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is it ok to take xanax and klonopin combined and which is better for serios anxiety
by sweetmalis, Apr 10, 2007 12:00AM
Hi. I have been on klonopin for about 6 months now and have been as high as 8 mg daily to the 6 mg I take now. I mentioned to my doctor that I felt I was becoming tolerant and was not getting the results I got in the beginning. I have severe anxiety and depression so I have been on alot of meds so this isn't far from true. So he gave me a script of Xanax 1mg to take with the klonopin for now til we feel comfortable enough to wean me off of the klonopin. However after reading alot of these postings I wondering if I made a mistake and should stay with the klonopin? I would appreciate any insight. Thanks Malissa
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First, let me describe the differences between Klonopin (Clonazepam), and Xanax (Alprazolam).
Both drugs are Benzodiazepines (minor tranquilizers), and are indicated for the treatment of anxiety and panic disorder.
Klonopin was designed as a maintanence drug to prevent panic disorder. Klonopin has a long half life, and when taken in two divided doses daily, will establish a "steady-state" blood plasma level. The recommended target dose is 1/2 mg, taken twice daily. Doses of up to 4 mg daily are allowable for Klonopin when used for the treatment of panic disorder. Doses in excess of 4 mg have no additional therapeutic effect.
In 30% of individuals, Klonopin will lose its effectiveness.
Xanax was designed to "stop" the effects of anxiety/panic rapidly (within 10-20 minutes), and is intended for PRN (as needed) use only.
6 mg of Klonopin is a rather massive dose (equal to 120 mg of Valium/Diazepam). Once a dose of 4 mg daily loses it's efficacy, no further benefit can be obtained from Klonopin.
Adding another Benzodiazepine (the Xanax) will probably not prove to be benefical in your case (and the Xanax will have an "additive" effect on the Klonopin, which is undesirable). If you decide to use the Xanax, keep its use to an absolute minimum (using it only when needed), as to prevent loss of efficacy. Combining two Benzodiazepines together is poor practice, as it will only serve to increase tolerance to Benzodiazepines.
At this point (in my opinion), the Klonopin should be withdrawn very gradually, and substituted with another class of anxiolytic (anti-anxiety drug). The Klonopin should be withdrawn is 0.125 mg incriments, every two weeks, until the drug is completely withdrawn. This slow taper regimen will prevent or minimize withdrawal phenomenon.
6 mg, as stated, is a fairly uncommon dosage, and its gradual withdrawal is essential. A crossover to Valium (Diazepam) may be necessary to remove the drug safely at this point.
Furthermore, Klonopin and most Benzodiazepines aggrevate depression (particularly, Klonopin). Switching to a Tricyclic antidepressant with both anxiolytic and antidepressant effects would be a good choice (Sinequan-Doxepin).
Trileptal was mentioned above, and it has NO useful indication for depression/anxiety. Trileptal is a derivative of Tegretol (Carbamazepine), and is used in epilepsy, and in bipolar disorder as a mood stabilizer.
At this point, you need to speak with your Psychiatrist about a switch in medication. Clearly, the Klonopin has lost its efficacy. The drug will need to be withdrawn slowly, and another drug substituted simultaneously in its place. I would suggest Sinequan.
-Ryan
-Kim