Tapering diazepam and cyp induction

[3dmusic]

Hi

I probably should have put this in the advanced drug discussion, but I am not science tech savvy at all, and was afraid I would not understand their answers, but if you feel it needs moving please let me know if it needs moving.

I have been tapering valium for the last three years and got down to 3.17mg a day.
I feel stuck at this dose and no matter how small an amount I cut, i feel it.

I found out that smoking tobacco was the problem because of something I find hard to explain, but will try.
Diazepam is metabolized by two enzymes called Diazepam is metabolized by CYP2C19 and CYP3A4 (why can't they have proper names it may be less cofusing)
Because tobacco and nictotine are 'inducers' of cyp, smoking tobacco can enhance the elimination of diazepam and decrease its action.
This is why I was struggling with symptoms and not stabilising.

I knew I had to either quit tobacco or at least cut down.
Quitting was impossible. As I have a naturaly explosive temper which I turn inwards by attacks of rage on myself, and as these got worse due to the benzo withdrawal (benzo rage) quitting was not an option.

No problem, I thought, I will just smoke cannabis in my pipe and only have tobacco when i get cravings.

This has worked out fine for the last three days, but today, I found out that the cannabis may also be clearing the diazepam from my system after reading this :

"Cannabinoids are metabolized by several enzyme systems, including Cytochrome P450 (CYP 2C9, CYP 3A4) and can induce or inhibit CYP 3A4, but there is little evidence of important drug-drug interactions based on CYP 450 systems. Smoking itself (e.g., cannabis or tobacco) induces CYP 1A2, "

from here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358713/

Does this mean that smoking cannabis is inducing clearance of diazepam faster?

Thanks

 

[laCster]

^ no and no....

i used to think the same thing with benzos and ciggs, like i would avoid ciggs like the plague because i thought they would induce my liver enzymes, but not i am a daily smoker, and take benzos regularly (mostly temazepam and sometimes klonopin) and i never notice a difference. it honestly the induction of liver enzymes from tobacco is trivial IME/IMO. also i know what iit is like when you actually take a true liver inducer (modafinil) with klonopin which exponentiallly makes a difference! modafinil literally cut the duration from 8-12 hrs to 4-8 hrs, i was kind of pissed. while i usually smoke than usual on benzos and i have never noticed any difference.

also, cannabis/THC is mostly metabolized through CYP2C and only minimally metabolized by 3A4 and 2D6 so it really does not interact hepatically with most other drugs.

if you are that worried tobacco will affect your benzo, drink some WGFJ or take some tagamet before you dose. also, valium has an extremely long halflife, so i think you are straight

GL on getting off valium

 

[Swimmingdancer]

No, that's not causing it. The enzymes that smoking tobacco induces are not the same ones that metabolize benzos. [source]

It is very common for people to reach a point where they get stuck in their tapering, (regardless of whether they smoke or not), this seems to happen with many people tapering off long-term use of drugs like benzos, other GABA-ergics, or opioids.

I'm not sure what causes this getting stuck at a certain point, it's like once you get below a certain dose your body doesn't adjust to the dose cuts anymore, it's like being trapped in semi-withdrawal land all the time, and even incremental dose cuts with loads of time in between doesn't seem to help. My doctor says one needs to just persevere with the taper and taper the rest of the way quickly. But that's easier said that done.

As for cannabis, as the article you quoted said, it may induce or inhibit CYP3A4, but it is probably slight and there is little evidence of this actually causing drug interactions.

 

[3dmusic]

No, that's not causing it. The enzymes that smoking tobacco induces are not the same ones that metabolize benzos. [source]

It is very common for people to reach a point where they get stuck in their tapering, (regardless of whether they smoke or not), this seems to happen with many people tapering off long-term use of drugs like benzos, other GABA-ergics, or opioids.

I'm not sure what causes this getting stuck at a certain point, it's like once you get below a certain dose your body doesn't adjust to the dose cuts anymore, it's like being trapped in semi-withdrawal land all the time, and even incremental dose cuts with loads of time in between doesn't seem to help. My doctor says one needs to just persevere with the taper and taper the rest of the way quickly. But that's easier said that done.

As for cannabis, as the article you quoted said, it may induce or inhibit CYP3A4, but it is probably slight and there is little evidence of this actually causing drug interactions.

Hi Swimmingdancer and thanks for your post. I am sorry I have just seen it now.

I am not very familiar with scientific stuff, but I read the paragraph you linked me to.
Please forgive me if I am wrong, but my understanding, from the literature, is that smoking does induce CYP CYP1A2, and this enzyme is used by the liver to metabolize diazepam.
Please could you clarify?

Many thanks.

 

[laCster]

Yes that is what swimming was referring to. However, after a good duration of combining the two, I doubt the tobacco is making much of a difference. Your body most likely acclimated itself to the induction (if any) and has made adjustments.

That being said, ciggs do make me feel shitty sometimes probably due to also the noxious chemicals that are sprayed on them.

Good luck

 

[Swimmingdancer]

Hi Swimmingdancer and thanks for your post. I am sorry I have just seen it now.

I am not very familiar with scientific stuff, but I read the paragraph you linked me to.
Please forgive me if I am wrong, but my understanding, from the literature, is that smoking does induce CYP CYP1A2, and this enzyme is used by the liver to metabolize diazepam.
Please could you clarify?

Many thanks.

Sorry I don't remember making that post and am just on my phone right now so I'll try to provide some better clarification later. It's possible I might have been wrong, I'll have to do some research to remind myself of what I was thinking at the time.

My main point was that unless you started smoking recently it should not be stalling your taper, as it would have always been slightly decreasing the effects you got from diazepam - does that make sense?

The other point I THINK I may have been trying to make is that smoking shouldn't significantly increase the enzymes primarily responsible for eliminating diazepam, which is the part I'm now confused about. Will post more later

 

[3dmusic]

Yes that is what swimming was referring to. However, after a good duration of combining the two, I doubt the tobacco is making much of a difference. Your body most likely acclimated itself to the induction (if any) and has made adjustments.

That being said, ciggs do make me feel shitty sometimes probably due to also the noxious chemicals that are sprayed on them.

Good luck

Hi LaCster

You have raised an interesting point, as in, my body will be used to me smoking and so used to the level of induction. That is worth a thought or two
I don't smoke cigarettes, I smoke rolling tobacco. I don't like smoking ready made cigarettes.

Sorry I don't remember making that post and am just on my phone right now so I'll try to provide some better clarification later. It's possible I might have been wrong, I'll have to do some research to remind myself of what I was thinking at the time.

My main point was that unless you started smoking recently it should not be stalling your taper, as it would have always been slightly decreasing the effects you got from diazepam - does that make sense?

The other point I THINK I may have been trying to make is that smoking shouldn't significantly increase the enzymes primarily responsible for eliminating diazepam, which is the part I'm now confused about. Will post more later

Hi Swimmingdancer

Throughout my taper, I have always smoked, but this last few months, smoked less.
As laCster said, yeah, it does make sense that if I have always smoked during my taper, then it would be always decreasing the effects I get from diazepam.
I don't know why I am feeling worse. I got to 2.4mg but have gone back up to 2.7mg, as the main benzo withdrawal symptom I get is mental torture and it is really scary.
Thanks to you and laCster