Medication / Drug Usage During Benzodiazepine Withdrawal and Recovery
People who are in the midst of or have completely withdrawn from benzodiazepine drugs often ask the question of what medications they need to avoid in order to ensure they don't risk the danger of making their existing withdrawal symptoms worse. The following lists some, but not all medications, which are commonly prescribed during withdrawal and highlights both the dangers and benefits which can be derived from such medication thereby enabling the reader to make an informed judgment when in discussion with his/her doctor.
The information given on these medications is primarily related to benzodiazepine withdrawal but, for the most part can probably be equally applied to other GABA addictive drugs e.g. barbiturates and alcohol.
NOTE:- BCNC as an organisation does not advocate any drug treatment other than a slow taper using a long acting benzodiazepine preferably diazepam for benzodiazepine withdrawal. BCNC can only speak with authority on sedative hypnotics (tranquillisers and sleeping pills) and cannot and do not promote other drug treatments. We do however on this page give some information on some drugs commonly taken in withdrawal and any benefits/risks associated with these drugs in relation to benzodiazepine withdrawal. The need for additional drugs for managing benzodiazepine withdrawal is usually due to tapering too fast or abrupt withdrawal. Slowing down the taper rate and regular support and reassurance usually negates the need for additional drugs for BZD withdrawal. It is our view point that the most effective drug for alleviating benzodiazepine withdrawal symptoms is a benzodiazepine preferably a long acting benzodiazepine. We cannot take responsibility for clients' other medical conditions or treatments, this responsibility lies with the individual person and thier healthcare provider. See our disclaimer.
Quinolone Antibiotics
Fluoroquinolones are probably the worst type of medication to be taken during withdrawal or recovery and should be avoided at all costs. This class of medication is well known in provoking a severe adverse reaction which often results in the symptoms associated with it persisting for a long time after exposure, (Central Nervous System effects, although not permanent can persist from weeks to years ) definitely a class of drug to be avoided. This class of drug has a very strong antagonistic effect on GABA receptors (benzodiazepines are GABA/BZD receptor agonists) and is the most likely explaination for the intense reactions reported from consuming this drug. CNS (Central Nervous System) effects do not seem to be permanent thankfully however they can persist anywhere from weeks to sometimes years.
Ciprofloxacin (cipro, ciproxin) is a commonly prescribed quinolone. There are at least a dozen other quinolone antibiotics on the market.
People should be aware of the increase in the CNS toxicity of Fluoroquinolones when combined with with certain other medications and the following gives examples.
NSAIDs (Non Steroidal Anti-Inflammatory Drugs) can enhance the GABA antagonism. Studies on Rats have shown increases by up to 90 times. Examples of NSAID's are Aspirin - Solprin, Diclofenac - Voltaren, Ibuprofen - Brufen, Indomethacin - Indocid, Ketoprofen - Oruvail, Naproxen - Naprosyn, Synflex, Tenoxicam - Tilcoltil, Tiaprofenic – Surgam.Fluoroquinolones combined with corticosteroids increases the risk of toxicity to the Achilles tendon resulting in rupture of the tendon and can in 20% of cases cause permanent disability. The elderly are at enhanced risk of Achilles tendon tears or ruptures. There is a large amount of anecdotal evidence suggesting that this combination significantly increases the risk of peripheral nerve damage resulting in intense pain or numbness which can often be permanent.
NOTE:- the FDA and CSM both now give warnings about the increased risks of combining fluoroquinolones with either corticosteroids or NSAID’s.
If you are prescribed FluoroQuinolones please do discuss the pros and cons of this medication, highlighting the fact that you are in benzodiazepine recovery, with your medical practitioner. Usually a safer alternative anti-biotic can be used.
For more information please visit these websites www.fqframes.org or http://www.fqresearch.org
NOTE:- NSAID's when used alone only have a weak GABA antagonist effect on GABA and most recovering "benzodiazepine people" can tolerate them although occasionally people notice an usually small increase in withdrawal symptoms.
Alcohol
Alcohol acts on GABA/BZD receptors in a similar way to that of benzodiazepines and although some people have been able to drink, in small amounts, during recovery from benzodiazepines, others have found the consumption of alcohol although initially helping when the alcohol wore off they often find it flared up their withdrawal symptoms and could not tolerate any alcohol at all. Alcohol may slow down or even prevent recovery from benzos. It is best advised to avoid alcohol as best possible while in recovery. Most people can tolerate an occasional drink when they are fully recovered from benzodiazepines. Use caution with alcohol. Be careful that you are not replacing one addiction with another. Remember alcohol is cross tolerant with benzodiazepines.
Cannabis
Cannabis, although illegal, is occasionally used in an attempt to cope with withdrawal anxiety experienced during the withdrawal from benzodiazepines. Occasionally it helps but for most people it has the opposite effect of increasing anxiety and paranoia. Depersonalisation, derealisation and paranoia are particular symptoms made worse by this drug in benzodiazepine withdrawal. Because its mode of action is different, it is unlikely to reactivate or 'kindle' the withdrawal symptoms on a long lasting basis. Adverse reactions tend to be transient, in time scale, while under the influence of this drug. Best avoided due to adverse effects in recovery and also because of its position legally.
Antidepressants
This class of medication is sometimes prescribed in recovery. Some people say they obtain benefit from these drugs however most people find that antidepressants don't help benzodiazepine withdrawal and they are left with yet another drug to taper off of. The mode of action of antidepressants is completely different from that of benzodiazepines and thus they are typically ineffective at alleviating benzodiazepine withdrawal effects. Sometimes they can actually worsen depression or anxiety in what is known as a paradoxical adverse effect. A benzodiazepine slow taper and benzodiazepine recovery time is the most effect treatment for alleviating benzodiazepine withdrawal effects.
As with almost all psychotropic drugs you can get withdrawal symptoms or what is sometimes called a discontinuation syndrome. Antidepressants should be gradually tapered instead of stopped suddenly to reduce the severity of any withdrawal symptoms. Generally speaking antidepressants usually do not cause as bad withdrawal symptoms as benzodiazepines.
From a personal point of view the only antidepressent that I would advise against is Mirtazapine (BRAND NAMES:- Zispin, Remeron, Avanza, Norset, Remergil, Mirtabene). I have noticed many people having horrendous symptoms, which seem to last an extremely long time after discontinuation of this drug. Whether this bad experience is because of people's past experience with benzo's or whether these bad reactions occur with everyone I am not sure as my points of contact have been mainly with people who were either addicted to or had a past history of being addicted to benzodiazepines.Visit our recommended links page for links to websites which have more information on depression and also websites for those wishing to withdraw from antidepressants.
Antipsychotics
Antipsychotics are sometimes prescribed for benzodizepines withdrawal symptoms such as anxiety, agitation or paranoia. The B.N.F (British National Formulary) warns to avoid this class of drug in benzodiazepine withdrawal as it may aggravate withdrawal. As with antidepressants the BNF advises that if these drugs are to be discontinued they should be done so gradually to prevent acute discontinuation syndromes or relapse of the underlying conidtion being treated. Those who are prescribed this class of drug and are stabilized on them for a serious psychiatric disorder rather than benzodiazepine withdrawal should only consider reduction after discussion with their doctor.
Antiepileptics
These are sometimes prescribed for benzodiazepine withdrawal, included in this class of medication are Tegretol (carbamazepine) or Neurontin (gabapentin). This class of medication may benefit patients who have been taken off benzodiazepines "cold turkey" or over rapidly. Peoples experiences are very different, and whilst some find these medications of no use, others have found they got some symptom relief. Antiepileptics can have some serious side effects associated with them and should not be used as an alternative to a gradual benzodiazepine reduction regime.
If you are on this class of drugs for underlying epilepsy you should not discontinue this medication without first consulting your doctor.
If you were prescribed this class of medication for benzodiazepine withdrawal and you wish to come off it you should gradually taper to avoid a discontinuation syndrome.Beta blockers
This class of medication is sometimes prescribed for the relief of tremors and heart palpitations. Peoples benefit is again varied with some finding some benefit and others finding no benefit. The medical literature says avoid abrupt discontinuation as there may be an increase in anxiety and heart arrhythmia's as a discontinuation syndrome. These medications appear not to have as severe a withdrawal/discontuation reactions as benzodiazepines and can usually be tapered faster than benzodiazepines.
CorticoSteroids
Corticosteroids can flare up benzodiazepine withdrawal symptoms during recovery. This seems to be only when steroids are taken orally. Creams and inhaled steroids seem to be okay. There is a binding site on the GABA receptor for steroids. If you click on this link you can see in a picture of the GABA receptor system the main binding/recognition sites on the GABA receptor. The GABA receptor complex includes the benzodiazepine site, barbitone site, GABA binding site and the steroid binding site. There is some cross tolerance between steroids and benzodiazepine acting drugs. It is important to note however that corticosteroids are sometimes prescribed for serious medical conditions and sometimes in life threatening situations. If taking corticosteroids is necessary due to serious health conditions and you experience a "set back" or a flare up or return of withdrawal effects try not to dispair no permanent harm is done just ride out the bad patch.
Herbal Remedies and Vitamins
Herbs
We don't advocate herbal remedies but accept some people wish to try them. People often turn to herbs and vitamins for relief. Whilst some herbs may not flare up symptoms others can. Herbs like man made drugs often have pharmacological effects in the body or mind and thus can produce adverse effects although when adverse effects occur they are usually milder than the more potent and refined drugs. I would say exercise caution when using herbs. It is unlikely herbal products will help benzo withdrawal and some may even cause a flare up in symptoms particularly herbal remedies which act via a GABA mechanism. If buying herbs it is important however to buy them from a reputable supplier. Avoid herbal providers who have poor quality controls e.g. suppliers based in developing third world countries. There have, believe it or not, been some reports of herbs being mixed with benzodiazepines and sold as anti-anxiety preparations reported in the British Medical Journal. This is unlikely to be a problem if the herbs are bought from a supplier who uses strict quality controls. Also most of the anti anxiety or sedating sleep promoting herbs e.g. (Valerian, Kava Kava) unfortunately just like prescription sleep aids work through a GABA benzodiazepine receptor mechanism and are no different than a low dose benzo preparation.
Some people swear by herbal remedies. At the end of the day it is a personal choice of whether you take them or not. We at BCNC don't promote nor condemn anyone for choosing complimentary medicine but leave it to the user to choose whether they take herbs or use other complimentary therapies.Vitamins and Minerals
Generally these are safe although some people find they can make them feel worse. Eating a healthy balanced diet of vegetables, meat, milk, fish and carbohydrates is likely to give you all the nutrition you need. Some vitamins may have a mild stimulating effects eg B vitamins and some people say that they hype their anxiety up. High doses of certain vitamins have been linked to increased risk of disease for example prolonged usage of high doses of vitamin A has been shown to cause an increased risk of osteoporosis. If using vitamins it is better to take a tablet containing the RDA (recommended daily allowance) of minerals and vitamins rather than single high dose vitamin supplements which are more likely to cause adverse reactions in people coming off benzos. A balanced diet is probably the best way to go as opposed to supplements.
Magnesium is one of the few minerals which is commonly reported to benefit certain benzodiazepine withdrawal symptoms particular withdrawal symptoms such as joint pain and muscular problems. Magnesium has a stabalising effects on cells and neurones.
Meal replacement drinks
Occasionally these are prescribed particularly in the first few weeks or months when appetite loss can sometimes become serious. Can be very good for those with poor appetite to obtain their daily nutritional needs until their appetite returns to normal.
Caffeine
Caffeine is unlikely to stop or hinder your recovery from benzodiazepine withdrawal as it does not work on GABA receptors. However it has the potential, as a stimulant drug, to enhance withdrawal symptoms temporarily. You should not stop caffeine suddenly if you are addicted to it as it can provoke a withdrawal/discontinuation reaction of anxiety, depression, irritability and craving.
Aspartame (Nutrasweet)
Aspartame is a common additive in foods and drinks. It is an artificial sweetner. It is probably the most controversial additives to foods today. Much of the controversy surrounds pre-release trials which were with held from the FDA which showed brain tumours in monkeys fed aspartame and also epileptic seizures in some of the monkeys. It was eventually approved for human consumption. Some critical doctors on the aspartame subject claim that the rise of brain tumours following the release of aspartame is no coincidence. The jury is certainly out and as I say it is a very controversial additive. Aspartame is a pro-convulsant; it decreases serotonin, nor-adrenaline and other neurotransmittors. When metabolised aspartame is broken down into methylalcohol aka methanol which is a toxic form of ethanol. This is certainly the last thing one needs when withdrawing from benzodiazepines to be consuming large quantities of aspartame and possibly lowering the seizure threshold. See this site for more information Dorway.
Also this video Sweet Misery:- Part 1 - Part 2 - Part 3
Painkillers
People sometimes need to take opiate based pain killers e.g morphine or codeine. These drugs will not prevent recovery from benzodiazepine withdrawal as they work on the brain through a completely different mode of action. They are however addictive and should not be stopped suddenly. They can usually be tapered off faster than benzodiazepines sometimes by switching to a long acting opiate such as methdaone. Pethidine should be avoided though because the active metabolite of pethidine acts as a proconvulsant. Pethidine for this reason is generally only prescribed for short term usage to avoid toxicity.
Tramadol (ultram), has additional effects on the brain besides its opiate mode of action. Mainly the serotonin system and there have been a handful of negative reports of tramadol's effects whislt in benzo withdrawal. It is hard to have a firm opinion on tramadol as the negative reports are limited to a handful of personal anecdotal reports of people in recovery from benzodiazepine dependence. Opiate dependency does not tend to cause the serious cognitive and psychiatric and physical toxicity/damage for example that benzodiazepines or alcohol seem to induce in many people and the withdrawal syndrome is typically shorter and less pronounced than benzo withdrawal lasting a few days to a few weeks typically. So if you need to take pain killers for chronic or occasional pain relief you are still fully capable of recovering from the effects benzodiazepines.
General anesthetics
Sometimes surgery or an investigation requiring a general anesthetic is unavoidable in withdrawal. A single dose can reactivate the withdrawal or enhance withdrawal symptoms often several years after withdrawal. This phenomenom is well known in addiction circles and is one reason why alcoholics and other drug dependent people are told to avoid there drug of addiction for a long time after abstinence has been achieved, sometimes for life. Anesthetist's often use benzodiazepines together with the general anesthetic to enhance its effect. Most anesthetists are flexible and if you explain your problem with benzodiazepines they will be willing to use a general anesthetic alone without the conjunctive use of a benzodiazepines.The commonly used anesthetic propofol seems to be well tolerated by 'benzo people' during or after withdrawal. If you need surgery, you need surgery, so don't let medication phobia prevent you from having medically advised surgery.
The 'Z' Drugs
These drugs are fairly new on the market. They are decievingly classed as 'non-benzodiazepines' (because structurally/chemically they are distinct from benzodiazepines despite their almost identical mechanism of action) despite the fact that they bind and act on benzodiazepine receptors. They reportedly have a higher affinity for the sedating benzodiazepine receptor but still bind to the other benzodiazepine receptors and therefore have the same or at least a very similiar addiction profile. Unfortunately doctors and patients mistakenly think of this class of drugs as different from benzodiazepines with unfortunately often disasterous consequences usually re-establishing the addiction / withdrawal process.
See our HOME page for a full list of benzodiazepines and 'Z' drugs and their brand names.
Examples of these drugs on the market are Zolpidem ( Stilnoct, Ambien ) Zopiclone ( Zimovane, Zopimed, Zopivane, Z-dorm, Alchera ) Zaleplon ( Sonata ) Eszopiclone ( Lunesta )Miscellaneous
Viruses
When in recovery from benzodiazepines commonly reported is symptoms of benzo withdrawal increased during a bout of the flu or a bad cold. Strange as it sounds there does seem to be a link as so many people seem to experience this. Often a simple explaination can reassure people why they are feeling worse so I will try to put forward a theory.
The immune system does interact with the brain by releasing chemicals known as cytokines which make you feel headachey and sleepy and fatigued and reducing your appetite by interacting with cytokine receptors in the brain and also throughout the body. It is the body's way of telling you that you are ill and you need to rest. There are also parts of the brain activated during an infection e.g. pituitary gland secreting hormones during an infection. It may be this chain of events which causes benzo symptom increase during a flu or bad viral infection.
The good news is a virus is temporary and so is the symptom increase so if you find yourself under the blankets with a flu and your benzo symptoms increased rest assured it is most likely just because you have a virus and not that you are 'going back to square 1'. You will start feeling better within a few days to a few weeks. I have not yet seen any medical studies of this increase in symptoms of withdrawal during a flu or virus infection. However I felt it worth mentioning because so many people give anecdotal reports of this symptomatology increase during times of illness.
Some people who suffer from allergies can get flare ups in symptoms such as feeling lethargic and headachy not to mention the typical allergic symptoms of sneezing and itching. Allergies are when the body mistakenly attacks a harmless protein thinking it is a virus infection and may cause some symptom increase in benzo withdrawal especially headaches and feeling run down with distrubed sleep etc. By going to this page on hayfever and allergies allergy sufferers who are also withdrawing from benzodiazepines can find some useful tips on dealing with allergies including some great non drug solutions.
A Final Note
There are literally 10's of thousands of different drugs and thousands of different classes of drugs. It is impossible to know how anyone individual will respond to any given drug. The vast majority won't cause any problems in benzodiazepine recovery nor will they prevent recovery.
We have done our best to give the readers of this page an informed knowledge base on commonly used drugs in benzodiazepine withdrawal and commonly problematic drugs in withdrawal/recovery and how people have responded to them. The information we have given on this page is based on a combination of medical papers and also in most cases a large amount of anecdotal evidence from speaking to hundreds possibly thousands of benzodiazepine suffers over the years and also from being in contact with several benzodiazepine organisations via the phone and internet based support/campaign groups. If you notice an adverse reaction to a drug please discuss it with your doctor so you can make an informed decision on whether that particular drugs benefits outweigh its side effects or adverse effects. Of course as with any drug there is always a risk of an adverse reaction and it is often difficult if not impossible to predict in many circumstances.
Forum Disclaimer SiteMap Home Contact us The Ashton Manual