Switching from klonopin to diazapam.

[lei]

although this picks up where my "tapering questions" leaves off, it's time for a new thread. i have the same range of anxiety disorders (basically all of them, inherited and triggered) only worse, and new medication confusion.

to avoid the rollercoaster from my increasing tolerance to klonopin, and in hopes of eventual tapering, i went to my DO to get more diazapam (until now he prescribed it only for nighttime, with klonopin for day.)

according to the ashton and other equivalency charts, .5mg klonopin = 10mg diazapam. i was taking 3.5mg klonopin (staggered to avoid the rollercoaster) over the course of the day and 10mg diazapam at night to avoid nightmares. according to the charts this translates to a whopping 80mg diazapam.

yet my DO prescribed 30mg diazapam for all day and night. he says that the charts don't make sense for a round the clock anxiety sufferer, because more remains in the system, the dosages are less frequent, etc.

but according to ashton etc i'm cutting the amount of medication down to only 3/8!

i'm gonna try his way and i want it to work. i just wanna know if his rationale makes sense to anyone and their experience, or if i might expect to be in worse shape tomorrow.

BOTTOM LINE -- what i'm looking for is someone who has found that "for all day/night coverage, 30 (or whatever) mg diazapam has really worked as well as (whatever) mg klonopin)" for them.

god i hope that makes sense and i'm sorry this isn't more concise.

as i have a reserve of klonopin, i could start my own ashton plan, but i'm scared i'll be exceeding doc's recommendation so much, and messing up my refill schedule. i would just experiment but i'm in the middle of three major life crises (today i got upgraded to "severe anxiety", woohoo!) so yeah, all input welcome, as always, thank you and aloha.

[chimpmaster]

note that when u look at benzos there are 2 types of equivalency  - for purposes of withdrawal and for efficacy.

hence .5mg xanax = 10mg diazepam when looking at withdrawal but in terms of efficacy 5mg may do the trick. 

only problem is if you have been on one of the stronger benzos first you will have tolerance and might find yourself needing a higher dose than if you started afresh.

i was on 1-3mg/day of xanax for a year and when i switched to valium i found myself needing 40mg/day.

ive tapered down and now been off valium for 10 days.  its been hard but i guess the hardedt part is over now.

fyi i am now taking seroquel instead which seems to work pretty well in conjunction with my paxil for ocd and anxiety..  i still have access to both xanax and valium - in the cupboard and scripts, and no doubt i will use it again casually.  i hsd to get off it first though if you know what i mean....

[lei]

thank you, chimpmaster, for all this helpful info. i recall you helped me on the old board but i didn't have enough valium to make the switch and my doc was hesitant -- now he sees my basketcaseness (new word?) and appreciates my situation and that the klonopins have become so impotent for me.

and you just explained better than he did about the 2 types of equivalency, and so i understand that his estimate may work. or if my mileage is like yours i may need to go into my cupboard for a more gradual taper, and if that's what it takes to function, so be it.

a huge CONGRATULATIONS on your taper -- that is really awesome!!!

i'm interested in your new meds. i tried paxil a while back but it didn't help (and my doc is under the impression it's harder to stop?) i wonder if i should look into the seroquel. fyi, although it's least debilitating in the midst of my crises, OCD is otherwise the most prominent anxiety feature for me. i share it with 7 immediate family members, woo.

as always i'm open to more info from all. thank you and aloha.

[chimpmaster]

Hi again freedom.  Thanks for the warm words.

I typed that post last night on my pda so it was a little slow lol.

Yeah it all depends.

Last year I was on 200mg luvox and xanax as required. My new p-doc reassessed my diagnosis and med regime, and my diagnosis changed from Major Depressive Disorder, OCPD & Panic disorder w/out agorophobia to OCD, MDD, GAD & PD w/out ag.

He changed my medication also, he felt that luvox and xanax were agitating me, and on top of the obsessions i seemed to have some sort of pychosis at the time - probably depressive. 

Anyway I switched over to 60mg Paxil, which is a pretty strong dose, and gradually from xanax to valium, and then weened off the valium and increased the seroquel, which I now take at 400mg/day.

Its generally prescribed for schizophrenia and psychotic disorders, but it has a very good reputation at treating OCD and GAD when combined with an SSRI (there is a degree of synergistic anti-depressant effect as well as anti-anxiety and anti-obsessive properties). 

Ive found it to be pretty good so far.  It doesnt block GABA at all, so I found myself at first and evening now feeling some agitation and anxiety daily as a result of not taking a benzo, but I am told this will pass in the coming weeks - if I can stick it out. 

Seroquel is weird. Its really strong at first, but you adjust to it quickly and I found higher doses easy to take pretty fast.  Aparently unlike benzos you do not build any sort of efficacy tolerance and discontinuation is also much easier.

As for the paxil, its the strongest ssri and meant to be the most sedating, but we all respond differently to these drugs.  I tried 40mg at first and it just wasnt enough.  If it were to poop out on me id be left with effexor, prozac, zoloft, celexa and lexapro as options, although my p-doc strongly suspects that prozac and zoloft would aggravate my insomnia, so who knows. 

I also take mianserin (tolvon) occasionally, which helps with the jaw clenching I get from the paxil (you know you are in trouble when you start taking one drug to counter the side effects of another hehe )

[lei]

wow, thank you again sir. your knowledge and experience help many of us, i'm certain.

i thought i was gonna need extra valium today, took my second dose a bit early, then something "clicked" like the build-up was beginning. now i'm close to my night dose but feeling less wear-off,  like i'm on a smoother road by still feeling some of the afternoon AND even remnants from the morning dose. it's still only day 1 but it sure beats the klonopin 4 hour rollercoaster!

and when more sociopaths are out of my life and/or i'm zen enough to not worry about them, i can imagine a much smoother taper, or an "as needed" thing (then at least some of that klonopin and xanax stash won't go to waste, heh.)

and perhaps someday a non-benzo route for my OCD. may i ask if you have a sense of which of your meds works most for that, or is it the combo?

i think the paxil i was prescribed long ago for a short-term trigger was a way too small dosage. maybe someday an ssri with seroquel (sleep sounds good to me!) will work.    besides benzos, all i know is that effexor made me want to die, wellbutrin gave me nightmares (doc wanted to counteract the benzo downer effect, but my problem isn't about sadness, it's fear) and inderal gave me an ulcer.

but a change like that would be for the future (and another forum, though i'd still appreciate your answer about the ocd here or by message) --  for now at least i'm on a smoother benzo ride, which helps me deal with life better, which will lead to less benzos, etc, i think!

thank you again. my kitties and i still say you're gonna be a great doc.    aloha.

[lei]

update of good news -- i made it through yesterday with the 30mg prescribed -- that's only 3/8 the ashton equivalent. despite needing the doses a bit early and staggered, it was a MUCH smoother ride, and i had better dreams, and woke up not completely freaked, i.e. i reached for the pill bottle much more slowly even though i was "overdue". i can see stepping down reasonably when a few external things clear up. just wanted to share in case that's helpful to anyone.    the charts ain't perfect for everyone, thank goodness.

thank you and aloha.