Drugs . . . Their names sound the same, but ARE they the same?
Original Post: Is there a difference in how a polio brain/body process Xanax vs Diazepam? My PCP switched out my longtime use of 0.5 mg clonazepam with 0.5 mg Xanax. I just finished my 2nd night using diazepam, and it definitely addressed the twitching/spasm, but my sleep is fitful, I keep waking up. Could I still have clonazepam in my system?
Dr. Bruno’s Response: Your post is incredibly important and asks vital questions. Yes as Xanax is the short acting medication and it could be interacting with the clonazepam. But let's look at the issue of these drugs from 35,000 feet.
Let's talk about Valium–like drugs and GABA. Neurons in the brain and spinal cord produce a chemical called GABA. GABA is the chief inhibitory or "sedative/calm you down" neurochemical. GABA is released by a neuron, floats across the gap between one neuron and several others and plugs into a GABA receptor on the neurons, like a key in lock. However there are at least 19 different GABA receptors! So when you plug the GABA key into the GABA receptor locks it can have a powerful effect, a mild effect, cause you to be sleepy or calm or, if the receptors are on your motor neurons, stop muscle spasm.
The drugs that are manufactured to plug into GABA receptors are the benzodiazepines, of which Valium is the grandfather. Our research has shown that Valium (diazepam) is the best medication for treating spasm in large muscles, especially in the back and neck. We found that Klonopin (clonazepam) is effective in treating spasms of the esophagus that prevent food from going down; Valium doesn't relax the esophagus and Klonopin doesn't relax back muscles.
Finally, Xanax (alprazolam) is effective in turning off spinal cord motor neurons that cause your legs to twitch and jump during sleep, where neither Valium nor Klonopin is effective; however Xanax does not stop back muscle spasms or relax the esophagus.
There are a number of other oral benzodiazepines that have different effects such as decreasing anxiety (clorazepate (Tranxene), chlordiazepoxide (Librium), lorazepam (Ativan)) and promoting sleep (temazepam (Restoril) and triazolam (Halcion)).
Bottom line: There are different “key” drugs for different receptors that cause different effects in the body. You can't just substitute one Valium-like drug for another and expect it to have the same effect. Without even considering interactions with other medications that you may be taking, the dose of the benzodiazepine you take or how quickly your liver gets rid of the drug, just the 19 GABA receptors and the drugs we mentioned above can have 10,888,869 trillion, trillion different effects!
Talk to your physician.