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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 11353
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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I've had Tranxene my medicine chest 15 years as I used to

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I've had Tranxene my medicine chest 15 years as I used to suffer from panic attacks and gad. Over the last 10 years I take it very seldom and only when I feel super agitated or drank too much coffee. FOr the last 8 mo I've probably taking more than usual (a 3.75 tab into fourths and sometimes only taking a quarter or maybe a half). I had a botox injection in AUgust and could swear I had a bad reaction (vertigo, achiness,foggy head) which sent me in a spin and I was so stressed I took more than usual but still always about a fourth of a 7.5 once or maybe twice a day.I usually don't take them every day. Then to make matters worse, I had the Norovirus two months ago which totally wrecked my sleep cycle. I would wake up at 3 every morning and could not go back to sleep. So I started taking 3.75 every night before bed and that would at least get me to 5 am. I did that for a couple weeks and then my doctor sent me to an endocrinologist for all the "vague" symptoms I have since every blood test under the sun says there is nothing wrong with me even though I was still tired for a month and half after the stomach virus. The endo said all my problems were from lack of sleep tied to my hot flashes/menopause and prescribes an estrogen patch (Estriadol 0.1 mg) I put it on and stopped taking the Tranxene at night. By the end of that first week my stomach started to hurt, I felt achy (especially my thighs) and I had severe insomnia. Yesterday I woke at 1 am and could not go back to sleep. So I ripped the patch off and since I was so anxious from lack of sleep I took a 3.75 mg Tranxene and felt somewhat better...don't know if it's from removing the patch or taking the Tranxene. When I went to bed last night I took a half effect...heart fast...took half a 20 mg Inderal ( I have that on hand too for heart palps)nothing...took another half Tranxene and another half Inderal -- blood pressure 170/110. Withdrawal or Estrogen patch? If wd -- how do I taper?


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Customer: replied 4 years ago.

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I am online and happy to help you with your question today. Thank you for your patience.
I've reviewed your very informative post. I would like to ask you a few questions so I can better understand what is going on right now.
Have you been on the Tranxene consistently for over 15 years?
Would you say that you change dosages yourself as needed?
How long has it been since you stopped the Tranxene cold turkey?
Do you have any other medical problems or take any other medication?
What type of doctor(s) are currently treating you and prescribing your medication?
This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 4 years ago.


I am in good health. I take Zocor for cholesterol and Aciphex for GERD. I have not taken Tranxene consistently for the past 15 years. I started having general anxiety and panic attacks after I lost a son to kidney cancer in 1991 and the anxiety started pretty much during his illness . The Tranxene was given to me by my general practitioner at that time and my doctors up until now renewed my prescriptions as I sometimes still am prone to anxiety but not usually on a daily basis. Since I get a refill of 30 pills once a year or even longer than that I guess it was never a worry. SInce August I have been completely stressed out because of what I believe was a reaction to a Botox injection. I've seen an ENT , oral surgeon, heart doctor for all these vague symptoms and now am just seeing an endocrinologist who thinks menopause might have a lot to do with my issues. To make matters worse I contracted the Norovirus 2 months ago which made me worse and the insomnia actually started during and after that bout.It was a long recovery and I stressed even more. So to answer your question no I have never taken Tranxene daily or regularly but only as needed UNTIL the past 7 months when I found if I took a quarter of a tab I at least could feel somewhat normal. Then after the stomach virus I started taking it daily, especially at night (3.75) so I could sleep through since the insomnia was making me MORE stressed out. Then the endo put me on an estrogen patch as he thought my insomnia was coming from menopause so I quit taking the Tranxene completely and after 7 days started to feel quite not well again---achiness, especially the legs, agitated and then severe insomnia and my blood pressure shot up to about 170/110. That was four nights ago. On that night I took a WHOLE Tranxene and one Inderal (I have on hand for when I go to Europe -- jet lag gives me heart palps) and then I slept for five hours. I took the patch off as I thought it was that. Called the endo and the nurse practitioner said she would lower the dose, The next day it dawned on me that it might be withdrawal but I have stopped Tranxene before and nothing ever happened. I called the doc back and he said to cut the Tranxene in half and keep the patch on. SO I am taking 3.75 at night again but the problem is I wake up anxious and am now taking a half of twice during the day as well because I feel when it wears off I start to get anxiety.. God I hate this..beings back old memories. ANyway I remember a doctor once prescribed 1/4 a tab of Lexapro for anxiety (back in the id 90s)and I remember it working so well I ended up not needing the Tranxene ever and then one day stopped everything. Since then all has been fairly good with the occasional anxiety until the botox!! then all hell broke loose. ANy suggestions?

Thank you for that extra information.
As you already know, your issues are complex and intertwined.
From what you have posted it seems like the issue at the bottom of all of this is the increased anxiety you have been experiencing for the last few months....if we could get that under control then, perhaps, many of these other issues would be better.
Since the lexapro has worked so well for you in the past, it might be best to go back on that and stop the Tranxene.
But, what I think is really needed in your case is one doctor who can step back and look at every issue and how everything relates to everything else. Right now one doc is saying menopause...try this; another doctor is saying something else and others are just refilling a Rx from years ago without giving anything any new thought.
So. What is the take home message? Find a primary care MD to take over all of your medical needs. Have her review all your medical records and carefully think about every medicine she prescribes you. If necessary this doctor can "farm you out" to specialists, but she should maintain close contact with what the specialists want to do.
Does this make sense to you?
I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.
Thanks in advance,
Dr. Rick MD FACS
Customer: replied 4 years ago.

Thank you. Actually I do have a primary who has "farmed me out" for the past seven months as I had different symptoms. I think he's almost tired of me (I hope not) because all tests come back fine and yet I haven't felt like myself, He considered menopause as well and thus sent me to the endo. However, I've been in menopause for years but I can new symptoms can arise?? I agree that this is probably all stress-related. My last question is concern about Lexapro. Yes it worked well in the past but since then with all the hype about SSRIs I'm concerned that it is not good to take them. Is it significant that I was only on a quarter of a pill? Or does taking them in any dose cause harmful effects? I'm so confused. And although I do not like taking Tranxene daily I guess I should right now unless I substitute with something else correct? I'm a teacher and I'm just trying to get through the next 7 weeks...then I can deal with getting off these things!! Ugh..

New symptoms can come up,sometimes when you least expect them to.
Just because something, like a medication, is "old" doesn't mean it is bad. Lexapro is a good medication and, since it has worked for you in the past, there is no reason to switch to the newer SSRIs.
Lexapro is a fairly safe medication. That being said, the lowest dose that is effective is what you should use. 1/4 of a pill is not very much so you really should be just fine.
Since you have 7 weeks left to get through on this school year, I agree: Continue with the Tranxene and, when summer break is here change things around if needed.
From what you have posted I really think, when push comes to shove, things will work out for you.
Does this make sense?
It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 11353
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
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