Benzos Is lorazepam or clonazepam better for opioid withdrawal?

[Swimmingdancer]

Just wondering which is ideal to use for, say 2-6 weeks to help with methadone withdrawal: clonazepam (Klonopin/Rivotril), lorazepam (Ativan), or a combo of both (say using a low dose of clonazepam 1x a day and using the lorazepam on top as needed)?

Considerations:
I don't want to have withdrawal symptoms from the benzo when I stop, but even the acute stage of methadone withdrawal lasts for a very long time (usually a month or more in my experience), so it's unrealistic for me to only take the benzo for a few days. I'm thinking maybe benzo withdrawal could be avoided/minimized by tapering off the benzo(s) when stopping? Thoughts?

Would clonazepam be more dependence-causing than lorazepam but perhaps easier to taper?

Anything else I should know? Anyone done this? I am thinking a rapid taper off the methadone using a combo of either clonidine or lofexidine plus the aforementioned benzo(s). I'm thinking: the methadone would be decreased, while the other drugs would be increased, and then I would just stop the methadone completely, stabilize on the other drugs, then taper off them.

 

[AlphaMethylPhenyl]

Benzodiazepines all have roughly the same potential to create dependence, though hypnotics (neither of which lorazepam or clonazepam is) generally are more so apt. Long and short acting benzodiazepines have similar withdrawal, just vary in intensity/length based on half-life.

I would stick to taking only one benzodiazepine so as to minimize developing addiction. And four weeks is the standard institutional maximum if one wants to avoid this, assuming you haven't been addicted to a gabaergic before (if yes, then the window is substantially smaller).

Since clonazepam is longer-acting, it might be easier to taper from, and would produce more of a constant presence in your system than lorazepam.

I'd really suggest seeing a doctor about this though. I don't give medical advice.

 

[Znegative]

I never have found any benzodiazepine to be effective really for withdrawal, except for insomnia perhaps, but even then I find Gabapentin to be vastly more effective for every aspect of opiate detox.

However, my advice would be to switch up the shorter acting lorazepam with the longer acting clonazepam, and its probably best to use the shorter acting benzo more than clonazepam as IME it is easier to form a dependency to clonazepam as opposed to alprazolam or lorazepam. I would try also to dose a maximum of once a day.

Clonazepam is certainly easier to taper from than lorazepam. I used to switch between the two, dosing either 1mg of lorazepam 2xday, or clonazepam .5 2xday. With clonazepam I've always felt maintained but with lorazepam I experience interpose withdrawal.

 

[Swimmingdancer]

Benzodiazepines all have roughly the same potential to create dependence, though hypnotics (neither of which lorazepam or clonazepam is) generally are more so apt. Long and short acting benzodiazepines have similar withdrawal, just vary in intensity/length based on half-life.

I would stick to taking only one benzodiazepine so as to minimize developing addiction. And four weeks is the standard institutional maximum if one wants to avoid this, assuming you haven't been addicted to a gabaergic before (if yes, then the window is substantially smaller).

Since clonazepam is longer-acting, it might be easier to taper from, and would produce more of a constant presence in your system than lorazepam.

I'd really suggest seeing a doctor about this though. I don't give medical advice.

Oh I am doing it through a doctor, it's just that doctors don't have personal experience and aren't always knowledgeable about things like methadone withdrawal or benzo dependence, so I like to get outside opinions.

I thought clonazepam would be worse for dependence than lorazepam because it is longer-acting and the withdrawals are longer, like how methadone causes a dependence faster and has longer-lasting withdrawals (and IMO worse, although that might just be because they're so long) than heroin.

I never have found any benzodiazepine to be effective really for withdrawal, except for insomnia perhaps, but even then I find Gabapentin to be vastly more effective for every aspect of opiate detox.

However, my advice would be to switch up the shorter acting lorazepam with the longer acting clonazepam, and its probably best to use the shorter acting benzo more than clonazepam as IME it is easier to form a dependency to clonazepam as opposed to alprazolam or lorazepam. I would try also to dose a maximum of once a day.

Clonazepam is certainly easier to taper from than lorazepam. I used to switch between the two, dosing either 1mg of lorazepam 2xday, or clonazepam .5 2xday. With clonazepam I've always felt maintained but with lorazepam I experience interpose withdrawal.

Interesting, I will ask about gabapentin as well. I hadn't heard about it being used for opioid withdrawal before. I get a lot of anxiety and insomnia with opioid withdrawal, so I was thinking that a benzo would be helpful for those things.

Do you guys think that after relatively short-term use of a benzo, like 2-6 wks, that with tapering off the benzo one should be able to completely avoid withdrawal symptoms?

 

[AlphaMethylPhenyl]

The debate rages on as to whether benzodiazepines with a shorter or longer half-life are more addictive. I can tell you for a fact that when I stopped taking alprazolam I experienced some nasty panic attacks, which would have manifested as a more smooth discomfort with clonazepam or diazepam; also I only took it about fifteen times over two months (though I've had prior GABA addiction). As stated above, its a trade-off: longer withdrawal but less intense with clonazepam (assuming you're taking an equivalent dose).

As I said, I think it would do well to keep use under four weeks. Alternatively, you might want to ask about taking lorazepam only as needed, allowing a greater time-frame.

You probably wouldn't completely avoid withdrawal even if you were tapering with a longer-acting opioid, so not on the regimen which you plan.

Gabapentin and pregabalin are frequently given as a sort of substitute to drug addicts. I've heard good things about it in this regard as well as in its ability to treat anxiety.

May I ask why you're planning on getting off methadone?

 

[laCster]

gabapentin, better yet, lyrica is provides astonishing relief from WD pain for opiates and benzos.

i'd suggest a taper of klonopin because it has a longer half life, and try to get some lyrica, if not go with some gabapentin. use gabapentin and.ir lyrica to help WD symptoms while reducing your dose. once you are completely off of the benzos, taper the gabapentin/lyrica, and your done. few people exeperience intense WD, but most of the people i talk to on BL and i also think that gabapentin or lyrica WD is not that intense, i only felt slight symptoms, sleep difficulties, loss of energy, body pain. but i was still able to work and the WD was over in 3-4 days, and if felt better. good luck!

 

[helium-4]

Benzos are so user dependent on their effects imo (besides with strong hypnotics) that it is really hard to tell which ones will work best for you. Its imo better to just look at the half-lives of the drugs over peoples preferences. Also, if you can get multiple types of benzos I'd go for that rather than just one. For example, if you could choose lorazepam and clonazepam, I'd take clonazepam as your long acting day long anxiety reliever. When ever some of the physical or mental symptoms spike, take a lorazepam sublingually and it will help with in 45 mins. It also ime pretty sedating and with the time before bed often being the hardest part of the WD day, take another lorazepam to push you to sleep/get rid of some of the racing thoughts.

I'd also see if you can get any gabapentin or pregabalin as they take away the physical effects of the WD pretty damn well. Mix those in with a bit of lope and you'll be golden. I've never had a alpha2 adren agonist like clonidine but it worth trying to get from all the great reviews for WDing.

I personally think if you keep your benzo doses reasonable, you don't need to worry about a benzo dependency after 1 month. Especially if during the WD peroid particularly the tail end, you really start eating healthy, and exercising that any little mental effect from the benzo halt will be easy to get rid of after a month.

 

[PinK~cloud]

Clonazepam IMO. I've only tried lorazapam during opiate withdrawal and found it to not help too much.

In my opinion and experience, you're better off with clonidine. Its absolutely amazing for opiate withdrawal.

 

[Swimmingdancer]

That's good to know, I've never tried clonidine before. The benzos would be as needed on top of the clonidine. Can clonidine lower your blood pressure too much though? I already have fairly low blood pressure and it doesn't tend to go up much during withdrawal.

 

[shreddedlettuce]

Swimmingdancer I'm sure you are aware of all the dangers of benzo addiction and are a responsible person.
So to answer your question "Is lorazepam or clonazepam better for opioid withdrawal?".
Clonazepam.
Diazepam would be better, but I'm not sure if that applies to to both opioid withdrawal AND benzo withdrawal.

From a previous thread of yours (can't remember when) I remember saying that "benzo w/d was by far worse than opioid w/d. I remember you replied saying how strong opioid w/d was.
With this in mind try go with Diazepam, or 2nd best Clonazepam.
I'm sure you will avoid the "traps" and thus making your w/d as comfortable and effective as possible.

 

[chrisalt]

id say clonazepam. Itas longer acting and smoother IMO then lorazepam.

 

[Znegative]

IME clonidine has not been very helpful, though others swear by it.

And yeah, I forgot to mention Lyrica, which is basically a more potent version of Gabapentin. Both are insanely good for withdrawal, and have many similar effects to opiates which helps a lot.

 

['medicine cabinet']

^really, didnty find clonidine helpful? that shit has been a lifesaver for me manytimes..ah well to each his/her own.

id say clonazepam if you are going to choose of the 2, tho i must say valium is a solid contender as well just because it lasts so long and has musculoskelatal (sp) relaxant properties, kinda makes trhe aches easier to deakl with, esp in the legs.

i cant say from personal experience about gabapentin or lyrica, but from what i have read it works pretty well. always worth a shot. just check a reliable med source before you go pill poppin to make sure there are no dangerous interaction. a moderate interaction is ok, severre is a whole different story. just be careful. i know how easy it is to start poppin pill in the hopes to start to feel better. GL.

 

[Lucas23]

Clonidine was an absolute must-have for me. Under a doctors supervision I used a combination of clonidine (1mg), lorazepam (1mg) and zolpidem (12.5mg) along with suboxone to get off an absurdly high oxycodone addicition (600mg - 800mg a day at the peak). The combination allowed me to get off the oxy without any significant withdrawal symptoms. I was stunned. Maybe because I was expecting hell (and hell will arrive when I want to get off subs).

I was off the clonidine within a month. No issues. Down to one lorazepam before bed from three throughout the day/four at night. No issues tapering down. I continue to take one zolpidem. No issues sleeping. Oh, and 8mg suboxone every morning.

Into my 11th week.

 

[tricomb]

Benzodiazepines aren't going to help much as ZNegative said, and of all the benzodiazepines, clonazepam and lorazepam would be my last choices.

I'd say the clonazepam though perhaps, just for the steadier plasma concentrations.

 

[brutus]

Taking benzos during opiate WD has always been like taking putting on a band-aid over a gaping wound in my experience. I've had IV Ativan during methadone withdrawal and I could barely tell any effects from it. I've taken Klonopin a million times trying to quit methadone and never could tell any improvement versus not taking benzos.

 

[Swimmingdancer]

Thanks for the advice everyone

I asked about lorazepam versus clonazepam because the choices I've been given by my doctor at this point are:

- either clonidine or lofexidine
- clonazepam, lorazepam or both

By the way, I'm thinking of going with the lofexidine because studies have found it to be just as effective as clonidine for opioid withdrawal, but with less hypotension (and fewer doctor's visits or stopping of the medication due to hypotension/side effects) than clonidine.

I've used lorazepam before and did feel like it helped for me somewhat at least. I think a benzo is better than no benzo. I don't know yet whether or not diazepam is an option, I am lucky to get anything considering that where I live most doctors treat methadone patients as drug seekers and I couldn't even find an inpatient detox in my area which gave you anything more than clonidine. Detoxing from methadone is not very common (here at least) and there are not many doctors knowledgeable about it. Most of them just believe that methadone is the treatment for opioid addiction or that everyone should be able to taper off the methadone with no withdrawals at all. Which is totally not the case for me, I am so sick of tapering.

I will ask about gabapentin or pregabalin.

Swimmingdancer I'm sure you are aware of all the dangers of benzo addiction and are a responsible person.
So to answer your question "Is lorazepam or clonazepam better for opioid withdrawal?".
Clonazepam.
Diazepam would be better, but I'm not sure if that applies to to both opioid withdrawal AND benzo withdrawal.

From a previous thread of yours (can't remember when) I remember saying that "benzo w/d was by far worse than opioid w/d. I remember you replied saying how strong opioid w/d was.
With this in mind try go with Diazepam, or 2nd best Clonazepam.
I'm sure you will avoid the "traps" and thus making your w/d as comfortable and effective as possible.

Thanks lettuce
Yeah, I remember that thread (I don't think I started it though? can't find it), I think you said benzo withdrawal is way worse than opioid withdrawal and I said something about every person and situation being different, but of course I still definitely have a healthy respect for benzos and want to minimize dependence if at all possible, and I especially don't need to go through benzo withdrawal while going through methadone PAWS.

So yes, I am asking which one is most effective for opioid withdrawal and which one is has a lower physiological dependence profile and/or would be easiest to taper off of with minimal withdrawal symptoms? I would still like to know if people think tapering off clonazepam would be enough to eliminate withdrawals?

 

[shreddedlettuce]

I would still like to know if people think tapering off clonazepam would be enough to eliminate withdrawals?

Eliminate is maybe too strong a word, but clonazepam would be the advice I would give. (Not to everyone, but just for Swimmingdancer's situation).

 

[helium-4]

ooo, I'd be very interested in lofexidine. I've read good things about it.

I'd go with lofexidine and if you can get possibly a low dose of benzo PRN incase anxiety gets bad or you can't sleep.

 

[T. Calderone]

This is a hard situation. During my last rehab, I talked to a guy there who was w/d from methadone. He was in so much pain and told me it hurt like hell. The doctors gave him oxy 30's for withdrawal medication. This went on for weeks but if I hadn't seen it myself it would be hard to believe.

You're in for a rough ride. But I think it's great you want to beat this on your own. A hospital setting may be beneficial in the case you get real sick in the process but then you're giving up your comforts of home. You can do this, just don't take too many benzos. Only enough to help you sleep. Keep yourself awake during the day, I know it's difficult. Whichever benzo you take will help you rest at night. Get through this Godspeed. It's going to take a while but think about how good it will feel when you are no longer a slave to these drugs.