Morphinator
Bluelighter
- Joined
- Jul 15, 2007
- Messages
- 329
^ It's no use Ham-milton, I've been trying to explain this klowns, but he's convinced clonazepam is the "king" of benzo-dom!
It's not even that clonazepam is rarely used as an anticonvulsant (I think its use as such is not too rare), but when it is used, it's used orally to help people who are prone to seizures prevent them and reduce their frequency. Still, it's often used only short-term because tolerance to its anticonvulsant effects develop rapidly and after a while it's basically useless as an anticonvulsant.
Lorazepam is the most commonly used benzo for epileptic seizures not because it is the strongest anticonvulsant, but for various other reasons that make its use more convenient for clinicians and the patients (unless patient is allergic or too sensitive to lorazepam). Diazepam is actually a stronger anticonvulsant than lorazepam is, it's also highly lipid soluble and so is quickly absorbed via any route of administration - but because of that it doesn't stay in the vascular space and it gets redistributed into other body tissues, meaning: repeat dosing on diazepam would be required to maintain anticonvulsive action. With lorazepam, it's the complete opposite - it doesn't get redistrubted outside the vascular space.
Midazolam is a very powerful anticonvulsant and is occasionally used to treat status epilepticus, but it's too short-acting and, as a hypnotic, way too sedating and problems with memory are an issue.
None of that means that any of them are stronger anticonvulsants than nitrazepam, temazepam, and most definitely not nimetazepam (which is supposed to be the strongest anticonvulsant benzo). The 3 have all been used to manage seizures - but very rarely. Nitrazepam has been used to manage seizures in children and to manage refractory epilepsies, and a study on infantile spasm (west syndrome) treatments is already out there that proves nitrazepam as a stronger and more effective anticonvulsant than clonazepam, regardless of that, clonazepam is much more commonly used to treat infantile spasms because nitrazepam. Temazepam has been used to manage refractory epilepsies ("refractory" means if a person's epilepsy cannot be brought under control after adequate trials of two or three different drugs) and myoclonic seizures.
However, neither nitrazepam nor temazepam are hardly ever used as such, despite being very powerful and effective anticonvulsants because not only is long term prophylactic treatment of epilepsy with benzos basically futile (tolerance develops very quickly), but the side effects of nitraz and temaz can be overwhelming, and not just the immediate effects of strong sedation, amnesia, slurred speech, motor function impairment, often high levels of confusion, and ataxia. Long-term use of temazepam and nitrazepam is very dangerous, I hate to admit it.
Studies have actually shown that nitrazepam and temazepam are carcinogenic and both drugs have been found to be both photogenotoxic and photocytotoxic. They are also are both teratogenic, especially temazepam (which is listed in Pregnancy Category X). Temazepam and nitrazepam possesses both embryotoxicity and teratogenicity toxicities in vivo.
Because temazepams abuse is so common and widespread, withdrawal from it is well documented.
More:
Some stuff on Mazzies:
As you can see, the hypnotic benzos are on an another level here...(though I hate to admit it, because nitrazepam and temazepam are my favorite and I use them A LOT - the sh!t above scares me when I read it).

It's not even that clonazepam is rarely used as an anticonvulsant (I think its use as such is not too rare), but when it is used, it's used orally to help people who are prone to seizures prevent them and reduce their frequency. Still, it's often used only short-term because tolerance to its anticonvulsant effects develop rapidly and after a while it's basically useless as an anticonvulsant.
Lorazepam is the most commonly used benzo for epileptic seizures not because it is the strongest anticonvulsant, but for various other reasons that make its use more convenient for clinicians and the patients (unless patient is allergic or too sensitive to lorazepam). Diazepam is actually a stronger anticonvulsant than lorazepam is, it's also highly lipid soluble and so is quickly absorbed via any route of administration - but because of that it doesn't stay in the vascular space and it gets redistributed into other body tissues, meaning: repeat dosing on diazepam would be required to maintain anticonvulsive action. With lorazepam, it's the complete opposite - it doesn't get redistrubted outside the vascular space.
Midazolam is a very powerful anticonvulsant and is occasionally used to treat status epilepticus, but it's too short-acting and, as a hypnotic, way too sedating and problems with memory are an issue.
None of that means that any of them are stronger anticonvulsants than nitrazepam, temazepam, and most definitely not nimetazepam (which is supposed to be the strongest anticonvulsant benzo). The 3 have all been used to manage seizures - but very rarely. Nitrazepam has been used to manage seizures in children and to manage refractory epilepsies, and a study on infantile spasm (west syndrome) treatments is already out there that proves nitrazepam as a stronger and more effective anticonvulsant than clonazepam, regardless of that, clonazepam is much more commonly used to treat infantile spasms because nitrazepam. Temazepam has been used to manage refractory epilepsies ("refractory" means if a person's epilepsy cannot be brought under control after adequate trials of two or three different drugs) and myoclonic seizures.
However, neither nitrazepam nor temazepam are hardly ever used as such, despite being very powerful and effective anticonvulsants because not only is long term prophylactic treatment of epilepsy with benzos basically futile (tolerance develops very quickly), but the side effects of nitraz and temaz can be overwhelming, and not just the immediate effects of strong sedation, amnesia, slurred speech, motor function impairment, often high levels of confusion, and ataxia. Long-term use of temazepam and nitrazepam is very dangerous, I hate to admit it.
Studies have actually shown that nitrazepam and temazepam are carcinogenic and both drugs have been found to be both photogenotoxic and photocytotoxic. They are also are both teratogenic, especially temazepam (which is listed in Pregnancy Category X). Temazepam and nitrazepam possesses both embryotoxicity and teratogenicity toxicities in vivo.
Because temazepams abuse is so common and widespread, withdrawal from it is well documented.
Six psychotic states developing after abrupt withdrawal from temazepam and 2 psychotic states developing after abrupt withdrawal from nitrazepam including delirium from doses of just 30 mg of temazepam and 20 mg nitrazepam, and in another case auditory hallucinations and visual cognitive disorder developed after abrupt withdrawal from 10 mg of temazepam, 5 mg of nitrazepam, and 0.5 mg of triazolam. Gradual and careful reduction of the dosage, preferably with a milder long-acting benzodiazepine such as clonazepam or diazepam, or even a milder short to intermediate acting benzodiazepine such as oxazepam or alprazolam, was recommended to prevent severe withdrawal syndromes from developing. Depersonalisation has also been a well documented benzodiazepine withdrawal effect from temazepam and nitrazepam.
Abrupt withdrawal from very high doses is even more likely to cause severe withdrawal effects. Withdrawal from very high doses of temazepam will cause severe hypoperfusion of the whole brain with diffuse slow activity on EEG. After withdrawal, abnormalities in hypofrontal brain wave patterns may persist beyond the withdrawal syndrome suggesting that organic brain damage may occur from chronic high dose abuse of temazepam. Temazepam withdrawal has been well known to cause a sudden and often violent death.
SOURCES:
Hindmarch I (Nov 1977). "A repeated dose comparison of three benzodiazepine derivative (nitrazepam, temazepam and flunitrazepam) on subjective appraisals of sleep and measures of psychomotor performance the morning following night-time medication". Acta Psychiatr Scand 56 (5): 373-81.
Viukari M; Linnoila M, Aalto U (Jan 1978). "Efficacy and side effects of flurazepam, temazepam, and nitrazepam as sleeping aids in psychogeriatric patients". Acta Psychiatr Scand 57 (1): 27-35.
Terao T, Tani Y (1988). "[Six cases of psychotic state following normal-dose temazepam withdrawal and two cases of psychotic state following normal-dose nitrazepam withdrawal]" (in Japanese). J. UOEH 10 (3): 337–40.
Terao T, Yoshimura R, Terao M, Abe K (1992). "Depersonalization following temazepam and nitrazepam withdrawal". Biol. Psychiatry 31 (2): 212–3.
Kitabayashi Y, Ueda H, Narumoto J, et al (2001). "Chronic high-dose temazepam dependence 123I-IMP SPECT and EEG studies". Addict Biol 6 (3): 257–261.
More:
Nitrazepam therapy compared with other drug therapies increases risk of death when used for intractable epilepsy in an analysis of 302 patients. The risk of death from nitrazepam therapy may be greater in younger patients with intractable epilepsy.
Source:
Rintahaka PJ; Nakagawa JA, Shewmon DA, Kyyronen P, Shields WD. (Apr 1999). "Incidence of death in patients with intractable epilepsy during nitrazepam treatment.". Epilepsia. 40 (4): 492-6.
Some stuff on Mazzies:
Temazepam may cause sudden death. Temazepam therapy can cause swallowing incoordination, high-peaked esophageal peristalsis, bronchospasm, delayed cricopharyngeal relaxation and severe respiratory distress necessitating ventilatory support. Temazepam may promote the development of parasympathetic overactivity or vagotonia leading to potentially fatal respiratory distress. The toxicity of temazepam relative to other benzodiazepines is well established and documented in medical literature, including the research findings of the Central Intelligence Agency's (CIA) done in the 1960's and 1970's on making temazepam the ultimate "truth serum" and as a behavior modification drug.. New research findings show that death as a result of overdose from temazepam alone is a much greater risk than previously thought.
SOURCE:
Lim HC; Nigro MA, Beierwaltes P, Tolia V, Wishnow R. (Sep 1992). "Temazepam-induced cricopharyngeal dysphagia, abnormal esophageal peristalsis and associated bronchospasm: probable cause of temazepam-related sudden death." 14 (5): 309-14.
NPR Fresh Air. June 28, 2007 and Tim Weiner, The Legacy of Ashes: The History of the CIA.
Ranelagh, John O'Beirne, The agency : the rise and decline of the CIA, Simon and Schuster, 1986
As you can see, the hypnotic benzos are on an another level here...(though I hate to admit it, because nitrazepam and temazepam are my favorite and I use them A LOT - the sh!t above scares me when I read it).