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Is Reducing The Dosage Of Zolfresh And Dropping Rivotril A Better Choice To Avoid Withdrawal Symptoms?

Posted on Mon, 6 Jul 2015

Question: Hi, I have sleeplessness with anxiety problem for last two months. My physician initially suggested zolfreash ( zolpedium) 5 mg and revotril ( clonazepam) 0.5 mg daily at bed time for 15 days. On getting better, he reduced zolfreash 5 mg and revotril 0.5 mg on alternative days. Now on getting even better, he suggested to take zolfreash 10 mg on alternative days and drop revotril as it is more addictive and my anxiety has got reduced a lot and sleeping got better. keeping respect in doctor, my psychology says instead of taking zolfreash 10 mg on alternative days, I would like to take zolefreas 5 mg daily and observe the sleep in absence of revotril for one week and drop zolfreash 5mg further to alternative days. Please tell me which is better choice

Answered by Dr. Shubham Mehta (37 minutes later)

Brief Answer:
Zolpidem 5mg daily for a week and stopping rivotril is better option.

Detailed Answer:
Hello
Welcome to HCM.
I understand your concerns.

In my opinion, taking zolfresh 5mg daily and dropping rivotril is a better choice.
Then you can gradually reduce the zolfresh 5mg on alternate days, then every 2 days and so on.

This will also prevent occurrence of withdrawal symptoms, if any, due to stopping of rivotril. Zolfresh will take care of it.

But kindly keep your doctor informed about this.

Hope this helps.

Feel free to ask further.

Take care.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shubham Mehta (1 hour later)

Thanks for your answer. Now, it may take longer time to drop the zolfreash 5mg permanently because I need to see through the comfort of first going to alternative days and then once in three days and further to permanent drop. I do not have worries about side effects as I already accustomed to this dosage for last two months. But I ask about will it have any long term effect as I read some bad things about life of the person and developing cancers. Please give me the proper suggestion

Answered by Dr. Shubham Mehta (54 minutes later)

Brief Answer:
zolpidem does not cause cancer.

Detailed Answer:
You are welcome :)

Regarding the long term effects, Zolpidem does not cause cancers.

The long term side effects appear only when drug is taken on daily basis continuously for months to years with increasing dose.
And the side effects most likely is impairment in memory and risk of dependence.

Short term use (usually less then six months), that too on as and when required basis, does not cause any permanent damage or long term side effects.

Otherwise, the drug is very safe.

As you are tolerating the drug well and your anxiety is much relieved now, I do not think you would take long time to stop the drug. Thus, there would be no long-term/permanent side effects.

Hope this answers your query satisfactorily.

Kindly close the discussion if you have no more queries and give your valuable feedback.

Take care.
Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shubham Mehta (6 days later)

Hi doctor, Please read full content in my above questions. Firstly I used to take zolfreash 5 mg/day and revotril 0.5 mg/day for 15 days and then dropped to zolfreash 5 mg/day on alternative days and revotril 0.5 mg/day on alternative day for one month and then completetely dropped revotril and taking only zolfresh 0.5 mg daily for last 8 to 9 days. Every time I change the dosage , it is getting 3 to 4 days to get reasonable sleep.Now I am sleeping reasonably ok during nights with zolfreash 5 daily. But I am not getting naps during journey time and other relaxed time in day. Is it really to be considered for further dropping of the zolfreash 5 either to alternative days or cutting this lowest dosage tablet into two halves. Not getting naps in day is due to addiction of body to medicine to get sleep in nights or any other reason I do not know. But suggest me is it right time to go for further dropping of medicine

Answered by Dr. Shubham Mehta (4 hours later)

Brief Answer:
continue with same dose.

Detailed Answer:
Hi again.

I think zolfresh 5mg is sufficient dose for you for now.
Do not reduce the dose at present. You are taking this dose from last 8-9 days.
I would suggest you to take it for another 7-10 days.

Then youcan cobsider taking it on alternate days.

The reason for not getting naps in daytime is your stoppibg of medications.
The body takes time to re-adjust.
You will be fine in few days. But I would suggest you to continue with zolfresh 5mg for now.

Kindly keep your doctor informed about this.

Hope this helps.

Take care.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (21 hours later)

Thank you doctor and I will follow your suggestion of continuing zolfreash 5 mg/day for next 10 days. I still have one worry that I am getting shuddered/ trembled especially during day time naps which is disturbing the further sleep and mood. As there is a sleep medicine support, I am not getting disturbed by this much during nights. I request your suggestion to get rid of this. Then only I can feel my sleep problem is solved. Looking forward for your valuable suggestion.

Answered by Dr. Shubham Mehta (7 hours later)

Brief Answer:
most probably due to withdrawal of rivotril.

Detailed Answer:
You are most welcome.

These are most probably withdrawal effects of rivotril.

These should disappear in another 4-5 days.
If they still persist and are disturbing, you can take rivotril 0.25 (prescription drug) mg to relieve these symptoms.

Please do keep in touch with your doctor.

Hope this helps.

Kindly close the discussion if you have no more queries and give your valuable feedback.

Take care.
Thanks.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Shubham Mehta (17 days later)

Hello Doctor, It has been 15 days since I last consulted. Please see my history in above messages. Now my sleep quality got reasonably well. Trembling got reduced. Is it time to go for gradual withdrawl of zolfreah 5 mg. If yes, can it be the cutting of tablet into two halves and consuming half a day. Although it gives psychological advantage of having medicine daily, the tablet does not have provision (lines) to make in to two halves. Please tell me which is the better option whether should I go for 5 mg on alternative days or any other method of withdrawl. Also tell me what will be the withdrwal effects whether it is only psychological or any technical.pLEASE SUGGEST

Answered by Dr. Shubham Mehta (4 hours later)

Brief Answer:
zolpidem one tablet alternate day.

Detailed Answer:
Hello again.
Nice to hear from you.

I feel glad that you are doing good and your sleep has improved.
I have our past discussion.

Yes, I think its the to reduce the dose.
I would prefer one tablet on alternate day.

I prefer this method in my patients for the following reason:
Zolpidem has short half-life. This gives body the time to get accustomed 'no daily drug'.

The withdrawal symptoms are both psychological and physiological like tremors, restlessness, irritability.

Along with this, you should follow some sleep hygiene tips like:
Avoid daytime naps.
Avoid physical exercises in evening.
Not taking heavy fatty meals in dinner.
Avoiding tea, coffee in night.
Taking warm water bath before bed.
A glass of warm milk after dinner.

This will help you to stop the drug comfortably.
Kindly keep your doctor informed about this.

Hope you find my suggestions helpful.

Feel free to ask further.
Take care.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar