Posted by ed_uk on June 21, 2005, at 10:22:15
In reply to Re: Flumazenil: an option for Paul???, posted by Paul Smith on June 20, 2005, at 20:38:51
Hi Paul,
When you took diazepam the first time around, before you tapered, did you ever take as much as 40mg?
Do you take the diazepam as a single daily dose or in divided doses? Perhaps you could try taking 10mg four times a day to minimise fluctuations in your blood level - which might lead to withdrawal symptoms.
Apart from diazepam, are you on any other medication at the moment? Even if you can't withdraw, treatment with an anticonvulsant such as Tegretol or Neurontin might be effective in relieving some of your symptoms. I think you need to be evaluated by a neurologist if at all possible.
Here is my *theory*..........
Your brain has adapted to the presence of diazepam .........but the adaptations are in excess of what would have been necessary to 'cancel out' the anxiolytic/sedative effect of diazepam. As a result, you are experiencing 'withdrawal symptoms' despite the fact that you're on a high dose of diazepam.
I came up with this theory because of what can occasionally happen with other drugs of dependence eg. opioids..........
For example, opioid analgesics are used to treat severe pain. In the long term, tolerance to the pain-relieving properties of opioids develops in some patients (but not others). Increasing the dose is usually effective in restoring the effectiveness of opioids. However, a few patients develop 'paradoxical' pain when the dose in increased. It is thought that the brain's adaptations to the opioid may in some cases exceed that which would have been necessary to simply reverse the pain-relieving properties of the opioid. As a result, the pain gets worse despite the fact that the dose has been increased - this phenomenon is known as hyperalgesia.
RE opioids.........
'One consequence of repeated drug administration is the development of adaptations in the nervous system, sometimes termed 'drug-opposite' responses. During administration, the effects of the drug are diminished by these adaptations (tolerance), while cessation of drug use results in the emergence of these drug-opposite responses as the withdrawal syndrome..............While opioids.......produce analgesia, people with a history of opioid self-administration are hypersensitive to certain kinds of pain during the time they are under the influence of the analgesic drug. This suggests that in pain systems, the drug-opposite response exceeds the pain inhibiting effect of the drug itself. This hyperalgesia is evident in people with a history of heroin use and is not modified by methadone or buprenorphine treatment but is reduced by long-term abstinence from opioids. This same pattern of the drug-opposite response exceeding the drug effect may also occur for mood. While opioids cause elevation of mood, commonly described as euphoria and reduction of emotional distress, methadone maintenance participants show significant negative mood disturbance relative to controls. Thus, for pain and mood, the chronic opioid user under the influence of the drug does not experience an opioid effect diminished by tolerance but a state opposite to the effect of the drug.'
I suggested flumazenil (for you) because it might be able to 'reset' your benzodiazepine receptors and 'normalise' the function of your nervous system. I wonder whether there are any clinical trials of flumazenil (for benzo withdrawal) that you could join?
If you were able to withdraw from diazepam and obtain treatment with flumazenil, protracted withdrawal symptoms might be treated/prevented by flumazenil, allowing you to recover.
Other options........
When opioids produce hyperalgesia, switching to a different opioid in often effective in restoring pain relief. Since flumazenil treatment would be very difficult to obtain, trying a range of different benzodiazepines seems like a reasonable option. I know you've already tried clonazepam but didn't like it. Perhaps could try a different benzo.
>There are magic words you can say where they have to keep you 3 days minimum even if you do not have insurance, which will do little good but it is something.
I think you should ask to swap to a different benzo while you're in hospital. What about Xanax XR? If you don't want to switch, perhaps it would be best to return to 40mg diazepam eg. 10mg four times a day.
Kind regards,
Ed.
poster:ed_uk
thread:513250
URL: http://www.dr-bob.org/babble/wdrawl/20050611/msgs/516564.html