Ativan Addict change to Klonopin?

I hope someone can help me.  I've really screwed up.

I've been on Ativan for 6 years.  4 mgs a day...1 mg at 7 pm, 1 at 11 pm, 2 at 3 am.  
I know that is a strange schedule but I have panic attacks only at night and can't sleep.

I noticed I was about 30 pills short over the last couple of months.  I asked the pharmacist about it and they did not show a discrepancy in their numbers.  The pharmacist suggested that I could be getting up in the middle of the night and taking an extra dose, having forgotten that I already took my scheduled dose.  

This totally freaks me out because I don't remember doing anything like this, but I was informed that long term Ativan use can lead to memory problems....sort of like people who take sleeping pills and then they wake up and take another......

So I am running out of pills early.  I'm terrified of withdrawal....been there, done that...for many different drugs in my life all prescribed of course.  Gotta love these docs.

I am embarrassed and humiliated to go to my doctor early and ask for pills.  I do not believe I am trustworthy, because I am in recovery for alcoholism (yes, I know how this all sounds......) but have been off booze for 20 years.  And I know what it will sound like to anyone who understands addiction...Gee Doc, really I didn't mean to take extra pills....I mean, I barely believe it myself.

I went to see a different doctor a few months ago for an emergency in a different town (kidney stone) and he told me Ativan was bad...that I should be taking Klonopin.  He gave me a prescription.

So the question is:  I need to take Klonopin for 5 days or so until I can get my Ativan prescription filled.

How much do I take?  With the strange pill schedule with all my pills bunched up at night, I am afraid to take too much Klonopin.  I have never taken it before.  I have read these forums and realize it will make me sleepier than Ativan.  But I have no idea what dose I should take and when.

I'm pretty scared.

And if there is a silver lining here...I've decided I'm done with prescriptions.  Easy to say, right? But seriously, after reading these forums I have so many symptoms from the Ativan, that I never connected with Ativan.  Severe depression, isolation, suicidal tendancies, and almost violent anger can come over me, when I am just about the mousiest person in the world.  I had no idea this drug was changing my personality like this.  And I want to go back being myself.

Can anyone help?

Thanks for your time.

TotallyLoca

[lynn57]

I would slowly work the Klonopin in, with the doctors help.  Your schedule is off the wall.  You are not getting a good night''s sleep if you have to wake up to take another dose of ativan.  The second doctor you saw that suggested the Klonopin was right in my opinion.  Ativan is not a good long term drug.  Klonopin two to three times a day(even though you only have a prob at night) will keep you steady and within a week you should be sleeping normally.  You should never have to get up in the middle of the night to take a dose of medicine.  No wonder you have depression and anger,.  You are sleep deprived.  Please talk to your doc and tell him what is going on.  If he won't help find a new doctor!

[frankenkittie]

Effexor XR has been my lifesaver when it comes to panic attacks. I took it for 6 years with not a single panic attack, went off it for 6 months (BAD CHOICE) and am going back on it now. Is there a reason you are taking benzodiazipenes long term? Especially with your history of addiction, I would say this is a bad idea. I would check out Effexor or Zoloft (what I took when I was pregnant and could not take Effexor) Zoloft didn't work quite as well, but close. Panic disorder is not something that just goes away, and you don't want to take benzos forever as they are highly addictive and the effecacy wears off fairly quickly requiring you to take more to achieve the same effects.

[nursegirl6572]

To be honest, I don't think that any benzo would be a great choice for you, just based on what you've shared.  It's great that you made the decision to stop the meds, because quite frankly, I think you're treading on some possibly dangerous ground here.  Like lynn said, for starters, you shouldn't need to wake up and "re-dose".  Also, the fact that somehow you're missing doses and not entirely sure HOW is worrisome.

All of that being said, please do NOT attempt a taper yourself.  With benzos, it can be dangerous, and your dose is moderately high compared to average,  I think you really need to just lay it all out on the table with your doctor, telling him exactly what you've told us here.  I realize it sounds "weird" (your missing doses, etc), but you need his help to do this safely and properly.  100% honesty and a frank discussion with your doc is necessary here.  Sure, he might not "buy" everything, and that's OK.  YOU even recognize that it's kind of a wonky situation.  The important thing is that you explain what is going on, your wish to stop the Ativam, and do so safely.

I think it also is important to come up with an alternate way to treating anxiety, whether it be with antidepressant meds, therapy, or both.  Again, this is something you need to communicate with your doc.  I just don't think Klonopin would be the way to go, even just if you used it to come off the Ativan.  It actually would make more sense to simply taper off the Ativan....get to your doctor and ask him.

Please let us know how you're doing...best of luck!

[lynn57]

It didn't sound to me like she has made a decision to quit benzos.  She was asking about taking Klonopin until she could refill her ativan.  I think that Klonopin is the lesser of two evils for her if she is going to continue with the meds.  Like I said, it can't be good getting up at night to re-dose.  She probably was half asleep and really did take extra pills.  This is a scary situation and the middle of the night dosing needs to stop.

[nursegirl6572]

Hiya Lynn...I got that notion from this quote in her OP..

"And if there is a silver lining here...I've decided I'm done with prescriptions"

I agree that if she IS going to stay on something like a benzo, Klonopin would make far more sense, due to the long acting nature of it.  I'm surprised a doctor would even recommend a dosing schedule like that...with a middle of the night dose!  That just doesn't make any sense!  No wonder the OP is missing pills...she's half a asleep and popping pills due to routine!

The only other thing that concerns me is her substance abuse history (alcoholism).  

Hopefully her doctor will be receptive to helping her find a better solution, b/c her current regimen is just not good!  

[lynn57]

Thanks nurse girl!  We both put the emphasis on different parts.  Totally Loca, you are the one making this decision.  I am a bit concerned that a stranger (the doc from out of town) prescribed you Klonopin when he knew you had another doctor prescribing you ativan. He should of instructed you to ask your regular doc about that change over.  Now you are left not knowing the dose of Klonopin to take, but it should be on the script.  If he knew what your script of Ativan was for, he probably prescribed the proper crossover dose.  Check with your regular doctor to make the change.  Or if you are looking to wean off Ativan, Klonopin or Valium are sometimes used to make the taper easier because of their longer half-life.  You really must involve your regular doctor in this, anyway.

[TotallyLoca]

Thanks so much to everyone for answering and giving suggestions.

I should have clarified, that I have a strange schedule due to my job.  I do not wake up in the middle of the night to take my last dose.  I go to bed around 4 am and awaken around noon.

I was shocked actually when the out of town doc gave me the Klonopin prescription.  I was honest and told him about my history with addiction, but he gave it to me anyway.  I never filled it, but did keep the paper ( I guess that in and of itself is a sign of addiction).

I went off Ativan when I went off alcohol.  When my panic came back, they put me on Xanax for a couple of years.  I got off of that about 15 years ago, but then my panic attacks came back about 6 years ago.  Sometimes I can go a long time between bouts of panic attacks, or if I get them, they are specific to something like upcoming surgery or something stressful, but not enough to have me take pills daily.  I am hoping that when I get off the drugs this time, my panic won't be bad.  I hope.  Or that I don't need to take something every day, just as needed.

I have tried just about every anti depressant on the market.  I generally throw them up, or have other digestive side effects that I cannot tolerate, so I have never been on them for more than a week...not enough to work and not enough to get past the side effects, unfortunately.  And I have been in therapy also off and on.  I do find some relief in biofeedback, but not in talk therapy.

What I can tell by what you all say, is that Klonopin is easier to come off of than Ativan?  I have tried in the past two years or so, to taper off Ativan every now and then, and I have gotten down to 2.5 mgs/day but have never made it past that point.  It is very frustrating.  I get some panic, but mostly high anxiety.....like my brain is saying NO Don't do this, you NEED drugs to function!  So I end up back on my normal dose.

But I am so tired of drugs.  And I don't like how I feel and who I have become.  And even before this, I was always nervous every month if I would be able to get my pills on time.  I travel weekly for my job, and am not always home or near a chain pharmacy to fill my prescription.  Sometimes I think that simply worrying about getting the pills is causing me to have anxiety and panic.  

So very frustrating.  Sometimes, I don't think doctors know what they are doing.  On the other hand, I am the one who accepted the pills so it is my doing also.

Again, thank you so much for your input.  I may just have to humble myself and call my long time doc and explain.  I'm just scared.  We are very good friends and it is not a comfortable situation explaining to a friend who trusted you, that somehow, you blew it.

[lynn57]

If your script for Klonopin was written months ago, I don't think the pharmacy can fill it anyway because controlled substances usually only have a thirty day window with no refills.Maybe a new local doctor is in order.  Tell him your story and go from there.