Brief Answer:
Sublingual medication aborbs quickly into the bloodstream

Detailed Answer:
Good evening. Many thanks for your question here on Healthcaremagic. I am assuming that when you say, "....react with my system" you are trying to ask how long it takes for the medication to get into your system and start working.

Sublingual medications typically penetrate into the bloodstream within several minutes and are at their target sites almost instantly after absorption especially if we are talking about head and neck structures. This is because of the anatomy of the drainage system for the head and neck which goes into the internal jugular vein. This in turn flows directly into the right side of the heart and within seconds is traveling through the arterial system to the brain.

Now, in the case of diazepam I would clarify a couple of things. The first is that you wrote that you're taking a 10 GM (gram) presentation. I don't think that's the case. You are more likely taking 10 MG (milligrams). Also, you did not specify whether or not the tablet is a special formulation known as ODT (oral dispersion tablet) or it's just a normal tablet simply placed under the tongue. If it's an ODT then, depending upon which chemical disintegrant is being used the time to full break up in the mouth is anywhere from 40-60 seconds with a time to entry into circulation and transport to the target organ from 10-12 minutes.

If it is not an ODT presentation form and simply an oral tablet that is designed to be swallowed then, if it is held in the mouth and under the tongue it will take approximately 20-30 min. for the medication to fully disintegrate and enter the bloodstream finally reaching the target organ. Most people find it very difficult to hold a pill in their mouth for more than several minutes before swallowing it which is why ODT's were developed. Notwithstanding, if you are using regular tablets it is clearly to your advantage to hold the pill in the mouth for the duration until it melts and gets absorbed since you will avoid metabolizing a good portion of the medication which will happen if you swallow the tablet or the saliva containing the tablet which then, is processed by the liver and excreted in the urine.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.

I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information informative and would be grateful for a few words of feedback.

Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible.

All the best to you during these holidays!

This consult request has taken a total of 55 minutes of time to read, research, and respond.

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Brief Answer:
Glad to be of help

Detailed Answer:
I agree that having a conversation with your doctor on the medication change is a very good idea so you can let him know what the differences are between the action of the Klonopin and the Valium. I could take some guesses as to why a physician might want to change you from one to another, however, that would be pure speculation on my part and from what you've presented my feeling is that if you were my patient I would've likely left things as they were from a medication point of view if it was working.

Yes, ODT tablets can get into the system rather quickly. I use them in my patients when I want to get quick responses to anxiety (such as pre-procedurally for an LP or something) and we are not in a position to give IV sedation. In fact, ODT typically gets into one's system more quickly than IM injections as well.

Have you been recommended to approach your anxiety and fear from your fall using other methods of relaxation such as paced breathing, visualization techniques, biofeedback, Cognitive Behavioral Therapy (CBT; that's a big buzz word these days in psychiatry and neuropsychology circles).

I understand why your neurologist would tell you that he can only help as far as epileptic seizures are concerned. I am in agreement up to a point. In other words, it's true that the use of antiepileptic medications targeting actual electrical disarray in the brain is useless in these types of seizures.

I am not aware at this moment of any particular center in the U.S. that specializes or is recognized as a leader in treating non-epileptic seizure disorder cases resulting from TBI. I simply refer my patients (and I have quite a few since I work with veterans through the VA hospital) to appropriate psychological or neuropsychological services and most of my patients do quite well. I'm sure there must be people in XXXXXXX who could help equally well. There is no surgical fix to this type of problem since it is the non-epileptiform variety of seizure.

Now, there is one thing I try to do for my patients and that is absolutely confirm the fact that what you have is PURELY non-epileptiform and not a MIXED picture. Did the center in XXXXXXX put you in for prolonged video monitoring when they made the diagnosis? Did you repeat that procedure at least twice and/or have at least 2 ambulatory monitors for a minimum of 72 hrs. each as well as interictal imaging studies in order to rule out as much as possible the chance that you may be having a mixed picture of seizure types?

If so, then, the workup's complete in my opinion and nothing more to be said there....but if you have not really had that type of aggressive diagnostic study set performed then, my suggestion is that you pursue something along those lines. You don't want to be missing REAL seizures for which you are only treating with benzodiazepines when there are much better drugs to control things. Imagine reducing your seizure frequency by any amount by treating the EPILEPTIFORM types. I guarantee you and your husband would think it a step forward.

As far as falls are concerned; this is not uncommon in TBI patients but the condition usually doesn't worsen being this far out. So why things are getting worse is not immediately clear to me unless you could be suffering from medication effects or something else metabolically may be going on. However, have you ever been sent or recommended to try VESTIBULOTHERAPY. In other words, learning or relearning how to balance yourself can be very important in TBI since damage can occur in the absence of MRI findings due to the multiplicity of connections between the cerebral hemispheres, spinal cord, and cerebellum which can be disrupted. Good news is they can be retrained with diligent and consistent work.

That may reduce your falls and improve things a bit.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.

I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information informative and would be grateful for a few words of feedback. If there are no further comments as well it would be much appreciated if you could close the query. We can always reopen communication at the web address below in the New Year if you'd like.

Write to me at: bit.ly/drdariushsaghafi

Have a Happy and Safe New Year as well!

This consult request has taken a total of 78 minutes of time to read, research, and respond.

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