Jump to content
CrazyBoards.org

Iceberg

Trouble with Xanax Timing ?

Recommended Posts

So I am having an interesting experience. I have Xanax 1 mg, which I sometimes use for sleep, but I seem to be metabolizing it weirdly or something. The other day I took .5 at about 9 pm to get to bed on time. Several hours later, nothing. So I take another 1 mg, and I end up sleeping for like 12 hours. It almost like a delayed effect. Its not just sleep either. its also happened on long car rides and airplane flights, where I wake up for the end of the trip just to find myself in the full throes of benzo sedation. Ive tried the main benzos before, but should I talk to pdoc about maybe switching to something that comes on smoother? I thought the whole point of Xanax was quick-acting, short duration of action. We switched to it from klonipin because we thought the "punchiness" would be Beneficial to my symptoms. Is this delayed reaction a thing that ive never heard of? Should I retry a more gradual med (valium/clonazepam?) 

Share this post


Link to post
Share on other sites
26 minutes ago, Iceberg said:

So I am having an interesting experience. I have Xanax 1 mg, which I sometimes use for sleep, but I seem to be metabolizing it weirdly or something. The other day I took .5 at about 9 pm to get to bed on time. Several hours later, nothing. So I take another 1 mg, and I end up sleeping for like 12 hours. It almost like a delayed effect. Its not just sleep either. its also happened on long car rides and airplane flights, where I wake up for the end of the trip just to find myself in the full throes of benzo sedation. Ive tried the main benzos before, but should I talk to pdoc about maybe switching to something that comes on smoother? I thought the whole point of Xanax was quick-acting, short duration of action. We switched to it from klonipin because we thought the "punchiness" would be Beneficial to my symptoms. Is this delayed reaction a thing that ive never heard of? Should I retry a more gradual med (valium/clonazepam?) 

So 0.5 mg Xanax does nothing, but a full 1 mg can knock you out but lasts too long? Am I understanding you correctly?

Valium is actually rather quick-acting, actually quicker than Xanax for some. Klonopin is pretty slow-acting and is long-acting.

If you want a short-acting one that has a gradual onset of action, I'd try Serax. I believe it's the slowest to act, in fact. 30 mg is approximately equivalent to 1 mg Xanax, but you may wish to start with 15 mg but have more of them available in case you need an extra 15 mg.

Share this post


Link to post
Share on other sites
1 minute ago, mikl_pls said:

So 0.5 mg Xanax does nothing, but a full 1 mg can knock you out but lasts too long? Am I understanding you correctly?

Valium is actually rather quick-acting, actually quicker than Xanax for some. Klonopin is pretty slow-acting and is long-acting.

If you want a short-acting one that has a gradual onset of action, I'd try Serax. I believe it's the slowest to act, in fact. 30 mg is approximately equivalent to 1 mg Xanax, but you may wish to start with 15 mg but have more of them available in case you need an extra 15 mg.

maybe I should have said "smooth acting" instead of quick acting. I am trying, I don't think this always happened, in fact I used to take 2 mg for sleep. Maybe its just because my overall mood symptoms are less intense. Unfortunately, I do need to have a benzo in place for sleep or emergency agitation, so maybe a change in overall symptom structure requires a change in benzo? I don't know about the serax with my pdoc. He is not at all uncreative, but he has never mentioned using it to me, and we've been deep in the bag of tricks several times. Also, if the serax is really slow onset, does that make it less useful as a PRN? 

Share this post


Link to post
Share on other sites
11 minutes ago, Iceberg said:

maybe I should have said "smooth acting" instead of quick acting. I am trying, I don't think this always happened, in fact I used to take 2 mg for sleep. Maybe its just because my overall mood symptoms are less intense. Unfortunately, I do need to have a benzo in place for sleep or emergency agitation, so maybe a change in overall symptom structure requires a change in benzo? I don't know about the serax with my pdoc. He is not at all uncreative, but he has never mentioned using it to me, and we've been deep in the bag of tricks several times. Also, if the serax is really slow onset, does that make it less useful as a PRN? 

That makes sense to me. Each benzo is different in every way from how quickly it works to the subjective experience of the anxiolysis/sedation/amnesia it causes. For instance, Ativan is like dementia in a pill for me: it does nothing but make me forget everything and not know where or who I am. It's incredibly frightening. Yet Ativan is a miracle drug for other people, most people in fact.

I will say that Valium, while quick acting, is pretty smooth. It's quite long-acting, but even taken four times a day as it's usually taken, it wasn't overly sedating while I was on the lowest dose (2 mg qid). 5 mg tid was a little too sedating for me, and once I was on 10 mg tid and it was way too sedating. Klonopin used to just depress me but now it's profoundly sedating no matter how I take it.

Serax is kinda like... it has already done what it was supposed to do before you realize it has done it. I'm always like, "huh, I don't feel like I'm about to die anymore... when did that happen?" It's that smooth in action. It's far less likely for me to want to take a bunch of it at once to really quell a severe anxiety/panic attack emergency to stupidly try to get myself under control, unlike Xanax. I'm very reckless with Xanax and probably should not be allowed to have any anymore.

That's just my experience.

There's also Restoril, which actually can be used as an anxiolytic at high doses like 30 mg. It actually is a metabolite of Valium, and produces Serax as an active metabolite. Serax has no metabolites and is very clean. Valium has a ton of metabolites and is somewhat similar to Librium and Tranxene in metabolites produced IIRC.

If your pdoc doesn't go for Serax, which I don't see why he wouldn't because it's one of the oldies but goodies, there's Ativan as aforementioned. It's about half as potent as Xanax (0.5 mg Xanax = 1 mg Ativan). Many people swear by it, but I see it didn't work for you at pretty high doses.

For emergency agitation, I personally find low- to moderate-dose typical antipsychotics, especially Stelazine, either alone or in combination with a benzo to be more effective than benzos alone. Haldol works well too, but is like a sledgehammer and flattens my affect to hell and back. Stelazine used to have a profound mood-brightening effect for me in addition to anxiolytic and antipsychotic at higher doses, and while that has diminished over the years, it still doesn't smash my affect into oblivion and can sometimes light me up a bit if I'm in the pits, especially of psychotic depression or severe anxiety or agitation. But if your pdoc isn't creative or willing to prescribe out of the box, he may not go for that at all. Compazine is also indicated for non-psychotic anxiety. Trilafon is used in combination with Elavil for anxiety, especially for anxious depression and psychotic depression (Triavil and Etrafon). But low-dose Seroquel can be used in much the same way, but may be too sedating to use for this during the day, which your pdoc may go for.

Share this post


Link to post
Share on other sites
4 minutes ago, mikl_pls said:

That makes sense to me. Each benzo is different in every way from how quickly it works to the subjective experience of the anxiolysis/sedation/amnesia it causes. For instance, Ativan is like dementia in a pill for me: it does nothing but make me forget everything and not know where or who I am. It's incredibly frightening. Yet Ativan is a miracle drug for other people, most people in fact.

I will say that Valium, while quick acting, is pretty smooth. It's quite long-acting, but even taken four times a day as it's usually taken, it wasn't overly sedating while I was on the lowest dose (2 mg qid). 5 mg tid was a little too sedating for me, and once I was on 10 mg tid and it was way too sedating. Klonopin used to just depress me but now it's profoundly sedating no matter how I take it.

Serax is kinda like... it has already done what it was supposed to do before you realize it has done it. I'm always like, "huh, I don't feel like I'm about to die anymore... when did that happen?" It's that smooth in action. It's far less likely for me to want to take a bunch of it at once to really quell a severe anxiety/panic attack emergency to stupidly try to get myself under control, unlike Xanax. I'm very reckless with Xanax and probably should not be allowed to have any anymore.

That's just my experience.

There's also Restoril, which actually can be used as an anxiolytic at high doses like 30 mg. It actually is a metabolite of Valium, and produces Serax as an active metabolite. Serax has no metabolites and is very clean. Valium has a ton of metabolites and is somewhat similar to Librium and Tranxene in metabolites produced IIRC.

If your pdoc doesn't go for Serax, which I don't see why he wouldn't because it's one of the oldies but goodies, there's Ativan as aforementioned. It's about half as potent as Xanax (0.5 mg Xanax = 1 mg Ativan). Many people swear by it, but I see it didn't work for you at pretty high doses.

For emergency agitation, I personally find low- to moderate-dose typical antipsychotics, especially Stelazine, either alone or in combination with a benzo to be more effective than benzos alone. Haldol works well too, but is like a sledgehammer and flattens my affect to hell and back. Stelazine used to have a profound mood-brightening effect for me in addition to anxiolytic and antipsychotic at higher doses, and while that has diminished over the years, it still doesn't smash my affect into oblivion and can sometimes light me up a bit if I'm in the pits, especially of psychotic depression or severe anxiety or agitation. But if your pdoc isn't creative or willing to prescribe out of the box, he may not go for that at all. Compazine is also indicated for non-psychotic anxiety. Trilafon is used in combination with Elavil for anxiety, especially for anxious depression and psychotic depression (Triavil and Etrafon). But low-dose Seroquel can be used in much the same way, but may be too sedating to use for this during the day, which your pdoc may go for.

I use thorazine for that purpose, but it can get ugly. Trilafon was a total fail, and we are weary of the others because I am super prone to akathisia. So, since the goal is for me to almost never take it, we stick with the thorazine which we know works. I did try it daily but it was too sedating (with Ativan at one point.) Trilafon was up to 56 mg a day. I think the goal is to have a rung on the ladder between nothing and a typical, because once I get in the pattern of needing a typical a lot its not gonna end well. Tried Restoril, nothing. I was on valium 10 qid for awhile for a certain panic-y spell, and we switched back to clonazepam but idk why. Also have tried low dose Seroquel and low dose Zyprexa for prn agitation (and established that risp/Invega are off the table.) The problem is ive basically switched off all of them onto another one of them, so its hard to even remember whats what 

Share this post


Link to post
Share on other sites
8 minutes ago, Iceberg said:

Trilafon was up to 56 mg a day.

Duuuuuuude!!! 😮 

9 minutes ago, Iceberg said:

The problem is ive basically switched off all of them onto another one of them, so its hard to even remember whats what

I'd try to document your experiences with your meds somehow if you don't already. That way you can look back and remember why you switched or quit taking something and whether it's worth revisiting or not.

Thorazine is a good one for anxiety/agitation. I was about to ask if you have tried any doses lower than 100 mg for agitation, but I see you take anywhere from 25-100 mg. Do lower doses like 25-50 mg work well for you? They make a 10 mg pill but that may useless and pointless.

Prolixin used to be combined with nortriptyline in low doses for anxiety. Not sure if you've tried that one or not. It does nothing for me personally, but figured I'd mention it.

I will say that Thorazine + Clozaril is quite a heavy combination. I'm struggling to think of another avenue for anxiolysis, because you've got lots of antihistaminergic meds, a beta-blocker, and a benzo for sleep in addition to Xanax.

There are supplements that can sometimes help with anxiety, but many times they're nowhere near as effective as pharmaceuticals. Have you tried BuSpar? Nardil? Gabatril? Still struggling to think of more... Atarax is not quite as anxiolytic as Vistaril for me. Atarax doesn't cross into the CNS as much as Vistaril does. It may be worth a trial, but hell, you've got so much antihistamine already going on. Vistaril has 5-HT2A antagonism too, but you've already got that covered as well.

How was Xanax XR? You can go up to 6 mg on that one (I see you went up to 2 mg). It isn't really effective for me at all, but I took it for a while. My pdoc never wanted to go above 1 mg at all for any reason whatsoever.

I still say Serax is worth trying if your pdoc will prescribe it though.

Share this post


Link to post
Share on other sites

Yeah... any Thorazine with the cloz requires me to skip any type of activity that involves thinking or social interaction. I’ve actually been on both Atarax and vistaril (long story.) we’ve decided no MAOI’s, my doctor and I agree that BuSpar probably isn’t worth it since I often need help with nasty dysphoric anxiety stuff and not more typical GAD like symptoms. Never tried Gabatril, but same thing, I’m not sure it would do a lot, and I’m already on a high dose of lamictal... I’m sorry to keep shooting it all down, I know my med history is a total mess, party do to resistant symptoms, some bad doctoring, and the fact that most people seem to not know how to handle an acutely manic 14 year old. 

Thanks for the suggestion on the med charting. I do do that, but it’s still tough with all the contradictions. Ex. I went from klonipin to Ativan back to klonipin - it’s hard to really come away with a. Good conclusion there. I am very good at charting my doses/frequencies, I had to be because I got seriously med blitzed when I was first Dx’d and it was the med go round from hell until after I graduated high school (such as 56 mgs of trilafon - which was with  zyprexa and seroquel at the same time too) 

the problem with the Xanax XR was it couldn’t be a PRN for me. I had to take it as a standing for it to do much, and while I am not one to object to daily benzos when necessary, I’d rather not go there unless I really need it

Again, I don’t mean to shoot it all down, thanks for the input!!

Share this post


Link to post
Share on other sites
1 hour ago, Iceberg said:

@mikl_pls do you think switching to the ODT could make a difference ? 

Absolutely! Niravam was one of the game changers for me and anxiety. I needed 2 mg at the time though, so I was given x30 for a 30 day supply and I used them very carefully. (Normally she would give me x90 1 mg of the regular kind.) I used them sublingually and it worked incredibly fast—I mean almost 1-2 miniutes as opposed to 15 to 30 minutes for the normal tablets for me—and felt the anxiolytic effects quite profoundly. They taste kind minty if you've never had them before.

Edited by mikl_pls

Share this post


Link to post
Share on other sites

Went with the Niravam. He gave me .5s To try first cuz the goal is just to chill a bit for sleep. He said go to 1 mg if needed. Only gave me 30, but that was partially due to him trying to lower my out-of-pocket cost, and partially because he feels if I start going heavy on the benzos he wants me to check in, cuz it could be transitioning from “sub syndromal” to “needs attention now” especially cuz he knows benzos don’t hold off my mania very well. Of course pharmacy out of stock. He also suggested taking a daily tiny dose of melatonin ( <.5) in the afternoon which has helped some patients to reestablish their circadian rhythm (as opposed to higher doses intended to knock you out). Apparently it is evidence supported, but I’ve never heard of anyone on here doing it 

17 hours ago, mikl_pls said:

Absolutely! Niravam was one of the game changers for me and anxiety. I needed 2 mg at the time though, so I was given x30 for a 30 day supply and I used them very carefully. (Normally she would give me x90 1 mg of the regular kind.) I used them sublingually and it worked incredibly fast—I mean almost 1-2 miniutes as opposed to 15 to 30 minutes for the normal tablets for me—and felt the anxiolytic effects quite profoundly. They taste kind minty if you've never had them before.

Went with the Niravam. He gave me .5s To try first cuz the goal is just to chill a bit for sleep. He said go to 1 mg if needed. Only gave me 30, but that was partially due to him trying to lower my out-of-pocket cost, and partially because he feels if I start going heavy on the benzos he wants me to check in, cuz it could be transitioning from “sub syndromal” to “needs attention now” especially cuz he knows benzos don’t hold off my mania very well. Of course pharmacy out of stock. He also suggested taking a daily tiny dose of melatonin ( <.5) in the afternoon which has helped some patients to reestablish their circadian rhythm (as opposed to higher doses intended to knock you out). Apparently it is evidence supported, but I’ve never heard of anyone on here doing it 

Share this post


Link to post
Share on other sites
3 minutes ago, Iceberg said:

Of course pharmacy out of stock.

I don't think any pharmacy anywhere actually stocks Niravam. My family pharmacy actually can't even get it from the company they order from. They didn't tell me this the first time I tried to fill a Niravam prescription there, so they just filled it as regular 2 mg Xanax bars and didn't say anything. I called and asked the next day and they were like "yeah we can't get that..." One of the only downsides to my pharmacy is that the meds they can get is kinda limited, and if I need something rather uncommon, they just can't get it while other pharmacies could (like protriptyline, trimipramine, Niravam, etc.)

5 minutes ago, Iceberg said:

He also suggested taking a daily tiny dose of melatonin ( <.5) in the afternoon which has helped some patients to reestablish their circadian rhythm (as opposed to higher doses intended to knock you out). Apparently it is evidence supported, but I’ve never heard of anyone on here doing it

Yes, I would say to go even smaller of a dose, like 0.3 mg (300 mcg), which you can find in some drug stores/supplement stores and online. I believe that is referred to as "phase shifting," but I could be wrong. I've tried it but never stuck with it. I probably have delayed sleep phase disorder or non-24 hour sleep disorder. It's some kind of CRSD.

Your body actually responds more to lower doses supposedly because it more closely emulates endogenous melatonin release rather than flooding your brain with melatonin and it's all like "wtf you doin??"

Another good thing to do is get a sustained release melatonin supplement to take about 30-60 minutes before bed. About 1-3 mg I think I read is a good range. If you wake up in the middle of the night, take another instant release microdose (300-500 mcg). That's how I've read to most efficiently use melatonin supplements anyway.

Hope it all works out for you!

Share this post


Link to post
Share on other sites
2 hours ago, mikl_pls said:

I don't think any pharmacy anywhere actually stocks Niravam. My family pharmacy actually can't even get it from the company they order from. They didn't tell me this the first time I tried to fill a Niravam prescription there, so they just filled it as regular 2 mg Xanax bars and didn't say anything. I called and asked the next day and they were like "yeah we can't get that..." One of the only downsides to my pharmacy is that the meds they can get is kinda limited, and if I need something rather uncommon, they just can't get it while other pharmacies could (like protriptyline, trimipramine, Niravam, etc.)

Yes, I would say to go even smaller of a dose, like 0.3 mg (300 mcg), which you can find in some drug stores/supplement stores and online. I believe that is referred to as "phase shifting," but I could be wrong. I've tried it but never stuck with it. I probably have delayed sleep phase disorder or non-24 hour sleep disorder. It's some kind of CRSD.

Your body actually responds more to lower doses supposedly because it more closely emulates endogenous melatonin release rather than flooding your brain with melatonin and it's all like "wtf you doin??"

Another good thing to do is get a sustained release melatonin supplement to take about 30-60 minutes before bed. About 1-3 mg I think I read is a good range. If you wake up in the middle of the night, take another instant release microdose (300-500 mcg). That's how I've read to most efficiently use melatonin supplements anyway.

Hope it all works out for you!

Yeah, this is a big Rite Aid, and they’ve been helpful to me in the past so I’m keeping my fingers crossed. When I did a price check through my insurance a couple places popped up, so someone somewhere must be able to get it I guess. 

Thats exactly what he said about small doses often being better..and your right he did mention trying as low as possible (I can do .25 with the unmeasured bottle). I have tried a range of bedtime doses with no effect, but since this is a tiny afternoon dose, maybe I’ll try again under can’t hurt. He did make it clear that we don’t have a ton of good options left (assuming I want to avoid the possible side effects nightmare of cloz + typical which may not even work) which is why he said I should start them both together

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...