![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by socialphobic on September 26, 2008, at 9:15:58
I currently take 30mg oxazpeam or 10mg valium 1 - 2 times a week for insomnia. However, both are starting to lose their effectiveness (can this happen just from taking 1 - 2 times a week?). The first time I took a benzo it knocked me out good which was great, but over the years it seems i've built up a mild tolerance even when I rarely take them? (1 - 2 times a week max).
So what is another good benzo to try? I've heard klonopin is the best, but its not available on the PBS in australia unless you have epilepsy.
So what is the next best thing after klonopin? I've heard xanax is pretty good?
Also, once you build up a tolerace to one benzo, do you build up a tolerance to them all at equivilant dosages?
Posted by mav27 on September 26, 2008, at 12:11:12
In reply to Which benzo should I try next?, posted by socialphobic on September 26, 2008, at 9:15:58
Im using klonapin (clonazepam) for my social phobia. I find it's really great stuff. I'm also in Australia. I wouldn't worry too much about it not being on the pbs as it is very cheap stuff. it costs around $9 for a bottle of 100 .5mg tablets. I found .5mg to be a decent strength in itself for me(some days i only need .25mg), 1mg seems to be the more usual dose though for social phobia. 2mg knocks me out.
Posted by Nadezda on September 26, 2008, at 12:12:28
In reply to Which benzo should I try next?, posted by socialphobic on September 26, 2008, at 9:15:58
My pdoc suggested I take lorazepam (trade name in the US, ativan), after I had felt that xanax, at the dose I was using, had less effect. So I infer that lack of response to one doesn't mean lack of response to all.
I'd try lorazepam first, although xanax is also good for sleep, especially since you don't use it that often. Both have a shorter half life than valium, but closer to oxazepam.
Nadezda
Posted by desolationrower on September 26, 2008, at 13:02:38
In reply to Re: Which benzo should I try next?, posted by Nadezda on September 26, 2008, at 12:12:28
I think you should get a med like trazodone for sleep, and save the benzos for anxiety.
-d/r
Posted by Phillipa on September 26, 2008, at 13:09:53
In reply to Re: Which benzo should I try next?, posted by desolationrower on September 26, 2008, at 13:02:38
10mg of valium and .5 of xanax let me sleep in about l5 minutes with 50mg of luvox. Always wake in about 4-5 hours used to take more valium now down to 2.5 at that time. Love Phillipa
Posted by med_empowered on September 26, 2008, at 19:25:19
In reply to Re: Which benzo should I try next?, posted by Phillipa on September 26, 2008, at 13:09:53
I think it depends. The ultimate sleepy-time Benzo is Restoril (temazepam). Here in the US it seems to be regaining some popularity, but I've heard that other countries have more restrictions on it b/c of addiction and abuse (apparently the geniuses who make it put it capsule form, so some people break open the capsule to snort it, inject it, and slip it into other peoples' drinks.)
Klonopin is a good anxiolytic, but I'm pretty sure its not that great as a sleeping pill...it loses its hypnotic effect pretty quickly.
Can you try a pill designed for sleep? THe thing about Valium is that you're going to get less drowsy off of it over time b/c its really meant for use as a daytime anxiolytic than as a sleeping pill. Benzo-type sleeping pills include: Dalmane (old school, hangover problems), ProSom, Doral, and Halcion (may not be available in your country...sometimes makes people insane).
Does Aussie healthcare cover the "z" hypnotics, like zolpidem, zoplicone, and Sonata (whatever its generic name is..) ? Those are designed for sleep.
Good luck.
Posted by azalea on September 26, 2008, at 20:35:24
In reply to Re: Which benzo should I try next?, posted by med_empowered on September 26, 2008, at 19:25:19
Sonata brand is generic zaleplon. Another brand name it goes by is Starnoc. The "z" medications (zolpidem, zoplicone, zaleplon) are non-benzodiazepine hypnotics that are quite beneficial for sleep and don't cause next day sedation.
If there is a depression component to your insomnia, trazodone or Remeron (mirtazapine) are 2 options.
>I think it depends. The ultimate sleepy-time Benzo is Restoril (temazepam). Here in the US it seems to be regaining some popularity, but I've heard that other countries have more restrictions on it b/c of addiction and abuse (apparently the geniuses who make it put it capsule form, so some people break open the capsule to snort it, inject it, and slip it into other peoples' drinks.)
>
> Klonopin is a good anxiolytic, but I'm pretty sure its not that great as a sleeping pill...it loses its hypnotic effect pretty quickly.
>
> Can you try a pill designed for sleep? THe thing about Valium is that you're going to get less drowsy off of it over time b/c its really meant for use as a daytime anxiolytic than as a sleeping pill. Benzo-type sleeping pills include: Dalmane (old school, hangover problems), ProSom, Doral, and Halcion (may not be available in your country...sometimes makes people insane).
>
> Does Aussie healthcare cover the "z" hypnotics, like zolpidem, zoplicone, and Sonata (whatever its generic name is..) ? Those are designed for sleep.
>
> Good luck.
>
>
Posted by socialphobic on September 26, 2008, at 21:19:20
In reply to Re: Which benzo should I try next? » socialphobic, posted by mav27 on September 26, 2008, at 12:11:12
Wow only $9 not on the PBS? My doctor said it would be like $50 ???
Posted by mav27 on September 26, 2008, at 22:54:29
In reply to Re: Which benzo should I try next?, posted by socialphobic on September 26, 2008, at 21:19:20
> Wow only $9 not on the PBS? My doctor said it would be like $50 ???
>
>absolutely no where near that much. $9 is for the generic brand which i have had no problem with at all... for the brand name version which is rivotril here in australia you are looking at $12
http://www.epharmacy.com.au/searchresults.asp?searchsection=products&terms=clonazepam&stype=NP&expand=0
Posted by socialphobic on September 27, 2008, at 3:49:17
In reply to Re: Which benzo should I try next? » socialphobic, posted by mav27 on September 26, 2008, at 22:54:29
Hmm don't you need an authority script to say you have epilepsy though?
Posted by mav27 on September 27, 2008, at 4:00:13
In reply to Re: Which benzo should I try next?, posted by socialphobic on September 27, 2008, at 3:49:17
> Hmm don't you need an authority script to say you have epilepsy though?
Nope, just a normal script.. technically a private script if you are being prescribed it for something other than epilepsy but will be on a normal looking script just you wont get the pbs price of $5 i think it is.
Only time the doc needs an authority script for clonazepam is if he wants to prescribe you 200 tablets at a time.
Posted by cactus on September 27, 2008, at 5:46:04
In reply to Re: Which benzo should I try next?, posted by socialphobic on September 27, 2008, at 3:49:17
I pay $29 for 100 2mg tabs of Rivotril in Australia and the generic brand Paxam is about $25 for 100 2mg tabs. It used to be about $55-60 for a private script but I don't pay that anymore. Go ask a chemist, I think your doc might have old information. I think it's status has changed from epileptics only. It's great for social phobia but for some reason doctors in Australia loathe to prescribe it. Xanax and ativan aren't great for sleep, temezapam might be a good choice but it wears off quickly like serapax does. Don't forget good old trusty mogadon. It's the best sleeping pill you can get that's a benzo.
I would personally really steer clear of xanax, it would have to be the most addictive benzo on the market and one of the hardest to come off for most people. Everyone reacts differently, but I'd go for mogadon for sleep or rivotril for anxiety/SP, it does help with sleep too. Good luck. C
PS I don't like taking benzo's anymore but it's the only thing keeping me going at the moment until my situation changes. I'm going to have a very long and tiresome withdrawal from rivotril. I take 6mg daily for severe anxiety/panic/SP but hopefully it wont be for much longer before I start to taper again. Just to let you know it took me 2 months last time to get from 6mg to 4mg, so be careful and take care
Posted by cactus on September 27, 2008, at 6:09:28
In reply to Re: Which benzo should I try next?, posted by desolationrower on September 26, 2008, at 13:02:38
> I think you should get a med like trazodone for sleep, and save the benzos for anxiety.
> -d/rtrazodone isn't available in Australia
Posted by cactus on September 27, 2008, at 6:30:37
In reply to Re: Which benzo should I try next? » med_empowered, posted by azalea on September 26, 2008, at 20:35:24
The "z" medications (zolpidem, zoplicone, zaleplon)
In Australia zoldipem (stilnox/ambien) is under very close scrunity due to the overwhelming adverse reaction people have experienced from it, so it's being prescribed less, zopiclone (Imovane) is available and it's not bad except for the lovely taste it leaves in your mouth the next day, which I don't think paint stripper would remove LOL, but it is a very effective drug for sleep and another option but zapelton is available here either.
I'm just trying to explain the great suggestions you have offered up aren't all available in Australia. Peace. C
Posted by mav27 on September 27, 2008, at 7:20:44
In reply to Re: Which benzo should I try next? » azalea, posted by cactus on September 27, 2008, at 6:30:37
if it is just for sleep then personally i use 25mg of seroquel.. just can't beat the stuff... knocks ya out and you don't feel it the next day.
Posted by socialphobic on September 27, 2008, at 7:20:50
In reply to Re: Which benzo should I try next? » socialphobic, posted by cactus on September 27, 2008, at 5:46:04
> I pay $29 for 100 2mg tabs of Rivotril in Australia and the generic brand Paxam is about $25 for 100 2mg tabs. It used to be about $55-60 for a private script but I don't pay that anymore. Go ask a chemist, I think your doc might have old information. I think it's status has changed from epileptics only. It's great for social phobia but for some reason doctors in Australia loathe to prescribe it. Xanax and ativan aren't great for sleep, temezapam might be a good choice but it wears off quickly like serapax does. Don't forget good old trusty mogadon. It's the best sleeping pill you can get that's a benzo.
>
> I would personally really steer clear of xanax, it would have to be the most addictive benzo on the market and one of the hardest to come off for most people. Everyone reacts differently, but I'd go for mogadon for sleep or rivotril for anxiety/SP, it does help with sleep too. Good luck. C
>
> PS I don't like taking benzo's anymore but it's the only thing keeping me going at the moment until my situation changes. I'm going to have a very long and tiresome withdrawal from rivotril. I take 6mg daily for severe anxiety/panic/SP but hopefully it wont be for much longer before I start to taper again. Just to let you know it took me 2 months last time to get from 6mg to 4mg, so be careful and take careHow long ago did the price come down from $55 - 60 to $29? My doctor told me it was around $50 probably a few months ago. Could it have changed in that time?
I have tried temazepam but its didn't do much. Mogadon (nitrazepam) was pretty decent at 10mg.
Posted by socialphobic on September 27, 2008, at 7:39:16
In reply to Re: Which benzo should I try next?, posted by socialphobic on September 27, 2008, at 7:20:50
I am also wondering how come i've built up a tolerance when I only take benzo's like 1 - 2 times a week? I have been doing so for probably 6 years but not every week. Sometimes my insomnia won't be as bad so I won't need to take any for maybe a month.
I wouldn't think that only taking them 1 - 2 times a week on average would be enough to build up a tolerance? The first time I took a benzo was great, it knocked me out and I felt nice and calm for the whole next day. I just don't get that anymore at the same dosage.
Also if you cross over between different benzo's does it not affect your tolerance? Eg, if you took diazepam on monday, oxazepam on tuesday, nitrazepam on wednesday, temazepam on thursday etc... would you not build up a tolerance? Or would you still build up a tolerance because they are from the same family? I asked this once before but no-one seemed to know.
If taking different benzo's DO build up a tolerance due to being in the same family, would it be okay to criss-cross with other sedating meds eg, zyprexa, seroquel, avanza? Eg could you take zyprexa one night, avazna the next, and a benzo the next? Would this prevent tolerance due to being in different families?
Hopefully this makes some sense to people. I've always wondered this but no-one seems to know the true answer.
Posted by socialphobic on September 27, 2008, at 7:47:23
In reply to Re: Which benzo should I try next? » azalea, posted by cactus on September 27, 2008, at 6:30:37
> The "z" medications (zolpidem, zoplicone, zaleplon)
>
> In Australia zoldipem (stilnox/ambien) is under very close scrunity due to the overwhelming adverse reaction people have experienced from it, so it's being prescribed less, zopiclone (Imovane) is available and it's not bad except for the lovely taste it leaves in your mouth the next day, which I don't think paint stripper would remove LOL, but it is a very effective drug for sleep and another option but zapelton is available here either.
>
> I'm just trying to explain the great suggestions you have offered up aren't all available in Australia. Peace. CNo way, i'm steering clear from the hypnotics. I have seen the strange things they do to people :\
Posted by mav27 on September 27, 2008, at 8:48:13
In reply to Re: Which benzo should I try next?, posted by socialphobic on September 27, 2008, at 7:20:50
> > I pay $29 for 100 2mg tabs of Rivotril in Australia and the generic brand Paxam is about $25 for 100 2mg tabs. It used to be about $55-60 for a private script but I don't pay that anymore. Go ask a chemist, I think your doc might have old information. I think it's status has changed from epileptics only. It's great for social phobia but for some reason doctors in Australia loathe to prescribe it. Xanax and ativan aren't great for sleep, temezapam might be a good choice but it wears off quickly like serapax does. Don't forget good old trusty mogadon. It's the best sleeping pill you can get that's a benzo.
> >
> > I would personally really steer clear of xanax, it would have to be the most addictive benzo on the market and one of the hardest to come off for most people. Everyone reacts differently, but I'd go for mogadon for sleep or rivotril for anxiety/SP, it does help with sleep too. Good luck. C
> >
> > PS I don't like taking benzo's anymore but it's the only thing keeping me going at the moment until my situation changes. I'm going to have a very long and tiresome withdrawal from rivotril. I take 6mg daily for severe anxiety/panic/SP but hopefully it wont be for much longer before I start to taper again. Just to let you know it took me 2 months last time to get from 6mg to 4mg, so be careful and take care
>
> How long ago did the price come down from $55 - 60 to $29? My doctor told me it was around $50 probably a few months ago. Could it have changed in that time?
>
> I have tried temazepam but its didn't do much. Mogadon (nitrazepam) was pretty decent at 10mg.
I reckon your dic was just guessing a price.. i paid $32 a year ago for the 2mg tablets but from a chemist that is slightly more expensive.. don't forget chemists can charge what they want so your doc may just live near an expensive one or hasn't looked at the price of it in years.
Posted by socialphobic on September 27, 2008, at 8:51:28
In reply to Re: Which benzo should I try next?, posted by mav27 on September 27, 2008, at 8:48:13
So why are people saying klonopin is isn't that great for sleep but good for social anxiety?
When people say its "good" for social anxiety, do they mean it just makes you less anxious around people, or does it make you "pro-social" in the same sense as nardil? I'm guessing it feels kinda similar to valium?
So would it be worth going on klonopin for sleep?
Posted by mav27 on September 27, 2008, at 9:39:34
In reply to Re: Which benzo should I try next?, posted by socialphobic on September 27, 2008, at 8:51:28
> So why are people saying klonopin is isn't that great for sleep but good for social anxiety?
>
> When people say its "good" for social anxiety, do they mean it just makes you less anxious around people, or does it make you "pro-social" in the same sense as nardil? I'm guessing it feels kinda similar to valium?
>
> So would it be worth going on klonopin for sleep?Just for sleep, i would say probably no. I still take seroquel everynight to sleep as the klonapin doesn't put me to sleep. The klonapin doesn't really make me pro social.. just gets rid of the anxiety and makes it easier for me to want to be social. But nardil didn't really make me all that pro social either.. i found i was more spontanious at saying things but i was still nervous as all hell.. it was actually while on Nardil that i started klonapin in order to calm the anxiety down so i could go out and be around people.
Posted by cactus on September 27, 2008, at 16:19:08
In reply to Re: Which benzo should I try next? » socialphobic, posted by mav27 on September 27, 2008, at 9:39:34
> > So why are people saying klonopin is isn't that great for sleep but good for social anxiety?
> >
> > When people say its "good" for social anxiety, do they mean it just makes you less anxious around people, or does it make you "pro-social" in the same sense as nardil? I'm guessing it feels kinda similar to valium?
> >
> > So would it be worth going on klonopin for sleep?
>
> Just for sleep, i would say probably no. I still take seroquel everynight to sleep as the klonapin doesn't put me to sleep. The klonapin doesn't really make me pro social.. just gets rid of the anxiety and makes it easier for me to want to be social. But nardil didn't really make me all that pro social either.. i found i was more spontanious at saying things but i was still nervous as all hell.. it was actually while on Nardil that i started klonapin in order to calm the anxiety down so i could go out and be around people.
>Hey socialphobic and mav, I buy my rivotril from chemist warehouse which is the cheapest place around here for me. I restarted taking it about a year ago. Before that it was probably 3 years ago when I was paying the price of $50+
You're right about the rivotril making it easier to socialise. I would say it's pro social either but it just makes it easier to get out and about and it helps me just get on with my day. It is similar to valium in that respect but quite a bit stronger. I also forgot to mention that rohypnol/hypnodorm is still available in Australia for sleep but no GP would prescribe it.
I personally have nasty reactions to AP's. Seroquel, Zyprexa and Zeldox/Geodon mess me up to the point that I can't wake up and get out of bed let alone function, that's why I'm a benzo boy at the moment. I can't wait to start tapering and get off them, once I move house and get out of this nightmare. Peace C
Posted by azalea on September 27, 2008, at 20:02:10
In reply to Re: Which benzo should I try next? » azalea, posted by cactus on September 27, 2008, at 6:30:37
Thanks cactus. I'm learning that psychobabblers are from all over the world and may not have access to the same medications we have in the US.
> The "z" medications (zolpidem, zoplicone, zaleplon)
>
> In Australia zoldipem (stilnox/ambien) is under very close scrunity due to the overwhelming adverse reaction people have experienced from it, so it's being prescribed less, zopiclone (Imovane) is available and it's not bad except for the lovely taste it leaves in your mouth the next day, which I don't think paint stripper would remove LOL, but it is a very effective drug for sleep and another option but zapelton is available here either.
>
> I'm just trying to explain the great suggestions you have offered up aren't all available in Australia. Peace. C
Posted by yxibow on September 30, 2008, at 2:33:21
In reply to Tolerance question, posted by socialphobic on September 27, 2008, at 7:39:16
> I am also wondering how come i've built up a tolerance when I only take benzo's like 1 - 2 times a week? I have been doing so for probably 6 years but not every week. Sometimes my insomnia won't be as bad so I won't need to take any for maybe a month.
Six years is enough to build some tolerance even if they are only being taken twice a week because the plasma level (not the half life) of the medication will slowly build up and down and up and down -- creating eventually a steady low level, possibly. I don't really know actually, but that's just theoretical.
> I wouldn't think that only taking them 1 - 2 times a week on average would be enough to build up a tolerance? The first time I took a benzo was great, it knocked me out and I felt nice and calm for the whole next day. I just don't get that anymore at the same dosage.
This is a typical reaction to agents like this -- the first time I took Ambien it was amazing but it was dull afterwards. You may not feel a 'zing' but if it is doing something to calm you down, it may still be working. If it isn't doing any of the above, you may have some tolerance.
> Also if you cross over between different benzo's does it not affect your tolerance? Eg, if you took diazepam on monday, oxazepam on tuesday, nitrazepam on wednesday, temazepam on thursday etc... would you not build up a tolerance? Or would you still build up a tolerance because they are from the same family? I asked this once before but no-one seemed to know.
Yes. Tolerance will build up to some extent, for an unknown period of time in individuals. And doing a merrygoround of benzodiazepines is not a sound idea.All of those are mixtures of sedative benzodiazepines and hypnotic benzodiazepines -- actually all benzodiazepines have four features, but usually one is a primary.
For most people, it is a best idea to stick with a primary long half life benzodiazepine, and for emergency purposes something like Xanax or Ativan, but not all the time.
> If taking different benzo's DO build up a tolerance due to being in the same family, would it be okay to criss-cross with other sedating meds eg, zyprexa, seroquel, avanza? Eg could you take zyprexa one night, avazna the next, and a benzo the next? Would this prevent tolerance due to being in different families?Neuroleptics cannot be taken one night and then another one the next. You just don't know what will happen, there are too many variables and side effects and things that you really don't want to happen as a result of crossing. At best, they will only serve as a temporary sedative and at worse they could cause akathisia which certainly wouldn't serve a purpose.
As for their real effects, only one should be cautiously tried at once and two weeks is a minimum window to start feeling something from them, if you are taking them for a specific purpose.
> Hopefully this makes some sense to people. I've always wondered this but no-one seems to know the true answer.
There isn't a full answer to all of this -- sometimes there are the unexplained. But I think the one thing is not jumping all over the map, because that isn't necessarily going to prevent things and could aggravate problems.
As for the original post, Serax (oxazepam) is a very low potency agent, more potent than Librium but on the low end of things. Valium is much stronger.
Best wishes, and I think you should discuss this with your doctor. I don't think that he/she would prescribe multiple agents like that, because it just makes a chemistry mess.
-- tidings
Jay
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.