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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by simcha on November 29, 2004, at 21:13:17
OK, occasionally I have Ambien for sleep. My insurance has it as a non-formulary drug. I'm lucky that the co-pay is only $35. They would charge much more for a 30 day supply. Still, for a poor grad-school student like me, it's a lot of money considering all of the other medications I have to buy for depression and asthma. I manage about eight medications.
I'm now going on their drug maintanence program where I pay 2 copays for a 3 month supply and have the meds delivered to my mailbox.
So, I called my insurance company and they have formulary drugs for sleep assistance. They are all benzodiazepines. I know that my doctor will not be adverse to prescribing benzos for sleep. I do know that my pdoc would not be very happy. He took me off of the Klonopin because it allegedly interrupts the stage 4 sleep. I was using it for bruxism and restless legs syndrome. Now I use Neurontin with decent success...
I only take a sleep med (Ambien) about two times per week. Most times I want sleep I'm fine. I've had chronic insomnia for my entire life. It's a great relief to have Ambien for the occasional real difficulty. I can also take extra Neurontin, with varying results...
Anyway, the formulary covers the following:
Restoril (temazepam) at $20 for 30-day supply (brand)
Halcion (triazolam) at $10 for 30-day supply(generic)
Restoril (lorazepam) at $10 for 30-day supply (generic)Does anyone have any experience with these three benzos? I have only had klonopin before. I think I got valium injected in my gludius maximus before a surgery before...
Anyway, if I were to choose a less expensive alternative, what would you recommend?
Do all of these mess up sleep architecture so that you are exhausted when you wake up? I never did find this to be the case on Klonopin no matter what my pdoc says.
So,
Please Help!
Confused,
Simcha
Posted by anxiety_free on November 29, 2004, at 22:10:43
In reply to Sleep Meds and Ins. formularies Recommendations?, posted by simcha on November 29, 2004, at 21:13:17
Hey! First off, I'd recommend you go generic. I'm a student too, and the cash you save will come in handy. Anyway, temazepam is a kinda long acting benzo...it helps you go to sleep and, to some extent, stay asleep. Lorazepam (AKA Ativan) is a somewhat short acting benzo; longer then Xanax, shorter than Klonopin or (I think) Valium. In addition to treating anxiety, it can be used for sleep. In this department, I rank it as pretty good...for me, about as good as Restoril/temazepam. Then there's Halcion (triazolam) which I seriously do not recommend. It's short acting, but unfortunately has more side effects (including psychosis) than most other benzos, except perhaps xanax, to which it is chemically similar. There's also ProSom and Dalmane, both of which are good. My advice on handling the docs: go ahead and take the script from the one that's OK with benzos, and only tell your pdoc if necessary...sounds like a benzo-phobe. If s/he gets huffy, explain the insurance situation and your need for sleep in order to function. Good luck!
Posted by simcha on November 30, 2004, at 12:43:22
In reply to Sleep benzos, posted by anxiety_free on November 29, 2004, at 22:10:43
Thanks for the great report. It gives me more information for my appointment tomorrow... I can check if ProSom and the other one are on the formulary... Insurance sucks... At least I have it. I'm so fortunate compared to many Americans without it. I would not be able to afford treatment without it.
Simcha
Posted by King Vultan on November 30, 2004, at 16:41:47
In reply to Sleep Meds and Ins. formularies Recommendations?, posted by simcha on November 29, 2004, at 21:13:17
I have very bad insomnia from Parnate and have had to do a lot of work to find a med or combination thereof that can be used for chronic insomnia. I take 0.25 mg triazolam (Halcion) every other night, which is also only a $10 copay on my insurance, and the other night, I take 25 mg Benadryl + 5 mg Ambien. The Ambien is a $50 copay on my insurance for 30 x 10 mg, so at the rate I use it, it is only $12.50/month. I tried 10 mg Ambien by itself and found it nearly worthless in this case; although, it has worked for most of the other insomnia-inducing antidepressants I've taken. You can also try 25 or 50 mg Benadryl (or some other product that is pure diphenhydramine) by itself; this is not as clean a drug as triazolam or Ambien but is obviously very cheap and easy to try. I find 50 mg Benadryl to be more powerful than 10 mg Ambien for my Parnate insomnia.
The triazolam is a more powerful sleep aid than Ambien IMO, but it does have more of a tendency to cause tolerance than Ambien if a person takes it every single night. Triazolam also has a relatively short half life (3.5 hour mean) not that much different from that of Ambien (2.6 hour mean), and I haven't ever noticed any hangover effects from it. Triazolam has garnered a fair amount of bad press in regard to some negative psychological issues, but they are more prevalent in the elderly and/or at higher doses (the maximum dose was reduced to 0.25 mg some years ago, and the 0.5 mg pill is no longer even made). When I was on the other MAOI, Nardil, I only needed half of a 0.25 mg pill, which I felt was still more powerful than 5 mg Ambien; I can't remember if I tried 10 mg Ambien in that situation.
Todd
Posted by simcha on December 1, 2004, at 0:03:07
In reply to Re: Sleep Meds and Ins. formularies Recommendations?, posted by King Vultan on November 30, 2004, at 16:41:47
So maybe this means that Halcion is not as scary as people would like to make others know. I'm just concerned that my family has a strong history of psychosis and I've heard on various sites that Halcion might cause hallucinations in some people.
I do like the fact that it's short acting like Ambien because I'd hate to feel groggy in the morning.
Thanks for the information. I see my GP tomorrow at 2:15 pacific time.. I'll check the messages to see if anyone else has any suggestions before I go to the appointment. I'll also report back to let you all know whatever he and I decide.
This is the doctor that doesn't think twice about giving me cough syrup with codeine when I've had bronchitis. I've found that to be the most compassionate cough suppressant for bronchitis ever. It takes care of the pain and the cough and it lets me sleep. I trust my gp at the moment more than I do my pdoc.
Thanks,
Simcha
Posted by ZenTen on December 1, 2004, at 9:23:19
In reply to Re: Sleep benzos » anxiety_free, posted by simcha on November 30, 2004, at 12:43:22
Hi. I am sorta in the same situation as you. 35.00 copay for Ambien and 10 for generic Benzos.
I have prob tried all the usual ones used here in the U.S. at some point. Valium, Serax, Ativan, Klonopin, Halcion, Restoril, Xanax and I currently take Ambien. For me it relaxes me a bit more for some reason than other sleeping pills.I personally liked Restortil/temazepam the best. First at 15mgs and then at 30mgs. It didn't for me make my head as groggy as say klonopin. I even take minute doses for anxiety. And even though it takes forever to kick in, I feel its the cleanest benzo for me. It only comes in Capsules here in the U.S. which I am not too fond of. Because if you want to adjust doses it makes it difficult.
I thought halcion was all hype... granted at the time I was taking 2mgs of Klonopin a day. it didnt even put me to sleep at the max dose. it felt like any other benzo. Maybe, I am just strange.
Ambien seems to cause more hallucination than Halcion, if you try and stay up while you are on it....much more so than any other benzo i have taken. I am assuming it must also be effecting dopamine to be having this effect. Unfortunatly, after 3 years of almost steady use, the Ambien doenst do anything at all--unless I take it with something else.
I find taking ambien under the tongue. Letting it absorb .... (make sure you are in bed when doing this) makes it work quicker and stronger.... also if you take it with food it seems to make it 50% less effective and forever to kick it.
Posted by simcha on December 2, 2004, at 23:40:37
In reply to Re: Sleep benzos, posted by ZenTen on December 1, 2004, at 9:23:19
Zen and all who helped me here...
Here's what my gp and I decided. He suggested that I remain on Ambien because it's the best by far with a side-effect profile.
He said that if cost was a consideration that Restoril would be his favorite choice out of all of the ones listed on the formulary.
In the end I went with his recommendation. I get 90 pills fo $70 now with the mail-prescription refill source. So, it's not perfect but $23.34 per month is not bad for a med that I use maybe 3 times a week at the most...
So, that's the way it went... Now all my meds are mail order and come in 90 day supplies. I can't wait, I'll save at least 1/2..
Ooooo! And I have been taking 600mg of Neurontin per night... It is not generic at that strength. It is generic at 300mg. So, my wonderful gp rewrote the rx to 2 300mg gabapentin pills per night making it a $20 copay for 90 days instead of $40 with the 600mg...
What's with Neurontin and the generic strengths not coming out?
Simcha
This is the end of the thread.
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