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    Old 08-24-2005, 06:51 PM   #1
    dizzyblond
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    A question for Scott re Valium

    Scott,
    I thought you might be a good source for an on-going question/dilemma I'm facing. Any input would be appreciated. I mentioned in a previous posting the situation with my nightly dose of Restoril and the fact that I recently discovered that it is in the benzo family, my need to get off of it just in case it's interfering with my compensation process, etc. (In fact, you encouraged me not to panic, which is what I want to do!)

    I came across a website that suggests a gradual reduction of the Restoril while replacing it with a comparable dose of the longer-acting Valium, the theory being that it is easier on the body to wean off of the Valium because of its longer half life. It looks to be about a 17 week process, according to the schedule listed.

    I'm aware that titration is common in the UK, though not here in the states... your advice is appreciated! I tried to go off the Restoril cold turkey last week, but after two nights of only a couple hours of sleep (which equals horrendous vest. symptoms for me), I knew I just couldn't do it that way. I'm just now able to begin to get back to work and back to life, and I can't afford to "rock the vestibular boat" in such an extreme and difficult way.

    Thanks so much,
    Robin

     
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    Old 08-24-2005, 08:56 PM   #2
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    Re: A question for Scott re Valium

    Hi Robin,

    Really glad to see you taking this action to get off the benzos - especially for sleeping. I totally sympathise with the vestibular symptom increase when drugs are reduced too. While I haven't experienced this with a benzo, I have to be careful as I reduce the SSRI. Apprently Prozac is the way to go for people who experience a rough ride coming off SSRIs. They have a huge half-life. A review of the meds again first:

    Quote:
    Temazepam (Ristoril or Normison):

    Pharmacokinetic studies have shown that temazepam is well absorbed and has a relatively short elimination half-life of approximately 10 hours (half-life range 5 to 15 hours). Peak plasma levels of the drug occur 35 to 65 minutes after administration of the capsules and 30 to 120 minutes after administration of the tablets. With multiple dosing, steady state is obtained by the third day, and there is little or no accumulation of parent drug or metabolites.

    Diazepam (Valium):

    Pharmacokinetics - After oral administration the active ingredient of Valium is rapidly and completely absorbed from the gastrointestinal tract, peak plasma concentrations appearing 30 to 90 minutes after oral intake. The speed of onset after intramuscular administration is variable, depending on the muscle mass used and other factors. The plasma concentration time curve is biphasic, an initial rapid and extensive distribution phase with a half-life of up to three hours, followed by a prolonged terminal elimination phase (half-life 20 to 48 hours). The elimination half-life is 90 hours at age 80 and increased two to threefold in patients with cirrhosis.

    Clonazepam (Klonopin)

    Half-life - The calculated plasma elimination half-life in humans after oral doses of 1.5 to 2 mg varied from 22 to 54 hours.
    So to me it looks like using valium OR klonopin is an excellent plan and it's *definitely* really smart to pursue it as you are - that is, an incremental reduction over a few weeks. I've also heard many times that valium is the choice benzo for withdrawal (although it appears clonazepam is just as good). I'm not sure how easy this will be for you but take it really slowly and I reckon you should sort this out fine. In the meantime, why not look at other things you can add to make you feel relaxed in the evening before bed?

    Try drinking chamomile tea before bed, no TV or PC just before bed, try Tai Chi or just sit quietly and silence your mind before crashing out for 20 minutes - or read a book. Apparently some good aerobic exercise 3-4 hours before bed is a good way to make you sleep well too.

    Also the following herbs work for sleep: passionflower, valerian, skullcap...etc. You can buy these in pill form or make a tea out of them before bed.

    If I don't do some or all of these things, it can mean a tougher night's sleep.

    edit: here's more info on benzos from Timothy Hain's site (the inner ear guru).
    Quote:
    Benzodiazepines are GABA modulators, acting centrally to suppress vestibular responses. In small doses, these drugs are extremely useful. Addiction, impaired memory, increased risk of falling, and impaired vestibular compensation are their main shortcomings. Lorazepam is a particularly useful agent because of its effectiveness and simple kinetics. Addiction, the biggest problem, can usually be avoided by keeping the dose to 0.5 mg BID or less. Similarly, low doses of diazepam (Valium) (2 mg) can be quite effective. Clonazepam (Klonopin), is as effective a vestibular suppressant as lorazepam (Ganaca et al, 2002). The author prefers to avoid use of alprazolam (Xanax) for vestibular suppression, because of the potential for a difficult withdrawal syndrome. Long acting benzodiazepines are not helpful for relief of vertigo.
    Let us know how it goes.

    Best....Scott

    Last edited by studyin; 08-25-2005 at 02:15 AM.

     
    Old 08-25-2005, 09:55 PM   #3
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    Re: A question for Scott re Valium

    Scott,
    Thanks so much for your input and all the excellent information. I've read Dr. Hain's site re: the 2 mg. of Valium being beneficial for some - do you think that at that low dose one can avoid the dependency possibility? I will definitely begin the withdrawal process as soon as I return from a trip out of town next week. I also appreciate your thoughts and ideas about getting a good night's sleep - some of them I've tried, as well as being careful to observe good "sleep hygiene." I have a long history of being a very poor sleeper, and the thought of returning to the sleep-deprived state that I've endured in the past is an awful prospect.... which brings me to one more question for you.

    If all of the benzos pose the possibility of hindering compensation, what are your thoughts about different families of drugs that are used for sleeping assistance (Ambien, Lunesta, etc.)? Do they, as well, dampen the part of the brain that needs to learn how to deal with the vestibular problem? My guess is that anything that causes sedation could be problematic, but I haven't been able to find any specific information that says so.

    Again, thanks for your help - and I do hope this finds you feeling back at the top of your game. Think I'll go drop in on the Sleep Disorder message board for now!
    Have a great weekend,
    Robin

     
    Old 08-26-2005, 01:20 AM   #4
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    Re: A question for Scott re Valium

    Hi Robin,

    Here's the story on those other two meds you mentioned:

    Quote:
    Ambien or Stilnox (Zolpidem tartrate)

    Tolerance. Continuous long-term use of Stilnox is not recommended and should not exceed four weeks.

    Dependence. Use of sedative/ hypnotic agents may lead to the development of physical and psychological dependence. The risk of dependence increases with dose and duration of treatment; it is also greater in patients with a history of psychiatric disorders and/or alcohol or drug abuse. These patients should be under careful surveillance when receiving hypnotics. Once physical dependence has developed, abrupt termination of treatment will be accompanied by withdrawal symptoms. These may consist of headaches or muscle pain, extreme anxiety and tension, restlessness, confusion and irritability. In severe cases the following symptoms may occur: derealisation, depersonalisation, hyperacusis, numbness and tingling of the extremities, hypersensitivity to light, noise and physical contact, hallucinations or epileptic seizures.

    Rebound insomnia. A transient syndrome whereby the symptoms that led to treatment with sedative/ hypnotic agents recur in an enhanced form may occur on withdrawal of hypnotic treatment. It may be accompanied by other reactions including mood changes, anxiety and restlessness.

    Lunesta

    Dependence and withdrawal. Experiments in monkeys have shown intermediate withdrawal signs at doses of 16 to 32 mg/kg orally twice daily. A risk of withdrawal phenomenon after abrupt discontinuation of zopiclone following prolonged use in patients cannot be excluded. It is therefore recommended that after prolonged use the dose should be decreased gradually and the patient advised about such a possibility.

    Risks of dependence or abuse increase with dose and duration of treatment; history of alcohol and/or drug abuse; and use with alcohol or other psychotropics.

    Zopiclone should be prescribed for short periods only (two to four weeks). Continuous long-term use is not recommended, especially in the elderly. There have been reports of withdrawal symptoms and difficulty in stopping treatment after long-term therapy.
    These sedative/hypnotic drugs seem more intense than a benzo. The dependence factor is risky. I'm not sure just how much valium one can have before dependence starts. I imagine it's different for everyone but it appears (according to Hain) that 2 mg once a day for a short while should be OK.

    I'd agree with what you're saying that any sedative could have the end result of slowing recovery in the long run. Great while symptoms are acute but not so good over time.

    Enjoy your trip!

    Best...Scott

     
    Old 08-26-2005, 05:07 AM   #5
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    Re: A question for Scott re Valium

    Robin:

    I had a lot of problems sleeping and became addicted on things like restoril and ambien. They also made me feel worst vestibular. I have been taking low dosages of Zoloft and a real low doasge of klonopin (.125) normal dosage is .50. I sleep fine now (7 hours a night) and dont have that hang over feeling. You might need a little more of klonopin in the beginning but it is not hard to get off that.

    Best of Luck,

    Howie

     
    Old 08-26-2005, 07:10 AM   #6
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    Re: A question for Scott re Valium

    I just started taking the klonepin a week and a half ago. I started with .25 and then it was bumped up to .50 which I have been told is a very low dosage. I have felt much better the past few days and really think that after 8 months of this, the klonepin is helping me. I guess you have to weigh the pros and cons of taking this class of drugs.

    I have felt a little sleepy from it, but it has helped my mental health greatly.

    Just a little F.Y.I.

    Take care,
    Gloria

     
    Old 08-26-2005, 04:21 PM   #7
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    Re: A question for Scott re Valium

    Thanks to you all for your input!

    Scott,
    Again, thanks for the info on both Ambien and Lunesta. After reading the descriptions you've posted, as much as I hate to admit it, I am realizing that sleep aids are serious meds! But then, ask any insomniac - so is no sleep!! I do feel best about slowly weaning off the benzos and then staying off, unless traveling. (Unfortunately, I do quite a bit of that, but I guess I can't worry about that aspect of it, yet!) I do have a sinking feeling that any sedating med is going to slow the brain down - so that's that, and I'm going to have to gently and slowly deal with it!

    Howie,
    Thanks for your input, as well. As a past fellow sleep-seeker, I'm sure you can relate to the anxiousness that comes when you're tossing and turning in bed, looking at the clock, watching the hours creep by - and it feels like everybody else in the world must be asleep except you!!! I'm so glad you've found the right balance of meds to work in your case! (I only wish I could say that I felt badly on Restoril - but in fact, I have absolutely no problems with it. One of my drs. had me try trazadone for sleep, and after 2 nights of vivid, nightmarish dreams and horrible agitated sleep, I knew it wasn't for me.) Sigh. I'll be remembering your meds (Zoloft and Klonopin) to mention at my next appt.

    Gloria,
    Thanks for your little note, too! Again, I'm making a mental note about the Klonopin. Can you explain just how it's helped you? Are you feeling a difference in the degree of your symptoms? Believe me, I'd gladly take a little sleepiness in trade for this sometimes-debilitating disequilibrium and spinning!!!!

    For now, I guess I'll begin the withdrawal process a week from Monday, and if completely intolerable, I'll be back to the dr. to try these other suggestions.

    Thanks again to all -
    Robin

     
    Old 08-27-2005, 02:07 PM   #8
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    Re: A question for Scott re Valium

    Robin,

    My whole overall mental attitude towards all this is like night and day since taking the klonepin. I wonder if my anxiety (like Scott had in the beginning of his) was/is holding me back from recovery. My symptoms don't feel nearly as bad as before. I don't know if it is the klonepin or about time it is just starting to go away but I hardly feel dizzy at all (my dizziness was not spinning or things moving it was an off really strange out of reality type feeling with brainfog). The pressure in my ears seems less and the headaches have not been as severe. The tinnitus doesn't seem to bother me as badly as it was before. The tinnitus was so loud and made me so anxious. I was crying everyday almost the whole day for the last 8 months and I have not cried in a good week and have been taking it for under just 2 weeks. I'm hoping now that I am getting my mental health under control from this illness, I will continue to heal fully. The only thing I haven't noticed a change in is my vision. I have some distorted vision but am hoping as the other ear symptoms disapate the vision will go back to normal again.

    I went to the Neil Diamond concert last night (I did wear ear plugs so not to damage my ears anymore from the noise) and I have to say for the first time since December, I really enjoyed myself and really don't believe that 2 weeks ago (before the klonepin) I would have been able to even go.

    I'm not saying by any means that the klonepin is curing me, but after deciding a month after it was prescribed by my neuro oto to take it, I really believe it is helping me. My symptoms didn't just totally go, but they seem less severe.

    Oh and one more thing. The sleepiness seems less and less each day; like I am getting use to the side effects. The real test is I am leaving tonight for the beach for the week. This will be the final test so I'll let you know how I felt there all week.

    Take care,
    Gloria

    Last edited by gloria2936; 08-27-2005 at 02:11 PM.

     
    Old 08-27-2005, 03:31 PM   #9
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    Re: A question for Scott re Valium

    Gloria,
    Sounds like the klonopin is really making a difference!!! HURRAY!!!!! So glad to hear that you were able to actually enjoy an evening out last night (esp. in what I suppose was a BIG arena or venue of some sort with lots of people - sometimes a challenge for me!)! I'll be crossing my fingers for your week away - may it be completely refreshing and relaxing, and I hope you come home feeling even better than you do now!!!
    Be sure to let us know how it goes. (Will you be swimming? I just had an interesting experience today, so thought I'd ask. I've been afraid to get in the water all summer, since I'm already constantly fighting that "rocking in the water" feeling 24/7 - but it was so hot here today that I couldn't resist getting in the pool.... and though it might be too soon to tell, I think the water movement actually seemed to lessen my vest. sensataions - at least for the past hour or so. Oh, who knows with this miserable stuff?!!!!!! :-))))))))))))))))))))

     
    Old 09-01-2005, 02:42 AM   #10
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    Re: A question for Scott re Valium

    Hi Robin,

    I came across an interesting study that was published in the newspaper in Sydney today and thought you should know about it. In the study they looked at people that were having troubles with sleep and compared sleeping pills vs cognitive behavioural therapy (CBT) vs sleeping pills + CBT. They studied 63 young females and guess what happened? CBT alone produced the greatest number of normal sleepers than any of the other therapies even when combined!

    Perhaps you could look into this as a way of helping you get off the meds and also help solve the sleeping problems.

    The Australian Psychology Society is the place for Australians to call for referrals to registered, CBT-trained psychologists (mentioned in the article).

    Best - Scott

     
    Old 09-01-2005, 05:24 PM   #11
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    Re: A question for Scott re Valium

    Hi Scott,
    Thanks so much for the info on the article. I find it fascinating that there was such success with the CBT alone! I must admit, I do wonder how age comes into play - why these women were having trouble sleeping in the first place, etc. For many people stress is an issue - and that isn't what keeps me awake. I wish I could include myself in the "young woman" category, but because of my age and the way my sleep problems came on, my guess is that my problems with insomnia are probably due to hormonal changes. I'm going to see if I can find that article online to find out more specifics on the study.
    BTW, I've cut my Restoril dosage in half this past week while at the same time taking 7.5 Valium - next week I'll stop the Restoril and then begin the tapering of the Valium. Hopefully the whole process will be done within a month or so. And then (I hope!!!) I can truly be on the road to better compensation!!!
    Thanks for your continued help and interest - I appreciate it so much.
    Take care,
    Robin

     
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