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View Full Version : Withdrawal comfort drugs... give b-blockers a try



resorcinol
11-08-2008, 05:04 PM
In recent threads I mentioned that clonidine alone or benzos alone didn't help me with my w/d symptoms very much. The combination did end up helping me, but I found out, as I'm sure many of you already know, that clonidine has pretty nasty side effects. For me, the worst one was feeling totally "wiped out" and listless, which worsens the feeling of exhaustion that is already present in opioid withdrawal.

I ended up trying propranolol in combination with benzos, and it worked equally as well as clonidine in combo with benzos without that "wiped out" feeling.

Propranolol really helps with the body restlessness by calming the sympathetic nervous system.

if you have access to this drug and are in w/d, give it a try in combo with your benzo of choice. 10 to 30 mg is the effective dose.

It's no panacea either, but I've found it's a better choice than clonidine for calming the sympatheic nervous system overactivity since it only acts peripherally and not centrally (meaning no exhaustion side effect). Again though, it only helps me in combination with some clonazepam or oxazepam.

Also note that some beta blockers are preferable for calming the RLS and akathisia than others. Atenolol, for example, is cardioselective, and won't help nearly as much as propranolol which is a nonselective beta blocker.

W/d symptoms that are associated with overactivity of the SNS include RLS / akathisia, chills, goosebumps, and temperature flashes. In combo with a benzo to take care of the anxiety, this drug cocktail can really have you feeling more comfortable.

Remember not to overdo the b-blockers though, as you don't want to lower your BP too much. I'd stay under 50 mg propranolol in a day.

SeVeN
11-08-2008, 05:16 PM
Odd u brought this up. I was recently considering beta blockers for anxiety. Also remember beta blockers can have seriously adverse effects when mixed with other drugs like alcohol.

Hoss
11-08-2008, 06:31 PM
Also note that some beta blockers are preferable for calming the RLS and akathisia than others. Atenolol, for example, is cardioselective, and won't help nearly as much as propranolol which is a nonselective beta blocker.

W/d symptoms that are associated with overactivity of the SNS include RLS / akathisia, chills, goosebumps, and temperature flashes. In combo with a benzo to take care of the anxiety, this drug cocktail can really have you feeling more comfortable.

Man, can I relate to this! During my recent escapade getting my ass back on Bup, I have gone through a 2 week quest in an attempt to feel normal again, with the Bup getting stabilized in my system. I was able to attain some Atenolol, and it really didn't help out with what I was going through at all, which was essentially SNS overactivity as aforementioned. Every symptom of such that you mentioned was exactly what I was going through, heavy, in addition to other WD/WD-like symptoms as well, but the SNS overactivity was definitely a pain in the ass, and was the most prevalent.

Very nice post, though, and in the past I have been able to take other Beta-Blockers with positive results whilst in the grip of opiate withdrawal.

Thebane
11-08-2008, 08:06 PM
Interesting, I have a running script of propranolol (not for withdrawals), and I always take it in withdrawals because I saw it was related to clonidine and it just seemed to help me when I took my normal daily dose and happened to be sick.

I do think taking 30-40mg of propranolol + 1-1.5mg of clonidine might have made the crawling skin feeling worse when I laid down to sleep at night. And I think I read somewhere that's a sign of too low of a bp, which obviously makes sense it would be a problem taking 2 bp-lowering medications (it even says in the clonidine information not to take beta-blockers without asking a pharmacist, but I asked mine and he said it was definitely fine for a short time at normal doses). But I can take 70-80mg of propranolol alone (well or sick) and feel perfectly normal, so I wouldn't worry too much about overdoing it in withdrawals since your bp is going to be elevated to start with.

resorcinol
11-08-2008, 11:04 PM
Interesting, I have a running script of propranolol (not for withdrawals), and I always take it in withdrawals because I saw it was related to clonidine and it just seemed to help me when I took my normal daily dose and happened to be sick.

I do think taking 30-40mg of propranolol + 1-1.5mg of clonidine might have made the crawling skin feeling worse when I laid down to sleep at night. And I think I read somewhere that's a sign of too low of a bp, which obviously makes sense it would be a problem taking 2 bp-lowering medications (it even says in the clonidine information not to take beta-blockers without asking a pharmacist, but I asked mine and he said it was definitely fine for a short time at normal doses). But I can take 70-80mg of propranolol alone (well or sick) and feel perfectly normal, so I wouldn't worry too much about overdoing it in withdrawals since your bp is going to be elevated to start with.

I'd agree with you that higher doses than those I stated are probably safe in w/d, since blood pressure is indeed elevated in w/d. I was erring a bit on the cautious side since I don't want to feel responsible for something bad happening to somebody who tries propranolol in w/d on my suggestion. It is true though that in people who use it for its intended purpose, hypertension, 100 mg doses or more are not uncommon.

I honestly find propranolol equally effective as a benzo add on as clonidine, but without the clonidine exhaustion. Clonidine is also not so good for me since it blocks my antidepressant's (remeron's) mech of action for a few half lives. Beta blockers only act peripherally to calm the SNS so they don't effect my remeron.

And I find beta blockers just as effective at calming SNS overactivity symptoms of withdrawal as clonidine. Keep in mind these are both combined with benzos... without benzos, I find clonidine and beta blockers both totally useless. Likewise, I find benzos alone useless. It's the combination that actually makes things noticeably easier to deal with.

The combo of a nonselective beta blocker like propranolol, a potent benzodiazepine, and loperamide, is the best w/d comfort combo i've found so far.

Remember, if you try this, you want a nonselective b blocker like propranolol, nadolol, or tilisolol preferably. Cardioselective ones like atenolol won't be anywhere near as effective.

It would be tough to get a hold of, but I'd image a combination, nonselective, beta and alpha blocker, would be the best of all. These drugs antagonize all of the peripheral epinephrine and norepinephrine receptors and may be the best of all at blocking the SNS related opioid w/d symptoms. You'd have to be careful with these though, as an overdose could basically shut your cardiovascular system down.

Narkotikon
11-09-2008, 08:07 PM
Yeah, I've been scripted this stuff (propranolol) before for anxiety, and have also used it in w/d too. You're right, it's sort of similar to Clonidine, but it doesn't give you that tired / no energy feeling. Although I don't think it helps nearly as much as a benzo would. My only other complaint with propranolol for anxiety (in w/d or not in w/d) is that I sort of become tolerant to it, and after about a week of use, it really doesn't help anymore. But, on the upside, it is fairly easy to get. Unlike benzos, it's non-addictive. Just don't take too much, because you don't want to faint or pass out from lowering your blood pressure too much. I imagine the combo of it and a benzo would work better than it alone. Maybe adding a benzo to it would make the propranolol itself work longer too? I don't know. I just know that if I take it everyday for anxiety or w/d, that it really doesn't do much after about seven days of use. I usually take 20mg at a time. The initial dose is (I think) 10mg if I remember correctly.

resorcinol
11-09-2008, 10:55 PM
Yeah, I've been scripted this stuff (propranolol) before for anxiety, and have also used it in w/d too. You're right, it's sort of similar to Clonidine, but it doesn't give you that tired / no energy feeling. Although I don't think it helps nearly as much as a benzo would. My only other complaint with propranolol for anxiety (in w/d or not in w/d) is that I sort of become tolerant to it, and after about a week of use, it really doesn't help anymore. But, on the upside, it is fairly easy to get. Unlike benzos, it's non-addictive. Just don't take too much, because you don't want to faint or pass out from lowering your blood pressure too much. I imagine the combo of it and a benzo would work better than it alone. Maybe adding a benzo to it would make the propranolol itself work longer too? I don't know. I just know that if I take it everyday for anxiety or w/d, that it really doesn't do much after about seven days of use. I usually take 20mg at a time. The initial dose is (I think) 10mg if I remember correctly.

Yep, starting dose is 10 mg for propranolol pills.

I find 30 mg propranolol plus 2 mg clonazepam with optional 10 mg loperamide to be the best ever withdrawal help combo.

Tea Time
11-13-2008, 03:07 PM
You are definitely right Resorcinol! Another thing to try if clonidine doesn't work well for you is tizanidine. It is classified as a muscle relaxant but it works similarly to clonidine and other related meds. It worked amazingly well for me while in severe opiate wd's.

resorcinol
11-13-2008, 07:35 PM
You are definitely right Resorcinol! Another thing to try if clonidine doesn't work well for you is tizanidine. It is classified as a muscle relaxant but it works similarly to clonidine and other related meds. It worked amazingly well for me while in severe opiate wd's.

Hmm, cool stuff. I just looked it up (the tizanidine) and it looks like it has the same mechanism of action as clonidine, but a weaker affinity at the receptor and potency by weight. Might be great for people who find clonidine very helpful for withdrawal but very difficult to deal with on the side effects front. Thanks for bringing up another drug to the discussion that might help someone.

I've realized that I've gotta avoid all drugs that have clonidine's mechanism of action (CNS presynaptic a2 agonists). Unfortunately, they're not selective for the parts of the brain they agonize presynaptic a2 autoreceptors in (ideally for w/d and plain old hypertension too only presynaptic a2 in the locus ceruleus would be activated since the LC is the brain's control center for the SNS). These drugs are agonists at presynaptic a2 receptors at all locations where they're expressed in the CNS. What they do (drugs like clonidine and tizanidine) is trick the brain into thinking there's more epinephrine and norepinephrine circulating in the synapses of the CNS and SNS than there really is by acting as agonists at the a2 autoreceptors that sense levels of these catecholamines.

I take the antidepressant remeron. It works by exerting the exact OPPOSITE mechanism of action. It increases norepinephrine release by acting as an ANTagonist at these presynaptic a2 receptors. It acts on serotonin by being a direct agonist of several post synaptic 5HT receptor subtypes (except 5ht2a, where it's an antagonist and not an agonist. Sucks if I ever wanna trip on shrooms or acid. I'd need a bigger dose than everyone else to overcome the remeron block). Basically, clonidine and drugs like it have the unwanted effect of blocking half of the effects of my antidepressant. Not good, since remeron has actually helped me better than any SSRI or SNRI.

So instead of slowing down the sympathetic nervous system by tinkering with its central nervous system control centers, I've gotta opt to slow it down by blocking the receptors that epinephrine activates... and epinephrine's agonism at its receptors in the SNS causes the nasty w/d feelings of temp flashes, goosebumps, sweating, and RLS.

So propranolol it is for moi, to block sympathetic nervous system nastiness in w/d. My shrink gave me propranolol over clonidine because of the contradiction with my remeron.

I'm not sure why clonidine is normally given over propranolol. The end result seems about the same....

Morgulon
10-13-2011, 04:04 PM
Gabapentin w/ flexeril is what I take while w/ding, and although I wouldn't mind a benzo or some tizanidine to take regularly as well, what I've got works pretty darn well. The gaba both gets me kinda 'high' and more capable of dealing with life, as well as making me feel better, and the flexeril makes it so I can sleep. I've tried the propranalol but it didn't help. Next time I have a benzo as well I'll try both

ausativa
10-13-2011, 04:15 PM
3 year old thread... fail

ouaisOut
10-14-2011, 02:33 AM
On the contrary as to the usefulness of bumping a 3-yr-old thread, I've recently been using propanolol for w/ds and was extremely pleased to read others' experiences with it.

I've had great success combining it with the regular comfort meds and since I REALLY sweat during w/d, it's been a godsend for that symptom.

Unbalanced
12-17-2012, 02:31 AM
Out of curiosity does Metoprolol work as good as propanolol or is it one of those that doesn't do much in aiding opioidswithdrawals ?

LorTabitha
12-17-2012, 02:45 AM
you might want to make a new thread since most folks who posted in this thread haven't been around in a couple years or more.