![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by JohnM on March 4, 2001, at 19:30:29
I need to know what would be the next longest acting benzodiazepine after Klonopin. Although I can get by on very low doses of benzos (for social anxiety/phobia) the problem I have with them is that my body "metabolizes" (if that's the word) them very quickly. Xanax, Ativan, and Valium all worked well for me, but I needed to take another dose after about 2 hours with Xanax and Ativan and about 3 hours with Valium. I've used Klonopin and it lasted 5 hours which I felt was "reasonable", but I felt it had a sort of "depressing" effect on me (I know Klonopin is often indicated for its anti-convulsant and anti-manic properties)--maybe that has something to do with it.
I would appreciate some information on other possibilities. From my own research, I came to the conclusion that Serax (oxazepam) would be the next choice. Your suggestion? John
Posted by Jeff on March 5, 2001, at 12:26:33
In reply to Please suggest a long-acting benzodiazepine, posted by JohnM on March 4, 2001, at 19:30:29
I could be wrong, but I thought Valium (diazepam) was or is one of the longest acting benzos out there. I take it now, but think my body kicks it out pretty quick. Later, Jeff
I need to know what would be the next longest acting benzodiazepine after Klonopin. Although I can get by on very low doses of benzos (for social anxiety/phobia) the problem I have with them is that my body "metabolizes" (if that's the word) them very quickly. Xanax, Ativan, and Valium all worked well for me, but I needed to take another dose after about 2 hours with Xanax and Ativan and about 3 hours with Valium. I've used Klonopin and it lasted 5 hours which I felt was "reasonable", but I felt it had a sort of "depressing" effect on me (I know Klonopin is often indicated for its anti-convulsant and anti-manic properties)--maybe that has something to do with it.
>
> I would appreciate some information on other possibilities. From my own research, I came to the conclusion that Serax (oxazepam) would be the next choice. Your suggestion? John
Posted by Daveman on March 6, 2001, at 0:01:31
In reply to Please suggest a long-acting benzodiazepine, posted by JohnM on March 4, 2001, at 19:30:29
John,
Have you checked out the Benzodiazepene Equivalency Charts on this website? They list the time to peak plasma for each of the benzos.
My own experience is limited to Xanax and Klonopin. However, I've been told that some of the benzos are used to treat anxiety with depression (Xanax, Ativan, Serax) while others usually aren't. I'd check this out with your pdoc before deciding on your next move.
Daveman
> I need to know what would be the next longest acting benzodiazepine after Klonopin. Although I can get by on very low doses of benzos (for social anxiety/phobia) the problem I have with them is that my body "metabolizes" (if that's the word) them very quickly. Xanax, Ativan, and Valium all worked well for me, but I needed to take another dose after about 2 hours with Xanax and Ativan and about 3 hours with Valium. I've used Klonopin and it lasted 5 hours which I felt was "reasonable", but I felt it had a sort of "depressing" effect on me (I know Klonopin is often indicated for its anti-convulsant and anti-manic properties)--maybe that has something to do with it.
>
> I would appreciate some information on other possibilities. From my own research, I came to the conclusion that Serax (oxazepam) would be the next choice. Your suggestion? John
Posted by JohnX on March 7, 2001, at 4:27:43
In reply to Please suggest a long-acting benzodiazepine, posted by JohnM on March 4, 2001, at 19:30:29
> I need to know what would be the next longest acting benzodiazepine after Klonopin. Although I can get by on very low doses of benzos (for social anxiety/phobia) the problem I have with them is that my body "metabolizes" (if that's the word) them very quickly. Xanax, Ativan, and Valium all worked well for me, but I needed to take another dose after about 2 hours with Xanax and Ativan and about 3 hours with Valium. I've used Klonopin and it lasted 5 hours which I felt was "reasonable", but I felt it had a sort of "depressing" effect on me (I know Klonopin is often indicated for its anti-convulsant and anti-manic properties)--maybe that has something to do with it.
>
> I would appreciate some information on other possibilities. From my own research, I came to the conclusion that Serax (oxazepam) would be the next choice. Your suggestion? JohnDo you remember if the inserts to Xanax,Ativan,
or Valium contraindicated taking them with
graprefruit juice or cemitidine (Tagamet)?I seem to recall these meds being
deaminated (broken down) in the liver by an enyme
that is inhibited by one of the two. I could
dig up the drug interactions if you are interested.It will be playing with fire, but possibly you can
drink a small amount of grape fruit juice to increase the 1/2 life (decrease metabolization) of the med. Anyone scream at me for suggesting this.Have you tried SSRI anti-depressant medications
like Paxil? I took benzos and hit the addiction
wall. I'll tell you it's pretty heinous when this happens.-John
Posted by JohnM on March 7, 2001, at 16:17:14
In reply to Re: Please suggest a long-acting benzodiazepine, posted by JohnX on March 7, 2001, at 4:27:43
Sure, I wouldn't mind you looking it up for me (the grapefruit juice trick) ha ha! Any information would be useful!
I take a small dose of Nardil at present. I've tried almost all the SSRI's and they didn't work for me (made me agitated/anxious). Thanks for your input. John
Posted by JohnX on March 9, 2001, at 2:57:28
In reply to Thanks John X, posted by JohnM on March 7, 2001, at 16:17:14
> Sure, I wouldn't mind you looking it up for me (the grapefruit juice trick) ha ha! Any information would be useful!
>
> I take a small dose of Nardil at present. I've tried almost all the SSRI's and they didn't work for me (made me agitated/anxious). Thanks for your input. JohnWell I've looked at Xanax, and from the PDR and studies the best way to increase the 1/2 life is to take it with Luvox, which you can't do with the Nardil. Other meds like Serzone and some anti-biotics increase the plasma concentrations but have less effects on the 1/2 life meaning you could get the same effect of Xanax at a lower dose, but it still would crap out in the same amount of time.
The clearance of most of those benzos occurs within the CYP 3A group of enzymes in the liver.
Here is a good table that shows how various meds work on certain liver enzymes.:
http://www.georgetown.edu/departments/pharmacology/davetab.html
Generally if med A uses substrate X and med B inhibits substrate X, then the clearance of med A is reduced. If med B induces substrate X, then the clearance is increased. Are you taking any of the substances listed under the 3a4,5,7 inducer table?
I haven't checked on Nardil's metabolism.
If you can find the PDR for a med by going to the manufacturers web page it should list how the drug is metabolized (which enzymes are involved) and what the major interactions are with other meds.
-John
Posted by jb on March 9, 2001, at 15:53:30
In reply to Please suggest a long-acting benzodiazepine, posted by JohnM on March 4, 2001, at 19:30:29
One idea may be to augment Klonopin with Modafinil. Klonopin is the longest acting benzo of which I'm aware. Augmentation with Modafinil might offset the lethargy which accompanies Klonopin. You may want to ask your pdoc about half-lives of other benzo's. But, Klonopin remains the benzo gold standard, in my opinion.
JB
Posted by JohnM on March 9, 2001, at 18:58:01
In reply to Re: Please suggest a long-acting benzodiazepine, posted by jb on March 9, 2001, at 15:53:30
I seem to find contradictions with half-life of a med and its duration of effect in the CNS. For example compare Ativan to Valium. Ativan, although it has a much shorter half life, supposedly has a longer duration of effect than Valium.
From a nursing pharmacology book I looked at, it seems that Tranxene (clorazepate) or Serax (oxazepam) would be my best bet.
Posted by JohnX on March 10, 2001, at 1:41:06
In reply to Is half-life the whole story?, posted by JohnM on March 9, 2001, at 18:58:01
> I seem to find contradictions with half-life of a med and its duration of effect in the CNS. For example compare Ativan to Valium. Ativan, although it has a much shorter half life, supposedly has a longer duration of effect than Valium.
>
> From a nursing pharmacology book I looked at, it seems that Tranxene (clorazepate) or Serax (oxazepam) would be my best bet.I believe the 1/2 life is with respect to how long it takes for the body to clear 1/2 of the medication from the blood plasma. The longer the med is in the blood plasma, the more time it has to penetrate the blood/brain barrier. How long it takes for the the medication to be deaminated within the brain may be different. Anybody correct me if I'm wrong.
-John
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.