Switching to another benzo after Xantax tolerance?

Question

Once you develop a tolerance for one benzo, like say Xanax, do you automatically have a built in tolerance for the other benzos as well. In other words I would like to think that If I develop a tolerance for Xanax at sometime and it stops working for my anxiety, that I would be able to switch to another benzo which would work effectively for me at lower doses (like when I started the Xanax). Or, would I automatically need doses of the new benzo comparable to the doses of the Xanax. Being that all benzos are chemically similar yet not identicle, I would think because the chemical in the new benzo would be unfamiliar to my body, that the effects would stronger (relating to anti-anxiety) at lower doses rather than maximal. Is this correct? Thank you...

Answer 1

Cross-tolerance would develop to all benzos and would also develop to other sedatives that affect the GABA receptors, including alcohol.

Benzodiazepines produce their variety of effects by depressing the Central Nervous System and by modulating the GABA-A receptor, the most prolific inhibitory receptor within the brain. The GABA-A receptor is made up from 5 subunits out of a possible 19, and GABA-A receptors made up of different combinations of subunits have different properties, different locations within the brain and importantly, different activities in regards to benzodiazepines.

In order for GABA-A receptors to be sensitive to the action of benzodiazepines they need to contain an α and a γ subunit, where the benzodiazepine binds. Once bound, the benzodiazepine locks the GABA-A receptor into a conformation where the neurotransmitter GABA has much higher affinity for the GABA-A receptor, increasing the frequency of opening of the associated Chloride ion channel and hyperpolarizing the membrane. This potentiates the inhibitory effect of the available GABA leading to sedatory and anxiolytic effects. As mentioned, different benzodiazepines can have different affinities for GABA-A receptors made up of different collection of subunits. For instance, benzodiazepines with high activity at the α1 are associated with sedation whereas those with higher affinity for GABA-A receptors containing α2 and/or α3 subunits have good anti-anxiety activity.

Tolerance develops to many of the therapeutic effects of benzodiazepines rapidly with daily or frequent use. Generally, tolerance to the hypnotic and sedative effects occurs within days, however, tolerance to the anxiolytic effects of benzodiazepines takes longer to develop. There is little evidence of continued anxiolytic properties from benzodiazepines after four months of continuous use other than the suppresion of withdrawal signs.

Benzodiazepines share a similar mechanism of action to various sedative compounds which act via enhancing the GABA-a receptor. Cross tolerance typically means that one drug will alleviate the withdrawal effects of another. It also means that taking of one drug will result in a decreased pharmacological effect of another similar acting drug. Benzodiazepines are often used for this reason to detoxify alcohol dependent patients and can have life saving properties in preventing and or treating severe life threatening withdrawal syndromes from alcohol such as delirium tremens. There is also cross tolerance between benzodiazepines, the barbiturates and the nonbenzodiazepine drugs which all also act via enhancing the GABA-a receptor's function via modulating the chloride ion channel function of the GABA-a receptor.

Hope this helps.

Answer 2

The other answers were great! I take Benzo's so I thought I might be able to add a bit. First off, Xanax is i "light" benzo meaning that its effects are not enormously strong. I take Klonopin for seizures (Clonazepam). Klonopin is a "heavy" benzo. It will knock out anxiety. However, if you raise your dose of Xanax high enough (under a Dr.s care of course) you will need to start out at a higher dose of Klonopin. Once you are used to Klonopin, no other benzos will be effective. Also Klonopin is HIGHLY addictive - so do not take it if you can stay on "light" benzos. 36 hours without Klonopin at my dose (4 mg) and you will have a seizure even if you never had one before. Just be careful. Benzos are not fun. Also - be aware that benzos are notorious for causing depression and worsening depression as well. Check with your Dr. if you become depressed. It could be your meds. Hope this helps!

Answer 3

While specific benzodiazepines may have some variable tolerance-in a practical sense tolerance to this class is broad. Without fail, all my patients who take chronic benzodiazepines require significantly larger doses than the general population for clinical effect. This is regardless of the drug they are routinely taking and the one which I am administering.
Additionally, I see significant cross tolerance to other psychotropic and pain medicines.
You can try others under physician supervision. You might have to change drug class. As tolerance develops the gap between desired clinical effect and dangerous side effects narrows.