Posted by Chairman_MAO on October 6, 2011, at 11:59:21
In reply to Re: Phenobarbital as a benzo detox » Chairman_MAO, posted by SLS on October 6, 2011, at 5:31:47
Disclaimer: fact-check everything I am saying here, please.
Ultimately, there is nothing that is going to make this process easy because of the neurophysiological changes that have occurred in the GABA receptor complexes. You could put someone on a cocktail of phenobarbital, topiramate, memantine and whatever else and benzo withdrawal is _still_ going to be a hell ride. You can prevent seizures, delirium, some agitation, etc., but ultimately there's just nothing I'm aware of that can be done.
From wikipedia: "The exact mechanism of action is unknown,[38] but four properties that may contribute to topiramate's antiepileptic and antimigraine efficacy include a blockage of voltage-dependent sodium channels, an augmentation of gamma-aminobutyrate acid activity at some subtypes of the GABA- A receptors, antagonism of AMPA/kainate subtype of the glutamate receptor, and inhibition of the carbonic anhydrase enzyme, particularly isozymes II and IV ."
OK, so just get that up to a high dose (and forget about having working memory for a while) and add memantine. How much broader of a net can one cover?
Call me crazy, but I think the easiest thing to do is probably administer a gargantuan loading dose of clorazepate and let the nordazepam just taper itself. There is probably some reason this is not done, but I'd like someone to clue me in as to the reason Tranxene is not the drug of choice for benzo discontinuation.
poster:Chairman_MAO
thread:980391
URL: http://www.dr-bob.org/babble/20111006/msgs/998929.html