Clonazepam (klonopin) 24mg a day too much?

[bbq33]

I have been taking Clonazepam for about 25 years or so for seizures and panic attacks. My Doctor has raised my dose to 24mg a day. I seem to be doing fine on this dose. No memory loss, speech problems, walking problems, sleepiness. I am a little tired though. Could be to lack of oxygen from low blood cells because that it just started when it occured. I'm taking iron with a glass of orange juice now. My Doctor and I know 20mg a day is the limit but he thinks 24mg should be fine do to my tolorance. I tried a new medicine (can't even pronounce the name). I dropped my Clonazepam down to 6mg a day over two months. other than the seizures and panic attacks came back, I was surprised that I had no withdrawl systems from the Clonazepam except for little appitite during that time. Lost 23 lbs! I am back up to 24mg a day. For me, even with my tolorance, taking Clonazepam as directed for a medical reason and not for recreation is not addictive. My question: is that much going to hurt my health? It is about the only dose that gives me a good quality of life. Anybody else in my situation. I'm on medical disibility so I can get two months of medicine for $2. Lucky for that!

[RCA759I]

Honestly, Clonazepam should not generally be used as a first line agent for the treatment of epilepsy - the reason being that the anticonvulsant effect is lost after three months in 1/3+ of patients. Generally speaking, Clonazepam would be used as an adjunct in combination with other anticonvulsants at a dosage of 4 mgs or lower daily, rather than in monotherapy. If you've tried other anticonvulsants without benefit (Depakote, Dilantin, Gabatril, Keppra, Lamictal, Neurontin, Lyrica, Phenobarbital and Tegretol), then you would have little choice in the matter.

If you have been relatively well-maintained on Clonazepam for twenty-five years (ie: have not had to increase the dosage in excess of 0.5-1 mgs/year to maintain efficacy), you shouldn't have a problem with the 24 milligrams. The 20 milligram recommendation has more to do with the risk of increased side effects than anything else (ie: cognitive dysfunction, ataxia, somnolence). The actual dosage should be tailored to your needs. So long as you do not experience severe side effects, there is no real concern or contraindication. There is the potential risk of loss of efficacy, in which case increasing the dosage again would likely reestablish efficacy.

I would recommend that you have a Clonazepam serum level obtained, as plasma levels in excess of 70 ng/mL are indicative of excessive accumulation of the parent compound (toxic range). In addition, it is imperative that your serum transaminases and blood counts be measured on a periodic basis to monitor for potential hepatic (liver) complications or thrombocytopenia (low platelet count), anemia, leukopenia, or eosinophilia.

Provided that the above labs are normal and you do not experience adverse effects, Clonazepam will not compromise your health. You are taking it for a legitimate purpose, and you have obviously benefited from it. The side effect profile for Clonazepam (even at this dosage) is benign compared to other anticonvulsants.

I might also point out that the 20 mg figure specified in the prescribing information is a mere recommendation - nothing more. The figure was derived from small clinical trials held in 1976, and is a generalized figure. As with any agent, it needs to be individualized for the patient. Some require only small amounts to achieve control of epilepsy, while others require far more. Don't get hung up on some arbitrary number.

Ryan