This is my least favorite benzodiazepine to use. Shrink Rap explains the reasons why.
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{ 4 comments }
I hate Rx’ing Xanax, too! And now there’s the CR version. I’ve been using Xanax CR for years. It’s called Ativan.
All of the benzos have their positive and negative issues. Xanax is certainly a good choice for some because of the way it acts, quickly and briefly. So for the claustrophobic, some Xanax 30 min prior to an MRI is a good thing.
One of my favorites is clonazepam (Klonopin). I don’t think it’s as “heavy” as Ativan, and I think the abuse potential is less — when people take too much they conk out. It’s especially useful for a variety of evening/nocturnal leg cramping syndromes.
Xanax was overmarketed. For a potent benzo I use a lot more clonazepam. For many patients where less potency will serve, Valium is still a good choice–long half-life means fewer ups and downs. Fewer withdrawel problems and not as aggressively abused. I have had some patients doing well on a mere 5 or 10 a day for 20 plus years with no problems and good control of what had been life-long chronic anxiety.
Yeah, the Xanax CR only delays the *release* of the drug, not the half-life, so it does not resolve the problem with sudden discontinuation… you may still get a seizure, but instead of having it 36 hours after your last dose, maybe it will be 44 hours.
Valium, Librium, and Ativan are our most commonly used benzos (this is in a general hospital, mostly inpatient, setting). The Valium (diazepam) and Librium (chlordiazepoxide) are particularly helpful in treating alcohol or benzo withdrawal due to their longer half-life. Get enough of a loading dose in, and they mostly self-taper, reducing the likelihood of severe withdrawal from *that* drug. I can’t tell you how many times I get a consult for someone agitated and hallucinating after coming out of the ICU where theywere initially successfully treated with Ativan for DTs. The symptoms stop, the Ativan stops, and the withdrawal returns. (I ask them if they also DC the O2 after their pulse ox returns from 86% to 97%).
(Thanks for the link.)
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