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Dose - Xanax (Alprazolam) v Valium (diazepam)

Discussion in 'Benzodiazepines' started by Killa Weigha, Feb 12, 2011.

  1. Killa Weigha

    Killa Weigha Newbie

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    Some sex-addicted perv asked me to post this for him as his hands were previously engaged:

    Couple things. First, my doctor said 2mg Xanax = 10mg valium. Why do I need 20 valium to get the same effect as 2mg Xanax? Is it me or him?

    And is it any use switching back and forth every month or two between them so as to avoid catching an addiction or am I dreaming on that one?

    I'm on 30mg Ritalin (long acting) in the am (adderal is illegal in Mexico) which lasts all day until "Miller Time" when I drop the valium or xanax to chill with and can get to sleep like a normal human being.

    Lastly, is Focalin any more effective than the Ritalin LA?

    Any input is welcome as I only ever partied on benzos in the (way distant) past but they really have improved my life along with the Ritalin (though thinking about trying small doses of methamphetamine mixed in OJ for breakfast instead)

    Advice? Experiences? Anyone? Bueller? Thanks y'all, KW
     
  2. neverspeakagain

    neverspeakagain Silver Member

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    Re: Xanax v Valium

    2mg of alprazolam is roughly equivalent to 20mg of diazepam.

    And you can not 'switch between' to avoid 'addiction'... benzodiazepine dependence is benzodiazepine dependence...regardless of what you're taking, You could take alprazolam one night, clonazepam another, diazepam another...it doesn't matter, your body will still develop both dependence and tolerance to benzos. And very quickly too.
     
  3. Killa Weigha

    Killa Weigha Newbie

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    Re: Xanax v Valium

    OK, that perv said:
    Yeah, that's what I was afraid of with the addiction thing. But I was pretty sure (just from partying with them in the past) that the doctor was wrong in saying I should only have to take one blue val to equal a zany bar. Been on em for a month and haven't noticed any tolerance. What do you mean by "very quickly"? Unfortunately, it doesn't matter about the addiction considering the alternative (depression, ennui and anhedonia)
     
  4. Piglet

    Piglet Titanium Member

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    Re: Xanax v Valium

    Alprazolam has a much shorter half-life in the body. Doctors tend to think about constant effect, not peak effect.
     
  5. Killa Weigha

    Killa Weigha Newbie

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    Re: Xanax v Valium

    So when I run out after 45 days instead of 90 is he gonna give me a hard time? I mean, luckily I live in Mexico instead of one of the Euro/N.American states so I don't think so but... Sorry, I've never been on a script for anything in my life. Doctors are fairly unknown to me. Any more advice will be much appreciated. Thanks to Piglet and neverspeakagain.
     
  6. NeuroChi

    NeuroChi is not his mind Platinum Member & Advisor

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    Re: Xanax v Valium

    One cannot truly equate X amount of Alprazolam with X amount of Diazepam if they have different efficacy. However, for sake of generalization, if alprazolam is ten times more potent than diazepam, then 2mg of the former would rougly equal 20mg of the latter.

    Potency is a measure of the dose required to produce a given response, ie. if the response to 2mg Alprazolam is comparable to 20mg Diazepam, then the former is ten times more potent.

    However, intrinsic activity, or efficacy, is an inherent property of the drug itself. If at the molecular level, one molecule of Alpazolam affects the GABA[sub]A[/sub] receptor in a slightly different way than one molecule of Diazepam (ie. opening it more and alowing more Chloride to flow through) then you have two different drugs. Take into account factors like lipid solubility which affect absorption, distribution, and metabolism, and you can see why they are two different drugs, not just different potency, and no amount of one drug will truly equate the other
     
  7. RaoulDuke32

    RaoulDuke32 Silver Member

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    Re: Xanax v Valium

    Every doctory is different. You should have a general idea of whether or not your doctor is ok with prescribing these meds to you.
    Why did he take you off xanax in the first place? If its because its addictive, then he may have a problem with you taking twice as much diazapam as he prescribed.
    Honestly if you go in there and tell him the diazapam just isnt working he'll most likely switch you to something. Tell him you get panic attacks and need it to act fast to calm your racing heart. Or just tell him that you tried alprazolam(xanax) illegally and it worked. You should know just how honest you can be with your doctor more than any of us.
    If you wish to avoid addiction, cut back on downers in general. They're all addictive.
    If you must take something, then switch to clonazapam. It has a much longer half-life.
    Alprazolam has the most pronounced effect of everything, since thats what your used to you might not realize that the diazapam is working because its more subtle.
     
  8. Killa Weigha

    Killa Weigha Newbie

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    No, I asked to be switched so as not to become (as) dependant on one. I realize that is futile but hope it will be a little better than just getting on one of those two forever. diazapam works just as good as xanax but I need 20mg to get similar effedts as 2mg xanax. As the doctor said 10mg diaz = 2mg alprazalom I wonder if I'm fucking myself worse by taking 20mg/day diazapam for a month then switching to 2mg/day alprazalom for a month. If the doc is right seems like I should just stay with the 2mg xanax and forget about the diazapam. Zat make sense or not? Thanks, guys, for the advice thus far.
     
  9. Troppo

    Troppo Titanium Member

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    These are just some thoughts on this...

    Like someone else said, unfortunately you can't avoid the risk of getting dependent on benzos just by switching between two different ones. This would include tolerance.

    Valium lasts a lot longer in the body than Xanax, so taking a fairly large dose of Valium every day could cause some people to feel bombed-out after a while, since it would be building up in the body (you would be taking more of it each day than your system can get rid of). Xanax doesn't build up in the system anywhere near as much, due to its much shorter half-life. On the other hand the level of Xanax fluctuates a lot more over the course of 24 hours than Valium, so taking just one dose of Xanax per day could end up causing some withdrawal symptoms before the next dose is taken. Valium provides a far more steady, smooth level of drug within the body. These are the main differences I have heard of between these two drugs anyway. It's also possible that being on the same dose of Valium every day for weeks/months could result in serious withdrawal problems when suddenly switching to a short-acting benzo like Xanax.

    A doctor who is an addiction specialist once told me that Xanax is 15-25 times stronger than Valium (dose equivalence I mean) so 2 mg of Xanax would be equivalent to 30-50 mg of Valium going by that opinion. However the whole dose-equivalence thing is hard to be certain about, as there are differing opinions on it. I'd imagine you wouldn't need to take that amount of Valium every single day to get effects similar to 2 mg of Xanax, as the Valium would build up due to its long half-life.

    Hope this helps a bit. Take care.
     
    Last edited: Feb 15, 2011
  10. RaoulDuke32

    RaoulDuke32 Silver Member

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    From the most reliable source I has heard, diazapam is 10 or so times as strong as alprazolam. The alprazolam effects are more pronounced, as it comes on fast and doesnt target as specific receptor sites as diazapam.

    The diazapam however builds up in the body over time, having several strong metabolites that stay for up to 200 hours. This is a tricky area because it could leave you feeling more sedated as time goes on if it bio-accumulates, or it could leave you not feeling shit after you take one because the metabolites are so strong on your receptors still. Its a tricky business. alprazolam is off and then your hungering to get more back on.
    I could see how one could keep taking more valium to get the desired effect if onces used to the way alprazolam kicks in, he could also see how someone would take more and more alprazolam if their used to the way that diazapam doesnt wear off so fast.
    Both can be addictive in different ways. I dont say equally because alprazolam still kills all other benzos addiction wise in swims case.
    My been back on alrazolam for a week and hes already feeling the edginess during the time hes not on it and the urge to take more and more.
    Before this I took 1 mg clonazapam every evening with no incidence for months.
    This is the best drug to control anxiety without the cravings and need to up the dose like other benzos, at least in swims case.

    RaoulDuke32 added 1 Minutes and 49 Seconds later...

    I should say diazapam is 10 - 20 times more powerful than alprazolam. Different strokes for different folks. For him its always been not much. About 10X, but doesnt work as well even at that dosage.

    RaoulDuke32 added 5 Minutes and 9 Seconds later...

    Reading your post again I would say that its perfectly normal to take that dosage. Your doctor doesnt seem quite up to par saying alprazolam is only 5X stronger. Thats a load of BS. But it sounds like you would benefit from 2mg of clonazapam a day.
    But then again if your doctor thinks that diazapam is that strong compared to alprazolam, he may think that clonazapam is half as strong as some have suggested.
    Shit, if thats the case and he thinks alprazolam is so weak in affect, just stick with that and work it out. could be worse.
     
    Last edited: Feb 16, 2011
  11. Scifisam

    Scifisam Newbie

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    Re: Xanax v Valium

    Are you absolutely sure about the tolerance between various "benzos"? Where is this information coming from.Is it scientific fact or just your opinion?

    Scifisam

    Scifisam added 1 Minutes and 48 Seconds later...

    Tolerance and addiction I admit are seperate issues allthough they are connected.

    Scifisam
    What I really want to know is if what you say is fact or opinion
     
    Last edited: Feb 17, 2011
  12. DanTheFuckinMan

    DanTheFuckinMan Silver Member

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    My cat has been on benzos for over 30 years. In his opinion it doesn't matter which benzo you take, if you take them daily, no amount of switching back and forth is going to make you immune to tolerance and or dependance. Ask anyone that has been on them for any length of time. Same as with opiates, you can take vicodan one day percocet the next morphine the day after that and you will build a tolerance if used daily. Since you seem to be looking for hard evidence, why not ask an addiction proffesional?
     
  13. catseye

    catseye Gold Member

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    Re: Xanax v Valium

    benzos work on the same receptors regardless of which type they are, but in differing ways as Neurochi pointed out.
    All benzos enhance the action of the neurotransmitter GABA, and the benzodiazepine receptors. Various subtypes of benzodiazepine receptors have slightly different actions. One subtype (alpha 1) is responsible for sedative effects, another (alpha 2) for anti-anxiety effects, and both alpha 1 and alpha 2, as well as alpha 5, for anticonvulsant effects - hence the differing categories of benzos. All benzodiazepines combine, to a greater or lesser extent, with all these subtypes and all enhance GABA activity in the brain.
    So the way I understand that, tolerance to one type benzo will effectively build tolerance to other types of benzos as they all effect the same receptors albeit to a greater or lesser extent, and may perform like different drugs.
    *For an excellent reference on benzodiazipines, do a web search for Professor Heather Ashton's fantastically informative Ashton Manuel which is where the above information is from :)

    And strictly speaking it's 1mg of alprazolam that is dose-equivalent to 20mg diazepam, not the 2mg = 20mg that neverspeakagain quoted ;)

    KW, does the sex addicted perv have any idea how long they may be taking the script for? If it is longer than the 3 or so weeks advised for the use of benzos, then catty would think it wise to stay with the diazepam as the long half life will make it easier to do a slow taper when it's time to come off. Benzo wd can be a real bitch as catty is sure KW knows ;)
     
  14. RaoulDuke32

    RaoulDuke32 Silver Member

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    Re: Xanax v Valium

    Yes. Ditto.
    Lets make sure that everyone who potentially reads that swimmers question regarding fact vs opinion on tolerance knows that its a FACT. The closest metaphor coming to mind is with alcohol. If you drink a 12 pack of beer every day, your not going to have no tolerance to whiskey.
    All benzos work on basically the same receptors. I dont want to say exactly, but for all intensive purposes, especially regarding tolerance and addiction, it is scientifically proven tolerance to one will give you tolerance to another. QED.
     
  15. Troppo

    Troppo Titanium Member

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    I definitely agree with the above three people on this one. Everything I have ever read has said that the benzos all work pretty much the same as each other, by enhancing the effects of GABA in the brain, and that differences between them are mainly their half-lives and dosages. I have also read that any (GABA-acting) CNS depressant can substitute for any other one during acute withdrawals, and Valium is used to substitute for other benzos in people who have become dependent on them...for these reasons alone they would all be expected to be able to act in place of each other. And yes they pretty much work via the same receptors, sometimes more generally called GABA(A) receptors.
     
    Last edited: Feb 17, 2011
  16. Piglet

    Piglet Titanium Member

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    There are 6 different GABA A sub-receptors that benzos target. The anxiolytics & hypnotics target each in different proportions. An example of a REALLY bad benzo was triazolam. It binds far too well to the A5 subunit causing people to act in insane ways. Of course, enough of most benzos will have the same effect - they aren't too choosy.

    Here is some data that I ripped off but I think is important to anyone choosing a benzo:



    The Alpha (α) subunit

    The most important subunit is the "alpha" (α) and its subtypes isoforms (α1,2,3,and 5). The alpha subunit is responsible for mediating most of the effects of the benzos. All benzos bind to this subunit but they also all have different affinitie levels to the different subtypes.

    α1 subtype: Sedation, respiratory depression, sleep, ataxia, motor-impairment, amnesia, anti-convulsive, and reinforcing behavior.

    α2 subtype: Anxiolysis, disinhibition

    α3 subtype: Anxiolysis, anti-convulsive, muscle relaxation

    α5 subtype: Learning and memory, amnesia, minor sedation

    α3 & α5 subtype: Sensorimotor information processing

    The Beta (β) and Gamma (γ) subunits

    γ2 subtype: Physical dependence, respiratory depression

    β3 subtype: Anti-convulsive, minor sedation, muscle relaxation, various other reactions related to respiration. This receptor subtype is a barbiturate receptor.

    Benzos affinity to the GABA(A) receptors

    High α1 affinity: midazolam, triazolam, flunitrazepam, temazepam, lormetazepam, nitrazepam, brotizolam, nimetazepam, loprazolam, and flutoprazepam.

    Low to Moderate α1 affinity: wide range of 1,4 benzodiazepines including diazepam, estazolam, flurazepam, oxazepam, lorazepam, alprazolam, bromazepam, camazepam, quazepam (highly selective affinity), clonazepam, medazepam, nordazepam, chlordiazepoxide (very weak affinity), clorazepate, and most other benzo as all benzos are α1 agonists with varying degrees of affinity levels. Also included here are the nonbenzodiazepine "z-drugs" such as zolpidem, zaleplon, zopiclone, and eszopiclone which are all highly selective of the α1 subtype receptor but with only weak to moderate affinity.

    High α2 affinity: diazepam, clonazepam, bromazepam, lorazepam, alprazolam, camazepam, nitrazepam, loprazolam, lormetazepam, and flutoprazepam.

    Moderate α2 affinity: oxazepam, prazepam, phenazepam, temazepam, flunitrazepam, halazepam, midazolam, and other less commonly known benzos.

    Weak α2 affinity: triazolam, chlordiazepoxide (stronger affinity for α3), brotizolam, quazepam, tetrazepam (stronger affinity for α3), and a few others.

    High α3 affinity: diazepam, clonazepam, temazepam, lorazepam, tetrazepam, flunitrazepam, nimetazepam, phenazepam, and bromazepam.

    Moderate α3 affinity: alprazolam, adinazolam, estazolam, chlordiazepoxide, clorazepate, and flurazepam.

    High γ2 affinity (these benzos are the most physically addictive): temazepam, brotizolam, triazolam, alprazolam, lorazepam, loprazolam, midazolam, flunitrazepam, clonazepam, lormetazepam, flutoprazepam, nitrazepam, nimetazepam, and estazolam

    Low to moderate γ2 affinity: diazepam, chlordiazepoxide, oxazepam, and most other benzos.

    High β3 affinity: mostly the hypnotics (nitrazepam, temazepam, triazolam, etc)

    Low to moderate β3 affinity: diazepam, alprazolam, most other benzos.
     
  17. kailey_elise

    kailey_elise Gold Member

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    Because of diazepam's long half-life (& thus it building up in the system), if one's body is used to 2mg alprazolam a day, after 2-4 weeks on the 10mg/day regime of diazepam one's body would be responding the same way as it was to 2mg/day of alprazolam.

    Basically, the patient has to allow the diazepam to build up before they get the overall full daily effect, know what I mean?

    Having said that, alprazolam (because of it's short half-life) tends to hit HARD. And if a patient is accustomed to thinking that hard hit = end of anxiety, it's gonna take a little understanding of how the drugs work & rewiring of the thought processes to make diazepam a good fit. Clonazepam might work better, if the patient is seeking a longer-acting medication.

    Going from alprazolam to diazepam is sort of like going from heroin to methadone, know what I mean?

    However, there's such cross tolerance for one benzodiazepine to the other, that if the only reason the patient is taking diazepam is to "counteract" tolerance/dependence upon alprazolam (or vice versa), the patient is labouring under a false assumption & would be far better off just getting stable on one or the other & try to take it only as needed. Benzos aren't really meant to be taken daily on a long-term basis; it would be far better to address the causes of the irrational anxiety than try to put a Band-Aid on it. ;)

    It's a personal opinion (from researching) that diazepam or clonazepam would be a better choice for long-term and/or daily "generalised anxiety", as it provides a steady-state blood plasma concentration. Alprazolam would be better suited to occasional anxiety attacks. In fact, many doctors prescribe, say, diazepam to be taken on a daily basis, with a smaller "as needed" alprazolam 'script for "breakthru anxiety". Which would be like a pain doctor prescribing methadone or OxyContin to be taken daily no matter what for a chronic pain situation and additionally prescribing a small Percocet 'script to handle those occasional days where the pain is higher.

    All the best!!

    ~Kailey

    ETA: If the only reason the benzo is being prescribed is to "come down" from the methylphenidate, something like clonidine might be a better fit; it would do the job needed without the same risk for addiction.
     
  18. Pieces Mended

    Pieces Mended Silver Member

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    It sounds like it's been well explained a couple of different ways already, but I just wanted to reinforce the concept dosage of short term vs long term benzos. When an individual takes Valium daily, they will have a constant amount in their system- which is to be accounted for when considering what the true impact of the next dose will produce. Someone on consistent 10mg treatment of Valium will find roughly the same amount of anxiety relief as someone taking 1mg of Xanax. Quite simply, Alprazolam is too short acting to ever build a continuous plateau of relief. Valium users can actually skip a single dose and not suffer from any ill effects for the most part, depending how often they are accustomed to taking their pills.

    As for tolerance, the best bet for anyone on a benzo long-term is to get away from Alprazolam ASAP! When taking the strongest med within an entire class of drugs is a bad idea- especially when alternating back to something that has a much more gradual impact like Valium the other half of the time. Someone on a daily schedule of 2-3 Valium doses will always have the option to increase their dose, switch to a stronger benzo (there are plenty)- and perhaps most importantly, are less tempted to re-dose or overdose their meds, since the gradual, subtle relief is so much less "fun" than the instant punch of Xanax. On the other hand, once someone is on a good dose of Xanax, there isn't any stronger drug to move to, and it's easy to hit the daily dosage ceiling of where most doctors will prescribe. A friend's roommate lived through this entire scenario, so it isn't just theory.
     
  19. Piglet

    Piglet Titanium Member

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    There is a lot of evidence that many symptoms that benzos are used to treat can be better addressed with an appropriate antidepressant. Doctors only give benzos for crippling symptoms & only while the other medication is kicking in.

    Honestly, benzo addiction is a terrible thing. With opiates you may want to die during withdrawal but with benzos, sudden withdrawal really can kill. Tonic-clonic seizures can be fatal.
     
  20. Pieces Mended

    Pieces Mended Silver Member

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    Piglet,

    I don't disagree that benzo addiction is awful, that it can be extremely dangerous, and that the drugs do have obvious abuse potential for those who aren't truly just seeking relief.

    However, knowing a friend with severe general anxiety mixed with panic attacks since he was around 10 years old, he can safely say that long-acting benzos can be the best possible solution at times. They lack the side effects that every anti-depressant comes with, and there isn't a six or eight week trial period every time a drug doesn't work and something new needs to be tried.

    Given, it takes a very good psychiatrist for this to be reasonable advice. They need to know how to work with the patient to find the correct benzo, dose amount and frequency, watch for signs of tolerance and/or abuse for at least the first year, and be willing to correctly taper the patient off the drugs if the time comes.

    The problem is so many people get treatment from a GP and not a psychiatrist, and honestly a GP isn't going to provide the kind of care needed to make benzo treatment as safe and effective as possible. This is why so many family doc's will go straight for one or two specific SSRI's that they are familiar with, then refer the patient on if those don't work. :(