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Advice on diazepam together with fluvoxamine


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Hello everyone,

 

I'm currently on 0.75 mg/d alprazolam after 9 years on 0.5 mg/d clonazepam that I managed to get down to 0.125 mg/d on my own. I'm looking to taper by substitution with diazepam but since I also take 100 mg/d fluvoxamine there is a strong interaction. Any advice on potential alternatives?

 

Thanks,

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Thank you Gerbera,

 

Before starting liquid titration, do you know if I need to stabilize on my doses first? I haven't felt that great over the last couple of weeks. Is there a possibility I'm going on interdose withdrawal given the shorter half life of alprazolam compared to clonazepam? Is 0.75 mg/d a stable dose?

 

Thanks,

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I would take .25 mg every 8 hours with Alprazolam, which I think is how you are already dosing. I see from you first post you had to change from K to A due to moving.

 

You have made recent changes to your medication(s), time is needed to allow our body to adapt to them. If you can get to a stable baseline of symptoms, meaning they are the same day to day and/or you feel them lessen, then you would look in to making another removal of the benzo, and as mentioned in my other reply, I would most definitely look in to liquid titraton. That method allows for fractional amounts to be removed and no cutting of pills. When we do that, there is much less shock to our CNS and whatever symptoms are generally much less is severity.

 

I would post a question in that section(link in first reply), to get a sense of how the process is and what supplies you will need. You do not need to start anything until you feel ready. I hope that helps.

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I've been takin 0.25 X at 9h, 0.12 at 15h and 0.25 at 22h, I don't feel I have stabilized yet. Symptoms do not feel under control and even feel worse for the last few days.

 

Should I increase further Xanax? I don't want to increase too much either as I'm taking also fluvoxamine which inhibits the absorption of xanax.

 

I've started to ask on the liquid titration but I need to reach a stable level first.

 

Thanks,

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I've been takin 0.25 X at 9h, 0.12 at 15h and 0.25 at 22h, I don't feel I have stabilized yet. Symptoms do not feel under control and even feel worse for the last few days.

 

Should I increase further Xanax? I don't want to increase too much either as I'm taking also fluvoxamine which inhibits the absorption of xanax.

 

I've started to ask on the liquid titration but I need to reach a stable level first.

 

Thanks,

 

I do not understand the dosing that is in bold and underlined. How are you dosing .12mg's Xanax? If you are currently on .75 mgs Xanax, you would be dosing .25 mg every 8 hours or as close to that as you can.

 

And you are correct, Luvox inhibits the Xanax, which means increasing its effectiveness:

 

https://www.drugs.com/interactions-check.php?drug_list=1128-9754,133-54

 

You would not want to change the Luvox dosage in any way until you are tapered off the Xanax.

 

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I'm sorry I should have explained this from the first post, I'm dosing as follows

 

9 am - 0.25 mg ( one pill)

3 pm - 0.12 mg ( half pill)

10 pm - 0.25 mg ( one pill)

 

So the actual daily dosage is 0.62 mg, I didn't want to increase the 3 pm dose to a full pill, afraid of making it too much with the fluvoxamine potentiation effect, I'm scared of a Xanax overdose caused by the fluvoxamine.  Should I keep 0.25 in the afternoon nonetheless?

 

Thanks

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No one can tell someone else what to do, you must make up your own mind based on how you feel. The moderate inhibitory effect from the Luvox to Xanax would not cause an issue, IMO, at .75 mg's, however, you must do what you feel is best. From what I can gather:

 

1- You tapered from .5 mg K down to around .125 mg K without much issue. I am assuming dry cutting, though, I don't know and I am unsure how quickly you did this.

2- The above was within 2 months ago.

3- No idea how fast you tapered and if that is causing any issues now, there are times the cuts catch up with us plus you switched from K to X.

 

As mentioned before, I would look in to liquid titration, It tends to be more gentle on our CNS. Whenever we make changes, we must allow time to pass and things to settle down, then re-assess our strategy to taper. As far as 4 doses, again, it is up to you. I am not a proponent of splitting pills, however, if you feel you need to dose 4 times a day, then you do what you must.

 

Good luck.

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The k taper was done on my own according to how I was feeling over the course of several months, I started sometime last year, September probably, I remember having a rough day in late October so I hold for a while then I continued, I must have been on the last dose 0.125 for a few weeks between february and may until my clonazepam ran out ( I cannot get clonazepam where I live now) that's when I switched to Alprazolam, starting with a low dose 0.125 at night daily and steadily increasing until the current dosages.

 

I did dry cut for the k, from 0.5 mg pill in half and then in a quarter that part i managed fine, it wasnt until the switch to x that things started to get rough. I keep asking myself if it is due to the half life differences or the luvox interactions.

 

I guess  I need a little patience until I stabilize.

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The K & X both have moderate interactions with Luvox. I think you are correct when you think of the duration of action difference between K and X, X being less than the K.

 

I understand your questions better now and would agree to dose 3-4 a day, until you feel that is working better for you, then, look in to liquid titration from the X.

 

Good luck.

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