
Is Taking Suboxone And Librium Together Safe?

librium-suboxone together cause more side effects
Detailed Answer:
Thanks for direct question.
I agree with you that after taking benzo for few years it is almost impossible to stop them. We generally explain risks with long term benzo use and ask those patients to come to us regularly for prescription so at least if anything serious is there, it can be evaluated.
In your case due to situation and method of medical practice, which somewhat differ from we do, you are not able to get benzo. And pregabalin and gabapentin are useful in benzo withdrawal so gaba is helping you in symptoms of anxiety which is mostly due decreasing the dose of benzo.
Your question about simultaneous use of Librium and suboxone:
Suboxone(Buprenorphne) is an opiate and Librium(chlordizepoxide) is benzo.
Both act on central nervous system through different receptors. Both can cause sedation and confusion. If by chance both given in higher dose without medical supervision it can be lethal combination.It leads to severe confusion, sedation, respiratory depression and sometime death also. This applies to suboxone and benzo like Xanax,klonopin,Librium,valium. Because of this reason rehab centre there has denied to give them.
However if both used under medical supervision and in appropriate dose, no problem occurs.
We use mostly lorazepam (Ativan) which is less potent and short acting among benzo and purpose is to treat withdrawal symptoms of insomnia and anxiety of opiates with buprenorphine.
In some cases we also use klonopin in 0.5 mg or valium 5 mg with buprenorphine. We never came across any problem.
However for initial 5 days we keep the patient indoor for observation.
Hope I have answered your query, I will be happy to answer more.
Regards,
Dr.Chintan Solanki.


See detail answer please for queries
Detailed Answer:
Hello,
Though it is long query with few questions, I will surely answer without any bias.
It is the problem of the system of two different countries. In USA most of the doctors work strictly as per protocol and literature/studies. They are not used to with clinical judgment and believe in taking risk because of strict consumer laws and risk of suing by patients. While in XXXXXXX due to lack of resources and quantity of work we used to take clinical judgment and fast outcome. That’s why they are not giving enough medicines though you required I guess.
It is really good that you did not take heroin. Though you believe , they are causing severe problem.
The belief of yours about SSRI (which you heard) is also not so significant. SSRI are really good medicines and they changed life of lots of lots of people with anxiety and depression.
Instead of effexor, you can take paxil cr 12.5 mg maximum 50 mg per day. It is quite useful in with anxiety/panic symptoms. Here the point is whether your problem is due to decrease/withdrawal of BENZO or itself anxiety disorder.
If itself, paxil will be helpful for sure. If it is due to tapering benzo, pregabalin/gabapentin will be helpful. Do not stop effexor suddenly. Effexor should be tapered gradually and simultaneous increase in paxil. You can add desvenlafaxine (prestique) 50- 100 mg, if you are not happy with paxil alone after stopping effexor.
Clozaril is not at all useful in your case. It is indicated in resistant schizophrenia/psychotic disorder and I think you do not have any symptoms like that.
Seroquel is also useful in depression but sedation and weight gain are the issues. I am not personally using it more in my patients..
Hope I have answered your queries, if anything remains do not hesitate to ask.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki


Forgot to ask, not sure what you meant by 2 different countries. Do you mean XXXXXXX md.s are more apt to take chances than XXXXXXX docs, and does that mean only in India? Especialy since both my docs are XXXXXXX and they seem to be the ones that don't like to break out the Rx pad. My mothers docs are XXXXXXX and she gets klonopin qid and 7.5 vicodin qid, along with 600mg gabs tid along with about 5 other meds.
Please see detail answer for queries
Detailed Answer:
Hello,
Sorry for misunderstanding.
You can try Prestique(SNRI), Mirtazapine(SNRI), and Bupropion(NRI), if not tried yet as SSRIs are not effective.
Another option is old medicine imipramine (depsonil) from TCA group.
Benzo are gold standard for anxiety. They are medicines which treat the symptoms, so they will be useful in almost all cases. The main drawback of benzo is tolerance, means they are not effective in same doses after time progresses.
Xanax is very bad drug in that regard as it is the benzo with maximum tolerance and dependence potential. I probably never use it. Maximum dose depend on person’s history of past intake of same medicines. If by chance xanax continues, it is not going to be effective in same dose as many people take 10 mg at a time who are highly dependent for proper effect. Recommendation maximm dose is 5-6 mg in panic disorder.
Klonopin is good benzo. Generally it is choice of anti anxiety medicine. For anxiety disorder it is used 5-6 mg depending upon severity. However in seizure disorder (in which it is not generally used) it can be given up to 20 mg.
For you I recommend no xanax and 4 mg klonopin in divided doses (it can be increased if needed up to 6 mg).Simultaneous pregabalin 75 to 150 mg will help to reduce dose of klonopin. Klonopin is long acting so you would feel better. There is no chance that you can be off from this medicine as you have taken for almost 25 years. But yes we can try to reduce is minimum dose which is effective for you.
No I am not specifically telling about doctor origin. I mean laws and method of practice different in both countries. In USA as per my knowledge lots of cases occur for suing doctors while in XXXXXXX rarely. So we can change dose as per patient’s need without hesitation, while there I think doctors follow strict rules according to treatment guidelines to prevent themselves from suing.
One point is that if you have used medicines on your own without doctor’s consultation or not according to recommendation in past frequently, they might be afraid of prescribing you more.
And it doesn’t matters that it is taken qid or tid. Dose per day matters more as klonopin has good half-life.
Hope you get satisfactory reply, if still any query, you are welcome.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki


Klono works longer, frequency of dose less needed
Detailed Answer:
Hello,
I also wish if I were your doctor, you need not to go for such questions and you can get the treatment as per need. But it is not like that, so either you can request your doctor gently and frequently to prescribe the dose you required or can change the doctor!
Hope you can get 4 mg dose.
Klonopin half life (time required to clear half of the drug from body/plasma/circulation) is at least 18-20 hours and extended up to 40 hours depending upon individual metabolism, physical structure and duration of intake. So if it is at least taken two times a day, it can be available round the clock in body to be effective. So if you are taking 3 times a day or four times a day, concentration of the drug in circulation is not going to be affected much. Means if you take 0.5 mg four times a day or 0.5 in mornings and afternoon and 1 mg at night, it is going to have same effect. Ultimately it is 2 mg per day.
Hope you have got some clarification and some relief from our whole discussion, wish you good health.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki


accurate level can not be measured in urine
Detailed Answer:
Hi,
thanks for query.
I could not understand your question clearly,"With all these variables" means?. But I will try my best to answer your question.
Actually urine test is done to identify the molecule among benzodiazepines. There is cut off level of each drug which suggest that more than that amount of the substance should be present in urine to test it positive. It is not like that by urine test , you can exactly measure what amount you take orally.As drug elimination depends upon many factors.
Hope you got the answer,
Regards,
Dr.Chintan Solanki.


also, when you said about urine test is done to identify the molecule among benzos, did you mean to identify the exact type of benzo in system, like wether it is klonopin or xanax for example?
You misunderstood the answer. Molecule can be identified
Detailed Answer:
Hi XXXXXXX
I thought I was clear last time. Let me try again.
Yes, which means with the urine test it is not practically possible to say what amount (dose) has been taken by mouth. In urine test, we can identify if there is benzo molecule in it or not by enzyme assay method. We can identify specific molecule with liquid chromatography and spectrometry methods.
Repeated blood test and urine tests are the best way to check if a molecule is taken by mouth or not. This is practically complex hence not routinely done.
Individuals have different genetics and metabolism pathways. For example a young person has taken 2 mg clonazepam and after 10 hours if the urine test is done it shows up positive as half life of the clonazepam is at least 20 hours. When person takes drug for longer time it is distributed in fat tissue of the person. So even after 2-3 week it can be detected in urine.
So unless the person agrees the quantity of intake we cannot calculate the exact amount. In the above example there are number of factors like age of person, half life of drug in the person, fat distribution of the person and quantity consumed.
Regards,
Dr.Chintan Solanki.


You are welcome
Detailed Answer:
Hello,
Thanks for words. It's my duty. I am also thankful to you for giving me chance to help you.
I will be glad to answer of your future queries if any,
Regards,
http://bit.ly/drchintansolanki

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