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Benzos Is lorazepam or clonazepam better for opioid withdrawal?

tricomb said:
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.
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Wise wordz. IMO NO way lorazepam that drug is highly addictive itself. Id go to rehab fcuk it never been addicted to opiods though.
 
Clonazepam and Lorazepam are relatively weak benzodiazepines really, for people that have a tolerance anyways. Clonazepam can be VERY disappointing on its own because it peaks within 1-4 hours which is ridiculous. Its an okay anxiolytic medication, but I wouldn;t say its anymore stronger than Lorazepam. Actually Lorazepam has all six benzodiazepine characteristics for it. But, the best option for Opioid withdrawal would be Diazepam + Clonidine. That is the perfect combo for opiate withdrawal. Diazepam because of the long half life, and long lasting metabolites and effects. Fuck I find Bromazepam way STRONGER than Clonazepam, thats for sure. Clonazepam can kind of make you depressed, and is a 'very' subtle benzo. Most of those Benzodiazepine equivalency charts are WRONG. 0.5mg Clonazepam = approximately 7.5mg of Diazepam, I can back this up for sure as soon as I find the link in my bookmarks for this on pubmed. There is no fucking way that 0.5mg Clonazepam = 10mg Diazepam, I'm sorry but that is false. And its not 20mg of Diazepam to 1mg of Clonazepam, that is total and utter bullocks. Its more like 1mg of Clonazepam = 12-15mg of Diazepam, not 20. A lot of these benzo equivalency charts are outdated.

Alprazolam has a much harder, and more effect than Clonazepam, thats for sure. Clonazepam is just subtle and lasts longer, but does not produce near enough anxiolytic/panic effects compared to Alprazolam. 0.5mg of Alprazolam = roughly 10mg of Diazepam, but Clonazepam is different. 0.5mg of Alprazolam is also much shorter acting than Diazepam, and has a shorter half life. Diazepam is the best benzo, next to Phenazepam for benzo tapering that is. If you want to talk in terms of strength of Lorazepam VS Clonazepam? They are roughly about the same, I wouldn't say Clonazepam is that much stronger than Lorazepam. I would just say it lasts longer than Lorazepam but Clonazepam has VERY slow onset, peak 1-4 hours, whereas Lorazepam sublingual peaks in about 45 minutes - 1 hour, still not as good as Diazepam as Diazepam peaks in about 20 mins Orally on an empty stomach.

But for the Lorazepam VS Clonazepam for Opioid w/d. I would probably choose LORAZEPAM. But depending on my benzo tolerance, its tough to say, bromazepam + flurazepam = WIN against both without a doubt.
 
It's been two days Swimmingdancer, have you made your decision yet, or can we all carry on diagnosing your w/d's and confusing the fuck* out of you?

*(sorry, but had to be said for tense/comedic purposes).
;)
 
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junglebook said:
Wise wordz. IMO NO way lorazepam that drug is highly addictive itself. Id go to rehab fcuk it never been addicted to opiods though.
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I'm not hugely worried about it being mentally addictive for me, if that's what you meant, we're all so different and I've had lorazepam in the past with no cravings or addictive behaviours of any sort (I think I may even still have one or 2 kicking around here somewhere from like a year ago). I'm not going to rehab (which doesn't give you any meds and wants you to be detoxed first anyway) or to an inpatient detox. I researched all the ones in my area and they are in no way appealing to me. I've already reduced my methadone dose by over 90%, I am just so tired of being sick all the time and just want to get off it completely now, but I'd like to reduce the pain as much as reasonably possible while I do so.

shreddedlettuce said:
It's been two days Swimmingdancer, have you made your decision yet, or can we all carry on diagnosing your w/d's and confusing the fuck* out of you?
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Haha :) I'm not seeing my doctor til next week, so I am still open to more feedback or suggestions, but I think I've gotten plenty of good advice on the benzo choices.

What I will do depends on what my doctor is open to. I am going to take the advice you all gave and ask about clonazepam, diazepam (although I doubt I'll get that one), and perhaps a shorter-acting benzo for as needed use, and I'll ask about gabapentin/pregabalin as well, sounds like for opioid withdrawal some people have better luck with benzos and some people have better luck with gabapentin. I may try one and then try the other if the first one isn't working. And I'm going to get the lofexedine regardless.

I'm also assuming I can't take benzos and gabapentin/pregabalin close together?
 
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Swimming, what kind of dose of methadone are you detoxing from and how long you've been on it? Just curious.
 
Swimmingdancer said:
What I will do depends on what my doctor is open to. I am going to take the advice you all gave and ask about clonazepam, diazepam (although I doubt I'll get that one), and perhaps a shorter-acting benzo for as needed use,
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Don't doubt the diazepam. Just mention the long half life and therefore fewer doses and the actual drug used for withdrawal (in this case "taper" would be a better word).
And kinda not actually needing a shorter acting benzo.
Logically the longer half life would cover the length of the opiate "high", whereas a shorter acting one won't. And the opiate w/d being the main purpose for this thread (I know this might sound ridiculous but I thought I'd mention it anyway).

My last words would be
1. Diazepam would cover most of the w/d symptoms.
2. Diazepam hits pretty quickly (20 minutes at the most) and with the long half life you won't need to redose as often as any other benzo.
3. A diazepam taper would be the best (if needed).
4. I'm sure at low doses of gabapentin/pregabalin would be safe, but with diazepam it might not even be necessary.
And if your doc still says no, then try any other long acting benzo.
Try stay away from the short acting ones.
ShreddedLettuce out.
 
I'm gonna say to any nay sayers on benzos for opioid WD, they may not help with much of the physical symptoms, but they certainally help keep the anxiety low, which can be a huge part of the WD for some people, and anything to help one sleep is a plus. WDs for me are worst at night because i'm rolling around crying because i can't fucking sleep.
 
Well its only when you take it everyday if you can use it situationly then fine but i do not advise taking lorazepam daily youd just be swapping one addiction for another no doubt, been there got the t-shirt it isnt pleasent. Situational use, fine.
 
For sure clonidine (bp med), neurontin, and lyrica work wonders. You will have much sleepiness with them and dry mouth from hell but better than being dopesick. I would seriously consider other options besides benzos. They never worked for me in w/ds but everyone is different.
 
Thanks again everyone :)

cook said:
Swimming, what kind of dose of methadone are you detoxing from and how long you've been on it? Just curious.
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I've been on methadone for 10 years. I have spent the past year reducing my dose from 100mg/day to 6-7mg/day (3-3.5mg every 12 hrs). Now 6-7mg/day may not seem like much, but going to zero is still really rough for someone like me whose brain and body have been dependent on methadone for 10 yrs and opioids for 16 yrs.

This taper has been really miserable for me, ever since I got below about 30mg/day I have had "mild" withdrawal symptoms pretty much constantly, and "moderate" withdrawal symptoms any time I lower the dose and most days when it's getting close to the time for my next dose, even with taking the methadone 2x/day (I metabolize it rapidly). So I really just want to get off of it, but if I don't take it I still get even worse withdrawals that feel like too much for me to handle. So my plan is to rapidly taper the rest of the way off the methadone, while increasing my dose of other meds to help with the withdrawals, then stabilize on the other meds, then taper off them. (I'm also using a whole bunch of vitamins/supplements/natural remedies).

If anyone is curious as to what my withdrawal symptoms are/what I consider "mild", "moderate" and "severe": (just NSFW'd to save space)

NSFW:
I currently have the following symptoms most/all of the time: diarrhea (average of 2x/day+ for the past 6 months), slight nausea, anxiety, insomnia, all-over aches/pains, headaches, sweating, feeling very cold (with occasional hot flashes), all sorts of unpleasant skin sensations, anhedonia (absence of pleasure/joy), on/off depression, total lack of energy, very low motivation, no libido, yawning/lacrimation, slight sniffles, feeling dehydrated, low appetite, mild/infrequent heart palpitations ... I probably forgot some but you get the picture.

When I lower my dose or in between doses I get all of the above symptoms except worsened, plus suicidal thoughts (although don't worry, I have no desire to act on them), agitation, restlessness (internal + in limbs), heart palpitations/irregular heat beat, and sometimes a weird tickling/choking cough that is really unbearable and hard to describe.

If I, say, skip a dose, I get all of the above even worse. I think the hardest things are probably the depression, anxiety, constant pain, restless legs/arms, insomnia, heart stuff, and that terrible weird cough, (which all get more pronounced/frequent). I'm not sure what will happen when I stop taking it for even longer, it's been so long since I've done that.


shreddedlettuce said:
Don't doubt the diazepam... [cont.]
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Thanks lettuce, I will bring up all that stuff with my doc :)

Cloudy said:
I'm gonna say to any nay sayers on benzos for opioid WD, they may not help with much of the physical symptoms, but they certainally help keep the anxiety low, which can be a huge part of the WD for some people, and anything to help one sleep is a plus. WDs for me are worst at night because i'm rolling around crying because i can't fucking sleep.
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Yeah, being less anxious and able to sleep sounds like a blessing :)

SableStarr said:
For sure clonidine (bp med), neurontin, and lyrica work wonders. You will have much sleepiness with them and dry mouth from hell but better than being dopesick. I would seriously consider other options besides benzos. They never worked for me in w/ds but everyone is different.
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I think I'm going to go with lofexedine instead of clonidine because it causes less hypotension (low blood pressure) and less sedation than clonidine.

What are the other downsides to gabapentin/pregabalin?
 
Oh shit that's a long time on the poison. Have you considered ibogaine treatment, I wonder if it would work with methadone too?
 
i'd take lorazepam over clonazepam for any indication. i agree with shredded though, diazepam in my opinion is the best benzodiazepine for any kind of withdrawal.
 
cook said:
Oh shit that's a long time on the poison. Have you considered ibogaine treatment, I wonder if it would work with methadone too?
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Yeah, ibogaine doesn't work as well for methadone. The ibogaine detox in my area is 8-10 days inpatient, they strongly recommend you to switch from methadone to a shorter-acting opioid for 3 weeks beforehand, you have to stop all drugs (including the opioid) 1-2 days beforehand (longer for some drugs), and it's prohibitively expensive.

Also I've used ayahuasca, which works in a similar way to ibogaine but is less dangerous and I was able to take during my taper, and while I found it very helpful mentally and would recommend it for addiction - it helped with reducing cravings for heroin (I never really get cravings for methadone, just cravings for heroin) and making me able to better mentally bear the withdrawal symptoms and stick to my plans to taper - for me, I only found it a little helpful for the actual withdrawal symptoms and only very temporarily. Perhaps it would be more helpful in that regard for someone quitting a shorter-acting opioid.

shreddedlettuce said:
I would say the price.
Here is a link (if you haven't already read it), that might help with the Lyrica decision.
http://www.bluelight.ru/vb/threads/497568-Lyrica-and-opiate-withdrawal?p=10280232&viewfull=1#post10280232
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Thanks :) I guess my main concern is that Lyrica has a high prevalence of side effects. Many of the side effects sound like things I really do not need more of during opioid withdrawal: suicide/suicidal thoughts/behaviours, depression, agitation, muscle twitches, tremors, increased heart rate, sweating, flushing, rash, muscle cramps, vivid dreams, irritability, parasthesia (sensation of tickling, tingling, burning, pricking, or numbness of the skin), nausea and vomiting, fatigue/weakness, and an abnormal increase in sensitivity to stimuli of the senses. And there are many others - those are just the side effects that sounded a lot like opioid withdrawal to me.

Also I've heard some people say the withdrawal symptoms from Lyrica were worse than benzo withdrawal.
 
^I would be more concerned about pregabalin's efficacy. I don't think it's a very good drug, and it certainly would not help much with opioid withdrawal, especially when benzodiazepines are available.
 
I would avoid lorazepam. The *only* benefit I can see that it might have over clonazepam for opioid detox might be Ativan's increased anti-emetic profile compared to clonazepam...

Despite it's relatively lackluster effects, Lorazepam has been shown to be one of the most dangerous benzodiazepines when it comes to potential for physical dependence.

http://www.ncbi.nlm.nih.gov/pubmed/7439058
 
If it were either or for me I would go the Clonazepam for the muscle relaxant effects. But If it were me I'd find a doctor to help you through it a bit better. Good luck. I am having pretty bad issues with pain and the drugs I am on at the moment and I feel like the people here really know what they're talking about most of the time.
Seems like everyone agrees the Clonazepam would be the the better as it also he the as a longer half life which would help.
 
^My doctor is helping me, I just wanted to get opinions from people who had personal experience in this area as well.

Thanks for all your help everyone :)

I'm seeing my doctor in a couple days and I'll keep you guys updated.
 
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