Author Topic: Benzo free - flumazenil works!  (Read 45619 times)

[Buddie]

Benzo free - flumazenil works!
« on: March 02, 2012, 01:48:23 pm »

On the 9th of January I stopped taking benzo and started the flumazenil treatment as per the pioneering work of Doctor George O’Neil / Fresh Start Foundation, Australia.
I was the first pilot carried out in the Nederlands under the care of Addiction Doctor Erik Paling (Novadic Kentron) and Addiction Professor Core de Jong (Nispa). The treatment entailed subcutaneous infusion of Flumazenil for 9 days. Additionally I was give an antiepileptic (Depakina) and a anti depressive (Mirtazapine).
From the 9th of January I have stopped taking diazepam. I was on benzo’s for 2 years, my highest dosses was 2 tablets of 2 milligram loremetazapam = 40 diazepam. By the time I entered treatment I had managed to go down to 17 diazepam. I choose to do the treatment even though it was experimental because I realized that I was unable to reduce the diazepam on my own. I had to many withdrawal symptoms. I signed an indemnity form in which I took full responsibility of my choice.
The first days were the most challenging ones. My sister had specially take off work to support me during the first two days. I initially had stopped at 5 days, but as I realized that my brain was over stressed I went on for another 4 days. By that time when I stopped the infusion I managed to function reasonably well. Initially I was hipper sensitive to impulses sound, light… but as the days went on I could manage more and more. I now started going to the gym doing simple work outs. The only medication I am still taking is ˝ a tablet of 17 milligram mirtazapina.
How does flumazenil work, it is not yet clear. The thinking is that is somehow repairs the gaba receptors so that they work properly. How much time must flumazenil must be administered to achieve this is still an unanswered question
 All in all I had 4 panic attacks, one just after stopping after 5 days of treatment, one when restarting the extra 4 days and one during the first week at home, and the last one now that I am sick with flu and my sinus hurt so I don’t sleep well. These are the times when I felt my heart flutter. For the rest I am doing well, better and better every time. It nearly feels unreal that I had so much stress. I am able to do more, handle more and start thinking about the my future.

I am grateful that this opportunity appeared, that I had the courage to do it. But it wasn’t just me, you benzo buddies helped me. I wanted to thank the Benzo Buddies team and all its member for without all the information I got from the site I would have believed that I was mentally ill. All the symptoms we discussed, all the postings kept me focussed and gave me courage to take the plunge. Thank you.
The advice that [...] give you is flumazenil works, Professor de Jong will be undertaking a formal study but that takes time before it gets published. For those that don’t want to wait you could follow this treatment in Australia at the Fresh Start Foundation. For those that can’t afford such a trip I would advise them to contact a professor of addiction nearby and convince him/her to do a pilot. Perhaps make a benzo buddies flumazenil group and work together at organizing the treatment in the USA. Coming to the Netherlands is not an option because its public health care and you need to be a Dutch citizen. When looking on internet I have seen some detox centres in the USA that work with flumazenil, I don’t know what their protocol is. So I will give you some important points that you need to keep in mind:
subcutaneous infusion is better than intravenous, it is just as affective and your body fat doesn’t get bruised as easy as veins.
George O’neil uses a small pomp that you carry around your neck and you are allowed to go home after two days. That is you are only hospitalized for two days. This allows you freedom of movement and helps you keep your sanity.
The longer you stay on flumazenil the smaller the drop in well being when you stop. Therefore a place where you can decide for how long you want to have flumazenil and gives you the option to restart your treatment when you don’t feel well is the best.
Ideally you stop all medication before you stop the flumazenil. Stopping medication gives you stress and you want to be done with all the pills while you are on flumazenil.
Having a Buddy to be with you while you detox and support you the days, weeks and after is importatn. Somebody that understands, care, loves you and has time for you.
Last but not least please note that this is an experimental treatment, it has not been officially verified through quantifiable studies. Thus you are navigating uncharted territory, therefore you will be fully responsible for your choices and the consequences that arise from it. I wish you wisdom and courage regarding the decision you take.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #1 on: March 02, 2012, 02:23:11 pm »
Hi [...],

Congratulations on being Benzo free :)

[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #2 on: March 02, 2012, 02:55:07 pm »
[...] - I am so thrilled that this treatment worked for you!

I wonder if there is a place in the US that offers this,  and if it would work for those who have been off for a couple of years and still experiencing symptoms.

Please keep us posted on how your are feeling.  I know that I didnt have a single sx until about 6 weeks out of detox.  Then everything hit.  It would be nice to know if it's effects are long term.

If this treatment gives total and complete recovery from benzos it would be such a blessing to so many people.  I've known about it but have never seen anyone post that they tried it.  We need to hear from those who have.

Please keep in touch and let us know how you are progressing.
Smiles,
[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #3 on: March 02, 2012, 03:08:53 pm »
Gefeliciteerd [...]! It was very interesting to read that. Please keep us posted on developments.
[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #4 on: March 02, 2012, 03:21:36 pm »
I am very happy for you that you have gotten through the first few weeks so well and I [...] you continue to feel better and better.  However, this is a very dangerous method and I [...] others are not encouraged to try this in place of a proper taper.  This is basically a very abrupt cold turkey with some additional drugs added to prevent seizures.  There are indeed a few clinics in the US who already use this method, and I have heard of anecdotal stories of deaths caused by it.  In fact, when I was doing my own research on the subject a couple of years ago, I was told by one of these facilities that they no longer use this treatment for benzo withdrawal because it was too dangerous and was not effective at relieving symptoms in the long term.  They felt like it was still helpful for people withdrawing from opiates, cocaine, and speed, mainly because it reduced "cravings."   

The consensus seems to be that for people still taking benzos, this is an extraordinarily dangerous treament to undertake.  I have read several accounts of people with protracted withdrawal taking flumazenil IV's.  Some said it helped for a few days and then symptoms returned as normal.  Some said they felt worse than before after a few days had passed.  Some said it did nothing but make them dizzy.  There is a small study published online about the use of flumazenil in protracted withdrawal cases, which said that it did relieve symptoms in a lot of patients.  However, all of the patients had a return of symptoms within a few days to a few weeks. 

I hate to be a naysayer because it would be truly amazing if something came along to eliminate the scourge of benzo withdrawal.  I was one of the people who got very excited about the prospect of a shortcut to recovery early on in this process and even had some arguments of my own defending flumazenil as a possible miracle cure.  However, this treatment is definitely not new and it seems to be somewhere between ineffective and dangerous for most people who try it. 
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #5 on: March 03, 2012, 06:25:38 am »
There are 2 places in the US that will use this method for wd.  One is in Dallas, Texas where I live called The Urshel Addiction Recovery Group.  The second place I do not remember the name but it is in Kentucky.  I personally have a friend who is a BB buddie here who did this and was made very ill by it.  He is now, 6 years later, back on Benzos going through another rough taper which as many of us know, gets harder the more you taper for most people.

Before I had to leave my job as an administrator in a large hospital in Dallas, we treated several patients with Flumazenil that came in and had overdosed on benzos in combination with other drugs.  My basic understanding of Flumazenil is that it clears the GABA receptors of the benzo not that it repairs receptor damage.  Even the group in Kentucky said that they could say this treatment would take people off benzos but could not promise no proctacted wd sxs. 

I am very happy that it worked for you.  It is not experimental in the US, its already out there.  The Urshel clinic in Dallas will use it for benzos but they mainly use it for alcoholics.

I would not recommend to anyone.   Sorry.  Just my limited experience and my friend who was destroyed by it.

[...]
« Last Edit: March 04, 2012, 05:15:14 am by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #6 on: March 04, 2012, 10:06:19 am »

 :yippee: :yippee: :yippee: :yippee:


Thats incredible! I am so happy for you :thumbsup:
Hearing about flumazenil is very interesting... can there finally be a specific treatment for us benzo suffers rather than just having to bite the bullet and wait? This is exciting!

-[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #7 on: March 04, 2012, 11:52:41 am »
Studies on the subject matter

Intravenous flumazenil versus oxazepam tapering in the treatment of benzodiazepine withdrawal: a randomized, placebo-controlled study.
Gerra G, Zaimovic A, Giusti F, Moi G, Brewer C.
SourceAddiction Research Center, Ser. T., AUSL, Via Spalato 2, 43100 Parma, Italy. gerra@polaris.it

Abstract
Flumazenil (FLU), a benzodiazepine (BZD) partial agonist with a weak intrinsic activity, was previously found unable to precipitate withdrawal in tolerant subjects submitted to long-lasting BZD treatment. The potential use of FLU to treat BZD withdrawal symptoms has also been evaluated tentatively in clinical studies. In the present experiment, FLU (treatment A) was compared with oxazepam tapering (treatment B) and placebo (treatment C) in the control of BZD withdrawal symptoms in three groups of BZD dependent patients. Group A patients (20) received FLU 1 mg twice a day for 8 days, and oxazepam 30 mg in two divided doses (15 mg + 15 mg) during the first night, oxazepam 15 mg during the second night and oxazepam 7.5 mg during the third night. FLU was injected i.v. in saline for 4 hours in the morning and 4 hours in the afternoon, in association with placebo tablets. Group B patients (20) were treated by tapering of oxazepam dosage (from 120 mg) and with saline solution (as placebo) instead of FLU for 8 days. Group C patients (10) received saline instead of FLU and placebo tablets instead of oxazepam for 8 days. FLU immediately reversed BZD effects on balance task and significantly reduced withdrawal symptoms in comparison with oxazepam and placebo on both self-reported and observer-rated withdrawal scales. The partial agonist also reduced craving scores during the detoxification procedure. In addition, during oxazepam tapering, group B patients experienced paradoxical symptoms that were not apparent in FLU patients. Patients treated with FLU showed a significantly lower relapse rates on days 15, 23 and 30 after the detoxification week. Our data provide further evidence of FLUs ability to counteract BZD effects, control BZD withdrawal and normalize BZD receptor function. The effectiveness of FLU may reflect its capacity to upregulate BZD receptors and to reverse the uncoupling between the recognition sites of BZD and GABA, on the GABA(A) macromolecular complex, that has been reported in tolerant subjects.

Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #8 on: March 04, 2012, 12:10:36 pm »
Agonist substitution for high-dose benzodiazepine-dependent patients: let us not forget the importance of flumazenil
FABIO LUGOBONI, MARCO FACCINI, GIANLUCA QUAGLIO, REBECCA CASARI, ANNA ALBIERO, BENEDETTA PAJUSCOArticle first published online: 14 FEB 2011

DOI: 10.1111/j.1360-0443.2010.03327.x

© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Issue
Addiction
Volume 106, Issue 4, page 853, April 2011
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How to Cite
LUGOBONI, F., FACCINI, M., QUAGLIO, G., CASARI, R., ALBIERO, A. and PAJUSCO, B. (2011), Agonist substitution for high-dose benzodiazepine-dependent patients: let us not forget the importance of flumazenil. Addiction, 106: 853. doi: 10.1111/j.1360-0443.2010.03327.x

Author Information
Addiction Unit, Department of Internal Medicine, Verona University Hospital, Verona, Italy. E-mail: fabio.lugoboni@ospedaleuniverona.it
Publication History
Issue published online: 3 MAR 2011
Article first published online: 14 FEB 2011
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Share|AbstractArticleReferencesCited ByGet PDF (70K)Keywords:Benzodiazepine;dependence;detoxification;flumazenil;infusion;substitutionWe read with great attention the paper by Liebrenz et al. about the potential use of an agonist substitution with long-half-life benzodiazepines (BZD) in cases of high-dose BZD dependence [1]. We would like to contribute to this debate, because in our hospital in-patient unit, BZD represent the main reason for people seeking detoxification. We fully agree about the difference between the liability of BZD having a fast- versus slower-onset of action. Lormetazepam, lorazepam and alprazolam (available world-wide, except for lormetazepam which is not approved for sale in the United States and Canada) represent 81% of the BZD abused by our patients, while clonazepam, clobazam and ketazolam (three drugs eligible as possible substitutes) represent fewer than 1% of the recovered cases.

Liebrenz et al. did not discuss the slow infusion of flumazenil (FLU-I) [2–5] as one of the fastest and most effective treatments for BZD high abuse [4,5]. In our 8-year experience with FLU-I we have treated 294 severe BZD-dependent patients (median daily BZD dose was 14-fold greater than the maximum recommended dose). Patients usually immediately stop using the abused BZD and move rapidly to low doses of clonazepam in 3 days and then no BZD on day 4. FLU-I (1–2 mg/24 h) starts on day 1 and lasts up to discharge at days 8–10. For patients eligible for an agonist substitution, the most suitable dose (usually about 1–2 mg of clonazepam) can be reached rapidly and stopped after patient discharge.

Although we have not submitted our results to peer review, we are able to state that no patients have dropped out of treatment during hospitalization and preliminary data suggests promising results, although these will need to be confirmed through peer-reviewed research publications.

One of the more critical aspects of Liebrenz et al. agonist substitution method resides, in our opinion, in the starting phase, when it is difficult to keep patients in treatment by proposing substitution with a slow-onset BZD (subjects are normally taking very high doses of BZD, mainly of the fast-onset action type, and many of the patients are also polydrug users).

The receptor resensibilization obtained with 4–6 days of FLU-I allows patients to experience a good therapeutic effect with very small doses of low-power BZD, without significant withdrawal symptoms. Nevertheless, we should clarify that for the majority of patients being treated with FLU-I, the real aim is total abstinence from BZD.
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1Liebrenz M., Boesch L., Stohler R., Caflisch C. Agonist substitution—a treatment for high-dose benzodiazepine-dependent patients? Addiction 2010; 105: 1870–4. Direct Link:AbstractFull Article (HTML)PDF(116K)References2Gerra G., Giucasto G., Zaimovic A., Fertonani G., Chittolini B., Avanzini P. et al. Intravenous flumazenil following prolonged exposure to lormetazepam in humans: lack of precipitated withdrawal. Int Clin Psychopharmacol 1996; 11: 81–8. PubMed,CAS,Web of Science® Times Cited: 63Gerra G., Zaimovich A., Giusti F., Moi G., Brewer C. Intravenous flumazenil versus oxazepam tapering in the treatment of benzodiazepine withdrawal: a randomized, placebo-controlled study. Addict Biol 2002; 7: 385–95. Direct Link:AbstractPDF(170K)References4Quaglio G., Lugoboni F., Fornasiero A., Lechi A., Gerra G., Mezzelani P. Dependence on zolpidem: two case reports of detoxification with flumazenil infusion. Int Clin Psychopharmacol 2005; 20: 285–7. CrossRef,PubMed,Web of Science® Times Cited: 35Hood S., O'Neil G., Hulse G. The role of flumazenil in the treatment of benzodiazepine dependence: physiological and psychological profiles. J Psychopharmacol 2009; 23: 401–9. CrossRef,PubMed,CAS,Web of Science® Times Cited: 1
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Benzo free - flumazenil works!
« Reply #9 on: March 04, 2012, 12:12:35 pm »
The role of flumazenil in the treatment of benzodiazepine dependence: physiological and psychological profiles.
Hood S, O'Neil G, Hulse G.
SourceSchool of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia. sean.hood@uwa.edu.au

Abstract
Two-related studies are presented here, detailing our early experience with benzodiazepine-dependent patients treated with a four-day flumazenil infusion using a novel delivery technique. Patients with long-term benzodiazepine dependence who attended the Australian Medical Procedures Research Foundation (AMPRF, Perth, Australia) for treatment were recruited for these studies. Self-reported psychological and physical symptoms, as well as objective vital signs data were collected at intervals before, during and 2 weeks postinfusion. Study A is a case series with cardiovascular measures; study B is an open trial that tracks the psychological profiles of 13 subjects. Withdrawal symptoms were tracked, however, the nature and severity of these symptoms differed between patients. No major complications or discomfort prompting study dropout was observed. Significant benzodiazepine abstinence occurred with this flumazenil infusion method despite high levels of initial dependence, comorbid substance use and comorbid psychiatric illness. Low-dose flumazenil infusion appears to be a safe and effective treatment resulting in withdrawal symptoms of lesser severity than any other cessation method currently available. Recommendations for future research are discussed.

Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.