![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Bobby on February 12, 2006, at 20:52:55
I'vr tried Lunesta, serax, Dalmane, and valium. what about Seconal?
Posted by Phillipa on February 12, 2006, at 23:02:15
In reply to ie there anything stronger that restoril for sleep, posted by Bobby on February 12, 2006, at 20:52:55
Is seconal still around? Chloral hydrate works well without any alchohol or it is a Mickey Finn. Fondly, Phillipa
Posted by vainamoinen on February 13, 2006, at 12:44:05
In reply to ie there anything stronger that restoril for sleep, posted by Bobby on February 12, 2006, at 20:52:55
All those things aren't very good for regular use. Especially the barbituates. Kicking a reds habit can kill you.
Try Seroquel,I guarantee 500mg of that will knock you on your *ss.
Or maybe Remeron, or even good old fashioned Sinequan. Very sedating.
Posted by ed_uk on February 13, 2006, at 14:26:00
In reply to Re: ie there anything stronger that restoril for s, posted by vainamoinen on February 13, 2006, at 12:44:05
Seconal works well but you should only take it for a few days. Most docs won't prescribe it anymore.
Ed
Posted by yxibow on February 14, 2006, at 2:31:23
In reply to ie there anything stronger that restoril for sleep, posted by Bobby on February 12, 2006, at 20:52:55
> I'vr tried Lunesta, serax, Dalmane, and valium. what about Seconal?
At what dose did you try Lunesta... I didn't have good luck with it until 3mg.
If you're an insomniac like me, you won't have luck on Ambien until 20mg. Its perfectly safe longterm at that dose.
You could probably increase the dose by a bit on the Dalmane, but eventually you may habituate.
Messing with barbiturates is just a cheap substitute for modern medicines and is dangerous. I dont know why they're still widely used in the UK other than they're cheap. Here nobody would give a prescription for them.
Hope you get better sleep
Jay
Posted by ed_uk on February 14, 2006, at 15:58:24
In reply to Re: ie there anything stronger that restoril for s » Bobby, posted by yxibow on February 14, 2006, at 2:31:23
Hi Jay
>I dont know why they're still widely used in the UK other than they're cheap.
They're not :) What made you think they were?! Seconal is more expensive than Ambien in the UK. Ambien is pretty cheap here, but not as cheap as zopiclone or temazepam.
Barbiturate hypnotics do have their uses, especially for a few days (nights) in hospitalised psych patients when other drugs haven't worked. Seconal Sodium has the advantage of inducing sleep/sedation in as little as 10 minutes.
Regards
Ed
Posted by Phillipa on February 14, 2006, at 18:33:53
In reply to Re: ie there anything stronger that restoril for s » yxibow, posted by ed_uk on February 14, 2006, at 15:58:24
Ed when I was pregnant with my third child I went into false labor. They didn't know about meds hurting an unborn child at the time. The OBGYN gave me two seconals in the hospital and they didn't even put me to sleep. Love PJ O
Posted by paulbwell on February 15, 2006, at 6:01:26
In reply to Re: ie there anything stronger that restoril for s » yxibow, posted by ed_uk on February 14, 2006, at 15:58:24
> Hi Jay
>
> >I dont know why they're still widely used in the UK other than they're cheap.
>
> They're not :) What made you think they were?! Seconal is more expensive than Ambien in the UK. Ambien is pretty cheap here, but not as cheap as zopiclone or temazepam.
>
> Barbiturate hypnotics do have their uses, especially for a few days (nights) in hospitalised psych patients when other drugs haven't worked. Seconal Sodium has the advantage of inducing sleep/sedation in as little as 10 minutes.
>
> Regards
>
> EdSeconal was called "the gift of sleep" when advertised in the 1950's and was/is exactually that. It is a VERY effective sleep aid to thoes who are strung out, or very ill, and despite the tremoundous attacks on Barbs for desperaturate sleep sufferers, they are a very effective measure, when all else fails. I'v had more than 1 person report that taking Nembutal (Pentobarbitual) gave them the best sleep in memory-no small matter when YOU SIMPLY CANNOT GET TO SLEEP.
As a person who takes stimulants a stimulant med to treat a medical condition, Diazepam often isn't enought, this is where Diphenhidramine comes in, or a few Vokka's+Diazepam, I SIMPLY MUST GET SOME SLEEP.
I really feel that the Babiturates dangers, which my nan took for many years, (very successfully) are over dramatised, when they are required for sever cases where the lesser potency, benzo-class doesn't work.
Cheers
Posted by ed_uk on February 15, 2006, at 14:39:57
In reply to Secobarbitural Sodium! » ed_uk, posted by paulbwell on February 15, 2006, at 6:01:26
Hi P
Although the barbiturates are much more dangerous in overdose than the benzos, the differences between barbiturates and benzos have been overexaggerated IMO. It seems that they have quite a lot in common.
You need some diphenhydramine by the sound of it. Why don't you just ask your doc to prescribe it?
Ed
Posted by yxibow on February 15, 2006, at 23:15:22
In reply to Re: Secobarbitural Sodium! » paulbwell, posted by ed_uk on February 15, 2006, at 14:39:57
> Hi P
>
> Although the barbiturates are much more dangerous in overdose than the benzos, the differences between barbiturates and benzos have been overexaggerated IMO. It seems that they have quite a lot in common.
>
> You need some diphenhydramine by the sound of it. Why don't you just ask your doc to prescribe it?
>
> EdBarbiturates are dangerous in the hands of people who are extremely depressed, Ed. LD50 and comatose ranges are much closer, its far better to prescribe things like Restoril. But I know we disagree on this :)
Posted by yxibow on February 16, 2006, at 4:04:37
In reply to Re: Secobarbitural Sodium! » ed_uk, posted by yxibow on February 15, 2006, at 23:15:22
> Barbiturates are dangerous in the hands of people who are extremely depressed, Ed. LD50 and comatose ranges are much closer, its far better to prescribe things like Restoril. But I know we disagree on this :)
It's just that I dont think people, especially those depressed, etc.. need to have their sleep "induced in 10 minutes." I'm still up, back from the bed, even with my medicine load because I couldn't sleep.. yeah I'll be cranky, but I don't need Versed or IV pentothal every night to go to sleep. Its dangerous and far too artificial. But anyhow.... tomato, tomahtoe ? :)
Posted by ed_uk on February 16, 2006, at 13:00:44
In reply to Re: Secobarbitural Sodium! » ed_uk, posted by yxibow on February 15, 2006, at 23:15:22
Hi J
>Barbiturates are dangerous in the hands of people who are extremely depressed, Ed. LD50 and comatose ranges are much closer, its far better to prescribe things like Restoril. But I know we disagree on this :)
I think you've misunderstood me. I wasn't recommending barbiturates for outpatients suffering from severe depression. I suggested that they might be useful for the short term treatment of severely anxious psych inpatients who were suffering from insomnia.
>.......its far better to prescribe things like Restoril
Yes. Barbiturates are not a first line treatment......not everyone responds to Restoril, Lunesta or Ambien.
Kind regards
Ed
Posted by ed_uk on February 16, 2006, at 13:36:41
In reply to Re: Secobarbitural Sodium! » yxibow, posted by yxibow on February 16, 2006, at 4:04:37
Hi J
>It's just that I dont think people, especially those depressed, etc.. need to have their sleep "induced in 10 minutes."
Clealy, barbiturates are not appropriate for the treatment of insomnia unless it is associated with severe distress. Rapid-acting sedatives can be useful in numerous situations. I never said anything about depression! Seconal Sodium works fast. It can treat a severe panic attack for example. It can calm an intensely agitated manic individual. It can be used as a sedative premedication prior to anesthesia or other medical procedures.
>I don't need Versed or IV pentothal every night to go to sleep.
Thiopental (Pentothal) is only used by anesthetists ;-) Midazolam (Versed) is a short acting benzodiazepine. It is active orally and by injection. It has similar effects to triazolam (Halcion). Midazolam is preferred to other benzos for IV/IM use because it is much less irritant to the vein/muscle. Apart from this, it is not at all unique.
>Its dangerous and far too artificial.
I don't believe I suggested anything dangerous. Barbiturates are safe when used under appropriately controlled conditions. Up to 200mg Seconal Sodium or Sodium Amytal can be safely administered to patients who do not have any contra-indications. The barbiturate hypnotics are faily well tolerated in the short term, the risk of serious adverse effects is low in properly selected patients. Barbiturate treatment of insomnia should normally be limited to a few days.
The barbiturates have numerous indications....
1. Phenobarbital remains a valuable treatment for epilepsy. It is as effective as the newer anticonvulsants in the treatment of grand mal epilepsy and partial seizures. The low price of phenobarbital is particularly important in developing countries. Many elderly people still take pheno for epilepsy. Younger patients may benefit from pheno when other drugs have been ineffective or poorly tolerated. Pheno is also useful in the management of resistant status epilepticus.
3. Low doses of primidone (Mysoline) are used to treat essential tremor.
4. Intermediate-acting barbiturates (eg. Seconal) can be useful in hospitalised patients.......as descrived above.
5. Very small quantities of Seconal or Amytal can be prescribed to carefully selected outpatients eg. for the treatment of acute panic attacks or severe insomnia.
6. Barbiturates (or benzodiazepines) are used every day/night by elderly people who have been dependent on them for many years, despite the fact that the original indication has long since disappeared. Several weeks supply can normally be prescribed at once.
Kind regards
Ed
Posted by Phillipa on February 16, 2006, at 18:35:17
In reply to Re: Secobarbitural Sodium! » yxibow, posted by ed_uk on February 16, 2006, at 13:36:41
Ed are you calling me elderly? I'm hurt now too!!!!!Love PJ O
Posted by yxibow on February 17, 2006, at 2:55:04
In reply to Re: Secobarbitural Sodium! » yxibow, posted by ed_uk on February 16, 2006, at 13:00:44
> Hi J
>
> >Barbiturates are dangerous in the hands of people who are extremely depressed, Ed. LD50 and comatose ranges are much closer, its far better to prescribe things like Restoril. But I know we disagree on this :)
>
> I think you've misunderstood me. I wasn't recommending barbiturates for outpatients suffering from severe depression. I suggested that they might be useful for the short term treatment of severely anxious psych inpatients who were suffering from insomnia.Yes -- that would be the only situation that would occur here in the states, I assure you... doctors want to keep their DEA licences. Of course there are still backwater county hospitals who use "vitamin H" (haldol), but that's a horrible practice.
>
> >.......its far better to prescribe things like Restoril
>
> Yes. Barbiturates are not a first line treatment......not everyone responds to Restoril, Lunesta or Ambien.No.. not everybody does.. but they're all GABA related agents... so the patient may not respond to a reasonable dose of barbiturate either.
>
> Kind regards
>
> Ed
Posted by yxibow on February 17, 2006, at 3:07:42
In reply to Re: Secobarbitural Sodium! » yxibow, posted by ed_uk on February 16, 2006, at 13:36:41
> Hi J
>
> >It's just that I dont think people, especially those depressed, etc.. need to have their sleep "induced in 10 minutes."
>
> Clealy, barbiturates are not appropriate for the treatment of insomnia unless it is associated with severe distress. Rapid-acting sedatives can be useful in numerous situations. I never said anything about depression! Seconal Sodium works fast. It can treat a severe panic attack for example. It can calm an intensely agitated manic individual. It can be used as a sedative premedication prior to anesthesia or other medical procedures.Yes -- again, those are inpatient medical procedures. Severe panick attacks can also be solved by a 1mg or more of Xanax, which is also fast acting and safer, but not as cheap.
>
> >I don't need Versed or IV pentothal every night to go to sleep.
>
> Thiopental (Pentothal) is only used by anesthetists ;-)I know, I was putting a bit of this humour in the UK-US barbiturate argument. I assure you, they're not used as much here.
Midazolam (Versed) is a short acting benzodiazepine. It is active orally and by injection. It has similar effects to triazolam (Halcion). Midazolam is preferred to other benzos for IV/IM use because it is much less irritant to the vein/muscle. Apart from this, it is not at all unique.
Yes, they're all presugery prep agents with the exception of Halcion, here, or conscious sedation, which has been banned most places.>
> >Its dangerous and far too artificial.
>
> I don't believe I suggested anything dangerous. Barbiturates are safe when used under appropriately controlled conditions. Up to 200mg Seconal Sodium or Sodium Amytal can be safely administered to patients who do not have any contra-indications. The barbiturate hypnotics are faily well tolerated in the short term, the risk of serious adverse effects is low in properly selected patients.> Barbiturate treatment of insomnia should normally be limited to a few days.
I'll agree with you there....
>
> The barbiturates have numerous indications....
>
> 1. Phenobarbital remains a valuable treatment for epilepsy. It is as effective as the newer anticonvulsants in the treatment of grand mal epilepsy and partial seizures. The low price of phenobarbital is particularly important in developing countries. Many elderly people still take pheno for epilepsy. Younger patients may benefit from pheno when other drugs have been ineffective or poorly tolerated. Pheno is also useful in the management of resistant status epilepticus.I wasn't referring to special situations... I know that certain epileptic disorders are very hard to control.. and you've hit the point right square that barbiturates are just plain cheap. But benzodiazepines here aren't all that much more expensive. Trust me, a **** load of Valium is $20.
>
> 3. Low doses of primidone (Mysoline) are used to treat essential tremor.Here, after experimenting with propranolol, which is a first line, and pindolol and nadolol. Then such agents might be used.
>
> 4. Intermediate-acting barbiturates (eg. Seconal) can be useful in hospitalised patients.......as descrived above.agreed
>
> 5. Very small quantities of Seconal or Amytal can be prescribed to carefully selected outpatients eg. for the treatment of acute panic attacks or severe insomnia.Very small. A script for 0.5 Xanax is equally effective.
>
> 6. Barbiturates (or benzodiazepines) are used every day/night by elderly people who have been dependent on them for many years, despite the fact that the original indication has long since disappeared. Several weeks supply can normally be prescribed at once.Dependent is the problem.... I don't advocate taking people off of things that work for them but I saw the mismanagement of medications by my grandmother and if she had a barbiturate in her hands instead of Xanax..... oh, never mind.
>
> Kind regards
>
> Ed
>Kind regards to you too Eddy. Write me sometime even if we disagree on the NHS use of barbs. :) Although I really wish I could have a prescription for Soma instead of gargantuan gobs of its weak cousin generic Robaxin that I am prescribed. But of course Soma is a barb cousin, so I'm making a double standard... ah anyhow.... can't mix it with high dose benzos even though a weak 250mg of Soma does more wonders for my back and neck....
Cheers
-- Jay
Posted by ed_uk on February 17, 2006, at 14:32:41
In reply to Re: Secobarbitural Sodium! » ed_uk, posted by yxibow on February 17, 2006, at 2:55:04
Hi J
>Of course there are still backwater county hospitals who use "vitamin H" (haldol), but that's a horrible practice.
Don't forget than some patients actually prefer haloperidol to atypical APs. Zyprexa are similar drugs cause substantial toxicity, obesity being one of the most commonly observed side effects. Xbunny, a babbler who suffers from schizophrenia, prefers the typical neuroleptic flupenthixol, another high potency neuroleptic.
>I assure you... doctors want to keep their DEA licences.
That would appear to be one of the major factors controlling US doctors prescribing.
>No.. not everybody does.. but they're all GABA related agents... so the patient may not respond to a reasonable dose of barbiturate either.
.....but they might. They'd have to try it to find out.
Ed
Posted by ed_uk on February 17, 2006, at 14:56:23
In reply to Re: Secobarbitural Sodium! » ed_uk, posted by yxibow on February 17, 2006, at 3:07:42
Hi
>Severe panick attacks can also be solved by a 1mg or more of Xanax, which is also fast acting and safer, but not as cheap.
No, because barbiturates would only be suitable for patients who didn't repond well to benzodiazepines.
>I was putting a bit of this humour in the UK-US barbiturate argument. I assure you, they're not used as much here.
This isn't a UK-US argument. The barbiturates are almost never prescribed in the UK. The vast majority of UK pdocs will never have prescribed a barbiturate. I don't understand why you are under the impression than barbiturates are used more frequently in the UK, I very much doubt it. Sedative (eg. benzo) use is strongly discouraged in the UK. The benzodiazepines are treated with disdain here.........most docs probably don't even know that the barbiturates are still available.
>Yes, they're all presugery prep agents with the exception of Halcion, here, or conscious sedation, which has been banned most places.
Midazolam can be taken orally as a sleep aid. It is used in this manner in some countries.
> I know that certain epileptic disorders are very hard to control.. and you've hit the point right square that barbiturates are just plain cheap
Price doesn't come into it RE barbiturates in the UK. Phenobarbital is never used as a first line treatment for epilepsy in the UK. I was referring to developing countries when I mentioned the price of pheno.
>But benzodiazepines here aren't all that much more expensive. Trust me, a **** load of Valium is $20.
Phenobarbital is not the same as the barbiturate hypnotics (eg. Seconal), the anticonvulsant dose is less than the sedative dose. Other barbiturates are only anticonvulsant at doses which produce substantial sedation. Pheno's anticonvulsant efficacy may not be related to potentiation of GABAergic neurotransmission. Pheno has always been considered to be effective in the long term treatment of epilepsy, the same cannot be said of benzodiazepines, which are most suitable for emergency treatment of prolonged seizures. In some patients, clonazepam can be effective in the long term treatment of epilepsy, but tolerance develops in many.
>Very small. A script for 0.5 Xanax is equally effective.
No, because Seconal would only be prescribed if Xanax didn't work!
>even if we disagree on the NHS use of barbs :)
I never once mentioned the NHS! Barbiturates are very rarely used by NHS doctors.
>........and if she had a barbiturate in her hands instead of Xanax..... oh, never mind.
I'm sorry to hear that J.
>Soma is a barb cousin
Carisoprodol and meprobamate are chemically unrelated to the barbiturates.
Regards
Ed
Posted by yxibow on February 18, 2006, at 1:36:43
In reply to Barbiturates » yxibow, posted by ed_uk on February 17, 2006, at 14:32:41
> Hi J
>
> >Of course there are still backwater county hospitals who use "vitamin H" (haldol), but that's a horrible practice.This I mean as a one-off practice, instead of using a small dose of intravenous benzodiazepine to restrain a patient.
>
> Don't forget than some patients actually prefer haloperidol to atypical APs. Zyprexa are similar drugs cause substantial toxicity, obesity being one of the most commonly observed side effects. Xbunny, a babbler who suffers from schizophrenia, prefers the typical neuroleptic flupenthixol, another high potency neuroleptic.Aha, we've opened another can of worms :).. Yes, Zyprexa has serious obesity problems, Seroquel, which I take, comes in fairly less, in my experience. Its not a question of whether they cause these issues, its also a quality of life.. the one thing and I've mentioned this before, that they leave out of the report about atypicals vs old line drugs is the gobs of Cogentin that one has to take because they would be climbing the walls with akathisia.
>
> >I assure you... doctors want to keep their DEA licences.
>
> That would appear to be one of the major factors controlling US doctors prescribing.Yes, we're a litigious society, we learned it from the best <g> only we took off like mad.
Across the pond
Jay
Posted by yxibow on February 18, 2006, at 1:56:03
In reply to Re: Secobarbitural Sodium! » yxibow, posted by ed_uk on February 17, 2006, at 14:56:23
> Hi
>
> >Severe panick attacks can also be solved by a 1mg or more of Xanax, which is also fast acting and safer, but not as cheap.
>
> No, because barbiturates would only be suitable for patients who didn't repond well to benzodiazepines.
>
> >I was putting a bit of this humour in the UK-US barbiturate argument. I assure you, they're not used as much here.
>
> This isn't a UK-US argument. The barbiturates are almost never prescribed in the UK. The vast majority of UK pdocs will never have prescribed a barbiturate. I don't understand why you are under the impression than barbiturates are used more frequently in the UK, I very much doubt it. Sedative (eg. benzo) use is strongly discouraged in the UK. The benzodiazepines are treated with disdain here.........most docs probably don't even know that the barbiturates are still available. ]I dont know, because it just seemed that there was a sense of blase between barbiturates and benzodiazepines so I figured it was part and parcel of the NHS' arsenal. And I remember you mentioning now that the benzodiazepines are treated with disdain which is unfortunate because klonopin has allowed plenty a shutin to leave their house due to a variety of phobic and panic disorders.
>
> >Yes, they're all presugery prep agents with the exception of Halcion, here, or conscious sedation, which has been banned most places.
>
> Midazolam can be taken orally as a sleep aid. It is used in this manner in some countries.Versed as a sleep aid ? I think it would be very very limited in the US.
>
> > I know that certain epileptic disorders are very hard to control.. and you've hit the point right square that barbiturates are just plain cheap
>
> Price doesn't come into it RE barbiturates in the UK. Phenobarbital is never used as a first line treatment for epilepsy in the UK. I was referring to developing countries when I mentioned the price of pheno.Well actually surprisingly Dr. Reddy's of India has applied for electronic NDAs in the US of all places for cheap benzodiazepines so you can bet that they are even cheaper as dirt in their home territory.
>
> >But benzodiazepines here aren't all that much more expensive. Trust me, a **** load of Valium is $20.
>
> Phenobarbital is not the same as the barbiturate hypnotics (eg. Seconal), the anticonvulsant dose is less than the sedative dose. Other barbiturates are only anticonvulsant at doses which produce substantial sedation. Pheno's anticonvulsant efficacy may not be related to potentiation of GABAergic neurotransmission. Pheno has always been considered to be effective in the long term treatment of epilepsy, the same cannot be said of benzodiazepines, which are most suitable for emergency treatment of prolonged seizures. In some patients, clonazepam can be effective in the long term treatment of epilepsy, but tolerance develops in many.Tolerance can and has developed to many barbiturates too, but I'm not arguing the unique use of it in this arena.
>
> >Very small. A script for 0.5 Xanax is equally effective.
>
> No, because Seconal would only be prescribed if Xanax didn't work!good, good :)
>
> >even if we disagree on the NHS use of barbs :)
>
> I never once mentioned the NHS! Barbiturates are very rarely used by NHS doctors.Well it was an assumption because you do seem rather relaxed about the use of Barbiturates, on a forum, that like it or not, have people who have serious psychiatric disorders, no fault of their own. It would be horrifying if they managed to get barbiturates for sleep from some offshore pharmacy.
>
> >........and if she had a barbiturate in her hands instead of Xanax..... oh, never mind.
>
> I'm sorry to hear that J.
>
> >Soma is a barb cousin
>
> Carisoprodol and meprobamate are chemically unrelated to the barbiturates.Actually there is a distant relation between Miltown, felbamate, and barbiturates if not in structure but in action. My conservative prescribing psychopharmacologist wouldn't have used the term lightly otherwise, and I would have my happy back pill (humour).
"Barbiturate-Like Actions of the Propanediol
Felbamate and Meprobamate"
JPET 280:1383–1391, 1997
Anyhow, dear Eddy, I'm bantering with you, no real arguments here.Tidings
Jay :)
Posted by ed_uk on February 18, 2006, at 12:27:51
In reply to Re: Barbiturates » ed_uk, posted by yxibow on February 18, 2006, at 1:36:43
Hi Yxi
>the one thing and I've mentioned this before, that they leave out of the report about atypicals vs old line drugs is the gobs of Cogentin that one has to take because they would be climbing the walls with akathisia
Akathisia doesn't necessarily occur if the dose is appropriate. Akathisia tends to occur when an excessively high proportion of D2 receptors are blocked by an inappropriately high dose.
I once took prochlorperazine (Compazine, Stemetil) and suffered no akathisia......the dose was low. I got bad akathisia with chlorpromazine (Thorazine, Largactil) at a high dose, but none whatsoever at a low dose.
Regards
Ed
Posted by ed_uk on February 18, 2006, at 13:53:17
In reply to Re: Secobarbitural Sodium! » ed_uk, posted by yxibow on February 18, 2006, at 1:56:03
Hi Yxi
>I dont know, because it just seemed that there was a sense of blase between barbiturates and benzodiazepines so I figured it was part and parcel of the NHS' arsenal. And I remember you mentioning now that the benzodiazepines are treated with disdain which is unfortunate because klonopin has allowed plenty a shutin to leave their house due to a variety of phobic and panic disorders.
Yes, benzos are treated with disdain here. Many (most?) pdocs believe that the long term use of benzos for anxiety is never justified. Barbs are treated with extreme disdain.
>Versed as a sleep aid ? I think it would be very very limited in the US.
There's nothing really special about midazolam except that it's particularly appropriate for use by injection (because it doesn't irritate the vein). Oral midazolam isn't any more sedating that any of the other short-acting high potency benzodiazepines.
Midazolam tablets aren't marketed in the UK, but they are available in some countries.
I doubt that a standard dose of midazolam would sedate you at all Yxi!
>Tolerance can and has developed to many barbiturates too, but I'm not arguing the unique use of it in this arena.
Definitely, tolerance to the sleep inducing effect of Seconal and Amytal often develops within 2 weeks (of nightly use).
Pheno is different to the other barbs. Tolerance to its anticonvulsant effect doesn't often develop......so it would seem.
>Well it was an assumption because you do seem rather relaxed about the use of Barbiturates
Rather relaxed?! Whatever gave you that impression? I advocated their judicious use only in a few specific situations.
>It would be horrifying if they managed to get barbiturates for sleep from some offshore pharmacy.
I'm not sure what you're trying to say here Yxi!
>Actually there is a distant relation between Miltown, felbamate, and barbiturates if not in structure but in action.
That's true, meprobamate is structurally different from the barbiturates but may be similar in its mechanism of action.
>My conservative prescribing psychopharmacologist;-) Your pdoc is hardly conservative Yxi! Conservative pdocs do not prescribe high doses of diazepam!
Regards
Ed
PS. If you like carisoprodol Yxi, I imagine you would like Amytal! (Ironically)
Posted by yxibow on February 18, 2006, at 16:30:27
In reply to Barbiturates » yxibow, posted by ed_uk on February 18, 2006, at 13:53:17
> Hi Yxi
>
> >I dont know, because it just seemed that there was a sense of blase between barbiturates and benzodiazepines so I figured it was part and parcel of the NHS' arsenal. And I remember you mentioning now that the benzodiazepines are treated with disdain which is unfortunate because klonopin has allowed plenty a shutin to leave their house due to a variety of phobic and panic disorders.
>
> Yes, benzos are treated with disdain here. Many (most?) pdocs believe that the long term use of benzos for anxiety is never justified. Barbs are treated with extreme disdain.I know... and then there's the benzo.org.uk site which I guess reflects this but I wont go further for getting slapped with a wet noodle for my free speech. There are people who have been on Valium without sequelae since 1962.
> >Versed as a sleep aid ? I think it would be very very limited in the US.
>
> There's nothing really special about midazolam except that it's particularly appropriate for use by injection (because it doesn't irritate the vein). Oral midazolam isn't any more sedating that any of the other short-acting high potency benzodiazepines.Huh.
>
> Midazolam tablets aren't marketed in the UK, but they are available in some countries.
>
> I doubt that a standard dose of midazolam would sedate you at all Yxi!Hah... I dunno... Some dose of Restoril would be sedating. 0.5 Xanax is still sedating because of its quick onset and short action and not blocked at 3A4.
> >Well it was an assumption because you do seem rather relaxed about the use of Barbiturates
>
> Rather relaxed?! Whatever gave you that impression? I advocated their judicious use only in a few specific situations.Which we clarified again. :)
>
> >It would be horrifying if they managed to get barbiturates for sleep from some offshore pharmacy.
>
> I'm not sure what you're trying to say here Yxi!Well I just don't want someone finding out how to get seconal from the Caribbean or something. That's all.
> >My conservative prescribing psychopharmacologist
>
> ;-) Your pdoc is hardly conservative Yxi! Conservative pdocs do not prescribe high doses of diazepam!Oh he's concerned about that one allright but it seems to be rather necessary than necessarily a dose escalation. He doesnt give refills but thats not necessarily a matter of trust, I dunno... but then we meet frequently. I am a fast metabolizer of some things. Conservative in the sense that he doesnt go up and down on doses nearly as fast as I hear about other doctors on here doing. Should have clarified that..
Tidings
Posted by yxibow on February 18, 2006, at 16:35:03
In reply to Re: Barbiturates » yxibow, posted by ed_uk on February 18, 2006, at 12:27:51
> Hi Yxi
>
> >the one thing and I've mentioned this before, that they leave out of the report about atypicals vs old line drugs is the gobs of Cogentin that one has to take because they would be climbing the walls with akathisia
>
> Akathisia doesn't necessarily occur if the dose is appropriate. Akathisia tends to occur when an excessively high proportion of D2 receptors are blocked by an inappropriately high dose.An ED of Haldol can exceed the threshold of akathisia easily.
>
> I once took prochlorperazine (Compazine, Stemetil) and suffered no akathisia......the dose was low. I got bad akathisia with chlorpromazine (Thorazine, Largactil) at a high dose, but none whatsoever at a low dose.Its the other things that worry me about that study too... we don't know, its true, but there was a giant study on your side of the pond in the BJP which estimated the emergence of TD with Zyprexa to be around 1/2% per year, and one can extrapolate that Seroquel is quite even smaller. That's the quality of life also that I'm referring to. With thousands of patient hours we have known high numbers of TD emergence with old line, especially the oldest. Also, Geodon isn't the only one with a QTc interval issue, Mellaril has a worse issue with QTc elongation.
Cheers
Jay
Posted by ed_uk on February 18, 2006, at 17:10:04
In reply to Re: Barbiturates » ed_uk, posted by yxibow on February 18, 2006, at 16:30:27
>I know... and then there's the benzo.org.uk site which I guess reflects this but I wont go further for getting slapped with a wet noodle for my free speech. There are people who have been on Valium without sequelae since 1962.
I'm not a 'benzophobe', I was just describing a common attitude of English pdocs. There are also patients who've been on pheno since 1912 without sequelae :)
>Huh.....
Midazolam injection produces similar effects to diazepam injection. Midazolam injection is used mainly as a sedative-anxiolytic during unpleasant medical procedures eg. colonoscopy, angiography. It is also widely used as a pre-medication prior to anesthesia. Diazepam injection can be used similarly. Midazolam and diazepam are rarely appropriate drugs for the induction of anesthesia because very high doses may be required, inducation is slow, some patients fail to loose consciousness, emergence is slow and other drugs are always required to achieve satisfactory anesthesia. Although midazolam is used during anesthesia, it is *not* a general anesthetic. Diazepam can be used as an alternative but it frequently irritates the vein into which it is injected.
>Well I just don't want someone finding out how to get seconal from the Caribbean or something. That's all.
Our discussion has provided no sources of obtaining drugs without a prescription :)
Regards
Ed
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