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I am confused as to why it is "easier on all" to tell them you are allergic? You are dealing with health professionals who usually have the capacity to understand. I wouldn't sell them short.
To answer your last question, I would say maybe, it depends. There are multiple reasons why you would need higher doses of Versed, some indicate that this effect would last across the class, some do not. For some background (I'm sorry, this is the only way I can feel relevant on this board...) Versed (midazolam) is in the benzodiazepine class of drugs. Other drugs you may have heard of that fit in this class are Valium, Ativan and Klonopin.
There are two major reasons I can think of for why this may happen. It could be a pharmacokinetic reason or a pharmacodynamic reason.
Pharmacokinetics means, what does the body do to the drug. Versed is metabolized in the liver by the CYP3A4 enzyme. The body oxidizes the drug so that it can be eliminated through the kidney. It is possible that you have a highly active 3A4 enzyme, in this case the body would eliminate the drug very quickly. Also, you could be on any number or drugs that induce the 3A4 system, decreasing your drug levels. These drugs range from certain antibiotics to steroids, to certain anti-seizure meds as well. A good medication history would have eliminated this cause, but there is not always someone around to check these interactions. Also Versed distributes to proteins and fat in the body, so if you have any "abnormalities" there, you may see a decreased effect. I guess my point is, if it is any of these reasons they can still use a different drug from the same class, because a lot of these properties are drug specific and not class specific. It may even be as simple as eliminating your caffeine intake that morning.
However
If it is a pharmacodynamic reason, you will not see any difference using other drugs of the same class. Pharmacodynamics is what the drug does to the body. Benzos facilitate the binding of an inhibitory neurotransmitter in your brain, which is why you see amnesia, anti-anxiolytic, and sedative effects. You could have a high tolerance to these drugs for many reasons. Alcohol, benzos and barbiturates all affect the same pathway in your body, so by chronically using one, you may set yourself up to be tolerant. It could also be just plain old genetics, maybe you are just not as sensitive to benzos as the next guy. So, if it is these reasons, you may not see any effect from switching drugs in the same class.
So, aside from justifying my choice to skip class today, why did I write this? I was just trying to illustrate the multitude of causes for a problem like yours. Your doctor would be aware of all of this information, and could probably do a detailed enough history to eliminate most of the causes. He/She could probably determine whether to switch drugs, switch classes, or even just know to start with higher doses. By telling them you are allergic, you completely shut off the door for any benzo use, under any circumstances, forcing physicians to use secondary options that may not be as good.
A patient who thinks for themselves is a good thing, but you need to understand your own limitations. Physicians are smart, they can handle the truth.
As a side note, ss, do you find Precedex (Dexmedetomidine) to be useful as an adjunct? Is it widely used, or is it still too new to have grabbed a foothold yet? I know there is concern over the CV side effects.
SR
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