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How To Taper Down Xanax Dosage?

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Posted on Sat, 18 Oct 2014
Question: I am prescribed Xanax 1mg tid na vicodin 5mg bid, but I have been taking a lot more I am concerned about my po checking for a level. how long before it goes back to acceptable if I taper back to my prescribed dosage?
doctor
Answered by Dr. Manisha Gopal (8 minutes later)
Brief Answer:
need to know amount you take now.

Detailed Answer:
Hello,

The levels will depend on the amount you are currently taking and on your kidney and liver function tests.
So, I would need to know how much xanax and vicodin you are taking, from how long and if there are any liver or kideny problems presently. Only after this information I can help you further.

wish you good health.

Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (2 minutes later)
3omg vicodin and 6-10 mg Xanax daily

you said you needed to know how much and how long. I replied 30 mg vicodin and 6-10 xanax , about 2 years on the xanax and 1 year on thevicodin

i am prescribed xanax 1mg tid and vicodin 5 mg bid but have been using them increasingly more, up to6-8 mg xanax and 30 mg vicodin aa day. i am worried about my po doing a level test, how much do i have to reduce to fall within normal limits?
doctor
Answered by Dr. Manisha Gopal (4 hours later)
Brief Answer:
reduce xanax first and then vicodin

Detailed Answer:
Hello,

Your current usage of both drugs is almost twice or thice the amount prescribed to you.In a way it is not much and one can reduce it ...but all will depend on your tolerance of the reduced dosage.

If you havent tried reducing the drugs ever before then you may find it somewhat difficult - but it is not impossible.

You have not replied in any follow up answer about an imporant question regarding your liver and kidney status. I have asked it because both vicodin and xanax can affect these organs and may hamper the process of quitting.
So, taking your liver and kidney status to be within normal limits I will try to guide you with reducing the dosage.

It will be easy for you to satrt reducing the dosage of xanax first. Try reducing the dosage by 0.5-1mg in a day and take it for two to three days- the further reduce by next 0.5-1mg. Like this you will be able to reduce it back to original prescribed levels in 2 weeks.
It is easier to do the reduction of afternoon dose first and last for the eveing dose. If you can reduce more than 1mg in a day then it is much better.

After you have done with xanax- start with vicodin.
You take 30mg vicodin at present. Tapering this will need an additional pain killer for which you can use diclofenac sodium 50mgtwice or thrice a day. You may also need an antacid like pantoperazole and take enough water.. You should ideally stop vicodin altogether. BUt if not, then take 10ml less (i.e. only 20ml )in a day and do so for 3-4 days before reducing 10ml more. After this you will reach your original amount.

Reducing and stopping these addictive meds depend on patient's condition - both physical and mental. If you have a comorbid anxiety then this may pose some trouble. You havent mentioned anything about sadness or anxiety in you but it seems you do have it and to get rid of these you have increased the amount of both xanax and vicodin.

please dont worry, start with reducing xanax and within few days you will be better and in limit of blood levels.

Wish you speedy recovery.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (13 hours later)
yes, i do have a comorbid condition, i have only been on the vicodin for about a year and i have only been increasing it lately, but i have been on xanax for 30 years and it is hell trying to reduce it. as far as taking other drugs to help, i was in rehab for a week. i thought they were going to give me suboxin, but all they gave me was some librium for withdrawls for BOTH meds. i dont know about my liver or kidneys but they have been alright so far on my blood tests. also, i dont know how to reduce by .25mg a day because i take different amounts each day, my vicodin i am usually only taking 15- 20mg a day,last couple days, some times less. i am really worried about this xanax, though. even after reducing to 1mg. tid i start getting anxiety, chest pounding, and shortness of breath. i have been down to 1mg tid before, but it wasnt enough and my doctor wont raise it, not to mention 30 years of building tolerance to it.
doctor
Answered by Dr. Manisha Gopal (5 hours later)
Brief Answer:
please have courage, you can do this

Detailed Answer:
Hello,

I can understand the problem and why its difficult for you to reduce xanax.. you said that you have a comorbid illness but have not given details of the same. Cases of comorbid psychiatric illness should be mamaged accordingly during withdrawals else the treatment almost always fails.

It was right for you to enter a rehab for quitting xanax and vicodin as some support and over all attention boosts morale of the person. However, it is surprising that no pain killer or other withdrawal meds were used apart from librium...I think that was the reason you went back to drug escalation.

Look, first is that you already know that reducing the dosage of any of these will not be harmful or fatal as it would be of taking these medicines constantly. Though it is difficult and full of anxiety to stop them ,still you know that the phase of withdrawal will pass...So,its better to start it slow but complete the detox once and for all and get rid of this habit.

There are several good medicines available which make withdrawal phase less troublesome and offer relief to the patient but almost none is symptom free. Some problem/ anxiety and pain is bound to come but this is usually tolerable.

You must gain strength and start this process...xanax can be reduced by 0.5mg ina day from the minimum amount taken by you in last three days ( as you take varied amount each day so you can follow this pattern). Eat and drink enough and also take an antacid in morning..this helps.
You may take librium 25-50mg in a day but avoid taking more.
Remain physically active and be in company of others--- this will distract you from your withdrawal anxiety.

Its not an impossible task, many many people do it everyday (as the awareness of harmful effects of these meds is increasing)..

Please give me detail of comorbid illness so that we can satrt medicine for the same; which would be helpful in handling withdrawal as well.

Hope the reply helps you in moving ahead with quitting drugs successfully!

wish you good luck. Please feel free to ask more queries for clarification.

Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (48 minutes later)
you said withdrawl it would not be harmful or fatal in reduction of these drugs, what about siezures? oh, the conorbid condition are pain and panic attacks. I have been on xanax for 30 years and built up a tolerance, hence the abuse. actually i am on klonopin right now 1 tid, but but even when i did get back to that dose i was still in terrible condition, didnt even want to get out of bed and agoraphobia. i was off the vicodin for about a week, i dealt with the pain but only 3 xanax a day wasnt enough my doctor wont give me 4 a day, i dont know why, it is stilll within recommended dosage 7.5 or even 10 mg vicodin is perscribable. i would be ok with these amounts but my urinalysis will show that higher level.
doctor
Answered by Dr. Manisha Gopal (5 hours later)
Brief Answer:
start antianxiety med-this will help

Detailed Answer:
Hello,

1. The possibility of seizres is negligible when librium is taken along. Moreover, the dosage reduction is small so this will not lead to sharp fall in level.

2. The comorbid condition neccesiate use of anti anxiety medicine. We usually prefer starting them simultaneously with detox...or may be start them now and let the anxity settle--this approach can make detox even easier. The choice is made by concensus.

3. Your medicine is still in prescribable range but it is not in the treatment modality. We are not authorised or advised to continue or supply the addictive meds to help patient remain addicted. This helps noone.
Also, there are grave long term consequences attached- which a doctor has to take care of. This is the reason your doctor is reluctant to give you more.

4. Taking additional anti anxiety medicine will help in handling withdrawal phase agoraphobia and you can try to socialise. I think you must discuss this with your treating team. There are several good choices available.

You are able to handle painful vicodin withdrawal--this is really appreciable & not everyone can bear this..
The only problem thing is xanax- as it is being abused from longer duration and this drug is very addictive. Im hopeful that with librium and other medicine you can quit it successfully.

Have courage, its never easy to do a right thing but it is always worthwhile.

please feel free to ask more queries to clarify any doubts, I will try my best to help you.

Good luck.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (15 hours later)
im not following you on the xanax reduction and taking librium for the withdrawls. are you saying reduce tha xanax while taking librium at the same time ? no doctor will do that. It would be nice. oh, how many mg of librium is = 1mg. xanax and how many mg = 1mg klonazapam?
doctor
Answered by Dr. Manisha Gopal (9 hours later)
Brief Answer:
0.25mg xanax is 25mg librium but better

Detailed Answer:
Hello,

I prefer 0.5 reduction of alpraxolam at one time (or more if patient is able to handle it).

The drug equivalent of 0.25mg alprax is 25mg librium. The biggest advantage is that of the half life ...Drug eqvivalent of librium would stay in blood for four to five times longer compared to xanax. So, at same dosage patient will have relief for longer time and need less frequent dosing and also less tendency of addiction/ withdrawal.

Drug eqvivalent of librium to that of klonopin is 0.5mg to 25mg.

It is a standard procedure in which we substitute a short acting benzodiazepine with a longer acting molecule- and finally reduce and stop that too....
Without any help it is diffciult and even dangerous to reduce the drug fast.

You can talk to your doctor for helping you out and also get your liver and kidney tests repeated.

I hope the reply clears your concerns.
please do ask more queries if still there are some issues left.

Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (2 days later)
forgot to ask, If liver and kidney functions affect the trans ition of elimination of the drugs, how can they get an accurate level count?
doctor
Answered by Dr. Manisha Gopal (12 hours later)
Brief Answer:
yes, liver & kidney should be normal

Detailed Answer:
Hello,

Yes, the metabolism and elimination of all drugs takes place via liver and kidneys. So, it is important that these two organs are in normal state else the process can be delayed ( or disturbed).

There are tests to determine the functioning of these organs and if found disturbed there are relevant medicines and precautions.

Noone can tell what to take without getting the tests.
The tests for liver include- LFT and ultrasound abdomen ( in some cases)
& kidney is tested by RFTs.

Hope the reply is useful for you.
please ask more questions to clarify any doubts.
Wish you good health.

Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Manisha Gopal (5 hours later)
thank you doc, but you still didnt quite answer my question. how can they get an "accurate level" count [they dont know or care if your liver or kidneys impaired]. I would like also to ask this question for the 3rd time {hate typing lol} going back to your drug equivalency, you said 25 mg librium= .25 xanax or .5 klonopin. therefore klonopin is twice as strong and 1mgklonopin =2mg xanax? my doc switches me every 3 mos.he says it will help with the tolerance build up. I think a benzo is a benzo in the right proportions, excepting the half lifes, and if you build up a tolerance to one you build up a tolerance to any of them. what do you think?
doctor
Answered by Dr. Manisha Gopal (17 minutes later)
Brief Answer:
altered organ tests will point to drug abuse only

Detailed Answer:
Hello,

I have answered the query but will do so again in simple language.

you are right in thinknig that if organs are damaged or not working properly doctors wont get accurate levels of the drugs in your body, but-
1. The high levels of drugs are taken primirarily due to a case of drug abuse unless proved otherwise (in your case)

2. Even if liver and kidney tests are altered (when tested) then reason will be taken to be abuse of the prescribed drugs....

there has to be a reason for altered organ functioning which in your case would point indirectly to drug misuse.

So, it will not help you in a way: either in drug elimination or drug level testing.

Secondly, you are right that a benzo is finally a benzo but...there is a catch---these all have different names and chemical formula...so, deapite being from the same family they have different properties and different uses ...

like, one can abuse xanax easily but not librium...(just like siblings from the same family can be very different even though they share the same sir names!!).

Hope you got the point .
wish you luck.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (30 minutes later)
not sure what you mean by"altered" organ tests. Alcohol, plain tylenol, other drugs like statins [which im also on] can all ruin your liver, and hypertension, which i also have, can hurt your kidneys. And if you please: if 25 mg. librium =.25 xanax or .5mg klonopin, then am i right in assuming that 1mg klonopin = only .5 xanax?
doctor
Answered by Dr. Manisha Gopal (10 hours later)
Brief Answer:
regular meds donot harm in prescribed range

Detailed Answer:
Hello,

Altered organ tests means that the tests are disturbed or deranged.

You are on multiple meds but when hypertention is controlled adequately with its medicines- then it is unlikely to harm liver or kidney.

Same is the case with statins- they lower cholesterol and within prescribed range are unlikely to give any harm to any vital organs.

And, yes the equivalent dosage you mentioned regarding librium,klonopin and xanax are correct.

Please ask more queries to calrify any further issue.

Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (9 hours later)
JUST TO MAKE SURE BECAUSE THIS IS IMPORTANT, LIKE I SAID MY DOCTOR SWITCHES ME BACK AND FORTH BETWEEN XANAX AND KLONOPIN, BUT HE GIVES ME 1 MG. OF EACH [ NOT AT THE SAME TIME], SO THEN I AM TAKING AN EQUIVALANCE OF 2MG. XANAX WHEN HE GIVES ME 1MG. KLONOPIN? I AM DOWN TO 3.5 ON THE KLONOPIN AND ALITTLE OVER TEN [PER DAY] ON THE VICODIN. DOING PRETTY GOOD, JUST DONT HAVE MUCH AMBITION TO DO ANYTHING.
doctor
Answered by Dr. Manisha Gopal (28 minutes later)
Brief Answer:
Lack of ambition/drive will go itself in sometime

Detailed Answer:
hello,

It's good that you are keeping fine on lower dosage of both Vicodin and Xanax (or klonopin) for some time now....this is appreciable.
please try to cut down further, this will be very useful in attaining drug free status. It's fine that your doctor changes the drug from Xanax to klonopin in between, he must be doing it with some clinical basis (May be corresponding to your symptoms).

The issue of lack of motivation or drive is quite common during and (sometimes)after completely quitting the substances. This a motivation can accompany withdrawal of many substances of abuse : ranging from benzo, opioids, to cannabis and even alcohol. This feeling or lack of drive can go by itself in few days to weeks to might even take upto 3-6months. We usually wait for sometime for this to settle on its own, but if the symptom increase or move towards depression then it is treated with appropriate medicines.

I have seen in my clinical practice that most of the patients recover from this feeling within 1-3weeks. It is helped by eating good, exercising and being more social. Please try to do these three things (in a way which is possible and comfortable for you in your settings) to get well soon!

I'm happy that you are trying to reduce the dosage of both the molecules nicely (and don't let minor fluctuations deter you from moving ahead..)
All the best!
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (49 minutes later)
thank you, doc , but please clarify this equivalent 1mg klonopin = X mg, xanax.

doctor
Answered by Dr. Manisha Gopal (1 hour later)
Brief Answer:
given the details below; good luck

Detailed Answer:
Hello,
1mg klonopin ( clonazepam) = 2mg xanax.

But again the catch is that klonopin stays for thrice as long in the body as xanax . And the effect ( peak levels in blood) comes slightly late in klonopin.

Good luck and good health to you!
Dr. Manisha Gopal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (32 minutes later)
Damn, then Im not doing as good as I thought. 3.5 mg, that means im doing the same as seven mg. xanax. but are you sure because if you look back, i previously asked 1mg klonopin =.5 xanax and you said that was correct. that would be just the opposite and i would be doing better than i thought please check for certain, doc. this is hard enough the way it is.
doctor
Answered by Dr. Manisha Gopal (8 minutes later)
Brief Answer:
you are doing good- trust yourself

Detailed Answer:
Hello,

Look, its not only about the dosage of the benzo being abused but also the type of benzo and its frequency. So, as the clonazepam is not as addictive as xanax: your progress is good.

You should not ideally compare eqvivalents here as they cant guide you properly. Even though by eqvivalent terms you are taking around 7mg xanax --but the point is that you are not on xanax but on klonopin. Ok.
and the two are different.

Drug dosage eqvivalents are important in cases of poisoning and where acute treatment is indicated or where there is risk of seizures. Your situation is not that grave and is also showing improvement.

So, you should not panic like this and trust the treating team.

Take care.
Dr. M Gopal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (43 minutes later)
so maybe i should stay on the klonopin instead of switching this time?
doctor
Answered by Dr. Manisha Gopal (7 minutes later)
Brief Answer:
stay on klonopin and reduce it further

Detailed Answer:
Hello,

You should not go back to xanax and should follow your doctor's prescription.

Klonopin or librium are easier to handle compared to xanax during withdrawal phase.

Please see if anything else is bothering you regarding the medicines, I will try to help out.
Good luck and good health!
Dr. Manisha Gopal
MD Neuropsychiatry
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Manisha Gopal

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How To Taper Down Xanax Dosage?

Brief Answer: need to know amount you take now. Detailed Answer: Hello, The levels will depend on the amount you are currently taking and on your kidney and liver function tests. So, I would need to know how much xanax and vicodin you are taking, from how long and if there are any liver or kideny problems presently. Only after this information I can help you further. wish you good health. Dr. Manisha Gopal MD Neuropsychiatry