Flumazenil

Anyone on here aware of the Flumazenil de-tox? I have a friend going through it right now and was wondering if you had heard anything about it. So far, things are going fine. Another man went for the same treatment and is doing fine now, too. Just wondered if anyone had any opinions??

 

 

My best,

Carol

Carol,

 

To my understanding there was an individual from this board who flew to Australia to have this procedure done. From what I was told it was less than successful.

 

Dave

 

http://www.benzobuddies.org/forum/benzo-chat/flumazenil-study-looks-promising-for-future-of-benzo-detox/0/

Hi, Dave,

  The reason it wasn't successful is because she didn't finish it. Someone from BI went and it was a success. We're hoping this one is successful, too. Do you think these people, who were really out of options, are being pioneers or guinea pigs? I'm hoping it's the first one.

 

:)Carol

Do you think these people, who were really out of options, are being pioneers or guinea pigs? I'm hoping it's the first one.

 

Hi Carol...I was one who was really out of options.  I went through the flumazenil detox four months ago and have had minimal withdrawals.  I think your friend who is undergoing it at the moment is a mutual friend.  But no names...

 

I do think the flumazenil procedure is dangerous as it can so easily go wrong in inexperienced hands.  I do not recommend it unless all other options have been tried.  I don't regard myself as a pioneer (in fact, another member preceded me by a couple of weeks) but, when I was going through the procedure I promised myself that if I got through it I would make my experiences known so that others could make a decision based on what I went through.  Up to now, I have done this on a member-only forum (TRAP), but I'm willing to discuss my experience of the detox here as long as there is no objection from the moderators or admins.

 

Best regards,

 

Ed

 

 

Another man went for the same treatment and is doing fine now, too.

 

That would be me. 

Hi Lexofree,

 

You can discuss it here - I'd be interested to learn of your experiences. Though I do caution anyone reading of Lexfree's experinces that their experince could be very different.

Thanks, Colin.  The procedure was done here in Hong Kong.  I was lucky enough to find a doctor with a background in biochemistry who practiced for many years in Government hospitals.  He has performed many flumazenil detoxes and recently went into private practice.  The five-day procedure was performed at a private hospital and the total cost came to around US$6,000 including the cost of a private room for a week.

 

The introduction of flumazenil was via an intravenous tube in two four-hour sessions per day.  The initial dose of flumazenil was low, to assess my reaction to it.  Depending on the patient's reaction, the dose is increased to a maximum of 4mgs/day.  I was already on an anticonvulsant (Tegretol 400mgs) and a beta blocker (Inderal 10mgs/day) to assist with tapering (they did not help) and no other drugs were used for the procedure or since.  Certain drugs are kept as a backup in case the reaction to the flumazenil is severe and the doctor may have to resort to these.  In my case, Ketamine was the first-line drug and it was tested on me.  It caused an intense psychedelic reaction in my case which I am told is not normal.  It was unpleasant, but was not needed following the test as the flumazenil produced no reaction or adverse effects.  Other drugs kept in reserve are antipsychotics such as olanzapine (Zyprexa).

 

If withdrawal symptoms occur, the flumazenil can be stopped which prevents further withdrawal symptoms.

 

After the procedure, I felt like I had been run over by a bus for the following 24 hours, but I was better after that.  All of the pain, nausea, anxiety etc. was gone.  I have had some reminders of the withdrawal symptoms I experienced over the past two years, but they were mild and short-lived.  I am now leading a normal life with only residual tinnitus as a noticeable withdrawal symptom.

 

I can post much more detail if needed as I kept a full record of the procedure including size of flumazenil doses and IV flow rates.  That might just be too much info, methinks, but I am quite happy to provide this if anyone is interested. 

Hi Lexo,

 

I must say, it sounds a rather seat-of-your-pants proceedure! Can you clarify a couple of things for me: what were your previous experiences of withdrawal; what do you mean by "benzo toxicity developed" (from your signature)?

 

Thanks.

I must say, it sounds a rather seat-of-your-pants proceedure!

 

In a way it is, Colin.  Because individual reactions to flumazenil are unpredictable, the doctor has to 'wing it' and have reserve drugs in case of psychotic reactions (that are not unknown, which is why I have always said that this procedure is only for the truly desperate).

 

I had pretty much the full range of withdrawal symptoms - it would be far easier for me to list the symptoms I didn't have than to list those I had.  The most unbearable of these was very loud tinnitus.  The tinnitus was intense enough to induce suicidal mania, hence my reinstatement.  Reinstating only partly alleviated the withdrawals, but being in limbo was better than topping myself.  That limbo lasted from August 2005 to June 2006, when tolerance developed.

 

I would class 'benzo toxicity' as a stage beyond tolerance, when updosing does not have any effect other than to increase symptoms.  I could not titrate up or down by even a tiny amount without experiencing intensifying withdrawals.  Benzos had in effect become poisonous to my system.  I was in a worse state than even the worst of my post-withdrawal state from March to August 2005. 

 

Regards,

 

Ed

Hi Ed,

 

I asked about 'toxicity' because it is often used inappropriately. Benzodiazepine toxicity is pretty rare, but potentially fatal. As you are probably aware, flumazenil competitively binds to GABA receptors, so dislodging benzodiazepine drugs. In the case of a severe toxic reaction to benzos, it is more important to stop the effects of the benzos as quickly as possible. Of course, as you have already explained, the use of an anticonvulsant would probably be advisory too. You seem to have suffered from paradoxical effects of benzos, so when you went through a forced rapid withdrawal, you actually felt better soon after. This is not the case for most people that go through such rapid withdrawals. Most of us would suffer more from withdrawal symptoms, but for you, they were minor compared to the adverse side effects of benzos. You are right, this is an extreme solution to an extreme situation, but on occasion a rapid withdrawal is the only solution.

 

Jan, a former admin of BenzoBuddies, had to go through a very accelerated withdrawal because of adverse and dangerous side-effects. She did not withdraw as rapidly as you, but she did complete her withdrawal over a few weeks. I suspect that if you could have stood the effects of such an accelerated taper, you would have, in the end, felt pretty much the same as you have with the flumazenil-assisted withdrawal. The flumazenil meant that your withdrawal was even faster than it would be if you had stopped your benzos cold turkey (not to be recommended). You did what you had to do - I'm just trying to make clear to those reading this that your circumstances were highly unusual.

 

It might be an idea for you write more about this. People need to understand that such withdrawals are, very occasionally, medically necessary, but will cause far more problems than they resolve outside of these rare situations.

Hi, Ed,

 

I'm so glad this worked for you and that you're feeling so well. This is very interesting.

 

From reading your posts, it sounded like the flumazenil is used only during the procedure itself, and not after. Is that right? So are you now drug-free?

 

Therese

Hi Therese...thank you for the kind words. 

 

Yes, the flumazenil was only used during my stay in hospital.  I have heard that a follow-up dose can be beneficial, but my doctor has not mentioned it and I have felt no need for it.  I am not drug-free though - as mentioned in an earlier post, I am taking Tegretol 400mgs and Inderal 10mgs.  These were prescribed to help with tapering at the beginning of this year, not for the flumazenil detox.  No other drugs were prescribed for the procedure.

 

I am not particularly happy to be taking these drugs as my aim is to be drug-free.  However, they are a means to an end, as well as a precaution.  During my first taper from Lexotan (bromazepam), I suffered from seizures (the falling-on-the-floor type) every 20 minutes on the third day off.  I have to stay on the Tegretol until I can be sure there is no further risk of seizures.

 

Colin posted:

 

It might be an idea for you write more about this.

 

I'd be happy to, Colin.  I kept notes of all that happened during the procedure, but they're on the technical aspects (doses, flow rates) and rather dry reading.  Perhaps a questions and answer format in this thread would be better.  If you don't mind, I'll PM you what I have written for your comments.

 

People need to understand that such withdrawals are, very occasionally, medically necessary, but will cause far more problems than they resolve outside of these rare situations.

 

Well put.  I couldn't agree more.  It was also a very scary experience. 

Ed, from Colin's post about the flumazenil competing for the GABA receptors, I can understand how it dislodges the benzos--it sounds like it takes the place of them temporarily. But I don't understand how it seems to be able to reduce w/d symptoms *after* the flumazenil has left your body. I'm assuming that your body, if chemically dependent on benzos, has shut down some of its normal operations in this regard and has to "re-educate" itself to do the job, which takes time. Can you explain this for us? I'd love to be able to wrap my mind around it!

I think this is by far one of the more intersting topic's and would love to hear more.

 

Dave

Ed, from Colin's post about the flumazenil competing for the GABA receptors, I can understand how it dislodges the benzos--it sounds like it takes the place of them temporarily. But I don't understand how it seems to be able to reduce w/d symptoms *after* the flumazenil has left your body. I'm assuming that your body, if chemically dependent on benzos, has shut down some of its normal operations in this regard and has to "re-educate" itself to do the job, which takes time. Can you explain this for us? I'd love to be able to wrap my mind around it!

 

Hi,

 

Although the flumazenil competes to bind to the GABA receptors, and in so doing dislodges benzodiazepines, it has no other beneficial effects. Flumazenil has no threaeutic properties beyond being an anitoxicant (is that the correct word?). Flumazenil causes a very rapid benzo withdrawal - faster than cold turkey!

 

Interestingly, I suspect that Klonopin might be more of a problem if someone develops toxicity. This is because it can bind more tightly to the benzo recepetors than most other benzos. So for some, it may stick around bound up with receptors for far longer - not a good thing if you have developed toxicity! I don't enough about it to say for sure though.

So...if I understand things right, this procedure is mainly going to benefit people who are experiencing benzo toxicity and need to get off the benzos ASAP? That sounds like it was Ed's case, that the benzos themselves were making him feel just as bad--or worse--than the w/d from them. What a horrible spot to be in!

the benzos themselves were making him feel just as bad--or worse--than the w/d from them. What a horrible spot to be in!

 

Theresa, damned if you do and damned if you dont. Unfortunately I think most here can relate to that scenario

 

Dave

So...if I understand things right, this procedure is mainly going to benefit people who are experiencing benzo toxicity and need to get off the benzos ASAP? That sounds like it was Ed's case, that the benzos themselves were making him feel just as bad--or worse--than the w/d from them. What a horrible spot to be in!

 

That was very much the case, Therese.  It was a very ugly place to be, and in the end deciding to go for the flumazenil procedure was a no-brainer.  I had been 'toxic' for many months.

 

I have no explanation for the almost complete lack of symptoms.  Even my doctor is surprised.  He was surprised when he injected a 2mg bolus of flumazenil on the first night of the procedure in a deliberate attempt to precipitate a panic attack (to test his 'reserve' drug when I started panicking).  I had no reaction to the flumazenil at all.  Even though I was in theory going through an accelerated cold turkey, I felt no withdrawal symptoms and my doctor was unable to induce any.  Sheesh...lucky I had complete faith in him.

 

But I don't understand how it seems to be able to reduce w/d symptoms *after* the flumazenil has left your body.

 

Neither do I, but I'm grateful that it did.  I thought I would be in for a long period of withdrawals, given my past experience, but I'm not experiencing any.  I'm so grateful that I seem have my life back and can look forward to the future again.

 

Ed

I don't have an explanation of why Lexo was almost symptomless beyond being very lucky. After the flumazenil has left your system (I have no idea of its half-life), if there is any benzo left in your system, would it not be free to to again bind with GABA receptors? Klonopin could take a few weeks to be completely gone from your system.

 

How long does it take for benzos to be cleared from your system: http://www.benzobuddies.org/forum/general-withdrawal-support/how-long-does-it-take-for-benzos-to-leave-your-system/0/

Hi Colin...flumazenil's half-life is measured in minutes according to this Wikipedia article.

 

This has me scratching my head as there was a 14-hour overnight break between the afternoon/evening infusion and the following morning's infusion.  One would think that the benzo would rebind to the receptors once the flumazenil had lost effect.  I can only guess that there was a lot of 'free benzo' being eliminated from my system during the eight hours per day when the flumazenil was active.  That is, the process of benzo elimination was much faster than normal as it was not bound to any receptors - it was free-floating, for want of a better term.

 

I had a urine test before the procedure and the benzo level was set at 200 (an arbitrary number).  The benzo urine level was measured again at the end of the procedure and the reading was 2.5 (a 98.75% drop).  My doctor judged this to be too high and he wanted the number to be as close as possible to zero, so he injected a final 1.5mg bolus of flumazenil after the procedure.

 

Also, according to my doctor, it makes no difference if the benzo half-life is long or short.  A flumazenil detox from, say, Xanax takes the same length of time as that from Valium.

 

My head hurts from trying to work this out.   

 

Ed

Hi,

 

I guess that if the benzo is not bound up with the GABA Receptors then it would be more easily metabolised. I'm still surprised that it is so complete though. Benzo levels are detectable in the blood, so unbound benzo must be slowly metabolised too - or so I would think. This doesn't make much sense to me.

Hi All,

 

  Can we keep this thread alive?  I would like to know more about where Ed did the flumazenil detox, who was the Dr. and how to get ahold of him or the clinic.  How did Ed find the Dr.?  what kind of credentials does this guy have?  What is the success rate for this kind of procedure?  I have googled Flumazenil Benzo detox Hong Kong centers and all sorts of variations thereof and have come up with nothing. 

 

  Ed, can you enlighten us some more on this?

 

  XXXChristine/BlueMoth

Hi Christine...my doctor is in private practice and the procedure was done in a public hospital in Hong Kong (there is no clinic here that offers the procedure).  Dr Ben Cheung is his name and he is a doctor of biochemistry and psychiatry who specializes in addiction (mainly narcotics) and has worked in Government institutions for most of his career, going private last year.  The psychiatrist who prescribed Remeron recommended him after it became clear to her that my case was beyond her scope of competency (it was nice of her to admit that, rather than try to pump me full of alternatives to Remeron).

 

I have no idea what the success rate is.  It is not 100%, that's for sure.  There are far too many variables involved.  But any stories about this procedure have been anecdotal at best.  Prior to undergoing the procedure, I could not find a single case of anyone who went through a flumazenil detox and wrote about it.  That's why I decided to 'go public' as soon as I realized that the procedure had been a success.  However, my circumstances were quite unique, as Colin has pointed out.  Maybe I was lucky, or maybe the benzo 'toxiciy' I was experiencing provided a set of circumstances that favored a flumazenil detox.  I still think the procedure has many dangers and would like to see a lot more success stories (in less extreme circumstances than mine) before recommending it.

 

If you have any more questions, please feel free to holler. 

 

Ed

Hi Ed,

 

  Ok, after much debating with myself over asking this, can you throw out this Drs. contact information?  I don't know if I would have money to get over to Hong Kong, but it might be worthwhile to at least talk to this doctor and ask about the procedure, his success rate and the cost etc. 

 

  thanks.

 

  Christine/BlueMoth

Christine,

 

Please read the thread carefully! This is about getting people off benzos 'safely' (seizure-free), very quickly because of toxicity issues. It is not about getting people off benzos in a humane fashion! Lexofree has been very fortunate to have experienced so few problems - VERY FORTUNATE! He had to get off quickly; he had no choice. This is a super-fast cold turkey technique because it drives away benzos from GABA receptors. Lexofree himself recognises that he has been very fortunate and does not recommend such a withdrawal except for those that find themselves in a similarly desperate situation to the one in which Lexo found himself.