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Dr. Bob is Robert Hsiung, MD,
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Posted by greywolf on March 31, 2006, at 15:00:50
In reply to Re: Is Valium more potent than Xanax?, posted by Sobriquet Style on March 31, 2006, at 11:08:35
I think you have to distinguish between "addiction" and "habituation." It is my understanding that addiction rates between Valium and Xanax are relatively similar, but that Xanax is more habituating.
Posted by ed_uk on March 31, 2006, at 15:30:06
In reply to Re: Is Valium more potent than Xanax?, posted by greywolf on March 31, 2006, at 15:00:50
Diazepam (Valium) is extremely unfashionable among doctors in the US. This is not based on science, it is based on reputation. Diazepam is a very old benzo, it was introduced a long time before clonazepam (Klonopin). It has, as a result, had plenty of time to establish itself a bad reputation. If clonazepam (Klonopin) was an older benzo than Valium, Klonopin would be the one with the bad reputation. All benzos are useful drugs. Nevertheless, all benzos are associated with the development of physical dependence, hence the bad reputation.
Different countries have different fashions. In the UK, diazepam (Valium) is the most frequently prescribed benzo for severe anxiety. Diazepam is also popular in Australia. In the US, Klonopin is the 'it' benzo.
>Is Valium more potent than Xanax?
No, Valium is about 10 times less potent than Xanax. 1mg Xanax is equivalent to about 10mg Valium.
Ed
Posted by yxibow on March 31, 2006, at 15:33:39
In reply to Re: Is Valium more potent than Xanax?, posted by greywolf on March 31, 2006, at 15:00:50
> I think you have to distinguish between "addiction" and "habituation." It is my understanding that addiction rates between Valium and Xanax are relatively similar, but that Xanax is more habituating.
>
>(all caps are substituted for bold, not yelling)
And we come to the addiction and habituation argument threads... I've beat various dead horses and unicorns despite being a pacifist over things... lets see.. wildebeest this time. Benzodiazepines have more potential for HABITUATION than addiction (some, when properly prescribed, and in the right hands).
I'm actually rather surprised that the Dr would prescribe a medication (Xanax) that has to be taken up to to 4 times a day (it has in some people a half life as little as 4-6 hours), and has street abuse potential (that is ADDICTION -- the use and escalation of dose of drugs for no medical purposes, in my dictionary.) Valium has low street abuse potential, with its 3 metabolites has a half life exceeding 24 hours although it can be dosed more than once a day if desired. But if your doctor is convinced that way, then that's how you should follow it unless you want a second opinion. I just find it odd, personally.
And potent is subjective -- to me, Xanax is more potent than either Ativan, Valium, or Klonopin (in descending order)... that is, time from the pill entering your system to efficacy and also it has a sense of immediacy -- a slight "rush" at times.
My 2c
Cheers- J
Posted by ed_uk on March 31, 2006, at 15:48:05
In reply to Re: Is Valium more potent than Xanax? » Sobriquet Style, posted by zazenduck on March 31, 2006, at 11:49:53
American psychiatrists are unlikely to be familiar with Valium as they prescribe it so rarely. Their opinions of Valium are therefore valueless, as they have virtually no experience with it. There is no reason to believe that Valium causes more side effects than Klonopin. Valium is easier to taper than most benzos, which accounts for its popularity in many countries. Tapering benzos can be very difficult. Xanax is extremely difficult to taper, making it much more problematic than Valium in many ways.
There is no reason to believe that Valium is more likely to be abused than Xanax. Both drugs have a rapid onset of action.
As an aside, Valium has a short duration of action after a single isolated dose, it only lasts a few hours. It is only long-acting after regular daily use for several days or more. In the long term, Valium can usually be given as a single daily dose in the evening, making it much more convenient than Xanax.
Advantages of Valium......
1. Easier to taper than other benzos
2. Rapid onset of action after a single dose - this is important if it is used to treat an acute panic attack
3. Short-acting after an isolated dose. Contrary to popular belief, Valium is not long acting after a single dose.
4. Long-acting when taken daily, less frequent dosing is convenient. Unlike Xanax, withdrawal symptoms rarely occur between doses.
5. Very inexpensive
6. Available in many different forms eg. 2mg tabs, 5mg tabs, 10mg tabs, oral syrup, IV injection, suppositories etc. Suppositories may be used if nausea/vomiting prevents oral use.
7. Broad-spectrum efficacy in anxiety disorders. Valium is NOT ineffective in panic disorder. The only reason it may appear to be ineffective is because doctors tend to prescribe doses which are too low.
Ed
Posted by SLS on March 31, 2006, at 16:00:05
In reply to Re: Is Valium more potent than Xanax?, posted by ed_uk on March 31, 2006, at 15:48:05
Thanks for the concise description.
Does Valium have any hypnotic properties?
- Scott
Posted by rjlockhart on March 31, 2006, at 16:27:46
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by SLS on March 31, 2006, at 16:00:05
Well thanks everyone. Anyways, ed put it really good. Valium amoung american doctors are rare, exept here for Phillipa. I dont know why they they say Valium has a euphoric properties when it is not streetly used much. With Xanax, i have taken xanax at a low dose and felt fine, higher doses feel like klonopin, and yea i do feel depressed.
My doc is in his 70's..... he said hes prescribed valium for years before, he said hes had alot complicated problems, thats why he always choses Klonopin.
I have heard Valium makes you depressed. Xanax i think has antidepressant properties at low to moderate doses, such as .5-1mg.
I do have panic attacks but they are seeming to go away.
Now I dont know why.....considering a this poster Ame Sans Vie he takes 16mg of XANAX a day! plus desoxyn (methamphetamine) 45mg dexedrine (dexamphetamine) 40mg GHB (i dont know how the heck that got prescribed that) I think he has some issues....
Anyways, back down to earth prescrbing...
Xanax i think had its hit in the 80's.
But thanks.
Matt
Posted by ed_uk on March 31, 2006, at 16:44:32
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by SLS on March 31, 2006, at 16:00:05
Hi Scott,
>Does Valium have any hypnotic properties?
Yes. All of the commonly used benzos are somewhat hypnotic, including Xanax and Klonopin. I have taken Xanax a few times myself. I found it very hypnotic, more so than Valium!
The common distinction between 'anxiolytic benzos' and 'hypnotic benzos' is mainly due to marketing. Temazepam (Restoril), which is marketed as a hypnotic, could be taken during the day as an anxiolytic. Alprazolam (Xanax), which is marketed as an anxiolytic, could be taken at night as a hypnotic. Clonazepam (Klonopin) was originally marketed by Roche as an anticonvulsant. In many parts of the world, clonazepam is still used almost exclusively for epilepsy. Roche had already marketed numerous benzos for anxiety and insomnia. Clonazepam effectively expanded their benzos market share.
A large dose of any benzo will act as a hypnotic for most people. Clobazam (Frisium) is perhaps an exception. Alprazolam (Xanax) is generally sedating, although 'paradoxical excitement' may be more frequent with Xanax than with other benzos.
Relatively small doses of any benzo given in divided doses throughout the day will be anxiolytic for most people eg. temazepam 7.5mg three times a day.
Benzos with a rapid onset of action and a relatively short duration of action are most suitable for insomnia eg. temazepam 7.5mg-60mg.
A rapid-acting benzo is needed to treat an acute panic attack eg. Xanax, Valium.
A long-acting benzo is most suitable for chronic severe anxiety eg. Librium, Valium, Klonopin.
Some benzos may be more hypnotic that others, although this has recieved surprisingly little study. In general, any benzo will induce sleep if the dose is adequate.
Ambien and Lunesta are different from the benzos. Both drugs are predominantly hypnotic. Neither drug is a suitable treatment for anxiety.
Ed
Posted by ed_uk on March 31, 2006, at 16:46:24
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by SLS on March 31, 2006, at 16:00:05
It's often noted than the benzodiazepines differ more in their pharmacokinetics than in their pharmacodynamics.
Ed
Posted by bassman on March 31, 2006, at 18:10:47
In reply to Is Valium more potent than Xanax?, posted by rjlockhart on March 31, 2006, at 10:28:11
I have panic disorder and have found Valium useless for extreme anxiety-Xanax is just the opposite; very effective. If panic is the problem, Xanax is a drug to consider. Look at Remedyfind.com for people's opinion on drugs for panic-Valium isn't even mentioned in the the top 10, and by my experience, for good reason. I've tapered from 4 mg Xanax/day and as long as you take a long time (I took a year), it's fine. But I was able to withdraw from Klonopin and Ativan with basically no discomfort whereas Xanx was managable, but not fun.
Posted by Phillipa on March 31, 2006, at 21:17:07
In reply to Re: Is Valium more potent than Xanax? » Sobriquet Style, posted by zazenduck on March 31, 2006, at 11:49:53
Yes it gets into the blood stream much faster my doc always told me to put it under the tongue when I felt a panic attack coming on. Love Phillipa
Posted by Phillipa on March 31, 2006, at 21:23:58
In reply to Re: Is Valium more potent than Xanax? » zazenduck, posted by Phillipa on March 31, 2006, at 21:17:07
And xanax is definitely more effective for panic attacks. Phillipa the Queen of benzos.
Posted by rjlockhart on March 31, 2006, at 21:32:54
In reply to Re: Is Valium more potent than Xanax?, posted by Phillipa on March 31, 2006, at 21:23:58
The Queen of Benzo's
You cracked me up phillipa. Thats an original.
And ed is the KING of Valium.and giving info
a
I took to much Prozac today....Matt
Posted by tizza on April 1, 2006, at 1:54:28
In reply to Re: Is Valium more potent than Xanax?, posted by rjlockhart on March 31, 2006, at 21:32:54
If phillipa is the queen of benzo's then I'm the prince, not quite king yet!! (maybe another queen or princess but who knows ; P) Anyway I just have to say that Valium is fantastic for anxiety and panic attacks but you have to give it a chance. I don't think that it is nearly as euphoric or addictive as xanax. I still take Valium and it works great for me, Xanax on the other hand worked too well, maybe not a bad thing for some but I found it EXTREMELY addictive and had a very nasty time coming off it. That was over 10 years ago now. Valium is used widely in Australia and it's actually very hard to get a RX of xanax here because of it's very addicting properties. It's a very well known fact here that xanax is a major problem for chronic addiction, doctor shopping behaviour and very it's hard to discontinue and is also noted for it's anti depressant effects and very euphoric high that doesn't last very long so you need more, then more, then more. It's a big problem for some people who don't even know that they have addictive personalities. Why would someone be prescribed something that you need to take 3 or 4 times a day (ie. xanax) when you can knock it on the head with one dose of valium, preferably at bed time because it does have slight hypnotic effects even though it's not predomidently prescribed for that but it does help you sleep and it lasts all the next day. I'll give you a list of benzo's I have been prescribed over the years and if you have any questions about them I can tell you how they effected me, pls feel free to babble mail me about it or I could go on for ages. I'd just like to say that xanax was very bad for me personally where something like valium would have been better if I had have given it a better go for a few days to a week. Most people have to wait for 4 weeks for a SSRI to kick in so I don't think a few days is very long to wait. I would take Valium over xanax ANYDAY because it's so much easier to taper off, Blah blah blah.... Here is a list of benzo's I have tried, not all of them worked for me. Paul
temezepam:- restoril, normison,
oxezepam:- serapax, murelax, serax? (not sure about US name)
diazepam:- Valium, it has many names
lorazepam:- Ativan
alprazolam:- Xanax, Kalma
Clonazepam:- Rivitrol, Klonopin, Paxam
Flunitrazepam:- Rohypnol, hypnodorm
Nitrazepam:- Mogadon, Alodorm
Posted by bassman on April 1, 2006, at 8:08:34
In reply to Re: Is Valium more potent than Xanax? » rjlockhart, posted by tizza on April 1, 2006, at 1:54:28
That's interesting...as I said, Valium doesn't do anything for me in terms of panic, but Xanax works exceptionally well. But the interesting thing is that I don't experience any euphoria or any other sensation other than thankfulness that I don't feel as crazy, really. Maybe if you get a buzz out of Xanax it should be avoided. I do think Xanax has antidepressant effects and that is helpful for me. In addition to not helping with panic (God, I used to take mounds of the stuff years ago to try and calm down), if I take Valium and fall asleep, I wake up feeling awful. So, YMMV, yet again. I agree that Valium might be a better drug to start with-when I was taking oodles of it, I just decided one day that it really wasn't helping and just stopped. Maybe 50-60 Valium mg/day for several years to zippo. Hard to say if I withdrew because I felt so awful anyway. :>}Now people know that was foolish to withdraw that quickly. My point is that Valium must be reasonably easy to withdraw from, as has been mentioned, compared to Xanax-which if I drop the dose by 0.25 mg/day, I feel mightily in terms of anxiety. I've been taking Ativan to relieve early-morning nightmares and I'm withdrawing from 1 mg/day (over a period of about two weeks) of that with absolutely no problems; I don't even know I'm withdrawing. I think the Ativan worked slightly at the beginning and now doesn't do anything, so I'm dumping taking it.
In answer to a previous question in this thread, there are oodles of references out there that people that use benzos so they can function generally decrease their dosage as time goes on. If anyone finds that interesting and doesn't want to Google/etc. it, I'd be glad to find some references. My experience is that people HATE their psychoactive meds (my pet theory is that the sicker the person is, the harder it is to get them to take medication-I don’t know why), no matter what they are and periodically declare themselves fully well and get off their meds. Then they feel miserable for months while until they realize they felt O.K. because their meds were working. Heck, I've done that.:>}
Posted by ed_uk on April 1, 2006, at 13:00:45
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on March 31, 2006, at 18:10:47
Hi
>I have panic disorder and have found Valium useless for extreme anxiety-Xanax is just the opposite; very effective. If panic is the problem, Xanax is a drug to consider. Look at Remedyfind.com for people's opinion on drugs for panic-Valium isn't even mentioned in the the top 10, and by my experience, for good reason.
Xanax is highly potent. Valium is not. You'd probably need 40-80mg Valium to substitute for 4mg Xanax.
Most people who post on remedy find are Americans. Most Americans have either never been prescribed Valium or have only taken it MANY years ago. Inevitably, it will not be in the top 10.
Regards
Ed
Posted by ed_uk on April 1, 2006, at 13:07:12
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 1, 2006, at 8:08:34
Hi Bassman
I guess Valium wasn't the right drug for you at any dose!
My guess is that you find Xanax particularly effective due to its antidepressant-like effect which other benzos seem to lack. Valium and Klonopin seem more 'depressing' than Xanax, but can be good meds for some people.
Regards
Ed
Posted by bassman on April 1, 2006, at 13:32:51
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by ed_uk on April 1, 2006, at 13:07:12
Hi Ed,
I think you're right-it just may be that Valium and Klonopin are too sedating/depressing for me and that just makes the panic more difficult to handle. When I experience panic, I simulataneously feel depressed. I do think Valium and Klonopin are drugs that are worth trying in general; and probably before Xanax. I'd feel more at ease (less concerned about habituation) with either Valium or Klonopin, but they just haven't worked for me. No sense taking a drug that isn't helping. Thanks for the note!
bassman
Posted by ed_uk on April 1, 2006, at 14:10:15
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 1, 2006, at 13:32:51
Hi bassman,
What is your opinion of Xanax XR?
Ed
Posted by rjlockhart on April 1, 2006, at 15:48:47
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by ed_uk on April 1, 2006, at 14:10:15
I think ed is right.
He is the King of knowing of Benzo's... ROFL
I take Xanax regualar, it does have some antidepressat properties, like i feel relief with out feeling down. Similar to Ativan, but more potent. Xanax wears off quuick, thats the bad thing about it because all sudden you feel like a arousol feeling. I was on 6mg of Clonazepam (Klonopin) i mean i was so, well wasnt drugged but felt liket like it. Yes, ed rerember me being on Klonopin.
Previous before Klonopin:
Ativan (6mg 2mg X 3) - didnt work at all for painc attacks. And i have severe. That im going to just lose it.Mmm, i dont know if Ativan is good effects diffrent people diffrent, but i wasnt depressed on Ativan i was just having panic attacks ROFL, its longer half life (lasts 6 hours) is good. And it doenst make you depressed much like Klonopin.
But we are all diffrent on meds.
Ed do you still take Valium?
Posted by ed_uk on April 1, 2006, at 16:03:43
In reply to Re: Is Valium more potent than Xanax? -- bassman, posted by rjlockhart on April 1, 2006, at 15:48:47
Hi Rj
I don't often need Valium anymore. I used to take 15mg PRN.
Ed
Posted by bassman on April 1, 2006, at 18:00:23
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by ed_uk on April 1, 2006, at 14:10:15
Ed,
Xanax XR is strange...I thought I'd substitute it for Klonopin-sort of like having a longer half-life (other than it drops off like a rock at some point). Funny you should ask, because I tried the XR about a month ago. My experience was that after about 12 hours at 0.5 mg XR, I would seem to have more panic. That wasn't the idea. :>} My guess is that if I had taken 1 mg XR twice a day, I would have been alright-but that scared me-it felt like I was on a one-way train to instant dependence. I'm O.K. with taking 1 mg Xanax a day, if that was the only benzo I was taking-but as I said, I’m tapering off the Ativan, which I find useless, and the Klonopin, which seems to depress me at 1 mg and above. But I convinced myself XR was the way to go for me, and I have a whole bottle of pills that cost me $43 after insurance, but I'm not going to take them. Xanax ER works best for me, but damn, the XR idea seems great in theory.
bassman
Posted by Meri-Tuuli on April 2, 2006, at 3:37:20
In reply to Re: Is Valium more potent than Xanax? -- bassman » rjlockhart, posted by ed_uk on April 1, 2006, at 16:03:43
Hi Ed!
I got a huge panic attack last weekend and I made my partner drive me to A+E (ER). I was just seen by a nurse, who didn't do anything and told me to go home. Anyway, I have never taken any benzos in my life, and I was wondering what a GP would think to prescribing something for me PRN?? I was under the impression that GPs would get their hands slapped if they ever prescribed a benzo so I have never asked/mentioned panic attacks. I read in the BNF that they are to be rather strict with them. Particulary if you've never touched one before.
Kind regards
Meri
> Hi Rj
>
> I don't often need Valium anymore. I used to take 15mg PRN.
>
> Ed
Posted by special_k on April 2, 2006, at 7:15:49
In reply to Re: Is Valium more potent than Xanax? » ed_uk, posted by Meri-Tuuli on April 2, 2006, at 3:37:20
hmm.
and now the people come out to play...
so... valium can take a couple days in your system.
does that explain why i puked my guts out at a cocktail party the other night?????
dammit.
Posted by Sobriquet Style on April 2, 2006, at 7:47:17
In reply to Re: Is Valium more potent than Xanax?, posted by bassman on April 1, 2006, at 8:08:34
>In answer to a previous question in this thread, there are oodles of references out there that people that use benzos so they can function generally decrease their dosage as time goes on. If anyone finds that interesting and doesn't want to Google/etc. it, I'd be glad to find some references.
I've been trying to obtain some medical studies about people being maintained on Benzo's longterm (especially Diazepam) and not building tolerance to the anxiety effects. Basically something that will challenge what is said by Ashton at benzo.org.uk.
If you can provide any new information about this, it would be extreamly helpful for me, I've read over 200 studies about benzo's being used longterm and can't find any studies that I need (studies newer than the 1980's!)
~
Posted by bassman on April 2, 2006, at 11:13:09
In reply to Re: Is Valium more potent than Xanax? » bassman, posted by Sobriquet Style on April 2, 2006, at 7:47:17
I hope these will be of help:
Schweizer et al. (58) have conducted an 8-month, placebo-controlled study of continuation therapy for panic disorder with alprazolam and imipramine that found sustained efficacy for both compounds with no dose escalation, suggesting an absence of tolerance to the therapeutic effect
Preliminary evidence for the efficacy of continuation therapy of GAD comes from two studies (43, 47). In both studies the benzodiazepine therapy achieved sustained remission of anxious symptomatology with no tolerance and no dose escalation over a 6-month period.
http://www.acnp.org/G4/GN401000129/CH127.html
A total of 136 patients received clonazepam nightly for a mean 3.5 (+/- 2.4) years, with no significant difference in initial versus final mean dose: 0.77 mg (+/- 0.46) versus 1.10 mg (+/- 0.96). Similar results were obtained with chronic alprazolam treatment and with other benzodiazepine treatments. CONCLUSION: Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep resulted in sustained efficacy in most cases, with low risk of dosage tolerance, adverse effects, or abuse.
Fifty-nine panic disorder patients originally randomized to treatment in a controlled trial comparing alprazolam, clonazepam, and placebo were reevaluated in a follow-up study. At a mean follow-up of 1.5 years, 78% of patients remained on medication and the mean dosage of alprazolam and clonazepam did not increase.A 15 year study:
Maintenance medication was common. No benzodiazepine abuse was reported. CONCLUSION: PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.I think this is interesting because it basically says the physicians are quite prejudiced concerning benzo use, even when it comes to outcome. Who knows the benefits better, the physician or the patient? That’ s easy.
The participants were 93 patients over 60 years of age using a benzodiazepine for insomnia and 25 physicians comprising sleep specialists, family physicians, and family medicine residents. The main outcome measure was perception of benefit and risk scores calculated from the mean of responses (on a Likert scale of 1 to 5) to various items on the survey. RESULTS: The mean perception of benefit score was significantly higher in patients than physicians (3.85 vs. 2.84, p < 0.001, 95% CI 0.69, 1.32). The mean perception of risk score was significantly lower in patients than physicians (2.21 vs. 3.63, p < 0.001, 95% CI 1.07, 1.77). CONCLUSIONS: There is a significant discordance between older patients and their physicians regarding the perceptions of benefits and risks of using benzodiazepines for insomnia on a long term basis. The challenge is to openly discuss these perceptions in the context of the available evidence to make collaborative and informed decisions.
The Task Force Report, although over 10 years old, is still a standard reference for benzodiazepine use. Its points—that there is undue reluctance to use minor tranquillizers, and that many people are undertreated—still hold, and are borne out by the Roy-Byrne study. Other relevant literature includes a review of 2719 adult out-patient charts2 (medical and psychiatric) for evidence of benzodiazepine abuse that found no patients meeting the criteria. Another study, of long-term alprazolam users, found no dose escalation with long-term use.3 Tyrer’s 19884 paper on minor tranquillizers notes an absence of evidence that benzodiazepine dependence leads to dangerous long-term sequellae, and blames "excessive media attention" for distortion of scientific attitudes.
http://fampra.oxfordjournals.org/cgi/content/full/20/3/347
Benzodiazepines are relatively safe drugs that are probably under- rather than overprescribed. Periodic reassessment of chronic users is appropriate, although generalized anxiety disorder and panic disorder are chronic conditions for which long-term treatment may be necessary. In the more recent era of safer antidepressants, these agents may be able to supplant minor tranquillizers for the control of chronic anxiety in many patients. Long-term benzodiazepine use is appropriate for some patients.
http://fampra.oxfordjournals.org/cgi/content/full/20/3/347
Tolerance is the need to increase the dose of a drug to maintain the desired effects. Tolerance to the anxiety-relieving effects of benzodiazepines is uncommon and most individuals do not increase their benzodiazepine dose
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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