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Crossover to Valium Really Needed at Tiny Dose of Xanax for Dental Anesthesia?


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Hi All Buddies,

 

Crossover question...

 

I've been on Xanax for 7 years.  It was given to me by an oral surgeon because I seemed nervous in his office, and, not knowing anything about benzos, I accepted the prescription and got hooked on it.

 

He initially gave me .25mg, once at bedtime, and after 4 years of that dose, I started to feel very anxious and fearful during the day.  I didn't realize it was inter-dose withdrawal.  So I updosed slightly to .3mg for 3 months and then learned about tapering.

 

I've been tapering down the .3mg for the last two and a half years, dry cutting with a lab-grade gram scale, at a rate of roughly .001g (.003mg) every 14 days, sometimes holding longer for anxiety caused by pain from dental problems.

 

I worked my way down to a tiny dose of just .01mg (still once at bedtime).

 

I think I've done really well, because I don't feel much different now than I did 2.5 years ago at .3mg

 

However, I still have terrible inter-dose withdrawal during the day, with anxiety, fear and brain fog, sometimes bordering on dr/dp.

 

My problem is, now I need extensive dental work.  I've had terribly infected gums for ten years, causing bleeding, pain, and loose teeth.  I'm looking at gum surgery and multiple extractions. 

 

The only way I can have any dental work is with general anesthesia - IV sedation which probably contains a big dose of benzo (Versed aka Midazolam).

 

I'm thinking of seeing a psychiatrist to ask for a crossover to Valium.  By my calculations I shouldn't need more than 2mg (or 4mg at the most) of Valium to alleviate my inter-dose withdrawal.

 

I've read about people having problems with Valium, including depression, scary thoughts, and sleepiness.  I can still function (somewhat) during the day and drive my car even with the inter-dose withdrawal, so I have reservations about these possible tradeoffs with Valium.

 

However, I'm afraid if I don't cross over to Valium, my benzo-compromised brain will not handle the anesthesia well, and I may experience a setback with more severe withdrawal symptoms which could last for an extended period.

 

Do you feel a crossover is in order for me in order to have general anesthesia?  I could be looking at a year's worth of dental work until I'm finished with implants and bridges, and I would probably have the same kind of anesthesia every 2-3 months.

 

Or should I just take the plunge, have the anesthesia without crossing over, stick to my current Xanax taper (I have maybe 2 more cuts before jumping), and possibly take a small "PRN" dose of Xanax right before each dental visit to sort of "stabilize" me in preparation for the anesthesia?

 

I don't want to mess up my taper.  I'm almost off the Xanax, but I still can't sleep without taking the .01mg at night, and if I try to nap during the day, I wake up after ten minutes in a panic, so I know my brain is not close to being healed yet.

 

I've read where some benzo-wise dentists and doctors refuse to administer general anesthesia to someone who took benzos, even if they've been off for years, while some patients have done it during or after a taper with no problems whatsoever.

 

Any advice would be greatly appreciated!

 

Thanks,

Scott

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Hi UpRegulator

 

Congratulations on the progress you made with your taper! You are at an extremely low dose of Xanax. If you look at this conversion calculator the Valium equivalent of your current dose is 0.25mg https://clincalc.com/Benzodiazepine/.  I jumped when I was at the Valium equivalent of 0.5mg. At this stage I think you are barely getting any therapeutic value from the Xanax. I don't think you're having interdose withdrawal, I think you're almost in PAWS because the drug has minimal effect.

 

As per the Ashton Manual (all measurements talking about diazepam):

In any case the 1mg or 0.5mg diazepam per day which you are taking at the end of your schedule is having little effect apart from keeping the dependence going. Do not be tempted to spin out the withdrawal to a ridiculously slow rate towards the end (such as 0.25mg each month). Take the plunge when you reach 0.5mg daily; full recovery cannot begin until you have got off your tablets completely.

 

If it were me, I would definitely not crossover to Valium at this stage of the taper, and especially not updosing when you're basically done. I would just jump. But that's me.

 

I know many people ask for propofol instead of a benzo when going under anesthesia and they do just fine. Can you explain why you would need Xanax to stabilize you before the procedure? Is it for anxiety? For me personally I do not use and have never used rescued doses or "as needed" benzo's since my taper or jump. I have seen too many horror stories here from people in setbacks to justify it for myself. I'm too scared to do it. I feel I need to learn how to navigate life without relying on these. Please ask if you have anymore questions.

 

Dental work is tough and horrible. I'm sorry you have to face it. The good news is though, you're done with your taper if you want to be! Congratulations!

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Hi jelly baby,

 

Thank you for the reply, and the confidence boost!

 

Yes, I could ask for Propofol (if the dentist has it available) and specify "no benzos" in the IV cocktail.

 

My fear has more to do with waking up in that dental chair in an outright panic (and possibly frightening the dental staff), because when I sometimes try to sleep during the day, I wake up after 10 minutes in a panic.  I feel if I have some Xanax in my system when I wake up in the dental office I'll be more relaxed, and able to deal with the fact that I am missing several teeth and have gums stitched up.  Plus, having to eat baby food for a year during dental work won't do much for my anxiety either.  I was thinking maybe an "as needed" dose of .05mg (I know it's 5x my nightly dose now, which is probably too much) just to be sure I'm calm & comfortable before & after the anesthesia.

 

I know .01mg is an extremely low dose, but I must be getting some therapeutic value from it, because I'm able to sleep at night, albeit broken sleep, for about 7 hours total.  And I have perfectly benign dreams, and wake up without panic.  Then the tiny dose seems to wear off, the daytime anxiety kicks in, and further sleep is not possible until the following night's dose.  It's been said this drug is more addictive than heroin, and it has a tight grip on the brain until the very last speck.

 

I was also thinking Valium might help me get through the rough times of having no ability to chew solid food for quite a while.  My fear during the day is just off the chart.  Just thought the Valium might help me to feel more "normal" again, like my pre-benzo days, until my mouth is in good shape again.  I just feel awful these days from not being healed (possibly the PAWS as you mentioned).

 

Of course, it would be nice not to have to trade one addiction for another and not to involve a psychiatrist for long-term visits.  It might take a few months for my brain & CNS to heal after jumping.  But I don't feel I have the time to jump off now and sacrifice my sleep at night, especially when my dental issues could become an emergency at any time.  The gum infection is serious, and the stress from withdrawal has undoubtedly weakened my immune system.  But, without enough sleep, I'm walking into walls, and can't even face anyone to have a conversation.  Even if I do sleep, I still have this thick brain fog during the day where things almost don't seem real.  Maybe Valium would clear that up?  Anyway, I tell myself it's just the healing process, and I deal with it.

 

If I did start on Valium, I feel I could taper off it in about 3 months, or 100 days at a 1% reduction per day, with a daily micro taper.  But I might have to wait a year until the dental work is complete to begin tapering, so I can feel comfortable during that rough time.

 

The truth is, I really don't want to start a new benzo, or have to see a psychiatrist for at least a year just to get the script.  It's a real hassle.  But I'm afraid of not sleeping, panicking during the day (both at dental appointments and at home), and just generally feeling awful, not being able to function, drive my car, etc.

 

Definitely a conundrum to ponder.

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Here's another reason why I wanted to stabilize on Valium before anesthesia.  Maybe if I started over with a new benzo (Valium) I would not be considered tapering, and no longer in a vulnerable position.  Or maybe that reasoning is totally flawed, because I would still be compromised by Xanax, regardless of the new med.

 

I think these 2 statements came from people on this site...

 

Person # 1

 

Let the anesthesiologist or doctor know you are on benzos before surgery.  Benzos affect other sedatives.

I was told by my GP that people on benzos don't react well to general anesthesia due to the body's inability to process it.

 

Person # 2

 

I was lucky enough that the oral surgeon I went to today for a tooth extraction was also a medical "benzowise" doctor who refused to administer anesthesia to me, even though I was 3 years off the benzo.

 

He said it was like playing russian roulette and wouldn't chance it, not even for 5 minutes.  He said there was a very large possibility one of 2 things would happen...

 

1)  My brain would down-regulate immediately, sending me back to benzo hell, or

 

2)  My heart would stop from my weakened central nervous system.

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Hello UpRegulator, I am sorry to hear that you're in so much distress about your upcoming procedures!  :therethere: Please know that you're not alone, and you can ask as many questions as you want, and we will do our best to help you. I can't tell you what to do, but I can share my experiences and hopefully that will help you in making a decision.

 

First of all, I have to agree with jelly baby, from the symptoms that you are describing, you seem to have BIND (Benzodiazepine Induced Neurological Disoreder), also known as PAWS. I was in the same situation and can recognize the sxs. After finishing my taper, I still continued to have wd symptoms for 5 years, and then I reinstated 5mg Valium, but things are not going well and I feel worse than before.  My guess is that once the damage is done you cannot "reset" your brain anymore, only wait for time to heal you. Valium acts on the same GABA receptors as Xanax btw, as they are both benzos, you won't get a "clean" start on it. In regards to the brain fog, Valium doesn't help, as it has a long half life, and you're basically drugged the whole day. Also, keep in mind that if you choose to do the crossover, it may take a long time to stabilize on the Valium, and some people just don't do well on it at all. If you are apprehensive about jumping, as jelly baby suggested, why not hold the current Xanax dose, until you feel you are ready?

 

Second, I had also extensive dental work done that took around a year to complete, and yes, you do get tired of eating only smoothies, soups, oats and ice cream (well, maybe not ice cream  :P), but the procedures in themselves where not so difficult to tolerate. I had everything done under local anesthesia, but I am in Europe and that's the standard here, general anesthesia is not required for this type of intervention.  Really there is nothing to be so afraid of.  Also, about a month ago I had a partial mastectomy done, only under local anesthesia as well, because I want to avoid any hard drugs on my CNS. That was as you would say "proper" invasive surgery, normally done only under general anesthesia, but even that I could tolerate. Since the idea of having this dental work done is so distressing to you, I would suggest working with a psychologist specialized in phobias, to have progressive desensitization done, if you can afford it.

 

I hope this helps to put your mind somewhat at ease, and wish you the best of luck with your treatment!

:smitten:

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Hello new0girl,

 

Thank you for the reply!  You're a brave lady to have gone through all you did, and no doubt, still are.

 

Yes, holding my current dose through the dental work for a year is an option.  I was just hoping to feel much better on Valium in order to cope with my procedures and newly handicapped mouth.  That will be very distressing - it will be mouth trauma on top of head trauma from withdrawal.  Maybe if my head felt better, the mouth issues wouldn't be so bad.

 

Some people do very well to switching to Valium.  Their interdose-withdrawal is completely eliminated and they are able to easily taper off Valium.  Wilson's story here is one example of a crossover success:

http://www.benzobuddies.org/forum/index.php?topic=166995

 

I wanted to not only feel better, but make it safer for myself to undergo general anesthesia, in the case that only the benzo type were available at the dentist.

 

I was shocked to learn you still had symptoms 5 years after being off benzos.  Perhaps the other meds you were on were complicating things?

Some lucky people feel well only a couple of months after jumping.

 

I am still thinking over my options and will wait to see if a few more buddies drop by with their opinions.

 

Best of health to you!

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[ne...]

Thanks, UpRegulator, for your kind and thoughtful words of encouragement. I can tell that you are a very compassionate soul.  :hug:

 

I think I ended up protracted for such a long time because I did a very rapid taper while I was extremely symptomatic + possible kindling from the previous CT/ rapid wds off of various other psych meds. You did very well taking your time to taper off the Xanax. I hope you take your time now too, weighing in all your options and deciding the best course to follow.

 

Whatever you decide, we are here for you.

:smitten:

 

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I think you're overthinking things, which is understandable because that's what withdrawal do to us.

 

I wanted to not only feel better, but make it safer for myself to undergo general anesthesia, in the case that only the benzo type were available at the dentist.

 

 

Have you discussed the anesthesia with your dentist? They should be able to tell you what anesthetic they use, and you should be able to request propofol. Instead of going "what if this" or "what if that" why not just ask them? Going round in circles trying to solve hypothetical situations does not really achieve anything other than raise more hypothetical questions.

 

As I said before, I doubt you're having interdose withdrawal, so I don't think Valium will make any difference in that regard and crossovers have their own challenges. But ultimately this is your decision, we can't tell you what you should do. I can only tell you what I would do if this were me, but this is not me. You are the one that's going to have to face this situation and you have to do what you feel is best. There is no judgement whatever you decide to do.  :hug:

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Appreciate your response. 

 

The reason I feel it is interdose withdrawal is because symptoms only occur between doses, when the nightly dose wears off.  I do feel noticeable relief when I take the .01mg at night.  Not sure why Valium wouldn't improve things when its half life is 48 hours on average, as opposed to Xanax's 6 hours.  Yes, I'll be drugged 24 hours at a time, but my receptors should be happy, and this should allow me to taper down in relative comfort.

 

Today was just horrible as far as anxiety, brain fog, and feeling toxic.  Possibly the worst I've ever felt.  There's no way I can walk into a dentist's office feeling like this, even for a consultation, let alone submitting to anesthesia and having my mouth literally torn apart.

 

I have not secured a good dentist yet.  It's difficult to find one who has general anesthesia.  I'm currently writing to a few offices asking questions.

 

Thanks for sticking with me.  I'm in an awful predicament. and I feel I may just cave and see a psychiatrist and ask for advice.  They will probably tell me either switch to Valium, or updose on the Xanax, which may be the safest option.

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