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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Chairman_MAO on March 12, 2011, at 0:49:44
In reply to Phenobarbital as a benzo detox » ed_uk, posted by Quintal on December 23, 2006, at 10:48:11
There is no reason to resort to using phenobarbital unless you cannot obtain benzodiazepines for some reason. If your benzo dose were high enough, you could still seize or be *very* uncomfortable. Trust me, don't go there.
IMHO, the best benzodiazepine to use for detox is Tranxene (clorazepate). In theory, you could give a huge loading dose (or titrate to effect by dosing every hour or two). Clorazepate is a prodrug for nordiazepam, which has a very long half-life (36-200+ hours).
Posted by Phillipa on March 12, 2011, at 11:33:29
In reply to Re: Phenobarbital as a benzo detox » Quintal, posted by Chairman_MAO on March 12, 2011, at 0:49:44
Is he here? Haven't seen a post from him in ages. Phenobarbitol is strong stuff though. Phillipa
Posted by Chairman_MAO on September 29, 2011, at 16:22:57
In reply to Re: Phenobarbital as a benzo detox » Chairman_MAO, posted by Phillipa on March 12, 2011, at 11:33:29
Actually, yeah, I am. ;-)
Hello.
Phenobarbital is not the drug of choice.
Posted by Phillipa on September 29, 2011, at 19:58:58
In reply to Re: Phenobarbital as a benzo detox, posted by Chairman_MAO on September 29, 2011, at 16:22:57
Welcome back Phillipa
Posted by jono_in_adelaide on September 30, 2011, at 19:42:22
In reply to Re: Phenobarbital as a benzo detox » Chairman_MAO, posted by Phillipa on September 29, 2011, at 19:58:58
This seems to be mainly an american thing - never heard of it being done in Australia.
here, we tend to use diazepam, which is also a prodrug, for benzo detox.
Posted by SLS on October 1, 2011, at 6:34:57
In reply to Re: Phenobarbital as a benzo detox, posted by jono_in_adelaide on September 30, 2011, at 19:42:22
I would be interested to know if anyone had thought to use an anticonvulsant to help ease the symptoms of BZD withdrawal. I am guessing that a component of the withdrawal syndrome involves kindling. Perhaps kindling increases the severity and persistence of withdrawal.
I was thinking Trileptal or Neurontin.
- Scott
Posted by Chairman_MAO on October 1, 2011, at 15:33:29
In reply to Re: Phenobarbital as a benzo detox, posted by SLS on October 1, 2011, at 6:34:57
I'm almost positive kindling is a big factor, and you're probably right.
I think carbamazepine has been used in treating benzodiazepine withdrawal, but really the only safe way to deal with this is to use a benzo to taper.
For the life of me I don't know why they just don't use huge loading doses of clorazepate and then taper that gradually. It seems ideal for it (prodrug for nordazepam--even available in an extended-release formulation!)
Posted by Chairman_MAO on October 5, 2011, at 23:09:10
In reply to Re: Phenobarbital as a benzo detox, posted by SLS on October 1, 2011, at 6:34:57
If I had to pick one off the top of my head, this layman's choice would be topiramate (many mechanisms of action). Oh, and throw in memantine on top of that also for good measure (each drug acts as a blocker of a different subtype of glutamate receptor).
Tegretol certainly has been used in the past. Complex topic, and I'm off to bed.
What do you think?
Posted by SLS on October 6, 2011, at 5:31:47
In reply to Re: Phenobarbital as a benzo detox » SLS, posted by Chairman_MAO on October 5, 2011, at 23:09:10
> If I had to pick one off the top of my head, this layman's choice would be topiramate (many mechanisms of action). Oh, and throw in memantine on top of that also for good measure (each drug acts as a blocker of a different subtype of glutamate receptor).
>
> Tegretol certainly has been used in the past. Complex topic, and I'm off to bed.
>
> What do you think?Your proposed cocktail is intriguing. I would not have thought to add memantine to the list. I think there must be antiglutamatergic and anti-kindling properties combined. I guess pro-GABAergic drugs would help with anxiety.
I know that topiramate keeps being ascribed more and more mechanisms. What are the properties that you are aware of? Topiramate is probably under-utilized because of its liabilities for cognitive
side effects and kidney stones if it is not administered carefully. If dosages are kept between 100mg and 200mg and the drug is titrated very gradually, these can be avoided for the most part.
- Scott
Posted by Chairman_MAO on October 6, 2011, at 11:59:21
In reply to Re: Phenobarbital as a benzo detox » Chairman_MAO, posted by SLS on October 6, 2011, at 5:31:47
Disclaimer: fact-check everything I am saying here, please.
Ultimately, there is nothing that is going to make this process easy because of the neurophysiological changes that have occurred in the GABA receptor complexes. You could put someone on a cocktail of phenobarbital, topiramate, memantine and whatever else and benzo withdrawal is _still_ going to be a hell ride. You can prevent seizures, delirium, some agitation, etc., but ultimately there's just nothing I'm aware of that can be done.
From wikipedia: "The exact mechanism of action is unknown,[38] but four properties that may contribute to topiramate's antiepileptic and antimigraine efficacy include a blockage of voltage-dependent sodium channels, an augmentation of gamma-aminobutyrate acid activity at some subtypes of the GABA- A receptors, antagonism of AMPA/kainate subtype of the glutamate receptor, and inhibition of the carbonic anhydrase enzyme, particularly isozymes II and IV ."
OK, so just get that up to a high dose (and forget about having working memory for a while) and add memantine. How much broader of a net can one cover?
Call me crazy, but I think the easiest thing to do is probably administer a gargantuan loading dose of clorazepate and let the nordazepam just taper itself. There is probably some reason this is not done, but I'd like someone to clue me in as to the reason Tranxene is not the drug of choice for benzo discontinuation.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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