What to do with my PRN(s)

[Iceberg]

So I am just wondering about the use of PRN meds in our current lockdown situation. Is anyone finding that increased stress/worry is making them rely on PRNs more? By the way, I know that not all PRNs are for anxiety but this forum seemed the closest fit. In other words, has anyone talked with their pdoc about either taking the PRN more frequently or just going to something nearer to round the clock dosing. Especially with being stuck inside while the virus is outside, I would imagine that people might need their anti anxiety/anti agitation meds more than ever, and I'm interested to see if anyone (with their doc) has just decided to tack on a "quarantined" med (such as a long acting benzo) instead of trying to chase down the symptoms with spot doses (like maybe some xanax.)

I am curious because my current prn is alprazolam ODT, which I have really grown to like, because its fast action is good for both quick onset of agitation and for knocking me out at night for sleep. However, it does not provide coverage for a very long time (as compared to other PRN meds ive taken, both benzo and antipsychotic) and I would rather avoid the "peaks and valleys" effect that can come with short acting meds. In the past, I have done round the clock valium or klonipin with a Xanax prn booster. I am not necessarily advocating to get back on that amount of benzo, but I was wondering if having a low-dose daily med available to start as reassurance if my brain decides to stop cooperating, even just for a small background effect (ex. .5 klonipin or 1 mg Xanax XR) 

I guess I should clarify here so everyone doesn't think I am drug seeking. Historically, spring has been rough for me because it can put me on the manic express really fast. And not grandiose mania, but more like raging asshole fits and inability to get along with anyone mixed mania. My pdoc is very aware of this and we always watch carefully. however, my pdoc is very far away and getting to him could be a challenge in the current situation. I have been stable (or stable-ish) for the longest period ever and I don't want to ruin that. In the past, benzos have been the first line PRN to try and calm things down before it goes too far south. Also, I can function on them much better than the back up plan, which is basically titrate up thorazine to make me a zombie at home so I don't have to be a zombie inpatient. The complication is that now my brother and parents are literally stuck with me, and it is not fair to them if they have to manage me as an overcharged, irritable insomniac. 

I will be talking to my pdoc somewhat soon, and I will of course bring up the concerns. The expressing my worry is easy, because we both know the "springtime" drill. The meds might be more tricky, not because he won't give me any benzos but more because its an unprecedented problem that is really hard to plan for. I would be welcome to any thoughts, comments or suggestions about strategies to consider. Thanks!!

P.S. … my main cocktail (lamictal, Clozaril, lithium, Inderal) has been set up really well and at the moment it cant be changed, for more than one reason actually) The Adderall is very tricky, because without it I cant really conquer the Clozaril sedation... he sometimes will give me some leeway as to when I feel like I don't need as much of it, or don't need it at all.

 

[Unstrung Harp]

I switched back to Klonopin from alprazolam a few months ago because my anxiety was out of control and I was looking for the longer half life, and Pdoc agreed to prescribe for three times a day at .5mg (I respond to a pretty low dose luckily, and have mostly not habituated). I will say that I took a full 1 mg. last night because my anxiety was through the roof (though I hadn't taken any earlier), and I think that it carried over through a lot of today. I'll probably do the same thing tonight. I agree, I don't know that there's really a model for how to dose anxiety during a pandemic, and especially if you tend towards mania/mixed in the Spring. It seems like something more long acting or slightly more frequently as approved by Pdoc might not be a terrible idea.

[Juniper29]

How does anyone even get a new script for a benzo filled right now? Doesn't it have to be a paper script (as opposed to called in)?

(And yes, I have been taking my Ativan more.)

Edited March 22, 2020 by Juniper29

[Wonderful.Cheese]

@Iceberg
 

I have been relying on more and actually recently restarted my PRN med (which is up to 10 mg extra of zyprexa Zydis, or 5 mg twice daily). I actually just took a 5 mg one now. Ironic.

I have absolutely been taking my PRN more often. It’s been about every other day, maybe every 2 days I take one. I so far have not taken the full 5 mg, twice a day yet. I’ve only taken one extra 5 mg zydis per day when needed so far.

I too see my pdoc soon (I think, and hope so anyway).

I should also mention that I take klonopin 1 mg, three times a day. But I usually take 1 mg AM and 2 mg bedtime. Zyprexa helps me more anyway.

So I say, go for it. Especially since spring is rough on you in the first place. I’m sorry to hear that. I would ask for klonopin or a different benzo if you aren’t wanting another AP or AAP. Or you could ask for both just in case one doesn’t cut it? If your pdoc would allow that, that is.

But I would definitely ask about it now vs later. Don’t hesitate to bring it up. Keep us posted and stay well.

[Iceberg]

23 minutes ago, Juniper29 said:

How does anyone even get a new script for a benzo filled right now? Doesn't it have to be a paper script (as opposed to called in)?

(And yes, I have been taking my Ativan more.)

All depends on the state. My docs can call it in, but also send it to the pharmacy online 

11 minutes ago, Wonderful.Cheese said:

@Iceberg
 

I have been relying on more and actually recently restarted my PRN med (which is up to 10 mg extra of zyprexa Zydis, or 5 mg twice daily). I actually just took a 5 mg one now. Ironic.

I have absolutely been taking my PRN more often. It’s been about every other day, maybe every 2 days I take one. I so far have not taken the full 5 mg, twice a day yet. I’ve only taken one extra 5 mg zydis per day when needed so far.

I too see my pdoc soon (I think, and hope so anyway).

I should also mention that I take klonopin 1 mg, three times a day. But I usually take 1 mg AM and 2 mg bedtime. Zyprexa helps me more anyway.

So I say, go for it. Especially since spring is rough on you in the first place. I’m sorry to hear that. I would ask for klonopin or a different benzo if you aren’t wanting another AP or AAP. Or you could ask for both just in case one doesn’t cut it? If your pdoc would allow that, that is.

But I would definitely ask about it now vs later. Don’t hesitate to bring it up. Keep us posted and stay well.

Thanks for the support @Wonderful.Cheese. Unfortunately the only aps I’ve tolerated with clozaril have been the slow acting ones, namely Rexulti and Vraylar, so that probably wouldn’t do much. The complicating factor is that klonipin alone didn’t help much (thus the switch to Xanax/Xanax XR. When things were really bad it was usually some sort of combo, the most memorable being 2mgs Xanax XR and up to 2 1mg ir.... which is a lot of benzo. In other words, it’s not like there is an easy option to fall back on. But you’re right, probably worth the conversation 

[Juniper29]

6 minutes ago, Iceberg said:

All depends on the state. My docs can call it in, but also send it to the pharmacy online 

 

Ah, ok.

[CeremonyNewOrder]

So far no trouble getting meds *crosses fingers,* for a fast acting long acting PRN (going from least to high potency) I'd recommend seroquel, zyprexa and haldol.

Edited March 22, 2020 by CeremonyNewOrder

[Iceberg]

Yeah, unfortunately those are probably all no go’s. The first 2 due to sedation but also I am finally starting to lose weight, and while PRN doses may not have direct metabolic impact, if I get sluggish and can’t do shit I’ll gain all the weight back. I tried them both as PRNs both together and seperately  and it wasn’t productive. Since I have the Thorazine when I need heavy AP and we know it works he’d probably not go the haldol route. Thanks for the suggestions though, I appreciate it! 

[HAL9000]

The anxiety level is way up with me but I think its more physical health related stuff more then Corona Virus stuff. I'm no fool I know a pandemic is bad news but I just keep doing what I'm doing and try to keep out of crowds, keep my fingers off my face. I already wash my hands and haven't done much more of that.

Interesting drug. I was on Xanax PRN but the stuff really scared the hell out of me. The effect (while strong) was a little too good and very short lasting in my case. I asked about switching to something in the opposite direction and the PDoc I went to asked me what I had in mind and I said Valium. Its effect for me was not the Xanax POW!!! YOU FEEL GOOD GOOD GREAT!!!!........OK thats done now your freaking out.
Valium is more of a hummmm I feel pretty normal. My anxiety seems gone. Yeah I think so... where did it go? Hummm.... stupid valium it doesn't do anything or does it? Why I think it does!

The next time I saw the PDoc he said thats exactly the effect he wanted to hear and one reason he personally didn't like prescribing Xanax except in specific cases. It tends to make you feel TOO good then dumps you way too quickly. This effect (He thought) was why it was easier to get addicted or at least more dependant on Xanax. Not that people can't get screwed up with Valium. Finding the dose that eliminates an anxiety attack without you getting euphoric is the real trick to prescribing I think. What I hate is that I always seem to get little to no effect from low dose anything. What is it that breaks down a drug that can be so overactive that low doses just don't do anything? Your Liver??

As to asking for a PRN dose to go up I would not be shy and I would not put it off. If its not working be up front and just tell her/him that its not doing what you need and ask for a change. It might just be the wrong drug not the dose. One thing I think (personally) I would try to avoid is just taking it daily at the same time to avoid anxiety. Its taking it that way that seems (again just my opinion) to get people into trouble. Some drugs just don't work as good if your using them too often and Benzos have a really bad reputation which I think is more due to that then the drug. PRN stuff is the best way to take them. I should add this is all the advise of a patient so this is just 2 cents worth. I did have a good friend who really screwed himself up with Xanax btw so some of that might be coming across so if Xanax really works for you just ahhhhhh forget about what I said.

[Iceberg]

27 minutes ago, HAL9000 said:

The anxiety level is way up with me but I think its more physical health related stuff more then Corona Virus stuff. I'm no fool I know a pandemic is bad news but I just keep doing what I'm doing and try to keep out of crowds, keep my fingers off my face. I already wash my hands and haven't done much more of that.

Interesting drug. I was on Xanax PRN but the stuff really scared the hell out of me. The effect (while strong) was a little too good and very short lasting in my case. I asked about switching to something in the opposite direction and the PDoc I went to asked me what I had in mind and I said Valium. Its effect for me was not the Xanax POW!!! YOU FEEL GOOD GOOD GREAT!!!!........OK thats done now your freaking out.
Valium is more of a hummmm I feel pretty normal. My anxiety seems gone. Yeah I think so... where did it go? Hummm.... stupid valium it doesn't do anything or does it? Why I think it does!

The next time I saw the PDoc he said thats exactly the effect he wanted to hear and one reason he personally didn't like prescribing Xanax except in specific cases. It tends to make you feel TOO good then dumps you way too quickly. This effect (He thought) was why it was easier to get addicted or at least more dependant on Xanax. Not that people can't get screwed up with Valium. Finding the dose that eliminates an anxiety attack without you getting euphoric is the real trick to prescribing I think. What I hate is that I always seem to get little to no effect from low dose anything. What is it that breaks down a drug that can be so overactive that low doses just don't do anything? Your Liver??

As to asking for a PRN dose to go up I would not be shy and I would not put it off. If its not working be up front and just tell her/him that its not doing what you need and ask for a change. It might just be the wrong drug not the dose. One thing I think (personally) I would try to avoid is just taking it daily at the same time to avoid anxiety. Its taking it that way that seems (again just my opinion) to get people into trouble. Some drugs just don't work as good if your using them too often and Benzos have a really bad reputation which I think is more due to that then the drug. PRN stuff is the best way to take them. I should add this is all the advise of a patient so this is just 2 cents worth. I did have a good friend who really screwed himself up with Xanax btw so some of that might be coming across so if Xanax really works for you just ahhhhhh forget about what I said.

Just so you know, lots of people on the site do take scheduled dose benzos - typically klonipin if it’s an everyday thing... @Wonderful.Cheese Mentioned doing it above, there are others but my memory is blank right now, and in cases of treatment resistance some people are on them for extended periods of time. I am not taking an opinion on that here, but it is more common than one might think when first line combos fail.

Thank you for sharing your experiences! Valium was ok-ish for me but I was maxed out on the dose for it to work. I believe it was good for my sleep though. And I agree about the Xanax being so quick on and off. I was actually having this weird thing where it was a delayed onset. It would kick in late and then I’d be loopy way after I needed to be, which is why I switched to the desolving ones 

[notloki]

At least with me, but I think it is generally the method, he uses if you need to be on a benzo all the time. He prescribes a long acting one so you can miss a dose and not go into withdrawal. Then he offers a PRN script for those really bad days. For me the benzos have been Klonopin and Ativan for over a decade. If I start need both more days than not my doc would raise the long acting benzo and expect the PRN use to go down.. This probably satisfied whatever Drug Enforcement body. PRN scripts for abusable meds look better to the DEA, it demonstrates prescribing the least amount possible.

[Iceberg]

1 minute ago, notloki said:

At least with me, but I think it is generally the method, he uses if you need to be on a benzo all the time. He prescribes a long acting one so you can miss a dose and not go into withdrawal. Then he offers a PRN script for those really bad days. For me the benzos have been Klonopin and Ativan for over a decade. If I start need both more days than not my doc would raise the long acting benzo and expect the PRN use to go down.. This probably satisfied whatever Drug Enforcement body. PRN scripts for abusable meds look better to the DEA, it demonstrates prescribing the least amount possible.

Yeah my doc is definitely not worried about prescribing controlled meds. We’ve gone through quite a range at significant doses. I prefer to not do a daily dose, but I have several times when needed on multiple benzos. Which means for me, identifying that point of “well your PRN isn’t really covering things anymore” is tricky. And like I said, I didn’t have outstanding success with one particular benzo that would make it an obvious choice

[HAL9000]

I haven't been on this board for a long time so I probably shouldn't just jump in the middle. Anyway thanks for letting me jump in because its on my mind right now. The Docs are telling me "Its all in your head" and had the bizzare incident of more then one doctor telling me to take my Diazapam/Valium more. How often does that happen? Never to me. It seems more like people asking me do I really need them at all and maybe I should not use them... I think the real problem right now is I get serious anxiety when I start thinking I know whats physically wrong and its obvious but they just don't get it. And I'm getting to the point where I just am sick of talking to a wall.

Oh yeah I've been around I'm aware of the daily benzo prescriptions a lot of people are prescribed a daily dose. And if their problem can only be solved by that? Who am I to say? Long lasting Benzos I've never used. I know someone told me they had made Xanax last longer which seems like a good idea. Anyway don't take what I say very serious. I'm not trained or anything and would say whatever the doctor says. Personally like with Xanax I worry a little bit about it being a problem. Actually it was a problem because the crap scared me so much I didn't take anything and thats no fun at all. I have a doctor who is strict on Benzos and some of the other controlled stuff. She does the whole no notice bring in your pills thing and random screenings. I might be the only patient where she did the call for a pill check (The first time) and I was so anal about my Anxiety I had a run down of what was going on for every pill I took. She was counting out the pills while I went over dates and she just stopped and said something to the effect of some people have an addictive personality and then there is me. Guess I'm weirder then the typical nut she takes care of. Anyway it doesn't stop her from doing random checks and always telling me to take as few as possible.

[Banana Smurf]

I am on a maintenance dose of klonopin, too.  I dont know exactly how he decided to go from prn to daily.  It's been a while, though.  It freaked me out at first, but then I figured the withdrawals wouldn't be worse than many other drugs.  He was much more enthusiastic about it than me so if you feel like you really need a change to your benzo regimen, and your pdoc is more relaxed about benzos, it might not hurt to ask.  I was using benadryl for breakthrough panic and am trying l theanine now.  One thing I've taken around the clock that was like a prn was a tiny dose of Stelazine, for some anxiety and a tiny bit of agitation calming.  

Edited March 23, 2020 by Banana Smurf

[Wonderful.Cheese]

@Iceberg

I definitely need my klonopin daily dose. I can’t do much of anything but cry in bed if I am taken off of it (which only occurs at anti benzo psych wards, and I’m taken off of 3 mg cold turkey, and I’m given PRN vistaril as a substitute.....stupid). I have severe GAD and have since I was a young teenager.

Everything is too loud and overwhelming. I can’t think. I can’t leave the house nor drive to even well known places. I just feel terror constantly. I have taken anywhere from 0.5 mg daily to 3 mg daily. It varies. I go up and down over the years based on need. In fact, before this virus crap started, I was going to suggest going down in my klonopin daily dose to my pdoc because I had been doing better. Well. Maybe later on.

So, no worries in asking for what you need. Especially since spring is rough for you to begin with and with this whole pandemic going on. Do what you gotta do. Good luck at your upcoming appointment. I hope it goes well.

 

[CrazyRedhead]

17 hours ago, Juniper29 said:

How does anyone even get a new script for a benzo filled right now? Doesn't it have to be a paper script (as opposed to called in)?

(And yes, I have been taking my Ativan more.)

My pdoc calls in my clonazepam refills to the pharmacy....Benzos are classified Schedule 4 in most places......At least in my state, I don't need a paper script for my clonazepam refills, because Schedule 4 meds can be called in by the doc.....You might want to check with your pharmacy, or pdoc, to see if your Ativan can be called in.

[bpladybug]

On 3/22/2020 at 3:03 PM, Juniper29 said:

How does anyone even get a new script for a benzo filled right now? Doesn't it have to be a paper script (as opposed to called in)?

(And yes, I have been taking my Ativan more.)

my doctor called in my xanax 

[bpladybug]

I am using more xanax and sometimes more seroquel

my anxiety is high and I watch too much CNN news

this really is a horror, deaths are about to reach 15,000

I did get some masks, purchased them from a drag queen who got out his sewing machine

and got to work

at least the sun is out today

I am having a hard time with the pandemic and social distancing

trying to talk to at least 2 people a day on the phone beside my husband