Question regarding benzo switch

[[Buddie]]

Need opinions.. I have a new doctor who is suggesting a switch from X to a longer half life drug.  His thoughts are Klonopin or Librium.  I don’t know anything about Librium but it appears to me that Klonopin seems to cause a lot of symptoms.  Advice?? If I do this should I insist on switching to V? I know I ask a lot of questions but I trust this forum because of your lived experience… thanks!

[[Buddie]]

Hi [...]

How are you doing on the Xanax? Do you have problems with interdose withdrawals? How many times a day are you dosing?

If you are doing ok on the Xanax (no major interdose withdrawal problems) then I’d stick to tapering the Xanax.

If you are having issues, then you do have the option of crossing to a longer half life benzo following the Ashton Manual slow crossover Schedule, not a direct switch. I not familiar with Librium, but there are those who have faired well crossing to Librium. I crossed to Valium from Klonopin and although it was a difficult (painful) direct switch, there are still those who have difficulty crossing to Valium using a slow crossover, whereas others have no trouble at all. There’s just no way to guarantee how your crossover will be, which is why you would only consider crossing from the Xanax if you really were having significant issues with your Xanax dosing and interdose withdrawals.

[[Buddie]]

Hey WS, glad to see on your signature that you’re doing better.  I have some I/D withdrawals and they are worse after a bad night of sleep (racing heart, headache, body aches, increased tinnitus). Usually I can go for a brisk walk and power through.  Sometimes I have what I think are paradoxical effects after taking the Xanax.  Usually in the evening.  I’m dosing 4 time a day. You may remember from our discussion that my bedtime dose is much larger than the other 3. So I am currently working on reducing only that large bedtime dose.  I have made 4 cuts since October (totaling 24%).  The latest was this past Tuesday night.  My schedule is now .35 x 3 and .85 at bedtime (using compounded liquid).  Not doing anything else or making any decisions until after the holidays. I have been corresponding with Cooper5 who has done well crossing to diazepam.  Sleep is my biggest problem and I wonder if it would improve on diazepam.  I know.. crapshoot, no guarantees.   The psych I have been talking to suggested Librium or Clonazepam. Not doing clonazepam. That stuff is as evil as Xanax from what I can tell.  Don’t know much about librium at all. So I don’t know.  I just wonder if I can last the whole way on Xanax.  I respect your opinions and will appreciate any feedback or direction.  Thanks, D

[[Buddie]]

It appears your interdose is fairly manageable, I'd put off making a decision to cross to another drug until it isn't, it takes a powerful incentive to make the switch and severe interdose seems to be it.

Librium comes in capsules so it can be a little different to taper, some have counted the beads, others go for homebrew liquid titration but we do have a couple of members who have been successful, one is still around so she might be able to help you if you cross to it. 

[[Buddie]]

Thanks [...].  I won’t be doing anything without a lot of thought.  The latest doctor I talked to seems to think crossing over is the o my way.  We will see.  Being impulsive got me into this mess to start with. 

[[Buddie]]

Hey WS, glad to see on your signature that you’re doing better.  I have some I/D withdrawals and they are worse after a bad night of sleep (racing heart, headache, body aches, increased tinnitus). Usually I can go for a brisk walk and power through.  Sometimes I have what I think are paradoxical effects after taking the Xanax.  Usually in the evening.  I’m dosing 4 time a day. You may remember from our discussion that my bedtime dose is much larger than the other 3. So I am currently working on reducing only that large bedtime dose.  I have made 4 cuts since October (totaling 24%).  The latest was this past Tuesday night.  My schedule is now .35 x 3 and .85 at bedtime (using compounded liquid).  Not doing anything else or making any decisions until after the holidays. I have been corresponding with Cooper5 who has done well crossing to diazepam.  Sleep is my biggest problem and I wonder if it would improve on diazepam.  I know.. crapshoot, no guarantees.   The psych I have been talking to suggested Librium or Clonazepam. Not doing clonazepam. That stuff is as evil as Xanax from what I can tell.  Don’t know much about librium at all. So I don’t know.  I just wonder if I can last the whole way on Xanax.  I respect your opinions and will appreciate any feedback or direction.  Thanks, D

Hi WTS

I agree with [...], (the grass isn’t always greener) and hearing you won’t be making any changes (including no reductions) over the holidays, I think it will give you a good chance to see where you’re at in regard to inter-dose withdrawals on the other side of an extended hold. Holding for that period may give you a clear picture of whether or not to just continue tapering the Xanax, or possibly crossover to Valium or Librium. Keep us informed of how you feel holding on the Xanax.

[[Buddie]]

Excellent point WS, holding will give a clearer picture. 

[[Buddie]]

Just chiming in it might be worth doing the genesite psychotropic test to see how you metabolize each benzo. I am no way medical expert but I imagine how we metabolize these might play jnto why some might have harder times switching over etc. i thankfully was told aboit it before I tried to switch to Valium which I am an ultra rapid metabolizer of so I didn’t take the chance.

I know you can definitely still manage being either a rapid or slow metabolizer of different ones and make it off tapering but that’s a good convo to have with your pharmacist about your results (providing Dr moghy know but don’t hold your breath)….. just have to account to either dose more frequently or maybe less depending on your metabolizing of whatever  one you are on! 

I know there are other factors but think this might be the big one and heck I’d have never known there was such a test until my 3rd Dr mentioned it…… again not fool proof on the aspect of the test for green yellow red zones and might do better with green bc some of my green for meds hit me hard……but the metabolizing part I think is very spot on to help decide how you might dose and if you take chance to change you have some kind of info to steer you.

[[Buddie]]

Thanks for this information about metabolizing.  How do you get that test?  I can tell you that I am continuing to hold on the 11/29 cut.  3 weeks tomorrow.  Sleep has deteriorated since the first week after the cut which makes me anxious and I’m having internal shakiness.  I am functional but can’t say I’m stable.  I’m continuing to hold until at least Jan 4 when I talk to a new psych about a possible crossover.