Taking Xanax - worried about addiction

[Vol Fan]

I'm still taking the Xanax but not every night. Sometimes the symptoms come on early evening and I take one, but some nights it doesn't appear until the middle of the night, awakening me. I'd have to turn on the light and take a pill to get rid of it then, I'd not be able to awaken for work. If I take it, it has to be early enough so I can wake up in the a.m.


I've asked my doctor for a script for a RLS drug, and she prescribed one that starts with an R. After reading the side effects I'm hesitant to try it.

I'm like you Barbee. I take Xanax, but not every night. Partly because my symptoms usually hit me in the middle of the night & I can't take Xanax & be able to wake up early. Xanax doesn't actually put me to sleep, but it allows me to sleep very deeply. Xanax works very well for me, but truth to tell, I'm scared to death to take it very often. For fear of addiction. I know of people who became addicted to it & so I usually will only take it no more than twice a week and suffer the remainder.

I tried Requip, but had to stop taking it due to side effects.

I'm still on the look-out for something I can take during work day/nights that allows me to function well early the next morning.

Regular sleeping aids like Ambien, Tylenol PM etc., don't work for me, because I still will wake up with RLS & that is miserable! You awaken, drugged/sleepy/woozy & can't lie down.

P.S. Newby to the board!! I have fought RLS since I was a teenager. I have been able to find some relief over the years. Iron pills when I was low on iron. Soap in the bed worked for awhile. Requip for a short period. Xanax most definitely. But all the things that helped me once, never were a permanent fix. And it seems the older I get, the worse I have RLS now. I am thankful to have found this board and hear other stories & try some of other's remedies.

[Neco]

Tylenol PM is baaaaaad stuff.

It contains diphenhydramine, one of the worst anticholinergics (allergy medication in this case) you can take. In normal people it will make them a little drowsey and help them sleep.. But for us its the reverse. I found out the hard way many years ago as well.

If you can't tolerate Requip, you could still try Mirapex, Lyrica, or Neurontin. All have drowsiness issues in some people though. After that your only real option is something like a long-acting opiate. Instead of a normal large dose at once, multiple times a day, you'll get a slow release over a 12 hour (usually) period. You come up and come back down (if you feel it at all, depending on tolerance) very gently and I personally think this leads to less risk of habbit forming behavior.

[Vol Fan]

Tylenol PM is baaaaaad stuff.

It contains diphenhydramine, one of the worst anticholinergics (allergy medication in this case) you can take. In normal people it will make them a little drowsey and help them sleep.. But for us its the reverse. I found out the hard way many years ago as well.

If you can't tolerate Requip, you could still try Mirapex, Lyrica, or Neurontin. All have drowsiness issues in some people though. After that your only real option is something like a long-acting opiate. Instead of a normal large dose at once, multiple times a day, you'll get a slow release over a 12 hour (usually) period. You come up and come back down (if you feel it at all, depending on tolerance) very gently and I personally think this leads to less risk of habbit forming behavior.

So THAT'S why Tylenol PM (& the like) & even Nyquil has the absolute opposite effect with me! I never knew that. Those type of medicines have always kept me awake, jittery & wired, instead of making me sleepy. Thanks to you, now I understand why. Thank you!

After my bad experience with Requip, I had been afraid to try other medicines. My dr. had said that before these came out, people used Xanax and that is why we tried that route. And Xanax works wonderfully for me. I'm just scared to use it often. LOL

Can you give me an example of the kinds of opiates you are describing?

[Neco]

Well just make sure you explain this fear to your doctor, and ask if there is anything else she's willing to give you, that you can alternate (but are NOT in the same family, as it won't help your tolerance at all). In this case opiates are a good choice. Tramadol is also worth trying, it is not a controlled substance, but has opiate-like effects and binds to some of the same receptors. It also has anti-depressive properties in some people, but should NOT be taken with antidepressants, or other drugs that may lower the seizure threshold.

Check out the Mayo Algorithm link, in my signature. Perhaps you and your doctor will find some answers in there

[Vol Fan]

Well just make sure you explain this fear to your doctor, and ask if there is anything else she's willing to give you, that you can alternate (but are NOT in the same family, as it won't help your tolerance at all). In this case opiates are a good choice. Tramadol is also worth trying, it is not a controlled substance, but has opiate-like effects and binds to some of the same receptors. It also has anti-depressive properties in some people, but should NOT be taken with antidepressants, or other drugs that may lower the seizure threshold.

Thanks Zack! I will be sure & talk to her about this!

[mackjergens]

please read as much about rls as possible.
www.rlshelp.org
www.rls.org
www.wemove.org
and many more web sites with great rls info.

I have copied/pasted this info from www.rlshelp.org to help you with meds/foods known to make rls worse. Print this out and keep it with you at all times, so when you go to a Dr for a cold/flu or what ever you can ck this list and make sure you are not given a med that will make your rls worse

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(6) Drugs and Foods to avoid to improve RLS
This section will discuss various drugs and foods that may worsen RLS. Things that cause worsening of RLS in some patients may not bother others in the same way; in fact, others may even be helped by these same medications or foods that worsen others. Please free to email us with any foods or drugs that worsen your RLS problems. Keeping a diary or log of foods, medications taken and worsening of RLS may also be helpful to determine what might be affecting you.

Ice Cream
Some patients have found that ice cream (all flavors) cause worsening of RLS. Avoiding this food eliminates significant RLS worsening, especially in patients who eat a lot of ice cream. The cause of this relationship is unknown. For a possible explanation of why ice cream may exacerbate RLS, click here for a discussion of avoiding Mono and Diglycerides to help RLS.

Caffeine
Drugs and foods containing caffeine are very common. Coffee, tea, and colas are all commonly known beverages which contain significant amounts of caffeine and can cause worsening of RLS symptoms. Chocolate can also contains caffeine.

Many medications use caffeine in their formulation, especially pain pills, so you much check them out one by one. Some common medications with caffeine include: Cafergot, Darvon, Esgic, Exedrin, Fioricet, Fiorinal, Migralam, Norgesic, Wigraine, Anolaor, Butalbital, Femcet, Medigesic, Pacaps, Repan, and Synalgos-DC.

Antihistamines
These include the common allergy and cold remedies, most of which are available over the counter. Examples are Actifed, Benadryl, Chlortrimeton, Comtrex, Contact, Corcidin, Dimetapp, Drixoral, PediaCare, Sinutab, Tavist, TheraFlu, Triaminic, Tylenol (flu, cold, PM, allergy), Vicks. Note that many cough syrups may contain antihistamines, especially if they are recommended for cold or flu symptoms.

The newer, non-sedating antihistamines, Allegra, Zyrtec and Claritin are generally better (and some RLS patients can take these without problems), but can be just as bad as the over the counter medications.

Antidepressants
The tricyclic and serotonin uptake inhibitors (see Antidepressant Medication section above) can cause significant worsening of RLS problems. Paradoxically, some patients have noted marked improvement while on these medications, making it harder to understand why some patients worsen and others improve.

Antinauseants
Medications to treat nausea can worsen RLS symptoms. This class of drugs includes: Anitvert, Atarax, Benadryl, Bonine, Compazine, Phenergan, Thorazine, Tigan, Trilafon and Vistaril.

There is an antinausea medication only available in Canada and Mexico called Domperidone (available over the counter as Motilium 10 in Mexico) , which does not cause worsening of RLS symptoms. This can be obtained by Americans over the internet from Canadian pharmacies (example is canadameds.com or www.canadapharmacy.com) with a valid prescription from an American medical doctor.

Reglan (metoclopramide) is an anti-nausea agent that is also used to prevent reflux and has significant anti-dopamine activity, so it should be avoided.

There are two newer anti-nausea medications available in t he USA, Kytril (granisetron hydrochloride) and Zofran (ondansetron hydrochloride) which do not affect the dopamine system and thus should be safe for RLS. The only problem with these medications are that they are very expensive.

Cough syrups
Most OTC cough syrups are fine to use for RLS patients if they are just simple cough medications (like regular Robitussin which contains dextromethorphan and guaifenesin). When they are combination preparations (also good for colds, flu, etc.) they likely contain antihistamines which as noted above, worsens RLS. So, check the ingredients carefully before you buy any cough medication (OTC) as they may contain harmful ingredients.

The prescription cough syrups usually contain a narcotic (codeine or hydrocodone). The most common one prescribed is Phenergan with codeine, which contains the anti-nausea agent phenergan which usually worsens RLS. It is countered by the presence of a small dose of codeine, but this may not be enough to cover the RLS worsening effects of the phenergan. Tussionex is an example of the hydrocodone containing syrups. It is combined with chlorpheniramine, a potent RLS worsening antihistamine, but the hydrocodone is at a high dose of 10 mg which usually will overcome any worsening effects of the chlorpheniramine. Hycomine is similar to Tussionex but Hycotuss does not contain any RLS worsening medications so it may be a better choice.

Antipsychotic medications
Many of these drugs are similar chemically to the anti-nauseants (in fact many are used as anti-nauseants). They can worsen RLS just like the antinausea drugs. This class of drugs includes: Clozaril, Compazine, Haldol, Loxitane, Mellaril, Moban, Navane, Prolixin, Risperdal, Zyprexa, Serentil, Stelazine, Thorazine, and Trilafon. Also, lithium, a drug which is very helpful in the manic-depressive disorders, can worsen RLS.

Bladder Control drugs
We have gotten some case reports of worsening RLS with drugs such as Ditropan. These drugs should thus be used with caution in RLS sufferers.

Alcohol
Alcohol had been found by many RLS sufferers to cause worsening of their RLS. The amount that does this can be very small in some cases. Individual tolerance can vary considerably (many may not be bothered at all).

(7) Pregnancy and RLS
Pregnancy can cause a worsening of RLS (in at least 50% of patients who have RLS and become pregnant) or be the first time that a patient experiences RLS symptoms. It usually occurs in the third trimester and has been reported in up to 12% of all pregnancies. 10% of women will have their first experience with RLS during pregnancy. The RLS symptoms will usually go away after the pregnancy, then often come back later in life. Various problems such as iron or folate deficiency have been postulated as causes, but the real reason why RLS worsens with pregnancy is unknown.

If the symptoms are severe enough to warrant drug therapy, then the sedative category of medication has been used for treatment (with the approval of the patient's obstetrician). Many RLS specialists will prescribe the opioid category of medication during pregnancy, due to their safety in pregnancy.

The risk of RLS medication in pregnancy is as follows (Category A,B,C,D,X, where A is the best and X is the worst and should never be taken during pregnancy; Category A drugs are quite safe and have a proven track record in pregnancy, Category B drugs have limited data and experience and should be used only if clearly needed, Category C drugs generally have no adequate or well controlled studies in pregnant women and should be used only if the potential benefit justifies the potential risk to the fetus):

Pregnancy Risk Category
Drug Name

A
None

B
Pergolide (but limited data), Ambien, Percodan (short term use), Dostinex, Ambien, methadone (low dose), Percocet, Percodan, OxyContin

C
Mirapex, Requip, Sinemet, Ultram, Darvon (short term use), codeine (short term use), Vicodin or Lortab (for short term use), Sonata, Lunesta, Tegretol, Neurontin, Catapress

D
Xanax, Klonopin (and most benzodiazepine sedatives),
Darvon, codeine, Vicodin, Percodan, all for long term use, methadone (higher doses)

X
Restoril






Pregnant women should be checked for anemia and proper iron supplementation as indicated. Magnesium (used for treatment of toxemia of pregnancy) has recently been looked at for treating RLS, but this is only in the preliminary stages.

Nursing mothers can be treated with Darvocet (Darvon). Small levels of this drug will get into the breast milk, but no adverse effects have been noted in the infants getting the breast milk. Sedatives do get into the breast milk and can cause lethargy in the infants, so this class of medication should be avoided in nursing mothers. Dopamine agents may decrease lactation (milk production).

For more information on the risks of drugs in pregnancy or with breast feeding check out Motherisk Program or the Organization of Teratology.

(8) Quinine
This drug rarely (less than 5%) helps RLS and is only included on this page to help avoid RLS sufferers from receiving this drug for their disorder. It is probably one of the most common drugs prescribed by doctors unfamiliar with RLS when they hear the RLS complaints of their patients. This inappropriate treatment occurs because the RLS symptoms are confused with leg cramps for which quinine is the correct treatment.

We have received several reports from RLS sufferers that quinine has helped them, but we cannot be sure whether they have RLS and leg cramps, or in fact only leg cramps. I have treated several patients who definitely had RLS and found that quinine helped (sometimes very significantly) their RLS, but this is still a very small minority of RLS sufferers. As with many of the treatments above, some remedies seem to help only a few RLS patients and therefore cannot be recommended to the majority.

(9) Other RLS Information and Associations
Summer RLS
Many patients have found that there is a seasonal variation in their RLS. They do fairly well for most of the year, then start to have worsening of their RLS symptoms in the late spring or early summer. This generally will occur with a change in the weather to hotter and more humid. There is of course, no understanding of why this phenomenon occurs.

The treatment of this increased RLS in the summer is to increased the dose of current medication. If that does not suffice, then addition of other classes of medications may be necessary until the fall months.

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There is so much more info about rls on this website. The more educated you are about rls the better help you will be able to find for yourself.

[Wayne]

Wayne--

Glad you have something that works for you. If you're comfortable with your one-a-day schedule, I wouldn't expect you to develop a significant tolerance. Xanax comes and goes the quickest of all of the benzos, so with one dose a day you're probably avoiding the extended/continuous exposure that causes the body to adjust and develop tolerance.

Just as an aside, in case it's ever useful to you or anyone else reading:

If you ever find in the future that your RLS increases and the Xanax doesn't get you through the night, you could talk to your doctor about similar benzos that have longer half-lives. I would recommend that instead of taking additional Xanax, which is usually someone's first impulse. For instance, Klonipin (clonazepam) is a common alternative benzo that is often prescribed to RLS patients. Though it lasts much longer, most people still seem to find they can take it the way you take your Xanax and not develop too much tolerance.

But, right now, if it works, don't mess with it.

Replying to an old thread here, but found this in a search and it seemed appropriate.

My neuro put me on 0.5 mg of clonazepam at bedtime last month to replace the 0.5 xanax I had been using for so long. The Xanax hadn't stopped working, my neuro thought this might work better. It seems to be a little better in that I tend to sleep a little bit longer and it's harder to get up in the morning (on those mornings that I have to wake up for work, which is as it should be in my opinion as this is how I remember my mornings pre-RLS)

Haven't experienced the general all day grogginess or lethargy that others have described on clonazepam, or is that found in higher more frequent doses. Or maybe the longer I take it?

[badnights]

I get unusual daytime sleepiness after 2 or 3 nights of 0.25 clonazepam. It's bad for me. I don't use it unless I absolutely need to sleep, have nothing else, and can sacrifice the next day.

It has a 40-hour half life, so the amount in your system is going to continually increase if you take it every 24 hours. Some people have used it happily for years, but others (like me) become the walking dead.

[Andreadrea]

People have different reactions to the different benzodiazepines. It could be that your taking the Xanax previously could have raised your tolerance to that drug class, resulting in less daytime grogginess.

[ViewsAskew]

Ditto to Andrea. Some people do very well on Clonazepam. Others, like Beth and me, seem to be strongly affected by it. I wasn't functional the entire time I took it.