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Suggest Medical Methods To Detox Xanax From System
Question: Hi- I am 73 and have been on xanax for almost 3 years, 4 mg /day - sometime even 5. I take this to reduce anxiety which causes PVCs and other ectopics. However, now the xanax has lost its effect ( my tolerance) and I would like to get off it to avoid increasing my dose and having the horrible side effects of detox. What is the preferred medical method for detoxing off xanax. I have read about Valium substitution and tapering and other similar methods with Klonopin. I cannot afford a detox center but I have a doctor to work with. What do you recommend as a method. Is there anything that reduces PVCs?
Brief Answer:
Detox with klonopin will be better
Detailed Answer:
Hi, Thanks for your query. Welcome to HCM.
I have read your query and shall answer accordingly.
Xanax has very short half life and that is why it requires repeated dosing and has high potential for addiction. It is good that you have decided to detox yourself from it.
Valium has very long half life. After metabolism in the body it converts into many active metabolites and remain active for as long as 5 to 7 days. In your age the metabolising capacity has been already decreased, so you have higher chances of side effects from it's use.
Klonopin also has long half life but it is short then valium and it has few active metabolites which are active for only 1 to 2 days.
Strategy would be to gradually decrease the dose of xanax and at the same time building the similar dose of klonopin so that you will not experience the withdrawal symptoms. I would suggest in my patients to decrease xanax 0.5 mg in 2 days and start 0.5 mg of klonopin at the same time. Decreasing the xanax 0.5 mg every alternate day and increasing the klonopin 0.5 mg on the same days. I shall here suggest you to do not go beyond 3 mg of klonopin. It is not good to take benzodiazepines for longer duration. Use of it is approved for short duration only.
Another important point here is, if you have cardiac problems that is PVCs, You have to control your anxiety from the brain neurochemical level and taking benzos wont help for that. You have to take antidepressant drug which are safer in your cardiac co-morbidity like escitalopram, sertraline etc. MY opinion here would be to take SSRI antidepressant along with klonopin and then gradually withdrawing the klonopin after 6 weeks of treatment.
Psychotropic drugs usually do not decrease the PVCs but if it is related to anxiety then you will be benefited.
Discuss all these issues with your doctor and follow his advice.
Hope I have answered your query. if you have further query then feel free to ask. wish you good health.
Detox with klonopin will be better
Detailed Answer:
Hi, Thanks for your query. Welcome to HCM.
I have read your query and shall answer accordingly.
Xanax has very short half life and that is why it requires repeated dosing and has high potential for addiction. It is good that you have decided to detox yourself from it.
Valium has very long half life. After metabolism in the body it converts into many active metabolites and remain active for as long as 5 to 7 days. In your age the metabolising capacity has been already decreased, so you have higher chances of side effects from it's use.
Klonopin also has long half life but it is short then valium and it has few active metabolites which are active for only 1 to 2 days.
Strategy would be to gradually decrease the dose of xanax and at the same time building the similar dose of klonopin so that you will not experience the withdrawal symptoms. I would suggest in my patients to decrease xanax 0.5 mg in 2 days and start 0.5 mg of klonopin at the same time. Decreasing the xanax 0.5 mg every alternate day and increasing the klonopin 0.5 mg on the same days. I shall here suggest you to do not go beyond 3 mg of klonopin. It is not good to take benzodiazepines for longer duration. Use of it is approved for short duration only.
Another important point here is, if you have cardiac problems that is PVCs, You have to control your anxiety from the brain neurochemical level and taking benzos wont help for that. You have to take antidepressant drug which are safer in your cardiac co-morbidity like escitalopram, sertraline etc. MY opinion here would be to take SSRI antidepressant along with klonopin and then gradually withdrawing the klonopin after 6 weeks of treatment.
Psychotropic drugs usually do not decrease the PVCs but if it is related to anxiety then you will be benefited.
Discuss all these issues with your doctor and follow his advice.
Hope I have answered your query. if you have further query then feel free to ask. wish you good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
"Psychotropic drugs usually do not decrease the PVCs but if it is related to anxiety then you will be benefited." could you explain that considering my docs feel my PVCs are related to anxiety? How would Psychotropic drugs "benefit" me - what would the benefit be? - - would they decrease the frequency of PVCs or just reduce my reaction to them. They destroy my quality of life - disturb my sleep, and occur whenever I try to relax and watch a movie. Finally which SSRIs do you recommend - how long do I have to take them (it) to feel a result, and what would that result be , lower anxiety ?? My cardiac test show normal function and only very slight CAD , <50% on a a 64 slice angiography.My doc says this is normal at age 73. Thanks you will get a fine rating for this complete answer. HM
Brief Answer:
Antidepressants may be of benefit
Detailed Answer:
Hi, thanks for writing again.
I am here writing the words form an article published in 1982 which says that:"Sudden death amidst powerful emotional arousal is a familiar and dramatic event in the literature, history, and folklore of most cultures. Although physicians and laymen have accepted this association of mind and mortality for centuries, the arrhythmogenic potential of strong emotions only recently has been physiologically explained. Lown et al have shown that psychological stress may be associated with increased sympathetic activity that can provoke ventricular arrhythmias and may lower the threshold of ventricular fibrillation. The relationship between the CNS and cardiac arrhythmias is not limited to moments of strong emotions, however. Structural disease of the CNS also may be associated with life-threatening arrhythmias, distinctive ECG changes, and histopathologic changes." Here is the link:
XXXXXXX AL, Fozzard HA. Ventricular Arrhythmias Associated With CNS Disease. Arch Intern Med. 1982;142(2):232-233. doi:10.1001/archinte.1982.0000
If your anxiety is excessive then it may precipitate your PVCs sometimes but not always, it may be because of the increase sympathetic activity.
Psychotropic drugs particularly antidepressants like SSRIs will decrease your anxiety and by so it will decrease the sympathetic overactivity. It can reduce the frequency of your PVCs [but only when it is related to anxiety or provoked by anxiety]. Your overall functioning will improve if anxiety is taken care of.
I will recommend a safe SSRI like escitalopram [lexapro] which do not have any adverse events on heart. If you were my patient then I would have started with 5 mg at night along with klonopin 0.5 mg and gradually I would haave increased the dose to 10 to 20 mg of lexapro with 1 to 2 mg of klonopin in a day. The increment in the dosage depends upon the clinical benefit in the patient. It will show it's effects within 15 to 20 days and you will have to continue these drugs up to at least 1 year or unless your anxiety is completely resolved whichever is longer.
The result of the drugs will be decrease in the anxiety, improvement in sleep and appetite, lifting of mood from apprehensive and sad to euthymic and normal, increasing interest in activities etc. It is good that part from arrhythmias you do not have any significant abnormalities in heart.
Hope I have answered your query. If you do not have further query then close the discussion and rate the answer. Wish you good health.
Antidepressants may be of benefit
Detailed Answer:
Hi, thanks for writing again.
I am here writing the words form an article published in 1982 which says that:"Sudden death amidst powerful emotional arousal is a familiar and dramatic event in the literature, history, and folklore of most cultures. Although physicians and laymen have accepted this association of mind and mortality for centuries, the arrhythmogenic potential of strong emotions only recently has been physiologically explained. Lown et al have shown that psychological stress may be associated with increased sympathetic activity that can provoke ventricular arrhythmias and may lower the threshold of ventricular fibrillation. The relationship between the CNS and cardiac arrhythmias is not limited to moments of strong emotions, however. Structural disease of the CNS also may be associated with life-threatening arrhythmias, distinctive ECG changes, and histopathologic changes." Here is the link:
XXXXXXX AL, Fozzard HA. Ventricular Arrhythmias Associated With CNS Disease. Arch Intern Med. 1982;142(2):232-233. doi:10.1001/archinte.1982.0000
If your anxiety is excessive then it may precipitate your PVCs sometimes but not always, it may be because of the increase sympathetic activity.
Psychotropic drugs particularly antidepressants like SSRIs will decrease your anxiety and by so it will decrease the sympathetic overactivity. It can reduce the frequency of your PVCs [but only when it is related to anxiety or provoked by anxiety]. Your overall functioning will improve if anxiety is taken care of.
I will recommend a safe SSRI like escitalopram [lexapro] which do not have any adverse events on heart. If you were my patient then I would have started with 5 mg at night along with klonopin 0.5 mg and gradually I would haave increased the dose to 10 to 20 mg of lexapro with 1 to 2 mg of klonopin in a day. The increment in the dosage depends upon the clinical benefit in the patient. It will show it's effects within 15 to 20 days and you will have to continue these drugs up to at least 1 year or unless your anxiety is completely resolved whichever is longer.
The result of the drugs will be decrease in the anxiety, improvement in sleep and appetite, lifting of mood from apprehensive and sad to euthymic and normal, increasing interest in activities etc. It is good that part from arrhythmias you do not have any significant abnormalities in heart.
Hope I have answered your query. If you do not have further query then close the discussion and rate the answer. Wish you good health.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hello Dr. Soni- Thank you for asking. Actually I am not doing that well. You described for me a detox regimen for getting off Xanax, but here in the US, a patient cannot get prescriptions for more than one Benzodiazepam at any one period. So I cannot substitute say Valium and taper off that, therefore, my only alternative was to see a psychiatrist here who has me on a fast taper regimen which I find nearly impossible. I get very anxious when I have to taper even 1/2 mg of xanax per week, and I can feel some withdrawal symptoms. Also, my Internist is refusing to write more RXs for xanax so I will run out before my taper routine is done. I also had a bad reaction to Lexapro and almost all SSRIs. I don't know what to do, and I am taking my usual dose 4 or 5 mg/day until the new year when I will try to find a doctor who will prescribe for me the proper medicines. It's either that or I will fly to XXXXXXX to see you ( my wife was an airline employee, so we get flight discounts - I'm only partially serious). Is there any way YOU can prescribe Xanax for me - enough to detox at a slower rate. I have an actual RX from a psychiatrist doctor but the pharmacies here will not fill it until my current RX runs out and by then I will have used all the xanax weeks before. I actually know you can't do that, but I am very anxious and getting more and more so as I get to the point where I am out of xanax. I gave you an excellent rating because your total answer was very understanding and helpful - it's just not working here in the US. Thanks you for asking. HM
Brief Answer:
Limitations are on both sides
Detailed Answer:
Hi, thanks for writing again.
I appreciate your words and your past ratings but you can understand that I have to follow rules and guidelines of this site, which does not have a policy of giving online prescriptions to patients. Site does not take any responsibility about the side effects or harm that will happen to the patient that is why we suggest patients to visit a doctor before making changes in drugs and dosages.
Even if you contact me directly and I will write the prescription for you, your state guidelines will not recognize it valid because they require prescription from the registered doctor of your state with medical license for practicing in particular region.
I have suggested the best regimen for detoxification from xanax and starting antidepressant drugs. If lexapro and other antidepressant drugs causing you side effects then there are antidepressants from other class with different actions like cymbalta, effexor, pristiq, wellbutrine, reboxetine, trazodone, nefazodone, newer ones like vortioxetine, vilazodone etc.
What you can do is to visit a psychiatrist [obviously newer one] and ask for the solution of your problem. Ask him the best detox regimen and treatment for anxiety disorder.
I am sorry for my limitations but what can I do? The different regulatory bodies of various countries prevent us from helping patients across the globe.
Hope I have answered your query. If you have any query in future you can ask me directly on following link:
http://doctor.healthcaremagic.com/doctors/dr-ravi-soni/67402
Wish you good health.
Limitations are on both sides
Detailed Answer:
Hi, thanks for writing again.
I appreciate your words and your past ratings but you can understand that I have to follow rules and guidelines of this site, which does not have a policy of giving online prescriptions to patients. Site does not take any responsibility about the side effects or harm that will happen to the patient that is why we suggest patients to visit a doctor before making changes in drugs and dosages.
Even if you contact me directly and I will write the prescription for you, your state guidelines will not recognize it valid because they require prescription from the registered doctor of your state with medical license for practicing in particular region.
I have suggested the best regimen for detoxification from xanax and starting antidepressant drugs. If lexapro and other antidepressant drugs causing you side effects then there are antidepressants from other class with different actions like cymbalta, effexor, pristiq, wellbutrine, reboxetine, trazodone, nefazodone, newer ones like vortioxetine, vilazodone etc.
What you can do is to visit a psychiatrist [obviously newer one] and ask for the solution of your problem. Ask him the best detox regimen and treatment for anxiety disorder.
I am sorry for my limitations but what can I do? The different regulatory bodies of various countries prevent us from helping patients across the globe.
Hope I have answered your query. If you have any query in future you can ask me directly on following link:
http://doctor.healthcaremagic.com/doctors/dr-ravi-soni/67402
Wish you good health.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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