Suggest Remedy For Back Pain While Detoxing Off Benzos And Vicodin

Posted on Sat, 25 Oct 2014

Question: I am detoxing off benzos and vicodin at the same time by myself. reducing a little every day. I have severe panic disorder and severe back pain so they were originally prescribed legally but I started taking too many and I have stop. my question is how do I tell an anxiety attack from the with drawls.

Answered by Dr. Ravi Soni (27 minutes later)

Brief Answer:
You just say them as withdrawal symptoms

Detailed Answer:
Hi, thanks for your query again XXXXXXX .

The question is somewhat confusing here.

Whether you are getting any withdrawal symptoms after detoxing gradually?
Whether you started having panic attacks after decreasing the dosage of benzos?
You dont know how to report anxiety symptoms from xanax withdrawal because you were taking it in a higher dose, nobody prescribed it that way?

Benzodiazepine withdrawal can cause disturbed sleep, anxiety symptoms, nausea and vomiting, perspiration, increased bloop pressure, tremors in hands, hallucinations, seizures and finally it can cause delirium etc..

The withdrawal symptoms from vicodin that is opioid are completely different..

the management of withdrawal symptoms from these drug is complex management issue and that should be under the observation of a psychiatrist or addiction medicine specialist.

I am here waiting for the simple question what you want to know? waiting for the reply. wishing you a good health..

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ravi Soni (1 hour later)

i am worried because i have hypertension to begin with and the panic attacks increase it.

Answered by Dr. Ravi Soni (8 hours later)

Brief Answer:
I would give beta blockers for that

Detailed Answer:
Hi, thanks for writing again.

So now I have understood that before starting all these drugs you were having hypertension and may be taking treatment for that.

In the withdrawal from Vicodin, a doctor used to prescribe drugs to lower anxiety symptoms, which reduces the blood pressure. If I would be your treating doctor I would have given you Beta blocker [drugs to lower blood pressure] to decrease your anxiety which also decreases your BP and helps you in controlling your hypertension.

I will plan to add a beta blocker drugs and increase the dose, depending upon the response you will show to the drug. I suggest you to discuss these issue about adding a beta blocker with your doctor and follow hid advice.

These drugs are propranolol [not cardioselective], atenolol, metoprolol etc. in severe cases another drug which is centrally acting antihypertensive, clonidine can be added, but it has some side effects which needs to be observed in your age, so I wont suggest you to take any of it without consultation to a physician or your specialist doctor..

I hope this will help you. if you have further queries feel free to ask..

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ravi Soni (13 hours later)

Oh, sorry about that doc, that box in the beginning that say meds. tried, i didnt know if it meant for my condition now, in the past, or am on now. Anywaqy, I am on hyzaar 100/25, been on ace inhibitor before that, hypertention now for about 20 yrs. Also on effexor 150 [any higher will also raise my BP], a statin, trazadone, vitamin supplements. But like i said I've had panic attacks before which is actually the reason I was put on xanax, but after 25-30 years i have built up such a tolerance to them, hence the abuse, not to get "high".

Answered by Dr. Ravi Soni (40 minutes later)

Brief Answer:
Better option is to SSRI drugs here

Detailed Answer:
Hi, thanks for writing again.

So, it is good that you are on antihypertensive meds. continue them and get your BP check regularly.

Here, I am thinking that if you have panic attacks and severe anxiety from the beginning, then you must have been given SSRI meds like paroxetine, sertraline, fluoxetine, escitalopram etc. At present also, you are on effexor [which is a SNRI drug] and trazodone [ which is a antidepressant drug but also controls anxiety].
If you are on effexor for long and it is not helping, doctor has limitation that he cant increase the dose because of your hypertension then the drug should be changed.

Better option in my opinion is SSRI drugs mentioned above. I would start my patients on 12.5 mg night dose of paroxetine [paxil] and gradually increase the dose as per the response.

These drugs [SSRI meds] controls anxiety from the brain neurotrnsmitter level and they are different from xanax. they will take long time to show their effect but effects are long lasting. response starts appearing within 15 to 20 days.

Another suggestion here is the addition of beta blocker drug as per advice from your treating doctor who is giving you a antihypertensive meds. with this combination you will have better control over anxiety and detoxification will be much more easier.

I hope this will be helpful to you. if you have further query feel free to ask. wishing you a good health..

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ravi Soni (50 minutes later)

i have been on several ssrsi's throughout the years, including paxil 40 mg. The only one that seemed to even help a little was zoloft. But that stopped helping after a few years and my doc says it will do no good to try it again. He is also reluctant to take me off the effexor, [I heard it is also awful to try to get off of]. I would never have went on it if i knew that.{now i dont know if that means just coming off it without starting something else, or either way. I only asked for it because a nfew people said it helped them a lot. The trazadone is actually prescribed for sleep, and it doesnt help at all with anxiety, actually just the opposite. Once i take i must be ready to stay in bed cause my heart will pound if i get up. As far as adding,[you did say adding ?] a beta blocker, I didnt know you could do that. I will ask at my next appt. Thing is in the past even going to the dr. would bring on anxiety so I would take my xanax, usually 2, before i went and my pressure would usually be ok. Even when the second number [diastolic?] over 90, he doesnt seem concerned. thank for your advice on adding the beta blocker, do you have any other besides adding an ssri, seeing as i have tried so many of them without much help?

Just re reading your last suggestion. Are you saying beta blockers will help lower anxiety, or the lowering of my bp will help with my anxiety?

Answered by Dr. Ravi Soni (8 hours later)

Brief Answer:
It will lower your Anxiety and BP both

Detailed Answer:
Hi, thanks for writing again.

Beta blockers are the drugs which block the receptor for the action of the neurotransmitter epinephrine and norepinephrine. receptors are alpha and beta. beta blockers also work on alpha receptors.

In hypertension, cardioselective beta blockers are advice [which acts only on heart and lowers blood pressure], while in anxiety non selective beta blockers like propranolol is advised, which acts on all the receptors and lowers the anxiety. when a person has stage fear or exam fear, we advise to take this drug to lower anxiety.

Adding a drug to you depends upon the opinion from your cardilogist and your psychiatrist. Propranolol will help you a lot, but you have to take precaution while rising from the bed, similar with trazodone but not as severe as traz.

If your BP remains on higher side then propranolol further bring it down to normal level.

In SSRI, prozac is very good drug. Apart from that tricyclic antidepressant drugs like, nortriptyline, amitriptyline, imipramine can also be tried. these drugs have high rated of side effects but they are old drugs and of gold standard. Before the invention of SSRIs these drugs were the only to use and quite effective.

Another helpful drug can be the mirtazapine also discuss about it with your doctor in next visit.

Anything you will do is only after you discuss it with your doctor.

Hope I have tried my best to help you. wishing you a good health.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Ravi Soni (14 hours later)

Thanks, doc. I was thinking about trying remeron but my doc seems set on this damn effexor. I can probably get it if I am insistant, but can I go on that and stop the effexor at once, or taper off effexor 1st, which will be a nightmare, or take both. Oh, I also tried imiprimine, nohelp. As far as the beta blocker, that is only for social anxiety, am I correct? And i believe your not supposed to take it if you have severe depression, correct me if I am wrong.

OH, forgot to ask, My doc keeps switching me between xanax and klonopin every 3 mos. since i have been taking xanax for so long and built up a tolerance. He says this will help by giving it a time to "rest". Did you ever hear of this? I mean theyre both benzos, which leads me to another question, What is the equivalent between these 2? Like how many mg. klonopin = 1mg. xanax. I keep getting different answers.

Answered by Dr. Ravi Soni (10 hours later)

Brief Answer:
Give a try to propranolol

Detailed Answer:
Hi, thanks for your query again.

yeah, you should discuss about remeron with your doctor.

Propranolol has been shown to cause depressive symptoms in some patients.these kind of side effects are not occurring with every patients, there is a chance of 1 to 2% only. Just because they are reported does not mean they occur in each and every patient. So do not think much over the drugs, it is more important to control anxiety symptoms at present. It is not only prescribed for social anxiety, the indications written in the books are completely different in clinical practice.

the equivalent dose of xanax 0.5 mg = klonopin 1 mg. these is give differently by XXXXXXX and british guidelines.

If xanax has developed tolerance then repeatedly giving the same medication is questionable. actually your doctor must be withdrawing it because it is of short half life and has highest chances of causing addiction. So I think he must be doing it for your best interest. These kind of strategies are not written in books but in clinical practice everyone has their own strategies. So believe in him and follow his advice..

I hope this will be helpful to you.. best of luck..

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ravi Soni (13 hours later)

Thanx doc, ill see if my doc will do it. Actually iwas on Inderal about 25 years ago, before Xanax, but ill give it another try. Also im down to 3-4 klonopin a day. That means im down to like 2 Xanax? Yeah, me!

Oh, doc, you didn't answer my question about the remeron. Can I take along with the Effexor, take it along with and stop or taper off the Effexor?

Answered by Dr. Ravi Soni (9 hours later)

Brief Answer:
Effexor and remeron can be taken together

Detailed Answer:
Hi, thanks for writing again.

Inderal should be given a try.

Yeah, remeron can be started along with Effexor but the discontinuation of it should be done only after a therapeutic dose is reached. this is because if you discontinue effexor before achieving the therapeutic dose of remeron you might have problems with your anxiety and depression.

Another important thing here is, the combination of effexor and remeron is indicated in resistant depression, though you have not clear cut depression but i feel the combination can also work for you. Try to talk about, continuing the effexor and adding remeron to it, with your doctor.

Hi, I hope this will help you..wishing you a good health..

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Yogesh D