![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Nic on May 16, 2001, at 17:41:20
Was wanting to hear from others who are taking or have taken Klonopin for the treatment of Anxiety and Panic Disorder.
Not sure what the right dosage should be.
I have been on 3mg/day for a while now, but it just does not seem to be doing the job. Was wondering how high of a dosage you can take of Klonopin?????Thanks,
Nic
Posted by grapebubblegum on May 16, 2001, at 19:53:20
In reply to Klonopin Question??????, posted by Nic on May 16, 2001, at 17:41:20
Well, do you take that three times a day as in 1 mg at a time? How is the dosage timed?
Posted by grapebubblegum on May 16, 2001, at 20:01:30
In reply to Re: Klonopin Question??????, posted by grapebubblegum on May 16, 2001, at 19:53:20
I guess it would depend on what state of mind you are in. I have .5 mg tablets, and if I feel that I am in a vulnerable state of mind, as in the aura of panic attacks is looming, I take 1/4 of a tablet (only .125 mg) and it helps. That being said, I have been in a panic attack full swing where I dissolved .5 mg in my mouth (I was told that it gets the medication in your system faster that way) and I didn't feel much better. I can remember taking something like 2 or 3 tablets over a period of hours and I was so uncoordinated and could hardly speak, yet I still went to the hospital... sorry if that is depressing to hear.
If I am not in a panic attack, I am very sensitive to meds and even .125 mg is sedating. .5 mg can knock me on my a** if I am not in a true panic state.
Posted by Mitch on May 16, 2001, at 23:54:58
In reply to Re: Klonopin Question??????, posted by grapebubblegum on May 16, 2001, at 20:01:30
I take Klonopin to help prevent panic and the min. is half a .5mg tab three times a day (.75mg/day), and that may increase up to three whole tablets a day as needed 1.5mg/day. The thing that is GOOD about Klonopin is the long half-life (it washes out of your body slower-so you don't have withdrawal troubles. But, the downside is if you are having acute panic troubles like you are describing it usually takes about 4 hrs to reach peak blood level after any dose. (And you need it right now!) All of this is *NOT* depressing to hear-it is just being scientific. This is my suggestion: See if you can take 1.0mg (total) Klonopin a day for *prohylaxis* (prevention) of panic on a longer term basis, but *allow* you to take Xanax or Ativan (sublingually) for acute situations PRN (as needed).
> I guess it would depend on what state of mind you are in. I have .5 mg tablets, and if I feel that I am in a vulnerable state of mind, as in the aura of panic attacks is looming, I take 1/4 of a tablet (only .125 mg) and it helps. That being said, I have been in a panic attack full swing where I dissolved .5 mg in my mouth (I was told that it gets the medication in your system faster that way) and I didn't feel much better. I can remember taking something like 2 or 3 tablets over a period of hours and I was so uncoordinated and could hardly speak, yet I still went to the hospital... sorry if that is depressing to hear.
>
> If I am not in a panic attack, I am very sensitive to meds and even .125 mg is sedating. .5 mg can knock me on my a** if I am not in a true panic state.
Posted by grapebubblegum on May 17, 2001, at 8:07:02
In reply to Re: Klonopin Question??????, posted by Mitch on May 16, 2001, at 23:54:58
Thanks, Mitch. This is something that my pdoc and I go round and round on. I think she has told me in the past to do just what you said, but then she tells me to use the klonopin sparingly because it is addictive and a tolerance to it easily develops. Since I don't like to take a lot of meds, I have been on paxil 20 mg. every day with the klonopin reserved for emergencies. But I am getting really, really tired of paxil.
Here is what she has told me about klonopin; you tell me if it seems right since you seem pretty knowledgeable: She says it is short-acting, and she prefers me on paxil because she says that klonopin can worsen depression over the long term. Also, I don't know why she does not prescribe xanax; I seem to remember that it worked pretty well in emergencies and I guess klonopin does too, but pdocs are so afraid of prescribing xanax because of the addiction potential. Or is it because it is shorter-acting than klonopin with a greater potential of withdrawal anxiety? I know she said that is another downside of ongoing use of benzos; that the wearing off of the effects can cause anxiety that might not have been there otherwise. Anyway, I have clearly shown no propensity toward addictive tendencies since I mince my meds into little fragments and take the bare minimum I need to take for any given situation, and avoid taking them on an ongoing basis.
Posted by Mitch on May 17, 2001, at 11:32:38
In reply to Re: Klonopin Question??????, posted by grapebubblegum on May 17, 2001, at 8:07:02
Your pdoc is correct that it would be *better* to control your panic with AD's instead (that is if you can stand them and find the right one that works). When she is saying that Klonopin is short acting what she really means is that it works best as a "short-term" solution for the panic.
You are correct about Xanax and withdrawal anxiety. I saw a behavioural neuro that told me he *rarely* prescribes it because of that, he said: "With Xanax all you are doing is treating a withdrawal". I am not as concerned with the problem of addiction as with the problem of *tolerance*-because that means the benzo could stop working for you! And you have to take more. That is why she wants you to PRN the Klonopin. If you hate the Paxil-find another AD to take that will control your panic. I would suggest a more activating SSRI (i.e. Zoloft)and see how it goes (Paxil is fairly sedating-you said you were getting "very very tired" of Paxil). If you find that makes you too sleepy-maybe try some Effexor.
Hope this is of some help,
Mitch> Thanks, Mitch. This is something that my pdoc and I go round and round on. I think she has told me in the past to do just what you said, but then she tells me to use the klonopin sparingly because it is addictive and a tolerance to it easily develops. Since I don't like to take a lot of meds, I have been on paxil 20 mg. every day with the klonopin reserved for emergencies. But I am getting really, really tired of paxil.
>
> Here is what she has told me about klonopin; you tell me if it seems right since you seem pretty knowledgeable: She says it is short-acting, and she prefers me on paxil because she says that klonopin can worsen depression over the long term. Also, I don't know why she does not prescribe xanax; I seem to remember that it worked pretty well in emergencies and I guess klonopin does too, but pdocs are so afraid of prescribing xanax because of the addiction potential. Or is it because it is shorter-acting than klonopin with a greater potential of withdrawal anxiety? I know she said that is another downside of ongoing use of benzos; that the wearing off of the effects can cause anxiety that might not have been there otherwise. Anyway, I have clearly shown no propensity toward addictive tendencies since I mince my meds into little fragments and take the bare minimum I need to take for any given situation, and avoid taking them on an ongoing basis.
Posted by loosmrbls on May 17, 2001, at 12:34:04
In reply to Klonopin Question??????, posted by Nic on May 16, 2001, at 17:41:20
Klonopin has been around for a long time, and it is used for several different conditions.
It was used in the past for seizures/epilepsy and doses up to 20mg/day were given. It is also used for mania in varying doses.
For anxiety/panic, the dose varies but 3mg sounds like a good dose. However, if you are not sedated or affected by it at all, I can't see how increasing the dose would hurt. It's first major side effect will be sedation. If you do decide to play with the dose, don't drive and take it slow.
Posted by JohnM on May 17, 2001, at 18:43:07
In reply to Re: Klonopin Question??????, posted by Mitch on May 17, 2001, at 11:32:38
First of all, research I have read along with my experience is that tolerance does NOT develop with benzos.
I've used Xanax and would not recommend it because of the nasty rebound anxiety. I find Klonopin is quite potent and I can get by with eighths of a 0.5 tablet much of the time. I find Klonopin starts to work in a half-hour and reaches peak after about 2 hours.The negative I find with Klonopin is that it flattens my mood somewhat and reduces cognition slightly--that's why I have opted for smaller and smaller doses.
Posted by Alan on May 17, 2001, at 22:17:06
In reply to Re: Tolerance does NOT develop with benzodiazepines, posted by Alan on May 17, 2001, at 22:07:18
> > First of all, research I have read along with my experience is that tolerance does NOT develop with benzos.
> >
> > I've used Xanax and would not recommend it because of the nasty rebound anxiety. I find Klonopin is quite potent and I can get by with eighths of a 0.5 tablet much of the time. I find Klonopin starts to work in a half-hour and reaches peak after about 2 hours.
> >
> > The negative I find with Klonopin is that it flattens my mood somewhat and reduces cognition slightly--that's why I have opted for smaller and smaller doses.
*******************************
Ooops! sorry about the double post.
Wow! You're just asking for trouble from the anti-benzo lobby/zealots. I can just see it now...."addiction worse than cocaine and heroin", "addiction hell stories from xanax", etc, etc. Lotsa luck!Here's a good site talking about the description of/treatment of panic disorder that is well worth the time to read through...
http://bearpaw8.tripod.com/pd.html
and another about how to taper off of xanax when you're ready along with your doc....
http://lexington-on-line.com/naf_xanax.html
Happy reading!
Alan
Posted by loosmrbls on May 18, 2001, at 8:15:51
In reply to Tolerance does NOT develop with benzodiazepines, posted by JohnM on May 17, 2001, at 18:43:07
I am not an anti-benzo zealot, but tolerance to benzodiazepines is well described. It varies from person to person, but it does exist.
Posted by Cam W. on May 18, 2001, at 9:02:48
In reply to Tolerance does NOT develop with benzodiazepines, posted by JohnM on May 17, 2001, at 18:43:07
John - Tolerance does occur to the psychomotor side effects (ataxia, dizziness, "stoned feeling", etc >), but not the anxiolytic activity of benzodiazepines. Unfortunately, many people equate the psychomotor side effects with the anxiolytic (anti-anxiety) effects and when then "benzo-feel" is not there, many of these people increase their dose to get the psychomotor effects back.
I hope that this is of some help. - Cam
Posted by Mr.Scott on May 18, 2001, at 12:53:53
In reply to Re: Tolerance does NOT develop with benzodiazepines » JohnM, posted by Cam W. on May 18, 2001, at 9:02:48
Here's my two cents worth after using benzo's for extended periods of time at one time or another in my life.
1) Tolerance develops to many of the effects but Never to the amnestic effects (memory impairing), and only minimally if at all to the antianxiety effects.
2) They all suck wind to come off of, but with slow titration it is usually doable without going into the hospital. Neurontin and Tegretol may be helpful with this.
3) It is easier to taper a longer acting less potent drug, but still aint no cake walk.
4) People rarely abuse benzo's in the way street drugs are abused unless it is part of the street drug usage. (ie. coming off of a coke high, increasing effects of heroin, etc.)
5) The UK is a perfect example of how big government can go too far (New York too). It sounds like They might as well regulate Effexor and Paxil too from what I have heard on this board. I could never think of taking Effexor even though it might be a life saver (as benzo's were) after reading all the posts here.
6) Anxiety is the second leading non-psychotic cause of suicide in the US.
7) I don't buy the horror stories, unless you are talking about the rare person who was taking 30 mg of Ativan for 10 years.
Posted by JahL on May 18, 2001, at 13:31:53
In reply to Re: Tolerance does NOT develop with benzodiazepines, posted by Mr.Scott on May 18, 2001, at 12:53:53
> 5) The UK is a perfect example of how big government can go too farTell me about it. I can only get 5 days worth of low-dose diazepam at a time, despite the fact I've been an insomniac all my life, & I've known my doc for years. I don't even *like* benzos.
J.
NHS= No Help, Silly.
Posted by JohnM on May 20, 2001, at 7:55:11
In reply to Re: Tolerance does NOT develop with benzodiazepines » JohnM, posted by Cam W. on May 18, 2001, at 9:02:48
Good point! :)
Posted by JohnM on May 20, 2001, at 10:21:08
In reply to Re: Tolerance does NOT develop with benzodiazepines, posted by Alan on May 17, 2001, at 22:17:06
Those are some great sites!
Posted by Nic on May 21, 2001, at 13:53:55
In reply to Re: Klonopin Question??????, posted by grapebubblegum on May 16, 2001, at 20:01:30
>Thanks for all the great reponses, I really appreciated.
I do take 3mg./day as in 1mg/3 times a day.
I have experimented with going as far as 6mg/day and that seemed to work the best for me, but my Psy-doc does not want me to take anything over 3mg/day.Thanks,
Nic
I guess it would depend on what state of mind you are in. I have .5 mg tablets, and if I feel that I am in a vulnerable state of mind, as in the aura of panic attacks is looming, I take 1/4 of a tablet (only .125 mg) and it helps. That being said, I have been in a panic attack full swing where I dissolved .5 mg in my mouth (I was told that it gets the medication in your system faster that way) and I didn't feel much better. I can remember taking something like 2 or 3 tablets over a period of hours and I was so uncoordinated and could hardly speak, yet I still went to the hospital... sorry if that is depressing to hear.
>
> If I am not in a panic attack, I am very sensitive to meds and even .125 mg is sedating. .5 mg can knock me on my a** if I am not in a true panic state.
Posted by gilbert on May 21, 2001, at 22:33:43
In reply to Re: Klonopin Question??????, posted by Mitch on May 17, 2001, at 11:32:38
The most reputable panic anxiety sites on the internet recommend the use of benzos as a first line treatment for anxieties. Keep in mind the big rush to use the ssri's is that the patents have not run out on these drugs and the pharmacuetical reps are pushing them down the medical establishments throats. I have personally used xanax without any of the rebound effects or other negative comments you hear or read about. It is by the far the most effective drug for panic and anxiety. I am on the same dose I have always been on. If you look in the websites like tapir or anxieties.com you will see that the people that suffer from this disabeling problem have the greatest success with benzos. Without all the side effects of the ssris. The purist will shout from the mountain tops that you are not getting to the main chemical imbalance with benzos.....horse crap I have tried all the ADs including tricyclics they all made me a basket case or unable to perform sexually not to mention I felt like a damned robot. I have been more stoned out on a good ssri than any amount of xanax will ever do. You will see once the patents on the ssris run out and the next batch of wonder drugs come up we will hear how the ssris are addicting or the ssris are not going to fix the root chemical cause the way the new drugs will. Ya see my xanax costs under 30 bucks per month and my celexa used to cost me 80 bucks a month. The studies and I mean the good non biased non drug company funded studies show ssris to be quite ineffective for panic and social aniety disorder if you search the net long enough you will find them. When you go to your doctors office or pdocs look around at all the literature in the waiting room you will see no point of sale or brochures for non patented protected drugs....why because the drug reps and companies make far less money on them....When is the last time you saw an Elavil brochure in a doctors office. So be carefull everything you hear about the "big bad benzos" is more market driven than concern for your well being..................Gil
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.