged advantages of this route are a myth. At least it doesn't taste of anything. Oh, and I do not need amnesia thank you very much! Unlike diazepam, lorazepam has a relatively consistent duration of action of several hours, which is potentially useful in the elderly because diazepam tends to accumulate after a few days. Unfortunately, lorazepam causes withdrawal symptoms more readily than diazepam. The potential for misuse may be lower, however.
Clonazepam is another med I dislike. Tonnes of amnesia, negative mood, odd feelings of discomfort and anxiety, no relief of muscle tension.... and blah. Yuck.
Diazepam. Immensely rapid acting after an adequate dose eg. 10mg for an acute panic attack. Wears off extremely (and surprisingly) fast after single isolated doses, requiring frequent re-dosing every few hours. After regular use for a week or two, accumulation occurs and it becomes long-acting, you can then dose infrequently and taper the dose. Most doctors think diazepam is long-acting right from the start, which is generally incorrect, except perhaps for the very elderly or those with extremely low body weight. Diazepam is very highly lipid soluble. It's absorbed quickly, it penetrates the blood brain barrier quickly, but it's also redistributed to adipose tissue (fat) very quickly, terminating most of its effects. Only once accumulation has occurred does it become long-acting. Although diazepam has a long elimination half-life (as does its main metabolite), this only refers to elimination from the body. In reality, a single dose is redistributed to fat stores within a few hours and the sedative effect therefore disappears quickly, apart from a slight residual effect. Just because it's still in the body does not mean it's in the right place (ie. the brain)!
Temazepam. 20mg seems to start working after about 20 mins, and is (for me) an entirely reasonable hypnotic for short-term use ie. 1-2 weeks or PRN. Lower doses are not very sleep-inducing (but may be suitable for the elderly), higher doses tend to cause some next day drowsiness. Like diazepam, temazepam appears to produce muscle relaxation and relief of physical tension. It is sedating but in more of an anxiolytic manner like diazepam, as opposed to causing the nasty fatigued sensation than some meds do. Think trazodone or anything else that creates a next day 'run over by a bus' sensation.
poster:ed_uk2010
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URL: http://www.dr-bob.org/babble/20140104/msgs/1057988.html