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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Spriggy on April 17, 2005, at 23:01:38
Anyone know if there is any long term problems with using Ristoril? I've been on it for almost two full months now ( 30 mg's).
I am concerned if there is any long term problems with using it??
The pdoc only wanted me taking it up to 4 nights a week but my gp has me on it nightly.
Any ideas?
Posted by ed_uk on April 18, 2005, at 10:41:48
In reply to Long term on Ristoril?, posted by Spriggy on April 17, 2005, at 23:01:38
Hi!
Long-term use of temazepam is likely to result in physical dependence ie. withdrawal symptoms will occur if the medication is stopped abruptly. A gradual taper may be necessary in order to minimise withdrawal symptoms.
In the treatment of insomnia, the long-term effectiveness of temazepam is not reliable, many people find that it 'poops out' relatively quickly- sometimes within a matter of days or weeks.
Ideally, temazepam is best used on a short-term basis (eg. for a few days at a time), intermittently (eg. a couple of times a week) or 'as required' when insomnia is particularly bad.
Kind regards,
Ed.
Posted by Larry Hoover on April 18, 2005, at 12:25:09
In reply to Temazepam, posted by ed_uk on April 18, 2005, at 10:41:48
> Hi!
>
> Long-term use of temazepam is likely to result in physical dependence ie. withdrawal symptoms will occur if the medication is stopped abruptly. A gradual taper may be necessary in order to minimise withdrawal symptoms.
>
> In the treatment of insomnia, the long-term effectiveness of temazepam is not reliable, many people find that it 'poops out' relatively quickly- sometimes within a matter of days or weeks.
>
> Ideally, temazepam is best used on a short-term basis (eg. for a few days at a time), intermittently (eg. a couple of times a week) or 'as required' when insomnia is particularly bad.
>
> Kind regards,
> Ed.Sorry, Ed, but temazepam often gets a bad rap, just because it's a benzo. When they actually look at temazepam users, many people (certainly not all, but many) do not ever develop tolerance to it.
I saw one study of long-term temazepam users, (average 6 years, longest 17 years of continuous use), and all had responses to the drug similar to naive first-time users. I don't have that reference handy, though.
Lar
Br J Clin Pharmacol. 1997 Sep;44(3):267-75.
A study of the effects of long-term use on individual sensitivity to temazepam and lorazepam in a clinical population.
van Steveninck AL, Wallnofer AE, Schoemaker RC, Pieters MS, Danhof M, van Gerven JM, Cohen AF.
Centre for Human Drug Research, Leiden University Hospital, The Netherlands.
AIMS: The central effects of benzodiazepines may be attenuated after chronic use by changes in pharmacokinetics, pharmacodynamics or both. This attenuation may be influenced by the dosing pattern and the characteristics of the user population. The objectives of this study were to evaluate drug sensitivity in long-term users of temazepam and lorazepam in a clinical population. METHODS: The sensitivity to benzodiazepine effects in chronic users (1-20 years) of lorazepam (n = 14) or temazepam (n = 13) was evaluated in comparison with age and sex matched controls. Drug sensitivity was evaluated by plasma concentration in relation to saccadic eye movement parameters, postural stability and visual analogue scales. RESULTS: Pharmacokinetics of lorazepam and temazepam did not differ between patients and control subjects. Chronic users of lorazepam showed clear evidence of reduced sensitivity, indicated by lack of any pharmacodynamic difference between patients and controls at baseline, when drug concentrations were similar to the peak values attained in the control subjects after administration of 1-2.5 mg of lorazepam. In addition, there was a two- to four fold reduction in the slopes of concentration-effect plots for measures of saccadic eye movements and body sway (all; P < or = 0.01). By contrast, sensitivity in chronic users of temazepam was not different from controls. The difference between the temazepam and the lorazepam group appears to be associated with a more continuous drug exposure in the latter, due to the longer half-life and a more frequent intake of lorazepam. This pattern of use may be partly related to the more anxious personality traits that were observed in the chronic users of lorazepam. CONCLUSIONS: Chronic users of lorazepam show evidence of tolerance to sedative effects in comparison with healthy controls. Tolerance does not occur in chronic users of temazepam. The difference may be related to pharmacological properties, in addition to different patterns of use, associated with psychological factors.
Br J Clin Pharmacol. 1979;8(1):63S-68S.
Hypnotic efficacy of temazepam: a long-term sleep laboratory evaluation.
Mitler MM, Carskadon MA, Phillips RL, Sterling WR, Zarcone VP Jr, Spiegel R, Guilleminault C, Dement WC.
1 Temazepam was evaluated in a strictly defined insomniac patient population under sleep laboratory conditions. Two protocols were used: a short-term (26-night) and a long-term (54-night) protocol evaluated the efficacy of the drug administered at night at 15 mg (short-term study) and 30 mg (long-term study), respectively. 2 Temazepam seemed to be both safe and effective at doses of 15 and 30 mg with up to 5 weeks of ingestion. 3 Suppression of slow wave sleep was observed at the high dose, but no suppression of REM sleep, found in studies with other benzodiazepines, was noted. 4 No evidence was found for development of tolerance or rebound effects.
Posted by ed_uk on April 18, 2005, at 13:18:09
In reply to Re: Temazepam » ed_uk, posted by Larry Hoover on April 18, 2005, at 12:25:09
Hi Lar,
I wasn't saying that everyone develops tolerance, I was simply saying that temazepam's long term efficacy can be unreliable.
I'm not a 'benzophobe'. I wanted to inform Spriggy about some of the problems which *may* occur when temazepam is used on a long-term basis. I believe that people have a right to be informed about the *possible* negative consequences of long-term use. I was not suggesting that tolerance or dependence was inevitable, just that it was a possibility and that intermittent use may be preferable in cases where it is feasible. Although long-term use of temazepam is sometimes required, it should not be undertaken without an appreciation of the potential risks. I got the impression that Spriggy's doctor had not provided her with any information. I hope that my post has not caused anxiety or offence.
Regards,
Ed.
Posted by Spriggy on April 18, 2005, at 13:25:37
In reply to Re: Temazepam » Larry Hoover, posted by ed_uk on April 18, 2005, at 13:18:09
Thank you both. You both are always so helpful and resourceful.
So far, I haven't built up a tolerance but I'm only on month 2 and actually took a few weeks off of it to give Seroquel a try.
I like Restoril because it is a much restful/calmer sleep- it doesn't feel FORCED.
But I don't want to become addicted either. Maybe I should just try to go without it once or twice a week.
I'll just have to suffer and not sleep. LOL
Posted by ed_uk on April 18, 2005, at 13:44:50
In reply to Re: Temazepam, posted by Spriggy on April 18, 2005, at 13:25:37
Hi Spriggy,
>So far, I haven't built up a tolerance but I'm only on month 2 and actually took a few weeks off of it to give Seroquel a try.
I'm glad you haven't built up a tolerance :-)
It's a good sign that you were able to take a break from it. Among the most common temazepam withdrawal symptoms are anxiety and insomnia.>Maybe I should just try to go without it once or twice a week.
That could be a good idea. If you notice that you're having withdrawal symptoms on your 'day off' you can decide whether or not you want to taper the temazepam.
Ed xx
Posted by Larry Hoover on April 18, 2005, at 15:02:51
In reply to Re: Temazepam » Larry Hoover, posted by ed_uk on April 18, 2005, at 13:18:09
> Hi Lar,
>
> I wasn't saying that everyone develops tolerance, I was simply saying that temazepam's long term efficacy can be unreliable.Hey ed....maybe we're both compulsive at trying to give a more complete understanding?
The thing for me, as a chronic insomniac, is that risking tolerance (less than 100% risk) against the certainty of yet another night without sleep (unmedicated me), tolerance is a trivial issue. Truly, a trivial issue. Just as is opiate tolerance in pain control. It's a bump on the road, not a bridge washed out.
Anyway....keep up the good work.
Lar
Posted by Spriggy on April 18, 2005, at 15:35:48
In reply to Re: Temazepam » ed_uk, posted by Larry Hoover on April 18, 2005, at 15:02:51
Okay well, now that I think of it. My anxiety was always worse the days after I had no Restoril at night.
I was blaming it on other stuff; Klonopin, PMS, food, etc.. maybe it was a Restoril withdrawal.
Oh my.. Help me Jesus.
Posted by Larry Hoover on April 18, 2005, at 16:29:17
In reply to Re: Temazepam, posted by Spriggy on April 18, 2005, at 15:35:48
> Okay well, now that I think of it. My anxiety was always worse the days after I had no Restoril at night.
>
> I was blaming it on other stuff; Klonopin, PMS, food, etc.. maybe it was a Restoril withdrawal.
>
> Oh my.. Help me Jesus.Hey. When you wake up in the morning, the temazepam isn't gone altogether. On nights you didn't take any, though, you'd wake up with no temazepam at all.
I wouldn't call that a withdrawal, in any sense of the word. The nights you take it, you have protection against anxiety that carries into the day. The nights without temazepam don't offer you that extra umbrella.
Lar
Posted by Phillipa on April 18, 2005, at 17:49:19
In reply to Re: Temazepam » Spriggy, posted by Larry Hoover on April 18, 2005, at 16:29:17
Spriggy, So many things to sort out. Maybe what you need right now is that good night's rest. Worry about discontinuing the med when you know exactly what's wrong with you medically and emotionally. Fondly, Phillipa
Posted by ed_uk on April 19, 2005, at 8:38:58
In reply to Re: Temazepam » ed_uk, posted by Larry Hoover on April 18, 2005, at 15:02:51
Hi Lar!
>The thing for me, as a chronic insomniac, is that risking tolerance (less than 100% risk) against the certainty of yet another night without sleep (unmedicated me), tolerance is a trivial issue.
I agree :-)
I'm not sure whether Spriggy's a chronic insomniac. Have you always had really bad sleep Spriggy?
Regards,
Ed.
Posted by Spriggy on April 19, 2005, at 10:51:54
In reply to Re: Temazepam » Larry Hoover, posted by ed_uk on April 19, 2005, at 8:38:58
Well,
Let's see.. I have pretty much taken something to sleep since 2000- I did OTC stuff mostly; Benadryl, Tylenol PM, Nytol, etc..Occasionally I would fall asleep on my own but it was always late into the night (or morning)!
I went to camp with some youth kids' and deicded to try it without any sleep meds (so I could make sure they weren't sneaking out). let's just put it this way.. nobody ever could sneak out since I was up all night long staring at the walls. LOL
I would fall asleep around 3 a.m. and wake up was 6 a.m.
I hated that week. LOL
Posted by Larry Hoover on April 19, 2005, at 13:12:31
In reply to Re: Temazepam, posted by Spriggy on April 19, 2005, at 10:51:54
> Well,
> Let's see.. I have pretty much taken something to sleep since 2000- I did OTC stuff mostly; Benadryl, Tylenol PM, Nytol, etc..
>
> Occasionally I would fall asleep on my own but it was always late into the night (or morning)!
>
> I went to camp with some youth kids' and deicded to try it without any sleep meds (so I could make sure they weren't sneaking out). let's just put it this way.. nobody ever could sneak out since I was up all night long staring at the walls. LOL
>
> I would fall asleep around 3 a.m. and wake up was 6 a.m.
>
> I hated that week. LOLFive years. That's chronic insomnia. That distorts every aspect of waking life, although in some ways you may not be aware of, specifically.
I strongly suggest you give nightly temazepam a chance to show you what it means to get a good night's sleep. Damn the tolerance/dependence thing.
I took it every night for four years, and it did fade a little bit in effect (or the underlying insomnia got worse), but I went off it cold turkey and didn't even notice.
Benadryl is not in the same class a temazepam, IMHO. For occasional insomnia, sure. But not every night.
Lar
Posted by Spriggy on April 19, 2005, at 16:37:43
In reply to Re: Temazepam » Spriggy, posted by Larry Hoover on April 19, 2005, at 13:12:31
Thanks lar,
It is working with the sleep... that's for sure. I haven't slept this soundly for many years (pre children years!).One thing I noticed when I used Benadryl long term (more than a few months) was that for some reason, I was having to get up and go pee ( preschool word there.. ha) several times a night.
I even ended up having to see a urologist for it. He gave me more meds (that just made my mouth dry) but after I stopped using the Benadryl, I stopped having to go pee all the time!
Weird huh?
Posted by Larry Hoover on April 19, 2005, at 22:43:01
In reply to Re: Temazepam, posted by Spriggy on April 19, 2005, at 16:37:43
> Weird huh?
Ya, you're weird. ;-)
I don't know how you *could* take Benadryl for months. I became tolerant, absolutely tolerant, after three nights. It did nothing after that, even if I went without for many weeks.
I guess we is all diffewent.
Lar
Posted by Phillipa on April 19, 2005, at 22:45:19
In reply to Re: Temazepam, posted by Larry Hoover on April 19, 2005, at 22:43:01
That was cute Lar! Fondly, Phillipa
Posted by Spriggy on April 20, 2005, at 10:54:22
In reply to Re: Temazepam » Larry Hoover, posted by Phillipa on April 19, 2005, at 22:45:19
I personally prefer "unique" but I'll take weird.. LOL
I've been called worse.
:)
Posted by melspinyards on April 22, 2005, at 18:22:33
In reply to Re: Temazepam » Spriggy, posted by Larry Hoover on April 18, 2005, at 16:29:17
i have to take
30mg Temazepam
2mg Lorazepamat night to just bearly get to the edge of sleep.
I mean this is hell!
is there anyway to knock yourself out psychially without damage? so i can get some sleep...
nervous wreck...
matt
Posted by melspinyards on April 22, 2005, at 18:30:00
In reply to Re: Temazepam + Lorazepam, posted by melspinyards on April 22, 2005, at 18:22:33
sorry
Melody
i was looking at matt84's sc, i need a reality check.
Posted by Phillipa on April 22, 2005, at 18:46:18
In reply to Re: Temazepam + Lorazepam, posted by melspinyards on April 22, 2005, at 18:22:33
I keep asking my husband to hit me over the head with a baseball bat but he won't! Even staying up till 2am. Fondly, Phillipa
This is the end of the thread.
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