Why would benzodiazepines not work properly?

[Ripplyuk]

My dentist yesterday was extracting my tooth and I had the I.V. conscious sedation using midazolam. However, it didn't seem to have much effect. The amnesiac side of it must have worked because I started to forget parts of the procedure later but I know I was a total nightmare for the dentist during it. He looked a bit worn out after and the procedure took almost 3 times as long as it should have. He told me he had given me the absolute maximum that was safe, and that he's never had to use that amount with anyone before. This still didn't make me calm and cooperative as he expected it would.

He thinks I'm one of a small amount of people that midazolam just doesn't work well mentally, but has more effect physically (I couldn't walk after). That made me think back to another procedure in hospital where they tried midazolam with me but it had no effect and the procedure had to be rescheduled and done under G.A. Also, with Diazepam, it seems to take much higher doses with me to have any effect at all, than with other people I know.

Does anyone know what the reason for this is? I feel like there something weird about me! I've never abused these drugs so I haven't built up resistance to them. It's got me worried about any procedures I need sedation for in the future.

 

[Keif' Richards]

Some people have what are known as "paradoxical reactions" to Benzodiazepines or even sedatives in general. What this means, is that for some, instead of the expected effects of sedation, hypnosis, anxiolysis etc., they might experience effects more like anger, rage, hyperactivity etc. In other words, the opposite or paradox of what would be expected.

As for your tolerance. Some people just have innately high tolerance to certain medications. I know I certainly do. As far as sedating drugs go, like Alcohol, Benzodiazepines and Opioids, I generally require more than just about everyone around me. It's a shitty thing, but it's a reality. One thing that makes it particularly shitty, is that to get adequate care, you need to convince your prescriber that you're not just after more drugs for recreational reasons, but that you are genuinely different than most of the population.

This is hard for me especially, as I'm an admitted drug user and addict. I think this is clearly implied in my medical files, so everyone assumes I'm always trying to dick them. Once I got hooked up to my PCA (Patient Controlled Analgesia) machine after surgery and they could see first-hand how much I could tolerate without it affecting my heart rate or blood pressure, that was the only way I could prove it to them.

 

[Ignio]

Midazolam is often used during operations etc just to avoid that the patients makes memory during the procedure. For me midazolam is not that comparable to other benzodiazepines and the sedation you achieve from them. I just can remember much. If you don't remember much from the procedure I would say that it worked as intended.

But as Keif' Richards says, paradoxical reactions from benzo's do happen. The effect can be mild and it can be extreme. It have happened for me once where I ended up making a looooot of problems for myself as I reacted to it as if I had taken a lot of meth and some hallucinogen. I got extremely paranoid, I was hallucinating and I was running around. I ended op calling the police due to the paranoia and the "trip" lasted an entire night. I took a dose to sleep and the "trip" ended around 9 o'clock next morning. The few memories I have form it are very uncomfortable and it took a while to clear up the mess I made from it. The police actually did show up, lucky for me it was actually two nice police men for once and they found the bottle of (prescribed) benzo's and concluded that they were the reason for my behavior and they helped me calm down. They might as well have arrested me for wasting their time and all the mess I made, but for some reason one of them were extremely understanding and helped me. After that experience I have an extreme respect for the paradoxical effect benzo's might cause. Luckily it only happened once and I don't know why. I don't think I took any extreme dose, I was not under the influence while I took it for sleep, so I can imagine anything but that it was the same dose as always.

 

[Rybee]

I get a paradoxical reaction with Lorazepam, it actually makes me very, very anxious and irritable if I take 4mg>. It's very strange... I've taken many, many different Benzodiazepines and Lorazepam is the only one to do it.

 

[Toscacat]

You may also have experienced what is know as "wind up," where the clinical effect of Versed (or any other anxiolytic, analgesic, etc.) is insufficient due to the fact that the pain, apprehension, etc., associated with the procedure was already in place prior to the administration of the anxiolytic. Very common.

 

[Ripplyuk]

Thank you for the replies. I was certainly wound up before I went in. The anxiety was so bad for days beforehand that I kept throwing up, couldn't stop shaking and had the worst heart papitations in my life. I was absolutely terrified when I arrived. I guess the drug had a lot to work against! I agree it is a problem for any other medical procedures because they won't believe me and I'll either have to endure whatever painful stuff they do, or it'll have to be cancelled and done later under GA.

My memories of it all are even less now so it's good in that way and in a sense, it has worked for me because I don't remember it as frightening. A bit embarrassing though, because I'm not sure exactly what way I behaved with the dentist, apart from knowing I was really difficult for him. Would it help if I took diazepam beforehand? Maybe the two together might work better? I don't know what to do next time I need dental treatment. I'm sure he doesn't want to deal with that again.

 

[Ignio]

Taking a short-acting anxiolytic (Like Alprazolam, Etizolam or maybe Oxazepam) an hour or two before might be a good idea for you. When you are that afraid you the procedure, I feel sorry for you that you have to endure it. It cannot be right. If you tell your doctor about your severe anxiety of such a procedure he might gives you 10 Alprazolam or something on prescription.

Then I would find out what dosage reduces your anxiety without putting you to sleep or totally messing your balance and motor skills. A day where you have nothing to do, start with 0,25 mg Alprazolam and see how you feel on that, if you doesn't feel relaxed from that dosage increase it by 0,25 (now 0,5 mg Alprazolam in total), and continue until you feel relaxed. However, with no tolerance, 0,5 mg Alprazolam should make your feel plenty of relaxed. When you you find the dosage that makes you feel relaxed at home, this dosage should be sufficient to reduce your anxiety before the procedure.

Then you go to the dentist feeling nice and relaxed and he give you a dosage of Midazolam with the result that you dont't form new memories during the procedure effectively meaning that afterwards you will not be able to remember most of it.

In time, this should make you feel less and less anxious about such procedures, maybe even to a point where you don't feel anxiety anymore making it unnecessary to take anything before.

Alprazolam is just one possibility. As you mention, diazepam is a possibility too, however the long half-life of diazepam might make you feel tired an entire day or two making it a not so good choice. Clonazepam is another opportunity. This shouldn't affect you for days. Be careful though, clonazepam are potent and you will probably only need 0,25 mg to 0,5 mg. I also mentioned Oxazepam, this is one of the milder benzo's that treat anxiety. These often comes in 15 mg tablets, and 15 mg should be enough. If not, maybe take 7,5 mg more, or even 15 mg more. It isn't among the most potent benzo's (as you can see from the relatively high amount of mg's)

If your doctor will not prescribe you benzo's, Lyrica (pregabalin) or Gabapentin can also used to treat anxiety and these medications are not as strong as benzo's and according to some they do not possess abusive potentials (which I however doesn't agree with),

As a last resort, Phenibut is similar to Lyrica and Gabapentin and it is legal (in most countries, check your own) and can be ordered off of the internet.

But considering the anxiety you are feeling, your doctor really ought to give you a few Alprazolam for det procedure.

 

[Ripplyuk]

Thanks for that Ignio. I'll ask my doctor about getting some alprazolam. They always seem really reluctant to prescribe anything like that but it's worth another go. Another time they offered 2mg of diazepam (just one pill) which did nothing at all and the procedure had to be cancelled. I could always order them online.

Would chlorpromazine or or zopiclone be of any use? I have plenty of them. Or would another benzodiazepine really be best?

 

[dopemaster]

I prefer to zone out at the dentist. I started asking for gas and honestly they give me enough to pass out or zone out.

I started meditating at first but then I just asked them to turn it up a bit and once they realized that I was cool with them knocking me the fuck out procedures were easier for everyone.

I need to go to the dentist but am kinda aprehensize because I know it is going to hurt. With my medical record no doctor is going to iv me anything nor could I afford that type of dentist.

 

[Anxious.Individual]

Thanks for that Ignio. I'll ask my doctor about getting some alprazolam. They always seem really reluctant to prescribe anything like that but it's worth another go. Another time they offered 2mg of diazepam (just one pill) which did nothing at all and the procedure had to be cancelled. I could always order them online.

Would chlorpromazine or or zopiclone be of any use? I have plenty of them. Or would another benzodiazepine really be best?

Benzos are quite unreliable, simply because of their mechanism of action. Unlike classic GABAergics like barbs, alcohol or propofol which work directly on the Cl channel, benzos work on the sub-units of the GABA-A receptors which theoretically increases the frequency of the channel opening, however every person has different sub-unit formations, which can lead to so called "paradoxical reactions", and completely unpredictable effects from benzos.

Personally for me Alprazolam doesn't work in low doses, and makes me even more anxious and agitated. In large doses (6mg +) it just causes me to stumble around and black out. I find it useless. Large dose of diazepam on the other hand work for me really well. 80mg-100mg will have me nicely benzed out, while still being functional. Clonazepam used to work for me, and was nice only at ~2mg, however it doesn't seem to work anymore even when I take 10mg+. But obviously a doc won't prescribe you those kind of dosages.

To answer your other question, I wouldn't bother with thorazine, it will just make you tired and depressed and will do nothing for your anxiety. Zopiclone might actually do the trick, however it might also make you really impaired, so be careful and stay safe.

 

[Ripplyuk]

I might try a low dose of zopiclone next time if I can't get anything useful from the doctor.

I should have have mentioned that nitrous oxide also had no effect on me. I had it once going into surgery as I was panicking getting the i.v. in. The anaesthetist eventually used sevoflourane which worked a treat. Dentists only have nitrous so I thought there was no point trying it. I find it strange that it didn't do anything as I used to sniff butane gas for years. It's effects were instant and I assumed all gases would have a similar effect on me.

 

[Ignio]

Thanks for that Ignio. I'll ask my doctor about getting some alprazolam. They always seem really reluctant to prescribe anything like that but it's worth another go. Another time they offered 2mg of diazepam (just one pill) which did nothing at all and the procedure had to be cancelled. I could always order them online.

Would chlorpromazine or or zopiclone be of any use? I have plenty of them. Or would another benzodiazepine really be best?

Do NOT take zopiclone unless you are going to sleep. If you take it and stay awake your speech will get slurped and your movements will be clumsy and slow making it seems like you are extremely high on something. Zopiclone should only be used before bedtime.

Just describe the situation in clear terms to your doctor. It is not like you are asking to get 100 Xanax' prescribed each month. You are asking for a few to use when you have to undergo procedure that cause something close to panic attacks for you. I might be a bad idea to go in and ask for Xanax directly. Going in and asking for Xanax as the first thing will look like drug seeking behavior. Start by explaining the experience you described to us (however, do not tell your doctor that the dentist gave you midazolam, I would leave this out. Your doctor might conclude that this is enough) and while I am dancing close the the boarder relating rule I would say that it doesn't hurt to exaggerate how bad you felt a little . Explain that the situation made you feel so bad that you don't wanna go back. Then ask if he can prescribe something that you can use next time to make your anxiety more manageable. Hopefully he will offer you a prescription for a package containing something like 5-10 pills of some benzo's. Whatever benzo it is, just be thankful. If he prescribes you x benzo and you want y benzo it is a very bad idea to say it right there. However, after you have tried the benzo and if it don't work you can try to ask for another.


I am aware that I am very close to or maybe even above what the rules allow me to say. However, I justified my post by the fact that we are talking about a very few benzo's. I am not advising him on how to get an continous prescription of benzo's, just how he might be able to get a few so his next dentist visit will not be as bad.

If moderators find that my post breaks the rules I apologize on before hand. I have tried to be cautions and I have tried to explain why my post could be allowed. In this situation however, I don't believe I help anyone cheating their doctor, I believe the wish of the topic starter to get a one or two benzo's he can take before his next dentist visit is reasonable and my purpose it not to help him get drugs, but to help him manage his next visit. I hope that justifies my "dance with the devil" in relation to the rules