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Benzodiazepine FAQ

FREQUENTLY ASKED QUESTIONS

(1) Why do so many people get symptoms such as tingling, burning and numbness etc on the left side of the body rather than the right side of the body?

(2) Should I use phenobarbitol to come off of benzodiazepines?

(3) What is a drug half life?

(4) What is an active metabolite?

(5) I missed a dose of diazepam. Should I take it now?

(6) What does stabalising mean?

(7) Should I avoid Sugar?

(8) Can I drink alcohol during or after withdrawal?

(9) Why should I not take fluoroquinolone antibiotics?

(10) Are synthetic artificial sweetners such as aspartame fine to take?

(11) Should I avoid Caffeine?

(12) Are there any drugs which I can take to help withdrawal effects?

(13) How do I withdraw from other medications I am on which are not benzodiazepines?

(14) How do I know whether my symptoms are from benzos or from my other medications?

(15) After I have withdrawn from benzos can I take them occasionally?

(16) I am in protracted withdrawal and I am considering reinstating, should I?

(17) Should I take supplements or herbs for benzodiazepine withdrawal?

(18) Should I try Cognitive Behavioural Therapy for my symptoms?

(19) Is there a difference between different generic preperations of drugs?

(20) What does cross tolerance mean?

(21) I take several drugs. Which drug should I reduce first?

(1) Question: Why do so many people get symptoms such as tingling, burning and numbness etc on the left side of the body rather than the right side of the body?

Answer: This is commonly reported. The exact reasons for this phenomenom is not known but it may be that GABA-BZD receptors are more dense in the right hemisphere of the brain or more sensitive to the affects of benzos than the left.

(2) Question: Should I use phenobarbitol to come off of benzodiazepines?

Answer: Don't use the pheno. Barbiturates are cross tolerant with benzodiazepines but they don't work exactly the same. Phenobarbitol works on barbiturate receptors which directly gate or open the chloride ion channel whereas benzodiazepines increase the opening frequency. They have a different mechanism of action at the GABAa receptor than the benzodiazepines and Z drugs and thus you may only end up complicating matters by using pheno.

(3) Question: What is a drug half life?

Answer: The half life is the amount of time for a drug to be eliminated from the blood stream. Say the half life of a drug is 10 hours for example: After taking for example 20 mg then after 10 hours it would decrease to 10 mg and then 10 hours later to 5 mg and then 10 hours after that 2.5 mg, then 1.25 mg and so on until the drug is undetectable. In terms of drug withdrawal, the shorter the half life, the more quickly and intensely withdrawal symptoms will be experienced upon dosage reduction. Also short acting drugs can produce interdose withdrawal where withdrawal symptoms are experienced inbetween doses as the previous dose begins to wear off.

(4) Question: What is an active metabolite?

Answer: Some drugs also produce what is called an active metabolite during metabolism. An active metabolite is a metabolite of a drug which shares the same pharmacological properties of the origional or parent drug.

(5) Question: I missed a dose of diazepam. Should I take it now?

Answer: When talking about missed doses of diazepam, a general rule of thumb is if you forget to take it at a specific time and it has been less than 24 hours since the missed dose when you remember then just take it. If it is more than 24 hours since you missed the dose just carry on with your normal dosing regime. As diazepam is very long acting it can actually be taken as a single daily dose with very little fluctuation in blood levels over a 24 period. It is different if you are taking short acting compounds but with diazepam as long as the same dose is taken within a 24 hour period it should be fine.

(6) Question: What does stabalising mean?

Answer: Stabalising is your body getting used to a fixed dose of benzodiazepine. Stabalising can refer to the period after crossing from your benzodiazepine to the long acting benzodiazepine diazepam. Stabalisation can also refer to waiting for withdrawal symptoms to abate after making a dosage reduction. Stabalisation does not mean that a person will feel 100%, many people have some adverse symptoms on chronic benzodiazepines and don't feel well on the drug which is often why they want to withdraw. Stabalisation often means having tolerable symptoms which are bearable from being on a stable constant dose.

(7) Question: Should I avoid Sugar?

Answer: There shouldn't be any need to entirely cut out sugar for most people. However, sugar can be stimulating and cutting down on the amount consumed may help reduce symptoms especially in the early weeks and months of withdrawal when the system is very sensitive. Best way of cutting down on sugar is to make sure you eat complex carbohydrates and fill yourself up with them before having any sugary foods. So for breakfast you could have your cornflakes or for meals you could have potato's or pasta or whatever, so after a meal you will find yourself almost full and you will only need a small sugary snack to satisfy your appetite whereas if you skip meals or have sugary snacks shortly before your main meals you will end up eating twice as much sugary foods and half what you should be eating of complex carbohydrates. A small amount of sugary foods a day shouldn't do any harm. As far as sugar goes moderation is the key!

(8) Question: Can I drink alcohol during or after withdrawal?

Answer: No. You should not drink any alcohol. Alcohol is cross tolerant with benzodiazepines and is benzo like. Many people find that alcohol usage causes a return or worsening of withdrawal symptoms the days and weeks after exposure to alcohol. This becomes even more of a problem once a person is low down on benzo dosage or in withdrawal. If you want to recover from benzodiazepines it is strongly advised that alcohol is avoided entirely and for quite some time after full recovery.

(9) Question: Why should I not take fluoroquinolone antibiotics?

Answer: Fluoroquinolones should not be taken during benzodiazepine dependency or in withdrawal as they displace benzodiazepines from their receptor, in laboratory studies, they have GABA antagonist effects and are renowned for causing major problem for the majority of people who take them during benzodiazepine dependency and withdrawal. I cannot warn any stronger about the risks of taking these drugs. We have had people admitted with status epilepticus to intensive care facilities and suicides on benzo support groups from the consumption of fluoroquinolone antibiotics during benzo dependency or withdrawal. Adverse reactions to fluoroquinolones although they seem much more common in the benzodiazepine dependent population of people, they do ruin a lot of "non benzo" people's lives causing permanent peripheral neuropathy and long term central nervous system damage, joint, tendon damage, muscular damage and a wide range of other problems. You can visit these web sites to read about victims of these drugs FQresearch, FQvictims and Fluroquinolones websites to read about the effects of these drugs. I predict the truth will come out about these drugs or at least the partial truth in a couple of decades (after the patents expire), as that seems to be how long it takes the truth to come out about many of these rogue drugs eg lariam, ro-accutane etc as it took 30 years for the partial truth to come out about benzodiazepines. Fluoroquinolone is a drug class and they have many generic and brand names so if you are prescribed an antibiotic you will need to check that it is not a fluoroquinolone.

(10) Question: Are synthetic artificial sweetners such as aspartame fine to take?

Answer: Synthetic artificial sweetners should be avoided especially aspartame which has been linked to brain tumours and a host of other conditions and remains controversial to this day after decades on the market. One of the byproducts it is metabolised to is carcinogenic and the other metabolites affect the brain chemistry with reports of aspartame causing seizures, mania, dizziness, brain fog, muscle cramps, tingling, numbness, insomnia, skin rashes, anxiety and depression. Another metabolite is methanol which is only very slowly eliminated from the body and accumulates and is 200 times more toxic than ethanol (alcohol). Formaldehyde is another metabolite of aspartame. Because aspartame toxic stimulant effects on the CNS it is classified as an excitotoxin. By far the most controversial aspect of aspartame is its brain tumour promoting effects in preclinical trials with some of the origional scientists speaking out about how the pharmaceutical firm Searl tried to cover up these results and how the FDA initially refused to approve it until an intervention by Donald Rumsfeld in the 1980's. One of the controversies is the large increase in diagnosed brain tumours after the approval of aspartame which continues to this day which is alledgedly and controversially claimed to be the result of aspartame and its carcinogenic metabolite of aspartic acid.
Common sources of aspartame is sugarless gum and diet drinks and foods. Ordinary natural sugar is a much safer alternative than aspartame.
Other synthetic artificial sweentners also have some controversy associated with them eg sucralose (Splenda).
Further reading on aspartame's effect as an ant poison
FoxNews Report on Aspartame on youtube.

(11) Question: Should I avoid Caffeine?

Answer: Caffeine is a stimulant and is well known to cause anxiety and insomnia in a lot of people. People in benzodiazepine withdrawal may be more sensitive to caffeine than usual. Caffeine is an addictive drug and suddenly stopping it may lead to withdrawal effects such as depression, craving, irritability and commonly headaches. Caffeine works on completely different receptors from benzodiazepines and shouldn't stop benzodiazepine withdrawal from progressing. However we are all different and some people find caffeine irritates their symptoms and feel they have to quit this. As caffeine is an addictive drug it is probably best to gradually taper the dose of caffeine down over a period of a month or two in order to avoid withdrawal effects.
Caffeine is found in high quantities in chocolate and also various commercial drinks.

(12) Question: Are there any drugs which I can take to help withdrawal effects?

Answer: It is very unlikely that you will find any drug which will have any significant effect on withdrawal symptoms unless it is a drug which has similar properties to benzodiazepines, eg working on the GABA receptor complex in the brain. Taking drugs with similar properties to benzodiazepines eg the so called "nonbenzodiazepine" Z Drug hypnotic sleeping pills which work on benzodiazepine receptors is simply keeping the addiction going and the same is true for alcohol as mentioned above. The chances are more likely that you will feel either no benefit or worse from taking additional drugs as many people withdrawing from benzos are very drug sensitive as their CNS is compromised from the long term use and withdrawal from benzodiazepines and therefore will be much more likely to suffer adverse effects than the general public. Furthermore although benzodiazepines are the most difficult drugs to withdraw from, it is fairly safe to state that all drugs which affect the Central Nervous System will likely cause a withdrawal syndrome upon discontinuation.

(13) Question: How do I withdraw from other medications I am on which are not benzodiazepines?

Answer: We are only experienced in withdrawal of benzodiazepines and benzodiazepine like drugs so it would be impossible to give advice on every individual drug or drug class as there are literally thousands of different drug classes on the market. It is recommended that no drug is abruptly discontinued especially if it affects the central nervous system. Withdrawal from other drugs should be carried out in a similar fashion to benzodiazepines with a gradual reduction in dosage every few weeks of roughly 10%. Finding the generic name of your medication and doing a simple google or pubmed search including the generic name of your drug and the term half life should generate how rapidly eliminated the drug is and this should give you a rough idea of how quickly (or slowly) the drug is eliminated from the blood stream. As a general rule drugs with a half life of 24 hours or more can be taken once or twice daily. Drugs with a half life of 12 hours or more probably need to be taken 3 times daily and those with a shorter half life will need to be taken 4 times daily and gradually tapering the doses down accordingly. Google can be a great friend in gathering the basic pharmacokinetics (eg the half life) of your medication in order for you to formulate a withdrawal plan for "other drugs" unrelated to benzo or benzo like drugs.

(14) Question: How do I know whether my symptoms are from benzos or from my other medications?

Answer: As stated in the above answer there are thousands of drugs out on the market and it is impossible for us to determine for every person whether one drug is or is not causing a symptom or whether it is related to benzodiazepine withdrawal. It is recommended that you search Google for your medication with the key words side effects or the name of your medication and the symptom if you have any concerns. For example beta blockers eg propranolol can cause insomnia and statins can cause muscular and memory problems, SSRI's can cause anxiety and so on. These are all symptoms which one can get from coming off benzos. Like what has just been said there are simply thousands of medications out there and it will have to be up to the individual to do their own research to determine as to what is causing what symptom.

(15) Question: After I have withdrawn from benzos can I take them occasionally?

Answer: No you can't. Once your body has been addicted to a drug you can't re-expose it to the drug without consequences. Most of you readers will have heard of smokers who have quit for years or even decades and they have one cigarette and all their withdrawals and cravings come back and they are back on the smokes. This is true for other drugs of tolerance and dependence such as alcohol and unfortunately also benzos. This is a physiological problem not a psychological problem. Many people think that they can just take one and use their determination to keep it to occasional usage and don't understand that the body stays hypersensitive to the drug for years afterwards with persisting tolerance. A lot of people find that withdrawal effects return and they are worse after taking the occasional benzo than before they took it in this scenario. The brain stays tolerant to the drug and sensitised to the drug. So often taking the drug will typically cause a return of withdrawal effects after the benzo dose wears off and set your recovery back in time. Sometimes withdrawal effects can return very strongly after taking an occasional benzo.

(16) Question: I am in protracted withdrawal and I am considering reinstating, should I?

Answer: Reinstating or "going back on" after being off benzos for more than a couple of weeks is fairly unpredictable and is generally advised against unless the person is severely suicidal. The results from reinstating for protracted withdrawal are very unpredictable. It seems a lot of people find the pills don't work the way they did before they came off. Some people do get relief of withdrawal effects by reinstating for protracted withdrawal but often people either get no relief or only a few days of relief before feeling like they are back in withdrawal again even on a stable dose. Occasionally people actually feel worse, sometimes developing severe paradoxical reactions when reinstating for protracted withdrawal. When you come off the pills your benzodiazepine brain receptors switch states and there are all sorts of complex chemical and physiological changes involving gene transcription coding when you go into the post withdrawal phase and thus going back on pills has unpredictable effects in a lot of people. Some people from reinstating for protracted withdrawal do get relief but for many others they get little or no relief and for some they even feel worse and go paradoxical. In laymans terms you shouldn't generally interupt the delicate healing process of the central nervous system once it has begun. Another problem is to use the medical terminology, is the kindling effect, the kindling effect is where multiple withdrawals, putting the body into withdrawal and out of withdrawal multiple times can cause a hypersensitisation of the receptor systems and thus causing the nervous system to be hypersensitised which can lead people to not being able to stabalise on their benzos as well as they used to and as well as to feeling toxic on the drugs and as well as finding that each withdrawal is worse than the previous. In simple laymans terms it is often but not always harder the 2nd time around and even harder the 3rd time around at withdrawal, in people who have completely withdrawn and then went back on. This does not seem to be the case for people who have partially tapered down their dosage and then upped dose. It seems only the case for those who have completely withdrawn for more than a couple of weeks and then went back on multiple times.

(17) Question: Should I take supplements or herbs for benzodiazepine withdrawal?

Answer: There shouldn't be any need for supplements unless you have a serious deficiency which I doubt many readers will have. A simple blood test can check your basic biochemical and nutritional status. B vitamins are quite well known for causing anxiety and stimulating like effects in people withdrawing from benzos. It is much better if you try to get your nutrition from natural sources eg food so your body takes what it needs from the food in small amounts over the course of the day. With supplements there is a big flood all at once of nutrients much more than the body needs and this can have a mild drug like effect with some unpleasant symptoms and side effects in some people. I am not saying that supplements are as bad as benzos of course but I am just saying that a lot of people are sensitive to supplements especially in withdrawal. Also it is unlikely that you would benefit unless you were genuinely deficient. If you would like to make sure you are getting enough nutrition you should do some research on google on omega 3 rich foods, maybe eat more fresh fruit and vegetables (preferably organic), have a salad a couple of times a week and you will have the healthiest diet on your street with no side effects and all the nutrients that you need. Make sure you eat a diet rich in omega3, protein, vitamins and minerals and you will have all the nutrition you need. Some raw vegetables once or twice a week is even better for getting the best nutrition.
Some herbs for example KAVA and valerian and many others actually are benzo like drugs and work on the benzodiazepine receptors! This has been investigated in many neuroscience animal radiolabled binding studies and most of these herbs with sedative like properties have been demonstrated to work via the GABA-benzodiazepine receptor complex. Infact KAVA is an banned controlled drug is some countries around the world due to toxicity and abuse potential! Although most herbs sold over the counter are much weaker than pharmaceuticals many of them still exert pharmacological properties. So essentially they are less potent drugs. Infact natural herbal and plant extracts make up some of the most potent drugs we know including diamorphine (heroin) which for arguments sake could be said to be a flower extract and cocaine for arguments sake could be classed as a plant leaf extract and aspirin as bark extract. Extreme examples but you see the FAQ's point that natural drugs are not without pharmacological activity and thus side effects and interactions albeit probably less than many concentrated prescription drugs.

(18) Question: Should I try Cognitive Behavioural Therapy for my symptoms?

Answer: This depends on several factors. Firstly if you are currently taking benzodiazepines you should not receive CBT because simply at best you are likely to be wasting your time. There have been studies on CBT and most have found that CBT is ineffective whilst a person is still on benzodiazepine drugs. This is because benzodiazepines inhibit the learning of certain new skills especially cognitive and emotional skills. People who are still on benzodiazepines respond best to psychological support, such as reassurance, confirmation of the problem, understanding and practical withdrawal advice and information. Who provides that support can be a family member, a counsellor, a support group or religious leader, anyone who is willing to listen, learn, encourage and reassure. it should be born in mind most people unless they have been through benzo withdrawal will not be able to understand so the aim often is not to find someone knowledgable in benzos but the aim is more to find someone who is willing to listen and learn and believe you over time.
Once a person is off benzos CBT becomes more effective. It may be effective in people who have some phobia's or anxiety problems prior to benzodiazepines which still remain. I am sceptical of how successful CBT is for withdrawal symptoms as withdrawal symptoms are not a psychological problem but a physiological problem as a result of tolerance and toxicity and thus improvements seen in people receiving CBT may likely have nothing to do with CBT but have everything to do with withdrawal symptoms and after effects of the drugs improving as the months pass by as the body heals and thus it probably is not of any great or any benefit at all in improving benzodiazepine withdrawal in the opinion of this FAQ. Withdrawal symptoms get better regardless of CBT.
This is not to knock CBT in general however, it is certainly appears to be benefitial to a lot of people who have various other conditions and is certainly a big improvement on the money driven poly-drugging pharmaceutical model. Th FAQ is only sceptical of CBT's benefits specifically in benzodiazepine dependence, toxicity and withdrawal. CBT is seems benefitial in other areas such as mental health and a good non-drug alternative for various conditions.

(19) Question: Is there a difference between different generic preperations of drugs?

Answer: Yes. There can be some differences between the different generic brands. I have heard and read that ther can be up to 20% differences in dosage between the different generic drugs.
There can legally be a variation by think 20% in dosage between different generic drugs. If you notice some withdrawal effects from switching brand names you have two choices. Either switch to another brand or make of the drug in question or else treat it as a dose cut and wait for your body to get used to the difference in dose. You could ask your pharmacy if there is an alternative brand name that they stock that you could use or try. If there is a difference in dosage, like less, then you could just treat it as a dose reduction and wait for your body to level out on it. Your doctor and pharmacy would be your best bet to see if they could try you on a different generic brand name if you are experiencing any difficulty switching between brand names of the same drug.

(20) Question: What does cross tolerance mean?

Answer: Cross tolerant drugs are drugs which work on the same systems in the brain or body, by a similar or the same mechanism. Typically if you are tolerant to one drug and you take another drug which is cross tolerant you will have a reduced effect as you will already be tolerant to the drug. So say someone takes lorazepam regularly and then decide to take zopiclone instead of the lorazepam they will find that the zopiclone has a significantly reduced effect than someone who has never taken a cross tolerant GABAergic drug regularly before.
Also typically cross tolerant drugs will alleviate the withdrawal effects of another cross tolerant drug. For example the GABAergic drug families such as the barbiturates, benzodiazepines and the "non"-benzodiazepines will alleviate alcohol withdrawal and vice versa.
Cross tolerant drugs also have the capability of reactivating withdrawal effects in someone who has discontinued a drug they have been physically dependent on and also increasing a persons tolerance level if it is taken on top of the drug they are currently dependent on. For example if someone is tolerant and physically dependent on diazepam takes zopiclone or alcohol, their tolerance level may then be elevated and this may result in rebound withdrawal effects the next day.
Alcohol, benzodiazepines, nonbenzodiazepines, corticosteroids and barbiturates are all cross tolerant with one another and all work on the GABAa receptor complex via enhancing its function.

(21) Question: I take several drugs. Which drug should I reduce first?

Answer: Many people are on multiple medications which are often not needed, prescribed inappropriately or not are working and the individual may want to withdraw from other medications which are not benzos or Z drugs for example antidepressants or antipsychotics etc. As a general rule and in the majority of cases benzodiazepines or Z drugs should be gradually withdrawn first followed by gradually withdrawing other drugs such as antidepressants, antipsychotics or other psychotropic or other drugs. However, if someone is suffering acute and pronounced adverse effects such as akathesia, agitation or insomnia from say an antidepressant or antipsychotic to use as examples then it may be wise in this instance to gradually reduce the dose to a lower dose or even withdraw completely from the antidepressant or antipsychotic drug first before beginning the reduction in dosage of benzodiazepine or Z drug. It is also recommended that if you take medications for a condition which impairs insight into your condition for example schizophrenia that you do not reduce medications unless you are supervised by a doctor or healthcare professional who can monitor whether you're condition is deteriorating during dosage reduction. Decisions on whether to withdraw from any class of drug always lie with the individual taking a particular drug as only the individual can determine whether they require a particular medication or whether they want to withdraw and whether the benefits of withdrawing outweigh the risks.

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