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Old 09-22-2013, 09:35 PM #20
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Join Date: Aug 2006
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Default benzo's and possible dependence

To avoid dependence on benzos for occasional use over an extended period, total clearance is recommended between doses, at least after every 2 doses. And that said, there is no guarantee. Expected clearance time is calculated by half-lives. Half-life ranges are statistical data; individual experience occasionally falls outside of statistically determined expectations.

Benzos with short half-lives such as alprazolam and even lorazepam will clear in a week or even 5 days, in a typical individual.

However, the doctor will choose a drug depending on the clinical picture they see and on their personal preference. With recurrent anxiety, some doctors might prefer to give a longer-acting agent so as not to produce sharp peaks and troughs from the medication itself. Klonopin (mid-acting) is often used for this purpose as well as to aid in suspending other substances. This drug is unlikely to clear in 5 days. You'd be on a low dose and there shouldn't be much accumulation, so there might not be an issue. Bottom line: let the doctor know exactly how often you plan to use the medication and for how long you expect to be using it, to help them choose the best med for you.

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Fwiw, your dependence on gabapentin is not necessarily predictive of a predisposition to dependence on a benzo: the pharmacokinetics are different. Gabapentin mechanism of action is still not well understood but it does not function as a GABA analog (although it was developed for this purpose). More recent data have shown it to be a calcium-channel antagonist, but even there it appears only to act at certain threshold levels. Some experiments have directly tied this mechanism to its GABA-agonistic activity. Benzodiazepines, on the other hand, have a direct chemical affinity for a subset of GABA receptors, producing a higher GABA affinity at bound receptors. I apologize for not giving sources. I don't have them on hand as the last I read up was maybe a few months ago.

Last edited by waves; 09-22-2013 at 09:52 PM.
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