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The Benzo Beast

It's devious and deceptive, confusing and cunning. It messes with your intellect, your sense of reality, and your emotions. It puts unwanted, frightening, catastrophic thoughts in your head. It's as if it were alive like some kind of demon or monster that holds on and doesn't want to let go. It's a war. But it can be won. It's insidious and all pervasive, but it can't win in the end if we are determined. We can rid ourselves of it and we do recover. Trust me. it's the truth. I did it!

Medications To Avoid At All Costs, Especially During Benzo Withdrawal

Quinolone Antibiotics Avoid At All Cost Especially During Benzo Withdrawal

The quinolones are a family of broad-spectrum antibiotics.

    * Peripheral neuropathy (nerve damage): "Rare cases of sensory or sensor motor axonal polyneuropathy affecting small and or large axons resulting in paresthesias, hypoaesthesias, dysesthesias, and weakness have been reported in patients taking quinolones. Therapy should be discontinued if the patient experiences symptoms of neuropathy including pain, burning, tingling, numbness and or weakness or is found to have deficits in light touch, pain, temperature, position sense, vibratory sensation, and or motor strength in order to prevent the development of an irreversible condition."

    * Tendon damage: "Ruptures of the shoulder, hand, Achilles tendon or other tendons that require surgical repair or resulted in prolonged disability have been reported in patients receiving quinolones. Post-marketing surveillance reports indicate that this risk may be increased in patients receiving concomitant corticosteroids, especially the elderly. Fluoroquinolone therapy should be discontinued if the patient experiences pain, inflammation, or rupture of a tendon. Patients should rest and refrain from exercise until diagnosis of tendonitis or tendon rupture had been excluded. Tendon rupture can occur during or after therapy with quinolones.".

Other problems include:

    * Heart problems (prolonged QT Interval / Torsades de pointes)
    * Pseudomembranous colitis
    * Rhabdomyolysis (breakdown of muscle tissue)
    * Steviens-Johnson syndrome
    * Lowered seizure threshold
    * Hypoglycemia


The quinolones are divided into generations based on their antibacterial spectrum. The earlier generation agents are generally more narrow spectrum than the later ones.

 1st generation

    * cinoxacin (Cinoxacin)
    * flumequine (Flubactin) (Veterinary use)
    * nalidixic acid (NegGam, Wintomylon)
    * oxolinic acid
    * piromidic acid
    * pipemidic acid (Dolcol)

2nd generation

    * ciprofloxacin (Cipro, Ciproxin)
    * enoxacin (Enroxil, Penetrex)
    * fleroxacin (Megalone) (withdrawn)
    * lomefloxacin (Maxaquin)
    * nadifloxacin
    * norfloxacin (Noroxin, Quinabic, Janacin)
    * ofloxacin (Floxin, Oxaldin, Tarivid)
    * pefloxacin
    * rufloxacin

3rd generation

    * balofloxacin
    * grepafloxacin (Raxar) (withdrawn)
    * levofloxacin (Cravit, Levaquin)
    * pazufloxacin Mesilate
    * sparfloxacin (Zagam)
    * temafloxacin (Omniflox) (withdrawn)
    * tosufloxacin

4th generation

    * clinafloxacin
    * gemifloxacin (Factive)
    * moxifloxacin (Avelox)
    * gatifloxacin (Tequin, Zymar) (withdrawn)
    * sitafloxacin
    * trovafloxacin (Trovan) (withdrawn)

In development

    * ecinofloxacin
    * prulifloxacin


Neurontin (Gabapentin) and Benzodiazepine Withdrawal

Dr. Reg Peart

Victims of Tranquilizers

The attached information indicates that the pharmacological properties of neurontin (therapeutic actions, adverse reactions, and withdrawal symptoms) are similar to those of benzodiazepine and other sedative/hypnotic drugs.  Neurontin and the benzodiazepines are cross dependent and cross tolerant drugs and therefore neurontin will alleviate adverse reactions and withdrawal symptoms produced by the benzodiazepines.*

Neurontin does not meet all of the criteria needed for use in tapering from benzodiazepine withdrawals.  (See the notes on Diazepam vs. Clonazepam  Firstly, it has no active metabolites; secondly, the elimination half life is short and; thirdly, the drug equivalence is not reported for the various therapeutic actions.

The range of the short half life i.e. 5 - 7 hours is small compared with most CNS depressant drugs. For most the upper value is 3 to 5 times the lower value.  The limited range quoted may be the result of few studies and could very well be significantly larger.  The problem of a short half-life is to some extent overcome by three divided doses/day.  With a half life of 7 hours or more accumulation of about times 2 or more can be expected, but with half-lives of 5 hours or less very little accumulation is produced and may cause interdose withdrawals, especially if tolerance occurs.

I have been unable to find the drug equivalence between benzodiazepines and neurontin for the different therapeutic actions but, I have estimated the value from the anticonvulsant action for neurontin and klonopin.  This value is 1,000 mgs of neurontin is equivalent to about 5 mgs. of klonopin.

From a few reports I've had, patients have been prescribed the anticonvulsant dose of neurontin for benzodiazepine withdrawals.  This is cause for concern because such a dose is equivalent to high levels of klonopin (5-15mgs) and could lead to difficulty in tapering from neurontin.  It would be helpful to have reports of the doses used and any difficulty or otherwise in tapering from neurontin.

Neurontin (Gabapentin)

This information is a summary of that given in about six references including the data sheets published by Parke Davis, the manufacturer of neurontin.

This drug was first marketed in the U.S. in   1981 and in the U.K. in the early 1990's.  It appears that it was marketed after a limited number of controlled clinical trials (a total of only 543 patients) and a series of uncontrolled studies.


For treatment of epileptic convulsions and neuropathic pain.  Some of the studies reported anxiolytic, muscle relaxant, hypnotic, and amnesic actions.


Special procedures are required for diabetics taking neurontin and extreme care if used for patients with renal insufficiency.


As an anticonvulsant - 900 mgs. - 2,400 mgs./day reached gradually over a few days and given in three divided doses/day (U.K.)  Maximum value of 3,600 mgs. (U.S.)

For neuropathic pain - maximum of 1,800 mgs/day reached gradually over a few days given in three divided doses/day (U.K.).  Same dose as for anticonvulsant use (U.S.)

Mechanism of Action

Neurontin is structurally related to GABA. Its mechanism of action is unknown, but it appears to increase GABA turnover in several regions of the brain.

Absorption and Fate

Neurontin is not metabolized by the body, i.e., it does not produce active or inactive metabolites.  It is eliminated solely by renal excretion. For elderly patients and those with renal insufficiency, the elimination half-life is up to 52 hours.  For others it is quoted as 5 - 7 hours.

Adverse Reactions

Drowsiness, dizziness, fatigue, muscle tremor, vision disturbances, indigestion, weight gain, mood changes, hallucinations, decreased kidney function in over 60s, diarrhea, dry mouth, nausea, vomiting, peripheral oedema, anxiety, abnormal gait, amnesia, nystagmus, asthenia, parathesia, abnormal thinking, emotional lability, hyperkinesia, infections (urinary and upper respiratory tract), dysarthria, arthralgia, diplopia, amblyopia, constipation, flatulence, impotence, leucopenia, depression, psychosis, headache, pancreatitis, incontinence, alopecia, allergic reactions, rashes and angioedema, chest pain, palpitations, movement disorders, thrombocytopenia, tinnitus, acute renal failure, purpura, changes in blood pressure, seizures, confusion, impairment of mental alertness, coordination problems, ataxia, coughing, rhinitis, pharyngitis, nervousness, myalgia, back pain, dental abnormalities, puritis, twitching, fever, abdominal pain, confusion, acne, vertigo, decreased or absent reflexes, hostility, variations in blood glucose level.

Dependency Potential and Withdrawal Symptoms

All references warn of avoiding abrupt withdrawal and the use of a tapered withdrawal.  Some references suggest the dependency potential is low, but this generally refers to short-term use and that it can significantly increase with long-term use.

Withdrawal symptoms reported include - anxiety, insomnia, nausea, pain, sweating, vomiting, severe and repeated seizures, ataxia, nystagmus, fatigue and dizziness.

*Subject to the limitation that inter-individual response could vary widely.


Benzodiazepines and Z Drugs

Benzodiazepine drugs and Z drugs are sometimes prescribed for short periods to ease symptoms of anxiety, sleeping difficulty, and sometimes for other reasons. A benzodiazepine or Z drug is not normally advised for more than 2-4 weeks. If you take it for longer, the drug may lose its effect (you may become tolerant to the effect) and you may also become dependent (addicted) to it.

What are benzodiazepines and Z drugs?


Benzodiazepines are a group of drugs that are sometimes used to treat anxiety, sleeping problems and other disorders. Examples include: diazepam (trade name Valium), lorazepam (trade name Ativan), chlordiazepoxide, (trade names Librium and Tropium), alprazolam, clorazepate, oxazepam, temazepam, nitrazepam, flurazepam, loprazolam, lormetazepam, clobazam and clonazepam.

Benzodiazepines work by affecting the way certain brain chemicals (neurotransmitters) transmit messages to certain brain cells. In effect, they decrease the 'excitability' of many brain cells. This has a calming effect on various functions of the brain.

Z drugs

Drugs called zaleplon, zolpidem, and zopiclone are commonly called the 'Z' drugs. Strictly speaking, Z drugs are not benzodiazepines but are another class of drug. However, they act in a similar way to benzodiazepines. (They have a similar effect on the brain cells as benzodiazepines.) Z drugs have similar long-term usage problems as benzodiazapines.

What are benzodiazepines and Z drugs used for?

Benzodiazepines for anxiety

Symptoms of anxiety include: agitation, tension, irritability, palpitations, shakiness, sweating, excess worry, sleeping badly, poor concentration, fast breathing, and sometimes a 'knotted feeling' in the stomach and other muscles. There are various causes of anxiety. Sometimes it is a sudden life crisis such as a bereavement or redundancy. Some people have an anxious personality and feel anxious fairly often. Although most people will feel anxious at some time, sometimes the symptoms become prolonged and distressing. (See separate leaflets called 'Anxiety Disorders', 'Anxiety - A Self Help Guide' and 'Generalised Anxiety Disorder' for details.)

Treatments for anxiety include: learning to relax, anxiety management courses, cognitive therapy, and behaviour therapy. Simply talking things over with a friend, counsellor, or with members of a self-help group may also help. However, if symptoms become severe, you may be advised to take a benzodiazepine drug for a short time.

Benzodiazepines and Z drugs as sleeping tablets

A short course of a benzodiazepine or a Z drug may be prescribed if a drug is felt necessary to help with sleeping difficulty (insomnia). A separate leaflet called 'Sleeping Tablets' gives more details. However, there are other ways of helping to get a good nights sleep. These are described in another leaflet called 'Insomnia (Poor Sleep'.

Other uses of benzodiazepines

A dose of a benzodiazepine is often given as a 'pre-med' to reduce anxiety before an operation. A large dose is commonly given as a sedative during medical procedures that may cause anxiety or discomfort. The drug not only reduces anxiety but also has an amnestic effect. This means that you do not remember much about the procedure. Some benzodiazepines are occasionally used to treat certain types of epilepsy as they can prevent seizures.

How effective are benzodiazepines and Z drugs?

If you are not used to taking benzodiazepines or Z drugs, when you first take one it is usually very good at easing the symptoms of anxiety or at promoting sleep. A benzodiazepine does nothing to remove any underlying cause of anxiety such as a life crisis. However, if your symptoms are eased, you may be able to cope better with any problems.

Benzodiazepines and Z drugs work best in situations where anxiety or sleeping difficulty is expected to last only a short while. They are not so useful if you have an ongoing anxious personality or long term sleeping difficulty. However, a short course may help you over a particularly bad spell.

You can usually stop a benzodiazepine or Z drug without any problems if you take it for just a short period of time (no more than 2-4 weeks).

Why should benzodiazepine and Z drugs be used only for a short time?

When benzodiazepines were first used they were thought to be safe. The problems with their long-term use were not known. In 1981, benzodiazepines were the most commonly prescribed drugs in western countries. It was because benzodiazepines worked so well to ease symptoms of anxiety and poor sleep that many people came back for more. Some people started to take them regularly.

However, it is now known that if you take a benzodiazepine or Z drug for more than 2-4 weeks, you may develop problems (see below). Therefore, most doctors will now only prescribe benzodiazepines and Z drugs for a short period.

What happens if you use a benzodiazepine or Z drug for longer?


If you take a benzodiazepine or Z drug regularly, the helpful effect on easing anxiety or in helping sleep usually lasts for a few weeks. However, after a few weeks, the body and brain often become used to the benzodiazepine or Z drug. The drug then gradually loses its effect. The initial dose then has little effect. You then need a higher dose for it to work. In time, the higher dose does not work, and you need an even higher dose, and so on. This effect is called tolerance.

Dependence (addiction)

There is a good chance that you will become dependent on a benzodiazepine or Z drug if you take it for more than four weeks. This means that withdrawal symptoms occur if the tablets are stopped suddenly. In effect, you need the drug to feel 'normal'. Possible withdrawal symptoms include:

    * Psychological symptoms - such as anxiety, panic attacks, odd sensations, feeling as if you are outside your body, feelings of unreality, or just feeling awful. Rarely, a serious mental breakdown can occur.
    * Physical symptoms such as sweating, unable to sleep, headache, tremor, feeling sick, palpitations, muscle spasms, and being oversensitive to light, sound and touch. Rarely, convulsions occur.
    * In some cases the withdrawal symptoms seem like the original anxiety symptoms.

The duration of withdrawal symptoms varies, but often lasts up to six weeks and sometimes longer. Withdrawal symptoms may not start for two days after stopping the tablet, and tend to be worst in the first week or so. Some people have minor residual withdrawal symptoms for several months.

Therefore, you may end up taking the drug to prevent withdrawal symptoms but, because of tolerance, the drug is no longer helping the original anxiety or sleeping problem. But note: you are unlikely to become dependent on a benzodiazepine or Z drug if you take it for a short period only.

Some other possible problems with benzodiazepines and Z drugs

Even if you take a benzodiazepine or Z drug for a short time, you may feel drowsy during the daytime. Some people, especially older people, are at greater risk of having a fall and injury because of the drowsiness. If you drive, you may be more likely to be involved in a car crash. Some people have described themselves to be in a 'zombie' state when they were taking a benzodiazepine long-term.

For a full list of possible side-effects whilst taking any tablet, read the leaflet that comes with the packet of tablets.

What if I have been taking a benzodiazepine or Z drug for a long time?

If you have been taking a benzodiazepine or Z drug for over four weeks and want to come off it, it is best to discuss the problem with a doctor. Some people can stop taking benzodiazepines or Z drugs with little difficulty. However, many people develop withdrawal symptoms if they suddenly stop taking a benzodiazepine or Z drug. To keep withdrawal effects to a minimum, it is often best to reduce the dose of the drug gradually over a number of weeks or months before finally stopping it. Your doctor will advise on dosages, time scale, etc. There is also another leaflet called 'Stopping Benzodiazepines & Z drugs' which gives details.

EMIS and PIP 2006   Updated: June 2006



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