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Anxiety Community
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Xanax or Klonopan? Need your advice
by Northcoast, Jun 01, 2007 12:00AM
I suffer from generalized anxiety. Just seem to be stressed and tense most of the time. No panic or anything, just tense muscles in shoulders, neck and jaw. My doctor gave me a xanax prescription and it helps. I take one at night before bed and one in the morning if I feel I need it. At my last visit to my doctor, he prescribed Klonopan instead of the xanax. He said he thought it would get me thru the night better. I've had weird symptoms of not being able to open my eyes for five or so seconds when I get up to pee in the middle of the night. Like my eyes are clamped shut. This may be stress related but not sure. Anyway, does anyone have any advice on moving to Klonopan from the xanax. The pros and cons of each? I'd like to get onto a regimin and take a low dose every day to see if it helps me de-stress and actually enjoy my life. Any feedback would be appreciated. Thanks!
Klonopin has a 50 hour half-life (Xanax has a 4 hour half-life). The anxiolytic effects of Klonopin are longer lasting when compared to Xanax. Klonopin, when taken at a dosage of 1/2 mg BID (twice daily) reaches "steady-state". This gives you full, 24-hr coverage, where as Xanax does not.
Initially, Klonopin may sedate you excessively, which is why the starting dose is 0.25 mg BID. After three days, the dose is increased to 1/2 mg BID. The sedative quality is short lived, lasting about two weeks for the typical person. Since everyone is different, the drug should be individulaized to suit your needs. The target dose is 1/2 mg BID, as the clinical trials showed maximum efficacy at this dosage level.
Give the Klonopin a week or two, and the sedative effect will likely wear off. The anxiolytic (anti-anxiety) effect will be maintained, however.
Pro's and Con's:
XANAX:
Pro's:
-May be used "as needed"
-Rapid onset of action
-Does not accumulate
Con's:
-Not intended for the long-term
-Short half-life, effects wear off quickly (interdose anxiety)
-Tolerance is common (more drug is needed after a relatively short period of time)
-Dependency is high
-Withdrawal phenomena is severe if taken daily or in excessive doses
KLONOPIN:
Pro's:
-Indicated for the long-term management of anxiety/panic
-Intermediate half-life of 50 hours, effects are long lasting
-May be taken everyday as a maintanence anxiolytic
-Fairly easy to discontinue if done properly
-BID dosing maintains a steady-state level for 24-hr coverage
-No "interdose" anxiety
*Con's:
-Not a good "as needed" drug
-Slow onset of action (30 minutes to 2 hours)
-Accumulates
* Only Con's for short-term anxiety disorders. Does not apply to the long-term management of anxiety disorders.
-Ryan
Thank you and have a great day!
Hi Barbara,
Depending on the individual (and his/her metabolism), Ativan's half-life varies between 6-12 hours (median 8 hours).
Ativan is a good "as needed" drug, and it lasts somewhat longer than Xanax. It is also fast acting (even more so in the sublingual form). But it should only be taken "as needed" infrequently (no more than one tablet every other day).
Blocadren (Timolol) is a non-selective beta-blocker. It is a good drug for PAC's/PVC's and to control rapid heart rate (tachycardia). It's an older drug, but it works rather well. Blocadren is usually dosed BID (twice daily), and lasts about 12 hours per dose. Atenolol 50 mg is another choice that offers full, 24-hr coverage with a single daily dose. Atenolol should also have less side effects, as it is cardio-selective (acts only on cardio beta receptors).
I would not recommend Lexapro to anyone with cardiac manifestations of any form, as Lexapro and other SSRI's tend to worsen such manifestations. I personally would not take any SSRI/SNRI drug, for any reason.
If your anxiety condition worsens (recurs more often than it once did), I would recommend Klonopin 1/2 mg BID in place of the PRN Ativan. I would also recommend switching to Atenolol or Toprol-XL 50 mg, which would likely offer better control over the premature beats. I would choose Atenolol over Toprol, mostly because it is more affordable.
-Ryan
A single dose at night is not sufficient to reach "steady-state". While the effects will carry over through part of the next day, the drug will eventually wear off.
Also, the sedative quality will take longer to wear off when dosed qd (once daily).
I'd ask for 1/2 mg BID.
-Ryan
Barbara,
I'm not a *medical* doctor. I'm an electronics engineer, but have done extensive research on pharmaceuticals as well.
A blood pressure of 93/51 isn't very ideal, and it is rare for Atenolol to have such a profound effect on BP (beta-blockers in general are very poor choices for the control of hypertension). They are better suited for *rate* control.
Both Atenolol and Toprol are cardio-selective, while Blocadren (Timolol) isn't. If the Blocadren works most of the time, I'd stick with it. If it doesn't, you can try Inderal 20-40 mg BID instead (also non-selective like Blocadren). Inderal is a bit stronger, and may supress the PAC's to a more tolerable level. You could also ask the doctor to increase the dose of Blocadren/Timolol slightly.
You DO develop a *dependency* to beta-blockers, but not a tolerance to the *efficacy* (ability of the drug to limit the PAC's). The *dependency* is most notable when the drug is discontinued, and manifests primarily as tachycardia and rebound hypertension. You can take an extra dose as-needed with your doctors blessing. I frequently take an extra dose of Atenolol "as-needed". One doesn't develop a tolerance to the effects of beta-blockers.
The frequency of PAC's may also be increased by stress and anxiety. Controlling the anxiety may decrease the frequency of PAC's.
-Ryan