Klonapin

[alone33]

I take .5 four times a day of Klonapin, I also take 10mg of lexapro for SA. I'm thinking of getting off or not taking the Klonapin with my psychiyitrists help. The Klonapin makes me very tired and or sleepy. I'm thinking of getting a driving job but the Klonapin would get in the way. Is Lexapro enough? I started the Klonapin first about 7 to 10 years ago. Then took the lexapro about 3 or 4 years ago. Any comments, advice etc.. I'd appreciate. Thank you.

[Medline]

I don't know why you take Klonopin 4 times a day (because of it's long half-life this doesn't make too much sense IMHO), but ok. So you take (2mg) Klonopin daily since about 7-10 years? In this case tapering it down (or changing to Valium / Librium and tapering that down) should be done really slowly to avoid (potentially dangerous) withdrawal symptoms. You may ask your Pdoc to increase your Lexapro dose to 20mg btw.

[GSH]

Originally Posted by alone33

I started the Klonapin first about 7 to 10 years ago.

Pfff...let us know how that goes

[arth67]

theres no sense in KI at 4 times a day maybe its some placebo ritual, a single dose lasts about 4 hours and it should only be taken as needed

is the lexapro working for your anxiety, sometimes it does, sometimes not, this is the most important question, if it did help but quit, maybe up dose to 20

[alone33]

Thanks, arth67 for your comment. I really think the lexapro is working at 10mg. I'm not sure if I understand completly the placebo ritual thing you mentioned? It makes me tired and then feeling groggy in the morning wanting cigarettes and coffee. thank you again.

[Bluemeow]

I take my Lexapro before I go to bed instead of in the mornings, and I feel OK in the mornings. Maybe if you switched the time you take it from the morning to evenings it will help offset the tired and groggy feelings you have in the morning.

[meyaj]

Maybe talk to your pdoc about adding modafinil to your regimen, if you can afford it. It's still under patent in the USA (if that's where you are), but it can do wonders for increasing awakeness and alertness. If it's good enough for Air Force pilots, I think it will probably be okay for a driving job

More Lexapro isn't going to be a good substitute for klonopin. Although I wouldn't encourage klonopin in the first place, you've been using it for almost a decade so it won't be that easy to get off.

I agree with medline about switching to valium. Its longer half-life will mean that the drug will be more gradually removed from your body, lessening the severity of the withdrawals. Even then, I'd taper as slowly as you can. I don't know if it's possible in your area, but a compounding pharmacy should be able to make you pills in whatever dose the doctor prescribes. A compounding pharmacy in theory could make it so that you taper, say, 5% a day, rather than a sudden 33% taper every week. It would make it a lot more comfortable, and although it will probably cost you more, benzo withdrawals are the worst and you'll be wishing you didn't cheap out if you taper using the standard doses.

As for 4 times a day being a placebo, I disagree. They're right in that technically klonopin is long-acting enough to not have to take 4 times a day, but such a dosing schedule would give you much more stable blood levels than dosing 1mg twice a day. It might not even be noticeably different, but to say it's useless is hogwash. The only concern I'd have in a situation like this is patient compliance and remembering to take your pill on time, but this is less of a concern with benzos as patients with anxiety and benzos at hand tend to anxiously watch the clock until they can take their next dose.

[Medline]

Originally Posted by meyaj

I agree with medline about switching to valium. Its longer half-life will mean that the drug will be more gradually removed from your body, lessening the severity of the withdrawals. Even then, I'd taper as slowly as you can. I don't know if it's possible in your area, but a compounding pharmacy should be able to make you pills in whatever dose the doctor prescribes. A compounding pharmacy in theory could make it so that you taper, say, 5% a day, rather than a sudden 33% taper every week. It would make it a lot more comfortable, and although it will probably cost you more, benzo withdrawals are the worst and you'll be wishing you didn't cheap out if you taper using the standard doses.

There exists also liquid diazepam for oral use.

Originally Posted by meyaj

As for 4 times a day being a placebo, I disagree. They're right in that technically klonopin is long-acting enough to not have to take 4 times a day, but such a dosing schedule would give you much more stable blood levels than dosing 1mg twice a day. It might not even be noticeably different, but to say it's useless is hogwash. The only concern I'd have in a situation like this is patient compliance and remembering to take your pill on time, but this is less of a concern with benzos as patients with anxiety and benzos at hand tend to anxiously watch the clock until they can take their next dose.

I think after reaching steady state levels taking Klonopin 4 times a day is not necessary.

[jim_morrison]

Originally Posted by meyaj

Maybe talk to your pdoc about adding modafinil to your regimen, if you can afford it. It's still under patent in the USA (if that's where you are), but it can do wonders for increasing awakeness and alertness. If it's good enough for Air Force pilots, I think it will probably be okay for a driving job

One thing which I often wonder about modafinil and benzo polypharmacy, but which I have never seen specifically addressed in medical literature, is the fact that one of modafinils properties involves increasing glutamate and decreasing GABA, benzos ofcourse do the opposite, so adding modafinil to a benzo, makes me wonder 2 things A)would it upset the homeostasis and increase the seizure risk, and B) would it decrease the affectiveness of the benzo. Just something to think about.

In general though I absolutely agree with you, modafinil is a great first line wakefulness promoting agent.

[MissMay1977]

I take 1mg of Klonopin 3x a day. It reduces my anxiety and relieves my physical symptoms such as chest pain, but it does not calm me down. I have asked to be put on Valuim but have had no success.

[Medline]

When I've used Klonopin I always needed 8mg daily (4mg b.i.d.) to significantly reduce my anxiety symptoms. There were times I was on 8mg Klonopin in combination with 200mg Phenobarbital and 60mg Propranolol. This combo was of course very effective in killing anxiety, but I just used it for a couple of weeks as getting physically dependent on both benzos and barbiturates is not actually a good thing. Even with this potent cocktail I was not completely asymptomatic, I had no anxiety anymore and was functional, but I still had problems with my social drive (dopamine seems to play a key role here).