Hello from Australia by an alprazolam user

Hi, my name is Greg and I live in Australia.  I have joined BenzoBuddies to hopefully get withdrawal support and taper advice, aswell as sharing of information.

I am currently taking alprazolam (usual brand name Xanax) at a dosage of 1 mg per day and have been taking this level of benzo for several years.  I take 1 mg tablets which can be split in half as required.  I should point out that I was taking the medication during a period of heavy daily drinking, for the purpose of stopping alcohol withdrawal symptoms between drinking episodes.  I have now stopped drinking but realise that my benzodiazepine use remains a problem.

I haven't yet started a taper but am seeing my doctor about this early next week.  I have already spoken to him by phone about switching over to the equivalent dose of diazepam (Valium) and he agrees with this idea.

I look forward to being a member of BenzoBuddies.

Hi Greg,

Welcome to BenzoBuddies.

As you are probably aware, benzos and alcohol can be deadly when used in combination. You are doing the right thing by getting off.

Since you are seeking to substitute with Valium, I assume you must have already carried out some research. If for any reason you do not switch to Valium, and instead follow a direct taper off Xanax, be sure to obtain 0.25mg tablets, as these will allow you to make smaller cuts. On a related issue, I would recommend that you ask your doctor about a single prescription for 0.25mg Xanax pills, so that you can gradually substitute for Valium. Xanax has short half-life, so will leave your system very quickly when you quit (or cut your dose), but because Valium has a very much longer half-life, the amount substituted will take much longer to build up in your system. A gradual substitution means that the temporary drop in blood levels of benzo is related only to the proportion of benzo being substituted. I hope I've explained this well enough.

Anyway, good luck.

Colin.

Hi greg,

Australia is on my list of places to go before I kick the bucket  ...... Welcome to BB and I'm looking forward to reading your updates and taper progress. i believe your doing the right thing kicking the benzo monster

Good luck and once again Welcome 

Gman

Thanks Colin and Gman for the welcome, it is much appreciated.

Colin, yes alcohol and benzos are definitely not a good combination!  And yes I have already researched switching to Valium, and the equivalent doses of the various benzos.  You have actually answered a question I have long wondered about, namely what happens when switching from a short-acting benzo to the equivalent dose of a long-acting one.  I had imagined that taking the equivalent long-acting dose every day could result in massive accumulation of the drug and severe over-medication as a result, but you appear to be saying that the true equivalent amount is only reached in the body once accumulation has occurred.  That makes sense from a treatment point of view and would explain an initial period of less-than-optimal dosing if a short-acting benzo is abruptly stopped and a long-acting one substituted.  With the 0.25 mg Xanax tablets in conjunction with Valium, I assume you mean still taking some Xanax while the Valium is building up to its effective system dose.  Actually, sorry if I am the one who isn't explaining myself very well here!

Gman I hope you get a chance to visit Australia.  Obviously I'm biased but I do believe it is one of the best countries due to its variety of natural and artificial attractions and its easygoing lifestyle compared to many other countries.  We are lucky not to suffer from so many problems that affect other nations.

Thanks again for the welcome.

Greg

Hi Greg, welcome to BenzoBuddies!

Have to read the Ashton Manual? http://www.benzo.org.uk/manual/index.htm . It should help you understand the process of a crossover. Do you dose multiple times per day?

Congrats on quitting drinking! Good luck on your taper.

Amanda

Hi Amanda,

Thanks for the welcome.  I started reading Professor Ashton's manual one day recently but forgot about it until you mentioned the link.  It is definitely the state-of-the-art guide on benzos!

Er, this is going to sound really weird, but has anyone else ever actually felt SCARED about going on to a Valium substitution??  I have no idea why I am, since I could hardly feel worse than I am at the moment on the 1 mg. of Xanax.  I take it all at night, by the way, to try and get some sleep.  My alcohol cessation has left me very tired, and more than slightly depressed and edgy at night.  Now I'm stressed about getting off the Xanax even though I know I'll feel better!!  I don't know why on earth I would be worried about taking Valium, since I used it (along with a couple of large doses of Xanax)for my alcohol detoxification.  100 mg in one night did not have any bad side-effects, nor did mixing Valium and Xanax, and I'll only be taking 20 per day during my Valium substitution.  I think the one thing I haven't liked about Valium in the past is its long half-life, which makes its sedation go on throughout the day, but I'm sure it would help me sleep better than if I stay on the Xanax.

I may have made a mistake by starting on the drug baclofen to try and help myself stay off alcohol.  I have been taking around 50 mg per day to try and reduce alcohol cravings.  It seems to work for that purpose when taken during the day, but I can't tolerate baclofen at night.  I had hoped it would help me sleep at night like a benzo would, but it actually keeps me awake if I take a large dose anywhere near bedtime.  I should be looking to cut the baclofen out too, not just the Xanax.  I wonder if there would be a diazepam equivalent for that??

Anyway sorry for the rambling.  Just out of curiousity, has anyone heard of anticonvulsant drugs like tiagabine or gabapentin being used for anxiety or insomnia, or for treatment of benzo withdrawal symptoms?

Best wishes to all,

Greg

Hi Greg,

If you were taking 1mg Xanax (depending upon which equivalency chart you believe), you might decided to substitute for 20mg Valium (according to Ashton, but other sources would suggest substituting 1mg Xanax for just 10mg Valium). You would take Valium in proportion for just the part of the dose being substituted. I would recommend that you substitute no more than a quarter of your dose at a time (an eighth might be better), so, you would drop 0.25mg Xanax, and replace this with 5mg Valium. You would stay at this dose for a while (Ashton suggests a week or two), and the substitute another 0.25mg Xanax in a similar fashion, and so on.

Your doctor might well decide that 1mg Xanax is equivalent 10mg Valium. The danger in picking a steadfast number is that you might feel under- or over-medicated when switching. However, as I explained in my last post, this is somewhat mitegated by switching just a small part of the dose at a time. My view (assuming you have a doctor that understands the issues) is that it is better to go for a smaller dose in substitution, and increase the amount if you find this necessary. The truth of the matter is that correct amount in substitution varies from individual to individual. This is because the half-life value varies in individuals, and the longer the half-life (as you surmised), the greater the accumulation. Yes, it is "steady state" blood levels that are "equivalent", not a single dose.

Another strategy would be to employ a "loading dose". The prospect of substituting just a quarter or an eighth of your dose, holding for up to two weeks between each dose, and potentially substituting for more than you need (leading to a longer withdrawal), might seem a rather drawn out way to quit. In some ways, it is. What you might do instead is to potentially substitute for too low an equivalent (1mg Xanax to 10mg Valium), but think of these substitutions as part of your taper. If you substitute just a small part of your dose (a quarter: 0.25mg Xanax for 2.5mg Valium), but employed a "loading dose", this should help mitegate the drop in blood levels with each substitution. It would also allow you to make new substitutions more rapidly. I would suggest a loading dose (the dose of each substitution) of 5mg Valium instead of the usual 2.5mg. This would help short-cut the slow rise in blood levels for given dose. And don't worry, a single-day double dose of Valium in this situation will not send your blood levels higher than they should be, they still will have some way to go to reach "steady state".

It might look like this:

Start: 1mg Xanax.

1st Substitution: 0.75mg Xanax; and 5mg Valium. This would be for just the first day. For the six subsequent days you would take 0.75mg Xanax and 2.5mg Valium. After 1 week, you probably will be close to steady state blood levels of Valium, but only because of the loading dose.

2nd substitution: 0.5mg Xanax; and 7.5mg (2.5mg + 5mg) Valium for the first day of the second substitution, and 5mg Valium for each of the following six days.

3rd substitution: 0.25mg Xanax; and 10mg (5mg + 5mg) Valium for the first day of the third substitution, and 7.5mg Valium for each of the following six days.

4th substitution: 0mg Xanax; and 12.5mg (7.5mg + 5mg) Valium for the first day of the forth substitution, and 10mg Valium from then on (for at least another six days). Once you feel stabilised, you would then begin your taper off 10mg Valium.

This is just a suggestion though. You will need to talk with your doctor and see what s/he says about "equivalent" doses. My view is that the less flexibility exists, the more cautious you should be in your approach. Some people can switch, with few problems, much more quickly than others. There is now way of knowing how you will react until you try, but you should be fine if you can employ a felexible approach.

Hi Colin,

Thanks very much for this information.

I will discuss this in detail with my doctor and decide upon a plan.  During a brief phone conversation my doctor indicated that he views 1 mg Xanax as being equivalent to around 20 mg Valium.  Hopefully we will work all this out tomorrow.

Hi Greg-

Welcome to BB. Just letting you know I did a crossover from 1mg - 1.5mg Xanax to 20mg's Valium. For me, the dose substitution was good. As I did a direct crossover(didn't step over, just leaped ), it took a few days to feel level but once the Valium stabilized, I felt fine and about nine days later, made my first cut off the Valium.

Hoping that helps you to know it is possible to do...strange I did not fear the change over. Once the Valium dose stabilized, the feeling of being level was a welcome one.

Wishing you the best.

Just Breathe

Just checking on you, Greg.

Patty  xo

Thanks folks.

My doctor has recommended that I switch straight over to Valium from Xanax instead of gradually switching so I'll try this.  Since my dose is not all that high I may not have too much trouble.  He did warn about taking a few days to stabilise on the Valium but I'd rather put up with that than keep taking Xanax.

Hi GregW,

You might find that you experience withdrawal effects until the Valium builds up in your system. You might find it difficult for a week or two - just a heads up, that's all.