Dr. Ashok Kumar
Geriatrics
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
For a long time, I have been using the tablet Etizolam for my sleep. My doctor prescribed me tablet Etizolam 0.25 mg and tablet Paxil 12.5 mg at night for sleeping purposes. I have been on it for a longer time and managed to do it very well. So last year, I was able to get rid of my medicines and sleep normally. However, last month, I was not able to sleep even after taking medicines one day, and from there, I got huge anxiety that the medicines that worked for me were not working, and I got an unresolved sleep issue from there. So after that, there were some good episodes in which I could sleep. However, last night I had a major panic issue in which I realized I could not sleep, which led to me eating the tablet Etizolam 0.5 mg instead of 0.25 mg in the middle of the night while I was panicking. However, that led to very low sleep or no sleep at all, which further exacerbated my anxiety that the tablet Etizolam, which used to work for me, was not working. So I contacted my psychiatrist, and he said taking a tablet Etizolam in the middle of the night while panicking will not likely work and advised me to take a tablet Zapiz 0.5 mg instead of taking a tablet Etizolam in circumstances when I want to take medicine in the middle of the night.
Doctor, I want to ask you whether I have a situation the tablet Etizolam is not really working for me for the sleep or I am panicking endlessly because taking tablet Etizolam 0.5 mg in the middle of a panic episode hinders its effectiveness. Instead, I would be better off taking tablet Etizolam in the beginning while going to sleep or tablet Zapis in the middle of the night. Furthermore, I fear that if tablet Etizolam stops working, there is a likely situation where the other medicine would really not work for me like tablet Zolpidem as I have heard cases for many people except tablet Etizolam, nothing usually works. So I am now terrified that I will not be able to get out of this situation and somewhat feel hopeless.
Please help me, doctor.
Thank you.
Hi,
Welcome to icliniq.com.
I read your query and can understand your concern.
First of all, I like to inform you that the non-working of the tablet Etizolam on one day does not indicate Etizolam stopped working or that other medicines will not work. Both the assumptions are overgeneralized, which is common with anxiety disorders, particularly generalized anxiety disorder. Tablet Etizolam has an activity profile. Tablet Etizolam is one of the medications that act fast compared to other medications, and that is why it is often prescribed early in the course of treatment. Your doctor's suggestion that tablet Zapiz (Clonazepam) might work faster is partly true. For some patients, it acts more quickly when compared to tablet Etizolam, but this may not be true for all the patients using Benzodiazepines. I also like to inform you that tablet Zapiz (Clonazepam) and tablet Etizolam are for short-term use and may be stopped in due course of time. However, medications such as tablet Paxil (Paroxetine), tablet Zoloft (Sertraline), tablet Pristiq (Desvenlafaxine), and tablet Prozac (Fluoxetine), among others, are for long term use and may be needed for long term basis to stop anxiety from interfering in your life.
If you and your doctor are comfortable with tablet Paroxetine, the dose can be increased to 25 mg a day as the effective dose for most subjects lies between 20 to 60 mg per day. The current dose of 12.5 mg may be inadequate for you, resulting in an increased dose of tablet Etizolam on some or other day.
I hope this helps you.
Thanks and regards.
Patient's Query
Hi doctor,
Thank you for the prompt reply.
As discussed, I would talk with the psychiatrist to discuss the medications for the next visit. Also, I can understand I am trying to form a pattern because of my anxiety. Also, thank you for allowing me to ask a couple more questions.
1) What is the best time to take tablet Etizolam? I am trying hard not to find the pattern here, but it is bothering me to take tablet Etizolam in the middle of the night when I am already panicked, and I wonder if it might not be really useful for me. Is it any truth to the claim? For instance, would it be best to take tablet Etizolam alongside tablet Paxil which I take about an hour before my sleep? I am taking tablet Etizolam only when it is necessary. However, does taking the tablet Etizolam when you have some trouble sleeping and are somewhat in an arousal state work make sense? Is 0.5 mg tablet Etizolam appropriate, or might I require more?
2) As I said after my recent episode, I am having serious anticipatory anxiety in day-to-day life regarding my sleep. I know this is worse on some days and manageable at other times. I am only thinking about sleep mostly now. I would also ask my primary psychiatrist. However, currently, the thoughts are troubling me daily, and the solution I was able to find is not to think about this and treat it every day like it is a last (box approach), but it is hard for me to do. Should I take some antianxiety medicines after consulting with my primary psychiatrist to manage this anxiety? However, I then would worry about its effectiveness at night.
My Current Medication, as I told is tablet Paxil 12.5 mg and tablet Etizolam 0.5 mg, which I am currently taking at night.
Thank you, doctor.
Hi,
Welcome back to icliniq.com.
Regarding your first question, Etizolam can be taken on a need basis. Make sure it is a mouth dissolving format when you use it on a need basis. If you have anxiety symptoms that are affecting your life significantly, the tablet Etizolam can be used. Also, make sure to report the total use in a specified time so your doctor can modify the prescription. Suppose 0.5 mg of tablet Etizolam does not work for you. In that case, it is time to change the medication to either tablet Clonazepam, Lorazepam, or Alprazolam by consulting your doctor.
Regarding your second question, I feel the dose of primary medicine needs to change. It may be a tablet Paroxetine 25 mg. In addition, for a few days, say one or two weeks, the tablet Etizolam can be used regularly, and then it can be shifted back to a need basis (consult with a specialist doctor, talk with him or her, and take medicine with their consent).
I hope this helps you further.
Thanks again.
Patient's Query
Thank you doctor for the reply,
I am still having trouble getting hold of my primary psychiatrist, so I need to direct some questions if possible. A couple of days ago, I had an uneventful night during which I took 0.5 mg of Etizolam in the middle of the night. I remember being relaxed the whole night; however, the expected sleep or sedation never came. Is this a sign of Etizolam tolerance or an indication that I may need to increase the dose or switch medications? While I had a fine night after the past couple of days, I am not really relaxed, and my anxiety is not under control. Mostly because the combination of Paroxetine and Etizolam 0.5 mg, which worked for me before, is not working anymore. This is fueling my anxiety disorder, as I realize I do not have anything for now in case my sleep goes awry.
My psychiatrist has given me options to either switch the drug to Clonazepam or increase the dosage of Etizolam. However, my mind is still not ready to determine whether 0.5 mg is not working for me anymore for sedation or if it is because of general anxiety. Furthermore, I am really worried about the long-term usage of Clonazepam now.
Please help. Thank you.
Hello,
Welcome back to icliniq.com.
In regard to your first question, I feel that none of your assumptions are correct, and none of them are false. For example, on some occasions, we may have a partial response, but the other one may be missing, as in your case where anxiety was well controlled but sleep was not induced. This may indicate that Etizolam is good for the control of anxiety but may not be a suitable option for promoting sleep. An alternative explanation for the observed phenomenon could be that you had a panic attack on that eventful night, for which Etizolam is not a great option. To avoid such circumstances in the future, I suggest considering Lorazepam 1 mg or Clonazepam 0.5 mg for midnight crises if a similar situation arises.
In regard to your second question, I feel there is a need to increase the dose of Paroxetine. The usual effective dose of Paroxetine for most individuals varies between 20 to 60 mg per day, and it is possible that you are using a dose of Paroxetine that is below the effective range. With an increase in Paroxetine, you may feel less need for Etizolam or Clonazepam, as these medications are helpful in urgent situations, while Paroxetine controls anxiety more comprehensively. I believe my second answer sufficiently addresses your third question. I am not convinced about increasing the dose of either Etizolam or Clonazepam but feel that increasing the dose of an SSRI (selective serotonin reuptake inhibitors) may be more rewarding in the long term.
I hope this answers you. Feel free to write back to me if you have more questions.
Thank you.
Patient's Query
Thank you doctor for the reply,
I have been doing well since our last consultation. My psychiatrist switched my medication, and it worked wonders for my daily anxiety. Currently, I am taking 75 mg of Clomipramine, 25 mg of Quetiapine, 12.5 mg of Paroxetine, and 0.25 mg of Etizolam, all at night. I tapered the Clomipramine from 100 mg to 75 mg, while the rest I am taking as prescribed without increasing the dosage, and I am experiencing minimal side effects. So far, I feel fine; however, I am concerned if the medications are too much and whether they have become too dangerous or habit-forming, considering I have been taking them for two and half months now. I am scheduled to meet with my psychiatrist next week.
Please help. Thank you.
Hello,
Welcome back to icliniq.com.
The most important thing in managing anxiety disorders is regular follow-up with your doctor, and there is no such thing as taking too many medications. The number and dosage of medications depend heavily on your medical condition, and your doctor is the right person to suggest a decrease in dosage when appropriate. Therefore, follow your doctor's advice, meet as advised, and discuss the possibility of lowering the dosage if deemed suitable.
I hope your queries are resolved, and any further queries are welcome. Thank you.
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Geriatrics
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