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Suggest Medication To Manage Reactions While Weaning Off Phenobarbital
Question: OK ...what benzo is safest (and dose) to rapidly reduce a patient off 224 mgs of phenobarbital due to adverse reactions
Brief Answer:
Lorazepam can be considered
Detailed Answer:
Hello,
Thanks for using Healthcaremagic.
I read your query and understand your concerns.
Considering high GGT level and long term use of barbiturates it will be appropriate to consider use of lorazepam in dose range of 6-8 mg per day.
This particular benzo is not metabolized by liver (do not affect GGT) and highly effective in seizure disorders.
I hope this helps you.
Write back to me if you have more questions.
Thanks and regards.
Lorazepam can be considered
Detailed Answer:
Hello,
Thanks for using Healthcaremagic.
I read your query and understand your concerns.
Considering high GGT level and long term use of barbiturates it will be appropriate to consider use of lorazepam in dose range of 6-8 mg per day.
This particular benzo is not metabolized by liver (do not affect GGT) and highly effective in seizure disorders.
I hope this helps you.
Write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so stopping the phenobarbital cold turkey at 224 mgs ...the conversion factor is more like 12/14 mgs ....we have been using 8 mgs but it is not covering nearly all the physical symptoms (although remains seizure free, the patient also has trigeminal neuralgia (to which every drug has been tried to treat), with Brand Klonopin (no generics) per Mayo Clinic but getting him back there appears to be problematic given the same CYP450 enzymes are used and GGT OF 147 ...no alcohol or history of substance abuse. So goal 1 is to get the phenobarbital out as quickly as possible?
Brief Answer:
Follow up
Detailed Answer:
Hello,
Thanks for reverting back to me.
Considering the fact that he is seizure free with 8 mg of lorazepam I feel he should be continued at the same dose.
I understand that conversion factor indicates high but there is increased metabolism of self with prolonged use of phenobarbitone and we need to consider that part.
In addition there is high possibility that additional symptoms of phenobarbitone withdrawal will be under control in few weeks if not days.
In case we go for 14 mg or like, we may get more side effects related to benzos.
Considering GGT of 147 I do not think we can go for clonazepam.
I hope this clarifies further.
Thanks and regards.
Follow up
Detailed Answer:
Hello,
Thanks for reverting back to me.
Considering the fact that he is seizure free with 8 mg of lorazepam I feel he should be continued at the same dose.
I understand that conversion factor indicates high but there is increased metabolism of self with prolonged use of phenobarbitone and we need to consider that part.
In addition there is high possibility that additional symptoms of phenobarbitone withdrawal will be under control in few weeks if not days.
In case we go for 14 mg or like, we may get more side effects related to benzos.
Considering GGT of 147 I do not think we can go for clonazepam.
I hope this clarifies further.
Thanks and regards.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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