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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by mav27 on December 26, 2008, at 8:36:11
We don't have xanax extended release here. So i was after some thoughts on wether it it should still work if taking in 1 big dose at night and would last through out the next day.
My problem is it is the only agent working for my S.A.D but it knocks me out cold after every dose for at least 2 hours.. im on 1mg 3x day.. i've even tried lowering the dose but it still just knocks me out.. but once im awake i feel great and it feels like it's working fantstically.
It seems to be listed as having a half life of 11.0 hours (range: 6.3-15.8 hours)
So assuming the worse at 6 hours.. if i take 3mg at night after 24 hours i should have 0.1875mg left in my system right? Is that how it works ?
Its not that far off the minimal dose of .25g
Posted by Phillipa on December 26, 2008, at 10:59:59
In reply to xanax in a once daily dosage, posted by mav27 on December 26, 2008, at 8:36:11
Mav that's a new one. Do you know how long the lmg not lasts in your system. When on only xanax needed it during the day. But it didn't knock me out and took .5 during the day. Interesting. Love Phillipa
Posted by yxibow on December 26, 2008, at 19:04:01
In reply to xanax in a once daily dosage, posted by mav27 on December 26, 2008, at 8:36:11
> We don't have xanax extended release here. So i was after some thoughts on wether it it should still work if taking in 1 big dose at night and would last through out the next day.
>
> My problem is it is the only agent working for my S.A.D but it knocks me out cold after every dose for at least 2 hours.. im on 1mg 3x day.. i've even tried lowering the dose but it still just knocks me out.. but once im awake i feel great and it feels like it's working fantstically.
>
> It seems to be listed as having a half life of 11.0 hours (range: 6.3-15.8 hours)
>
> So assuming the worse at 6 hours.. if i take 3mg at night after 24 hours i should have 0.1875mg left in my system right? Is that how it works ?
> Its not that far off the minimal dose of .25g
Plasma level is involved. Xanax is RX'd 4x a day because the half life is even shorter than that typically, it has a rapid uptake. A theoretical model of half-lives is that after 5x the half life it is gone.But this doesn't take into count, the P450 system, your genetics related to that, the steady state plasma level, and a host of other things, such as body weight.
Among the pitfalls of this is that between such a long dose interval for a very short acting agent, you will be open to breakthrough anxiety in the interdosal period, which in this case would be 24 hours instead of about every 5-8 hours.
Its intended to calm people for extreme anxiety -- "knock you out cold" as you describe and the dose is too high, even if you've lowered the dose, it may still be too high for what you actually need. It shouldn't be "knocking you out".
Rather tapering down to .25 four times a day might help you better in the long run. However Xanax is still not a drug for SAD in the long run, because it has a potential for habituation.
Rather a more uplifting agent such as an SSRI would be a better choice for SAD, unless you've exhausted all of them, and there still are TCAs.There are also less often used things like low stimulants like Strattera or Wellbutrin.
Also there is light box therapy, yes, more expensive than a pill but it has shown to be an non-drug improving factor for SAD.
-- best wishes
Jay
Posted by mav27 on December 26, 2008, at 20:45:54
In reply to Re: xanax in a once daily dosage » mav27, posted by yxibow on December 26, 2008, at 19:04:01
Unfortunatly i've exhausted all ssri's snri's TCA,a and MAOI's, augmentations, and stimulants are out of the Question here is Australia. I've been on clonazepam for the last year but it wasn't quite strong enough, i've tried all the other benzos as well so xanax is a last resort.. it works it's just that it puts me to sleep for a short while even the .250mg doses.
Posted by yxibow on December 27, 2008, at 1:14:11
In reply to Re: xanax in a once daily dosage » yxibow, posted by mav27 on December 26, 2008, at 20:45:54
> Unfortunatly i've exhausted all ssri's snri's TCA,a and MAOI's, augmentations, and stimulants are out of the Question here is Australia. I've been on clonazepam for the last year but it wasn't quite strong enough, i've tried all the other benzos as well so xanax is a last resort.. it works it's just that it puts me to sleep for a short while even the .250mg doses.
I'm sorry to hear that you've been through a lot of agents. Is it at all possible to stay up through the Xanax by doing exercise, walking out the door, forcing yourself to stay up rather than getting into a possible cycle of sleep problems which may increase your SAD.
I know it sounds harsh and I have enough problems trying to do that but you can't beat everything with just medication.
Clonazepam is very subtle, Xanax has a slight stimulation to it so people interpret it as an antidepressant effect. In the long run though, other medications have to be a choice because habituation to Xanax is a reality, its just how long your system can take it, and that could be months to years.
I admit I'm on a high dose of benzodiazepines myself, I no longer "feel" Valium but it is still doing a fair bit to my treatment -- it has its pluses and minuses, and inbetweens, its very complex.
Strattera and Wellbutrin are available in Australia, they're not controlled, neither are they in the US. Provigil is also available from what I can see but not subsidized.
I realize there are stricter and arcane laws in Australia about stimulants but they are available at least in some states, in a restricted fashion.
When you say augmentations, have you tried all the worthwhile and available AEDs ? Is Lamictal readily available, as it is an antidepressant in its own right?And then there are neuroleptics, some which may be available in Australia and not in the US, such as Amisulpride.
There are agents of last resort, such as Clozaril to augment -- the registry is the same sort of blood test as in the US, but I don't know if it is restricted specifically to schizophrenia or whether it can be prescribed otherwise.
-- best wishes
-- Jay
Posted by Sigismund on December 27, 2008, at 1:31:01
In reply to xanax in a once daily dosage, posted by mav27 on December 26, 2008, at 8:36:11
>We don't have xanax extended release here.
No, and not only that, you need a diagnosis for panic disorder to get it prescribed at all.
Or is that only so you can get it on the PBS?I don't think your idea would work, unless you were benzo naive.
It wouldn't work for me.
Posted by mav27 on December 27, 2008, at 7:06:30
In reply to Re: xanax in a once daily dosage » mav27, posted by yxibow on December 27, 2008, at 1:14:11
Yeah i can force myself to stay awake if i stay out of bed.. but it's this wierd feeling of like all the energy has been zapped from my body and it doesn't want to move... it's the same feeling i get from anti-psychotics especially the atypicals. I have tried wellbutrin but it made my anxiety a lot worse and made me very very agitated
amisulpride worked for about a month and then just stopped.
$109.41 seems to be the starting price for stattera at 25mg 28 capsules.. out of my price range.
Clozaril is beyond restricted so no chance... needs an authority script in a private hospital.. would have better luck asking for coccaine.
Posted by Phillipa on December 27, 2008, at 19:49:57
In reply to Re: xanax in a once daily dosage » yxibow, posted by mav27 on December 27, 2008, at 7:06:30
Personally didn't have a problem with xanax and now taking .5 with total 12.5mg of valium at bed. I've never had problems stopping it. How bout lunesta since to me it's weaker? Just a thought. Sorry you're having so many problems. Love Phillipa
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