My Doc's Replys to ryan's advice lol RCA Check it out!

[mystruggle]

sup man,

so i went to my doc today not m.d. psychiatrist. he ok'd me to take the K .5mg 3x's a day, but said that it shouldn't really make a difference if i take .75 bid or take .5 tid. i'm like wouldn' the halflives overlap and then more of it be on my system and thus be more efficient? he replied, that it depended on the person. he also said that he won't ever prescribe over 2mg. which i'm cool with me. so he gave me the ok to take .5 three times a day however i want to. bid or tid and then said if i ever need to, i can take another .5 making a grand total of 2mg a day, but to not go over that. he also seemed clueless when i told him about it taking two weeks to build up in the blood plasma levels. he's a down to earth guy, he has no problems with me being involved with my treatment. unlike alot of shrinks who have a one track mind. he did mention lexapro, which i laughed at. i told him if the 1.5 tid or the 2mg qid doesn't work then i might be open to an ssri. i mean if K just seems to not work for me, then i have no choice. but it's obvious it does work some. i mean i'm out of the house, my panic attack (singular) that i had in the last year only lasted 45 seconds. so i think tweedling with the dosage is the right thing to do here and go from there, PLUS therapy. i'm just glad he's open minded and not an ego maniac. he had a med student sitting in on the session. which i didn't care, then he followed me out and was like, it's hard jay, i know, but the way my practice is set up i can't do CBT with you and talk therapy also. that's what the therapist is for. so i get the feeling he really does care alot about my wellbeing. it's reassuring. not sure what that means about his confidence in the therapist, but she does help.... the lack of knowledge on some aspects of clonazepam kind of disappoints me, but we're all human. he's the type of guy to learn from what i'm going through and what i tell him and if it works, then he'll use it to help others. overall good fella.

he also said there are guys twice my size that take K and get away with NO panic attacks at .25 bid. i kinda shrugged it off, they are probably cases of mild panic disorder and not extreme agoraphobia. he said i shouldn't listen too much to people on the internet. i said well the people i talk to deal with cold hard FACTS. he didn't get mad or anything, just said watch what i read due to the amount of B.S. online. which is true.

i just don't understand how he wouldn't know the difference of efficiency of .5 tid and bid. i talked with him about alcohol tolerance maybe being a factor etc. he said it could be, but you can't really tell, everyone is different. he said to keep up with the therapy and wrote me a script for 120 .5mg to go along with the 60 i already have. roughly enuff for 6 weeks qid if need be and said to call him if i have any problems in between.

just wanted your reaction to this ryan.

praying .5 tid will make a difference and therapy will do the rest. if not up to 2mg a day, which is a decently high dosage of K. if that don't make the significant dent then, i'm really gonna have to triple my efforts up on therapy, root causes, CBT etc. if not gotta take the ssri plunge. for some reason i don't think i'll have to do that though. i think this will get the job done. the breakthough panic attack really set me back some mentally and emotionally. once i get to the point where i know what the med will and will not do and then be able to handle the rest myself. gotta remember a tool not a crutch!

later....buddy....Jay

[RCA7591]

From the Merck Index:

"Absorption. Clonazepam is well absorbed after oral administration with peak serum levels being reached between 2 to 3 hours. With continuous therapy accumulation occurs. A steady state is usually reached within 2 weeks."

The doctor seemed clueless about the two-week accumulation of Klonopin to reach the attainment steady-state, and yet, this information is widely available (and has been, since 1976).

Obviously, with an average half-life elimination of 50 hours (range 18-54 hours), the drug must accumulate in the plasma (and be maintained) before optimal efficacy can occur. After two weeks have elapsed, steady-state is established - but it doesn't stop there. Within another two weeks, the drug accumulates to 1.5 times that of the steady-state plasma level before it finally levels off (this is for b.i.d. dosing).

Now, if the drug is dosed t.i.d., the elimination of Clonazepam from the body is obviously reduced, and it accumulates even further (3 times that of steady-state). This increases the steady-state plasma level, and when the plasma level is increased (and maintained), the efficacy is increased. This is NOT INDIVIDUALIZED! It does NOT depend on the person. The elimination is always reduced!

Thus, dosing Klonopin 0.5 mg, t.i.d. is more effective than dosing it 0.75 mg, b.i.d. Why? Because the plasma level is increased.

Put the analytical bullsh!t aside, and you have found a seemingly good doctor who cares - most importantly, one who listens to you. He may not be well-versed on some issues, but that doesn't make him a bad doctor. There are plenty of ill-informed doctors with a huge ego, and those types benefit no one. Here, you've found someone who will work with you.

There is certainly a lot of bullsh!t online (the majority of what you'll read is BS, especially info pertaining to the Benzodiazepines), and I agree with him on that. However, factual information does have a place, especially if you're trying to optimize the efficacy of a given drug.

So, those taking 1 mg, b.i.d. of Klonopin without an optimal result may be told that increasing the dosage to 1.5 mg, b.i.d. is the only option left. Not true, as that 1 mg, b.i.d. could be divided into four doses of 0.5 mg each, thereby increasing its efficacy by increasing the plasma level. Here, 2 mg is not exceeded. The same daily dose is maintained, but utilized in a more effective manner. Now, the same 2 mg is as effective as
1.5 mg, b.i.d. (3 mg). I think its helpful to understand things like this.

Thanks for posting back with his impressions. It's always interesting to read varying opinions.

Ryan

[mystruggle]

"So, those taking 1 mg, b.i.d. of Klonopin without an optimal result may be told that increasing the dosage to 1.5 mg, b.i.d. is the only option left. Not true, as that 1 mg, b.i.d. could be divided into four doses of 0.5 mg each, thereby increasing its efficacy by increasing the plasma level. Here, 2 mg is not exceeded. The same daily dose is maintained, but utilized in a more effective manner. Now, the same 2 mg is as effective as 1.5 mg, b.i.d. (3 mg). I think its helpful to understand things like this.'

quote----------------------------------------------------------------------------------

can you elaborate on that? i'm not sure what you mean? how can you divide 1mg into 4 doses of .5? did you mean 4 does of .25? typo? or am i reading this wrong?  also not sure what you getting at. i think it's basically dose more frequently to increase the K in the blood plasma giving you greater efficiency. but i'm not sure how you are getting there this way???

[RCA7591]

I wrote it as 1 mg, b.i.d. (twice daily), 2 mg daily total.

So, if 1 mg, b.i.d. falls short in efficacy, dosing it as 0.5 mg, q.i.d. would increase the efficacy, as the plasma level would be higher when dosed four times daily, as opposed to twice daily. The total daily dosage does not change, rather, it is arranged in a manner that allows it to be used more optimally, by utilizing the accumulation characteristics of Klonopin.

The typical doctor would be inclined to increase the dosage from 1 mg, b.i.d. to 1.5 mg, b.i.d. (from 2 milligrams to 3 milligrams). What the typical doctor doesn't realize is that if the 2 mg dosage were to be broken down into four equal doses of 0.5 mg each (spaced apart six hours), that the resultant plasma level would actually be the same (or greater) as if the drug were dosed 1.5 mg, b.i.d. This is a result of the accumulation process.

In your case, you were taking the Klonopin 0.75, b.i.d. (every twelve hours), or 1.5 mg daily.

Here's another way to look at it in your case (bad analogy because it's not practical, but a much easier one to understand):

You know that when Klonopin is dosed twice daily, it accumulates to 1.5 times that of steady-state. What does that mean? That on top of your 1.5 mg dosage, you have an additional 0.75 mg reserve in your system that has accumulated. This reserve is the accumulation value, and it is 1/2 that of steady-state (1/2 of your daily dosage, or 0.75 mg).

You also know that when Klonopin is dosed three times daily, it accumulates to 3 times that of steady-state. What does that mean? That on top of your 1.5 mg dosage, you have an additional 1.5 mg reserve in your system that has accumulated. This reserve is the accumulation value, and is unity (equal) to that of steady-state. 1.5 mg.

Think of 1.5 times as working overtime (time and a half), and 3 times as working double overtime (double your base pay). Taking Klonopin twice daily is like working overtime, and taking Klonopin three times daily is like working double overtime.

So the idea is to take your 1.5 mg daily dose, split it into three divided sections, and make it work double overtime instead of overtime.

But like I mentioned earlier, this is a bad analogy, as it does correlate with the plasma level in a linear fashion. Regardless, this is the basic principle.

Take the Klonopin 0.5 mg, t.i.d. and give it a full two weeks. You will see the benefit. Take it as close to every 8 hours as possible.

Ryan

[JSGeare]

Why not:

A) Print this puppy out and walk it into your shrink for his reaction/opinion, and,

B) Invite him to actually spend some time on the forum to see for himself what you are looking at?

Just a thought.

[RCA7591]

"But like I mentioned earlier, this is a bad analogy, as it does correlate with the plasma level in a linear fashion. Regardless, this is the basic principle."

^typo

Should read DOES NOT correlate with the plasma level in a linear fashion.  

[mystruggle]

i gotcha!

i don't think walking in with this printed out will help too much. the doc is already in favor of letting me dose the med however i want, with a daily limit of 2mg. i think that's giving me the benefit of the doubt to use it the best way i know how to or play around and find what's right. most doc's would NOT do this. he might take it as a slap in the face, like i'm trying to prove him wrong or something, i don't care about wrong or right, him or ryan, i just want to feel better haha. seems like ryan got the scientific proof. i'm just hoping 2mg will be enough.

anymore it's the anticipatory anxiety that is getting me. like i said, in the past 13 months i've had 1 full attack with limited symptoms (before K) just dizzy and depersonalization, the one that led me housebound for 3 months) and one 45 second attack while on K, .5 bid, and i was practicing a particularly hard thing for me to do. so i mean the K is working.

i believe there is alot of factors here. me being med phobic, not dosing the K bid from the beginning, quitting therapy months ago (i'm back now) and just alot of overall life stresses, after 5 years working my A.A. steps FINALLY! that's unheard of for someone to stay sober and not work the steps. i just started them last june. so i had alot of baggage to unload, anger, guilt, making amends, ego, pride, resentments etc...all killers for alcoholics emotionally! the girlfriend incident didn't help AT ALL! and i never got help or treament the last time this happened. it sort of went away because i was distracted by the girl, but i couldn't really drive outside my city. i was semi ok, but still agoraphobic.

my only questions now are....what if i get up to the 2mg and it doesn't help enough?  he won't let me go past that dosage (i think it will do the job tid or qid though) i'm just worried that my alcoholism might be blocking it from working properly or made me have some kind of huge tolerance to it so i'd have to be on like 8 mg a day to feel normal...can't have that! won't have that!

and....isn't clonazepam suppose to help with anticipitory anxiety also? seems like it blocks the panic fine but i walk around scared as heck to do stuff, which keeps me in the situation i'm in. not going out and not living a full life. i know some anx is part of life and maybe a lil more for folks like us with this disorder. but geesh!

[mystruggle]

also one last thing i just thought of....they claim a half life of 18-50 hours. i think i have a fast metabolism, will this effect the efficiency at all? like if the half life in my case is the minimum of 18 hrs and i have a faster metabolic rate will this make the med not work as well? or am i thinking too much here. and i just need to get the dang dosage right? and i rub snuff copenhagen like a can a day. real hillbilly here, you think that can affect the med too? it is a stimulant.

thanks to all for your comments and help. it really is much appreciated. as i stated before. i own a graphics shop ryan so if you ever need your drag car all done up, lettered or numbered, you know who to get ahold of...of course u'd get a discount haha.

[mystruggle]

bump bump bump haha