I take Valium Paxil and Xanax.I took a urinalysis & my Xanax came up negative.

[Roosworld]

I was diagnosed with severe panic disorder with associated depression, agoraphobia, insomnia and generalized anxiety.  I have for the past 3-4 years taken Valium Paxil and Xanax.  Recently I was asked by my Primary to take a urinalysis.  It showed the Valium and the metobolic breakdown, the Paxil wasn't tested for however my Xanax came up negative. I have absolutely no idea how that is possible as I take as directed. She had the lab run a more extensive test on the urine and not even a trace amount was shown. I was rushed that day and missed my morning dose and there is a possibility I didn't take my dose the night before as the Xanax was starting to become ineffective and as I've done over the years, my Xanax is changed out for Lorazepam and visa-versa.  But, because my urinalysis came back negative, they are hesitating to put me on lorazepam due to the negative Xanax results.  Can anyone help me with how this could have occuered as now I am without any short-term benzo and my panic is back as well as my insomnia!!!!!!!!  Please help.

[Paxiled]

Xanax doesn't stay in the body very long, and different people metabolize different drugs differently.  It could be you have never metabolized it.  Taking two benzos at the same time can be dangerous, and the fact it never bothered you could be a sign you've never metabolized it.  While longer acting than Xanax, Valium is also a rather short acting benzo -- the only long acting one I know of is klonopin.  You say you didn't take the Xanax, so as a short-acting drug it could also have been metabolized when you take it but you didn't take it so it might have completely left your system.  It could also be a mistake at the lab -- do two tests at two different labs and you'd be surprised at how often you'll get two different results.  I mention metabolizing because one of the main reasons different drugs work differently on people is that they metabolize them more or less efficiently.  Sometimes liver metabolites won't let you use a drug at all -- it's like drinking water.  You just evacuate it.  I don't know that you'll ever get a full explanation for this, but as you can see it's quite complicated to manufacture a drug that actually works because the body isn't manufactured by nature to take drugs -- it's manufactured by nature to eat food and get active ingredients that way.  Drugs have to be manufactured in a way that tricks the body into keeping what it perceives as "other" and toxic in your body and not excreting it right away to protect you.  That's why drugs have so many side effects -- they aren't food.  I'd try the test again at a time when you definitely take the Xanax, but the main thing that should be helping you is the Paxil as it works all the time if it's working.  It may be it's not working all that well.  Also consider that skipping a regularly taken dose of a benzo usually brings about a pretty strong withdrawal and possibly seizures -- it's never a good idea to quit these drugs abruptly or skip doses if you're not taking them as needed because of this (and don't quit Paxil abruptly either -- it can pack a wallop of a withdrawal).  Again, I have no idea if this explanation works, but remember, much of what makes medicine work of any kind is partly a placebo reaction -- you believe it's going to work and it does even if you're not absorbing it very well.  That could also explain any increased anxiety -- it's either a withdrawal reaction from skipping doses or the placebo effect is working the opposite direction -- you're thinking that not taking it will cause anxiety or that it isn't in your system and that will cause anxiety and so you feel more anxious.  That's how our brains work on anxiety.  

[Roosworld]

That is exactly the type of answer that helps me. As for my doc, not sure but will let you know.  I honestly had no explanation other than it was not being absorbed appropriately.  Thank you for your help.  And yes, I do receive great relief from the Paxil compared to Zoloft and with zero complications (knock on wood.) Also, thank you for pointing out that taking more than one benzo is NEVER advised but rather necessity when in patients such as myself are hyper-sensitive to many, many other types of medications and all else has failed.  Close monitoring of your liver and renal functions along with regular monitoring of the brain...i.e., basic memory and cognitive functions as those can be irreversible.

[Roosworld]

I did and I asked if there was another test which the lab used the same urine for another test that was supposedly more thorough and that's where they couldn't find trace amounts. I saw the lab results which showed the Valium and how it is metabolized into results showing how the Valium broke down into Oxepam, and two other benzos, which I found interesting since I though Valium was simply Valium and to see that it actually metabolizes into 3 different compounds was interesting but to see Xanax-Negative and then No Trace Amounts has me confused as even if I did miss 2 doses, there should have been something I would think which is why there is a stalemate between me and my doc as due to the results of the tests make it look as if I didn't take it which has now caused doubt with this doctor. I've been diagnosed since 1994 and have NEVER had trust issues and trust is imperative when working with health care providers.  That is why I found this site in order to hopefully find answers or at least ideas.

[AnxiousNoMore]

Did you ask the lab and your doctor how this result happened?