# Whats the strongest/most potent benzo?



## ThirdEyeGrind

I've been on Clonazepam for a while and am thinking of asking my doctor for a different benzo. What's the strongest/most potent?


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## korey

Flunitrazepam is probably the most potent being as it was taken off the market because it was too strong for conventional use (it's the originator of the whole "date-rape" thing).

However, if Klonopin isn't potent enough for you, then Xanax is probably your final option.


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## UltraShy

korey said:


> Flunitrazepam is probably the most potent being as it was taken off the market because it was too strong...


Better known by the brand name Rohypnol, it was never on the market in the US. It was brought across the border from Mexico where it's used as a sleeping pill.

The DEA makes a big deal about how it's "10 times more potent than Valium". Well, here's a news flash for the DEA: so is Xanax, you morons! The 10 mg of Xanax I take in a day = 100 mg of Valium: ten times more potent (per mg), yet I still don't rape myself.

This date rape thing is pure politics. They blame Rohypnol as that sounds like a scary drug. They seem to forget that the rape happened after it was slipped into one of the 15 drinks little Ms. Coed downed that evening at the frat party. Alcohol couldn't possibly have anything to do with it, even though it's well known to cause blackouts when used in staggering amounts like that. It has to be a pill as we need something to blame and vodka just isn't very sensational for the news media.



> However, if Klonopin isn't potent enough for you, then Xanax is probably your final option.


I'd say there is no such thing as one benzo being more potent than another. They all do much the same at equivalent dosages (such as 1 mg Xanax doing about the same as 10 mg Valium). Some people make a big deal out of high potency vs low potency benzos, but they're only talking about potency in terms of milligrams -- does it matter how it one takes more or less mgs to do the same job? Any benzo tablet is mostly filler anyhow. If you want some idea of how much a milligram is, consider that a packet of Sweet N' Low weighs 1,000 mgs.


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## korey

Sorry, I didn't meant to confuse. When I say "potency," I mean a smaller mg to anxiety relief ratio (yes, I'm aware that anxiety relief can't really be quantified accurately, but the idea remains valid...I hope :um). Klonopin and Xanax are probably rated as the two most potent benzos when people talk about how much it takes of each one to relieve their anxiety. With both, it's usually anywhere from 0.25 to 2mg per dose (estimating there), which is much smaller than doses of Valium or other high-mass benzos that would achieve the same anxiety relief. I suggested Xanax because it's about on par with Klonopin, only Xanax hits the brain with more of a punch because it lasts so shortly. Klonopin is strong when it comes to anxiety relief, but it is more like a subtle "easing-off" of anxiety. Frankly, I prefer the brain punch that Xanax provides because anxiety isn't something I enjoy experiencing, but to each his own :b


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## Nae

Probably midazolam. I'm not sure how well it is for treating anxiety as they use it frequently to knock people out for minor surgery and stuff.


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## korey

*Re: re: Whats the strongest/most potent benzo?*



Nae said:


> Probably midazolam. I'm not sure how well it is for treating anxiety as they use it frequently to knock people out for minor surgery and stuff.


Also known as Versed, I believe. I saw some videos on YouTube the other day of people receiving IV anesthesia, and one lady asked what she was getting, and the nurse said "Versed", and the lady was so happy about it. She was like "VERSED! I LOOOVEEE VERSED!" (This was all before the nurse had even injected her with anything :con). I suppose that woman had surgury often and was familiar with common IV sedatives.

My insurance website, which has a fairly all-inclusive database of every US prescription medication, doesn't even cover midazolam as a prescription medication. It lists it and the various forms it comes in (syringe, vial, and syrup), but it doesn't give any information further than that. I don't know if they even make midazolam in pill form :stu


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## Speak Easy

Maybe Rohypnol, although I have no idea (and most people probably wouldn't). But, out of benzos that are actually manufactured, IMO, I would have to say Xanax. Klonopin is potent, but Xanax is more hypnotic, so I actually _feel_ the effects, whereas I know the Klonopin is doing something, but I'm never really aware of the effects. Maybe that's better that way, though.


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## Caedmon

It really doesn't matter, because high- or low-potency only means that the dose needs to be adjusted accordingly. Potency does not equal efficacy, safety, or reliability. The *only *thing it means is that you have a different number on your Rx bottle.

I would not base a decision re: drugs based on an arbitrary number!


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## Caedmon

UltraShy said:


> However, if Klonopin isn't potent enough for you, then Xanax is probably your final option.
> 
> 
> 
> I'd say there is no such thing as one benzo being more potent than another. They all do much the same at equivalent dosages (such as 1 mg Xanax doing about the same as 10 mg Valium). Some people make a big deal out of high potency vs low potency benzos, but they're only talking about potency in terms of milligrams -- does it matter how it one takes more or less mgs to do the same job?
Click to expand...

I don't understand this either. It's like preferring a yellow tablet instead of a blue one.

There can be differences in terms of how benzos perform for different people (i.e. Klonopin causes relatively more depression in me versus Valium), but that has to do with how the drug works, NOT whether or not the tablet is white or pink, or if the number attached to it is 1.5 or 20.


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## korey

Sorry. I responded in the manner I interpreted the poster's question (with regard to my own explanation of my interpretation of "potency" as described above), especially considering that Klonopin was no longer being effective for them.

The only benzos that are still prescribed exclusively for anxiety relief and that available to most people in pill form are Klonopin, Xanax, Valium, Ativan, Librium (Valium's older brother), Tranxene, and Serax. I don't have any experience with the latter three (except for the fact that Valium metabolizes into Serax, aka oxazepam), but they're all relatively old. I'm not saying they're not worth a shot, but I can't help but think that you're looking for something strong and fast-acting, which is what led me to my original suggestion of Xanax. Valium is fast-acting, but it metabolizes into two other benzos that are generally only used as sleep aids (temazepam and oxazepam), so I don't know if that's what you're looking for or not. I've never had the chance to try Ativan, so I can't give you any help on that one.

I didn't mean to be presumptuous.


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## Speak Easy

*Re: re: Whats the strongest/most potent benzo?*



Caedmon said:


> Potency does not equal...safety...


I just thought about this, and wouldn't taking more pills increase metabolization, thus, furthering the possibility for damaged liver? So, wouldn't a more potent pill = fewer pills = less metabolization = safer on the liver?


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## ThirdEyeGrind

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> Maybe Rohypnol, although I have no idea (and most people probably wouldn't). But, out of benzos that are actually manufactured, IMO, I would have to say Xanax. Klonopin is potent, but Xanax is more hypnotic, so I actually _feel_ the effects, whereas I know the Klonopin is doing something, but I'm never really aware of the effects. Maybe that's better that way, though.


Since you seem to be one of the smartest persons on here (no offense to anyone else cause you all seem smart) I think I'll ask for this drug and see what he says, if not that then Xanax. Thankyou all.


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## Caedmon

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> I just thought about this, and wouldn't taking more pills increase metabolization, thus, furthering the possibility for damaged liver? So, wouldn't a more potent pill = fewer pills = less metabolization = safer on the liver?


I don't see how it would. :stu The amount put into a pill is arbitrary, and generally based on what is a convenient amount for doctors to prescribe. It's the actual drug that's metabolized, not the filler substances, so in actuality the only thing determining the effect on one's liver is the cumulative dose taken. The number of pills doesn't matter. At least, this is my understanding, jealibeanz might know more.


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## Scrotacles

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> I just thought about this, and wouldn't taking more pills increase metabolization, thus, furthering the possibility for damaged liver? So, wouldn't a more potent pill = fewer pills = less metabolization = safer on the liver?


In general short-acting benzos (xanax, ativan, oxazepam) are preferred for individuals with liver disease because there's less accumulation of drug. With longer acting benzos, there's greater accumulation and greater burden for those with liver problems. Furthermore, benzos like ativan, oxazepam that are broken down by conjugation are less affected by liver dysfunction. Benzos that require oxidation, (xanax, valium, clonazepam) etc. may have more problems with those with liver problems.

If you have no liver problems benzos are all safe and are very unlikely to cause any problems.

On the other hand, short-acting benzos have more rebound anxiety and withdrawal reactions than longer acting benzos like valium, clonazepam, etc. So both have their advantages and disadvantages. Unless you have liver disease or are taking other drugs that are associated with liver problems, I wouldn't worry about benzos causing liver problems.


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## path0gen

*Re: re: Whats the strongest/most potent benzo?*



> Since you seem to be one of the smartest persons on here (no offense to anyone else cause you all seem smart) I think I'll ask for this drug and see what he says, if not that then Xanax. Thankyou all.


It think it was already established that this medication is no longer manufactured, if it ever was in the United States. I'm curious as to the reason why you're seeking such a potent anti-anxiety med, and a benzo specifically. Klonopin is arguably the best option on the market for sustained anti-anxiety treatment. Just looking for something to knock you on your *** is a poor coping mechanism and your doctor will question your motives. In my experience, I can just walk into any shrink's office, say I heard about some drug and expect a prescription for it before I leave. So what would you say the Klonopin is failing to do? Would you be willing to modify your Klonopin prescription if it isn't performing adequately? This post resembles someone walking into a bar and saying "Gimme the strongest thing ya got!"

Also, to comment on Ativan since no one who has experience with this medication has yet posted, I don't recommend it. It may produce greater short-term effects but this was the first medication I was prescribed for my anxiety, I had to take it three times daily and I was either constantly psuedo-comatose or on the verge of panic. Missing a pill was disastrous and I actually did notice withdrawal symptoms with this as opposed to Klonopin which I rarely do.


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## Speak Easy

*Re: re: Whats the strongest/most potent benzo?*



AprilEthereal said:


> LDG 124 said:
> 
> 
> 
> Maybe Rohypnol, although I have no idea (and most people probably wouldn't). But, out of benzos that are actually manufactured, IMO, I would have to say Xanax. Klonopin is potent, but Xanax is more hypnotic, so I actually _feel_ the effects, whereas I know the Klonopin is doing something, but I'm never really aware of the effects. Maybe that's better that way, though.
> 
> 
> 
> Since you seem to be one of the smartest persons on here (no offense to anyone else cause you all seem smart) I think I'll ask for this drug and see what he says, if not that then Xanax. Thankyou all.
Click to expand...

Haha, AprilEthereal, unfortunately, no doc in the U.S. can rx you Rohypnol, and to tell you the truth, I wouldn't even bring it up in an appt. since most people who even know about Rohypnol, might be misinterpreted as drug-seeking individuals. It's a shame that such potentially therapeutic meds are seen as such horrible drugs, just because of a few incidents. GHB is responsible for so many more date rape instances than Rohypnol, but yet, GHB is manufactured as Xyrem for narcolepsy. Let's not even get started on the absurdness behind American scheduled drug classes.


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## Speak Easy

*Re: re: Whats the strongest/most potent benzo?*



Caedmon said:


> LDG 124 said:
> 
> 
> 
> I just thought about this, and wouldn't taking more pills increase metabolization, thus, furthering the possibility for damaged liver? So, wouldn't a more potent pill = fewer pills = less metabolization = safer on the liver?
> 
> 
> 
> I don't see how it would. :stu The amount put into a pill is arbitrary, and generally based on what is a convenient amount for doctors to prescribe. It's the actual drug that's metabolized, not the filler substances, so in actuality the only thing determining the effect on one's liver is the cumulative dose taken. The number of pills doesn't matter. At least, this is my understanding, jealibeanz might know more.
Click to expand...

So say someone takes 10mg Valium and 1mg Xanax to feel the same effects, you don't think the liver toll would be worst on the Valium user since he is actually popping much more diazepam in order to reach the same efficacy level of the alprazolam (which is reached by 1/10 of the amount of diazepam)? Like you said, it's the actual drug which is metabolized, so if someone is taking 1mg Xanax and 10mg Valium, in order to reach the same therapeutic benefit, I think 10mg diazepam would be harder on the liver than 1mg alprazolam (Possible with any 2 benzos, but these are the most widely accepted benzo equivalency ratios that I could think of off the top of my head).


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## Speak Easy

*Re: re: Whats the strongest/most potent benzo?*



path0gen said:


> Also, to comment on Ativan since no one who has experience with this medication has yet posted, I don't recommend it.


I didn't like Ativan either. Funny that it seems to be every doc's first line benzo treatment. Anyone else get rx'ed Ativan as their first benzo? Keith, you did right?


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## Scrotacles

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> I think 10mg diazepam would be harder on the liver than 1mg alprazolam (Possible with any 2 benzos, but these are the most widely accepted benzo equivalency ratios that I could think of off the top of my head).


Unlikely that any benzo will cause damage to the liver but if you had to choose benzos that have a slightly greater theoretical risk for liver problems...librium and diazepam would carry a slighly greater risk. This has to do more with greater half-life (~100 hrs), intermediatory metabolites and due to metabolism via oxidation which is primarily mediated by liver.

On the other hand, benzos that are metabolized by conjugation (e.g. ativan) are unlikely to cause liver problems because the actual metabolism can occur not only in liver but also in GI tract, kidney, etc., there are no ativan intermediatory metabolites and ativan has a relatively shorter half-life.

Wrt alprazolam, although it has a short half-life, it is metabolized by oxidation that heavily relies on liver and it does have some minor metabolites which would put in between ativan and diazepam wrt to potential liver problems but like I said the chances of any benzo causing liver problems are almost nil. The thing to note is that it's not just the actual mg of drug that determines liver or other organ toxicity but the actuasl chemical structure, the way it's metabolized, etc.


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## yeah_yeah_yeah

Boo.
I want benzos. You guys aren't getting addicted or selling it to junkies. Why can;t I have it?

Boo and triple boo to the paranoid health people, and that woman LDG mentioned.
Plus, why is my formatting double line spaced?

This evening is getting worse.

Ross


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## UltraShy

*Re: re: Whats the strongest/most potent benzo?*



yeah_yeah_yeah said:


> Why can;t I have it?


Because you live in a Nanny State. Maybe the Brits should take up arms and fight for freedom -- opps, I forgot, you guys don't have guns either.

Don't you just love being protected from the dangers of benzos by a state that cares so deeply for your well being?

Sarcasm mode off: perhaps UK residents should contact their elected representatives & submit editorials to every paper in the land to express their extreme dismay at how the UK treats anxiety patients (or rather fails to treat them).


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## Lostsoul

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> So say someone takes 10mg Valium and 1mg Xanax to feel the same effects, you don't think the liver toll would be worst on the Valium user since he is actually popping much more diazepam in order to reach the same efficacy level of the alprazolam (which is reached by 1/10 of the amount of diazepam)? Like you said, it's the actual drug which is metabolized, so if someone is taking 1mg Xanax and 10mg Valium, in order to reach the same therapeutic benefit, I think 10mg diazepam would be harder on the liver than 1mg alprazolam (Possible with any 2 benzos, but these are the most widely accepted benzo equivalency ratios that I could think of off the top of my head).


Wow 10 mgs of valium! My maximum ever taken was 5 mg and that made me act really drunk, I barely remember what happened but I fell asleep at dinner my face in plate...


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## Nae

Wow! a Scrotacles sighting. What's up our resident pharmacist?


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## Speak Easy

*Re: re: Whats the strongest/most potent benzo?*



Scrotacles said:


> LDG 124 said:
> 
> 
> 
> I think 10mg diazepam would be harder on the liver than 1mg alprazolam (Possible with any 2 benzos, but these are the most widely accepted benzo equivalency ratios that I could think of off the top of my head).
> 
> 
> 
> Unlikely that any benzo will cause damage to the liver but if you had to choose benzos that have a slightly greater theoretical risk for liver problems...librium and diazepam would carry a slighly greater risk. This has to do more with greater half-life (~100 hrs), intermediatory metabolites and due to metabolism via oxidation which is primarily mediated by liver.
> 
> On the other hand, benzos that are metabolized by conjugation (e.g. ativan) are unlikely to cause liver problems because the actual metabolism can occur not only in liver but also in GI tract, kidney, etc., there are no ativan intermediatory metabolites and ativan has a relatively shorter half-life.
> 
> Wrt alprazolam, although it has a short half-life, it is metabolized by oxidation that heavily relies on liver and it does have some minor metabolites which would put in between ativan and diazepam wrt to potential liver problems but like I said the chances of any benzo causing liver problems are almost nil. The thing to note is that it's not just the actual mg of drug that determines liver or other organ toxicity but the actuasl chemical structure, the way it's metabolized, etc.
Click to expand...

Very informative response, Scrotacles. How come I've never seen you on here before? Are you a med student?


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## Nae

I really, really, really try not to reply for others but I do believe Scrotacles is a student of pharmacy. He has a tendency to sorta sweep into the medication forum and make these deeply informative posts about a medication's pharmacodynamics and pharmacokinetics and then swoop off again as quickly as he appeared. It has been this way as long as I can remember being at SAS :b :lol :haha


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## Scrotacles

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> Very informative response, Scrotacles. How come I've never seen you on here before? Are you a med student?


I was a previous med student but quit after 2 years due to my SAD. I went back to school with medication the second time around and I managed to finish my pharmacy degree this year. Could not have done it without benzos. They've been my life-saver.


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## Speak Easy

*Re: re: Whats the strongest/most potent benzo?*



Scrotacles said:


> LDG 124 said:
> 
> 
> 
> Very informative response, Scrotacles. How come I've never seen you on here before? Are you a med student?
> 
> 
> 
> I was a previous med student but quit after 2 years due to my SAD. I went back to school with medication the second time around and I managed to finish my pharmacy degree this year. Could not have done it without benzos. They've been my life-saver.
Click to expand...

Very cool. And congratulations on your degree, that must be really exciting for you.


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## korey

*Re: re: Whats the strongest/most potent benzo?*



Scrotacles said:


> LDG 124 said:
> 
> 
> 
> Very informative response, Scrotacles. How come I've never seen you on here before? Are you a med student?
> 
> 
> 
> I was a previous med student but quit after 2 years due to my SAD. I went back to school with medication the second time around and I managed to finish my pharmacy degree this year. Could not have done it without benzos. They've been my life-saver.
Click to expand...

I'm where you were 5 or 6 years ago. My declared major is pharmacy, but I'm not really interested in counting pills everyday and putting on a fake smile for the rest of my life. I'm more interested in the research and development behind pharmaceuticals. Does a Pharm.D have the credentials to do R&D, or would I need to go specifically into a graduate-level pharmaceutical program other than Pharm.D? I sorta want the position of being a licensed, practicing pharmacist to be my fall-back job or night job or something while I work in a lab somewhere during the day. I would rather spend my time coming up with new medications and possibly curing some diseases (sounds corny, I know). What do you think about this? Any suggestions?


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## UltraShy

*Re: re: Whats the strongest/most potent benzo?*



Lostsoul said:


> Wow 10 mgs of valium! My maximum ever taken was 5 mg and that made me act really drunk, I barely remember what happened but I fell asleep at dinner my face in plate...


My first time with any benzo: it was August 2000 and I tried 5 mg of Valium. It was one of the most anti-climatic events of my life. I felt zip from this drug that has been turned into a legend.


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## UltraShy

*Re: re: Whats the strongest/most potent benzo?*



korey said:


> My declared major is pharmacy, but I'm not really interested in counting pills everyday and putting on a fake smile for the rest of my life.


Given how I barely passed my first semester of chemistry and had to drop the second semester I'd certainly never make it as a pharmacist. It strikes me that pharmacists have a vast amount of knowledge that will rarely be put to use. They learn all there is to know about chemistry and drugs just so they can make sure the pharmacy tech who counted the pills put the right pill in the right bottle so that Mrs. Smith doesn't drop dead because she got the wrong pills.


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## Speak Easy

*Re: re: Whats the strongest/most potent benzo?*



UltraShy said:


> It strikes me that pharmacists have a vast amount of knowledge that will rarely be put to use.


Same with some MDs. 
Ex: When is a psychiatrist, sitting at his desk, talking to a patient, ever gonna need to know anything about the actual detailed chemical/pharmacological structure behind Prozac, for instance. I honestly don't think it's that hard to be a doc, but I know that for political purposes, they need to go through all that training/studying, because once you are given prescribing powers, and once another person's life is "in your hands". 
I think that for psychiatry, specifically (no psychoanalysis, psychotherapy involved) you don't really need to be taking biochemistry, chemistry, and biology to get into med school. It just doesn't really seem necessary. But I suppose it makes _us_ feel better, too, when we see all those diplomas and certificates hanging up on the wall, right?


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## korey

I think bio, chem, and biochem are all just basic prerequisites for upper-level medical/pharmacy courses like Pharmacology, Pharmacokinetics, Toxicology, etc. (both doctors and pharmacists take those same courses, I think). Honestly, the main difference between a doctor and a pharmacist is the addition of all the Anatomy&Physiology that doctors have to take (med school cadavers, etc. :b). Other than that (and the amount of time that a med student spends in internship/residency/fellowship/etc.), the academics behind being a doctor and a pharmacist look pretty much the same. That's just based off what curriculum criteria I've read in the past for my state's one and only pharmacy school and med school (both of which are connected to the same university, which narrows it down for me, I guess )

And Karl is right...It really is a shame that pharmacists have pretty much (rather, they're supposed to have) the same medicinal knowledge of a doctor, yet pharmacists are stuck behind a counter all day counting pills and getting to yield to all-powerful keys to the horrendous "narcotics cabinet" :afr (that smiley was a sarcastic smiley) for tens of thousands of dollars less per year on their salary. Don't get me wrong, pharmacists make enough money as it is, but let's face it - doctors make much more.

As for whether or not psychiatrists (specifically) know about all of the pharmacological aspects behind the medications they prescribe, I would have to put mine up as an example of one who legitimately seems to. I know his benzo equivalencies are complete crap and he ultimately sees the human body as the actual "healer" and the medication as just the helper (kind of a weird perspective, but effective in keeping him focused and away from prescribing tons and tons of meds on top of eachother, yet not turning him into a medicationphobe). We even had a chat about why newer sleep aids cost so damn much when the older benzo sleep aids (Dalmane, Restoril, Valium, etc.) are just as effective and cost less than a tenth of the newer ones. I looked at the Lunesta tissue box on his desk and pointed out how it's just a product of the whole chirality thing (Lunesta being the new-and-improved/more expensive version of zopiclone, just like Lexapro is of Celexa). He seemed sorta down when he was forced to admit that the gross price difference really _is_ more of a product of marketing rather than the effectiveness of the medication. He tried to make it sound legitimate by saying that so much money and research goes into getting those newer medications out on the market, but even _he_ got quiet about it after a while and quickly changed the subject :lol. He did explain to me the principle behind which all medicine is practiced: morbidity. It's something like the extent to which illness(es) affect your ability to perform your everyday work (both home and business) because a gap in the economic circle caused by one ill or disabled person can have big consequences for the rest of society. Or something like that. He made it seem like medicine was just a big ploy to keep the economy running, and if you think about it, it really does seem like it. Doctors have no reason to care for their patients other than that fat paycheck that tells them they're doing a good job at keeping things flowing smoothly. I know there are plenty of doctors who genuinely care about their patients :blah, but like I said, that principle of morbidity is apparently what they _all_ work under.

Oh, and there are non-practicing medical doctors who do lab work their whole lives (sorta like what I want to do). Just look at Dana Scully from The X-Files :b


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## Scrotacles

*Re: re: Whats the strongest/most potent benzo?*



korey said:


> Does a Pharm.D have the credentials to do R&D, or would I need to go specifically into a graduate-level pharmaceutical program other than Pharm.D? I sorta want the position of being a licensed, practicing pharmacist to be my fall-back job or night job or something while I work in a lab somewhere during the day. I would rather spend my time coming up with new medications and possibly curing some diseases (sounds corny, I know). What do you think about this? Any suggestions?


The Pharm.D alone will not be enough to do that type of work unless you follow it up with further graduate-level studies. You can get an indusdtrial position with just a Pharm.D but it will often lead to work in areas like product formulation, quality control, pharmacoeconomics or limited clinical research.

I think your best option if you're interested in innovative R&D is doing a B.Sc in pharmaceutical/medicinal chemistry or just chemistry followed by MSc and PhD in Pharmaceutical sciences. Another option is a Pharm.D/PhD or MD/PhD program. These are the usual routes taken by most of the big shots who make major discoveries.


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## korey

A friend of mine suggested me going for the X/PhD program (only he suggested Pharm.D/MD for some reason, claiming that the Pharm.D degree is viable for the PhD position just because it's technically a doctorate degree... I don't think his suggestion is even an actual option :um). Under that suggestion, I figured I would never get out of school because MD's require so much pre-practice work (internship, residency, fellowship, etc.) However, if Pharm.D/PhD is a possibility for someone looking for both the fallback of being a practicing pharmacist _and_ for the option/credentials to do major pharmaceutical research, then I might look into it.

I might just go for a 4-year BS in Pharmaceuticals and then 2 more years for a PhD in Pharmaceutical Sciences (I've read that the masters degree can be surpassed in favor of going straight for the PhD once a proper bachelor degree is received, though I'm not sure how accurate that is).

I wonder what the difference(s) is between Pharmaceutical Science and Medicinal Chemistry. The two sound synonymous. :con


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## UltraShy

Korey forgot that an MD is a degree that can also include an ego the size of Texas as in "I'm an MD, not some pill-counter".

Though the era of docs being seen as gods has largely ended. I don't think anyone here views them as anything more than mere mortals, and in many cases some pretty stupid mortals at that. With the Internet to research meds & medical procedures docs no longer appear so magical. The Internet basically pulls back the curtain and shows you that the Wizard of Oz (a doc) is just an ordinary guy.


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## korey

If I were an MD, I would be a non-practicing one who only used my medical authority to do research. It seems like a waste of a degree to me being as I would probably get the same info and research authority from a Pharm.D/PhD dual degree.

And you're very right about MD's being thrown off Mt. Olympus in recent years. My own psychiatrist is sometimes flabbergasted (I love that word) when I explain my understanding of how certain medications work. Rather than saying "So, it makes it easier to go to sleep?" when refering to any of the many $100 sleep aids that are so strategically placed around his entire clinic, I say something like "So, it modulates the hypnotic/omega GABA receptors in the brain, just like those $5/month benzos that were used for this very same reason back before their patents ran out, yet are still readily available and commonly prescribed?" He once even suggested that I go into medicine or pharmaceuticals, and I told him that I was already on track to pharmacy school (which I have told him a few times before as reasoning for why I know what I know about medication to the extent that I do, otherwise he might think I'm a _drug seeker!_ :afr :lol).

Those 20-something idiots at the local medical clinic are, well, idiots. The old ones are mean, and some of them are gung-ho against antibiotics for no particular reason. The last time I had an antibiotic prescribed for me from that clinic was from one of those old farts who didn't even like prescribing antibiotics (but there's not much choice for internal infections, is there?). Apparently, they only prescribe Omnicef, aka the antibiotic that costs $100 for 20 pills. My sister had strep throat not too long after I got that prescription for Omnicef, and the doctor she saw at that very same clinic prescribed Omnicef syrup that still cost $100. Zithromax or amoxicillin probably would've worked fine (and would've cost less being as both are generic and older), but no, if you have a medical problem, you get to become an amputee at the pharmacy when you pay and arm and a leg for those damn prescriptions. :mum

</rant>


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## paranoia

> Rohypnol


 :agree


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## Down_But_Not_Forsaken!

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> path0gen said:
> 
> 
> 
> Also, to comment on Ativan since no one who has experience with this medication has yet posted, I don't recommend it.
> 
> 
> 
> I didn't like Ativan either. Funny that it seems to be every doc's first line benzo treatment. Anyone else get rx'ed Ativan as their first benzo? Keith, you did right?
Click to expand...

I was given Ativan by a GP (at my request) as the very first drug prescribed for my SAD.

I later went on Clonazapem and am now on Lexapro (as prescribed by the second psychiatrist last week) He's weaning me off the Clonazapem - 10 days on 2 mg. at night, next 10 days at 1 mg., last 10 days or so on .5 mg.

He gave me 2 repeats for the Lexapro - first day on it was yesterday. Felt nauseaous after an hour of taking it, had to go the the pharmacy and pick up some Gravol. That helped with the nausea.

Ray


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## Noca

*Re: re: Whats the strongest/most potent benzo?*



LDG 124 said:


> path0gen said:
> 
> 
> 
> Also, to comment on Ativan since no one who has experience with this medication has yet posted, I don't recommend it.
> 
> 
> 
> I didn't like Ativan either. Funny that it seems to be every doc's first line benzo treatment. Anyone else get rx'ed Ativan as their first benzo? Keith, you did right?
Click to expand...

i got ativan first when i was hospitalized


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## UltraShy

^ Regarding Ativan I'd say it's the same as Xanax or Valium. All benzos are much the same, though some have their own personal favorite (I personally don't care for Klonopin, for example).


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## jealibeanz

korey said:


> If I were an MD, I would be a non-practicing one who only used my medical authority to do research. It seems like a waste of a degree to me being as I would probably get the same info and research authority from a Pharm.D/PhD dual degree.
> 
> And you're very right about MD's being thrown off Mt. Olympus in recent years. My own psychiatrist is sometimes flabbergasted (I love that word) when I explain my understanding of how certain medications work. Rather than saying "So, it makes it easier to go to sleep?" when refering to any of the many $100 sleep aids that are so strategically placed around his entire clinic, I say something like "So, it modulates the hypnotic/omega GABA receptors in the brain, just like those $5/month benzos that were used for this very same reason back before their patents ran out, yet are still readily available and commonly prescribed?" He once even suggested that I go into medicine or pharmaceuticals, and I told him that I was already on track to pharmacy school (which I have told him a few times before as reasoning for why I know what I know about medication to the extent that I do, otherwise he might think I'm a _drug seeker!_ :afr :lol).
> 
> Those 20-something idiots at the local medical clinic are, well, idiots. The old ones are mean, and some of them are gung-ho against antibiotics for no particular reason. The last time I had an antibiotic prescribed for me from that clinic was from one of those old farts who didn't even like prescribing antibiotics (but there's not much choice for internal infections, is there?). Apparently, they only prescribe Omnicef, aka the antibiotic that costs $100 for 20 pills. My sister had strep throat not too long after I got that prescription for Omnicef, and the doctor she saw at that very same clinic prescribed Omnicef syrup that still cost $100. Zithromax or amoxicillin probably would've worked fine (and would've cost less being as both are generic and older), but no, if you have a medical problem, you get to become an amputee at the pharmacy when you pay and arm and a leg for those damn prescriptions. :mum
> 
> </rant>


Korey-

The antibiotics you've mentioned are all from different classes. Each class and individual drug has specific indications for use. It's quite complicated. The choice is based on what type of agent is most likely causing the infection, which is normally just determined by a "rule of thumb" when considering where the infection is in the body and where in the community is was probably acquired.

So it's not like there are necessarily "strong" and "weak" antibiotics, just different.

Also, a few things to think about when docs don't rx an antibiotic:

- Most upper respiratory infections are viral.

- Your own personal resistance to antibiotics is increased whenever you take one. So if you, years from now, have a nasty infection, you have a better chance of ridding it quickly and effectively if you aren't already resistant to numerous classes. (So if the "save the world" one person at a time reasoning bothers you as much as it bothers me, think of it this way.)

- Most infections, viral or bacterial, will be erradicated by the body's natural immune system fairly quickly in a healthy individual, without medication.

- In the long run, it's better for you to build up resistance to the infectious agent, not medications.

- It used to be that most docs would rx an antibiotic for a sinus infection because it's difficult to assess clinically without cultures. Recently studies have shown that sinus infections are more often than not caused by a virus. So there's been a new method adopted and a lot of docs have become much more discriminating with sinus infections.

Even with kids and ear infections, less antibiotics are being rx'd because the body usually can fight the infection. Some docs are rx'ing Tylenol #3 for the pain and some are using the "wait and see method" of antibiotic use. They either pre-date a script to be filled a couple of days after the visit, if it doesn't get better, or tell the parent to call in a couple of days and they'll rx an antibiotic if need be. It cuts down on usage significantly.


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## korey

I can understand that, but from what I've been told by other physicians in the past, zithromax is one antibiotic that will heal any infection in the body except a urinary tract infection (not quite sure why that particular type of infection, though). I'm aware that Omnicef is a "new school" cephalosporin antibiotic (the "cephalo" bit refering to the head, I'm assuming based off my very lite background in biology), which would make it a good candidate for infections in or around the head (like the ear/nasal infection I had or the strep throat my sister had), but jeez, is it really worth five bucks a pill? :con


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## jealibeanz

korey said:


> I can understand that, but from what I've been told by other physicians in the past, zithromax is one antibiotic that will heal any infection in the body except a urinary tract infection (not quite sure why that particular type of infection, though). I'm aware that Omnicef is a "new school" cephalosporin antibiotic (the "cephalo" bit refering to the head, I'm assuming based off my very lite background in biology), which would make it a good candidate for infections in or around the head (like the ear/nasal infection I had or the strep throat my sister had), but jeez, is it really worth five bucks a pill? :con


Antibiotics are one of the most difficult classes of drugs to learn, IMO! It's quite complicated when all things are taken into consideration.

There's a rhyme and reason for prescribing any specific one.

Some are "broad-spectrum", while others are "narrow spectrum". Omnicef is more of a narrow spectrum drug than Zithromax. It's used selectively for certain conditions, like you said, it's good for certain URI's.

When prescribing antibiotics it's best to use a narrow spectrum drug if it's fairly certain that it will work. It's more effective and causes less resistance... going back to the idea that you want to save those broad-spectrum, widely effective drugs for when you might realllly need it. This is all in your best interest.


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## Heatherx

korey said:


> Sorry, I didn't meant to confuse. When I say "potency," I mean a smaller mg to anxiety relief ratio (yes, I'm aware that anxiety relief can't really be quantified accurately, but the idea remains valid...I hope :um). Klonopin and Xanax are probably rated as the two most potent benzos when people talk about how much it takes of each one to relieve their anxiety. With both, it's usually anywhere from 0.25 to 2mg per dose (estimating there), which is much smaller than doses of Valium or other high-mass benzos that would achieve the same anxiety relief. I suggested Xanax because it's about on par with Klonopin, only Xanax hits the brain with more of a punch because it lasts so shortly. Klonopin is strong when it comes to anxiety relief, but it is more like a subtle "easing-off" of anxiety. Frankly, I prefer the brain punch that Xanax provides because anxiety isn't something I enjoy experiencing, but to each his own :b


What has been your experience with valium? Does it last longer so that you do not have to take so many ( building up tolerance ect...... Since I currently take 2mgs of xanax a day split up into 4 separate timees throughout the day, how much in mgs would i have to take and how often compared to the xanax?


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## 239

*Pure Pharmacokinetic Analysis.*

I am a Biochemical researcher with a large pharmaceutical corporation and we interact with common medications like benzodiazepines on almost a daily basis.

I didn't read every post here so forgive me if I am repeating any information here;

The most potent Benzodiazepine in regards to pure dose/response equivalence in reference to all other Benzodiazepines would unquestionably be be *Triazolam* (Brand name in US: Halcion).

Standard doses to treat severe insomnia start at 0.125mg and only increase to 0.25mg and the largest dose (In the US) is a mere, 0.5mg.

Just to give some perspective a 0.25mg dose of Triazolam is equivalent to 0.5mg of Alprazrolam (Xanax), 10mg of Diazepam, and 20mg of Temazepam.

It has a higher affinity for hypnotic effects than all the other classic benzo effects thus it's normally only indicated for severe insomnia rather than anxiolytic symptoms but it still provides significantly potent anxiolytic, powerfully sedative, anticonvulsant and muscle relaxant properties.

It's available by Rx in the states. But it is about 3rd line medication to treat severe insomnia that has shown resistance to first and second line (safer) hypnotics, 1st line medications being Z-Drugs like Ambien and Lunesta, and second line medications would be moderately acting Benzos, like Clonazepam or Temazepam.

Hope this helps!

Cheers.


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## Canadian4Life

Tried them all! ativan is useless, valium works but makes you depressed and dragged out majorly, xanax is junk it'll make you a zombie ...if your into that, clonazepam is the one I take and it works awesome. NO other benzo worked at all for me but once I was prescribed bromazepam 6mg and they were as good as my clonazepams.


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## Noca

Triazolam to my knowledge, but there is over 50 benzos worldwide, so I wouldn't know.


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## Pharmagreeable

Yeah, go ask for Rohypnol. I actually Laughed out loud when I read that you were "taking that advice" and Xanax was your back up. I have worked in the Mental Health field for a long time... that will garnish you a giant RED FLAG in your medical file followed by the word "drugseeking". 

I have some anxiety issues of my own , as of recent. I was in a horrible car accident last year and was almost killed. I suffer from PTSD and try to limit the amount of medication I put into my system. You have an entire body of organs to think about when you start ingesting this stuff. Obviously working in the feild I am a believer in Theraputic medication... but I also believe that people rely on it far to much sometimes and think it's going to SOLVE their problems. If you're not practicing any other therapy (behaviour modifications) to deal with your anxiety it doesn't matter how high that doseage gets, you're going to suffer through it till your drugged into a drooling blathering mess . Hopefully your physician is responsible and wont allow that to happen but... I am going to offer my ten cents on how effective these medications are. 

Adivan/Lorazapam - I firmly believe this SHOULD be the first line of defense. It's very effective when taken properly and like ALL Benzodiazapines, it ALSO carries the possibility of addiction.

Klonopin/Clonazapam - This is a GREAT option for sustained anxiety relief. As it's been said it's not FAST ACTING, but it has fewer instant side effects... some people dont even realize they've taken anything they just know the anxiety is greatly reduced and they FEEL better (this is the optimum result of taking drugs for anxiety)

Xanax/ Alprazolam - this drug is very fast acting but short lived... it's a take it now need it now kind of med. Some people take regular daily doses but I submit that Xanax is simply not as sustainable as Klonopin. 

And finally... 

Valium/ Diazepam - this, like Xanax is a pretty fast acting drug... need it now use it now. and is often Rx'd similarly to Xanax. I only take this drug before going to the dentist due to a severe fear of those sadists. I take 10mg and I can make it through an apointment and by the time I'm leaving it's already wearing off. PERFECT. 

I am a strong supporter of Klonopin. But if you're here trying to find out the quickest way to high from Benzo's (which by the way is street speak for them... I woudln't use that term with your doctor, if I were you!) I wont help you. If you want to be Anxiety free... I strongly suggest BMT (Behaviour Modification Therapy) and Klonopin combined.

Good Luck!!


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## Megs17

*I saw this and had to post*



jealibeanz said:


> Korey-
> 
> The antibiotics you've mentioned are all from different classes. Each class and individual drug has specific indications for use. It's quite complicated. The choice is based on what type of agent is most likely causing the infection, which is normally just determined by a "rule of thumb" when considering where the infection is in the body and where in the community is was probably acquired.
> 
> So it's not like there are necessarily "strong" and "weak" antibiotics, just different.
> 
> Also, a few things to think about when docs don't rx an antibiotic:
> 
> - Most upper respiratory infections are viral.
> 
> - Your own personal resistance to antibiotics is increased whenever you take one. So if you, years from now, have a nasty infection, you have a better chance of ridding it quickly and effectively if you aren't already resistant to numerous classes. (So if the "save the world" one person at a time reasoning bothers you as much as it bothers me, think of it this way.)
> 
> - Most infections, viral or bacterial, will be erradicated by the body's natural immune system fairly quickly in a healthy individual, without medication.
> 
> - In the long run, it's better for you to build up resistance to the infectious agent, not medications.
> 
> - It used to be that most docs would rx an antibiotic for a sinus infection because it's difficult to assess clinically without cultures. Recently studies have shown that sinus infections are more often than not caused by a virus. So there's been a new method adopted and a lot of docs have become much more discriminating with sinus infections.
> 
> Even with kids and ear infections, less antibiotics are being rx'd because the body usually can fight the infection. Some docs are rx'ing Tylenol #3 for the pain and some are using the "wait and see method" of antibiotic use. They either pre-date a script to be filled a couple of days after the visit, if it doesn't get better, or tell the parent to call in a couple of days and they'll rx an antibiotic if need be. It cuts down on usage significantly.


I was reading along here for myself about my anxiety issues and just so happen to come across your post. More importantly the last part about kids and ear infections and docs not wanting to write a script for an antibiotic. Its gotten better lately but doctors were so "ANTI-antibiotic" for a while. I never really thought too much of it until my 2 1/2 yr old son got sick over a weekend and was given the old "its probably just a virus...wait and see". Little did I know how much damage an untreated infection could do ESPECIALLY IN CHILDREN!! My son was seen on a Sunday morning by his doc and by Sun evening I rushed him to the ER and he died Monday at 2:31pm from a form of meningitis due to the misdiagnosed and untreated ear infection. The doctors and hospital could have caught it and darn well should have but didn't. The doctors just seemed so set on not giving antibiotics. I can see some reasons as to why they wouldn't want to but why not give it if the child hasn't EVER had an antibiotic in his life...still blows my mind every time I come across a conversation about antibiotics and how they shouldn't be given...

Really they shouldn't be given to the same person many times in a close time period but I do believe doctors had gotten carried away there for quite some time with not ever wanting to prescribe them. Just wanted to share my story...I know this might be a rare situation but I wanted to put it out there in case someone might read this and it might just help one person or save a life.


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## Arisa1536

I always thought it was triazolam, isnt .25mg the same as 1mg of Xanax and .50 of klonopin so the most potent and fast acting and ultimately addicting but also the best for sleep, i have only ever been given it once in hospital following a panic attack and it was intravenously given, and amazing, it sent me into the best sleep i have ever had  with no bad hallucinations and weird thoughts like the oxycontin gave me after my c section.


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## swim

it's midazolam


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## crayzyMed

Ive tried xanax, diazepam, lorazepam and clonazepam and my vote def goes for clonazepam, it binds to nearly all benzo subtype's strongly. Never tried famous midazolam or bromazepam.


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## yay

How's clona compared to lora? Is it weaker or stronger? And equally addicting? I don't think I'd get benzos from my doc. Doctors usually worry about addictions and fear benzos.


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## Kon

Clonazepam is arguably the most potent (of the ones most commonly prescribed). Have a look at the _equivalent dose/class_ column

http://www.midtownclinic.ca/rx7/89-Cht-Psyc-Benzodiazepines.pdf


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## yay

It has a longer halflife than lora. Is this good or bad?


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## Kon

yay said:


> It has a longer halflife than lora. Is this good or bad?


It depends. Straight from the link:

*SHORT ACTING (lorazepam):* more rebound anxiety effect & withdrawal reactions, better sedative/hypnotic; preferred over long acting in elderly (less accumulation) & in patients with liver disorders (easier metabolized).

*LONG ACTING (clonazepam):* less rebound symptoms; better choice when tapering off BZs;withdrawal may be delayed 1-2 wk for 2-Keto group.


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## Kon

Scrotacles said:


> I was a previous med student but quit after 2 years due to my SAD. I went back to school with medication the second time around and I managed to finish my pharmacy degree this year. Could not have done it without benzos. They've been my life-saver.


I wonder if this was me 6 years ago. I can't remember if this was my post, but I think it may have been.

Edit: Unbelievable! It was me and I can't even remember! This was just as I was beginning to overuse/abuse my meds. What was funny is I was about to respond to myself.


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## Chrisalias

During my self destructive years I took all of the Benzo's previously mentioned in significant dosages usually...with the exception of Bromazepam(never had it).

The 2 for me which I considered the strongest were(regardless of strength per mg)
1)Midazolam(Versed)
2)Flunitrazepam(Rohypnol)

both of which would currently be harder for the average individual to obtain so my
3) was probably Xanax.

I always thought it was odd that while most Benzo's gave me a wonderful,tranquil feeling & removed anxiety completely......there were a couple (Ativan in particular and Halcion to a certain extent that gave me more of a "confusion buzz" and seemed less euphoric to me. I'm not sure why Ativan affected me this way and I'm open to suggestion.

Those days are long gone ( 15 years clean) and if I were to recommend a Benzo for an anxiety disorder & non-recreational use it would probably be Klonopin.


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## Intricate

it depends on you which is the best one


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## cvanderh

Midazolam, the proper stuff from Roche. Hard to get as only doctors and specialicists can prescribe it. I am used to 2mg of Xanax, but 15mg of Midazolam knocked me out without a single memory. It's a marvel though scary, you have no control. To me it's the most potent Benzo. I tried Valium, Xanax, Oxazepam but Midazolam is in another league. Be sensible.


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## ellespirit

there are many strong benzo


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## Bubble B

In the US the strongest benzo you can get is Halcion, though it's only prescribed for sleeping. For daytime anxiety xanax is the strongest but only lasts a couple hours.


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## Anxietyistorture

ThirdEyeGrind said:


> I've been on Clonazepam for a while and am thinking of asking my doctor for a different benzo. What's the strongest/most potent?


Hey in reply to your post I think that you are seeking a Benz out that will get you messed up rather than help with your anxiety as clonazepam is the best medicine for relieving anxiety yet it doesn't provide the 12 punch that the Xanax does but in terms of half-life is it has a very long half-life which enables you to not have to crave Your next dose.

I just wanted to warn you as someone who has been and has experience with a lot of different benzodiazepines that if you are in a situation where you become extremely addicted or reliant upon the banjos you know I want you to know that they are extremely addicting and a withdrawal from them can be fatal and also is the worst withdrawal I have ever been through worse than H as I didn't know anxiety could take over and be so bad like living hell ask any one on here that knows what they are talking about and they will tell you please don't as if you have a chance as of now do not go down that path if you need to take banjos please just take the right amount in the right one for your condition please don't go down the road of getting extremely addicted and taking more than prescribed as I guarantee you that I've done just that and wish that upon nobody


----------

