Getting Back to you Ryan

[Pa1965]

In a previous post, I made a typo in my first paragraph making it harder for you to give me solid advice on tapering from the additional 0.5 mgs per day back of Clonazepam down to my maintenance dose of 2 mgs per day (my dose was increased to 2.5 mgs per day).  You asked me to post back with my exact dosages before the increase and how often I was taking them.

I was taking 1 mg bid for a total of 2mgs per day for 11 years before the increase in dosage, and am now taking 1.25 mgs bid for a total of 2.5 mgs per day.  My original doctor prescribed it as bid (every 12 hours) due to it's long half life.

I'm glad to hear dosages under 3 mgs per day (which I've never been at and don't ever want to be at) won't cause tolerance or lose efficacy.  Thanks for clearing that up.  The controversy on this alone has exacerbated my anxiety.

Now that I've been on this increased dosage for a month, how would you recommend I taper back down?

Would I reduce both morning and evening pills by .125 mgs (half of .25 mgs) simultaneously for two weeks, or reduce only my morning pill by .125 mgs for two weeks, then after that, decrease the night dose by .125 mgs for another two weeks?  I may even need this extra dosage, so not even sure if weaning back is something I should do yet since I still have some anxiety peaking through, but in the future I would like to try at least.

I've been on a generic brand of Clonazepam all along by the same manufacturer (Pharmascience).  The drugstore (Wal-mart) told me that they could order the brand name from Roche if I wanted it, but verified for me from their book there that they were equal 1:1.  What would you suggest?

Thanks for all of your expert advice, Ryan.  I really appreciate your input.

[Pa1965]

bump

[RCA7591]

"I was taking 1 mg bid for a total of 2mgs per day for 11 years before the increase in dosage, and am now taking 1.25 mgs bid for a total of 2.5 mgs per day.  My original doctor prescribed it as bid (every 12 hours) due to it's long half life."

^quote

If you wish to eliminate the extra 0.5 mg dosage from your routine and return to 2 mg daily, simply remove 0.25 mg from the morning dosage (continue to take the nighly 0.25 mg dosage). After two weeks, eliminate the night dosage of 0.25 mg. You are now back on your original daily dosage of 2 mg.  

You can also remove 0.125 mg from both the morning and night dosages, and discontinue the other 0.125 mg, b.i.d. after two weeks.

Either way is fine. The doctor should be notified of your intentions to reduce the dosage. You should only reduce the dosage if your symptoms are under good control. One month is not a prolonged period, and you should not experience any withdrawal phenomena. If you do intend to reduce the dosage, it should be done as soon as possible to prevent further accumulation.

If withdrawal symptoms appear after reducing the dosage (highly unlikely), they would do so after 3-14 days (depending on the individual). Such symptoms would NOT occur overnight, and if they did, you would then know that obsessive thinking (and not the drug) was at fault.

2.5 mg is not an excessive dosage, and if you feel as though you require it, take it as prescribed. Medical literature states that dosages under 4 mg are not associated with the development of tolerance. I like to give a margin of safety, and recommend no more than 3 mg daily. The larger dosages should be reserved for epilepsy only (4-8 mg).

Clonazepam will NEVER lose its efficacy in the case of panic disorder, provided that the daily dosage remains at or below 3 mg, and the drug is dosed at least twice daily.

The generic, in my objective and subjective opinion, is not equal to brand name Roche Klonopin. If you search the FDA documents, Mylan was the first generic manufacturer granted permission to produce Clonazepam. When compared to Roche, it fell short in bioavailability, potency, AUC(max), and T(max). In other words, the generic had less bioavailability, was less potent, and peaked more rapidly after administration compared to Roche Klonopin. Clonazepam, being an anticonvulsant, is an NTI (narrow therapeutic index) drug.

However, none of this applies to you. It would only apply to someone who was formally taking Roche Klonopin, and switched to a generic. Here is where problems may occur. I always suggest sticking to one brand, as this ensures consistency. The average cost of (60) 1 mg Clonazepam tablets is $20, while brand Klonopin is $125. With insurance, the generic copay is typically $10 (or less), while insurance rarely pays for brand name. If they do, the average copay is $50. Due to cost, I would not suggest switching to brand name.

Ryan

[Pa1965]

Thanks, Ryan!  As always, I really appreciate your advice and reassurance.  The doctor who originally put me on Clonazepam has the same thoughts towards it as you do and told me all the same things you did when he first put me on the drug.  It's too bad he's retired because it's so hard finding a doctor who isn't brainwashed by the marketing representatives of the SSRI companies that try to vilify the benzos as being highly dangerous.  It's all about money.

Merry Christmas! :)