Door: autologin
Datum: 24 maart 2023
Categorie:  | | | | | | | |

Ervaringsdeskundige geeft voorlichting

Dag vrienden,

Als beloofd stuur ik jullie hierbij wat meer informatie die ik van het internet geplukt heb over het afkicken van benzo’s. Het gaat verder dan de informatie die ik bij Rodersana heb gekregen en is voor ons allemaal belangrijk om te weten. Ontwenningssymptomen, do’s and dont’s, het komt allemaal aan bod.

 Het belangrijkste document is de ‘bijbel’ voor benzo withdrawal: the Ashton manual. Niet in dit document maar google maar even, er is ook een in het Nederlands vertaalde versie van dit door prof. Ashton gepubliceerde manual. De informatie op de Nederlandse Wikipedia (zie onder) is ook gebaseerd op het werk van Ashton. Bij Rodersana was men niet bekend met dit manual maar ze werken wel volgens het principe van prof. Ashton (alle benzo’s volgens een omrekentabel omzetten naar Valium (diazepam) en daarop gaan afbouwen). Alleen gebeurt het in de kliniek veel sneller dan de richtlijnen van Ashton aangeven.

Als je afbouwt van benzo’s is het verstandig om een dieet te gaan volgen, dat is het tweede inzicht. En bepaalde supplementen (vit B en D bijvoorbeeld en alles wat inwerkt op je GABA systeem) te vermijden. Ook dat is belangrijk, dat zijn bijvoorbeeld de gele pillen (vit B complex) die in de kliniek dagelijks worden uitgereikt en die bijvoorbeeld voor de ontwenning van alcohol belangrijk zijn. Maar voor het ontwennen van benzo’s dus juist niet aan te bevelen zijn. Wat je zoal moet vermijden staat in dit document

Als derde geldt dat er nogal wat mensen een opgezette buik (benzo belly) krijgen tijdens het ontwennen van benzo’s. Daar heb ik het minste over kunnen vinden maar ik weet uit eigen ervaring dat het klopt. Het volgen van de dieet voorschriften heeft bij mij nog geen afname van mijn buikomvang tot gevolg gehad…

Laten we van deze opzet een levend document maken. Als jullie nog iets weten of vinden voegen we het hier aan toe zodat we er allemaal ons voordeel mee kunnen doen. En met ons Rodersana en de clienten die daar werk willen maken van hun probleem.

Met hartelijke groet,

Jurgen

Benzodiazepinen

Slaapmiddelen (hypnotica)[bewerken]

Een lijst met preparaten: stofnaam gevolgd door (merknaam) van Benzodiazepinen die als slaapmiddel worden gebruikt. Meestal wordt een kort werkende benzodiazepine gekozen voor slaapstoornissen. Zie voor de halfwaardetijden en eliminatieschema’s het Farmacotherapeutisch Kompas.[6]

zeer kort werkend 

brotizolam (Lendormin) – midazolam (Dormicum) – triazolam (Halcion)

kortwerkend 

loprazolam (Dormonoct) – lormetazepam (Loramet) – oxazepam (Seresta) – temazepam (Normison)

middellangwerkend 

nitrazepam (Mogadon) – lorazepam (Temesta)

Langwerkende benzodiazepinen worden meestal niet als hypnotica (slaapmiddelen) voorgeschreven, aangezien ze overdag nog doorwerken. Meestal kiezen artsen voor de kortwerkende middelen, soms voor de zeer kort werkende middelen en een enkele keer voor middellange- of langwerkende middelen.

langwerkend 

langwerkende benzodiazepinen worden maar zelden als slaapmiddel voorgeschreven omdat ze soms meer dan 12-24 uur werken. Bij regelmatige inname kan de halveringstijd oplopen tot wel 75-100 uur bij diazepam en vergelijkbare benzodiazepinen.

flunitrazepam (Rohypnol)

Flunitrazepam is, ondanks zijn lange eliminatiehalfwaardetijd, toch te beschouwen als een kortwerkend hypnoticum. Omdat het verdelingsvolume van flunitrazepam zo groot is, wordt de werkingsduur niet meer door eliminatie bepaald, maar door de distributie over de weefsels (distributiehalfwaardetijd is 3 uur).[7]

Angstverminderende middelen (anxiolytica)[bewerken]

Nog niet onder slaapmiddelen genoemde benzodiazepinen die vooral als angstverminderend middel worden gegeven:

Afbouwschema[bewerken]

Het eventuele succes van een dosisreductie is mede afhankelijk van leeftijd, duur van de inname, dosis en de ernst van de klachten waarvoor het benzodiazepine werd gegeven. Het hieronder beschreven schema is niet de enige manier om te minderen. Hoe hoger de dosering en hoe langer het gebruik, des te voorzichtiger de afbouw dient te geschieden. Dit heeft tot doel de ontwenningsverschijnselen te minimaliseren.[16][10]

Stap 1. Overschakeling naar een benzodiazepine met lange halveringstijd zoals diazepam. Het overschakelen moet gelijkmatig gebeuren. Indien de patiënt het benzodiazepine in meerdere giften per dag nam, wordt het best één dosis per keer gesubstitueerd. Meestal wordt begonnen met de dosis vóór het slapengaan.

Stap 2. Bij elke stap zou om de twee weken met één tiende of één achtste van de aanvankelijke dosis kunnen worden geminderd. Afbouwen met 1/8 per 2 weken duurt 14 weken. Regelmatige controle door een huisarts is verstandig. Zulke kleine afbouwstappen zijn vaak niet mogelijk omdat er geen tabletten in voldoende kleine doses beschikbaar zijn. De patiënt of zijn arts kunnen de apotheker vragen speciale capsules te maken. Ook kan men zelf de tabletten handmatig of met een speciale ‘pillenbreker’ breken tot de juiste dosering.

Stap 3. Wanneer de dagdosis nog slechts 0,5 mg diazepam (of het equivalent daarvan) bedraagt, dient volledig te worden gestopt. Aanvullende behandeling tijdens het afbouwen kan bestaan uit gedragstherapie, relaxatietherapie, groepstherapie of het gebruik van een antidepressivum of een bètablokker.

Bij een klein deel van de mensen die (langdurig) een (hoge dosis van een) benzodiazepine hebben gebruikt, kan bij geen afbouw, onvoldoende afbouw of in zeer zeldzame gevallen zelfs na een afbouw van 3 tot 6 maanden of langer het “post-ontwenningssyndroom” ontstaan. Men spreekt hiervan als men na 2 jaar na het laatste gebruik (met uitzondering van een afbouwperiode) klachten houdt, die men voor het gebruik van de benzodiazepine niet of in veel mindere mate had. (langdurige ontwenningsverschijnselen)[17] Het gedrag van de persoon tijdens de periode van het gebruik van de benzodiazepine kan hier in mee spelen. Mensen met een zeer gezonde leefstijl (die sporten, gezond eten en drinken en niet roken), hebben (veel) minder kans op het ontwikkelen van dit syndroom, maar slikken over het algemeen minder benzo’s dan passievere mensen. Veel mensen die hogere doseringen van een benzodiazepine gebruiken krijgen vaak een dikkere buik (“benzo belly”), of worden door toegenomen eetlust en trek in zoetigheid veel dikker en raken door het gebruik van een benzodiazepine vaak minder gemotiveerd om gezond te leven en te sporten, wat de kans op langdurige ontwenningsverschijnselen vergroot.

 

Benzodiazepine withdrawal syndrome

From Wikipedia, the free encyclopedia

Benzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms that emerge when a person who has taken benzodiazepines, either medically or recreationally, and has developed a physical dependence undergoes dosage reduction or discontinuation. Development of physical dependence and/or addiction and the resulting withdrawal symptoms, some of which may last for years, may result from either drug-seeking behaviors or from taking the medication as prescribed. Benzodiazepine withdrawal is characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty with concentration, confusion and cognitive difficulty, memory problems, dry retching and nausea, weight loss, palpitations, headache, muscular pain and stiffness, a host of perceptual changes, hallucinations, seizures, psychosis,[1] and suicide[2][3] (see “Signs and Symptoms” section below for full list). Further, these symptoms are notable for the manner in which they wax and wane and vary in severity from day to day or week by week instead of steadily decreasing in a straightforward monotonic manner.[4]

It is a potentially serious condition, and is complex and often protracted in time course.[5][6] Long-term use, defined as daily use for at least three months,[7] is not desirable because of the associated increased risk of dependence,[8] dose escalation, loss of efficacy, increased risk of accidents and falls, particularly for the elderly,[9] as well as cognitive,[10] neurological, and intellectual impairments.[11] Use of short-acting hypnotics, while being effective at initiating sleep, worsen the second half of sleep due to withdrawal effects.[12] Nevertheless, long-term users of benzodiazepines should not be forced to withdraw against their will.[5]

Benzodiazepine withdrawal can be severe and can provoke life-threatening withdrawal symptoms, such as seizures,[13] particularly with abrupt or overly rapid dosage reduction from high doses or long time users.[5] A severe withdrawal response can nevertheless occur despite gradual dose reduction, or from relatively low doses in short time users,[14] even after a single large dose in animal models.[15][16] A minority of individuals will experience a protracted withdrawal syndrome whose symptoms may persist at a sub-acute level for months, or years after cessation of benzodiazepines. The likelihood of developing a protracted withdrawal syndrome can be minimized by a slow, gradual reduction in dosage.[17]

Chronic exposure to benzodiazepines causes neural adaptations that counteract the drug’s effects, leading to tolerance and dependence.[18]Despite taking a constant therapeutic dose, long-term use of benzodiazepines may lead to the emergence of withdrawal-like symptoms, particularly between doses.[19] When the drug is discontinued or the dosage reduced, withdrawal symptoms may appear and remain until the body reverses the physiological adaptations.[20] These rebound symptoms may be identical to the symptoms for which the drug was initially taken, or may be part of discontinuation symptoms.[21] In severe cases, the withdrawal reaction may exacerbate or resemble serious psychiatric and medical conditions, such as mania, schizophrenia, and, especially at high doses, seizure disorders.[22] Failure to recognize discontinuation symptoms can lead to false evidence for the need to take benzodiazepines, which in turn leads to withdrawal failure and reinstatement of benzodiazepines, often to higher doses.[22]

Awareness of the withdrawal reactions, individualized taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance and referral to benzodiazepine withdrawal support groups, all increase the success rate of withdrawal.[23][24]

Effects of long-term benzodiazepine use

From Wikipedia, the free encyclopedia

The effects of long-term benzodiazepine use include drug dependence as well as the possibility of adverse effects on cognitive function, physical health, and mental health.[1] Benzodiazepines are generally effective when used therapeutically in the short term. Most of the problems associated with benzodiazepines result from their long-term use. There are significant physical, mental and social risks associated with the long-term use of benzodiazepines.[2] Although anxiety can temporarily increase as a withdrawal symptom, there is evidence that a reduction orwithdrawal from benzodiazepines can lead in the long run to a reduction in anxiety symptoms.[3][4] Due to these increasing physical and mental symptoms from long-term use of benzodiazepines, slowly withdrawing from benzodiazepines is recommended for many long-term users.[5] Not everyone, however, experiences problems with long-term use.[6]

Mogelijke afkickverschijnselen:

Some of the symptoms that could possibly occur as a result of a withdrawal from benzodiazepines after long-term use include emotional clouding,[1] flulikesymptoms,[4] suicide,[7] nausea, headaches, dizziness, irritability, lethargy, sleep problems, memory impairment, personality changes, aggression, depression, social deterioration as well as employment difficulties, while others never have any side effects from long-term benzodiazepine use. One should never abruptly stop using this medicine and should wean themself down to a lower dose under doctor supervision.[8][9][10] While benzodiazepines are highly effective in the short term, adverse effects in some people associated with long-term use including impaired cognitive abilities, memory problems, mood swings, and overdoses when combined with other drugs may make the risk-benefit ratio unfavourable, while others experience no ill effects. In addition, benzodiazepines have reinforcing properties in some individuals and thus are considered to be addictive drugs, especially in individuals that have a “drug-seeking” behavior; further, a physical dependence can develop after a few weeks or months of use.[11] Many of these adverse effects of long-term use of benzodiazepines begin to show improvements three to six months after withdrawal.[12][13]

Other concerns about the effects of long-term benzodiazepine use, in some, include dose escalation, benzodiazepine abuse, tolerance andbenzodiazepine dependence and benzodiazepine withdrawal problems. Both physiological tolerance and dependence can lead to a worsening of the adverse effects of benzodiazepines. Increased risk of death has been associated with long-term use of benzodiazepines in several studies; however, other studies have not found increased mortality. Due to conflicting findings in studies regarding benzodiazepines and increased risks of death including from cancer, further research in long-term use of benzodiazepines and mortality risk has been recommended. Most of the research has been conducted in prescribed users of benzodiazepines; even less is known about the mortality risk of illicit benzodiazepine users.[14] The long-term use of benzodiazepines is controversial and has generated significant controversy within the medical profession. Views on the nature and severity of problems with long-term use of benzodiazepines differ from expert to expert and even from country to country; some experts even question whether there is any problem with the long-term use of benzodiazepines.[15]

Benzodiazepine withdrawal can be debilitating. The limbic system in the brain kicks into overdrive. Symptoms such as extreme fatigue, depression, and panic are common. How can you support yourself during the months-years long process of detox from benzos? Quitting a benzodiazepine medication can be made easier if you are prepared for what to expect and equipped with the right information about what benzo addiction is, how you can find the best addiction treatment program for you, and the rehab process entail. Learn more in this Benzodiazepine Addiction Treatment Programs and Help guide. With a section at the end for your questions and comments.

Benzos Overexcite Our Minds And Bodies

Before we talk about what you can do to support yourself when going through benzodiazepine withdrawal, let’s review how benzos affect the brain.

There are two opposing systems in the brain: the glutamate and GABA (gamma amino butyric acid) systems. Think of glutamate as the gas pedal: it excites things into action. GABA, on the other hand, puts on the brakes. Benzodiazepines damage GABA receptors so that glutamate is free to run rampant, overly exciting everything in our bodies.

Without enough working GABA receptors to calm down the excitement from glutamate, our central nervous system goes into overdrive. The limbic system, the region of the brain responsible for flight, fight or freeze kicks into action around the clock. We experience:

  • fear
  • terror
  • debilitating panic

Derealization and depersonalization are common withdrawal symptoms, as well. Severe depression, crushing fatigue, weakness, dizziness, burning skin, and a host of other debilitating symptoms can occur from taking a benzodiazepine.

We’re Still Learning About Benzo Withdrawal

It’s true that not everyone taking a benzo will experience a horrific withdrawal. Genetic mutations are the suspected culprits that cause the drug to mangle some brains but not others. However, the exact pathway of damage is not yet known.

What we do know about the experience of detoxing from benzo withdrawal comes from the collective stories of people who have survived it. The Internet is helping collect information about withdrawal and to disseminate more accurate facts to help people better navigate benzo withdrawal.

Why Do You Get Withdrawal Symptoms?

All benzodiazepines work by increasing the activity of the neurotransmitter GABA. Since GABA is an inhibitory transmitter, which slows or stops the firing of other neurotransmitters, by increasing GABA activity you quiet the brain’s overall activity level. GABA is the brain’s natural sedative, and benzodiazepines simply enhance its functioning.

GABA suppresses excitatory neurotransmitters like dopamine, serotonin, epinephrine (noradrenaline) and acetylcholine. These excitatory transmitters play important roles in memory, muscle movement, alertness, emotional regulation, heart rate and blood pressure and hormonal secretions. When taking benzodiazepines you quiet your whole brain’s activity level. This reduces anxiety and insomnia, but also causes changes to many of the body’s essential systems. This is why taking chronic high doses of benzos can cause such a variety of health problems and why people experience such a wide array of withdrawal symptoms after stopping.

Benzodizepine users quickly develop a tolerance and start needing increasingly larger doses to achieve any desired effects. Because of this, most prescribing guidelines advise against the use of benzos for more than 3 or 4 consecutive weeks.

With tolerance:

  1. The GABA and benzodiazepine receptors compensate for the medication’s continual presence by becoming less responsive to the medication (so less GABA)
  2. The excitatory systems that are naturally controlled by GABA also adapt by becoming less responsive to GABA inhibition (So less GABA and the GABA that’s left doesn’t do as much)

So once you’ve developed a tolerance you need large doses of benzos to just get the GABA system functioning at a ‘normal’ level. If a person with a benzo tolerance suddenly stops taking their medication, GABA activity drops substantially and this causes equally substantial increases in the activity of the brain’s excitatory dopamine, serotonin, noradrenalin etc. systems.2

In some cases, as your tolerance rises, you can start to experience withdrawal symptoms on a steady dose, and you need to up your daily dosage to keep these withdrawal symptoms at bay.

Five (5) Benzodiazepine Withdrawal Facts

http://prescription-drug.addictionblog.org/five-5-facts-about-benzodiazepine-withdrawal-you-need-to-know/

Here are five (5) of the facts that everyone taking a benzodiazepine should know:

1.  Going to a doctor who is not benzo-wise can make you worse.

Most doctors are not very well educated about the dangers of benzos or the withdrawal process and symptoms. It is important that you educate yourself by studying the Ashton Manual, the gold standard to date for getting off a benzo. You may want to join one of the new online benzo communities run by benzo survivors that are springing up in response to the global need for help and guidance in benzo withdrawal.

Rehabs and detox centers are not the place to go to stop taking a benzo. Both taper patients off very quickly, which shocks the brain so to speak. This can result in a more symptomatic and longer withdrawal.

TIP 1: Consult with a medical doctor with experience in benzodiazepine withdrawal.

2.  Time is the only thing that heals.

There are no pills, potions, or lotions that speed up the healing process or make it go away. Some things can take the edge off, however. Many of those things come with a steep price tag of their own to pay when you want to stop taking them. It may be better to gut out withdrawal without adding insult to injury.

Many drugs, vitamins and supplements make us worse, not better. Compiling the stories of so many that have gone though withdrawal we now know that vitamin D, vitamin B and magnesium often rev up our symptoms. Further, herbs and supplements that work on GABA receptors should be avoided. Kava Kava, Valerian, Phenibut, and Chamomille are known to cause problems.

Medical marijuana usually makes people have an increase in symptoms. Anxiety, depersonalization, derealization, fear, paranoia and panic can result from smoking or eating edibles. CBD, (cannabidiol) is a marijuana compound that does not cause a high. It is not psychoactive like THC. CBD has been shown to reduce seizures and pain. However, some people in benzo withdrawal react negatively to it. It is best to avoid the use of medical marijuana in benzo withdrawal.

Many naturopaths, acupuncturists and functional medicine doctors like to prescribe vitamins and supplements. You must do your homework before you agree to take any thing no matter how natural or organic it may be. Not sure how to find out if what you want to take is known to cause problems? Join one of the many online benzo groups and ask other members. Remember, we can’t rely on doctors (yet) because they are not educated about benzo withdrawal. They mean well, however, the often harm instead of help.

TIP 2: Avoid the following vitamins and supplements:

Phenibut is a close structural analogue of GABA, as well as of baclofen (dus ook niet igv benzo’s!) (β-(4-chlorophenyl)-GABA), pregabalin (β-isobutyl-GABA), and GABOB(β-hydroxy-GABA).[8] Phenibut is believed to act as a selective GABAB receptor agonist; studies are conflicting as to whether phenibut also acts as a GABAA receptor agonist. More recently, phenibut has been found to act preferentially as a blocker of α2δ subunit-containing voltage-gated calcium channels, similarly to gabapentin and pregabalin.[9][10] As such, by definition, phenibut is a gabapentinoid.[11][12]

  • Valerian
  • Vitamin B
  • Vitamin D
  • Any herbs and supplements that work on GABA receptors

3.  Watch what you eat. Food can trigger an avalanche of symptoms.

It’s not just drugs, vitamins, herbs or supplements that can cause an unbearable spike in benzo symptoms. Food can trigger very uncomfortable reactions as well. Many people going through benzo withdrawal become food sensitive. I couldn’t eat garbanzo beans without an increase in symptoms. Salmon revved up my symptoms too. Cane sugar and honey can increase withdrawal symptoms.

Monosodium glutamate (MSG) needs to be avoided. It is an excitotoxin. Food additives, colorings, preservatives and artificial sugars can increase withdrawal symptoms. Sugar substitutes such a xylitol have been known to cause severe gastro problems. Caffeine and alcohol also make us much worse and should be avoided.

Benzo survivors usually try many different eating styles in order to feel better. Some try the GAPS diet, while others go Paleo. Some become strict vegans, while others just shun gluten. Diet is personal choice that only you can decide for yourself. Nothing to date speeds up the healing of the damaged GABA receptors, however, some diets do allow us to feel a bit better than others.

TIP 3: Find a diet that works for you. Look into GAPS, Paleo, vegan, or gluten-free diets. Avoid certain foods like:

  • Alcohol
  • Artificial sugars or sugar substitutes
  • Caffeine
  • Cane sugar
  • Food additives, preservatives, or coloring
  • Garbanzo beans
  • Honey
  • Monosodium glutamate (MSG)
  • Salmon

Magnesium, L-theanine, calcium, B vitamins, 5-HTP, taurine, melatonin, homeopathic remedies, GABA, valerian, kava, passiflora, lemon balm – all these supplements may be beneficial in non-withdrawal situations but they cannot accelerate the repair of the GABA receptors. There is no evidence suggesting that they cause symptoms to disappear. If your withdrawal is not problematic then at best they will supply added nutrients. In terms of affecting the duration of withdrawal, anecdotal reports confirm that it can prolong the process in those who are sensitive. The use of supplements during withdrawal continues to be a highly debatable topic.

Of special note is oral GABA which some regard as the obvious cure. Post-benzo problems are not due to GABA deficiency but rather to the inefficiency of the damaged receptors in attracting the GABA that may be already present. Even if the orally ingested GABA crosses the blood-brain barrier and one ended up having more than adequate GABA, the down-regulated, temporarily incapable receptors would not be able to attract it, and so the nervous system would still be in overdrive.

4.  Don’t up dose or reinstate unless it is to save your life.

One of the worse pieces of advice people are given in benzo withdrawal is to take more of the drug if they are struggling while tapering, or to reinstate (go back on the drug) if they are off.

A process called “kindling” can take place once you have been exposed to a benzodiazepine. No one knows exactly what takes place in the brain to cause this phenomenon. However, we know that it exists. If you go down in dose then go up, getting back down can be even harder the second time. The brain has been “kindled.”

If you are off the drug, especially for more than four (4) weeks, going back on the drug can backfire. You may become tolerant to the dose you reinstate on, and up dosing will not bring relief. You may be far more symptomatic and tapering may be brutally hard.

TIP 4: Keep moving down in dose. Once off, stay off, unless you feel your life may be in danger.

5.  Chances are good your old anxiety will be history!

Many people who have navigated benzo withdrawal find that the original complaint that drove them to see their doctor is long gone after withdrawal ends. You may be frightened in the midst of withdrawal and feel that your old anxiety has returned. That is your damaged brain misfiring fear.

You’ll know when withdrawal ends if you still have your original anxiety. (you’ll be able to seek appropriate help if you feel you need to do so.) Once we are healed, many of us feel we are made of titanium. We’ve lived through hell on earth. Nothing much ruffles our feathers. Chances are good that you will feel this way, too.

TIP 5: No matter how much fear, anxiety and panic you have in withdrawal, know that once your brain heals, it will fade away. The amount of fear you feel in the depths of withdrawal is not the way you will feel the rest of your life.

Tapering Methods

Tapering should be slow and gradual (months, not weeks) – it doesn’t really matter how long it takes (it probably took you a long time to build up your tolerance) and what’s most important is making steady progress towards your goal while minimizing your discomfort along the way (see below for example tapering schedules).

By tapering you can

  • Minimize your withdrawal symptoms – by reducing at a rate that’s comfortable to you
  • Stay in control – you decide how fast you want to go forward and you don’t have to endure strong withdrawal symptoms if you don’t want to

You can do:

  1. A direct taper – where you make steady reductions off whatever benzo you’ve been using
  2. A substitution taper – where, if you’ve been using a short-acting benzo like Xanax, you first switch off to a longer acting benzo like diazepam, and then once stable on the diazepam, start to taper down

The Benefits of a Substitution Taper (to Diazepam)

Many clinicians recommend switching to diazepam prior to initiating a tapering program.

  1. Diazepam has a very long half-life (between 20 and 100 hours). Because of this, benzo levels in the bloodstream remain very constant and you avoid the peak and valley levels seen with shorter acting benzos like alprazolam. These more constant benzo levels facilitate neural recovery (the brain ‘heals’ faster) and minimize withdrawal symptoms.
  2. Diazepam has very low tablet strengths, and this low potency allows you to easily make very small dose reductions. For example, It’s quite easy to take one fewer 2mg diazepam per day – it’s much harder to shave 0.1 mgs of Xanax off a 0.5 mg tablet.6

Because of diazepam’s long half-life, and difficulties in finding exact equivalent dosages between benzos, it is generally recommended that you switch over to diazepam gradually, in a step-wise fashion over a period of weeks, and then once stable on diazepam, start your tapering from there.7

Roughly Equivalent Diazepam Dosages

Because of the wide variations in half-life and thus variations in how people respond to different benzodiazepines (influenced by factors such as age and hepatic impairment) it’s quite difficult to provide an exactly equivalent diazepam to other benzodiazepine dosage.

According to the Victorian (Australia) Gov. drug withdrawal practice guidelines (zie ook: Drug and Alcohol Withdrawal Clinical Practice Guidelines – NSW)

, as of 2009, 5 mgs of diazepam was approximately equivalent to:8

  • Alprazolam (Xanax, Kalma) 0.5 mg
  • Oxazepam (Serepax, Murelax) 30 mg
  • Clonazepam (Rivotril) 0.5 mg
  • Nitrazepam (Mogadon, Aldorm) 5 mg
  • Flunitrazepam (Hypnodorm) 1 mg
  • Lorazepam (Ativan) 0.5 mg

So, for example, if you wanted to switch from 2mgs of Xanax to an equivalent amount of diazepam you would need to take 20 mgs of diazepam.

  1. However, this is just a rough guideline and you won’t necessarily feel exactly the same on atheoretically equivalent dosage of a different benzodiazepine.
  2. So, what you need to do, is transfer gradually off your current benzo to diazepam, and then dial in a minimum dose of diazepam that keeps withdrawal symptoms at bay but doesn’t leave you feeling over sedated. Once stable on this dose, you can start your tapering regimen.

Example Tapering Schedules

  • Reduce your dose by 10% every 1 or 2 weeks until you’re at 20% of your original dose, and then taper down by 5% every 2 to 4 weeks9

Or, a more aggressive approach, endorsed by the Oregon State College of Pharmacy10

  • Taper by 25% per week for the first 2 weeks and then start a 12.5% reduction per week for the next to 6 weeks (note, tapering usually gets harder as you progress to smaller doses).This aggressive approach may not be suitable for people who have tried and failed in the past with a tapering regimen. For such people a 6 month tapering regimen is recommended.

As a general rule, it doesn’t really matter how slowly you taper and it’s a good idea to stabilize at a dosage before moving further down. Reductions tend to get harder in the second half of the process, so it’s OK to slow down as you need to, as you approach the finish line.

However, you should definitely avoid:

  • Taking extra pills in times of great stress
  • Going back up to an earlier plateau, if a new dosage seems difficult
  • Using other substances that mimic the GABA effects of benzos (this obviously corrupts the tapering process)
  •  

Avoiding Alcohol during Benzo Withdrawals

Drinking may worsen your withdrawal symptoms (especially the morning after) but there’s another important reason to avoid alcohol until you feel better.

  1. You experience withdrawal symptoms because your GABA system is all messed up and it needs to normalize before you’ll feel better
  2. Alcohol increases GABA activity, just like benzos do
  3. So if you drink, you slow your brain’s healing and there’s a risk that you’ll just start to drink more and more as you taper further as a way to compensate, without really allowing your brain a chance to heal

And if you do this, at the end of it all not only is your GABA system still out of whack – now you’ve got an alcohol problem too!

Coping with Withdrawal Symptoms: Self Help

To minimize your symptoms:12

  • Strive to eat a healthy diet with lots of fresh fruits and vegetables. Drink lots of water
  • Avoid caffeine
  • Exercise (as much as you can…you can’t do too much)
  • Rest up as well as you can
  • Keep a recovery diary and chart the progress you make
  • Ask for help and support from friends or family for things like household chores and general responsibilities
  • If interested, explore alternative healing, such as acupuncture or Chinese medicine11
  • Avoid using alcohol or drugs. They may help in the short term but will exacerbate symptoms over the long run
  • Avoid making major decisions or adding unnecessary stress to your life while going through withdrawals
  • Relax in a hot bath
  • Practice relaxation techniques, like deep breathing exercises
  • Meditate and practice mindfulness
  • Learn Cognitive Behavioral Therapy (CBT) techniques (with a therapist or in a group, or on your own through a self help program or books) and learn to challenge negative thoughts and harmful inaccurate beliefs

Keeping Things in Perspective

Staying focused on how bad you’re feeling won’t help you feel better, and the more you obsess about your symptoms, the worse you’ll perceive those symptoms to be – in fact, sometimes worrying about how you’ll feel after dose reductions causes more negative symptoms than the dose reduction itself!13

One trick you can use to minimize the worry is to accept that after each dose reduction you might catch a touch of ‘Benzo Flu’

Think objectively about how you feel after a dose reduction and compare these symptoms to how you feel when you catch a cold or flu. Are they comparable? When you get a flu do you worry a lot about how terrible you’re feeling or do you just accept that you’ll feel crummy for a few days and that you’ll feel better in time.

With benzo withdrawal symptoms it’s pretty much the same thing. You may feel crummy for a short time after a dose reduction, but you’ll feel better quickly enough, so why not just think of your symptoms as a case of benzo flu – and since you know that this flu will pass quickly enough, you don’t need to get too stressed about how bad you feel.

Duration[edit]

After the last dose has been taken, the acute phase of the withdrawal generally lasts for about two months although withdrawal symptoms, even from low-dose use, can persist for six to twelve months gradually improving over that period,[29][93] however, clinically significant withdrawal symptoms may persist for years, although gradually declining.

A clinical trial of patients taking the benzodiazepine alprazolam for as short as eight weeks triggered protracted symptoms of memory deficits which were still present up to eight weeks after cessation of alprazolam.[139]

 Medications and interactions[edit]

While some substitutive pharmacotherapies may have promise, current evidence is insufficient to support their use.[95] Some studies found that the abrupt substitution of substitutive pharmacotherapy was actually less effective than gradual dose reduction alone, and only three studies found benefits of adding either melatonin,[96] paroxetine,[97] or trazodone and valproate[98] in conjunction with a gradual dose reduction.[95]

  • Antipsychotics are generally ineffective for benzodiazepine withdrawal-related psychosis.[43][99] Antipsychotics should be avoided during benzodiazepine withdrawal as they tend to aggravate withdrawal symptoms, including convulsions.[28][100][101][102] Some antipsychotic agents may be more risky during withdrawal than others, especially clozapine, olanzapine or low potency phenothiazines (e.g., chlorpromazine), as they lower the seizure threshold and can worsen withdrawal effects; if used, extreme caution is required.[103]
  • Barbiturates are cross tolerant to benzodiazepines and should be avoided.
  • Benzodiazepines or cross tolerant drugs should be avoided after discontinuation, even occasionally. These include the nonbenzodiazepines Z-drugs, which have a similar mechanism of action. This is because tolerance to benzodiazepines has been demonstrated to be still present at four months to two years after withdrawal depending on personal biochemistry. Re-exposures to benzodiazepines typically resulted in a reactivation of the tolerance and benzodiazepine withdrawal syndrome.[104][105]
  • Bupropion, which is used primarily as an antidepressant and smoking cessation aid, is contraindicated in persons experiencing abrupt withdrawal from benzodiazepines or other sedative-hypnotics (e.g. alcohol), due to an increased risk of seizures.[106]
  • Buspirone augmentation was not found to increase the discontinuation success rate.[7]
  • Caffeine may worsen withdrawal symptoms because of its stimulatory properties.[5] Interestingly, at least one animal study has shown some modulation of the benzodiazepine site by caffeine, which produces a lowering of seizure threshold.[107]
  • Carbamazepine, an anticonvulsant, appears to have some beneficial effects in the treatment and management of benzodiazepine withdrawal; however, research is limited and thus the ability of experts to make recommendations on its use for benzodiazepine withdrawal is not possible at present.[104]
  • Ethanol, the primary alcohol in alcoholic beverages, even mild to moderate use, has been found to be a significant predictor of withdrawal failure, probably because of its cross tolerancewith benzodiazepines.[5][104][108]
  • Flumazenil[edit]

Flumazenil is being studied as a potential treatment to reduce withdrawal symptoms.[62] As its use may result in seizures this should only be done within hospital in areas experienced with the procedure.[63]

  • Flumazenil has been found to stimulate the reversal of tolerance and the normalization of receptor function. However, further research is needed in the form of randomised trials to demonstrate its role in the treatment of benzodiazepine withdrawal.[109] Flumazenil stimulates the up-regulation and reverses the uncoupling of benzodiazepine receptors to the GABAAreceptor, thereby reversing tolerance and reducing withdrawal symptoms and relapse rates.[110][111] Limited research and experience and possible risks involved, the flumazenil detoxification method is controversial and can only be done as an inpatient procedure under medical supervision.

Flumazenil was found to be more effective than placebo in reducing feelings of hostility and aggression in patients who had been free of benzodiazepines for 4-266 weeks.[112] This may suggest a role for flumazenil in treating protracted benzodiazepine withdrawal symptoms.

A study into the effects of the benzodiazepine receptor antagonist, flumazenil, on benzodiazepine withdrawal symptoms persisting after withdrawal was carried out by Lader and Morton. Study subjects had been benzodiazepine-free for between one month and five years, but all reported persisting withdrawal effects to varying degrees. Persistent symptoms included clouded thinking, tiredness, muscular symptoms such as neck tension, depersonalisation, cramps and shaking and the characteristic perceptual symptoms of benzodiazepine withdrawal, namely, pins and needles feeling, burning skin, pain and subjective sensations of bodily distortion. Therapy with 0.2–2 mg of flumazenil intravenously was found to decrease these symptoms in a placebo-controlled study. This is of interest as benzodiazepine receptor antagonists are neutral and have no clinical effects. The author of the study suggested the most likely explanation is past benzodiazepine use and subsequent tolerance had locked the conformation of the GABA-BZD receptor complex into an inverse agonist conformation, and theantagonist flumazenil resets benzodiazepine receptors to their original sensitivity. Flumazenil was found in this study to be a successful treatment for protracted benzodiazepine withdrawal syndrome, but further research is required.[113] A study by Professor Borg in Sweden produced similar results in patients suffering from protracted withdrawal.[37] In 2007, Hoffmann–La Roche the makers of flumazenil, acknowledged the existence of protracted benzodiazepine withdrawal syndromes, but did not recommended flumazenil to treat the condition.[114]

  • Fluoroquinolone antibiotics[115][116][117] have been noted by Heather Ashton and other authors as increasing the incidence of a CNS toxicity from 1 to 4% in the general population, for benzodiazepine-dependent population or in those undergoing withdrawal from them. This is probably the result of their GABA antagonistic effects as they have been found to competitively displace benzodiazepines from benzodiazepine receptor sites. This antagonism can precipitate acute withdrawal symptoms, that can persist for weeks or months before subsiding. The symptoms include depression, anxiety, psychosis, paranoia, severe insomnia, parathesia, tinnitus, hypersensitivity to light and sound, tremors, status epilepticus, suicidal thoughts and suicide attempt. Fluoroquinolone antibiotics should be contraindicated in patients who are dependent on or in benzodiazepine withdrawal.[5][118][119][120][121] NSAIDs have some mild GABA antagonistic properties and animal research indicate that some may even displace benzodiazepines from their binding site. However, NSAIDs taken in combination with fluoroquinolones cause a very significant increase in GABA antagonism, GABA toxicity, seizures, and other severe adverse effects.[122][123][124]
  • Gabapentin can relieve most of the discomfort of benzodiazepine withdrawal; including anxiety, insomnia, irritability, tremor and muscle spasms. However, gabapentin may give rise to its own withdrawal syndrome upon discontinuation if taken continuously for long periods.
  • Imidazenil has received some research for management of benzodiazepine withdrawal, but is not currently used in withdrawal.[125]
  • Imipramine was found to statistically increase the discontinuation success rate.[7]
  • Melatonin augmentation was found to statistically increase the discontinuation success rate for people with insomnia.[7]
  • Phenibut may help with the anxiety, insomnia and muscle tension brought on by benzodiazepine discontinuation. However, there is a commonly known ‘rebound’ effect felt with Phenibut that may be exacerbated for people in withdrawal, it is also not recommended to be taken for more than 3 consecutive days to avoid developing a dependency.
  • Phenobarbital, (a barbiturate), is used at “detox” or other inpatient facilities to prevent seizures during rapid withdrawal or cold turkey. The phenobarbital is followed by a one- to two-week taper, although a slow taper from phenobarbital is preferred.[22] In a comparison study, a rapid taper using benzodiazepines was found to be superior to a phenobarbital rapid taper.[126][127]
  • Pregabalin may help reduce the severity of benzodiazepine withdrawal symptoms,[128] and reduce the risk of relapse.[129]
  • Progesterone has been found to be ineffective for managing benzodiazepine withdrawal.[109]
  • Propranolol was not found to increase the discontinuation success rate.[7]
  • SSRI antidepressants have been found to have little value in the treatment of benzodiazepine withdrawal.[130]
  • Tramadol has been found to lower the seizure threshold and should be avoided during benzodiazepine withdrawal.
  • Trazodone was not found to increase the discontinuation success rate.[7]

Prognosis[edit]

Benzo belly

Re: benzo belly

« Reply #1 on: June 15, 2012, 01:00:32 pm »

Quote from: [Buddie] on June 15, 2012, 12:42:33 pm

I know you all are probably getting sick of hearing about my benzo belly. It is the only symptom I have left after almost 7 weeks off klonopin. Are there any stories out there that you can tell of your benzo belly healing. I have pain and spasm all day long. How long did it take for the pain to go away? I don’t care about the swelling and bloat, I just want the pain to go away. This is my 2nd run with the drug and it took a good 10 months before I felt relief the first time. i took it for about a year, and cold turkeyed it because I didn’t know any better. I stayed off for a year and a half then had severe belly pain in dec and had to reinstate in jan. I took it jan and feb and sort of cold turkeyed again. I should have known better but I felt worse trying to taper than if I just got off. I hope it doesn’t take another 10 months to feel better.


[…], I have not seen my feet in about 6 months. The gi problems are my worst symptom right now. It is encouraging yours went away after ten months. My stomach feels like i have tumors in it and after every meal i get bloating and stinging all over my torso. others that have had this symptom go away will chime in. I’m very interested in this topic myself. hope you feel better soon,[…]

https://drugs-forum.com/threads/benzo-belly-and-swelling.264970/

www.benzobuddies.org/forum/index.php?topic=58173.0

www.hormonesmatter.com/nightmare-benzodiazepine-withdrawal/

Links

Ashton Manual

Battle Against Tranquillisers

Baylissa.com website

Beating Benzos website

Benefits Advice – United Kingdom

Benefits Advice (Disability) – United States

Benzo Book

Benzo Book Review.com

Benzo Buddies support forum

Benzo Support Group

Benzo.org website (comprehensive)

Beyond Meds

Bloom in Wellness website

Bristol & District Tranquilliser Project

Council for Evidence-based Psychiatry (CEP)

Drugs Forum – Antidepressants

Facebook – There are many new facebook groups. Do Facebook searches for “benzos” or “antidepressants” and they should be listed.

Harm Reduction Approach to Mental Health – Will Hall

Loved Ones Guide to Benzo Withdrawal website

Mad in America – Psychiatric Care Resource & Community

MIND in Camden REST Minor Tranquilliser Service

Reconnexion Australia

Recovering from Psychiatry

Safe Benzo Withdrawal (offers self-management programme)

Surviving Antidepressants.Org