temazepam safer than lorazepam?

[MarkP]

To fall asleep, I need either 1.5mg of lorazepam (sometimes 2 or 3mg if I'm really fired up), or 15mg (or 30mg) of temazepam. Been on one or the other for the past 8 months, 5 or 6 nights a week.

Pharmacist insists that the benzo equivilancy between temazepam and lorazepam is 1mg lorazepam = 10mg temazepam. The Ashton chart states 15mg temazepam = 1mg lorazepam. The chart published in a reference guide for local doctors concerning benzo patient management says that 15mg temazepam = 6.66mg diazepam = 0.66mg lorazepam.

My questions:

a) Are low potency benzos easier to withdrawal from (ie: temazepam, chlordiazepoxide, oxazepam, diazepam), as opposed to high-potency benzos (alprazolam, lorazepam, triazolam, flunitrazepam)?

b) If a lower diazepam-equivilant dose of temazepam does the job for me -- is it not most prudent to use that, as opposed to, say, lorazepam?

c) Are benzos marketed for 'hypnotic' reasons truly more efficacious at accomplishing the job of being hypnotics, than the so-called 'anxiolytic' benzos, assuming dosing in diazepam-equivilancy?

d) Despite temazepam's popularity, it seems that most of the problems reported on Heather Ashton's benzo.org.uk website relate to the high-potency (high binding affinity) benzos, ie: lorazepam, alprazolam, triazolam. temazepam complaints are rare, and it was claimed that temazepam has fewer than 2% of the adverse reactions as experienced with triazolam. Is this because of the lower binding affinity?

e) My GP really is reluctant to prescribe Zopiclone, despite my pharmacist insisting that it is a safer alternative to the benzodiazepines. His attitude is, "if temazepam works well for you...why risk messing around". Is this something I should be concerned about? I guess I could doctor shop for another GP to give me a concurrent Rx of Zopiclone (not a controlled/scheduled drug, unlike benzos that are Schedule IV), but what would best for me in the long run?

I've been for a psychiatric evaluation with a psychiatrist, and aside from getting a stern lecture on the evils/dangers of benzos, he was unable to find anything wrong with me mental illness-wise. I've also been given trials of SSRI's, trazodone, TCA's, mirtazapine, and Seroquel (quietiapine), and none really did me any good. The SSRI/trazodone/TCA/mirtazapine side effects were horrible, and Seroquel made me dysfunctional the next day.

[gizmo]

Here's the bottom line of what you really want to know: it's perfectly ok to take either benzo. You aren't going to become "addicted" to either one.

Here's my $0.02 benzo story. It's worth exactly the price of admission. Addiction is a psychological thing. As in "I feel fine, but I need to take a benzo to feel super mellow. And I need to do this five times a day." Then there is tolerance, which is what you are talking about. Tolerance can happen on any benzo, be it the weakest benzo or the most potent benzo. It is highly individualized, and no one can tell if or when you will become tolerant on a benzo. In general, the chances increase the longer you take the drug. However, tolerance is not a bad thing as long as you remember to taper the drugs off slowly when you go to stop taking them.

There really is no reason to refuse to take benzos if you are offered them. They are most effective at what they do. It's like having pain relievers and being offered a massage instead. Yeah, a massage *may* relieve the pain in a roundabout way, but wouldn't you rather just have the pain reliever pill?

[ar27xc]

a) There's some evidence that higher potency benzodiazepines with short half-lives are harder to withdraw from.

b) With most psychotropic drugs, it's best to use the lowest effective dose for the shortest possible time.

c) Benzodiazepine equivalency can be misleading. All benzodiazepines possess anxiolytic, hypnotic, amnestic, anticonvulsant, etc., properties, but they do so in varying degrees: the relationship is qualitative rather than linear. Midazolam, for instance, is a better amnestic than most benzodiazepines, which is why it's used in endoscopies and the like.

d) Could be caused by the short half-life of triazolam. Some researchers have suggested that a single dose of a short-acting hypnotic compound can produce withdrawal symptomatology the next day.

e) The z-drugs and benzodiazepines work in much the same way, and have similar risks, adverse effects, etc.

If temazepam works for you, there's no particularly good reason to change, unless it's causing serious adverse effects.