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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Squiggles on August 30, 2001, at 15:14:56
Clonazepam is prescribed primarily as
an anticonvulsant. This makes it distinct
from other benzos. It is definitely different
from my experience, especially upon discontinuation.
Is the chemical composition of clonazepam
significantly different from that of other drugs
in the benzos class? I have heard the argument
that all benzos are the same and it is just a
drug marketing ploy to attribute different therapeutic
properties to them.The question interests me because it is important
in considering switchover methods for withdrawal,
e.g. to Valium which has a longer life. Is the longer
life of one versus the other, the only difference?Anyone with some pharmacological knowledge on
this?Squiggles
Posted by SalArmy4me on August 30, 2001, at 15:21:20
In reply to Clonazepam and other benzos:, posted by Squiggles on August 30, 2001, at 15:14:56
From http://www.vh.org/Providers/Conferences/CPS/33.html (How to Withdraw from Benzodiazepines)
"If the patient is receiving a short-acting BZD, consideration is given to slowly tapering the dose with the prescribed BZD using a similar schedule described above for long-acting BZDs or substituting a cross-tolerant, long- acting BZD. The rationale for the substitution method is the observation of less severe withdrawal symptoms with long-acting compounds. Though several reports suggest this is an acceptable approach to patients receiving a short-acting drug, this method has not been extensively studied (Perry 1981, Harrison 1984, Busto 1986, Albeck 1987). To accomplish the switch from a short-acting to long-acting BZD, approximate equivalent doses for BZD have been suggested (Smith 1983, Busto 1986). (See Table 1) However, inaccuracy in suggested BZD dose equivalents may affect the success of this recommendation. Though, theoretically, any long-acting BZD could be used, diazepam has been the most widely studied (Perry 1981, Harrison 1984, Busto 1986). Recently, clonazepam has been reported to be useful. Herman et al (1987) substituted on average 1 mg of clonazepam for every 2 mg of alprazolam that the 48 panic disorder patients were taking. Thirty-nine (82%) of the patients preferred clonazepam to alprazolam because of decreased interdose anxiety and fewer doses being required per day, e.g., twice daily dosing versus four times daily dosing."
Posted by Elizabeth on August 31, 2001, at 15:36:12
In reply to Clonazepam and other benzos:, posted by Squiggles on August 30, 2001, at 15:14:56
> Clonazepam is prescribed primarily as an anticonvulsant.
I'm not so sure about that. It's widely used in the treatment of anxiety disorders.
> This makes it distinct from other benzos.
The distinction is strictly a legal-political one, not a pharmacological one.
Obviously, the benzos are not all the same substance; there are variations, mostly minor, on the molecular level. One distinctive property of clonazepam is its long duration of action. This makes it well-suited to regular use. It is also relatively more potent than most of the older benzos (the "high-potency" benzos include alprazolam, lorazepam, estazolam, and triazolam as well as clonazepam).
> The question interests me because it is important
> in considering switchover methods for withdrawal,
> e.g. to Valium which has a longer life.The elimination half-life of Valium (and its active metabolite) is deceptive. Valium is rapidly taken up into the CNS (so it starts working shortly after you take it) and then redistributed throughout the body (so its central effects are actually pretty short-lived).
-elizabeth
Posted by Elizabeth on August 31, 2001, at 15:41:51
In reply to Clonazepam and other benzos:, posted by Squiggles on August 30, 2001, at 15:14:56
BTW, Ativan, Valium, and Tranxene are also used as anticonvulsants.
-elizabeth
Posted by Squiggles on September 1, 2001, at 9:34:30
In reply to Re: Clonazepam and other benzos: » Squiggles, posted by Elizabeth on August 31, 2001, at 15:36:12
> > Clonazepam is prescribed primarily as an anticonvulsant.
>
> I'm not so sure about that. It's widely used in the treatment of anxiety disorders.
>
> > This makes it distinct from other benzos.
>
> The distinction is strictly a legal-political one, not a pharmacological one.
>
> Obviously, the benzos are not all the same substance; there are variations, mostly minor, on the molecular level. One distinctive property of clonazepam is its long duration of action. This makes it well-suited to regular use. It is also relatively more potent than most of the older benzos (the "high-potency" benzos include alprazolam, lorazepam, estazolam, and triazolam as well as clonazepam).
>
> > The question interests me because it is important
> > in considering switchover methods for withdrawal,
> > e.g. to Valium which has a longer life.
>
> The elimination half-life of Valium (and its active metabolite) is deceptive. Valium is rapidly taken up into the CNS (so it starts working shortly after you take it) and then redistributed throughout the body (so its central effects are actually pretty short-lived).
>
> -elizabeth
Hi Elizabeth,Clonazepam is not a long-acting benzo - it is
a medium acting benzo. It has a half life of
up to 50 hrs; valium for example is 200 hrs.As for its anticonvulsant properties, though
other benzos will substitute, clonazepam is
used for epilepsy -- i know that from reading
and from my doctor who is familiar with its
use on children -- the doctor is an Obst. so
it's pretty good authority.Squiggles
This is the end of the thread.
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