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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Paul Smith on April 8, 2005, at 1:45:48
Hey thanks for your reply about the benzos. Appreciate good insight as my doc knows so little. How long does it take for Valium to smooth out in your system? Has been 8 days now. How hefty of a dose is 40 mgs? I could always try and cut it to 30... I thought 40 mgs of Valium was the same as 2 mg of K or Xanax, not all that much. Thanks.
Posted by ed_uk on April 8, 2005, at 7:40:32
In reply to benzos, to Philipa, posted by Paul Smith on April 8, 2005, at 1:45:48
Hi,
>How long does it take for Valium to smooth out in your system? Has been 8 days now.
About 1-2 weeks. You'll probably be able to reduce your dose shortly.
Regards,
Ed.
Posted by Paul Smith on April 8, 2005, at 9:43:58
In reply to Re: benzos, to Philipa » Paul Smith, posted by ed_uk on April 8, 2005, at 7:40:32
Ed you are da man, always eager to help in here. So do you think that pumping in 40 mgs for a week or two was like a "loading dose" and there may be no problem cutting dowm to 30 mgs in a week or so? I feel mostly human now. I was a certified debilitated zombie for 6 months. Just could not wait any longer. Once this stuff settles in more do you think it is possible I could cut down to 30 mgs a day over a couple of weeks? 40 mgs is a bit heavy for me, isnt much room to go higher with this med. Quality of life is the goal here, even on meds if I can manage it.
Posted by ed_uk on April 8, 2005, at 10:01:56
In reply to Re: benzos, to Ed, posted by Paul Smith on April 8, 2005, at 9:43:58
Hi,
>So do you think that pumping in 40 mgs for a week or two was like a "loading dose" and there may be no problem cutting dowm to 30 mgs in a week or so?
Yes exactly, it was a loading dose. You will soon be ready to reduce the dose.
>Quality of life is the goal here, even on meds if I can manage it.
That's the spirit, being med-free shouldn't ever be the ultimate goal, being well must be the goal. You will almost certainly find that you can taper down to a relatively low 'maintenance dose' and stay there. Do not force yourself to discontinue the diazepam entirely if the withdrawal symptoms are too severe. Many people stay on the same low dose of diazepam for years. You are unlikely to have any major side effects from a low dose. Take the diazepam in 'divided doses' if you find it helpful. Some people can get away with taking diazepam as a single daily dose but other people find that they need to take several doses per day. If you find that your anxiety and other symptoms are fluctuating throughout the day, it could be a sign that taking several smaller doses per day could be better.
Since you are on 40mg, you will probably be able to reduce your dose in fairly large steps at first, as the dose gets lower you will need to reduce in smaller steps.
Ed.
Posted by mworkman on April 8, 2005, at 12:40:45
In reply to Re: benzos, to Ed » Paul Smith, posted by ed_uk on April 8, 2005, at 10:01:56
I think 40 mg of valium is equal to 4 mg of xanax and 2 mg of klonopin.
Posted by Phillipa on April 8, 2005, at 17:03:27
In reply to Re: benzos, to Ed, posted by mworkman on April 8, 2005, at 12:40:45
I know why I was so tired on l.5mg of klonopin a day. I was shocked when I read the equivalency charts. I cut out and changed quite a few meds for sleep at the same time. But I'm on a total of l5mg a day now. And the namebrand is worth paying for. There was a Thread not long ago about this issue and the consensus was to take the namebrand. I don't see any reason why you can't begin to cut down now. Try 30mg for a while. You have to base it on how you feel. Fondly, Phillipa
Posted by mattw84 on April 8, 2005, at 22:04:39
In reply to Re: benzos, to Ed » mworkman, posted by Phillipa on April 8, 2005, at 17:03:27
Aside from the fact that all benzos act with a respectively unique pharmokinetic action -- their intended uses and exact pharmacology can differ quite widely. I believe Bob has put up a couple different "equivilency" charts somewhere on this site. Perhaps someone has the link to it?
I would not recommend relying exclusively on an equivilency chart to find the optimally equipotent dose; simply because there is literally no such thing for any benzo. I recently attempted to switch from Xanax XR to Klonopin and begin a very slow taper schedule, the consequences of which were very unpleasant... so back to my normal dose of Xanax XR I went. I gave my pdoc the task of coming up with a suitable withdrawal program -- and if that fails I plan to go to an inpatient detoxification facility. After all... benzos are essentially alcohol in a pill, whether you are aware of the cognitive side effects or not -- you are taking a narcotic substance simply to avoid realities of whatever phobia or trigger one may have.
I think I have figured out why Benzos are so appealing... Life is a l3*tch, and who doesn't want to escape from it all? Ignorance has be bliss, but reality keeps popping in through the Xanax cloud -- Seems to me it's time I learn to deal with it... That or increase my dose ;)
Also...
0.5 mg Xanax = ~1mg Ativan = ~10mg Valium
So my meager daily dose of 6mg of Xanax XR is *approximately* a mere 120mg of Valium... Now that's what I call "good medicine." =)
I mean no offense to anyone in this, just expressing my thoughts on the subject. Best of luck to all and hopefully we can look forward to a non drug-reliant future.
Sincerely,
Matt (in the Hat? [Sorry... that's the xanax acting up again...])
Posted by Phillipa on April 8, 2005, at 22:14:45
In reply to Equipotent Benzodiazepines... No such thing..., posted by mattw84 on April 8, 2005, at 22:04:39
Just out of curiosity. Have you ever been just sitting there with your life going just great only to have an acute panic attack? In my twenties that's what happened to me Enter valium. My sister, her daughter, my son, grandson, granddaughter,father, mother all had the same problem. We were all told that we had a chemical imbalance with GABA, and that we would need a benzo because it targets GABA for life. Now if you hate pills and don't get high or any pleasure out of taking them, how can you say they are addictive? Each time any of us has tried to totally eliminate them in a few days the panic comes rushing back. My Son lost his eyesight in Desert Strom, and has graduated Suma Cum Laude in Social Work, one of the only fields the Army would pay for for him to go into as he can still practice if he loses the slight ability to see out of one portion of his right eye. If it wasn't for a benzo he could have never gone to school and lead the productive life he is. Just another opinion. Fondly, Phillipa
Posted by mworkman on April 8, 2005, at 23:15:27
In reply to Equipotent Benzodiazepines... No such thing..., posted by mattw84 on April 8, 2005, at 22:04:39
benzos are in no way like alcohol. sure they both increase gaba, but alcohol also increase dopamine and endorphins. It is kinda like comparing extasy to ssri's. Sure they both block the reuptake of seretoin, but extasy does much more. benzos are in no way alcohol in a pill.
Posted by Phillipa on April 8, 2005, at 23:38:05
In reply to Re: Equipotent Benzodiazepines... No such thing..., posted by mworkman on April 8, 2005, at 23:15:27
Thank-you, no they're not. Besides my Son's success while on low doses of valium I started my own business, did some modeling, made two movies on excercise for fun, went through a divorce after 21yrs of marriage, took care of 3 kids, and put myself through Nursing school on the Dean's list, earning Awards that paid for my schooling, and graduated magna cum laude. I was offered the best positions the hospital I graduated had to offer but took another one. I was courted by the hospitals. In all my years of nursing[still on low doses] did I ever get in trouble or make a med error. I worked in all areas of the hospital from psych to ICU. I loved it. I quit nursing when I made my first mistake, I took the narcotic keys home by mistake. And benzos are not narcotics. They are schedule II drugs. When I first started nursing they were thrown in a central basket that anyone had access to for return to pharmacy when a pt was discharged. Never did I or anyone I worked with to my knowledge take any for personal use. I also had to take drug tests before any hospital hire along with all other staff members. The hospitals had no problem as long as you had a RX. Plus the only drugs that show up in the drug screen are illegal drugs. My children are all successfully employed. One daughter VP of bank, another a legal assistant. And they all have college degrees. One has a doctorate in Ministry as well. So a benzo is not a drug that those who need them abuse. They enable people to become all that they can be. And by the way, when i made the error of bringing home the keys by mistake I was taking a low dose of an AD. Fondly, Phillipa
Posted by mattw84 on April 9, 2005, at 1:46:48
In reply to Re: Equipotent Benzodiazepines... No such thing..., posted by Phillipa on April 8, 2005, at 23:38:05
I am an MS2 at OHSU, and ALL benzodiazepines fall under class IV (4) DEA Scheduling. As far as addiction is concerned, pro re nata (as needed) is not likely to cause addiction. However, continuous and long time (6+ months in general) administration of any sedative/hypnotic GABA enhancing drugs will result in PHYSICAL addiction as your body continues to produce less GABA naturally. Similarly to the SNRI example -- it's not MDMA, yet still an equally addictive group of drugs. (Effexor, Cymbalta, and the lesser...)
In response to your arguement that alcohol not similar to benzos: you are 100% correct that the two classes are just as different as they are alike. For example, baclofen will almost instantaneously cease intoxication by benzos and barbituates, yet has seemingly no effect alcohol intoxication. The pharmokinetics of ethyl alcohol are not completely understood, similarly nor are benzos or barbituates. It is however commonly acknowledged amongst the medical community that all of the forementioned are very addictive.
My aunt died March 24th, 2005 of alcohol poisoning at the age of 60. Fortunately it is nearly impossible for benzos to prove fatal at even the most extreme doses. So YES, you are correct that alcohol and benzos are completely different animals...
And to Phillipa:
I hoped not to offend anyone with the post -- but as usual that never seems to work, especially when I am of utmost care too... I owe a great debt of gratitude to benzos for enabling me to overcome agoraphobia w/panic attacks -- without which I would not be approaching residency. In my personal opinion, I would be much more confident in making life/death decisions and the like without excess GABA in my system. Though I I have several fellows who are reliant on much more narcotic medications (i.e., opiates...) yet the potential for error is greatly increased by the topic class.
Please don't take that as a discredit to the benefits of benzos for numerous individuals for whom without which life would not be possible. I also have a great faith in psychology, having a B.S. in behavioral psych. I firmly believe that CBT can be just as effective, if not moreso, than medication. Also, exercise is likely the best medicine nature and science have yet to illustrate.
Again -- I am not arguing with anyone's point of view. Simply stating what I am aware of, so please refrain from crude comments in response. I would like to think of this community as a wealth of experience and knowledge, rather than a battleground for those who have differing opinions.
I have two eyes and two ears, yet only one mouth; hopefully I can illustrate the significance of that statement by showing my utmost respect for everyone's opinion on this matter. That or I suspect I will regret ever throwing my $.02 in...
Best Regards,
Matt
Posted by Paul Smith on April 9, 2005, at 2:49:59
In reply to Re: benzos, to Ed » Paul Smith, posted by ed_uk on April 8, 2005, at 10:01:56
Ed, what do you consider a small dose of Diazepam? I was in bad shape before under 20 mgs, hardly functional, and could not function at all below 10 mgs. The biggest symptom I have now is shortness of breathe, really about my only symptom except some fear in new situations, thankfully it comes and goes but it is a pain. I hate to have to come here for insights but all the specialist docs I went to see want to load me up with coctails that do not work. They do not believe that some people have long term unbearable benzo withdrawals. I can get benzos from GPs.
Posted by ed_uk on April 9, 2005, at 12:34:25
In reply to Re: benzos, to Ed, posted by Paul Smith on April 9, 2005, at 2:49:59
Hi,
>I was in bad shape before under 20 mgs, hardly functional, and could not function at all below 10 mgs.
...but how fast did you taper?
>Ed, what do you consider a small dose of Diazepam?
That's a matter of opinion really! I suppose I'd say that less than 10mg a day is a small dose.
Ed.
Posted by Paul Smith on April 9, 2005, at 14:24:55
In reply to Re: benzos, to Ed » Paul Smith, posted by ed_uk on April 9, 2005, at 12:34:25
Tapered slow, over 8 months. I have two choices, see surreal, bright, dp and dr, vibrate 24/7, deal with burning skin, walk off balance, or take higher doses of benzos. And even on the benzos I get flulike feelings and shortness of breathe off and on. ADs do not work for me, tried several. I was off 6 months once and was a freak, very little improvement except a bit less fear and improved appetite. I could not wait any longer. I have been on and off benzos 3 times. Have been in the ER before. All tests come back normal, they give me antihistamine and send me home. Maybe I need some mega doses of Xanax XR like some in her take.
Posted by ed_uk on April 9, 2005, at 14:46:47
In reply to Re: benzos, to Ed, posted by Paul Smith on April 9, 2005, at 14:24:55
Hi,
>I have two choices, see surreal, bright, dp and dr, vibrate 24/7, deal with burning skin, walk off balance, or take higher doses of benzos.
I think you should take the higher dose then. I do think you'll probably be able to reduce below 40mg in a few weeks though.
>And even on the benzos I get flulike feelings and shortness of breathe off and on.
Do you take 10mg diazepam four time a day? It might help to keep your blood level more constant and reduce symptoms.
Ed.
Posted by Paul Smith on April 9, 2005, at 16:42:20
In reply to Re: benzos, to Ed » Paul Smith, posted by ed_uk on April 9, 2005, at 14:46:47
Hi,
>I have two choices, see surreal, bright, dp and dr, vibrate 24/7, deal with burning skin, walk off balance, or take higher doses of benzos.
I think you should take the higher dose then. I do think you'll probably be able to reduce below 40mg in a few weeks though.
>And even on the benzos I get flulike feelings and shortness of breathe off and on.
Do you take 10mg diazepam four time a day? It might help to keep your blood level more constant and reduce symptoms.
Ed.
Yep exactly, 4 times a day. Is so tempting to pump in Xanax. Could Valium be too weak? I have not felt normal in two years. Getting so very old. Everyone says I am not the same person anymore.
Posted by ed_uk on April 9, 2005, at 16:56:12
In reply to Re: benzos, to Ed, posted by Paul Smith on April 9, 2005, at 16:42:20
Hi Paul,
>Is so tempting to pump in Xanax. Could Valium be too weak?
No, I don't think Valium is too weak, I think you will feel better in a week or two. I wouldn't transfer to Xanax if I were you, I think you will suffer withdrawal symptoms between doses. Even Xanax XR doesn't last as long as it's supposed to.
>I have not felt normal in two years. Getting so very old.
How do you feel today? I think you have improved a lot since you've been back on Valium. I think you will improve even more over the next few weeks. You should be able to find a suitable maintenance dose which prevents any withdrawal symptoms while not being excessive.
>Everyone says I am not the same person anymore.
You have been through a lot in recent times. Valium can treat your withdrawal symptoms but you've been affected by the trauma. I do think you'll make a good recovery but it will take time.
Kind regards,
Ed.PS. Keep posting :-)
Posted by Paul Smith on April 10, 2005, at 13:48:26
In reply to Re: benzos, to Ed » Paul Smith, posted by ed_uk on April 9, 2005, at 16:56:12
Which is the worst in your opinions, particuarly male libido? I suppose it is dose relative to a degree but this can be a terrible side effect. Viagra is good but hey, no interest, it does not work...
Posted by ed_uk on April 11, 2005, at 9:58:59
In reply to benzos and libido, posted by Paul Smith on April 10, 2005, at 13:48:26
Hi,
>Which is the worst in your opinions, particuarly male libido?
I get the impression that clonazepam causes more sexual side effects than other benzos.
In the short term, diazepam does reduce my libido. I have never taken it long-term. I don't have enough personal experience with any other benzos to say what effect they would have on my libido, pdocs here much prefer diazepam to other benzos! My last pdoc never prescribed any other benzos!
Anxiety. 1994-95;1(5):233-6.Clonazepam-related sexual dysfunction in male veterans with PTSD.
Fossey MD, Hamner MB.
Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC 29401, USA.
Medication-induced sexual dysfunction can significantly interfere with patients' quality of life and lead to poor compliance. This retrospective study examined the records of 100 male veterans with post-traumatic stress disorder (PTSD) selected in alphabetical order from an active treatment file of 230 patients. Forty-two patients had received clonazepam (mean maximum dose: 3.4 +/- 1.6 mg/day) at some point during their treatment. Of these, 18 (42.9%) complained of significant sexual dysfunction (primarily erectile dysfunction). Eighty-four patients received diazepam (mean maximum dose: 52.1 +/- 29.7 mg/day), nine received alprazolam (mean maximum dose: 5.2 +/- 2.8 mg/day) and eight received lorazepam (mean maximum dose: 3.8 +/- 2.4 mg/day). None of these patients complained of sexual dysfunction during treatment with these three other benzodiazepines. Our findings suggest that benzodiazepines, particularly clonazepam in the current study, can be a cause of sexual dysfunction in many male patients. Prospective studies comparing the overall clinical utility of various benzodiazepines are indicated in this and other clinic populations.
Posted by ed_uk on April 11, 2005, at 10:02:19
In reply to benzos and libido, posted by Paul Smith on April 10, 2005, at 13:48:26
PS. There are various drugs available which *may possibly* increase libido but the risk of side effects is real. I don't know whether you'd be willing to go down that route.
Ed.
Posted by Paulbwell on April 11, 2005, at 10:13:05
In reply to Re: benzos and libido, posted by ed_uk on April 11, 2005, at 10:02:19
> PS. There are various drugs available which *may possibly* increase libido but the risk of side effects is real. I don't know whether you'd be willing to go down that route.
>
> Ed.As you know mate, I take Valium, and it DOES reduce libedo.
Dopamine meds-Ritalin increase it-yep
How ru?
Posted by ed_uk on April 11, 2005, at 13:13:26
In reply to Hi Ed, posted by Paulbwell on April 11, 2005, at 10:13:05
Hi P!
>How ru?
I'm ok thanks :-) Exams in a few weeks- need to start doing some work :-(
Regards,
Ed.
Posted by Paulbwell on April 11, 2005, at 13:30:27
In reply to Re: Hi Ed » Paulbwell, posted by ed_uk on April 11, 2005, at 13:13:26
This is the end of the thread.
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