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Misc Clozapine and Diazepam Combined

Michael_25

Bluelighter
Joined
Oct 19, 2009
Messages
703
I'm coming off opioids and I'm prescribed 550 mg of clozapine a night. However, that alone doesn't settle the restless-leg syndrome caused by opioid withdrawal. I find a large dose of diazepam, though, does the trick. Is it safe to combine these two drugs? I have a fairly high tolerance to benzos, as I've been on them for roughly 5 years. 100 mg is good for sleep. But should I decrease the benzo dose when it's combined with clozapine? Thanks in advance!
 
Do you have psychotic symptoms or something isnt that a pretty high dose of a potent atypical antipsychotic? Id think that alone could cause restless leg syndrome from from blocking dopamine d2 receptors. I take cogentin for zyprexa restless leg.
 
Are you prescribed the diazepam? If not - stop using it and notify your doctor now. The two drugs are seriously contraindicated - the psychiatrist I used to work under would not prescribe diazepam to his clozapine patients and a quick google search on the 2 will show how dangerously they can interact.
 
Not sure - I just remember having to confiscate diazepam from 3 or 4 patients when the psychiatrist came across the study about the increased risk of fatal collapse from the combination. We used to administer PRN lorazepam to other clozapine patients for the purposes of rapid sedation at times but these instances occurred within controlled hospital settings and were occasional doses only.
 
Were you prescribed opioids and clozapine concurrently? The sedation alone seem's enough to avoid the two together
 
Clozapine probably won't help with RLS, not for opioid withdrawal. It pisses me off seeing so many antipsychotics prescribed to treat opioid withdrawal. Totally inappropriate (outside maybe more responsible doses of less problematic comes for sleep issues, but only when other first line meds are used for treating the acute withdrawal, as antipsychotics don't treat opioid withdrawal).

Gabapentin, clonidine and diazepam are among the best essential treatments for acute opioid withdrawal. Of course you'll have to be careful about your blood pressure when combining them, but when you're in acute opioid withdrawal normal dosages (10mg diazepam/0.2mg clonidine) aren't really problematic unless you already have BP issues. Generally gabapentin is prescribed at 400-800mg three times a day, diazepam at 10mg twice a day and clonidine at 0.2mg once or twice a day (definitely at night).

100mg of diazepam is a rather high dose, but if you're tolerant it is understandable. Are you dependent on diazepam then, or just hugely tolerant?

Unless you need an antipsychotic for dealing with another condition/symptoms, you're really best off taking the bare minimum of that and instead relying on the diazepam/clonidine/gabapentin combo. That (sometimes used with buprenorphine as well) is pretty much the gold standard when treating acute opioid withdrawal.

Antipsychotics such for dealing with withdrawal. They're good for feeling like a zombie and getting sort of knocked out, but they don't actually treat the specific symptoms of acute opioid withdrawal (other than maybe a little of the anxiety or insomnia, they don't touch the physical symptoms though). As someone else mentioned, antipsychotics are known to exacerbate RLS.
 
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