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Is Taking Suboxone And Librium Together Safe?
Question: Thanks, doc. Thing is I really cant get my doctor or my shrink involved. if they find out I got addicted they will cut me off completely,,pretty much the reason I am online with you. I have been been detoxed off benzos 3 or 4 times and I know I cant function without them. Please don't try telling me I can because I have tried and it was hell and didn't get better with time, and even if, I don't have time right now with all that is going on right now. hence I am trying to do what I can with what I can get. Just happened to have access to these gabs because my mom got placed into skilled nursing, just 1 of the problems cause she never put me on her checking account and I cant get any of our money for bills or anything now. So you see I am sort of playing my own doctor here with your help. Anyway, I was re-reading 1 of your last replys and you said you place your your patients going through opiate withdrawls on that buprenorphine and [narcan] , basically the suboxone mixture along with benzos for the 1st ten days. When I went to rehab they said they couldn't give me suboxone because I was getting Librium and they cant be given together. Why did they do that to me?
Brief Answer:
librium-suboxone together cause more side effects
Detailed Answer:
Thanks for direct question.
I agree with you that after taking benzo for few years it is almost impossible to stop them. We generally explain risks with long term benzo use and ask those patients to come to us regularly for prescription so at least if anything serious is there, it can be evaluated.
In your case due to situation and method of medical practice, which somewhat differ from we do, you are not able to get benzo. And pregabalin and gabapentin are useful in benzo withdrawal so gaba is helping you in symptoms of anxiety which is mostly due decreasing the dose of benzo.
Your question about simultaneous use of Librium and suboxone:
Suboxone(Buprenorphne) is an opiate and Librium(chlordizepoxide) is benzo.
Both act on central nervous system through different receptors. Both can cause sedation and confusion. If by chance both given in higher dose without medical supervision it can be lethal combination.It leads to severe confusion, sedation, respiratory depression and sometime death also. This applies to suboxone and benzo like Xanax,klonopin,Librium,valium. Because of this reason rehab centre there has denied to give them.
However if both used under medical supervision and in appropriate dose, no problem occurs.
We use mostly lorazepam (Ativan) which is less potent and short acting among benzo and purpose is to treat withdrawal symptoms of insomnia and anxiety of opiates with buprenorphine.
In some cases we also use klonopin in 0.5 mg or valium 5 mg with buprenorphine. We never came across any problem.
However for initial 5 days we keep the patient indoor for observation.
Hope I have answered your query, I will be happy to answer more.
Regards,
Dr.Chintan Solanki.
librium-suboxone together cause more side effects
Detailed Answer:
Thanks for direct question.
I agree with you that after taking benzo for few years it is almost impossible to stop them. We generally explain risks with long term benzo use and ask those patients to come to us regularly for prescription so at least if anything serious is there, it can be evaluated.
In your case due to situation and method of medical practice, which somewhat differ from we do, you are not able to get benzo. And pregabalin and gabapentin are useful in benzo withdrawal so gaba is helping you in symptoms of anxiety which is mostly due decreasing the dose of benzo.
Your question about simultaneous use of Librium and suboxone:
Suboxone(Buprenorphne) is an opiate and Librium(chlordizepoxide) is benzo.
Both act on central nervous system through different receptors. Both can cause sedation and confusion. If by chance both given in higher dose without medical supervision it can be lethal combination.It leads to severe confusion, sedation, respiratory depression and sometime death also. This applies to suboxone and benzo like Xanax,klonopin,Librium,valium. Because of this reason rehab centre there has denied to give them.
However if both used under medical supervision and in appropriate dose, no problem occurs.
We use mostly lorazepam (Ativan) which is less potent and short acting among benzo and purpose is to treat withdrawal symptoms of insomnia and anxiety of opiates with buprenorphine.
In some cases we also use klonopin in 0.5 mg or valium 5 mg with buprenorphine. We never came across any problem.
However for initial 5 days we keep the patient indoor for observation.
Hope I have answered your query, I will be happy to answer more.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks, doc, I understand your answer,except what you said "Not able to get benzo", but that is exactly my point. I was in a rehab which means I was obviously closely monitored and they would be in charge of the dosage, so I still don't see the reason why they would not give it to me. Its not like im talking about giving it to me and let me use how much I wanted. They know the dosage and the reduction rate, at least I hope they do. You even said yourself, you do it at your place with no problems. I sort of wish I was on heroin instead. Those people were going around like happy little lambs while I was going through a terrible opiate withdrawl.Yes, I know there is the down side of coming off the subs eventually but that's also a gradual taper. But your gonna have that with almost any drug, even an ssri, which I have heard nightmares about. This also brings up the other question I wanted to ask. This Effexor that im on and doesn't seem to be helping at all: can I go straight to something else, like another ssri, do I have to stop this 1st,[which I have heard is also a nightmare], Start something else while tapering off this, or what? Basically what im asking is how would I get off this and on something else? ive pretty much given up on ssri's, but Im desperate and will try anything.What about clozaril? I knowit is a heavy anti psychotic, and I had a guy working for me who was on it for paranoia. He was very slow moving, but was living a very conservative but orderly life. I hear these people complaining about these drugs "Zombie-ing them out" , but with the anxietys I have compounded by the problems I have maybe that's what I really need. I am going to discuss this with my psych, but that's not 4 over a month and would like to get your opinion in the meantime. I was even on serequil, one of those drugs they complain about that zombie state, but it did not do that to me.Actually did nothing but make me paranoin, good thing I took it at bedtime. Sorry about the long query, but Im really at wits end here and don't want to go back to upping my meds to deal with it. Thank you.
Brief Answer:
See detail answer please for queries
Detailed Answer:
Hello,
Though it is long query with few questions, I will surely answer without any bias.
It is the problem of the system of two different countries. In USA most of the doctors work strictly as per protocol and literature/studies. They are not used to with clinical judgment and believe in taking risk because of strict consumer laws and risk of suing by patients. While in XXXXXXX due to lack of resources and quantity of work we used to take clinical judgment and fast outcome. That’s why they are not giving enough medicines though you required I guess.
It is really good that you did not take heroin. Though you believe , they are causing severe problem.
The belief of yours about SSRI (which you heard) is also not so significant. SSRI are really good medicines and they changed life of lots of lots of people with anxiety and depression.
Instead of effexor, you can take paxil cr 12.5 mg maximum 50 mg per day. It is quite useful in with anxiety/panic symptoms. Here the point is whether your problem is due to decrease/withdrawal of BENZO or itself anxiety disorder.
If itself, paxil will be helpful for sure. If it is due to tapering benzo, pregabalin/gabapentin will be helpful. Do not stop effexor suddenly. Effexor should be tapered gradually and simultaneous increase in paxil. You can add desvenlafaxine (prestique) 50- 100 mg, if you are not happy with paxil alone after stopping effexor.
Clozaril is not at all useful in your case. It is indicated in resistant schizophrenia/psychotic disorder and I think you do not have any symptoms like that.
Seroquel is also useful in depression but sedation and weight gain are the issues. I am not personally using it more in my patients..
Hope I have answered your queries, if anything remains do not hesitate to ask.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki
See detail answer please for queries
Detailed Answer:
Hello,
Though it is long query with few questions, I will surely answer without any bias.
It is the problem of the system of two different countries. In USA most of the doctors work strictly as per protocol and literature/studies. They are not used to with clinical judgment and believe in taking risk because of strict consumer laws and risk of suing by patients. While in XXXXXXX due to lack of resources and quantity of work we used to take clinical judgment and fast outcome. That’s why they are not giving enough medicines though you required I guess.
It is really good that you did not take heroin. Though you believe , they are causing severe problem.
The belief of yours about SSRI (which you heard) is also not so significant. SSRI are really good medicines and they changed life of lots of lots of people with anxiety and depression.
Instead of effexor, you can take paxil cr 12.5 mg maximum 50 mg per day. It is quite useful in with anxiety/panic symptoms. Here the point is whether your problem is due to decrease/withdrawal of BENZO or itself anxiety disorder.
If itself, paxil will be helpful for sure. If it is due to tapering benzo, pregabalin/gabapentin will be helpful. Do not stop effexor suddenly. Effexor should be tapered gradually and simultaneous increase in paxil. You can add desvenlafaxine (prestique) 50- 100 mg, if you are not happy with paxil alone after stopping effexor.
Clozaril is not at all useful in your case. It is indicated in resistant schizophrenia/psychotic disorder and I think you do not have any symptoms like that.
Seroquel is also useful in depression but sedation and weight gain are the issues. I am not personally using it more in my patients..
Hope I have answered your queries, if anything remains do not hesitate to ask.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
I don't think you understood what I meant about my"belief" in ssri's and what I what I "heard". What I heard is the withdrwls if you have to stop them. What I said was I have just about given up on them. Reason being I have tried so many without any relief and paxil was one of them. 40mg., he wouldn't give me any higher dose. I heard from a couple people that Effexor was really good, so that is why I tried it, but again no help. the only one that ever helped was my 1st one, Zoloft.But after 2 years that stopped helping. Since that I have not found a helpful ssri. My Xanax or klonopin seem to help with both anxiety and depression. Oh, also I havn't been on them a few years, more like 25 years so I think the main reason is the tolerance I have built up, tid is not much help anymore, what do you think? Like I said I have consistently asked him to give me them qid, but he says he doesn't give ANYTHING 4 times a day. what kind of rule is that? I believe here lies my problem, 4 mg. a day is within the dosage limit and I would be able to live with that. What is the maximum dosage of Xanax and klonopin anyway? Ihave read 8mg. a day. if not, why do they make them Xanax 2mg. BARS and klonopin 2mg. pills?
Forgot to ask, not sure what you meant by 2 different countries. Do you mean XXXXXXX md.s are more apt to take chances than XXXXXXX docs, and does that mean only in India? Especialy since both my docs are XXXXXXX and they seem to be the ones that don't like to break out the Rx pad. My mothers docs are XXXXXXX and she gets klonopin qid and 7.5 vicodin qid, along with 600mg gabs tid along with about 5 other meds.
Forgot to ask, not sure what you meant by 2 different countries. Do you mean XXXXXXX md.s are more apt to take chances than XXXXXXX docs, and does that mean only in India? Especialy since both my docs are XXXXXXX and they seem to be the ones that don't like to break out the Rx pad. My mothers docs are XXXXXXX and she gets klonopin qid and 7.5 vicodin qid, along with 600mg gabs tid along with about 5 other meds.
Brief Answer:
Please see detail answer for queries
Detailed Answer:
Hello,
Sorry for misunderstanding.
You can try Prestique(SNRI), Mirtazapine(SNRI), and Bupropion(NRI), if not tried yet as SSRIs are not effective.
Another option is old medicine imipramine (depsonil) from TCA group.
Benzo are gold standard for anxiety. They are medicines which treat the symptoms, so they will be useful in almost all cases. The main drawback of benzo is tolerance, means they are not effective in same doses after time progresses.
Xanax is very bad drug in that regard as it is the benzo with maximum tolerance and dependence potential. I probably never use it. Maximum dose depend on person’s history of past intake of same medicines. If by chance xanax continues, it is not going to be effective in same dose as many people take 10 mg at a time who are highly dependent for proper effect. Recommendation maximm dose is 5-6 mg in panic disorder.
Klonopin is good benzo. Generally it is choice of anti anxiety medicine. For anxiety disorder it is used 5-6 mg depending upon severity. However in seizure disorder (in which it is not generally used) it can be given up to 20 mg.
For you I recommend no xanax and 4 mg klonopin in divided doses (it can be increased if needed up to 6 mg).Simultaneous pregabalin 75 to 150 mg will help to reduce dose of klonopin. Klonopin is long acting so you would feel better. There is no chance that you can be off from this medicine as you have taken for almost 25 years. But yes we can try to reduce is minimum dose which is effective for you.
No I am not specifically telling about doctor origin. I mean laws and method of practice different in both countries. In USA as per my knowledge lots of cases occur for suing doctors while in XXXXXXX rarely. So we can change dose as per patient’s need without hesitation, while there I think doctors follow strict rules according to treatment guidelines to prevent themselves from suing.
One point is that if you have used medicines on your own without doctor’s consultation or not according to recommendation in past frequently, they might be afraid of prescribing you more.
And it doesn’t matters that it is taken qid or tid. Dose per day matters more as klonopin has good half-life.
Hope you get satisfactory reply, if still any query, you are welcome.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki
Please see detail answer for queries
Detailed Answer:
Hello,
Sorry for misunderstanding.
You can try Prestique(SNRI), Mirtazapine(SNRI), and Bupropion(NRI), if not tried yet as SSRIs are not effective.
Another option is old medicine imipramine (depsonil) from TCA group.
Benzo are gold standard for anxiety. They are medicines which treat the symptoms, so they will be useful in almost all cases. The main drawback of benzo is tolerance, means they are not effective in same doses after time progresses.
Xanax is very bad drug in that regard as it is the benzo with maximum tolerance and dependence potential. I probably never use it. Maximum dose depend on person’s history of past intake of same medicines. If by chance xanax continues, it is not going to be effective in same dose as many people take 10 mg at a time who are highly dependent for proper effect. Recommendation maximm dose is 5-6 mg in panic disorder.
Klonopin is good benzo. Generally it is choice of anti anxiety medicine. For anxiety disorder it is used 5-6 mg depending upon severity. However in seizure disorder (in which it is not generally used) it can be given up to 20 mg.
For you I recommend no xanax and 4 mg klonopin in divided doses (it can be increased if needed up to 6 mg).Simultaneous pregabalin 75 to 150 mg will help to reduce dose of klonopin. Klonopin is long acting so you would feel better. There is no chance that you can be off from this medicine as you have taken for almost 25 years. But yes we can try to reduce is minimum dose which is effective for you.
No I am not specifically telling about doctor origin. I mean laws and method of practice different in both countries. In USA as per my knowledge lots of cases occur for suing doctors while in XXXXXXX rarely. So we can change dose as per patient’s need without hesitation, while there I think doctors follow strict rules according to treatment guidelines to prevent themselves from suing.
One point is that if you have used medicines on your own without doctor’s consultation or not according to recommendation in past frequently, they might be afraid of prescribing you more.
And it doesn’t matters that it is taken qid or tid. Dose per day matters more as klonopin has good half-life.
Hope you get satisfactory reply, if still any query, you are welcome.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Don't know if last query went true, don't see it here, write again from memory. I have tried all those ssri also, except prestique which is very expensive and not covered by my insurance. I agree Xanax is bad drug and klonopin is better, but I wouldn't say it is a ''good'' benzo as it is still addictive and builds tolerance. I also agree docs afraid of suing here in usa , but these drugs were made for people who need them and should be given as needed without a preset limit for everybody as everybody is different. my doc does not know of my overuse of benzo, so that is not his reason for reluctance 2 raise dose, but I am stuck with him. wish YOU were my doctor. I am not taking more to get ''high'', just that my tolerance has built up that tid is not enough. I would love to have 5-6mg a day,my life would be so much easier, but even 4 would help. I will try not to bother you anymore since I tend to ramble in my queries, But that in itself has been very therapeutic and I thank for that also. Just one more,i don't understand that last line, you say qid or tid ''doesn't matter'' but dose per day ''matters'' more as klonopin has good half life. please explain.
Brief Answer:
Klono works longer, frequency of dose less needed
Detailed Answer:
Hello,
I also wish if I were your doctor, you need not to go for such questions and you can get the treatment as per need. But it is not like that, so either you can request your doctor gently and frequently to prescribe the dose you required or can change the doctor!
Hope you can get 4 mg dose.
Klonopin half life (time required to clear half of the drug from body/plasma/circulation) is at least 18-20 hours and extended up to 40 hours depending upon individual metabolism, physical structure and duration of intake. So if it is at least taken two times a day, it can be available round the clock in body to be effective. So if you are taking 3 times a day or four times a day, concentration of the drug in circulation is not going to be affected much. Means if you take 0.5 mg four times a day or 0.5 in mornings and afternoon and 1 mg at night, it is going to have same effect. Ultimately it is 2 mg per day.
Hope you have got some clarification and some relief from our whole discussion, wish you good health.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki
Klono works longer, frequency of dose less needed
Detailed Answer:
Hello,
I also wish if I were your doctor, you need not to go for such questions and you can get the treatment as per need. But it is not like that, so either you can request your doctor gently and frequently to prescribe the dose you required or can change the doctor!
Hope you can get 4 mg dose.
Klonopin half life (time required to clear half of the drug from body/plasma/circulation) is at least 18-20 hours and extended up to 40 hours depending upon individual metabolism, physical structure and duration of intake. So if it is at least taken two times a day, it can be available round the clock in body to be effective. So if you are taking 3 times a day or four times a day, concentration of the drug in circulation is not going to be affected much. Means if you take 0.5 mg four times a day or 0.5 in mornings and afternoon and 1 mg at night, it is going to have same effect. Ultimately it is 2 mg per day.
Hope you have got some clarification and some relief from our whole discussion, wish you good health.
Regards,
Dr.Chintan Solanki.
http://bit.ly/drchintansolanki
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thanks,doc. But with all these variables, how can they get an accurate urine level test?
Brief Answer:
accurate level can not be measured in urine
Detailed Answer:
Hi,
thanks for query.
I could not understand your question clearly,"With all these variables" means?. But I will try my best to answer your question.
Actually urine test is done to identify the molecule among benzodiazepines. There is cut off level of each drug which suggest that more than that amount of the substance should be present in urine to test it positive. It is not like that by urine test , you can exactly measure what amount you take orally.As drug elimination depends upon many factors.
Hope you got the answer,
Regards,
Dr.Chintan Solanki.
accurate level can not be measured in urine
Detailed Answer:
Hi,
thanks for query.
I could not understand your question clearly,"With all these variables" means?. But I will try my best to answer your question.
Actually urine test is done to identify the molecule among benzodiazepines. There is cut off level of each drug which suggest that more than that amount of the substance should be present in urine to test it positive. It is not like that by urine test , you can exactly measure what amount you take orally.As drug elimination depends upon many factors.
Hope you got the answer,
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
the variables are those which you spoke, metabolism, physical structure. now1st you say accurate level cannot be measured in urine, then you say you can exactly measure what amount you take orally as drug elimination depends on many factors. Did you mean to say to say you' cannot' measure what amount you take orally as elimination depends on many factors? for example, wont the level be higher if say you took a dose right before the test, than if it were several hours?
also, when you said about urine test is done to identify the molecule among benzos, did you mean to identify the exact type of benzo in system, like wether it is klonopin or xanax for example?
also, when you said about urine test is done to identify the molecule among benzos, did you mean to identify the exact type of benzo in system, like wether it is klonopin or xanax for example?
Brief Answer:
You misunderstood the answer. Molecule can be identified
Detailed Answer:
Hi XXXXXXX
I thought I was clear last time. Let me try again.
Yes, which means with the urine test it is not practically possible to say what amount (dose) has been taken by mouth. In urine test, we can identify if there is benzo molecule in it or not by enzyme assay method. We can identify specific molecule with liquid chromatography and spectrometry methods.
Repeated blood test and urine tests are the best way to check if a molecule is taken by mouth or not. This is practically complex hence not routinely done.
Individuals have different genetics and metabolism pathways. For example a young person has taken 2 mg clonazepam and after 10 hours if the urine test is done it shows up positive as half life of the clonazepam is at least 20 hours. When person takes drug for longer time it is distributed in fat tissue of the person. So even after 2-3 week it can be detected in urine.
So unless the person agrees the quantity of intake we cannot calculate the exact amount. In the above example there are number of factors like age of person, half life of drug in the person, fat distribution of the person and quantity consumed.
Regards,
Dr.Chintan Solanki.
You misunderstood the answer. Molecule can be identified
Detailed Answer:
Hi XXXXXXX
I thought I was clear last time. Let me try again.
Yes, which means with the urine test it is not practically possible to say what amount (dose) has been taken by mouth. In urine test, we can identify if there is benzo molecule in it or not by enzyme assay method. We can identify specific molecule with liquid chromatography and spectrometry methods.
Repeated blood test and urine tests are the best way to check if a molecule is taken by mouth or not. This is practically complex hence not routinely done.
Individuals have different genetics and metabolism pathways. For example a young person has taken 2 mg clonazepam and after 10 hours if the urine test is done it shows up positive as half life of the clonazepam is at least 20 hours. When person takes drug for longer time it is distributed in fat tissue of the person. So even after 2-3 week it can be detected in urine.
So unless the person agrees the quantity of intake we cannot calculate the exact amount. In the above example there are number of factors like age of person, half life of drug in the person, fat distribution of the person and quantity consumed.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you, doc, you have been very helpful, supportive, and patient.
Brief Answer:
You are welcome
Detailed Answer:
Hello,
Thanks for words. It's my duty. I am also thankful to you for giving me chance to help you.
I will be glad to answer of your future queries if any,
Regards,
http://bit.ly/drchintansolanki
You are welcome
Detailed Answer:
Hello,
Thanks for words. It's my duty. I am also thankful to you for giving me chance to help you.
I will be glad to answer of your future queries if any,
Regards,
http://bit.ly/drchintansolanki
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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