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Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment?

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Psychiatrist
Practicing since : 2004
Answered : 1843 Questions
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Dear Respected Sir, good evening. i am XXXXXXX XXXX from jammu. Hope you are very well. Thanks as you were kind enough to see me in the OPD at Columbia Asia.{MRN:PVRG-0000}. As you know; Sir , i had been on alprax 2mg /24 hrs and tab prothiaden 25mg one HS for 8 yrs . i could not come over and XXXXXXX you personally; which i had planned earlier ; as because of the fact that i sometimes feel dizzy or get headaches or numbness ; and as because i had to come from jammu by train all alone; i became apprehensive for the travel. my father is in 70s and not so well to accompany me. My Apologies for inconvieniences Sir. if it is possible to provide consultation for future management ; i would be grateful. Sir; As adviced ; i started having 3mg of clonazepam 1-1-1, along with mirtaz 15mg 1, HS from 3rd august ; on reaching home. Further i stopped prothiaden. till today; 10th august ; I have managed very well; all because of your Advice ; today i am on 0.5mg{1}, 0.5mg{1} and 1mg{1}. as prescribed , from tommorow it will be 1-1-1.5 for next 2 days and thereafter its 0.5-1-1......... and 0.5, 0.5 -1........ . i am personally feeling comfortable ; but yes slightly drowsy and instead of 8 hrly i have to take the doses 6-7 hrly, rest i have no complaints although a few sighns/symptoms are there like occasional weakness in legs; unsteadyness, headache; jittery sometimes. Can i take the XXXXXXX of asking as to what should be the future management plan Sir, I would be highly obliged and grateful ; if you can provide it online . Regrets for not being able to come over in person ; honestly speaking; because of the problems mentioned . Many Many thanks and good wishes from my mother and father for taking complete care of me. .

very warm regards

XXXXXXX XXXX 0000
Posted Mon, 28 Oct 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Ashish Mittal 18 hours later
Hello Dr XXXX,
Thanks for your query.

It is difficult to advice treatment on Online platform. But there is need to taper Lonazep doses.

Now reduce 0.125 mg of clonazepam (half tablet of lonazep 0.25mg) every 3rd day. For prescription you can visit nearby psychiatrist. Continue rest of of the medicines as prescribed by me.

Wish you good health.
Regards,
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 2 hours later
thanks very much for all the help.
Sir; from 13th august onwards i will be taking 0.5mg lonazep TDs. for next 4 days as prescribed by you without any reduction in doses ; till 17th august .
1. after that do i need to reduce 0.125mg from 0.5mg tab ; for every dose ; or only one single dose, is it like this--

0.375mg - 0.5mg- 0.5mg for three days ; then 0.375mg -0.375mg -0.5mg for next three days and 0.375mg-3.75mg-3.75mg for next 3 days and then 0.25mg -0.375mg -0.375mg for 3 days; 0.25mg -0.25mg -0.375mg for 3 days and so on.

2. Respected Sir;is there a need to reduce the night dose at the last and keep it as 0.5mg till end and continue reducing morning and afternoon doses only

3.Sir, if while reducing 0.125mg over the period of time, if i get any withdrawals; what should i do in that situation ?

4. can i continue my day and night duties as anyone else or take some rest while on this regime. ?

5. is there any chance of severe withrawl ? can i join the hospital work or delay it for 2 or 3 weeks ; as the PGDCC Programme has not started yet and i am at home.

i hope i have understood your management properly ; and will continue the same for next 7 days or more,

6. in case required ; can i ask for another online consultation in future ; although i will try to XXXXXXX you in OPD

should i step on into regular normal activities of day to day life gradually over a period of time while on reducing the doses ?

i feel tinnitus very often and occasionally mental tiredness; / heavyheadedness while concentrating on some work and 1-2 hrs before next scheduled dose ; i hope they will settle down .

thanks very very much for a brilliant support, compassion, empathy; sympathy and warmth. i am so much grateful to you. you have been exceptionally the best doctor i have ever met in my life.

WARM regards XXXXXXX XXXX

i had my night dose of lonazep 0.75mg after food ; but had slightly more withrawls; it happened for ist time;????


i waited ; but had to take 0.25mg just now; it worsened.
are mouth dissolving faster and useful in such siuations.. can i go upto 0.5 mg stat if such situation arises in future..... kindly suggest

thanks

regards XXXXXXX XXXX

dear sir;
good morning.
so from 17th august; the reductions in doses have to be 0.25mg per week, or in other words 0.125mg in 3 days.

regards
dr XXXXXXX

 
 
Answered by Dr. Ashish Mittal 16 hours later
Hello again,
Thanks for follow up.

0.375mg - 0.5mg- 0.5mg for three days ; then 0.375mg -0.375mg -0.5mg for next three days and 0.375mg-3.75mg-3.75mg for next 3 days and then 0.25mg -0.375mg -0.375mg for 3 days; 0.25mg -0.25mg -0.375mg for 3 days and so on.
Answer: Yes, this schedule is ok. First reduce morning dose, then afternoon and in last reduce night dose.

2. Respected Sir;is there a need to reduce the night dose at the last and keep it as 0.5mg till end and continue reducing morning and afternoon doses only
Answer: yes. It can be done.

3.Sir, if while reducing 0.125mg over the period of time, if i get any withdrawals; what should i do in that situation ?
Answer: You will get no or minimal withdrawal and it is better to bear them as they will subside in few days of each dose reduction.

4. can i continue my day and night duties as anyone else or take some rest while on this regime. ?
Answer: You can continue duty.

5. is there any chance of severe withrawl ? can i join the hospital work or delay it for 2 or 3 weeks ; as the PGDCC Programme has not started yet and i am at home.
Answer: You can work. If program has not started, you can rest also.

6. in case required ; can i ask for another online consultation in future ; although i will try to XXXXXXX you in OPD
Answer: Yes, you can.

i feel tinnitus very often and occasionally mental tiredness; / heavyheadedness while concentrating on some work and 1-2 hrs before next scheduled dose ; i hope they will settle down .
Answer: It appear due to anxiety disorder and due to drug withdrawal. It will improve in 1-2 months.

good morning.
so from 17th august; the reductions in doses have to be 0.25mg per week, or in other words 0.125mg in 3 days.
Answer: Yes, dose reduction will be 0.125 mg every 3rd day.

Wish you good health.
Regards

Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 9 days later
Dear Sir,
hello. hope you are very well.
i have been following your advice.
i tapered 0.125mg as adv. but after 2-3 days; felt jittery; numbness lower limbs; unsteady. it was from 1.5mg/day onwards.............

1. Sir what could be the reason.? being on alprax 2-2.5mg for 8 yrs making weaning difficult ;

i was on lonazep in yr 1997; for 1-2 yrs 1-1.5mg/day--- was tapered weekly; had after 3 days of last dose ; dizziness; numbness LL vertigo--- persisted for around 1 yr. { i presume this past history might be of some significance

3. should it be tapered even more slowly; i will reduce the dose by not crushing the tablet but by using sharp to reduce the amount ; so that i swallow it intact. not in bits

4. Sir; social/stage meets; if i have to take 0.5mg during this period; instead of weaning dose { once in a while} is it ok ...

lots of questions; but you are my hope, inconvienience caused if any is deeply regretted.

thanks for all your support.

warm regards
XXXXXXX XXXX

good morning sir,

today i scratched the tablet of 0.5mg lonazep and reduced less than 0.125 ; the advantage being ; the tablet remained intact, and then took it .
i didnt feel any symptoms. i guess by breaking the tablet ; the full quantity was not reaching the body or

could it be SIR; that tapered dose was less,

if the dose was less {which was actually} ; can i taper it by scratching little quantities from tablet every 3 days and titrating it with minimal or moderate withrawl symptoms....
 
 
Answered by Dr. Ashish Mittal 12 hours later
Brief Answer:
Hi,

Detailed Answer:
Hello Dr XXXX,
Thanks for follow up.

First it is good to see progress in your case. You are really working hard on it.

i tapered 0.125mg as adv. but after 2-3 days; felt jittery; numbness lower limbs; unsteady. it was from 1.5mg/day onwards.............
Ans: Yes, it is because of withdrawal. It will take few weeks to subside it. But continue gradual tapering.

1. Sir what could be the reason.? being on alprax 2-2.5mg for 8 yrs making weaning difficult ;
Ans: Yes, Prolong dependance on Alprax is one of the reason.

3. should it be tapered even more slowly; i will reduce the dose by not crushing the tablet but by using sharp to reduce the amount ; so that i swallow it intact. not in bits
Ans: For better and convenient use you can use lower strength like .25mg and mouth dissolving/sweet tablets like Lonazep MD/Petril MD in prescribed doses.
If withdrawal are too disturbing then, reduce 0.125 mg of clonazepam (half tablet of lonazep 0.25mg) every 5rd day.

4. Sir; social/stage meets; if i have to take 0.5mg during this period; instead of weaning dose { once in a while} is it ok ...
Ans: You can take 0.25mg sos only when withdrawals are severe.

Wish you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 1 hour later
thanks very much for a reassuring and detailed suggestions and advice.

thanks for your understanding and cooperation SIR.

i will follow the advice.

warm regards
XXXXXXX XXXX
 
 
Answered by Dr. Ashish Mittal 42 minutes later
Brief Answer:
hi

Detailed Answer:
You are always welcome.
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 8 hours later
hello Sir;

can i reduce 0.125mg over 3 days in small micro increments which means 0.125mg divided over 3 days or 5 days..... rather than 0.125mg every 3rd day all of a sudden. can i do it or its not adviced, respected Sir...

many many thanks

warm regards XXXXXXX

 
 
Answered by Dr. Ashish Mittal 10 hours later
Brief Answer:
Hi,

Detailed Answer:

0.125 mg already very less dose. So, reduce 0.125 mg of clonazepam (half tablet of lonazep MD 0.25mg) every 5th day.
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 10 hours later
thanks very much sir.... i am doing fine now.


many many thanks XXXXXXX

 
 
Answered by Dr. Ashish Mittal 14 hours later
Brief Answer:
hi

Detailed Answer:
You are always welcome.
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 10 days later
hello Sir..

hope you are very well. thanks for all the support.
i am doing fine.

from tommorow, onwards; Sir. i would be on Tab lonazep 0.25 mg TDS. i feel very happy about ; that it could happen steadily.

my concern is : am i going to reduce 0.125 mg every 3rd day ; till i achieve a state of 0.125mg TDS.... or it would be now in any different pattern .. kindly suggest please ...

2. once i would be taking only 2 doses of 0.125 mg in a day and then only one dose in a day, how should i manage if i feel uncomfortable? is it that i can take 0.25 mg SOS ; only when required ? as suggested earlier.

3. would it be an easy going once i am off clonazepam ... how would a patient feel - once off lonazep.. keeping in mind my history of alprax consumption .

4.is there any need to continue night dose of lonazep 0.25mg for some time..

5. and i presume tab mirtaz will continue in 15mg strength at bed time....

6. i presume due to gradual tapering; i will not get any major serious withrawl symptoms ; perhaps i believe minor to moderate withrawl symptoms might take place? if such a scenerio is there ; kindly guide me on that please...

thankyou very much indeed for helping me ; i am so much indebted to you ; respected Sir...

very warm regards
XXXXXXX XXXX





 
 
Answered by Dr. Ashish Mittal 11 hours later
Brief Answer:
Detailed below

Detailed Answer:
Hello Dr XXXX,
Thanks for follow up again.

I am very happy to see progress in your case and for hard work you are doing to get alprax free.

my concern is :
1. am i going to reduce 0.125 mg every 3rd day ; till i achieve a state of 0.125mg TDS.... or it would be now in any different pattern .. kindly suggest please ...
Ans: Pattern of tapering will remain same and you are doing fine on this pattern.

2. once i would be taking only 2 doses of 0.125 mg in a day and then only one dose in a day, how should i manage if i feel uncomfortable? is it that i can take 0.25 mg SOS ; only when required ? as suggested earlier.
Ans: It will not be much uncomfortable, as you are already on Mirtaz which will take care of anxiety.

3. would it be an easy going once i am off clonazepam ... how would a patient feel - once off lonazep.. keeping in mind my history of alprax consumption .
Ans: Yes, It will be easy going soon in few weeks. Patient feel relax and free from anxiety/withdrawal. Their confidence, self esteem and performance in social/occupational life increases.

4.is there any need to continue night dose of lonazep 0.25mg for some time..
Ans: Follow tapering schedule. If you have sleep difficulty or severe anxiety, then you take 0.125 or .25 Clonazepam SOS.

5. and i presume tab mirtaz will continue in 15mg strength at bed time....
Ans: Yes, It will continue for long duration. It is non addictive anti anxiety and antidepressant medicine with sedative property, which will help you in sleep too.

6. i presume due to gradual tapering; i will not get any major serious withrawl symptoms ; perhaps i believe minor to moderate withrawl symptoms might take place? if such a scenerio is there ; kindly guide me on that please...
Ans: Do not worry, you will not get serious withdrawal. If it occur (rare chance) you have option of SOS clonazepam use in serious withdrawal.

XXXX It would be nice if I see you in my clinic for evaluation.

Wish you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 24 hours later
Hello Dear Respected Sir.

very good morning.
THANKS FOR YOUR SUPPORT . AND HELP ONCE AGAIN.

I WILL CERTAINLY COME OVER AND XXXXXXX YOUR GOODSELF IN OPD; FOR EVALUATION. CAN I COME AFTER SOME TIME TILL I SETTLE DOWN WITH CLONAZEPAM TAPERING AND THEREAFTER A FEW MORE WEEKS ; IF TS POSSIBLE; THAT WOULD BE VERY KIND OF YOU SIR!!

I HAVE LOT OF WORRIES AND CONCERNS AT THIS STAGE; WHICH KEEP ME FEEL DEPRESSED . I HOPE TAB MIRTAZ IN STRENGTH OF 15MG IS SUFFICIENT TO TACKLE THAT DEPRESSION. MY TWO MAJOR CONCERNS BEING: STILL A STUDENT OF PGDCC WHEN OTHERS OF MY AGE ARE PRACTICING CONSULTANTS. 2. I AM SINGLE; WILL GET MARRIED BY THIS YEAR HOPEFULLY; BUT LIVING ALONE BRINGS STRESS TO MY MIND.

ALTHOUGH I DO MYSELF SOME KIND OF PSYCOTHERAPY AND LIFE STYLE MODIFICATION TO CHANGE MY THOUGHT ; IT DOES HELP.

THANKS ONCE AGAIN FOR ALL YOUR SUPPORT.

VERY WARM REGARDS

XXXXXXX

 
 
Answered by Dr. Ashish Mittal 4 hours later
Brief Answer:
Hi

Detailed Answer:
Hello Dr XXXX,

Your current 2 concerns are valid and age appropriate. But you can not change your past and age.

Two best thing which you can do in current situation:
-Accept the truth.
-Give your best in PDCC and patients service. You will also not get free to get bored while doing that.

You can also visit some nearby psychologist for supportive psychotherapy and CBT.

Mirtaz will also help you depression and anxiety.

Wish you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 8 days later
hello Sir.
hope this query finds your gooself in the best of health.
thanks very much for your tremendous support.

Sir, currently i am taking 0.25mg , 0.125mg , 0.25mg per day. with mirtaz at HS.

today ; i tapered morning dose to 0.125mg ; but felt shaky ; dizzy ; tremlousness after 3 hrs .. had to take 0.125mg imediately; felt relief.
i strongly apprehend that tapering from 0.25mg to 0.125 mg over every 3-5 days might be a challenging task. i presume so ; since its the lowest dose i would be on; i might be wrong as well.. but i couldnt manage today morning ? possible due to withrawl ? that i had.

1.
Respected Sir, is there any way ; whereby i can taper even more gradually.....

2. i have decided to take{ 0.25mg } morning and{ 0.25mg }late evening 7.30PM ; from tommorow; obliterating the middle dose ; rather than decreasing the morning dose; to 0.125mg; since i feel i will be taking a theureupeutic dose of 0.25mg after 12-13 hrs ; when i wake up in morning at 8am ; i will try this one.

3. but again the main aspect remains . can i taper slowly ; if 0.125mg 3-5 days doesnt work..

4. both at working place and at home; the withrawl symptoms are distressing ..
i am sure ; i will make it ; with your help; i need your help at this last moment; so that one step; and i am free off this medication.



very warm regards

XXXXXXX XXXX
 
 
Answered by Dr. Ashish Mittal 14 hours later
Brief Answer:
You can slow in tapering.

Detailed Answer:
Hello DrXXXX,
Thanks for follow up again.

Congratulation for good progress in case, which is possible due to your continued motivation and hard work.

As you have come on low dose of clonazepam, which is not troublesome, so we can reduce amount and frequency of tapering doses now.

1.Respected Sir, is there any way ; whereby i can taper even more gradually.....
Ans: Yes

2. i have decided to take{ 0.25mg } morning and{ 0.25mg }late evening 7.30PM ; from tommorow; obliterating the middle dose ; rather than decreasing the morning dose; to 0.125mg; since i feel i will be taking a theureupeutic dose of 0.25mg after 12-13 hrs ; when i wake up in morning at 8am ; i will try this one.
Ans: As clonazepam is long acting (>12hrs) you can reduce frequency of dosing 2 times a day. Now you can reduce 1/4th tab of clonazepam 0.25mg (0.0625) every week.

3. but again the main aspect remains . can i taper slowly ; if 0.125mg 3-5 days doesnt work..
Ans: Yes, You can taper slowly.

4. both at working place and at home; the withrawl symptoms are distressing ..
Ans: With very slow tapering it will be less.

Wish you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 34 minutes later
thanks very much Sir, for the helpful suggestions

it builds up a lot of confidence in a patients heart for the doctor as he feels that ; the doctor understands and realises his problems.
thanks once again.

so i would reduce 1/4 of 0.25mg from morning dose and after completion of 1 week; reduce another 1/4 from the remaining tablet .

i understood it.

very warm regards
XXXXXXX XXXX
 
 
Answered by Dr. Ashish Mittal 32 minutes later
Brief Answer:
Welcome

Detailed Answer:

Thanks for the kind words
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 8 hours later
HELLO SIR..

I HAD SOMETHING TO ASK FOR.

I WANT TO GET OFF FROM LONAZEP ; THATS MY PRIORITY ; SO IN THAT CASE---

1. IF I AM ABLE TO TAPER/TOLERATE 1/4 OF 0.25MG EVERY 3 -5 DAYS INSTEAD OF 1 WEEK; IS THAT FINE SIR......

2. I PERSONALLY ATTRIBUTE THE CO -EXISTING DOMESTIC ANXIETY; AND SUBSEQUENT ELEVATION OF BLOOD PRESSURE- MAY BE PRODUCING TREMULOUSNESS ETC ETC.. I MAY BE CONSIDERING IT AS WITHAWL WRONGLY.

3. I HAVE STARTED RELAXATION THERAPY AS ADVICED BY YOUR GOODSELF; SO THAT MY B.P AND ANXIETY IS REDUCED TO SOME EXTEND AND HOPEFULLY MIGHT AID IN TAPERING LONAZEP.

THANKYOU VERY MUCH FOR YOUR ENCOURAGEMENT.. IT REALLY HEALS

THANKS
REGARDS XXXXXXX
 
 
Answered by Dr. Ashish Mittal 14 hours later
Brief Answer:
You will be well. Continue slow tapering.

Detailed Answer:
Hello Dr XXXX,

1. IF I AM ABLE TO TAPER/TOLERATE 1/4 OF 0.25MG EVERY 3 -5 DAYS INSTEAD OF 1 WEEK; IS THAT FINE SIR......
Ans.: It is better to slow down (because of low daily dose of clonazepam currently) tapering as mentioned in previous reply to prevent withdrawal and better outcome.

2. I PERSONALLY ATTRIBUTE THE CO -EXISTING DOMESTIC ANXIETY; AND SUBSEQUENT ELEVATION OF BLOOD PRESSURE- MAY BE PRODUCING TREMULOUSNESS ETC ETC.. I MAY BE CONSIDERING IT AS WITHAWL WRONGLY.
Ans.: Yes, it may be possibility, but it is very difficult to distinguish between them. So keep slow tapering continue. For domestic anxiety, relaxation technique will work in long term.

3. I HAVE STARTED RELAXATION THERAPY AS ADVICED BY YOUR GOODSELF; SO THAT MY B.P AND ANXIETY IS REDUCED TO SOME EXTEND AND HOPEFULLY MIGHT AID IN TAPERING LONAZEP.
Ans.: Yes. It will help definitely.

Wish you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 31 minutes later
thanks once again...
very much.
very grateful to you. Dear Sir

regards
XXXXXXX XXXX

good morning.

can i take atorvastatin at bed time ; with mirtaz... in case i have to



i hope its ok.

thanks
regards
dr XXXXXXX
 
 
Answered by Dr. Ashish Mittal 24 hours later
Brief Answer:
You can take them together.

Detailed Answer:

You can take atorvastatin with our psychotropic medicines.
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 13 days later
hello sir!, hope you r very well. thanks for being of such a tremendous help.

I remain comfortable on 0.25mg TDS at home; but when I have to XXXXXXX people ; work in new place; new environment--- I have to add 0.125/0.25 mg SOS.

this was till yesterday.
but today ; I had already taken morning... 7AM & 12 noon 0.25mg ; 3PM -0.125mg + 0.125mg 4pm ; as I had to visit fortis Mohali CCU for meeting doctors there ; that's why I took this extra dose; but the moment; I entered ; CCU ; I had severe trembling... I went out ; and took 0.25mg at 5.20pm. somehow things settled over 2 hrs... took another 0.125mg .. then felt better after some time. over this time I realised; this trembling could be due to my severe depression and inferiority complex. so that moment I decided to fight it out; and geared up myself; that really worked.

Respected Sir; i don't want to increase clonazepam; but can i increase it to work properly for 5-6 days in new place; and then taper it back' till i get accustomed to new place... ifelt very very shaky today ; but I am sure ; my will power will overcome it in a week. as had it been WITHRAWL; then why didn't i get it at home------ where i was almost taking 0.25mg ; 0.125mg ; 0.25mg till 17 September 2013. I am sure its ANXIETY . may be i am wrong.


2. Sir; Mirtaz 15 mg ; it seems has helped me reach 0.25mg tds ; but now i presume its not ? may be sufficiently covering...

3. My main worry is this week or till next week; can i increase clonazepam by taking a 0.5mg in morning and afternoon atleast ;{ so that i don't have to take 0.25mg tablets from pockets SOS ; which happens occasionally ; say twice/day}; and then 0.25mg or 0.5mg ; at night for some time.....
i will definetly fight my depression; as its the culprit actually .... my confidence is very low; self esteem is low; mood is low.... but i will fight it; as i cannot live such a handicap life....

thanks very much Sir...
obliged to you Sir
XXXXXXX


thanks n regards




 
 
Answered by Dr. Ashish Mittal 14 hours later
Brief Answer:
Need management of your anxiety.

Detailed Answer:
Hi Dr XXXX,

Apart from alprazolam dependance, you also have generalized and social anxiety. Your current symptom not due to alprazolam withdrawal.

For generalized and social anxiety clonazepam is not good option for long term. These symptom will relieved by Mirtaz and nexito in few days.

Following steps will help you in current stage:
-Do not increase clonazepam dose on regular basis. You can take it sos basis.
-In social anxiety, you can take 20 mg propranolol for symptom relief. Hope you do not history of asthma and your BP is normal, to take it.
-Increase Mirtaz dose to 30 mg in night time.
-Start Tab Nexito 5mg after breakfast. After 5 days increase dose to 10mg per day.

Regards
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 8 hours later
dear Sir;

I was better today than yesterday.
I took 0.5mg in morning and then SOS basis, which amounted to same, XXXXXXX 1mg /24 hrs. it will be less in next 2-3 days till I sort out my things.
I will overcome social anxiety by facing situations ; let me face them; Sir.
as I have been depending on alprax like tablets always ;

sir ; i want to stop mirtaz--- reason being ; the night shifts;

there is pressure on me; in such a way; that i have to overcome anxiety by my will power; i have no way out; as working in CCU ; and taking mirtaz and increasing clonazepam ; its really difficult to work;

Sir; i will follow this regieme of lonazep 0.25mg tds ----tapering it as adviced ; and taking it SOS ; when required.

i hope i am right.... my aim is to get rid of these medicines;

thanks..... n regards

dr XXXXXXX

sir; i have tried nexito previously; i had bad experience with that.

i will take propranolol as adviced; i am not an asthamatic ; but yes htn is there.
for that i m on amlopress 5mg od

thanks very much sir......
 
 
Answered by Dr. Ashish Mittal 13 hours later
Brief Answer:
It is better to stick on treatment plan.

Detailed Answer:
Hi Dr XXXX,

In my view you should take mirtaz (it is not habit forming like alprax) as advised. You can take it before sleep during night duty period.

Many time it is difficult to control anxiety self that may be reason you was using excessive alprazolam. Mirtaz is one of the reason behind developing confidence of self control on symptoms. It is positive sign in your case.

Instead of nexito you can start sertraline 25mg in morning time, if you had bad experience with nexito.

Your case one of the difficult and chronic case. I can understand your concern but, in current situation, It will be better if you follow my advise (as I told you in past). We can alter treatment after few months after improvement.

Regards
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 11 hours later
Dear Sir;
thanks for understanding me.
I will stick to the plan.
thanks n regards

dr XXXXXXX
 
 
Answered by Dr. Ashish Mittal 2 hours later
Brief Answer:
Hi

Detailed Answer:
Welcome.

Whatever I say and all treatment decisions, are for your benefit.

I am for planning for long term benefit in your case.
Above answer was peer-reviewed by
 
Follow-up: Feeling dizzy, headache, numbness and occasional weakness in legs. Taking medication. Suggest further treatment? 11 hours later
hello sir,
thanks for your support.

so; I will finally taper lonazep; with in between SOS ; and as suggested by you earlier ; should I increase mirtaz to 30 mg/ 22.5mg or keep it at 15mg?

if the dose of lonazep increases on some day by taking it SOS ; is 30 mg mirtaz at HS ok;

thanks n regards
XXXXXXX

 
 
Answered by Dr. Ashish Mittal 3 hours later
Brief Answer:
Hi

Detailed Answer:

Yes, Increase Mirtaz to 30 mg per day.
Above answer was peer-reviewed by
 
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