Klonopin versus Ativan

[barfer]

I've now had one week of Klonopin at .25 twice a day.  I still feel some anxiety and am not completely comfortable in certain situations.  Tonight I am supposed to up the dose to .5 and tomorrow I will do the same in the morning.  I am to try that dose for one week and make a comparison as to which dose if any is the right one for me.  I see my doctor one week after that.  Now here I go again putting the cart before the horse...If I don't feel the klonopin is doing the job as well as the occasional ativan did for me in the past, do you think it would be OK to go back on ativan and take it twice a day @ .5 in the morning and .5 again at night?  What I'm finding with klonopin is that even though I feel tired on it, it doesn't really completely take care of the anxiety that I hoped it would.  I'm wondering at the higher dose, .5, if it will just make me even more tired and do very little for the anxiety as well.  When I was taking ativan, it never made me tired, it just made me calm and more relaxed which is exactly what I want.  I know that it is generally prescribed for short term use because of it's addictive nature and after a while you keep needing to up it but is that always the case?  Can someone take it for a long time?  SSRIs just don't seem to work for me.  I took remeron for about 5 years with the occasional ativan and that wasn't too bad but I always felt it was the ativan that really worked and with remeron I packed on 40 pounds.  If This klonopin doesn't do the job and the consensus is that I shouldn't take ativan on a daily basis, then I will probably have to go back to the remeron with the occasional ativan and just get used to being an over-weight person.  The thing is, I know I will need something that I can take probably for the rest of my life.  I'm not being negative here, I'm just being realistic.  I'm going for quality of life..the last thing I want to do is spend my retirement years sitting in my house doing nothing.  If a little pill will help me have a full life, I'm going to take it.

[amish1979]

Hopefully Ryan will chime in.

It takes up to two weeks for the clonazepam to reach it's steady-state plasma level (and you are only finishing week one.  Also, with any change in dosage it will need another two weeks to reach steady-state.  You are judging the effectiveness of klonopin BEFORE it has even had time to reach it's effective levels.  And then, before the .25 mg twice daily has reached it's peak effectiveness, you are going to up your dosage to .5 mg twice daily and then you are going to judge the effectiveness of THAT dosage before THAT dosage reaches it's effective level!

If you are needing to take ativan twice daily EVERY day, then I strongly suggest you consider sticking with clonazepam as that is it's intended usage.  Ativan should be taken on a as needed basis (and as needed does not mean twice a day every day).

You can't expect these things to work overnight.

[barfer]

I guess the reason I am questioning the clonazapam is because it is a benzo. and I expected it to start working right away, unlike SSRIs which can take up to six weeks before you know the result.  I really don't like this fluttering feeling that I never really had with ativan although I did have it when I wasn't on anything.  It makes me feel like a panic attack is coming on...not a comfortable feeling.  Also, I certainly won't be doing any driving unless the tiredness stops.  I will try to be patient but I'm not loving the way I feel right now.  

[barfer]

I have just spent, I don't know how much time going through old postings from Ryan.  I've learned a lot and after 101 posts, I finally gave up and decided that I've learned all I'm going to learn about klonopin tonight.  I must say, it has been a little grueling but worth the effort as it has eased my mind.  I've got to be a little more patient and I'm sure I will feel better within the next couple of weeks.

[amish1979]

Just so you know, I just started taking klonopin on Wednesday (two days ago) and I'm a little hesitant with it as well since I'm switching from ativan as needed.  In fact I'm only taking 1/2 of the prescribed dose right now and only doing it once per day instead of twice while I get used to it.  I think I'm going to ease into it slowly since I have a lot of anxiety with taking new meds.

Good luck to you!

[RCA7591]

Instead of reading the facts that pertain to Clonazepam in general, I'll provide some key facts in your particular case:

(1) Clonazepam will not work instantaneously in your case, as you've had prior exposure to Lorazepam. Lorazepam is a short-acting agent with a rapid onset of action, a short duration of action, and it is rapidly excreted from the body. Lorazepam does not accumulate in the plasma, and thus, its benefits are immediate. There is no delay. The downside to using Lorazepam daily is loss of efficacy over an "X" amount of time, and as such, it should be used only as-needed to prevent the development of tolerance.

(2) For Clonazepam to replace the anxiolytic properties of Lorazepam entirely, it must accumulate in the plasma over a span of two weeks. Clonazepam can only accumulate properly if it is dosed at a minimum of twice daily. After two weeks elapse, Clonazepam accumulates to steady-state, at which point its effects would offer comparable relief to taking a single dose of Lorazepam (minus the risk of tolerance, interdose and rebound).

The benefit doesn't stop, as after an additional two weeks elapse, Clonazepam accumulates to 1.5 times that of steady-state. What does that mean? Simply put, if you were taking 0.5 mg twice daily, you'd always have an additional 0.5 mg in your system - provided that you continued to take the drug on a daily basis, twice daily. This accumulation prevents tolerance from developing, as the plasma level is always consistent. By comparison, Lorazepam never accumulates due to its short half-life, and the resultant peaks and troughs in the plasma level give rise to interdose, rebound and loss of efficacy (tolerance).

(3) 0.25 mg, b.i.d. is a sub-optimal dosage, and this may result in an incomplete response or no response. While sedating (initially), sedation does not correlate with anxiolysis. The minimum dosage at which anxiolysis is typically seen is 0.5 mg, b.i.d. Any hypnotic/sedative quality wears off rapidly, leaving behind the anxiolytic/anti-panic property (which is maintained indefinitely).

Keep in mind that once you increase your dosage from 0.25 mg, b.i.d. to 0.5 mg, b.i.d. maximum efficacy may not be apparent for up to two additional weeks.

Amish - Take the Klonopin twice daily. A single daily dose will not accumulate, and it will not be effective. Even if you start at 0.125 mg, b.i.d., this would be better than taking 0.25 mg once daily. The key is to take it twice daily so that it accumulates. The recommended starting dosage is 0.25 mg, b.i.d., and this is generally increased to the maintenance dosage of 0.5 mg, b.i.d.

Ryan

[barfer]

Thanks for responding and helping me out with this.  You have really put my mind at ease.  My only questions and thoughts are:   1)  Do you ever sleep?  You spend so much time answering questions from people like me.  2)  As a mother, I hope you aren't neglecting your studies to help us.  3)  I hope you are eating properly.  4)  Don't forget to take care of yourself too.  Be good to yourself!  You are one in a million!

[amish1979]

Thanks Ryan, you were right.  I started taking the klonopin 2x per day yesterday (.25 mg at a time) and I actually already feel a ton better.  You know us anxiety-heads....every little thing scares us.

You are truly an asset here, bud.

[xanweaner]

I can never write it too much - You've really helped a lot of people here , and I'm hoping that you're doing well!!

[bgrimes86]

Klonopin is the lesser of two evils when it comes to my body. I was given Ativan once after going to the ER and it put me into a sort of psychedelic trance and didn't do anything for my anxiety. Okay, I have to get to bed...I have no idea why I'm here at 3 o'clock in the morning.

Good luck to you!

[lilokins]

I have an anxiety disorder and take Klonopin, but that is for panic attacks, and is not going to help everyday anxiety. For that, I take Zoloft, which is like a miracle drug. I am pretty much anxiety free for the past 7 or 8 months and am doing great with the combo of  both drugs. Good Luck!

[Siamo Uno]

I have been on 1mg of Ativan, twice a day, for 18 months, and it works well for me. I have not developed a tolerance at all, it is still working just fine. I have GAD and my psychiatrist prescribed this drug for me and will wean me off when the time is right. I also took the same dosage of Ativan several years ago, took it for two years that time and weaned off with no problems. And I just weaned straight off the Ativan. I did not replace it with Klonopin. I think everyone reacts differently to drugs.