4. Benzodiazepines

General Considerations

Benzodiazepines are a class of drugs that enhance the effects of the neurotransmitter GABA, producing sedative, hypnotic, anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxing effects. These drugs have been a factor in several fatalities temporally associated with ibogaine administration due to the onset of seizures related to withdrawals (Alper 2012).
Ibogaine has been shown to have no effect on the GABAnergic system (Popik 1998), and does not reduce withdrawal symptoms from benzodiazepines. In fact, hERG channel blockage, or syncopic episodes caused by QT prolongation can increase the likelihood of the onset of seizures in general.

Benzodiazepines may dull some of ibogaine’s psychoactive and psychologically therapeutic effects. This should be considered, especially in the case of non-benzodiazepine dependent patients. However, no other negative interactions are noted, and use should be continued throughout treatment to avoid withdrawals.  This effect can be a hindrance to the therapeutic process, but risks and benefits should be weighed accordingly. This effect can be beneficial in cases of overwhelming effects or prolonged insomnia.

If a patient is tolerant of a very high dose of benzodiazepines, or if questions arise about the accuracy of a patient’s reported dose (some users have been known to develop amnesia about the quantity and frequency of their dosage), this should be considered a high risk factor and the patient should be considered a poor candidate unless their use can be stabilized.
Preparation

Under no circumstances should benzodiazepine dependent patients be directed to stop benzodiazepine use before or during treatment. It is suggested that, if necessary, a long-term medically supervised taper be completed prior to intake, or conducted after discharge.

During Treatment

If patients are taking short-acting benzodiazepines, they should be switched onto a longer-acting benzodiazepine, such as oral diazepam or clonazepam, prior to arrival in order to avoid peaks and valleys of anxiety and withdrawal symptoms during treatment.

The Ashton Manual, and other sources, provide a clinical protocols for facilitating benzodiazepine detoxification, as well as for calculating half-lives and equivalent doses of different benzodiazepines.

It is usually possible to observe withdrawal symptoms from short acting benzodiazepines within 24-72 hours. As mentioned, if there are questions about the accuracy of a benzodiazepine dependent patients dosage, an observation period of 72 hours should be observed. In the case of longer-acting benzodiazepines, withdrawal symptoms may not be visible for up to 3 weeks. Patients should be considered a candidate only if the dose is justifiably stable.

In cases where patient is not alcohol or benzo-dependent, or benzo-naïve, use short acting benzodiazepines such as alprazolam.
Also it is important to note that if administering benzodiazepines as a sleep aid to benzo-naïve patients, note that a very small percentage may experience a mild waking dream state.

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