Posted by SLS on February 21, 2005, at 16:47:41
In reply to barbiturates for withdrawalSLS, posted by med_empowered on February 21, 2005, at 15:44:39
Thanks.
:-)
- Scott
> Hey! Yeah, I've heard of barbiturates (again, usually phenobarbital) used for the withdrawal of both barbiturates (which, fortunately, is increasingly rare) and non-barbiturate drugs. Usually, even those who are on higher levels of benzos can be tapered right off whatever benzo they're using or switched over to valium and then tapered...most of tapering, fortunately, can be done out-patient with few hassles. But, of course, sometimes...its a problem. So, there are conversion formulas docs can use to convert all kinds of drugs (seconal, nembutal, miltown, and the benzos, for example) to more or less equivalent doses of phenobarbital...once that's done, the doc involved can write for phenobarbital and gradually reduce that. The other option is "loading", which is really useful when you're dealing with a poly-drug user who may relapse if he/she experiences too much discomfort OR is believed to be at a particularly high risk of seizure. Basically, the doc involved "loads" the patient with phenobarbital or nembutal (nembutal is faster acting) until the desired degree of sedation is reached. If nembutal is used, the dose is then converted into an equivalent phenobarbital dosage. This is the patient's starting dose; if done inpatient, the withdrawal from whatever substance(s) will be managed through IV admninistration of the drug; outpatient, an RX is written and the patient is closely monitored throughout the withdrawal process. Other options for less-painful benzo withdrawal include: an RX for beta-blockers (helps with anxiety and cardiovascular weirdness that may occur), an RX for tegretol or one of the newer anticonvulsants (obviously, prevents seizures; over time, may help with underlying anxiety, depression, mood-disorders, etc.), an RX for certain anti-anxiety agents (Buspar, Atarax, etc. seem popular), an RX for anti-depressant(s) (usually, by the time the taper is completed, the anti-depressant(s) should be helping somewhat to control anxiety, and may help with rebound anxiety/insomnia). Of course, there's also Trazadone, Remeron (good for insomnia), and all patients undergoing tapers need to be monitored and have the ability to contact their doc as needed.
poster:SLS
thread:461083
URL: http://www.dr-bob.org/babble/20050217/msgs/461433.html