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Unread 11-03-2010, 08:13 PM   #1
OpioidsGotMe
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Default What is a average daily dose

Hi,
With xanax I know there is no set "average" daily dose but what is the range? I have started taking xanax when one night I had an attack that was so severe that I had to go. I have never sleep straight through a night. I have tried many sleep aides but the problem is not really falling a sleep it's staying a sleep. This is mainly from waking having what I guess would be called a panic attack. I didn't think much of it because my whole life I have never average more then 3 hours of sleep a night. I do have these attacks during the day also but before having used xanax I could just keep busy or wear myself out somehow. I did tell my suboxone dr. on my next visit about it and he did precribe xanax but he also prescribed buspar 3x. He wanted me to taper the xanax as the buspar built up in my system. He has increase my buspar but it seems not to be doing anything. I have to a couple xanax during the night and if I have to use it during the day it's usually just 1 or I can get by just using them at night. I know it's an additive drug. But I have not had to use as much suboxone since I've been on the xanax. I plan on being on suboxone for life because I have chronic pain issues from multiple brain surgeries. The thing is I have had to go to the E.R. several times because I can't cut back because the buspar is not helping. I know I survived without it before I used it but it help so much with what I thought was something I just had to deal with "panic attacks". At night I take 3mg through the night and maybe 1 mg more during the day. The most I have ever used in one day was 5 mg the average for a day is 4mg. Would this be wrong to ask my Dr. if I could be put on xanax daily. I know there is a xanax XR but my insurance will be running out within the year and the xanax XR is to costly for me. Xanax changed my life. I thought I was just a nervous person. I take one pill and I'm able to go back to sleep at night. This is something I have never been able to do my whole life. What is the right thing to do?

Darrin
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Unread 11-03-2010, 08:20 PM   #2
MaJaBe
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Xanax is something that some people need. They are people with anxiety/panic disorder, that usually need and AD med as well, as Xanax can cause depression when taken long term.
If you are one of those people, I don't see why your doctor wouldn't prescribe you it. 5mgs is kind of high, IMO. But everyone is different I guess.
I'm not a doctor, so I'd just tell your doctor how you're feeling, and that your sub use decreases when taking it, meaning that you're using sub for AD and anxiety as well as pain/addiction.
See what he says. If sleep is the issue, I would consider a non addictive sleep aid, and lower the xanax to be used for anxiety, not insomnia, because it's not intended for that purpose and is very addicting.
I'm in no way judging, I'm on xanax myself for the reasons I listed above, just seems like 5mg is alot. You just don't want to self medicate for other problems with xanax, so keep your doctor informed of how you're feeling. There are other longer acting benzos that may help, also, so you don't have to take it so many times during the day. (Valium, Klonopin) Then maybe you could just take one during the day and one at night.
Just suggestions/ideas. Talk to your doctor.
Best,
J
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Unread 11-03-2010, 09:00 PM   #3
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Thanks J, that was very helpful. Thanks for the suggestions of the other meds to aid in keeping my xanax to the lowest possible dose needed.

Darrin
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Unread 11-05-2010, 05:18 PM   #4
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No problem, let us know how it goes!
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Unread 11-05-2010, 06:39 PM   #5
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I'm not a doctor, so whatever I write you should confirm with yours.

It seems like a lot to me, too, to take every day.

Although they intersect, panic disorder, anxiety and sleep disorders are different.

For sleep, the best possible solution would be something that does not cause dependency. Many sleep aids simply contain Benadryl 25mg. You might find that helpful. Also, to naturally regulate your sleep Melatonin (maybe 3mg) would be helpful. These are less likely to build up a tolerance and thus a dependence.

When it comes to Panic, however, Xanax is an effective medication. I sometimes wake up in the early morning with my head spinning from all the issues in my life and I find myself in a panic. My psychiatrist said that as one gets older, this is natural for some people as responsibilities grow. In my case, I take Ativan, which is more for short-term anxiety. It does help me sometimes when I wake in a morning panic. I understand that Buspar can be an effective anti-anxiety medication, but I believe that once a patient is already on stronger benzodiazepines, it is not likely to be as effective.

For me, for sleep, sometimes I can go to sleep, sometimes I need a Benadryl, and a lot of times nothing will work but Ambien (a Z-class hypnotic that binds to the same GABA receptors as benzos like Xanax).

Rather than loading up on Xanax, it may make sense to speak to your doctor about which disorder should be treated with which medication so you don't end up taking too much.

Short-Acting Anxiolytics (Anxiety) - Ativan (Lorazepam), Xanax (Alprazolam)
Longer -Acting Anxiolytics (Anxiety and other) - Klonopin (Clonazepam), Valium (Diazepam)

Hypnotics - Restoril (Tamazapam), Ambien (Zolpidem), Lunesta (Zoplicone)

I hope some if this is helpful.

-Packrat
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Unread 11-05-2010, 08:42 PM   #6
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Thanks you guys for all the suggestions. My next appointment is November 15th. I'm getting panic attacks just thinking about this problem. I know xanax can be addictive. It just that it almost makes it worse knowing this. It's hard to explain but just one pill fix something I've lived with my whole life and now when I get the panic attacks instead of doing what I have my whole life (race around the house, cry, scream whatever it took to get through it) I can take one pill and in a very short time I'm cured. It's almost like I wish I didn't decide to go to the E.R. that one night when they gave me that xanax. I say this just because now when I get the panic attacks I know I can take a pill instead of going through what I used to my whole life. I'm not sure if I'm just rambling on here but I know how becoming addicted to pain medication ruined half my life. I just don't want to start down that path with xanax. Well I've been with my doctor for about 4 years and I trust him to lead me in the right direction. Just very scared. I just hope the cure is easier then it feels like it going to be.

Darrin
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Unread 11-06-2010, 01:22 PM   #7
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Darrin,

IMHO it sounds to me like you are in recovery for addiction to pain medications, but in treatment for panic and/or anxiety using benzos and are becoming physically dependent. These are two very different things. See http://www.naabt.org/faq_answers.cfm?ID=15 for the definition within the context of opiates.

I am in a similar situation. I am in recovery for opiate addiction - wherein I had an uncontrollable urge to use despite consequences. I am also in treatment for chronic anxiety using benzos. I am physically dependent on a relatively low dose of Ativan without which I will bounce off the walls. I am not addicted to benzos, but need them as a tool. If my doctor had a magic bullet for me (stand on one foot, turn around three times and sneeze - ) to treat anxiety, I would use that treatment instead and taper off of Ativan.

It doesn't sound like you are starting down the path to "addiction" with Xanax; it doesn't sound like you are abusing it or are exhibiting addicting behaviors, but need to work with your doctor on the root causes of your panic. It may be that you can find a way without medication, but maybe you'll need medication. I also sense a little guilt, too and I recognize it. I am a diabetic and I don't feel guilty about taking my diabetes meds. Try to be patient until the 15th and work with your doctor and make sure they know how you feel both about your life and your fears about Xanax as treatment.

Best of luck with your appointment.

-Packrat
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Unread 11-06-2010, 08:47 PM   #8
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Thanks Packrat. You seem to know exactly what I'm going through. I just looked it up and you have been a member 2 months longer then me, both a little over 4 years. I'm sure we have both written in the same post more then a few times. But this one has become very special to me. You have been saying things that just seem to me when I read them " yeah that's right" or "I didn't think of it that way but that makes a lot of sense". I mean like saying I'm becoming "physically dependent" not "addicted" to xanax. Something that we all talk about in this forum all the time. I'm just worrying and thinking to much that the outcome will be for the worse and forgetting some of the facts I've learned during my recovery. I just want to say thanks again.

Darrin
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Unread 11-07-2010, 08:03 AM   #9
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Darrin,

Thanks, and I worry, too - you are not alone. Anxiety and panic as a disorder are different from pain and painkiller addiction as a disease, at least for me, but I think for others, too. So I have had to try not to confuse the two. I am making good progress with Opiod addiction treatment and feel good about myself in this area, but it is quite different for me when it comes to anxiety. I have kids, a wife, a coupla cars, mortgage, taxes and a not-very-secure job. All of these spin around in my head in the early morning sometimes resulting in panic and cause anxiety during the rest of the day.

I work with my shrink and while he is good, these are far more complex problems for me to deal with than opiate addiction itself (not to minimize the problem of opiate addiction, though). Years ago, after refusing to go to a psychiatrist and "get medication" for anxiety, my primary care physician said to me, "You know, you don't have time in your life for middle-eastern Yoga," meaning that I live in a fast-paced society, have very real pressures that can't be exercised, wished, prayer'd, 10-deep-breath'd away, and I can't just take my family's life savings and get on a one-way ticket to Bora-Bora (although I could use a vacation - ). I resisted medical/psych advice for more than 10 years and didn't go on medication and in the process did irreparable damage to family, friend and financial situations. I finally went on meds and they have helped me in many ways. I wish I didn't need them, but I do. I feel some guilt about not being strong enough but that's really bull because I am the back-stop for my family and the buck stops with me. Many things have to happen before I can begin to even think about stopping the meds and they are long ways away. So, I continue, follow my doctor's orders and work on repairing the damage caused by NOT getting treatment.

Anyway, you are welcome and I think you may be right that we are in similar situations.

Regards,

-Packrat
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Unread 11-15-2010, 03:47 PM   #10
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Well saw the doctor today. He ask how I was doing, same as he has done for 4 years. I usually answer good. But this time the first thing out of my mouth was that I couldn't cope on the 1 1/2 mg a day he had me on. I told him I had been going to the ER and have also seen my Dr. I have assigned to me by Medicaid. That I have been getting xanax from other doctors and pharmacies. He ask how many I have been taking and I told him 3mg during the night and sometimes a little during the day. I was so relieved when he said he appreciated my honesty and ask me if I could try not using more then 3mg a day. I said I will try. He then wrote me a script for 1mg x3 daily. I had asked him if he would have to write anything on the script so Medicaid would fill it early. He said it should be ok because of the dosage change. Well I brought the script to my regular pharmacy. They went to see if it would go through. The pharmacist called me up to the counter and said that Medicaid said they had to review it and they would know in 4 hours. I asked if I could just pay cash and if they ok'd the script I would just send it in and get reimbursed. The pharmacist said she would rather wait and see if Medicaid oks it . The part that bothers me is I keep thinking that the pharmacist is gonna call around and found out that I have been getting scripts from other dr. and other pharmacies. I know I told the doctor but the pharmacist still has the right to not fill it if she doesn’t want to. I know I could call my doctor and get it called in else were if that happens but 1)I'm out of xanax now and it's just the waiting that is so hard to deal with. It's just hard to get control meds around here because of so many pharmacies around me know I had abused narcotics for so long. Well I'm gonna go back to the pharmacy in a couple hours and I will see what happens. One thing I should mention is the pharmacy I get my suboxone at is not where I get all the rest of my meds. This is only because my suboxone doctor is 25 miles away and he request that we get our suboxone filled at the pharmacy they are connected with. So the pharmacy I’m getting my xanax at does not know I am taking suboxone. Well wait and see I guess.
Darrin
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Unread 11-15-2010, 08:32 PM   #11
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All that worrying for nothing. I went into the pharmacies and at first the pharmacist seem to ignore me and came up to me after a few minutes and said can I help you. What worried me about this is I have gone to that pharmacy for the last four years and she has been one of two pharmacist that work there that know me very well, and besides that I was just in there 5 hours ago and talk to her for several minutes about the script for the xanax. I thought for sure this was a sign that meant I'm not getting the xanax. But I said I'm here to pick up my scripts. She then smiled and said oh and yes we have your auto fill meds filled and your xanax did go through your insurance.
The doctor besides keeping me on the xanax and buspar, he put me on Celexa. He said he's not just gonna make me stop the xanax and if need be I might have to stay on it everyday. But he said we need to try other meds to try to treat the anxiety, panic attacks and not just take as much xanax as I am. All I know is I'm gonna call his office if for any reason I can't stay on course with what he has me on. I know I don't want to fall into old habits. I mean I don't abuse it. I don't take it to feel the euphoria. I may have some panic attacks when I was out of xanax witch I know has to change but hopefully if I keep my doctor up to date on how I'm taking it and if I stray from what he says. This may be confusing what I wrote but basically I trust my doctor and I want to make sure he trust me.

Darrin
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Unread 11-15-2010, 09:04 PM   #12
MaJaBe
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I'm glad you told your doctor. I'm of the opinion that when on Sub, all your meds should go through that doctor, unless you have another serious medical condition, (heart, diabetes, cancer, etc) that requires a specialist. And even then your sub doctor (if they're a good one) should know about all your medication. Sub is a drug that not all doctors are knowledgeable about, so it's important to have your sub doctor (who hopefully IS knowledgeable) know about all medicines to help you be aware of any possible interactions.

3mgs a day is totally do-able. Just take 1 during the day, and two at night. If you need to break up the 1 during the day, then you can take it two times, just 1/2 mg at a time. Since you didn't have Xanax for a period of time (not sure how long you were out) you should be able to go back at a lower dose.

Best of luck,
J
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Unread 11-16-2010, 09:27 PM   #13
OpioidsGotMe
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Hi J,
Thanks. I had got myself down to 3 mg a day before I went into my appointment. I really wasn't out of the xanax I just did have 3 mg the two day before my appointment. I had 2 mg a day so at least I wouldn't be miserable. My anxiety was very high those two day. Like I said he put me on Celexa witch I have ready about and it sound like a lot of people have had success with help with their anxiety. Besides telling me he will not just yank me off xanax he also says that he hopes to lower the amount of xanax I need a day but it may turn out I may need to take a small amount of xanax everyday to deal with my anxiety and panic attacks.
Before this appointment I was worrying about things that I shouldn't have been. But that's just the way I am, I worry about anything if it may have a negative out come. I know I shouldn't but the phrase "easier said then done" fits very well. Once again I just want to thank everyone for their words of support and knowledge. I thank everyone but I want to pay special thanks to Packrat because even know this is just a forum and we are miles apart he really made me feel like he was right there with me going through the same feelings. But once again thanks to all.

Darrin
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Unread 11-18-2010, 07:33 PM   #14
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Darrin,

I'm just glad things are working out.

Best of luck!

-Packrat
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Unread 11-18-2010, 09:47 PM   #15
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Thanks Packrat,
Your knowledge and kind words helped me more then I can say. The biggest help was your explanation of what I was going through. I was so confused but with each of your replies made it clearer each time. You made it so I had more confidence when I went into my doctors appointment. I found out being honest with your doctor when you start to stray makes it a lot easier especially since I have built up a honest relationship with my doctor over the past four years. And again thanks.

Darrin
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Unread 12-04-2010, 11:10 PM   #16
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I had the same waking up in a panic attack. I was sent for a sleep test and told I have sleep apenia it was not panic attacks waking me but breathing. Hope this may help.
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