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On etizolam for chronic insomnia. Should I expect to develop tolerance over time?

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Practicing since : 2007
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I have been tried on a slew of pharmacological and nonpharmacological treatments for chronic insomnia since I was a child. I have tried everything imaginable from the standard zolpidem to trazadone and quetiapine, to hydroxyzine, etc etc etc.. So far but one either do not work at all or I am not comfortable with the health risks or side effects.

I was prescribed one drug while living in Japan, etizolam, known as Depas there, and I had no problem falling asleep, and there's never a single problem staying asleep until time to start my new day.

We started at .5mg each night, trying at that dose for three nights, and increasing the dose by another .5mg per night if there were no results by the third night. In the end it turned out that I needed 2mg to fall asleep properly and stay sound asleep until morning.

I have been taking 2mg etizolam each night without a problem for about one month and have not built any sort of tolerance at this point. Now I have moved to another country and so I import my etizolam from India as Etilaam and continue to take the medication as prescribed.

I have read that tolerance can be an issue, but that the tolerance might tend to develop differently depending on whether it is being used for anxiety, depression, sleep, etc. The effects of tolerance develop differently according to the different ailments. And in some cases, for some ailments, there might be no tolerance.

So could you tell me, without a simple "yes this is totally fine," or "no, this is quite similar to a benzodiazepine and is therefore highly tolerance-building and therefore addicting," whether this might be a viable long term solution to my sleeping issues, and whether I should expect to develop a tolerance over time.

Thank you.
Posted Tue, 19 Nov 2013 in Sleep Disorders
Answered by Dr. Jorge Brenes-Salazar 1 hour later
Brief Answer:
Development of tolerance is likely

Detailed Answer:
Dear patient,

Thanks for your health concerns. Indeed, etizolam IS a benzodiazepin, such as midazolam, alprazolam; short acting, fast onset of action and therefore useful as a sleep aid. However, all of these medications create tolerance over time, as tolerance is defined in pharmacology by an increase (at some point in treatment) of the required dose to reach the same effect as before; benzos act on the same receptors that alcohol does (GABA) so, imagine this scenario: a completely alcohol naive person decides to have a glass of red wine at night to improve cholesterol; the first nights I bet she is going to feel a bit wuzzy, but as nights and nights would go on, she starts surpassing those effects, and if she were to experience the same wuzzy feeling, she would proably need, who know, 2 or 3 glasses depending on the time.

Being 26 years old, with a life expectancy of at least 75 years by statistics, it would be "a lot" of years of etizolam, and for sure, there would be receptor tolerance.

Yours truly,

Dr Brenes-Salazar MD
Mayo Clinic MN
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