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Xanax ER to Valium? Not much guidance on Ashton. Unsure about doctor's plan.


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My twice daily dose of .5 Xanax ER is the lowest I can go. I originally took this at bedtime but was instructed by doc to transition from 3 doses .375 immediate release to one .5 ER in the morning. This was several months ago and I'm ready to take the next step. My doc is saying substitute 5 mg Valium for one dose. I've been reading Ashton manual and posts here about overlapping to change drugs. Has anyone had experience getting off the ER version of Xanax?  Is 5 mg Valium equivalent? He looked it up and said the range is 5-20!

 

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My dose was the same as yours, and I switched from 1 mg Xanax to 20mg Valium.  It was too sedating so I dropped immediately to 15mg and tapered from there.  Everyone is different, and these equivalencies have fairly big ranges.  You might have to just cross over and see what happens.
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My twice daily dose of .5 Xanax ER is the lowest I can go. I originally took this at bedtime but was instructed by doc to transition from 3 doses .375 immediate release to one .5 ER in the morning. This was several months ago and I'm ready to take the next step. My doc is saying substitute 5 mg Valium for one dose. I've been reading Ashton manual and posts here about overlapping to change drugs. Has anyone had experience getting off the ER version of Xanax?  Is 5 mg Valium equivalent? He looked it up and said the range is 5-20!

 

https://www.benzo.org.uk/bzequiv.htm

 

Might be closer to 10mg, but I think it can be different for different people. Be careful crossing over, Xanax activates adrenergic receptors, unlike other benzos. You may want to crossover at a slow tapering pace, or you also may want to try tapering from Clonazepam instead. You may find if you crossover too quickly that you suffer withdrawal symptoms.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/pdf/nihms947341.pdf

 

"In contrast to other benzodiazepines, alprazolam activates alpha-2 adrenoceptors, which could account for its reported enhanced effectiveness in the treatment of panic disorder, but also the hyperadrenergic state seen with its discontinuation (Eriksson et al., 1986). Rebound anxiety is common and is often severe with alprazolam discontinuation because of its short half-life and the unique alpha-2 adrenergic effect."

 

 

"The triazole ring may have a unique binding affinity for a subgroup of benzodiazepine receptors that are not generally affected by other benzodiazepines (Albeck, 1987), making substituting alprazolam with another benzodiazepine less effective in preventing rebound anxiety and withdrawal symptoms. There are published data on open-label clinical observations of 37 alprazolam-dependent patients who were successfully tapered from alprazolam using clonazepam substitution, with only 2 patients experiencing rebound panic symptoms, and no patients experiencing any other withdrawal symptoms (Patterson, 1990). Clonazepam is usually chosen because it has an intermediate to long half-life, ranging from 17 to 60 hours, and is associated with less rebound anxiety and withdrawal symptoms in comparison with shorter-acting agents. One should be mindful that longer-acting drugs have shorter durations of action when given acutely because of their pharmacokinetic properties, requiring a few days to a week to reach steady state. It is therefore recommended that for the first week, the substitution should be given on a twice or 3 times per day schedule."

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gogogaba,

Did you cross over one dose at a time ?

I was thinking of switching the evening dose to Valium and keeping the Xanax ER as the morning dose for a week or two.

I’ve been reading in the Ashton Manual and any other resources I can find, and am pretty convinced that I should take at least 10 mg.

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Nigella,

 

I crossed to an equivalent dose of Klonopin (for about three weeks) and then to Valium.  My interdose withdrawals were horrendous, so my goal was to get on a smoother, longer-lasting benzo as soon as possible.  20mg Valium was definitely too sedating for me, and I think I probably could have gotten away with dropping to 10mg and then tapering, but I decided to play it safe and go with 15mg.  I didn't mix benzos, though--I just went all in on Klonopin (or, ultimately, Valium).  No idea if this was a good move or not, but I don't recall having any trouble crossing over. 

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I have a couple more questions.I appreciate your response.

- Were the interdose withdrawals while you were on the Xanax ER?

I have insane muscle spasming, and it's worse because of a back surgery I had 1+ years ago. The last hour before my dose is due, I'm watching the clock.

- Why switch to the Klonopin first?

- Was the Valium 20 mg two 10 mg doses?

-When you say you didn't mix, did you switch both daily doses at once to the new drug?

 

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Yes, it was on Xanax ER. Horrible. Of course, I (stupidly) "enhanced" my X experience by downing them with whiskey (not recommended) so probably didn't help my plight... :)  I also know about watching the clock--I would literally sweat, start shaking, etc. waiting to dose.

 

I was initially prescribed X by a general practitioner.  He had no clue about the Ashton Method, so he thought switcking to K would help with the interdose withdrawals. It did, but in the state I was in, there was no way I could do the microtaper required to get off K.  I could not even get out of bed, let alone scale K with a dropper. Because I didn't trust this doctor (because he got me hooked on benzos) I switched to a new general practitioner, who helped me cross to Valium and then taper off. 

 

Yes, the Valium was in two 10MG doses--one in the morning, one at night.  Because I was severely drowsy on 20mg, I dropped my AM dose down to 5mg immediately, which helped keep my head out of the soup.

 

Yes, I didn't do, say, half K, half V, I just went all in on one drug. The transitions didn't seem to bother me (though I think was overdosed on Valium, but it's not an exact science, so I don't fault my second doc for that). 

 

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This is really helpful, thank you.

I’ve been on the XR for several months and definitely feel worse overall. The reason I haven’t gone ahead with more changes is I’m not really confident in the guidance I’m getting from this doctor. I’m considering changing to someone else.

You give me some hope that the interdose situation may not be with me throughout this process. I thought it would probably get worse. Because I never fully rehabbed from my back fusion- due to the muscle spasms- it’s pretty incapacitating.

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