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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Crotale on July 27, 2008, at 9:43:39
Is anybody here taking high doses (e.g., more than twice the recommended nightly dose) of Ambien or other "z-drugs" (sedative-hypnotics that are not benzos but are controlled, like zolpidem, zopiclone, etc.) If so, how much, and how did your doctor decide to prescribe that much?
-Crotale
p.s. also, anyone using these for something other than sleeping, such as daytime anxiety?
Posted by Phillipa on July 27, 2008, at 10:53:26
In reply to high dose zolpidem, posted by Crotale on July 27, 2008, at 9:43:39
When I took lunesta I also needed valium. Now I only need the valium. Maybe lunesta would be okay in the daytime but with ambien's reputation for amnesia I wouldn't think it would be safe. Phillipa
Posted by raisinb on July 27, 2008, at 11:55:44
In reply to high dose zolpidem, posted by Crotale on July 27, 2008, at 9:43:39
When I started Wellbutrin, the max dose of Lunesta (3 mg) did not work for insomnia. I started taking 5,6, 7.5 mg at a time. My doctor told me, "it's not ideal, but certainly understandable under the circumstances," and that it was okay to keep doing it in the short term. He also monkeyed with my meds, though, so that the insomnia caused by Wellbutrin was considerably mitigated and I only need 3 mg or less now.
Posted by Crotale on July 27, 2008, at 13:59:10
In reply to Re: high dose zolpidem » Crotale, posted by raisinb on July 27, 2008, at 11:55:44
Ambien [and generic therof, yay!] is the only one of those things that work for me at all...Lunesta and the rest don't seem to do anything (although I've only tried slightly higher-than-recommended doses).
I take 20mg q.h.s. of Ambien - have always needed this amount even when on no other meds. It's pretty okay (the only sedative-hypnotic I've ever found that doesn't stop working after a few nights tops) but it only lasts 4 hours, or less. However, I'm nervous about asking my pdoc if I can take a second dose in the middle of the night. Afraid if I ask for more he'll think I'm abusing it or something.
Good point about the amnesia thing. They've been giving me a very intense triazolobenzo [related to Xanax and Halcion] called Versed (midazolam) along with the anesthesia for the ECT. So when I wake up I'm always confused for a while, like it takes me a few minutes just to figure out that the treatment's over! It's kind of annoying, especially since I don't see why I need Versed with general anesthesia! (For that matter, it seems odd that they would give you a medication with anticonvulsant properties during ECT. I guess they compensate for that, though.)
-Crotale
(who, incidentally, thinks the idea of trying to get high on Ambien is pretty lame)
Posted by raisinb on July 27, 2008, at 16:47:46
In reply to Re: high dose zolpidem, posted by Crotale on July 27, 2008, at 13:59:10
I've taken 20mg of Ambien before--no permanent damage, though my doctor wasn't happy when she found out.
If it's only lasting 4 hours for you, maybe try the CR if you haven't already.
Posted by dbc on July 27, 2008, at 18:14:17
In reply to Re: high dose zolpidem » Crotale, posted by raisinb on July 27, 2008, at 16:47:46
Something to keep in mind, any drug that relies on GABAa for its mechanism of action is impacted by any sort of stimulant. NRI/SNRI drugs included. This is such a big deal that even after ingesting caffeine you can see lower blood levels of valium than normal in patients.
Posted by Crotale on July 27, 2008, at 20:32:39
In reply to Re: high dose zolpidem » Crotale, posted by raisinb on July 27, 2008, at 16:47:46
> I've taken 20mg of Ambien before--no permanent damage, though my doctor wasn't happy when she found out.
Well, I've been taking this dose for years; 10mg just wasn't enough to ever do any good for me. And I've tried just about every other sedative-hypnotic in existence.
> If it's only lasting 4 hours for you, maybe try the CR if you haven't already.
Tried it. It didn't seem to do much good relative to the regular stuff. Plus my insurance refuses to cover more than 30 pills a month and the CR isn't available in a generic and won't be for a long time.
-Crotale
Posted by Crotale on July 27, 2008, at 20:51:45
In reply to Re: high dose zolpidem, posted by dbc on July 27, 2008, at 18:14:17
> Something to keep in mind, any drug that relies on GABAa for its mechanism of action is impacted by any sort of stimulant. NRI/SNRI drugs included. This is such a big deal that even after ingesting caffeine you can see lower blood levels of valium than normal in patients.
I take Parnate...I have to take it at bedtime, because I take it not only for depression but also for a parasomnia (sleep disorder) called REM Sleep Behavior Disorder. It means I'm not paralyzed during REM sleep, so I act out my dreams. (My parents used to think I was sleepwalking, I only got diagnosed when I was 20 or so.) The MAOIs suppress REM sleep almost completely, which puts a stop to that. Other ADs suppress REM sleep to a degree but none of the other types did away with the "active dreaming" like the MAOIs.)
Yeah, MAOIs do interfere with sleep in my experience (regardless of what time of day I take them), but I can't find anything else that works as well both for the depression and the sleep d/o (desipramine was a good AD but it didn't solve the "active REM sleep" problem, plus I had a seizure on it).
I don't drink any caffeine, ever. Coffee, soda, anything. Even in the morning. Don't take any other stimulants either except very rarely, and only 1st thing in the AM, a modest dose of modafinil, 50-100mg.
Do you think Valium levels are affected by the pharmacodynamic action of caffeine (that seems weird), or is it a pharmacokinetic interaction? Have other bzds been found to be affected in this way too? I find the midazolam they give me along with the anesthesia during the ECT hits me plenty hard. Maybe if I have the confusion issues after I wake up from the next treatment - I'm pretty sure this is due to the Versed - I'll try taking some Parnate or something and see if that has any effect.
-Crotale
Posted by dbc on July 28, 2008, at 14:14:47
In reply to Re: high dose zolpidem » dbc, posted by Crotale on July 27, 2008, at 20:51:45
All the BZDs are or anything in general that relies on GABAa such as ambien because stimulants tend to produce cortisol/glutamate which are of course the main excitatory neurochemicals in the brain. As a reaction to this theres lower levels of GABA.
BZDs are the easiest to make an example of because you can literally see the blood level effected by a stimulant.
Posted by yxibow on July 29, 2008, at 2:20:02
In reply to high dose zolpidem, posted by Crotale on July 27, 2008, at 9:43:39
> Is anybody here taking high doses (e.g., more than twice the recommended nightly dose) of Ambien or other "z-drugs" (sedative-hypnotics that are not benzos but are controlled, like zolpidem, zopiclone, etc.) If so, how much, and how did your doctor decide to prescribe that much?
>
> -Crotale
>
> p.s. also, anyone using these for something other than sleeping, such as daytime anxiety?
I would not use it for daytime use. Sleep agents produce unknown and unintended effects. Even for their intended purpose they can cause sleepwalking in some people, finding that they have fixed a midnight snack and fallen asleep, all without ever knowing it. I would say that falls into the "recreational use category". I vaguely knew someone who was using like 30mg in clubs with alcohol.... ai ya.
As for the other answer -- yes... I have taken Ambien at 20-25mg and Lunesta at 4mg (the insurance would not pay for the extra).But besides my one "psychedelic trip" on Ambien when I was in college and desperately in need of something to take the edge off of Effexor since I took a midterm on one hour of sleep --- it said, sleep, come to me, oh my god it was wonderful --- I have never felt a "zing" from it again. It worked still vaguely for sleep but I never felt a reaction.
Your miles may vary, I'm sure.
-- tidings
Jay
Posted by blueboy on July 29, 2008, at 9:46:56
In reply to high dose zolpidem, posted by Crotale on July 27, 2008, at 9:43:39
> Is anybody here taking high doses (e.g., more than twice the recommended nightly dose) of Ambien or other "z-drugs" (sedative-hypnotics that are not benzos but are controlled, like zolpidem, zopiclone, etc.) If so, how much, and how did your doctor decide to prescribe that much?
>I take up to 30mg of zolpidem and I think 7.5mg Lunesta. I have major insomnia problems.
Since I got off Nardil, I tend to find slightly less to be necessary, e.g. 20-25mg zolpidem. The same is true of clonazepam/Klonopin -- for sleep, when I use it, I take 20-30mg, although the 10mg standard dose is useful for social anxiety when I want to stay alert. But since I have been on Lamictal and off Nardil, I've started using 20mg instead of 25-30, with pretty good success.
I have to say, Ambien at 30mg has given me a bit of a "high" on occasion :) Don't tell anyone, since the DEA would no doubt put it on a higher schedule if they found out someone actually enjoyed taking it.
Posted by Crotale on August 3, 2008, at 23:01:41
In reply to Re: high dose zolpidem, posted by blueboy on July 29, 2008, at 9:46:56
> I take up to 30mg of zolpidem and I think 7.5mg Lunesta. I have major insomnia problems.
Interesting combination. As I said I haven't gotten anything out of the other z-hypnotics. I suspect I would tolerate 30mg zolpidem fine, but I can't think of a delicate way to ask my pdoc to raise it.
> Since I got off Nardil, I tend to find slightly less to be necessary, e.g. 20-25mg zolpidem.
Yeah, I've found all the MAOIs interfere with sleep to some extent, and I have pretty bad insomnia anyway.
> The same is true of clonazepam/Klonopin -- for sleep, when I use it, I take 20-30mg, although the 10mg standard dose is useful for social anxiety when I want to stay alert.
err...are you sure that's Klonopin? that seems like an awfully high dose.
> I have to say, Ambien at 30mg has given me a bit of a "high" on occasion :) Don't tell anyone, since the DEA would no doubt put it on a higher schedule if they found out someone actually enjoyed taking it.
Naughty naughty! <wags finger> Can't have people actually enjoying anything!
My all-time least-favorite act of the DEA (or maybe it's the FDA that does this sort of thing?): They moved buprenorphine from C-V to C-III just because they started using it to treat drug addiction. Like all of a sudden it's a different drug or something. I wouldn't put anything past them, no matter how irrational.
-Crotale
This is the end of the thread.
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