Dr. Keith Roach
Dear Dr. Roach:For four years, I have taken 2 mg of alprazolamat in the evening to sleep. Over the past six months, I’ve noticed that if I take it at 10:30 p.m., I usually can’t fall asleep until 2:30 a.m. Is it safe to just stop taking this medication because it has lost its effectiveness and 2 mg is a small dose? Or should I taper off gradually? I am 72 years old.
J.A.
Dear JA:Alprazolam (Xanax) is a sedative in the benzodiazepine class. Recently, a research article was published highlighting the dangers of chronic use of these medications. The study was based on a survey and did not answer how often side effects may occur, but lack of energy, difficulty concentrating, memory loss, and anxiety were the most common side effects. reported. The authors proposed the term benzodiazepine-induced neurological dysfunction to describe the problems that chronic users may experience long-term and when tapering or stopping use of these medications.
Two mg of alprazola is not a small dose. People who are not used to this dose may be heavily sedated for several hours. I strongly advise you not to abruptly interrupt this dose. When treating my own patients who wish to stop diazepines, I gradually decrease the dose over six to 10 weeks. Some people can go a little faster, while others need more time. Since you are only using the medication at night, you can probably reduce your dose a little more quickly.
I also strongly recommend that you discuss your intention to stop taking alprazolam with the doctor who prescribed it (although, unfortunately, not all doctors are aware of the danger of long-term use benzodiazepines).
I recommend behavioral treatments for most people with insomnia, with cognitive behavioral therapy being a safer and more effective treatment for most people than daily prescription medications.
I should note that not everyone who takes benzodiazepines experiences side effects and some people do well with this treatment. Occasional use of alprazola or other sleeping pills is unlikely to be harmful. It’s long-term daily use that is of most concern.
Dear Dr. Roach:I am a woman of almost 83 years old, still active and in relatively good health. Should I take a fruit and vegetable supplement? The commercials seem to say that miraculous things happen when you take it. But it’s expensive ! If I stick to a good, balanced diet, should I use this product as a supplement?
FDB
Dear F.DB:No! If you invest the money you would have spent on these products into buying fresh fruits and vegetables, you would be much better off in my opinion. Supplements contain some, but not all, of the nutrients found in fresh fruits and vegetables.
If you don’t have fresh fruits or vegetables, use frozen fruits or vegetables, which provide the same benefits, rather than canned fruits, which lose their micronutrients over time and often contain excessive amounts of sodium.
Fruits and vegetables also contain fiber, which makes you feel full. So you’re less likely to eat other foods that aren’t as healthy for you.
Readers can email questions to ToYourGoodHealth@med.cornell.edu.
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