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To go off or not to go off?


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I have been on .5 to .75 mg of Alprazolam for some eight years. I use it for anxiety, but also for pelvic pain syndrome (PPS), which is a chronic condition. Benzos like Alprazolam are the only drugs PPS sufferers generally agree reduces pain, because anxiety causes the muscle clenching and spasms that lead to PPS. So for us, Benzos are very tricky. Last year, my PPS got much worse and now I'm concerned it is worse because my body is becoming too tolerant of the Alprazolam and I'm experiencing withdrawal symptoms (anxiety) that are leading to the increased pain. So I've been thinking about going off Alprazolam altogether to see if it reduces my pain symptoms.

 

So I started at .25 mg 3x/day and ten days ago I got it down to .125 mg 3x/day. At first I noticed very few w/d symptoms. Just a little jitteriness. Then about a week ago I started waking up earlier and earlier: six am, then five am, then four am. I think these are withdrawal symptoms. Also my physical therapist today said my muscles were much tighter than in previous sessions.

 

So I'm debating what to do. Keep trying to get off the Benzos, perhaps by titrating to minimize the w/d symptoms, and see what happens, or stick with a maintenance dose of .5 mg per day (.125 mg morning and afternoon; .25 mg at night so I can sleep). The more I read the more I'm concerned the Benzos may be exacerbating the PPS rather than helping, but I'm afraid the withdrawal process may just increase my PPS symptoms.

 

If I were to try titration, how would I schedule it to minimize symptoms? Let's assume I start Dec. 1 at 10% increments working with .25 mg tablets and would start with .125 mg morning and afternoon; .25 mg at night. Let's also assume I get a 100 ml cylinder.  

 

Complicating the issue is the fact I'm also on Neurontin and Wellbutrin and not sure how to handle those.

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