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surgery and xanax
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surgery and xanax

I have been prescribed xanax by my psychiatrist for panic disorder and have been taking every day for about 15 years. I am taking about 1 mg every 6 hours and have been for quite a while. I also have an upcoming surgery for prostate problems, specifically BPH, and the urologist has asked me to not take the xanax after midnight the night before the surgery. Its also unclear to me when I would be able to resume taking it after the surgery. It seems to depend on the anesthesia, pain medications, which can vary, so forth. I am quite concerned about xanax withdrawal before and after the surgery. I know it can be severe, both from personal experience and from reading. I don't think the urologist/surgeon understands all of that. I am considered switching to a longer acting benzo, even if only to xanax-xr, because that only has to be taken once a day. Switching to valium or konopin takes weeks of gradual taper, and I am not sure I have time for that. I longer acting benzo would make any short term withdrawal problems less of a problem. Does that sound reasonable? How should I deal with this?
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I think you are worrying about something that does not make any sense to worry about. If you take your xanax before midnight, you will still have a good high blood level ( the important fact) well into the next day, at which time your doctor will probably start you on your regular dose. You are better off complying with his request, it is meant to keep you as safe as possible, but if you don't agree, then talk it over with him rather than prescribing for yourself.
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Avatar_f_tn
It's possible the doctors don't see it as an issue.
Is it normal for you to get up during the night and take Xanax?  You mention taking it six hourly.
If it were me with your concerns I would be taking 1 mg of xanax prior to the midnight deadline.  I would be asking my surgeon to schedule my operation as early as possible.  I would take my medication with me so that I could take a dose at the first opportune time (with consent from my treating physicians).
As the urologist has asked you specifically not to take the xanax after midnight (for whatever reason) I feel it would be a risk to change the type of medication.

If you have concerns you need to discuss these with one of your doctors.  Stressing about all this prior to surgery will be unhealthy for you.

I know this seems like a woefully inadequate answer but you need explanations and reassurance from your doctors.

The expert here will have a better understanding of what is going on and will be better able to advise or direct.

Good luck for your surgery!!
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Avatar_n_tn
Yes, I get up in the night to take xanax. I am planning to do as you say about scheduling the procedure, taking xanax at midnight and so forth, and I would probably get through it, but I would probably be pretty panicky in the morning. I have panic disorder, which is what the xanax is  meant to treat. That is panic attacks.

I agree that I need to ask the doctor about taking a longer acting form before I do it. I do have the impression that he has a problem with taking anything after midnight, since he talked about the problem being aspirating/choking or something being why you need an empty stomach when we talked about xanax, he didn't talk about xanax being a bad idea by itself.  But I need to verify that and will ask. I am always very careful about following all the rules and being sure that doctors understand everything and all agree.

I had almost the same surgery scheduled with a different urologist about a month ago, which the other urologist/doctor decided to put off - its a long story - and the other urologist was fine with me taking xanax the morning of the surgery. I also have had permission to take it morning of when doing other sedating medical procedures, like colonoscopies, but sometimes there is confusion about whats ok. So it varies by doctor and I am careful now to make sure the doctors and I agree on everything beforehand in some detail.

I think this current urologist is unclear on the problems caused by abrupt discontinuation of xanax. I am going to try and have my psychiatrist who prescribes the xanax contact him and have explain it.

But in general I think that this must have come up many times before, and I would love to know what other people do about it.
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Avatar_f_tn
Hi
I hope you don't mind me saying this but it seems a bit strange that you would need to get up during the night to take medication.  The disrupted sleep can't be ideal either.
After your surgery I would be having a discussion with your psychiatrist to explore why you feel this is necessary and to see why the symptoms aren't being sufficiently managed.  I didn't want to mention this before either as I know surgery can be extremely stressful but you might like to look into some psychotherapy.  Hopefully this would reduce the need for the xanax.  That's if you aren't in therapy already.

I expect you will be pretty anxious prior to surgery.  If there are techniques you use to help with the panic (besides the medication) I would recommend you utilize those.

I don't see the difference between taking xanax in the morning and taking a pre-med (other than that hospital staff could perhaps regulate the amount of water you take with the pills).
Doctors operate on patients all the time with varying degrees of stomach contents.
I guess with elective surgery though it's best to minimize any risks.

I think you may have misunderstood because I would not recommend changing medication, etc.

It's good to clarify everything.  It's always important to have good communication with doctors and other health professionals.  It sounds like you're on track with all that.

There are always stories behind stories, etc.  I find them intriguing.

I had a couple of surgeries at the end of last year both of which I was extremely anxious about.  I was offered 250 mg of valium before surgery (which I politely refused.  I like to feel in control.).  The anesthetist actually said it was better to utilize the pre-med as that would reduce the amount of anesthetic required.
I guess different doctors have different experiences and different preferences.

I expect a urologist wouldn't understand the emotional upheaval.  Not unless they had experienced it themself.
I expect they are only asking you to miss one dose.  While it doesn't sound all that significant for some people it is.

If you really feel that desperate about it I would enquire about taking your normal morning dose (taken will a minimal amount of water).  Or ask for a pre-med.

My anxiety came up in discussions.  I find our opposite experiences interesting.  I don't take meds and was offered enough to knock out a small elephant while you take it regularly and are asked to abstain.  Crazy!

The doctor had some good advice.  I would follow his recommendations.  And please try not to stress too much.
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Avatar_n_tn
Oh, that is reassuring. I am won't prescribe for myself though - my psychiatrist and the urologist both have to both agree. I am careful about things like that.

A couple of things still bother me. One is that I get anxiety symptoms after about 10 hours of no xanax, and I have never gone past 12 hours without at least a reduced dose. So I would expect to be a wreck the morning of the surgery, even if its scheduled at 8 am, due to extra anxiety and it would be really bad it the surgery is scheduled late in the morning. Secondly, I have read that at somewhere like 24 hours onward the symptoms get really intense and possibly even dangerous with abrupt withdrawal (is that accurate?). The urologist suggested that I replace the xanax for the first few days after surgery with pain medication, if I need pain medication. I don't think that will take care of the xanax withdrawal, and I think it suggests that the urologist doesn't really understand the situation with abrupt xanax discontinuation. So I am planning to talk to both doctors and try to have them talk to each other.
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