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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by jonh kimble on April 24, 2004, at 23:29:31
They both act on gaba, but different ways. Question: does frequent alcohol use decrease the effects of benzodiazepins? (Taken daily) Tough question maybe, but my guess is yes. Love to hear your brains input.
Tomee
Posted by chemist on April 24, 2004, at 23:50:23
In reply to DOES ALCOHOL INC. BENZO. TELOERANCE?, posted by jonh kimble on April 24, 2004, at 23:29:31
> They both act on gaba, but different ways. Question: does frequent alcohol use decrease the effects of benzodiazepins? (Taken daily) Tough question maybe, but my guess is yes. Love to hear your brains input.
> Tomee
chemist here.....benzos + booze = dependence. FACT. if you need to cool down with a small dose of a benzo and a beer, and have nothing to do in re: driving, forgetting conversations, and want to get some sleep, well then, okay. but be warned: the combo will exacerbate your dependence on benzos, which are *no party* to get off from...all the best, chemist
Posted by silmarilone on April 25, 2004, at 0:18:01
In reply to Re: DOES ALCOHOL INC. BENZO. TELOERANCE? » jonh kimble, posted by chemist on April 24, 2004, at 23:50:23
I thought alcohol INCREASED the effects of klonopin. Anyway, I took 25mg last night, and I want to stop. Is it ok to take 50mg of benadryl so I can sleep tonight? I still feel groggy of course from the klonopin but can't sleep since I slept all night last night and all day today. (see my previous post about wanting to stop klonopin, for the full story.)
Tomorrow morning I want to tqke my wellbutrin XL and drink coffee, and try to get back to normal. I have stuff to do t omorrow...
thanks
Posted by chemist on April 25, 2004, at 0:26:51
In reply to klonopin/alcohol/? HELP! » chemist, posted by silmarilone on April 25, 2004, at 0:18:01
> I thought alcohol INCREASED the effects of klonopin. Anyway, I took 25mg last night, and I want to stop. Is it ok to take 50mg of benadryl so I can sleep tonight? I still feel groggy of course from the klonopin but can't sleep since I slept all night last night and all day today. (see my previous post about wanting to stop klonopin, for the full story.)
>
> Tomorrow morning I want to tqke my wellbutrin XL and drink coffee, and try to get back to normal. I have stuff to do t omorrow...
>
> thanksumm, you took 25 mg of klonopin???!!!! not even in the range....yes, alcohol INCREASES the effect of klonopin, i thought my post was unambiguous. benzos + booze = dependence onset more rapidly and benzos + booze + increaded sedation, memory loss, stupid behavior, etc. 25 mg??!!! as for benadryl, diphenhydramine at 50 mg is fine as long as you are not throwing it on top of 25 mg klonopin.....plase, please tell me it is typo and that you did not take 25 mg klonopin......best, chemist
Posted by silmarilone on April 25, 2004, at 0:31:43
In reply to Re: klonopin/alcohol/? HELP! » silmarilone, posted by chemist on April 25, 2004, at 0:26:51
The manufacturer said max dose was 20mg (I guess for epilepsy) ...I took 5mg at noon and another 20 at 8pm friday night. just wanted to know if i can stop cold turkey (please see my previous thread for teh whole story about my klonopin use over the past 7 weeks or so.
thanks! you're a mensch
Posted by chemist on April 25, 2004, at 0:57:38
In reply to klonopin » chemist, posted by silmarilone on April 25, 2004, at 0:31:43
> The manufacturer said max dose was 20mg (I guess for epilepsy) ...I took 5mg at noon and another 20 at 8pm friday night. just wanted to know if i can stop cold turkey (please see my previous thread for teh whole story about my klonopin use over the past 7 weeks or so.
>
> thanks! you're a mensch
hi silmarilone....checked out the previous post and the advice contained in subsequent posts is fine. you are not in the abuse category: you are simply not being effectively affected by klonopin. for prn (pro re nata, as needed) dosing, valium is superior to ativan, although ativan has a longer effect once it gets across the blood/brain barrier. so yes, you can go cold-turkey. but you clearly need another med to address the issue, and my votes are valium, ativan, or xanax (sustained release). you have been toying with klonopin for less than a month, and at very, very varying doses. not to worry. be careful if you start riding the xanax train, as this is the most difficult drug to come off of, in that you cannot substitute valium, ativan, or any true benzodiazepene for it. based on your history, i'd try valium or ativan and use xanax prn for breakthrough panic, at 0.5 to 1.0 mg as needed.....hope this helps, please respond if any further clarification.....all the best, chemist
Posted by silmarilone on April 25, 2004, at 1:13:04
In reply to Re: klonopin » silmarilone, posted by chemist on April 25, 2004, at 0:57:38
Thanks very much for the reassurance. Are you saying I won't get the horrible withdrawals people talk about (insomnia, high anxiety, etc etc.?) That would be nice.
i get suicidal a lot so i don't want a lot of that type of drug around...maybe my doc will give me like 5 pills a month of xanax or something, so i can just use it in an emergency..?
thanks.
Posted by chemist on April 25, 2004, at 2:07:02
In reply to klonopin, posted by silmarilone on April 25, 2004, at 1:13:04
> Thanks very much for the reassurance. Are you saying I won't get the horrible withdrawals people talk about (insomnia, high anxiety, etc etc.?) That would be nice.
>
> i get suicidal a lot so i don't want a lot of that type of drug around...maybe my doc will give me like 5 pills a month of xanax or something, so i can just use it in an emergency..?
>
> thanks.hi there....contrary to popular belief, it is almost impossible to commit suicide with benzos: you will fall asleep first, and unless you are familiar with antiemetics, the booze+benzo OD is even less likely. i endorse your plan to go with a low supply of xanax for emergencies, but do consider a low doe (0.5-1.0 mg qd) of klonopin for maintainence and some 0.5 mg xanax for emergencies. as for suicide, forget it. remeber laren ann quinlan and quaaludes + vodka? vegetable. you will NOT accompish your untoward goal via benzos. if it will make you feel better, there is a little factor known as the LD_{50}, the lethal dose for 50% of the subjects. for klonopin, it is more than xxx. rest assured: stop klonopin cold-turkey, get some xanax, and look into ativan or valium for long-term maintenece....best, chemist
Posted by Tedar on April 25, 2004, at 11:43:39
In reply to Re: klonopin » silmarilone, posted by chemist on April 25, 2004, at 2:07:02
To Chemist: you mentioned in previous post to get off Klonopin cold turkey and get switched to ativan or Valiun long term. Why?
Posted by chemist on April 25, 2004, at 21:53:15
In reply to Re: klonopin, posted by Tedar on April 25, 2004, at 11:43:39
> To Chemist: you mentioned in previous post to get off Klonopin cold turkey and get switched to ativan or Valiun long term. Why?
hi tedar...klonopin is notorious for tolerance at about 6 months. valium - although it has suffered a bad rap since valley of the dolls - is quite excellent for long-term treatment, with little to no need for increased dosage, and is the second-oldest benzo on the market. ativan i recommend as an alternative, with a slower onset of action (for prn dosing ONLY) than valium, and tolerance does not seem to be a problem in the literature i have perused. to be frank, klonopin is a long, slow ride that halts after a while. valium continues to do the job - and alleviates the need for xanax, for instance - due to long half-life of elimination. ativan has a shorter retention time in your system, but again, i come back to (in my experience) no need for ramping up the dose....hope this is of help, and all the best, chemist
Posted by Viridis on April 26, 2004, at 1:18:47
In reply to Re: klonopin » Tedar, posted by chemist on April 25, 2004, at 21:53:15
"klonopin is notorious for tolerance at about 6 months"
I'm puzzled by this statement. I've taken Klonopin at 1 mg/day for about three years and haven't found any need to increase the dose. My pdoc says that he has numerous patients in similar situations, and likes Klonopin precisely because tolerance to the anxiolytic effects is rare. Klonopin ranks very low on the "difficulty of discontinuation" scale, even in comparison to many more widely prescribed psychiatric meds such as antidepressants etc.
In contrast, I find that I develop tolerance to the effects of Xanax very quickly, even if used occasionally, so I really limit its use. As for Valium -- it makes me feel very disoriented and I don't like it at all.
We all respond differently, but I've never seen any evidence to indicate that Klonopin is "notorious" for tolerance -- my understanding and experience is exactly the opposite.
Posted by chemist on April 26, 2004, at 1:25:16
In reply to Re: klonopin » chemist, posted by Viridis on April 26, 2004, at 1:18:47
helo there, from chemist...the fact that you have stabilized and remained there makes good on the fact that extra dosing of klonopin results in little to mediocre effect.....best to stay where you are, and sounds like it is working just fine for you...all the best, chemist
> "klonopin is notorious for tolerance at about 6 months"
>
> I'm puzzled by this statement. I've taken Klonopin at 1 mg/day for about three years and haven't found any need to increase the dose. My pdoc says that he has numerous patients in similar situations, and likes Klonopin precisely because tolerance to the anxiolytic effects is rare. Klonopin ranks very low on the "difficulty of discontinuation" scale, even in comparison to many more widely prescribed psychiatric meds such as antidepressants etc.
>
> In contrast, I find that I develop tolerance to the effects of Xanax very quickly, even if used occasionally, so I really limit its use. As for Valium -- it makes me feel very disoriented and I don't like it at all.
>
> We all respond differently, but I've never seen any evidence to indicate that Klonopin is "notorious" for tolerance -- my understanding and experience is exactly the opposite.
Posted by Dr. Bob on April 26, 2004, at 8:43:49
In reply to Re: klonopin » silmarilone, posted by chemist on April 25, 2004, at 2:07:02
> there is a little factor known as the LD_{50}, the lethal dose for 50% of the subjects. for klonopin, it is more than xxx.
I know it was a lot, but I'd rather not have any lethal doses given out here, thanks.
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration.
Posted by chemist on April 26, 2004, at 11:52:45
In reply to Re: lethal dose » chemist, posted by Dr. Bob on April 26, 2004, at 8:43:49
> > there is a little factor known as the LD_{50}, the lethal dose for 50% of the subjects. for klonopin, it is more than xxx.
>
> I know it was a lot, but I'd rather not have any lethal doses given out here, thanks.
>
> Bob
>Dr. Bob: please accept my apologies and i will abide....all the best, chemist
> PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration.
Posted by Kon on April 26, 2004, at 11:56:36
In reply to Re: klonopin » chemist, posted by Viridis on April 26, 2004, at 1:18:47
> "klonopin is notorious for tolerance at about 6 months"
Unless I missed something in the literature, I've never come across this. In fact, in the Worthington et al. (1998)study "clonazepam alone" dose for panic disorder tended to decrease from 1.53 mg/day at 6 months to 1.22 mg/day at 12 months. The majority of patients tended to maintain same clonazepam dose or decrease dosage over time. Similar data exist for social anxiety disorder. Overall, most of the material I've come across suggests no evidence for tolerance wrt anti-anxiety effects. I'm also interested in knowing where you got the 6 month figure. Any references would be appreciated. Thanks
Posted by chemist on April 26, 2004, at 15:32:05
In reply to Re: klonopinchemist, posted by Kon on April 26, 2004, at 11:56:36
> > "klonopin is notorious for tolerance at about 6 months"
>
> Unless I missed something in the literature, I've never come across this. In fact, in the Worthington et al. (1998)study "clonazepam alone" dose for panic disorder tended to decrease from 1.53 mg/day at 6 months to 1.22 mg/day at 12 months. The majority of patients tended to maintain same clonazepam dose or decrease dosage over time. Similar data exist for social anxiety disorder. Overall, most of the material I've come across suggests no evidence for tolerance wrt anti-anxiety effects. I'm also interested in knowing where you got the 6 month figure. Any references would be appreciated. Thanks
>
hi kon, the ~3 pages of text i had written for posting strangrly disappeared. there are references (suzuki, several) and the worthington paper (psychopharma bull, 1998) abstract states ``clonazepam doses remained stable over time,'' so i am not sure where the decrease in dose you mention comes from, but i do not have the m.s....the data for clonazepam losing efficacy or reaching therapeutic dose in a short time is well-documented in literature concerning using it in patients with seizures (e.g., the suzuki papers and one by loscher et al., j. pharm. exp. ther. 1996). see rosenberg et al., epilepsia 30:276-285, 1989, for evidence that doubling the dose of clonazepam does not result in increased antiseizure activity. another abstract states ``...tolerance to the antipanic or antiphobic effects of clonazepam...does not occur in panic disorder/agoraphobia; doses also tend to decrease over time,'' (davidson, j. clin. psy. 51A:31-37, 1990). my point - which i think i was quite muddy about - was that tolerance to clonazepam does not appear to emerge quickly and thus dosing must continue upwards until asymptotically hitting the right dose.......as for the 6 month thing, a goof on my part, some internal information from a series of studies i participated in, apologies for the stonewall, but cannot disclose...all the best, chemist
Posted by Kon on April 27, 2004, at 3:16:17
In reply to Re: klonopinchemist » Kon, posted by chemist on April 26, 2004, at 15:32:05
Thanks chemist. I was specifically referring to tolerance to anti-anxiety effects. I use clonazepam for anxiety and when I researched the drug, all the studies I came across suggested no tolerance wrt anti-anxiety effects. My pdoc also mentioned this (although he used the phrase "very unlikely to develop tolerance"). There is an Ashton article suggesting that tolerance to anti-anxiety effects is inevitable over the long-term but her piece relied on tertiary sources and to the best of my knowledge these views were not based on primary sources. If you are aware of any primary sources suggesting tolerance, I’m very interested in looking at them...
Wrt the Worthington (1998) values, I got them from the "results" section. The decrease was not significant, but I just wanted to point out that there was an insignificant decrease in dose from 6 months to 12 months. Moreover, there was no significant change in dose up to 2 years (again suggesting no tolerance). Similar data (some of which you’ve mentioned in your post) also suggest no tolerance to anti-axiety effects (Davidson, etc.). I would appreciate if you have come across any primary sources that suggest otherwise.
Posted by chemist on April 27, 2004, at 14:25:05
In reply to Re: klonopinchemist » chemist, posted by Kon on April 27, 2004, at 3:16:17
> Thanks chemist. I was specifically referring to tolerance to anti-anxiety effects. I use clonazepam for anxiety and when I researched the drug, all the studies I came across suggested no tolerance wrt anti-anxiety effects. My pdoc also mentioned this (although he used the phrase "very unlikely to develop tolerance"). There is an Ashton article suggesting that tolerance to anti-anxiety effects is inevitable over the long-term but her piece relied on tertiary sources and to the best of my knowledge these views were not based on primary sources. If you are aware of any primary sources suggesting tolerance, I’m very interested in looking at them...
>
> Wrt the Worthington (1998) values, I got them from the "results" section. The decrease was not significant, but I just wanted to point out that there was an insignificant decrease in dose from 6 months to 12 months. Moreover, there was no significant change in dose up to 2 years (again suggesting no tolerance). Similar data (some of which you’ve mentioned in your post) also suggest no tolerance to anti-axiety effects (Davidson, etc.). I would appreciate if you have come across any primary sources that suggest otherwise.
>
kon, thank you for the info: let me dig through my resources in re: tolerance for anxiety. given the rather thorough nature of your posts, i get the feeling that my efforts to find primary sources in the public domain will be as fruitful as yours....and turn up the same results....give me some time to do some digging, and thanks again for your info: i am better educated on this matter thanks to you. all the best, chemist
Posted by Dr. Bob on April 27, 2004, at 21:42:36
In reply to Re: lethal dose (apologies to Dr. Bob) » Dr. Bob, posted by chemist on April 26, 2004, at 11:52:45
Posted by TEDAR on May 1, 2004, at 13:02:58
In reply to Re: klonopin » Tedar, posted by chemist on April 25, 2004, at 21:53:15
> > To Chemist: you mentioned in previous post to get off Klonopin cold turkey and get switched to ativan or Valiun long term. Why?
>
> hi tedar...klonopin is notorious for tolerance at about 6 months. valium - although it has suffered a bad rap since valley of the dolls - is quite excellent for long-term treatment, with little to no need for increased dosage, and is the second-oldest benzo on the market. ativan i recommend as an alternative, with a slower onset of action (for prn dosing ONLY) than valium, and tolerance does not seem to be a problem in the literature i have perused. to be frank, klonopin is a long, slow ride that halts after a while. valium continues to do the job - and alleviates the need for xanax, for instance - due to long half-life of elimination. ativan has a shorter retention time in your system, but again, i come back to (in my experience) no need for ramping up the dose....hope this is of help, and all the best, chemistKlonopin and valium have similar Brain pathway dynamics-very lipophilic. And with Valium being biphasic with its half life, the problem in the past existed with the initial buzz 20 minutes after administration, followed by a more stable pattern of brain levels. Valley of the Dolls was not the only reason. People liked the buzz and the conscious sedation. While I think Valium is a good med, a lot of psychs feel that Klonopin offers more predictable therapeutic effects, without the more rapid lipophilic related buzz that Valium gives..I appreciate your further thoughts. Maybe, I am missing something.
Posted by TEDAR on May 1, 2004, at 19:21:54
In reply to Re: klonopin » chemist, posted by Viridis on April 26, 2004, at 1:18:47
> "klonopin is notorious for tolerance at about 6 months"
>
> I'm puzzled by this statement. I've taken Klonopin at 1 mg/day for about three years and haven't found any need to increase the dose. My pdoc says that he has numerous patients in similar situations, and likes Klonopin precisely because tolerance to the anxiolytic effects is rare. Klonopin ranks very low on the "difficulty of discontinuation" scale, even in comparison to many more widely prescribed psychiatric meds such as antidepressants etc.
>
> In contrast, I find that I develop tolerance to the effects of Xanax very quickly, even if used occasionally, so I really limit its use. As for Valium -- it makes me feel very disoriented and I don't like it at all.
>
> We all respond differently, but I've never seen any evidence to indicate that Klonopin is "notorious" for tolerance -- my understanding and experience is exactly the opposite.> I agree with your being puzzled completely, in regards to the chemist's assertions with Klonopin.
I am concerned with some of the benzo opinions that were given from the chemist. I have seen a ton of Literature on Klonopin as I worked for the company that marketed it, and also for companies that were competitors....Thanks TR
Posted by chemist on May 1, 2004, at 19:24:35
In reply to Re: klonopin, posted by TEDAR on May 1, 2004, at 19:21:54
hi tedar.....please see my most recent 2 posts to patricia leahy in re: klonopin.....all the best, chemist
> > "klonopin is notorious for tolerance at about 6 months"
> >
> > I'm puzzled by this statement. I've taken Klonopin at 1 mg/day for about three years and haven't found any need to increase the dose. My pdoc says that he has numerous patients in similar situations, and likes Klonopin precisely because tolerance to the anxiolytic effects is rare. Klonopin ranks very low on the "difficulty of discontinuation" scale, even in comparison to many more widely prescribed psychiatric meds such as antidepressants etc.
> >
> > In contrast, I find that I develop tolerance to the effects of Xanax very quickly, even if used occasionally, so I really limit its use. As for Valium -- it makes me feel very disoriented and I don't like it at all.
> >
> > We all respond differently, but I've never seen any evidence to indicate that Klonopin is "notorious" for tolerance -- my understanding and experience is exactly the opposite.
>
> > I agree with your being puzzled completely, in regards to the chemist's assertions with Klonopin.
> I am concerned with some of the benzo opinions that were given from the chemist. I have seen a ton of Literature on Klonopin as I worked for the company that marketed it, and also for companies that were competitors....Thanks TR
Posted by michael0720 on February 11, 2007, at 20:24:37
In reply to Re: klonopin » Tedar, posted by chemist on April 25, 2004, at 21:53:15
Chemist, I hope you still check this board. I just saw this thread tonight and I have some questions. My wife seems to be going through a horrible bezo+alcohol trauma right now. Actually it started back in November 2006. Too much stress, a new job after post-partum depression, a wedding to plan, etc. I have my problems that have not helped her situation, but this is beside the point. She works a lot now, doesn't seem interested in anything having to do with our household or kids anymore. She's been taking Klonopin and Celexa (she weened off of Propranolol and some other one a month ago...yes some psychiatrist had her on all 4) then comes home from work and drinks 2 bottles of wine. The end result almost every night is passing out completely, not eating, saying things she's never said before, and barely remembering them, acting odd, repeating the same conversations over and over again every day, consumation with work, avoiding most of her time at home, etc. It's really out of control. She slurs her speach after a couple of glasses of wine, she wobbles around like she can't stand up, she falls asleep on the toilet, or couch, or chair, wherever she is when it all kicks in. I'm really worried, and have suggested MANY times that this is not the chemical mixup for her. She can't see how bad it is. She's developed this secret life through text messages, etc. And her attitude about it is totally different than what I would have expected from her. She's not the same person I've known for 19 years.
Have you heard this story before? I'm looking for some guidance to help her get off all this stuff. It's not the right regimen for her. But I hear the effects of discontinuace can be even worse. What's a guy to do?
Posted by Kellie on February 13, 2007, at 21:35:21
In reply to Re: klonopin, posted by michael0720 on February 11, 2007, at 20:24:37
I was just looking through some threads looking for some answers to some of my own questions but, your note took me by surprise. I guess it was because I used to be your wife. Meaning, it sounds so much like I used to be. Questions before advice are, if she doesn't mind going to the doc, have you ever been with her? If it is possible to go, then go. Trying to get her to see things the way you do at this point probably null. Therefore she probably isn't being upfront with doc either. If she is and doc is still continuing same treatment, find a new doc. Chances are great that she wants to be the person she was 19 years ago to. Sometimes we can't get there. Sometimes the medicine makes it worse. Not knowing her symptoms makes it hard to give advice but, sounds like quality of life for her isn't any better or may be worse than with no meds.
The key for me was finding the right doctor for me. That doctor may not be the one for her, or the next guy. Support is always good as long as it is not contributing to her self destruction. Sometimes cool level headed but firm directives are helpful. If you continue to bail her out with the kids and family, with the idea that you are protecting them, you probably aren't. Again, that depends on the age of your children.
I know it must be frustrating because I lost my husband during my down spiral. I am not any longer angry at him for leaving sometimes I am amazed that he stayed for as long as he did. But, having him leave did not cause me to "wake up" or get over it, or get help either.
The winner for me was to get off of the meds that did not work and finally find one that did.
Hope this helps! Good luck to both of you
This is the end of the thread.
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