Xanax ER

[rpooo]

First off I have cirrhosis so medication that metabolizes in the liver I must be very careful with. I have anxiety- hereditary and triggered from years of alcohol abuse.  I recently relocated and went to my new doctor (general medicine) on Monday and she started me on Xanax extended release tablets instead of the pop them as you go type. I have never heard of them but she said it is the only type she will prescribe. I have always been concerned with being dependent on Xanax so the pop as you go idea worked well since some days I could get by without any (that’s been a while since I've had a lot going on) or on a really bad day never exceed more than 2mg. My script was for 4mg daily! yeah right! I know I would be a zombie taking that much and asking for trouble. Have you heard of the extended release and will that guarantee physical addiction? I hear the withdrawals from benzo's are terrible and not a road I want to go down. Also is my doctor an idiot for prescribing it this way? Lol I used to use Lexapro but the side effects were difficult to deal with but the medication worked very well. Is there a better option out there for me other than Lexapro or Xanax? The withdrawals from Lexapro were difficult as well. Is dependency always going to be a factor when dealing with this type of medication? I know I need help with anxiety to be able to perform my daily functions and interactions but currently I do not use caffeine, alcohol nor am I dependent on medication(s).

I tried the Xanax ER and it seemed to work as a mood stabilizer due to how the medication works so no ups and downs in my mood was a nice change. Thank you for any suggestions and help.

Randy

[rpooo]

Hi Julia, thank you for your reply and suggestion.

Perhaps "idiot" is far from necessary but to me it seems that taking a patient using a benzodiazepine responsibly with no dependency and prescribing something that if used as directed will almost guarantee dependency is not such a good idea. I understand she may be very familiar with the abuse of this drug but she shouldn’t assume I am going to misuse it. I do not want to be dependent on anything. This is the major concern I thought I expressed in my original post. After a year on Xanax I have done fine. I did not mention I go "days" without needing medication but that "some days I could get by without any". I did inform her of this and that some days medication is very much need in order to perform my "daily functions and interactions ".

Once diagnosed with end stage cirrhosis I learned a very difficult lesson about addiction and never again will I live with it. Buspirone sounds like it could be an excellent choice but portal hypertension is a big deal for me. I am diagnosed with splenomegaly and as a result I have a platelet count of 60k. I also battle with hepatic encephalopathy since my ammonia level hovers in the upper 60's. Can you elaborate on how this medication effects hepatic impairment?

Again thank you for your reply :)

Randy

[Julia M Aharonov, DO]

I would not say that your doctor is an "idiot", since you have been taking Xanax for quite a while already and she thinks she is only giving you a smoother ride. You probably told her how bad your anxiety is and did not tel her that you sometimes go days without taking any.
You should be more clear with her, since 4mg every day will definitely lead to dependency and withdrawal upon cessation if done abruptly.
Lexapro does have some very unpleasant side effects, which most people are not willing to tolerate, but have you tries BuSpar? It is an excellent anti anxiety medication, which though has to be used carefully in hepatic impairment, can still be used safely and is not addictive.
Good luck to you.