Question about metabolizing Valium

[drummerswife]

I was wondering if any of our devoted professionals have any thoughts/insight on this:
My dentist has been giving me Valium for my appointments and the last two times it worked really well. I pretty much slept through the whole thing with littlle memory of what was done. This was fabulous for reducing my fear. As I wrote in my post, yesterday the Valium seem to take quite a bit longer to metabolize in my system which left me alert for a longer time which was very frightening to me especially as the dental assistant is trying to pull the temp crown off.
We used the same dosages administered at the same times as before so why would it have taken longer to affect me than before?
Any info appreciated

 

[brit]

I'm not a dentist, but I suppose it's like alcohol, your body chemistry acquires extra tolerance over time..no doubt there will be other variables in the mix too...I suppose if you are less anxious, you won't be so desperate for it to kick in as you originally were....it's a pity she had her Assistant work on you though,..I'm sure that didn't help at all.
It's not necessarily a bad thing though..you coped..despite the delay...the treatment was successful.....your long-term goal would presumably be to reduce the reliance on the valium over time anyway..especially when you are in 'maintenance mode' in a few weeks/months time. It's amazing progress whichever way you look at it.

 

[connab]

I dont take valuim but I take Halcion and I never have had any problems except when I had an extraction in Nov. I think that I was so worked up and upset that I blocked some of the benifit of the drug. It still worked but not 1/2 and good as it usually does. Also, I was told my the phamasist not to drink caffine or have caffine in my system that caffine can effect the drug. I took valuim when I had my wisdom teeth out in 94 and it didnt do anything for me so later when I had work done he tried Halcion and I have used it ever since.

 

[leela]

Hey drummerswife - there is no doubt that we can develop tolerances to drugs. I am not a pharmacist so I have no idea how long that would take, but it does happen.

As well, I am living proof that adrenaline can mute the effects of drugs. My other phobia is fear of flying. I always take Ativan (anti-anxiety) before I fly. I usually take it half an hour before boarding. When I'm in the airport I'm usually pretty out of it, kind of giggly with not a care in the world. As soon as my bum sits in the seat, I can actually feel a rush of adrenaline wash over me and completely eradicate the Ativan. I had the same thing happen the last time I went to the dentist. Took the Ativan and was fine in the waiting room, but as soon as I sat in the dental chair, the same rush of Adrenaline and the Ativan was completely neutralized - or so it seems.

Have you ever heard of someone being completely intoxicated and then being in a car accident or something and appearing completely sober? Or someone being shot and not falling down? It's the same thing - adrenaline can do amazing things.

I have another dental appt. on Friday, and this time my dentist told me to take 2 Ativan and a Gravol - apparently this combination is supposed to render you helpless, we'll see.

 

[Stress Doc]

Valium is an interesting medication. It has a very long half-life about 100 hours.

Here is the technical part. Many benzodiazepines have no active metabolites. A metabolite comes from the parent drug as a by-product. However, diazepam (Valium) is metabolized to oxazepam (Serax) and desmethyldiazepam, which themselves have sedative properties.

Metabolite reactions and interactions can be somewhat variable due to their interactions with GABA receptors in the brain. The affect changes due to many physical and psychological factors.

In regard to tolerance. You can develop tolerance and dependence in as little as one week of continous use. Benzos should not be used for more than 4 weeks. Their affect drops very quickly and continued use can result in "emotional anesthesia."

Valium is not the best choice for dental anxiety due to half-life and the metabolites. Ativan, in my opinion, is a much better choice. It has a shorter half-life and does not produce any metabolites. The affect is consistent and easier to predict. Valium has been around for 40 years. It was the "only game in town" and thus was widely used. There are much better medications that are far more specific and do not cause the side effects of Valium. But old habits die hard.

I hope this helps

 

[leela]

Hi Stress Doc,

Funny you should say that about Valium - I heard it now from my dentist and from the anesthetist when I was getting the root canal - that Valium is very "old school" now and that there are so many better drugs on the market.

I am fascinated by your answer. I used to work for a pharmaceutical company and have always been keenly interested in how drugs work.

I am curious though about this Ativan/Gravol combo that my dentist has suggested for me for Friday. This seems to be very common here now. What do you think of that, and do you have any idea as to why or how these drugs work together?

Thanks!!

 

[Stress Doc]

Hello Leela:

That is an interesting combo.

Gravol is a trade name for the nonprescription antihistamine dimenhydrinate. This medication works for relieving nausea and inducing sleep. It is not available in the USA. However, Dramamine, which is the same drug is.

We do not use this combo in the USA. The thought is using these two together would increase the sedation effect. One of the reasons we do not use Gravol is due to some problems with hallucinations in some people. This is the result of low level of acetycholine. The hallucinations are primarily auditory.

Other CNS effects occur within the limbic system and hippocampus causing confusion and temporary amnesia due to decreased acetycholine.

Personally, I think Halcion is a better choice than this combo. Gravol is very similar to Benadryl and is dosed the same.

I hope this helps.

 

[leela]

Stress Doc - I think the effect my dentist is going for is sedation, but not complete sedation. I've never used Halcion - what are the effects? I don't think she wants me completely out, just enough so that she can work on me without me being extremely agitated and anxious. Since Ativan wore off very quickly once I got in the chair, she thought adding the Gravol would work.

Is Halcion "stronger" than Ativan - is it in the same family of drugs or a different one altogether. For some reason, I thought Halcion was a sleeping pill??

Thank you again.

 

[Stress Doc]

Hello Leela:

Halcion is a sleeping medication that is excellent for oral sedation. It has a short half-life, 1.5-3 hours. It is a powerful amnesiac. You are still able to respond to directions but will have no memory of the event. It has a quicker affect time than Ativan, about 15 minutes. On a mg basis Halcion is faster and stronger than Ativan.

It is very safe. Very common in the USA.

You said the Ativan wore off quickly. What dose were you taking? It should last about 4 hours. You could also use Restoril as it is a good oral sedative.

Have you tried behavioral techniques along with the medications?

 

[gettingthere]

This is interesting. When I had extractions under GA last year, I was given diazapam just to get me there. The hospital recommended this and told me to get it from my gp, who recommended that I take 10mg, which I did and then got a telling off from the anaesthetist who said I had taken too much. Funnily enough however I don't think any doseage would have helped beacuse although I was "fine" in the car - I felt like I knew I was, or should be scared, but couldn't bring these feelings to the surface so it was okay - just as mentioned about getting in the airplane, as soon as I entered the ward I became hysterical and nothing could calm me.

Just about a month later I met a friend who said she had had 2 wisdom teeth extracted under sedation the previous day and was still "out of it" although she seemed fine to me. When I asked if it was iv sedation, she said no - 2mg of diazapam and she had been "unaware of the entire process". I was kind of skeptical about this at the time but what you say does make sense - I presumeably had so much adrenaline rushing around my system that no amount of medication would have worked whereas a small amount was probably enough for a lesser phobic.

Good to know there are other options too and if I ever get into a situation like that again (god, I hope not!) will ask about Ativan or another option.

 

[leela]

Hi StressDoc - when I say it wore off quickly - I don't mean that it gradually wore off. I mean that as soon as I landed in the dental chair it was like somone shot me up with speed. Not that I've ever been shot up with speed, but I instantaneously went from giggly and relaxed to sheer terror in seconds. I can only assume that was adrenaline kicking in. The same thing happened on the plane. The dosage I took both times was 1 mg - two .5 mg tablets. My doctor said the maximum dosage is 2 mg, but for my size (5'1" tall and 117 pounds), she said 1 mg should be enough. It isn't. My dentist told me to take the same dosage PLUS one gravol.

 

[Stress Doc]

Hi Leela:

For your size 2mg is a high dose. That is the thing about benzos. Working with them is more art than science. This is the reason for many "off label" uses.

I really think behavioral work would help. This allows you to control the reaction before it starts. I have seen immense success using this method. You can supplement anti-anxiety meds but the meds alone will not do the job. They are not a cure. They only open the door to allow for the behavioral work.

Blessings

 

[FinnishGirl]

Old school or not, Valium is what is used for dental anxiety in Finland. Here Ativan is considered to be a stronger (and, I think, more addictive) drug and only for very difficult anxiety. This is what you can read from a drugs manual for laypeople. (Except that they have different trade names here.) It's not easy to get Ativan here, Valium is much easier to get a prescription for. Here Valium is not primarly meant for muscle cramps as you StressDoc have said at some point. The first use on the list is anxiety and the last is muscle cramps. So things are different in different countries. Valium works perfectly fine for my Finnish brain and others say the same.

 

[Stress Doc]

Hello Finnishgirl:

That is interesting. If you go to your doctor in the USA and ask for Valium, the odds are you will not get any. However, Ativan is handed out like breath mints. It is not unusal to be given 120, 0.5 mg tablets for mild anxiety.

The reasoning here is valium has a very long half-life and causes motor impairment. It also has a long track record of abuse in this country.

Everywhere is different. I am glad it works well for you. I love learning about how different things are done are the world for similar problems. Thanks for the info.

 

[FinnishGirl]

I just checked the info I gave you was correct. I looked at an official website. I remembered right. Also on Finnish web forums you see what drugs are used often. And for some years ago there was no Ativan in pharmacies for a while. The newspapers said then it's a very rare drug.

Valium is so common in Finland that it's the only anti-anxiety medicine people know and used as a synonyme for anti-axiety medicine in everyday speech.

But maybe we just are old-fashioned. A while ago I somehow ended up watching a YouTube video about math education in US. I was surprised - I'm only 19 and I was taught to do math in what was the "old way" in the video! In the Finnish language there are many proverbs that mean that old ways to do things are often better than new ideas.