Beta Blockers.

[banglassie]

So, a year or so ago I asked about gabapentine here and got a lot of good help. Since then my nerve pain has become better as has my RLS, so I've quit all medicines that may give bad withdrawals.

However, I still suffer from sporadic anxiety and insomnia. Non of them is too bad and in most situations I can handle it quite well. But there are days when need to relax before bed time, or I truly need to stay calm while working. So I've been looking around for anything that is not a gaba-A or gaba-B drug but still will have a calming effect.

It seems beta blockers are perfect for this. I.e. propranolol, clonidine etc.

So, are any beta blockers sold OTC here? And if so, which one and under what brand names? Generic?

I've also heard that Rozerem is supposed to be quite a good alternative to get sleepy. Is that one available here?

I guess I could just walk around and ask in the pharmacies. But if someone has more information than me, or some good tips about sleep aids then that would be awesome.

Antihistamines like atarax, vistaril or benadryl doesn't really help at all..

[aircut]

yes you can. most places will have no problem filling your order according to the generic name. the beta blockers are known to reduce libido and have cardiac effects. why to go on a regular drug regiment when you can take anti anxieties like Xanax on symptomatic basis?

[banglassie]

yes you can. most places will have no problem filling your order according to the generic name. the beta blockers are known to reduce libido and have cardiac effects. why to go on a regular drug regiment when you can take anti anxieties like Xanax on symptomatic basis?

Mostly because I have found it getting harder and harder to find diazepam or xanax in bkk. And about 50% of the diazepam are fake (80% of those in zip-locks without blisters).

I much prefer diazepam to anything else since it both helps me sleep and helps me relax and it works best when not done everyday. But there is no way in h*ll I'm buying my meds from some dodgy guy on the street of upper sukhumvit..

Edited September 4, 2015 by banglassie

[aircut]

Go to see a physician and get treatment for panic disorders. If you are in Bangkok, the mission hospital is a good way to start. It will cost you 800 BHT for a dr. appointment, and you will be out in no time with a prescription. Panic disorders are diagnosed and treated according to the patient story. That's your best option - get genuine and legal diazepam.

if you are driving i suggest that you will not drive under the influence

there should be no implications to your work permit physical health statement.

PS

• propranolol is sold under the brand names: Atensin, Betalol, Inderal
• clonidine is sold under the brand names: Catapres

Edited September 4, 2015 by aircut

[peterjackson]

<p>Go to see a physician and get treatment for panic disorders. If you are in Bangkok, the mission hospital is a good way to start. It will cost you 800 BHT for a dr. appointment, and you will be out in no time with a prescription. Panic disorders are diagnosed and treated according to the patient story. That's your best option - get genuine and legal diazepam.if you are driving i suggest that you will not drive under the influencethere should be no implications to your work permit physical health statement. PS

• propranolol is sold under the brand names: Atensin, Betalol, Inderal
• clonidine is sold under the brand names: Catapres

I know you are in Bangkok, but about 6 months ago, I tried to buy Clonidine/Catapres in Chiang Mai and had no luck at about 10 pharmacies. Was told it was no longer imported into Thailand.

[meatboy]

bisoprolol is the same family BETA-BLOCKERS around 600bht.x 100tabs.

manu.sriprasit pharma co.ltd. HYPERCOR BISOPROLOL FUMERATE

[Camelot]

Propranolol (Atenolol) 50mg once daily is part of what my doctor prescribed for high blood pressure. It's available in most pharmacies and definitely has a calming effect. It also has the benefit of being inexpensive.

[Sheryl]

Do not self-prescribe beta blockers for this. They have a number of systemic effects on the heart, lungs etc and can be dangerous for some people. In addition, I don't think they will help as they do not relieve anxiety per se nor induce sleepiness. What you are thinking of is their use to deal with some of the physical effects of stage fright and the like. Not at all the same.

Benzos such as diazepam (valium) are illegal without a presecription in Thailand. They are also highly addictive, and more than a few people have become addicted from using them for exactly the problems you describe. Withdrawal is very difficult.

Rozerem (ramelton), a hypnotic, is not approved for use in Thailand.

The best thing to do is to treat the underlying anxiety disorder and that in turn is best done through short-term therapy with medication, if necessary, as an adjunct. There are newer, nonaddictive drugs for anxiety that are preferrable to benzos in treating anxiety. But selection of drug needs to be based on a thorough understanding of your problem (it is not unusual, for example, for some degree of depression to coexist with anxiety, and that has implications for medication). A counselor is in the best position for this as they spend far more time with the patient than a doctor can, and they al have doctors they work with for prescribing purposes.

If you are in Bangkok I suggest you start by seeing a counselor at PSI. Once the counselor has a handle on your situation s/he will be able to refer you to a doctor for appropriate prescription if necessary. http://www.psiadmin.com/

While you can no doubt manage to get a doctor's script for valium or atarax, I really do not recommend seeking to do that for the reasons above. It would be quite ironic to have stopped taking gabapentin out of concern for withdrawal issues only to get addicted to drugs which are far harder to come off of.

[banglassie]

thanks for everyone's concern,

I have been addicted to benzo, no specific one, just all of them.
I have jumped to lyrica and gabapentin and so on.
I have won over benzo as well as opiates when I was hooked on morphine due to an accident for 1,5 years.
I know I can beat addiction, I do it over and over, but I prefer to not do it again.
I would love diazepam like 2 times a week when I feel I need it, but I prefer to stay on the right side of the law now days..

[chubby]

if i'm reading this right, maybe try some iron supplements ............

Treatment

• For RLS: Pramipexole, ropinirole, a rotigotine patch, or gabapentin enacarbil, plus iron supplements if ferritin is < 50 ng/mL

• For PLMD: Usually the same treatments as for RLS

For RLS, numerous drugs (eg, dopaminergic drugs, benzodiazepines, anticonvulsants, vitamins and minerals) are used.

Dopaminergic drugs , although often effective, may have adverse effects such as augmentation (RLS symptoms that worsen before the next drug dose is given and that affect other body parts such as the arms), rebound (symptoms that worsen after the drug is stopped or after the effects of the drug dissipate), nausea, orthostatic hypotension, and insomnia. Three dopamine agonists, pramipexole, ropinirole, and rotigotine(used as a patch), are effective and have few serious adverse effects other than augmentation:

• Pramipexole 0.125 mg po is given 2 h before onset of moderate to severe symptoms and is increased, as needed, by 0.125 mg po q 2 nights until symptoms are relieved (maximum dose 0.5 mg).

• Ropinirole 0.25 mg po is given 1 to 3 h before onset of symptoms and is increased, as needed, by 0.25 mg nightly (maximum dose 4 mg).

• The rotigotine patch (1 mg/24 h) is initially applied any time during the day; dosage is increased as needed by 1 mg/24 h at weekly intervals, up to 3 mg/24 h.

Levodopa/carbidopa may be used, but other drugs, which are less likely to cause augmentation and rebound symptoms, are usually preferred.

Gabapentin may help relieve RLS symptoms and is used when RLS is accompanied by pain. Dosing begins with 300 mg at bedtime and can be increased by 300 mg weekly (maximum dose 900 mg po tid). However, this drug is not approved for the treatment of RLS.

Gabapentin enacarbil , a prodrug of gabapentin, may help relieve RLS symptoms and is approved for this indication. The recommended dose is 600 mg once/day taken with food at about 5 pm . Its most common adverse effects include somnolence and dizziness.

Pregabalin , a nondopaminergic α2δ ligand, may help relieve RLS symptoms; augmentation is less likely to occur than with pramipexole. Pregabalin may also be useful for RLS accompanied by pain. For RLS, a dose of 300 mg once/day has been used. Dizziness and somnolence are the most common adverse effects. However, use of this drug to treat RLS has not been extensively studied.

Benzodiazepines may improve sleep continuity but do not reduce limb movements; they should be used cautiously to avoid tolerance and daytime sleepiness.

[connda]

I'll toss my two cents worth in considering I'm using legally prescribed diazepam to withdraw from doctor perscribed benzodiazapines. But let's define some terms from the point of view of someone who has a lot of experience with this particular class of drug. Addiction to me means you 'crave' a substance; you have to have it. Think heroin, nicotine, alcohol. Benzodiazipines such as diazepam, in my case, aren't something I crave, but, long term use for what ever your reason (anxiety, anti-convulsive, sedative, insomnia) will cause changes in your brain chemistry and once you choose to stop - chances are you will go though withdrawals. The severity of withdrawal vary significantly from person to person. So I have no physical urge to take them, but if I don't, then as the drug flushes out of my system I start into a pretty nasty withdrawal.

I use lorazapam for insomnia primarily because Ambien is a prescription drug here in the LOS, and a visit to the doctor plus a 30 day prescription at a private hospital will set you back 4000 to 5000 THB. Not cheap. A 30 day prescription of lorazapam or xanax (faster acting / short half-life benzo) from a doctor at a public clinic will cost you about 100 THB. It's a no-brainer to understand what drug most people will choose to use, as in my case, for insomnia.

The problem with benzos are they eventually stop working unless you up your dose, and I stop at 2 mg of lorazapam once it stops working, and then I taper off the drug which takes me anywhere between 15 to 20 weeks of very slow, tapered withdrawal. 2 mg of lorazapam is equivalent to 20 mg of diazepam, which I cut at a rate of 1 mg per week.

So, for anyone who chooses to stop taking benzos, I recommend looking up The Ashton Manual online. The title pretty much says it all: Benzodiazepines: How They Work and How To Withdraw. I work together with my doctor using the taper schedules in this book. In fact, for anyone who chooses to stop using benzos, you should consider printing off the taper schedules for your doctor and include the URL to the site http://www.benzo.org.uk/manual/ . If your doctor won't work with you, find a different doctor. My experience is that Thai doctors are really good at prescribing benzos, but seem to know next to nothing regarding what to do when it comes to stopping their use, or perhaps they really don't want you to stop because it is a cash cow money maker especially if the doctor is running a private clinic possibly in conjunction with their 'day-job'. This includes general practitioners and specialist such as psychiatrists. Just an observation after dealing with quiet a few doctors regarding this issue when attempting to find a doctor to help a Thai person I know establish a taper program to permanently quit benzos after they were initially prescribed for a panic disorder that had run it's course. Having had insomnia for about 15 years, and having gone through this cycle a few time here in Thailand, personally I think I'm going to permanently stop their use at the end of this taper. As I get older and now being retired, it really doesn't matter if can't get to sleep until midnight and then wake up at Zero-Dark-Thirty unable to go back to sleep. I'm just learning how to deal with life without sleep.

Edited October 8, 2015 by connda

[dennis123]

I've been using betablockers for the last 1-1.5 years on irregular base, eg when I have to go somewhere that makes me a bit anxious I take one.

You can't compare this to Diazepam at all though, I once took Diazepam and it's a whole different thing as it calms you down and makes you a bit sleepy/dizzy, heck even with alcohol I started to semi-hallucinate when I took those Diazepam.

Beta blockers don't do any of that, it's not a relaxation drug, that's why they are available over the counter, all they do is fix symptoms, for example I might get a bit shaky when I get anxious, those beta blockers fix/reduce the shakyness, that's all. Because I know I won't shake I feel a little better, as I'd feel pretty ashamed were I to shake so it provides some peace though the anxiousness is still there, just less visible. I started with 10mg, which worked for a while (semi placebo effect perhaps), after it worked less and I switched to 20 and then 40mg which does a fine job.

For example two days ago I had to get my Thai driving license, I took one 40mg, though a bit late, and 5mg Seroxat and felt ok. Seroxat is not OTC btw. I did some reading and it says that betablockers are not meant for daily use while Seroxat can be taken for years, though it comes with withdrawal symptoms if you have to believe the stories on the internet. Seroxat is supposed to work well for anxiety, initially the doc gave me Stablon (which I took for two weeks) but it did nothing for my anxiety/agitation so we went for a bit stronger medication. Bit early to tell what Seroxat will do as I start with half a tablet a day for the first week and it's just my 3rd day but I did feel a little more relax in combo with the beta blocker. I also sleep a little better now.

Anyhow just go to see a doc to see what's best for you, if you don't then remember that beta blockers and valium are absolutely not the same thing.

[speedtripler]

Don't use valium or xanax if you can avoid it - I had been taking it daily for years until I ran out of them in a country where they are illegal and almost impossible to get hold of .....

I woke up in hospital and asked what happened - apparently I had my first benzo withdrawal seizure (can be fatal apparently)

Since then it's happened again when I tried to quit after 5 days of no sleep I was on route to the pharmacy to get more and my heart was beating so fast I thought it was going to explode.... Crashed motorcycle at low speed luckily outside a police box, straight to hospital and given a shot of valium and a handful to take at home

I don't know how to quit them and my daily dosage is enough to kill an elephant because the tolerance gets higher and higher over the years so I will probably be on them for life

Think about that the next time someone suggests taking a benzo to help you sleep

[dennis123]

Don't use valium or xanax if you can avoid it - I had been taking it daily for years until I ran out of them in a country where they are illegal and almost impossible to get hold of .....

I woke up in hospital and asked what happened - apparently I had my first benzo withdrawal seizure (can be fatal apparently)

Since then it's happened again when I tried to quit after 5 days of no sleep I was on route to the pharmacy to get more and my heart was beating so fast I thought it was going to explode.... Crashed motorcycle at low speed luckily outside a police box, straight to hospital and given a shot of valium and a handful to take at home

I don't know how to quit them and my daily dosage is enough to kill an elephant because the tolerance gets higher and higher over the years so I will probably be on them for life

Think about that the next time someone suggests taking a benzo to help you sleep

Why don't you reduce it slowly with 5 or 10mg at a time, eg two weeks 5mg less, another two weeks 5mg less and so on, not sure about the dosages but just as an example.

@OP I think you only have three choices:

1) Gaba, which you don't want like Paxil, works great for your problems but seems addictive

2) Benzos, also addictive and makes dizzy/sleepy

3) Beta blockers, much less effective then the above two though not addictive at all imo and more suitable for periodic use

I'm on GABA/Paxil for my 3rd day today and I think I'll keep using it for 6 months, then build it off and see how I feel, ok it has withdrawal symptoms but that's just a matter of biting through it, I might even go on a drinking tour during the withdrawal period and take some valium if it turns out to be a tough ride.

Edited October 16, 2015 by dennis123

[Thailand J]

My US doctor prescribed Concor 5, 5mg bisoprolol beta blocker and it is available OTC here, I take it everyday to control blood pressure and heart rate, not for anxiety. 1150B for 100.