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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by rjlockhart on February 14, 2007, at 14:38:51
Well in terms of non-hostpial benzodiazpine, such has the stuff they use to put you to sleep.
Im talking like doctor wise, Klonopin Ativan, Valium, Halcion, Xanax?
I heard it attaches 80% to the receptors (GABA)
Anyone
Posted by dbc on February 14, 2007, at 15:21:17
In reply to Is Xanax the most potent benzodiapine in the US?, posted by rjlockhart on February 14, 2007, at 14:38:51
The triazolo-ring in xanax causes it to pass through the blood brain barrier much easier. So yes it is by far the most potent benzo on a per dose basis.
Everyone has their own favorite benzo its purely subjective.
Posted by valene on February 14, 2007, at 15:57:25
In reply to Re: Is Xanax the most potent benzodiapine in the U, posted by dbc on February 14, 2007, at 15:21:17
I thought that Klonopin was equally as potent, only with a longer half-life, according to Prof. Ashton's charts.....1mg. Klonopin = 20 mg. Valium, 1mg. xanax = 20 mg. valium.
Val> The triazolo-ring in xanax causes it to pass through the blood brain barrier much easier. So yes it is by far the most potent benzo on a per dose basis.
>
> Everyone has their own favorite benzo its purely subjective.
Posted by dbc on February 14, 2007, at 16:36:34
In reply to Re: Is Xanax the most potent benzodiapine in the U, posted by valene on February 14, 2007, at 15:57:25
> I thought that Klonopin was equally as potent, only with a longer half-life, according to Prof. Ashton's charts.....1mg. Klonopin = 20 mg. Valium, 1mg. xanax = 20 mg. valium.
> ValAsk anyone with real experiance. Maybe 1mg xanax = 1.5mg of klonopin. Besides ashton is not the authority on benzos. Her manual is full of errors.
Posted by notfred on February 14, 2007, at 16:53:16
In reply to Re: Is Xanax the most potent benzodiapine in the U, posted by dbc on February 14, 2007, at 15:21:17
"Everyone has their own favorite benzo its purely subjective."
Very true. What does potent mean ? Longest acting ?
However some of the shortest acting benzos are used to knock people out, clearly they are "potent".
Posted by yxibow on February 14, 2007, at 17:08:11
In reply to Re: Is Xanax the most potent benzodiapine in the U, posted by notfred on February 14, 2007, at 16:53:16
> "Everyone has their own favorite benzo its purely subjective."
>
> Very true. What does potent mean ? Longest acting ?
> However some of the shortest acting benzos are used to knock people out, clearly they are "potent".
>
>Yes -- try Dalmane... well not without your doctor. If you've never used it for sleep, it sucks you in. I'd rank that with pretty powerful, but again the half life is only intended for sleep.
But I'd agree that Xanax is fairly potent which is why I save it for a PRN use and not a long term drug.
Posted by valene on February 14, 2007, at 17:59:51
In reply to Re: Is Xanax the most potent benzodiapine in the U » notfred, posted by yxibow on February 14, 2007, at 17:08:11
Jay,
That makes me nervous ("not a long term drug") as I have been on xanax for many years. So I should ask for another benzo when xanax is working and I have reduced the amount from 3mg to 1.75mg. ? This is scaring me. But, I found that valium made me more sedated and I actually had a car accident during the short time I was taking valium in place of xanax. Never had an accident before and am convinced it was the valium (11mg.) (low dose compared to the xanax!)
Val> Yes -- try Dalmane... well not without your doctor. If you've never used it for sleep, it sucks you in. I'd rank that with pretty powerful, but again the half life is only intended for sleep.
>
> But I'd agree that Xanax is fairly potent which is why I save it for a PRN use and not a long term drug.
>
Posted by Quintal on February 14, 2007, at 20:07:31
In reply to Re: Is Xanax the most potent benzodiapine in the U, posted by valene on February 14, 2007, at 17:59:51
Here are some quotes by Ashton herself that may help explain what you've observed;
__________________________________________________First you may ask how these equivalents were arrived at. Most were determined by direct clinical titration. In about 1983 Professor Michael Rawlins and I in Newcastle titrated the dose of diazepam required to substitute, in terms of anxiety symptoms, in 20 anxious patients on various doses of lorazepam. The mean came to an equivalence of 9.8mg diazepam for 1mg lorazepam. This is close to the equivalence of 1:10mg now officially accepted in most texts. Similar clinical tests were conducted for other benzodiazepine such as alprazolam though some equivalents are based on clinical experience during withdrawal of patients on various benzodiazepines who were switched to diazepam. Some equivalents were derived from animal work and human trials by drug companies. There is now a general consensus, at least in the UK, about equivalent potencies for both anxiolytic and hypnotic benzodiazepines. They are quoted in the British National Formulary produced by the British Medical Association and the Royal Pharmaceutical Society circulated to all doctors and in many published papers. Unfortunately, not all doctors read or heed this advice!
All these equivalencies are of course approximate. There is considerable individual variation in how people react to benzodiazepines. In addition, there are subtle differences in the pharmacological profiles of different drugs, and the equivalences do not always work at higher doses. For example, in my clinical experience diazepam is rather more sedative than lorazepam (Ativan) which is more anxiolytic. So if you abruptly change someone on say 6mg Ativan to 60mg of diazepam, he is likely to become very sleepy but may still be anxious. However, you can accomplish a changeover if you do it gradually and stepwise, dose by dose, titrating each dose to the clinical response. People also have differences in the speed at which they metabolise drugs, but on the whole the equivalences apply generally, except possibly in the case of benzodiazepines which have active metabolites such as diazepam where the half-lives of these can vary from 36-200 hrs.
http://www.psychmedaware.org/History%20of%20Benzodiazepines.html
__________________________________________________Q
Posted by saturn on February 14, 2007, at 20:46:44
In reply to Re: Is Xanax the most potent benzodiapine in the U » valene, posted by Quintal on February 14, 2007, at 20:07:31
I've found several online, each a little different, but if anyone knows of one that is particularly accurate, would you please post a link if possible? Thanks...Peace...Saturn.
Posted by notfred on February 14, 2007, at 21:16:03
In reply to Could someone provide benzo equivalency link plz, posted by saturn on February 14, 2007, at 20:46:44
"I've found several online, each a little different, but if anyone knows of one that is particularly accurate, would you please post a link if possible?"
There is no way for one to be particularly accurate because, as we are discussing in this thread, this is highly subjective.
That is why each of the charts you have found is a little different.
Posted by Phillipa on February 14, 2007, at 21:32:29
In reply to Re: Could someone provide benzo equivalency link p, posted by notfred on February 14, 2007, at 21:16:03
I've tried them all or had them prescribed at different times in my life and found at one time I could tolerate more, peri-menopause was one time, then less, then needed less, then I just decided one day to return to the original benzo I started with valium. But I find that xanax is probably better and I don't find meds like this recreational as I don't even drink. I just want anxiety relief and yes i deep breath. Love Phillipa
Posted by notfred on February 14, 2007, at 21:48:56
In reply to Re: Is Xanax the most potent benzodiapine in the U » notfred, posted by yxibow on February 14, 2007, at 17:08:11
This question comes up again and again and it bothers me. Questions like "which <insert scheduled
drug> is best for this condition or symptom" seem legit to me. But when questions like "which <insert scheduled drug> is the strongest" are asked again and again I get conserned that the real question asked is "Which one gets me higher"I would define potent WRT benzos on their knock me on my *ss potential. knock me on my *ss (KMOMA) to me is when you cannot resist sleep, slur your words the day after or so, and your recient memory is wiped clean. I do not find KMOMA benzos useful for day to day use because I do not want to be high all the time.
Posted by michael on February 15, 2007, at 2:34:23
In reply to Could someone provide benzo equivalency link plz, posted by saturn on February 14, 2007, at 20:46:44
>
> I've found several online, each a little different, but if anyone knows of one that is particularly accurate, would you please post a link if possible? Thanks...Peace...Saturn.
*****************************
Look in the "Tips" section here at PB.I think there are 2 (at least 1) benzo-equivalence charts.
michael
Posted by saturn on February 15, 2007, at 17:05:41
In reply to Re: Is Xanax the most potent benzodiapine in the U, posted by notfred on February 14, 2007, at 21:48:56
> This question comes up again and again and it bothers me. Questions like "which <insert scheduled
> drug> is best for this condition or symptom" seem legit to me. But when questions like "which <insert scheduled drug> is the strongest" are asked again and again I get conserned that the real question asked is "Which one gets me higher"While I see your point, it could be a completely legitimate question, regardless of its scheduled status.
Posted by ace on February 15, 2007, at 20:24:01
In reply to Is Xanax the most potent benzodiapine in the US?, posted by rjlockhart on February 14, 2007, at 14:38:51
> Well in terms of non-hostpial benzodiazpine, such has the stuff they use to put you to sleep.
>
> Im talking like doctor wise, Klonopin Ativan, Valium, Halcion, Xanax?
>
> I heard it attaches 80% to the receptors (GABA)
>
> Anyone
Its all to do with dosage and half-life my man!They all have very similiar effect and affinity for G. receptors.....
I could be wrong here as I havent reviewed this topic for a while...so sorry!
Ace
Posted by yxibow on February 16, 2007, at 2:28:57
In reply to Could someone provide benzo equivalency link plz, posted by saturn on February 14, 2007, at 20:46:44
>
> I've found several online, each a little different, but if anyone knows of one that is particularly accurate, would you please post a link if possible? Thanks...Peace...Saturn.I've found that Dr Bob's first one at
http://www.dr-bob.org/tips/bzd.html
is pretty accurate. It was accurate for transfer from Klonopin to Valium and is fairly accurate as to Xanax and Valium.
Posted by yxibow on February 16, 2007, at 2:32:46
In reply to Re: Is Xanax the most potent benzodiapine in the U, posted by valene on February 14, 2007, at 17:59:51
> Jay,
> That makes me nervous ("not a long term drug") as I have been on xanax for many years. So I should ask for another benzo when xanax is working and I have reduced the amount from 3mg to 1.75mg. ? This is scaring me. But, I found that valium made me more sedated and I actually had a car accident during the short time I was taking valium in place of xanax. Never had an accident before and am convinced it was the valium (11mg.) (low dose compared to the xanax!)11mg of Valium is pretty low, in fact you would have to deliberately take a 10mg tablet and a 1mg tablet, are you sure that was the dose?
What I meant is that for the majority of people who are taking a benzodiazepine for an extended period of time is that the best agents are the ones with the longest half life -- Klonopin, Valium, Librium, etc. because they have less problems with interdosal withdrawal and withdrawal from them in general.
On the other hand there are some people for whom Xanax is the only one that works for them, so if that scared you that wasn't my intention -- its just that if you're used to Xanax, it doesn't work very well as a PRN agent when you need something fast to knock down a panic attack, say.
Sorry for the worry
-- tidings
> Val
>
> > Yes -- try Dalmane... well not without your doctor. If you've never used it for sleep, it sucks you in. I'd rank that with pretty powerful, but again the half life is only intended for sleep.
> >
> > But I'd agree that Xanax is fairly potent which is why I save it for a PRN use and not a long term drug.
> >
>
>
Posted by valene on February 16, 2007, at 9:09:50
In reply to Re: Is Xanax the most potent benzodiapine in the U » valene, posted by yxibow on February 16, 2007, at 2:32:46
Yes, I was taking 11mg valium because I crossed over slowly from xanax to valium entirely ala Ashton. So I asked my pdoc to prescribe liquid diazepam and I measured it out and took liquid and tablet to get an exact dose, reducing valium by a tiny amount daily. I wish I had kept on going, as I could be off it by now :((( but things were very stressful and I ended up being so depressed on the diazepam that my pdoc wordlessly handed me a script for 1.5 mg. xanax, so right back on it! I never had big panic attacks, mostly GAD excessive worry, constant. Thanks for your answer.
> 11mg of Valium is pretty low, in fact you would have to deliberately take a 10mg tablet and a 1mg tablet, are you sure that was the dose?
>
> What I meant is that for the majority of people who are taking a benzodiazepine for an extended period of time is that the best agents are the ones with the longest half life -- Klonopin, Valium, Librium, etc. because they have less problems with interdosal withdrawal and withdrawal from them in general.
>
> On the other hand there are some people for whom Xanax is the only one that works for them, so if that scared you that wasn't my intention -- its just that if you're used to Xanax, it doesn't work very well as a PRN agent when you need something fast to knock down a panic attack, say.
>
> Sorry for the worry
>
Posted by kaleidoscope on February 16, 2007, at 16:22:33
In reply to Re: Is Xanax the most potent benzodiapine in the U » notfred, posted by yxibow on February 14, 2007, at 17:08:11
Hi
>Yes -- try Dalmane
'Potency' compares the effects of drugs mg for mg. The usual dose of Dalame is 15 to 30mg at night. Dalmane is clearly much less potent than Xanax, if you took 15 to 30mg Xanax, it would produce exceptionally powerful effects!
>I'd rank that with pretty powerful, but again the half life is only intended for sleep.
I don't understand what you mean by this. Flurazepam's major active metabolite (desalkylflurazepam) has an exceptionally long half life. As a result, repeated doses of Dalmane accumulate more than any other benzo. In short, Dalmane's duration of action is far too long. Pronounced daytime drowsiness and confusion can occur when desalkylflurazepam accumulates.
K
Posted by rjlockhart on February 16, 2007, at 21:56:00
In reply to Re: Is Xanax the most potent benzodiapine in the U » yxibow, posted by kaleidoscope on February 16, 2007, at 16:22:33
post.
GOd i want to chuck this laptop clear wear ever belongs!
Anyways thank you everyone, since i was discussing dalmane in my other post, im glad i didnt post it actually i didnt quite understnad the dalmane post. I thought Dalmane was actually more potent than xanax.
Anyways
I take 6mg daily is that alot?
Matt
Posted by yxibow on February 16, 2007, at 22:55:55
In reply to Re: Is Xanax the most potent benzodiapine in the U » yxibow, posted by kaleidoscope on February 16, 2007, at 16:22:33
> Hi
>
> >Yes -- try Dalmane
>
> 'Potency' compares the effects of drugs mg for mg. The usual dose of Dalame is 15 to 30mg at night. Dalmane is clearly much less potent than Xanax, if you took 15 to 30mg Xanax, it would produce exceptionally powerful effects!
>
> >I'd rank that with pretty powerful, but again the half life is only intended for sleep.
>
> I don't understand what you mean by this. Flurazepam's major active metabolite (desalkylflurazepam) has an exceptionally long half life. As a result, repeated doses of Dalmane accumulate more than any other benzo. In short, Dalmane's duration of action is far too long. Pronounced daytime drowsiness and confusion can occur when desalkylflurazepam accumulates.
>
> KI don't mean its rough benzodiazepine equivalency, which is on par as you noted and yes, it has a metabolite which stays around far too long even though it is only intended for sleep, I mean't the sheer feeling I felt when taking Dalmane, its immediacy effect is stronger than Xanax, its uptake is fairly instant and it is heavily tuned to be hypnotic, creating a sensation of powerlessness.
Posted by Phillipa on February 16, 2007, at 23:01:09
In reply to Re: Is Xanax the most potent benzodiapine in the U » kaleidoscope, posted by yxibow on February 16, 2007, at 22:55:55
That's what I need. Love Phillipa ps I really don't think I ever took it is it stronger than the two sequenols the OB-GYN gave me in false labor in l973? They didn't put me to sleep.
Posted by yxibow on February 17, 2007, at 2:26:59
In reply to Re: Is Xanax the most potent benzodiapine in the U » yxibow, posted by Phillipa on February 16, 2007, at 23:01:09
> That's what I need. Love Phillipa ps I really don't think I ever took it is it stronger than the two sequenols the OB-GYN gave me in false labor in l973? They didn't put me to sleep.
Well you'll have some cross-tolerance with Valium but the last time I took Dalmane I can safely say it was positively flattening. As they say your miles may vary. Definately far more "suck in" potential than Restoril. Sleep doesn't actually reach its peak for several days after its use because of its long half life, and thus abrupt discontinuation can cause insomnia withdrawal.
In general though, benzodiazepine sleep aids (Restoril, Dalmane, Halcion, Rohypnol [in parts of Europe]) work for a more short term solution than pseudobenzodiazepine sleep aids such as Lunesta and Ambien CR (and by proxy I suppose Ambien as well) which have been studied in long term trials. Habituation can occur more easily than with say, Lunesta, which of course can still cause habituation eventually.
Posted by Phillipa on February 17, 2007, at 19:34:37
In reply to Re: Is Xanax the most potent benzodiapine in the U » Phillipa, posted by yxibow on February 17, 2007, at 2:26:59
Jay but lunesta is pretty safe with the valium and xanax for now while they are regulating my up and down thyroid darn autoimmune system. Love Phillipa
Posted by yxibow on February 17, 2007, at 22:25:22
In reply to Re: Is Xanax the most potent benzodiapine in the U » yxibow, posted by Phillipa on February 17, 2007, at 19:34:37
> Jay but lunesta is pretty safe with the valium and xanax for now while they are regulating my up and down thyroid darn autoimmune system. Love Phillipa
Yes, Lunesta is perfectly safe with the levels of benzodiazepines you take. You may not get the same success that someone who is benzodiazepine "naive" that takes Lunesta, but its fine. I had to take 4mg to get something out of Lunesta. And then there's the lovely nickel or cobalt taste, but not too much one can do about it.
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