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  • BDD Moderators: Keif’ Richards | negrogesic

Benzos and opioids

I'm still in the dark as to why doctors in the US appear to use clonazepam for so many indications. In the UK it's only indication is myoclonus.

BUT the PDR doesn't rule out clonazepam + hydrocodone:

Acetaminophen; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If hydrocodone is initiated in a patient taking a benzodiazepine, reduce initial dosage and titrate to clinical response; for hydrocodone extended-release products, initiate hydrocodone at 20% to 30% of the usual dosage. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation. Avoid opiate cough medications in patients taking benzodiazepines.

I believe that clobazam was introduced into the UK pharmacopeia because it has limited sedative side-effects (and a plateau in it's effects). Certainly it was ignored when I was first prescribed codeine and later oxycodone. But maybe my doctor was simply incompetent? Multiple subsequent mistakes makes me question their competence.
 
Different doctors prescribe different things. I was once in the ER with a stiff painful neck and the doctor prescibed Diazepam and Percocet. Then a few years later I had the same problem and the doctor just gave me Flexaril. So, you never know what the doctor will prescribe. It's up to them.
 
Short question: does a little dose of a benzodiazepine interfere with the ability of an opioid naive person to nod?
 
Normally benzodiazepines increase the effects of opioids - the combination appears in forensic journals all the time (which is a hint, BTW).
 
Ah - tramadol can produce stimulation as a side-effect. In fact, in overdose I think seizures rather than respiratory depression are the maajor COD.
 
Hey OP :)

This definitely something that can happen. I'm not saying they're all evil. If A doctor identifies you in any way whatsoever of having been involved with drugs e knows you are an inherent risk and will be more conservative with controlled medications. These days, I'm genuinely surprised when I speak with people that are prescribed Benzo/Opioid combinations. Especially if a client has a past history of addiction/mental illness it's a gigantic risk

I'm not sure what your dosage of Hydrocodone (Vicodin; Lortab) is. Regardless, it's at least 30mg per day, with is moderate.

You don't have a lot of options for replacing the Benzodiazepine dosage. There are obviously placed on the internet that do that sort of thing. The problem is that dubious potency from batch to batch makes their use for anything practical, not possible.

If you think the reduction is causing problems, you could try to get something like Clonidine (Catapres) to help you with the physical symptoms of the withdrawal, including sleep. At any rate, the transition will end once your body adjusts to the change, which is likely 3-5 days.
 
TessaBella said:
I take norco 10s, 6 a day and klonopin.75mg at bedtime for the savage burning nerve pain from transverse myelitis, inflammation of the spinal cord. My pain is entirely under medicated for the unspeakable electric fire and my doctor recently reduced my klonopin from 1mg to. 75mg because he says that people are stopping breathing and dying in their sleep. All of a sudden?? I've been taking both for 15yrs with no problems. I'm forced to take as directed so no fun being had. If I take more, I run low before refill time. Please, you guys, have any of you heard of this horse shit about the dangers of this combo? Is there any validity to it?
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Yea, it's not horse shit. That combo has killed people before, and continues to do so. You must keep in mind certain people are more sensitive or predisposed to that sort of combo. Your tolerance is saving you more than likely.

I don't know the science behind it but anyone can look it up. Basically one lowers your breathing and the other effects your central nervous system. And together they intensify each other. , come to think of it I will look it up and come back. (Edit I put heart the first time)

I took 10mg hydrocodone 4 times a day with 1 mg of Xanax or Klonopin and woke up gasping for breath every night for years before I quit. It's real , had no real idea how close I really was to death until my roommate videoed me not breathing. Even then I still used.

When you are in that much pain , almost dying from not breathing is still a more reasonable outcome. So I get it.

But yea people die from from that combo. We didn't but I still wouldn't recommend it to just anyone.
 
AlsoTapered said:
I'm still in the dark as to why doctors in the US appear to use clonazepam for so many indications. In the UK it's only indication is myoclonus.
Click to expand...

My girlfriend once walked into the doctors office to complain about some anxiety she was having while driving, and the doctor basically just said "hmmm, should we go with the short acting lorazepam or a long acting clonazepam?" I was quite shocked since this was the same doctor I got my suboxone from so I know he knows about dependence.
 
Well I guess if it's for occasional use, lorazepam will act on anxiety quickly but I'm presuming that a low-ish dose of clonazepam would be used so therapeutic levels make take a day or two to arrive.

But yep - shocking that clonazepam is used. fast&bulbous posted why nitrobenzodiazipines are hepatotoxic. OK the dose makes the poison, but we don't know enough about ALL the toxic species the body breaks nitrobenzodiazipines down into.

I was given clonazepam for myoclonus but went to a specialist and asked for clobazam. When I explained why, that consultant had a rethink about their prescribing practices.

Not for nothing is their a special note on the front cover of my medical records with my qualifications written on it. I scare doctors. I don't mean to, but if I ask, it's usually not because I don't know - I want to know if THEY know.
 
I only take as directed by my doctor, which is why I'm living with level 8 pain. He only has me taking one clonazepam at bedtime and he just changed my pain medication to from 5 hydrocodone a day to morphine extended release tablets, 30mg, every 12hrs. It's only been a week but I can tell I'm still severely undermedicated for my condition. He's on vacation and I may wind up in the ER because the pain now is worse than before. He said he would increase the dosage if needed and then he went to swim with dolphins or something.
 
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