benzo question (sublingual)

[Deleted member 170540]

Roche Dormicum has not been designed specifically for sublingual use. It was only later noted that its more effective by that route.

 

[Tripman]

You realize they are talking about SUBLINGUAL TABLETS of midazolam.

We already know that sublingually taken drugs have a faster onset than regular tablets. I was just making that point.

Actually they weren't.

Did you read it?

I don't know, maybe I've just live a little - but its not at simple as Tripman makes it out to be.

You've just proven your lack of ability to read a source and knowledge of formulations of benzodiazepines.

 

[Renz Envy]

Tripman, I'm not being arrogant or anything but some of us here know more about the drugs we use than our doctors and psychiatrists.

Hah. Yeah I've corrected my doctor many times on medications and it always shocks him as I act completely ignorant 90% of the time.

 

[kokaino]

Actually they weren't.

Did you read it?

Yes, I did. Did you? They used tablets made to be taken sublingually and gave that to one group and they gave the other group regular oral tablets.

One hundred ASA physical status I and II gynaecolc~ical patients were randomly selected to receive a 7.5 mg tablet of midazolam either sublingually or orally as premedication about one hour before elective surgery.

 

[Renz Envy]

The two seem to kick in at about the same rate for me.

 

[Tripman]

Kokaino. There is no such thing as a sublingual dormicum - midazolam tablet.

 

[kokaino]

Roche Dormicum has not been designed specifically for sublingual use. It was only later noted that its more effective by that route.

Kokaino. There is no such thing as a sublingual dormicum - midazolam tablet.

Well like I said, its not the same for every benzo. Midazolam has qualities that make it more appropriate for sublingual use - it's water soluble and highly lipophilic. So it is much more easily absorbed than alprazolam.

 

[Tripman]

8).

Thirteen healthy volunteers received 1 mg of alprazolam, as the commercially available oral tablet, by sublingual and oral routes on two occasions in random sequence. Plasma alprazolam concentrations during 48 hours after each dose were measured by electron-capture gas-liquid chromatography. The peak plasma concentration after sublingual dosage was higher than after oral administration (17.3 vs. 14.9 ng/ml), and the time of peak concentration following sublingual administration was reached (1.17 vs. 1.73 hours after dose). However, these differences did not reach statistical significance. The mean total area under the plasma concentration curve for sublingual administration was slightly but not significantly larger than that following oral dosage (203.7 vs. 194.4 hr.ng/ml) and no significant differences between sublingual and oral dosage were found for elimination half-life (11.7 vs. 11.8 hours) or for clearance (86.4 vs. 92.4 ml/min). Thus, alprazolam absorption following sublingual administration is as rapid as after oral dosage on an empty stomach, and completeness of absorption is comparable. In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent. The sublingual route may be a useful alternative for panic disorder patients who cannot swallow pills or for those who do not have access to a liquid at the time of dosing.

http://www.ncbi.nlm.nih.gov/pubmed/3680603

 

[kokaino]

8).

Listen, when you're 28 and you've had experience with 15 different benzos then come talk to me about benzos. Like I said, I was abusing benzos along with opiates when you were probably still in the 1st grade. Benzos don't all work the same and not all people are you, either. So speak for yourself not in generalities because you don't have the experience to speak in generalities.

 

[Tripman]

Read my above post.

Besides I have experience with more than 15 benzos.

Benzos don't all work the same and not all people are you, either. So speak for yourself not in generalities because you don't have the experience to speak in generalities.

Does that mean that all people are you? Seeing as your opinion seems to matter more than two valid sources and you haven't shown anything proving your side of the argument.

 

[kokaino]

Read my above post.

Besides I have experience with more than 15 benzos.

Yeah sure, LMAO! We don't even have 15 different benzos on the market here in the US. I've actually travelled and experienced benzos we do not have here.

Your study worked said exactly what I said:

Thirteen healthy volunteers received 1 mg of alprazolam, as the commercially available oral tablet, by sublingual and oral routes on two occasions in random sequence. Plasma alprazolam concentrations during 48 hours after each dose were measured by electron-capture gas-liquid chromatography. The peak plasma concentration after sublingual dosage was higher than after oral administration (17.3 vs. 14.9 ng/ml), and the time of peak concentration following sublingual administration was reached (1.17 vs. 1.73 hours after dose). However, these differences did not reach statistical significance. The mean total area under the plasma concentration curve for sublingual administration was slightly but not significantly larger than that following oral dosage (203.7 vs. 194.4 hr.ng/ml) and no significant differences between sublingual and oral dosage were found for elimination half-life (11.7 vs. 11.8 hours) or for clearance (86.4 vs. 92.4 ml/min). Thus, alprazolam absorption following sublingual administration is as rapid as after oral dosage on an empty stomach, and completeness of absorption is comparable. In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent. The sublingual route may be a useful alternative for panic disorder patients who cannot swallow pills or for those who do not have access to a liquid at the time of dosing.

 

[Deleted member 170540]

Well like I said, its not the same for every benzo. Midazolam has qualities that make it more appropriate for sublingual use - it's water soluble and highly lipophilic. So it is much more easily absorbed than alprazolam.

Yeah thats right... When I was about 17 (I'm 29 now) I sometimes got high off zopiclone (technically not a benzo, I know) but for some reason I only got a buzz if I took it on a completely empty stomach to make it absorb quickly. So once I tried taking it sublingually for fast absorption, despite the terrible taste... Didn't work at all, maybe I should have raised the pH in my mouth with baking soda first.

 

[Tripman]

In a word, no.

If they are meant to be taken orally then they won't kick in much faster (not by a significant enough time to make it worth it) then they would if taken orally. If they were made for sublingual use then yes they will kick in faster. That's why there are tablets and sublingual wafers/tablets. If you parachute them, they will kick in a bit faster.

Yeah sure, LMAO! We don't even have 15 different benzos on the market here in the US. I've actually travelled and experienced benzos we do not have here.

Your study worked said exactly what I said:

It says "In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent."

We are talking purely about the onset of action here:

and the time of peak concentration following sublingual administration was reached (1.17 vs. 1.73 hours after dose).

Also:

OBJECTIVES:
This study evaluated sublingual administration of triazolam for preoperative sedation in dental outpatients.
STUDY DESIGN:
A double-blind, placebo-controlled study compared 0.25 mg sublingual triazolam, 0.25 mg oral triazolam, and placebo administered 1 hour before oral surgery.
RESULTS:
Sublingual triazolam resulted in significantly less anxiety and pain at 15 minutes intraoperatively than both oral triazolam and placebo (p < 0.05). Patients' global evaluation of the efficacy of sedation ranked sublingual triazolam as significantly more efficacious than placebo (p < 0.05) with oral triazolam intermediate between the two. No difference was demonstrated in the rate of recovery or incidence of side effects between the two drug groups. Plasma triazolam levels were higher after sublingual administration during and after the surgical procedure.
CONCLUSIONS:
These results indicate that sublingual triazolam results in greater anxiolytic activity and less pain perception than oral administration as a result of greater plasma drug levels and may be useful as an alternative for nonparenteral outpatient sedation.

http://www.ncbi.nlm.nih.gov/pubmed/9269010

 

[kokaino]

Yeah thats right... When I was about 17 (I'm 29 now) I sometimes got high off zopiclone (technically not a benzo, I know) but for some reason I only got a buzz if I took it on a completely empty stomach to make it absorb quickly. So once I tried taking it sublingually for fast absorption, despite the terrible taste... Didn't work at all, maybe I should have raised the pH in my mouth with baking soda first.

It all depends on the particular benzo and the way it works (pharmacokinetics). I've had enough experience to know this. Since the age of 15 I've tried diazepam, oxazepam, temazepam, nitrazepam, flunitrazepam, triazolam, midazolam, bromazepam, lormetazepam, loprazolam, lorazepam, brotizolam, bentazepam, flurazepam, etizolam, phenazepam, clonazepam, alprazolam, and prazepam.

Oh wow, look at that - I've tried 19. I've tried so many benzos that I've lost track of all of them. I totally forgot about etizolam, phenazepam, brotizolam, and loprazolam! I only tried each once.

 

[kokaino]

It says "In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent."

We are talking purely about the onset of action here:



Also:



http://www.ncbi.nlm.nih.gov/pubmed/9269010

"The difference wasn't statistically significant...In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent."

What about that do you not get?
It's clear I'm talking to someone who's lived very little. You can't even interpret a study appropriately. Goodbye.

 

[Tripman]

Etizolam isn't even a benzodiazepine.

It's benzene ring has been replaced with a thiophene ring.

Nice way to make an argument though.

EDIT:

It's clear i'm talking to someone who can't admit when they are wrong.

Tells me my opinion isn't everything and it isn't only that which matters. However it seems 100% that it is kokaino's opinion that matters based purely on the fact that he is older.

 

[kokaino]

Etizolam isn't even a benzodiazepine.

It's benzene ring has been replaced with a thiophene ring.

Nice way to make an argument though.

Dude, get over yourself. Even the study you provided said exactly what I said.

 

[Tripman]

3 studies were provided. Two were proving what I said. One was also but it was statistically insignificant which is not the same as being incorrect.

 

[kokaino]

No dude, you don't get it. Midazolam and triazolam proved themselves worthy of sublingual use. Alprazolam did not (just as I said). The alprazolam study, which is the drug you were originally talking about, said that: "In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent."

It proved everything I said: all benzos are different and will work differently based on their pharmacokinetics. Sorry, but you obviously don't have the experience or knowledge with benzos to try to speak in generalities.

 

[Deleted member 170540]

You can't reach statistical significance if there's only 13 test subjects like in the alprazolam study. In the midazolam study there was 100.