Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Remedies For Tinnitus While Weaning Off Oxazepam
Question: Hi - I have been tapering off Oxazepam since XXXXXXX 2016. I started on 30 mg and am now down to 7.5 mg - yes, it's taken that long! I also take 10 mg Citalopram and 10 mg Zolpidem at night. I really want to cut out the Zolpidem but each time I try to reduce it my tinnitus gets a lot worse. I'm not sure which way to go with cutting back on either of these drugs from this point. Diazepam doesn't suit me - it makes me feel aggressive and irritable so I avoid it. I'm wondering whether to:
a - cold turkey off the Zolpidem and hope the tinnitus improves (although I'd hate it to turn into another chronic problem)
b - substitute Zolpidem with Oxazepam (10 mg) at night then reduce off that (although because Oxazepam has a longer half life it may take me longer to reduce off it)
c - substitute both for a different benzo with a longer half-life and then reduce that slowly.
My main concern is the tinnitus - it seems to be a symptom of an over-active CNS, along with IBS - I can well do without these getting any worse.
Any ideas?
a - cold turkey off the Zolpidem and hope the tinnitus improves (although I'd hate it to turn into another chronic problem)
b - substitute Zolpidem with Oxazepam (10 mg) at night then reduce off that (although because Oxazepam has a longer half life it may take me longer to reduce off it)
c - substitute both for a different benzo with a longer half-life and then reduce that slowly.
My main concern is the tinnitus - it seems to be a symptom of an over-active CNS, along with IBS - I can well do without these getting any worse.
Any ideas?
Brief Answer:
Ok, let us start with the tinnitus.
Detailed Answer:
It's from an overactive nerve in the ear. The benzodiazepines work on this because they damp down nerve activity. There are a LOT of other medicines that can also damp down nerve activity. If they worked exactly like benzodiazepine., they would be identically addictive. There are many (seizure mediicines) that often work on tinnitus if benzodiazepine does and are NOT at all addictive. Gabapentin isn't the strongest but it is the safest as one of many possibilities.
So, first choice is substitution with a non-benzo.
HOWEVER, stopping benzo's is associated not just with overly active ear nerves but overactive nerves everywhere and this can produce seizures that can even be fatal.
Reasonably someone might say that if they've reduced them by two thirds, then isn't the rest of the reduction not as bad and not as risky as what's already been tolerated? Yeah, mostly. Isn't zolpidem safter to stop than other benzodiazepine well.. yes... especially if it was taken ONLY once a day. IF it was taken 4 times a day then it is risky to stop it suddenly definitely. If once a day, you might want some direct medical observation when stopping it; if more than once a day you really HAVE to have supervision when lowering the dose or stopping it.
For these reasons substituting the fairly weak benzodiazipine (zolpidem) with a stronger one is not recommended.
If stopping a benzo suddenly, the increased activity of the nervous system certainly lasts days and might last weeks. My tinnitus got worse 2 years ago and I just got used to it. Too much loud Trump podcasts.
so, with choice A, it is likely to be a chronic problem. It might be an unavoidable one and the drugs worked but the underlying nerve is broken. Or it might be only a sign of drug withdrawal and it will eventually get considerably better but it might take quite a while.
Choice B and C are possible. Valium is the longest half life. Ativan and Klonazepam are the next longest duration. Would not be my recommendation for someone who has had adverse effects from drugs to try similar ones. Generally we would recommend trying a very different choice.
But this brings up the main issue... where one is getting the drugs. If one is getting them prescribed, then the prescriber of them should advise. If you are getting them off the street without a prescripton, this implies a drug problem and is a reason to get medical intervention and also use the medical intervention to get better tinitus treatment as outlined above.
Ok, let us start with the tinnitus.
Detailed Answer:
It's from an overactive nerve in the ear. The benzodiazepines work on this because they damp down nerve activity. There are a LOT of other medicines that can also damp down nerve activity. If they worked exactly like benzodiazepine., they would be identically addictive. There are many (seizure mediicines) that often work on tinnitus if benzodiazepine does and are NOT at all addictive. Gabapentin isn't the strongest but it is the safest as one of many possibilities.
So, first choice is substitution with a non-benzo.
HOWEVER, stopping benzo's is associated not just with overly active ear nerves but overactive nerves everywhere and this can produce seizures that can even be fatal.
Reasonably someone might say that if they've reduced them by two thirds, then isn't the rest of the reduction not as bad and not as risky as what's already been tolerated? Yeah, mostly. Isn't zolpidem safter to stop than other benzodiazepine well.. yes... especially if it was taken ONLY once a day. IF it was taken 4 times a day then it is risky to stop it suddenly definitely. If once a day, you might want some direct medical observation when stopping it; if more than once a day you really HAVE to have supervision when lowering the dose or stopping it.
For these reasons substituting the fairly weak benzodiazipine (zolpidem) with a stronger one is not recommended.
If stopping a benzo suddenly, the increased activity of the nervous system certainly lasts days and might last weeks. My tinnitus got worse 2 years ago and I just got used to it. Too much loud Trump podcasts.
so, with choice A, it is likely to be a chronic problem. It might be an unavoidable one and the drugs worked but the underlying nerve is broken. Or it might be only a sign of drug withdrawal and it will eventually get considerably better but it might take quite a while.
Choice B and C are possible. Valium is the longest half life. Ativan and Klonazepam are the next longest duration. Would not be my recommendation for someone who has had adverse effects from drugs to try similar ones. Generally we would recommend trying a very different choice.
But this brings up the main issue... where one is getting the drugs. If one is getting them prescribed, then the prescriber of them should advise. If you are getting them off the street without a prescripton, this implies a drug problem and is a reason to get medical intervention and also use the medical intervention to get better tinitus treatment as outlined above.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Wachsman,
Many thanks for your detailed reply. Pregabalin has produced arrhythmia (Wenckebach) twice in me (very low dose) so wondering if Gabapentin might do the same thing... Other drugs that affect the CNS such as Amitriptyline have given me tachycardia - for six months - heart rate very easily increased.
Do you still think Gabapentin might be worth a try? Would I come off both the Oxazepam and Zolpidem at the same time? What sort of dosage might you recommend?
Other than that, which way would you go?
I get them on prescription, but from a GP. The GP doesn't understand that it's difficult getting off them and just recommends cold turkey... Hmmm... that's why I've contacted this site.
I originally took them for muscle spasms in the neck after a car accident 11 years ago (actually I started on Valium) but started using them for stress.
Many thanks
Many thanks for your detailed reply. Pregabalin has produced arrhythmia (Wenckebach) twice in me (very low dose) so wondering if Gabapentin might do the same thing... Other drugs that affect the CNS such as Amitriptyline have given me tachycardia - for six months - heart rate very easily increased.
Do you still think Gabapentin might be worth a try? Would I come off both the Oxazepam and Zolpidem at the same time? What sort of dosage might you recommend?
Other than that, which way would you go?
I get them on prescription, but from a GP. The GP doesn't understand that it's difficult getting off them and just recommends cold turkey... Hmmm... that's why I've contacted this site.
I originally took them for muscle spasms in the neck after a car accident 11 years ago (actually I started on Valium) but started using them for stress.
Many thanks
Brief Answer:
really good question.
Detailed Answer:
Gabapentin hasn't turned out to be as closely related to pregabalin as originally thought. Amitryptiline is not used in depression due to its effects on the heart.
Ok, there is a huge overlap between anti-arrhythmics and seizure medicines. DILANTIN is both. BUT it is a bit of a concern in WPW and should only be prescribed by a cardiologist! if someone has WPW.
Gabapentin is theoretically safe in WPW. In practice, it hasn't been a problem. Indeed, it is one of the safest drugs out there and doesn't have a firm upper limit. 300 mg tid is a standard starting dose. Even though it is a seizure medicine, it does NOT mean it is necessarily safe to stop any sort of benzodiazepine abruptly. Monitoring for problem while getting off of benzodiazepines is generally recommended. Generally they are not stopped cold turkey and people cut the usual dose they are taking by about half and see how that goes, then repeatnig that with a lower dose
really good question.
Detailed Answer:
Gabapentin hasn't turned out to be as closely related to pregabalin as originally thought. Amitryptiline is not used in depression due to its effects on the heart.
Ok, there is a huge overlap between anti-arrhythmics and seizure medicines. DILANTIN is both. BUT it is a bit of a concern in WPW and should only be prescribed by a cardiologist! if someone has WPW.
Gabapentin is theoretically safe in WPW. In practice, it hasn't been a problem. Indeed, it is one of the safest drugs out there and doesn't have a firm upper limit. 300 mg tid is a standard starting dose. Even though it is a seizure medicine, it does NOT mean it is necessarily safe to stop any sort of benzodiazepine abruptly. Monitoring for problem while getting off of benzodiazepines is generally recommended. Generally they are not stopped cold turkey and people cut the usual dose they are taking by about half and see how that goes, then repeatnig that with a lower dose
Note: In case of any other concern or query related to prevention, evaluation, diagnosis, treatment, or the recovery of persons with the any type of addiction or substance use, follow up with our Addiction Medicine Specialist. Click here to book a consultation now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
