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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by joe schmoe on February 18, 2013, at 16:48:37
I am curious as to why klonopin has lost a lot of its efficacy for me lately, after being on it for over ten years. I was wondering if it was related to my acquiring a daily drinking habit due to my discovery of craft beer.
I have seen some people elsewhere state with great confidence (but no citations to studies) that drinking alcohol can cause a cross-tolerance to develop to benzos, reducing their efficacy. It is hard to get good information on benzo tolerance in general, some doctors seem to think benzo tolerance is inevitable while others seem to think that people with anxiety can take them long-term with no tolerance developing.
Does anyone know if there is a scientific proof behind this idea of alcohol causing benzo tolerance, other than "they both affect GABA in some way."
Posted by rjlockhart37 on February 18, 2013, at 17:59:12
In reply to Alcohol and benzo cross tolerance, posted by joe schmoe on February 18, 2013, at 16:48:37
the only unsure thing i can give is that ethanol works on GABA just like benzos....it doesnt do the exact same thing on the receptors...but still it effects GABA...and sometimes the gaba system can regulate itself into equilibrium which causes tolerance.
that's all i know....check out depakote....its work on gaba may reduce tolerance
r
Posted by Phillipa on February 18, 2013, at 18:31:56
In reply to Alcohol and benzo cross tolerance, posted by joe schmoe on February 18, 2013, at 16:48:37
No before an ad drank beer or wind nightly and they worked fine for about 30 years? Phillipa
Posted by joe schmoe on February 18, 2013, at 18:54:30
In reply to Re: Alcohol and benzo cross tolerance, posted by rjlockhart37 on February 18, 2013, at 17:59:12
My impression of alcohol tolerance is that it comes from liver enzymes, not neurotransmitter receptors. If alcohol truly affected GABA receptors then tolerance should come from changes in the brain, not the liver. Benzo tolerance seems to come from neurotransmitter receptors. They appear to be totally different mechanisms, so I don't understand why alcohol could cause benzo tolerance.
Posted by jono_in_adelaide on February 18, 2013, at 20:44:44
In reply to Re: Alcohol and benzo cross tolerance » rjlockhart37, posted by joe schmoe on February 18, 2013, at 18:54:30
Benzos can suoress alcohol withdrawl symptoms, and are widely used for this purpose in detox clinics, alcohol and benzos are "cross tolorant"
That is, if you drink 2 bottles of wine every night, its likely you'd need a higher dose of a benzo than somebody whio drank one glass of champagne on new years eve, conversely, if you were on 6mg per day of Xanax, its likely that a glass of wine wouldnt get you tipsy, where as somebody who never drank or took benzos might get a buzz from it
Alcohol tolorance comes from brain (GABA) neurotransmitters, thats who accute alcohol withdrawl causes the DT's and convulsions, and why Valium stops these withdrawl symptoms
Posted by joe schmoe on February 18, 2013, at 20:57:34
In reply to Re: Alcohol and benzo cross tolerance, posted by jono_in_adelaide on February 18, 2013, at 20:44:44
It's interesting that benzos are used to stop alcohol withdrawals.
>conversely, if you were on 6mg per day of Xanax, its likely that a glass of wine wouldnt get you tipsy, where as somebody who never drank or took benzos might get a buzz from it
If that's true, then why are people who take benzos so often told not to drink alcohol, due to the risk of synergistic effects and fatal CNS depression (or at least extreme intoxication, car accidents etc.)? If taking benzos really raises your alcohol tolerance and vice versa, then it would seem benzo users would be less, not more, intoxicated by alcohol, as you say.
Posted by joe schmoe on February 19, 2013, at 16:54:18
In reply to Alcohol and benzo cross tolerance, posted by joe schmoe on February 18, 2013, at 16:48:37
An interesting article
Posted by jono_in_adelaide on February 19, 2013, at 17:51:39
In reply to Re: Alcohol and benzo cross tolerance, posted by joe schmoe on February 19, 2013, at 16:54:18
Girlpower, are you being deliberratly obtuse?
I was saying that a regular drinker who drank heavily would, if he required a benzodiazepine, would already have some aquired tolorance, so a benzo would effect him less if he took it when sober, say if he drank at night and went into the hiospital for an endoscopy, its likely that the usual 10mg of Valium wouldnt sedate him as much as it would in a non drinker.
I wasnt sugesting someone who had drunk 2 bottles of wine would need 6mg of Xanax
There is cross tolorance between benzos and alcohol is the point I was trying to make, if you're tolorant to benzos, you weill be partly tolorant to alsool, if you're an alcoholic, you will need higher than normal doses of benzo
Posted by Phillipa on February 19, 2013, at 20:34:03
In reply to Re: Alcohol and benzo cross tolerance - Girlpower, posted by jono_in_adelaide on February 19, 2013, at 17:51:39
Jono that's true as when worked in rehab an alchoholic was given hundreds of miligrams of benzos to stop withdrawal. When I took small doses of benzos 5mg of valim or .25mg of xanax. Drank 4-6 beers a night slept well and woke feeling great. Never a hangover. Never drank anything but beer and wine. Corona being my favorite with lime. Phillipa
Posted by joe schmoe on February 22, 2013, at 16:50:34
In reply to Alcohol and benzo cross tolerance, posted by joe schmoe on February 18, 2013, at 16:48:37
I wrote a long post which unfortunately got deleted in a purge of some posts by someone else (and all replies to them). I will try to remember what I said. Something along these lines:
I now suspect strongly that the reason clonazepam pooped out for me is because I developed a daily drinking habit after discovering craft beer. I think this caused me to have "tolerance withdrawals" to clonazepam as my tolerance to it grew, since I can remember having unpleasant anxiety attacks in bed late at night, after drinking, when I was subject to no social pressure (I take clonazepam for social anxiety).
No one, neither a psychiatrist nor a medicine insert, ever said anything to me about alcohol being able to lower the efficacy of my clonazepam. A lot of medicines have generic-sounding "don't drink alcohol while taking this medication" warnings, but they seldom say the reason, other than the equally generic "the two can have a synergistic effect, leading to respiratory depression or automobile accidents." Well I drink at home, so drunk driving is not an issue, and experimentation showed that if anything, alcohol affected me less while on benzos than it did before. So I tend to ignore such warnings, unless my research reveals a real danger (like liver damage).
I really wish someone had warned me that alcohol use could make a benzo poop out.
Generic warnings about alcohol are a disservice, I think, since it is the only legal intoxicant available to most of us. Saying "no alcohol" to someone on psych meds for life is essentially a life sentence of "no intoxication." I consider this quite a serious thing to say, given that intoxication has been called "the fourth drive" (along with self-preservation, food, and sex) and a lifetime without it is a serious loss in and of itself. In addition alcohol, a relaxant, has significant stress reduction functions in our society - some doctors think that is the mechanism behind moderate drinking's ability to lower heart disease risk - and its relaxing properties make it especially valuable to people who suffer with anxiety. Don't tell me not to drink and not give me a specific reason why. I wonder how many other anxiety patients are drinking and not realizing it is lowering the effectiveness of their benzo meds?
Another valuable function of alcohol is to facilitate meeting romantic or sexual partners. I find meeting people to be extraordinarily stressful as it is - at least booze is available to lower people's inhibitions and break the ice in a public setting (and hopefully later in a private setting). Again it is quite serious to me to tell an anxious person they shouldn't drink alcohol - with all the social, romantic and sexual problems such a loss will cause - without telling them why.
At this point I am down to 1/8 of my previous clonazepam dosage and I want to see what life is like off the stuff, since I think it is affecting my memory and cognition. So I will finish the taper and try life off of it for awhile to see how bad it is. After being on it over a decade, I think I need a breather, especially since it isn't doing its job anymore and I can't afford to be cognitively impaired since my job depends on my mind.
In the course of researching this subject I also came across references to "acute tolerance" or tolerance to alcohol which one develops in the course of a single drinking session. This concept was also an eye-opener, as it seemed to me that often the first few beers were the best ones and further drinking was a futile attempt to chase the feelings of relaxation caused by the initial drinks. Now I know there is some basis to this idea, and in fact it causes some people to drink too much as they try to "recapture the feeling" of that initial relaxation and euphoria of the first few drinks.
Posted by Phillipa on February 22, 2013, at 20:43:43
In reply to Re: Why didn't they tell me, posted by joe schmoe on February 22, 2013, at 16:50:34
I drank beer for so many years when on benzos and it didn't effect me this way. I just went to sleep and woke feeling good. Wasn't on clonazapam though. Valium, ativan, xanax were the three I have experience on drink with. I also am weaning off the benzos slowly as also tolenant. But I no longer drink. Only because of the loss of taste. If I could look forward to a corona with lime I'd switch back in a heartbeat. Phillipa
Posted by phidippus on March 1, 2013, at 19:47:26
In reply to Re: Why didn't they tell me, posted by joe schmoe on February 22, 2013, at 16:50:34
Benzodiazapines and Alcohol both agonize GABA receptors. It is doubtful drinking alcohol caused your clonazepam to poop out.
Eric
Posted by joe schmoe on March 1, 2013, at 20:04:41
In reply to Re: Why didn't they tell me » joe schmoe, posted by phidippus on March 1, 2013, at 19:47:26
> Benzodiazapines and Alcohol both agonize GABA receptors. It is doubtful drinking alcohol caused your clonazepam to poop out.
>
> Eric
Did you read that article I linked?" Ethanol exposure also reduced the modulatory efficacy of the benzodiazepine receptor agonists lorazepam, zolpidem, and zaleplon as well as that of the inverse agonists Ro 15-4513 and FG 7142,
effects that were associated with a reduced abundance of mRNAs encoding the receptor subunits
1, 3, 2L, and 2S. "
Posted by phidippus on March 2, 2013, at 15:42:58
In reply to Re: Why didn't they tell me » phidippus, posted by joe schmoe on March 1, 2013, at 20:04:41
Clonazepam is not listed. 'Modulatory efficacy' was reduced in what way? How was the reduction measured?
The reduction in efficacy is not permanent.
Eric
Posted by joe schmoe on March 2, 2013, at 16:00:05
In reply to Re: Why didn't they tell me » joe schmoe, posted by phidippus on March 2, 2013, at 15:42:58
> Clonazepam is not listed. 'Modulatory efficacy' was reduced in what way? How was the reduction measured?
>
> The reduction in efficacy is not permanent.
>
> EricHere is an article specifically on the effect of chronic ethanol exposure on clonazepam binding:
This is the end of the thread.
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