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Does Klonopin cause weight gain?
by fearfactor, Aug 02, 2007 03:24PM
I posted this under another topic on Klonopin but thought I'd start a thread all its own. I take Xanax and have thought about trying Klonopin since it's longer acting and to help me get off Xanax. I have read that Stevie Nicks had a really bad time with Klonopin and she said it caused her major weight gain. This CANNOT happen to me. Is it true Klonopin causes weight gain? Anyone experience this?
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Ultimately, the issue with Xanax is tolerance and loss of efficacy. After an "X" amount of time (typicaly four months) of prolonged use, Xanax simply loses its benefits. Continued use would not provide any benefical results at all, and you'd simply be taking the Xanax to prevent withdrawal phenomena. Once this occurs, it is important not to increase the dosage, as the same tolerance issues will result.
Switching to a long acting drug (Klonopin, Librium, Valium) is the better option, as the incidence of tolerance is far lower. Librium and Valium are good for treating "generalized" anxiety, and Klonopin is specific towards "panic".
Klonopin works on the principals of steady-state and accumulation. By maintaining a steady-state plasma level, Klonopin will greatly minimize or prevent panic and panic attacks from recurring. Nothing works 100%, although dramatic benefits can be had.
Keep in mind that if you take Xanax multiple times/day (typical dose would be 0.5 mg, t.i.d), that making the transition to Klonopin would not be instantaneous, and would require some patience on your part. There is a 3-14 day "window of vulnerability", during which time you will go through Xanax withdrawal. Klonopin reaches steady-state in roughly two weeks. The first 3 days would be the worst of it, and with each dose of Klonopin you take, it would accumulate towards steady-state. The withdrawal symptoms will gradually subside, and you will notice the full benefit within two weeks.
Xanax and Klonopin are dose equivalent. 1/2 mg = 1/2 mg in terms of potency.
Ryan
Thanks again!
If you want to get of off Benzo's all together, talk to your doctor about implementing a dose equivalent of Klonopin. Klonopin and Xanax are dose equivalent (0.25 mg = 0.25 mg). Klonopin 0.25 mg, b.i.d would be the equivalent to the dose of Xanax that you are currently taking.
Stabilize on Klonopin for one month. Every FOUR weeks, cut 0.125 mg from the daily dose, starting with the morning dose. Alternate between the morning and night doses every FOUR weeks, until the drug is discontinued. Total duration of taper = 16 weeks. This drug should not be tapered any faster than 0.125 mg every four weeks.
I would highly doubt that weight gain would be an issue, considering the very low dosage.
Ryan
You need to consult with a specialist - preferably an OB/GYN or an endocrinologist. What you describe is typical of hormonal balance - the result of menopause. This may be treated with oral conjugated Estrogens, such as Progesterone and Methyltestosterone. The loss and breakdown of Progesterone often mimicks anxiety symptoms and a constellation of other symptoms, such as insomnia.
You don't state the nature of the pain, but loss of bone density and osteoporosis are also common in states of hormonal imbalance and menopause. These are treated with oral Calcium supplements. Loss of bone density will absolutely lead to pain- indirectly.
Speak with the doctor in regards to your concerns. Referral to an OB/GYN or endocrinologist is warranted based on your description. These two specialists will be able to manage your symptoms more effectively as compared to a GP. I'd also recommend a bone density scan to assess for bone degeneration. If present, your GP can prescribe oral Calcium supplements to prevent further bone degeneration.
Cordially,
Ryan
^quote
That's a bizarre question to ask.
Chemically, Klonopin is:
5-(2-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4 benzodiazepin-2-one.
Looking at this formula, Klonopin is an Aromatic, Chlorinated Nitrobenzodiazepine. Unlike other Benzodiazepines, it contains a nitro ring instead of an oxide ring. This has to be oxidized (converted to oxide).
The biotransformation of Klonopin follows two pathways:
(1) Oxidative hydroxylation at the C-3 position (hepatic)
and:
(2) Reduction of the 7-nitro function to form 7-amino and 7-acetyl-amino derivatives. These are proteins, and Klonopin is highly bound in protein.
The 7-nitro function reacts with oxygen during hepatic metabolization, producing oxide. The rapid reaction of the 7-nitro function with oxygen produces free oxide radicals. The consequence of these free radicals on human physiology is unknown at the present time.
There are two scientific points of view on free radicals:
(1) That free radical promote disease and accelerate the aging process
and:
(2) That free radicals inhibit disease and halt the progression of aging
There is no concrete scientific evidence at the present time to support either view point, or to support that free radicals have any impact on physiology at all. There is not one shred of evidence that the metabolization of Klonopin accelerates disease or aging.
For what it's worth, a customer of mine has been on 1.5 milligrams of Klonopin daily since 1976. He is sixty years old, but looks 45. That's 32-years of use. I might also point out that he has never increased the dosage, nor has he experienced a full-blown panic attack in those 32 years. In his own words: "I still get funny sometimes, but I can talk myself out of it".
If there is any merit to the free radical theory, it would appear (in this man's case), that theory #2 holds water.
Ryan
^quote
That's a bizarre question to ask.
Chemically, Klonopin is:
5-(2-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4 benzodiazepin-2-one.
Looking at this formula, Klonopin is an Aromatic, Chlorinated Nitrobenzodiazepine. Unlike other Benzodiazepines, it contains a nitro ring instead of an oxide ring. This has to be oxidized (converted to oxide).
The biotransformation of Klonopin follows two pathways:
(1) Oxidative hydroxylation at the C-3 position (hepatic)
and:
(2) Reduction of the 7-nitro function to form 7-amino and 7-acetyl-amino derivatives. These are proteins, and Klonopin is highly bound in protein.
The 7-nitro function reacts with oxygen during hepatic metabolization, producing oxide. The rapid reaction of the 7-nitro function with oxygen produces free oxide radicals. The consequence of these free radicals on human physiology is unknown at the present time.
There are two scientific points of view on free radicals:
(1) That free radical promote disease and accelerate the aging process
and:
(2) That free radicals inhibit disease and halt the progression of aging
There is no concrete scientific evidence at the present time to support either view point, or to support that free radicals have any impact on physiology at all. There is not one shred of evidence that the metabolization of Klonopin accelerates disease or aging.
For what it's worth, a customer of mine has been on 1.5 milligrams of Klonopin daily since 1976. He is sixty years old, but looks 45. That's 32-years of use. I might also point out that he has never increased the dosage, nor has he experienced a full-blown panic attack in those 32 years. In his own words: "I still get funny sometimes, but I can talk myself out of it".
If there is any merit to the free radical theory, it would appear (in this man's case), that theory #2 holds water.
Ryan
^quote
That's a bizarre question to ask.
Chemically, Klonopin is:
5-(2-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4 benzodiazepin-2-one.
Looking at this formula, Klonopin is an Aromatic, Chlorinated Nitrobenzodiazepine. Unlike other Benzodiazepines, it contains a nitro ring instead of an oxide ring. This has to be oxidized (converted to oxide).
The biotransformation of Klonopin follows two pathways:
(1) Oxidative hydroxylation at the C-3 position (hepatic)
and:
(2) Reduction of the 7-nitro function to form 7-amino and 7-acetyl-amino derivatives. These are proteins, and Klonopin is highly bound in protein.
The 7-nitro function reacts with oxygen during hepatic metabolization, producing oxide. The rapid reaction of the 7-nitro function with oxygen produces free oxide radicals. The consequence of these free radicals on human physiology is unknown at the present time.
There are two scientific points of view on free radicals:
(1) That free radical promote disease and accelerate the aging process
and:
(2) That free radicals inhibit disease and halt the progression of aging
There is no concrete scientific evidence at the present time to support either view point, or to support that free radicals have any impact on physiology at all. There is not one shred of evidence that the metabolization of Klonopin accelerates disease or aging.
For what it's worth, a customer of mine has been on 1.5 milligrams of Klonopin daily since 1976. He is sixty years old, but looks 45. That's 32-years of use. I might also point out that he has never increased the dosage, nor has he experienced a full-blown panic attack in those 32 years. In his own words: "I still get funny sometimes, but I can talk myself out of it".
If there is any merit to the free radical theory, it would appear (in this man's case), that theory #2 holds water.
Ryan
If you are taking Xanax daily, you are not taking it p.r.n., but rather for maintenance purposes. Xanax is not intended to serve as a manintenance drug, as tolerance to its clinical effects tend to develop after prolonged use. There is no body of evidence available to determine how quickly tolerance builds to the anxiolytic effect of Xanax - but it is believed to occur after four months of chronic use.
From a therapeutic standpoint, 0.5 milligrams of Xanax is equal to 0.25 mg of Klonopin.
Of the two drugs, Klonopin is more ideal for the long-term management of panic disorder. Xanax is a good stand-by drug for emergencies, but it would appear that you're taking it daily. The simultaneous administration of two high-potency Benzodiazepines increases the risk of the development of tolerance and untoward effects, and also likely explains the somnolence that you continue to experience.
Would speak with the prescribing physican about removing the Xanax entirely, and replacing it with a dose equivalent of Klonopin in the morning (0.5 mg). You should not stop taking the Xanax if you have been using it on a daily basis. After two weeks, the daily Klonopin dosage should be divided (ie: 0.5 mg, three-to-four times daily). This will minimize somnolence. You can discuss this option with your doctor.
Ryan
Klonopin is most specific for panic. As of late, it's being prescribed more and more for other anxiety disorders as well (again, often with great success).
You should give the Klonopin an honest evaluation. Klonopin reaches steady-state in two weeks and accumulates to 1.5 times that of steady-state within one month. What this means is that at all times, you have the plasma equivalent of 0.5 mg in your system on top of the therapeutic steady-state figure (a sort of reserve).
I hope Klonopin proves to be effective for you, as the other options (mainly Valium) are not nearly as smooth in their action. Valium, for instance, has a sluggish onset of action and then peaks rapidly in the plasma. The duration of action for one dose is 6-8 hours only, despite the drug's long half-life. The main problem with Valium is that it is nearly 100% protein bound, highly lipophilic, and readily crosses the blood-brain barrier. It doesn't stay in the brain for long, but rather is redistributed to adipose tissue and stored. A long half-life is only of value if the drug stays where it belongs....in your head.
Never-the-less, Valium would be the second option, and the minimum *typical* effective dosage for GAD is 5 mg, q.i.d. It's not as convenient as Klonopin, as it must be dosed four times daily. Interdose is also common with Valium, but is not usually apparent with Klonopin (which has a duration of action ranging from 12-18 hours after a single dose. 12 hours for intermittent use, and 18 hours for twice daily use).
Tranxene is another option. 15 mg, b.i.d. as is Librium (10-25 mg, q.i.d.) Both drugs are metabolized to Desmethyldiazepam (Valium's main active metabolite). These are good for mild-to-moderate cases.
This should give you a general idea as to why the doctor prescribed Klonopin in favor of the older agents. 1/2 mg, b.i.d. is a standard maintenance dosage. Clinical trials revealed maximum effectiveness at this dosage for panic disorder (the drug has not been studied in GAD). A more typical real-world dosage is 1/2 mg, t.i.d. for more severe cases.
Each of these Benzodiazepine drugs have some trade-off's in the treatment of GAD.. Klonopin's trade-off in GAD is less specificity in favor of prolonged action (but not always). Valium's trade-off in GAD is a short duration of action in favor of greater specificity (but not always). The drugs should be individualized on a case-by-case basis by a psychiatrist. No two people respond alike to these drugs.
Give the Klonopin one month and see where you stand.
Ryan
Also, I posted in the OCD forum about my trichotillomania (hair pulling) that I had as a pre-teen through my 20's. I've recently started to wonder if my life long anxiety and mild depression (on occasion) could be related to a chemical imbalance in my brain that might have caused the trichotillomania years ago also. Do you have any feedback on this? I sometimes wonder if I should be on an anti-depressant but my MD told me he would advise against it since the drug may have long term side effects that we don't even know about now. Do some anti-depressants have anti anxiety properties too? The anxiety is my main issue, but have a bout of mild depression almost every year. Thank you again for your time and advice.
I gained alot of weight while on Klonopin, I gained around 30-40 pounds. But once I stopped using Klonopin, I'm back down to my normal weight, no exercise.
But everyone's system reacts differently to medication, many have taken Klonopin and hardly gained weight or gained non at all. I wasn't one of the lucky ones.
I'm wondering about my body's dryness and if I should go off of this Medication too?
thanks cathy~
And I ate like a total pig. Fast food and any other garbage I could get my hands on. I'd eat and lose five pounds. Seriously. It's one of those bizarre freaky side effects that only affects something like 0.1% of the population. Stress could certainly trigger weight loss, but if you've been losing substantial weight, you may want to consider the possibility that Klonopin induced it. At the minimum, request a complete metabolic panel (CMP) to exclude liver toxicity. It would be best to err on the side of caution.
Klonopin never really touched my severe panic. It helped with hyperventilation and the subsequent "pins and needles" feelings to some extent, but after a span of say about a year, it just compounded the problem. Where I thought I had made progress with certain phobias (particularly driving), I had not, and I didn't realize that until I had discontinued the Klonopin. The worst thing about this drug (and all "downers") is that they virtually negate your attempts at self-recovery by blunting your emotions. What is the point of exposing yourself to the things you fear if you are "dulled down" 24/7? If you are unable to process your feelings and learn from them, you can't recover. I think you'd be surprised at what this drug is actually doing to you, for it isn't doing what you think it is. You are living life in a chemical restraint.
Used during the acute phase of panic, Klonopin is definitely useful. It is beneficial during the acute phase in that it helps the user understand that the symptoms really are induced by panic, and it provides symptomatic relief. Once it is fully understood by the user that the symptoms are "merely provoked by panic", it's time for a new game plan; preferably one without dope. Used over the long-term as a crutch, the drug works against you. Now certainly, there ARE cases where long-term use is justified, but frankly, there aren't very many. Severe agoraphobia is one such use, and chronic health ailments such as CFS is another.
If Klonopin is no longer effective for you, don't increase the dosage, even under the direction of a physician. That is the worst thing you could do. It would be better to augment it with a Tricyclic antidepressant (Tofranil in particular has been studied extensively for use in panic disorder). Remeron is another possibility (you'd likely gain weight with that one). That, in combination with exposure therapy is one of the best ways to rid yourself of the panic. The worst possible way to treat panic is with alcohol, barbs, benzos and other "downers". Not only do those blunt your emotions and lessen the ability to learn new coping skills, they severely worsen depression (which almost always coexists with panic disorder). Many will deny being depressed, but the majority are in some capacity. And those who lean on Klonopin and other benzos, or those who become obsessed with them typically have coexisting major depression. Poly-drug use (the use of alcohol with Klonopin, for instance) also suggest a strong component of underlying depression.
Panic attacks can present in any psychiatric disorder. They are not limited to "panic disorder" - the term used to describe recurring panic attacks and recurring thoughts of having additional attacks, as well as the consequences surrounding the attacks. They can present in major depression, OCD, bipolar disorder, or in isolation. "Pure" panic disorder is rare, and there is usually another feature to complement it - a bigger part of the picture. Depression, an avoidant or antisocial personailty, obsessive-compulsive disorder, post-traumatic stress disorder etc are all possibilities. There are many more.
The first step in overcoming the panic is to get off of Klonopin or anything else that blunts perception. The second step is to unveil the underlying source of it, to gain insight into it, and to understand it. Once you understand what is causing it, expose yourself to it very gradually. It would be helpful to speak with a therapist, licensed social worker or psychologist, as they can help you to gain insight that you may have overlooked.
Perhaps not the response you had in mind, but cures do not come in the way of little orange pills. Ask any psychiatrist how many people he cured of their panic disorder. If the cited figure is greater than zero, run.
Good luck,
Ryan
It seems the reason for gaining weight for me was that it elevated my prolactin to astronomical levels - my Testosterone went down, and my Estrogen went up - hence my spare tire and mood swings...
(the person about mentioning seeing an endo would is wise)
I tried to counter this with magnesium, zinc and B6 but it wasn't strong enough....
Then one day i decided to quit caffenine (if you drink it - its worth a shot), to try to control my anxiety - i felt like total A$$ for 2 weeks - then felt better than ever - T levels went up - Estrogen, prolactin, and anxiety went down...(Females need optimum levels of Testosterone too - female levels)
If you get extremely depressed about 3-4 days after stopping caffeine - you should fare well in controlling your anxitey and getting back to normal in 2-3 weeks...
Might be worth a try...
Additionally, Valium will not instantaneously replace Xanax - Valium must accumulate in your blood plasma to steady-state before the Xanax will be replaced entirely. This process takes between two weeks to one month. Hence, it is advisable to slowly step the Xanax out, while stepping the Valium in to replace it. This way, the Valium accumulates, and the Xanax is withdrawn gradually to prevent withdrawal symptoms while the Valium accumulates. I can write you a schedule on how to perform this.
I will also add that Valium has no useful indication for panic states, and is not effective for panic disorder with agoraphobia. It is, however, a very good long-term choice for generalized anxiety disorder. I would recommend Klonopin over Valium for the long-term maintenance of panic disorder. 4 milligrams (1 mg morning, 1 milligram afternoon and 2 mg at night). Klonopin is more potent (equal in potency to Xanax), and more specific at targeting panic than is Valium.
Good luck,
Ryan
Confused.