Question for Ryan - Klonopin

[Baby123]

Hi Ryan.  I know I have read this somewhere while doing searches on this board but I can't find it now.  I take TEVA brand generic klonopin .75 mgs a day.  I just found out that my insurance is going to force all employees to use the mail in prescription method on all meds taken on a regular basis.  My sister also takes klonopin and uses this mail-in pharmacy (we work together).  Her pills are pink and mine are yellow, same dose, so I know express scripts doesn't use TEVA brand klonopin.  I know you have said to not change from one generic brand to another (I have only taken TEVA).  I am very sensitive to med changes and brand changes so I am guessing I am better off to just continue to get mine at CVS and pay the price out of pocket instead of trying to change over.  Do you know if the pink pills are equivalent to the TEVA brand or know how I can find out without messing myself up trying?

Thanks

[barfer]

I've sent you a note so that we can correspond privately.

[Baby123]

Ok, how do i contact you personally?  I would be interested in knowing how you weaned, what kind of problems you encountered, etc.  I have heard that some have more problems than others getting off remeron.  I guess I read so much about it on the internet (mostly horror stories) that I am scared and then I also get scared thinking what if I get worse when I am off!!  Amazing what anxiety does to us that are prone to anxiety anyway.  LOL

BTW, I take the beta blocker for mitral valve prolapse.  It has been a life saver for me.  I had skipped heartbeats, palpatations, racing heart all the time before I started betas 16 years ago.  My bp is generally low also but I guess my body got used to it.  It generally runs about 100/60 most of the time but I do ok with that because that is what it was even before betas.

Thanks.

[barfer]

I think Ryan is right about remeron negating some of the effect of the anit-anxiety medication because I did notice that once I was off remeron but still taking lorazapam, as needed, the effects of the lorazapam seemed greater.  Taking remeron, a beta blocker and the benzo, I'd probably be inclined to get rid of one of either remeron or the beta blocker, too.  For those people who have high blood pressure or essential tremor, the common medication to prescribe is a beta blocker with clonazapam.  The bonus is, the beta blocker is supposed to help with anxiety too.  So if that sounds like you, you will probably do very well with that combination.  My problem is, I tried a beta blocker for essential tremor with the hope it would help my anxiety as well and ended up with ridiculously low blood pressure and had to stop it.  I should have never been on it because my bp tends to be low at the best of times.  For those people who don't have that problem, it is a great drug that can help high blood pressure and essential tremor.  With the beta blocker plus the clonazapam, you should be golden.

I would be more than happy to walk you through your reduction of the remeron, if you'd like.  I can reassure you or give you pointers as to how to get through the rough patches, that's if you come across any.  Feel free to contact me personally.        

[xanweaner]

Good luck to you during your weaning down!!!

[Baby123]

My dr told me the same about remeron being more stimulating at higher doses.  I do take 30 mgs and am hoping that by lowering the dose (or even completely coming off) some of the stimulating effects I have will go away.  I am very sensitive to so many things, meds, supplements, caffeine, sugar, etc. that I think 30 mgs is just way too much for me.  I am pretty much a high strung person in general with lots of energy so I think the remeron has just pushed me over the edge.  I just started my wean process so I hope and pray I do ok and my anxiety goes down some.  

I have tried ambien and sonata and just don't want to be on another med since I already take klonopin and remeron and a beta blocker.  I guess to use on occasion would be fine but I just want to take the least amount of meds I can and use diet and exercise as my main way of controlling any sleep problems or anxiety I have.

So Barfer, when you went to 30 mgs you said you started having panic attacks?  I kinda think that is some of my problems, especially after a hard cardio.  The next day (after the strenuous cardio) I have what feels kinda like adrenaline rushes and stinging skin.  They probably would be full blown panic attacks if I didn't take the klonopin and beta blocker.  Ryan said that remeron can possibly negate some of the anti-anxiety affects of the klonopin.  And also remeron can lower postural blood pressure as can the beta blocker I take.  Ryan explains it well in that other post.  I just feel like for me the best thing to do is get rid of the remeron and see how I feel.

I will keep yall posted on how my wean goes.

Thanks for talking and for the suggestions and advice you have given me.  It has been very helpful.

[xanweaner]

That's my criticism of Remeron, too....weight gain, increase in appetite, and I definitely don't like the fac t that I have less energy, too.. It does provide great sleep, but so does Ambien. And, without the weight issues.

It's interesting that you had good results at 15 mg. - my Dr. told me that Remeron is unusual in the fact that as your dosage increases, the side effects decrease. So, you're supposed to have less sedative issues at the higher doses - I take 30 mg., which is the average dosage amount, I believe.

I hope your Klonopin works out well for you...
Best,
-xan-

[barfer]

When I started Remeron, I was at 15, my doctor was pushing me to go up to 30 because he thought it was the average dose for most people.  Of course, I am not like most people.  Very soon after going up to 30, I started to see a psychiatrist and I told him I was not feeling as well on 30 as 15 and I was having far more panic attacks at that dose.  He told me to go back to 15 and that he didn't care what the "average dose" was, if I felt better on 15 then that is what is right for me.  I did as he suggested and the panic attacks were greatly reduced and I took lorazapam only on an as needed basis.  I took so few lorazapam, that a bottle of 30 pills would last a year and most times there were more that 20 pills still left in the bottle.  I would renew my prescription just to have fresh pills.

The sleep aspect of Remeron is WONDERFUL and I really miss that.  I would dearly love to get a full night's sleep again.  

As far as the cardio, that is an interesting question.  I'm not really sure what your issues are with cardio and Remeron, but the fact that you are taking a beta blocker as well might have something  to do with your energy level during a workout.  I play badminton once a week and have for many years.  I put on a lot of weight with Remeron (40 lbs.) and I am a very small person, so it really showed.  Now that I'm off it, I've lost 25 lbs. and my game has improved.  I'm definitely lighter on my feet and more able to move quickly on the court.  I know that a lot of the weight gain was due to water retention. I'll go back and try to find your post about cardio and Remeron.

I went off Remeron for exactly the reasons that you are thinking about and to lose weight.  I didn't think it was helping the anxiety at all.  In retrospect, I think it may have given me a better base anxiety level, if you know what I mean.  I was convinced that the benzo was what was doing the trick for the anxiety.  The only flaw in my reasoning was that I was using the benzo so infrequently and should have used it more often during the hight stress times that I had this past year.  My doctor had suggested that I increase my Remeron dose during that time but I was reluctant because of my past experience with doing that.  I, instead struggled through and still didn't take the lorazapam when I should have.  I understand your situation and your struggle.  I still am not sure if I made the right decision with going off Remeron, but I am now committed to trying clonazapam on a regular basis to see if it works better for me.  If that doesn't work, I'll go back to Remeron and the occasional lorazapam.      

[xanweaner]

I do recall reading that post. It's so interesting the effects that these meds have on different people. For me, I found  remeron too sedating. However, I do take a low dose of Lamictal so that might also be contributing as it's considered a mood stabilizer. Dr.'s use it for BP and also for seizures. At the amount I take, which is only about 40 mg. or so, I didn't think it would cause this effect, but combining it with xanax may also be a contributor.

I didn't have any problems weaning off Remeron in the past, as if I recall, this is considered one of the easier drugs to taper down on.

Have you ever considered taking a sleep aid vs. the AD? I used to get great results from only 5 mg. of Ambien - I broke the 10 mg. in half. I find I get a good quality of sleep from it.

Good luck,
xan

[Baby123]

I think the remeron is too stimulating for me, at least at 30 mgs which is what I take.  If I feel like the stimulating feeling I get goes away as I get lower, I may not come completely off because I do like the sleeping qualities is has.  Although I don't have that affect as much as I did at the beginning.  Personally, I think the klonopin helps my anxiety the best.  I don't have depressive qualities either.  Just get depressed when I have anxiety and don't feel good.  I get really frustrated.  I posted a question to Ryan about a month or so ago about remeron and problems
I have with it.  I believe it is titled Question for Ryan.  I have issues after strenuous exercise and believe it is due to the stimulating qualities of the remeron along with some other things because I also take toprol, a beta blocker.  If you can find that post it explains more in detail why I have decided to wean off it.  I just don't think it is helping my anxiety much at all.  May even be contributing some to it, especially after I have a hard cardio.  And I do not want to stop exercising because of all the health benefits.  

[barfer]

Yes, I have weaned off Remeron.  I took my time, did it really slowly, experienced some headaches and sleeplessness, some stomach upset too, but it was all doable.  Some people who have gone off it have no problems doing it at all.  The only reasons I went off it was, I had put on 40 lbs. while on Remeron and I wasn't so sure it was helping with my anxiety.  (I'm still not sure if I am right about that or not.)  I have been Remeron free for about five months and was taking lorazapam as needed during that time.  I have just taken my first clonazapam (klonopin) and am trying that as an alternative to the lorazapam because the "as needed" was becoming more frequent.  Clonazapam is supposed to be safer than lorazapam for the long term.  We'll see how it goes.  If this doesn't work, I will probably go back to Remeron.  It was the only AD I've tried that didn't enhance my tremor (essential tremor).  The thing is, I don't have depression along with my GAD and panic.  I have GAD and panic first and foremost.  If I did feel some depression it was because of my inability to do things because of GAD.  When I have a handle on the GAD and panic, I don't feel any depression.  I'm really not a depressed kind of person at all.    

[xanweaner]

I also take Remeron - just curious, why are you getting off of it? I don't think I do great on AD's either...I feel I have more of an anxiety issue, too.

I also take TEVA brand of Remeron and it works well, so I think it should go smoothly for you.

Good luck...

[Baby123]

Thanks for letting me know about the remeron switch.  I have really been stressing over this but I am not going to worry about it anymore, hopefully when I have to start the new remeron I will be fine.  Have you already weaned off the remeron?  If so, was it pretty easy?  I started weaning about a week ago.  I take 30 mgs and have been on it for almost 4 years so I am hoping for an easy wean.  I plan to just take klonopin for my anxiety.  I don't do well on AD's.  

Thanks again for your help.

[barfer]

From personal experience, I switched from Remeron to generic mirtazapine with no problem at all and I was on it for about 5 years.  Ryan, like usual, is absolutely correct.  

[xanweaner]

Thank you for the great information!!!

[Baby123]

Thank you.

[Baby123]

Is there a link that gives all the different generic brands of drugs on the internet?  Just curious as to how many different ones there are that make remeron.

[Baby123]

Thanks for the help and advice.  I pay a $5 co-pay but if I can get it for $20 that is still a very good price compared to having extreme anxiety from changing brands.  I'm thinking quality of life here and don't want to get myself all messed up.

Ryan, I also take Remeron TEVA brand.  Do you know if the different generic brands of that drug would do the same thing by changing brands?  I don't think the mail-in uses TEVA remeron either.  Needless to say all this has really caused me ALOT of undue anxiety because I know from experience what changing brands can do to my anxiety.

Thanks again for your help!  I already feel somewhat better about it knowing I will not be paying hundreds of dollars a month for these meds.

[xanweaner]

Keep in mind that CVS also uses different generics, so you'll need to be sure to ask them for the TEVA brand. Sometimes, they'll have it and other times they won't, so you'll need to have them check the shelf when you're calling in your reorder.

If they have to order it, it can take several days for the shipment, so plan ahead.

Also, if you carry AAA, you can get a discount on drugs. Not many people know that...I didn't until one of the pharmacists at Save-on recommended it to me. There's a special code, and not all of the pharmacy techs will know what it is, but check that out, too.

Even physicians aren't up to speed on these differences that can occur in the generic brands. My pdoc did not know what a BA/BE study was until I explained it to him. I went through in-depth pharmaceutical training prior to selling generics. But, that was years ago...

Good luck in getting your TEVA brand. When I can, I always use the Brand name of the drug, even if a generic is available. (if I can afford it).

Glad my advice was useful...

[Baby123]

Hi.  I did call the mail in pharmacy  and they told me they use whatever is on the shelve that month.  CAN YOU BELIEVE THAT!!!???  They just get in their shipments from whatever brand and use what they have so it changes ALL the time.  I am so sensitive to any med changes (even the same brand) that I know I can't just change my brand all the time w/o having major physical anxiety problems.  So I will just have to pay out of pocket at CVS and use the TEVA brand.  I don't know how much it will be.  I have been using CVS for over 10 years and they have never had anything but TEVA without me even asking.  Before that I was taking the regular brand klonopin, not generic.

It just makes me so mad that our insurance companies can force us to use meds that we can't tolerate or that don't work for us.  The only time I tried to change generic brand names I got so sick after a week or so on the new med and it took me several weeks to realize it was the different med and then another several weeks to finally start feeling good again.  It is just not worth it.

But thanks for the advice.  :)  

[xanweaner]

I know that you're looking for Ryan's input, but I just wanted to let you know that many times the generic company's name is listed on the bottle - somewhere on your tag.

If not, have your sister contact the pharmacy by phone and ask what brand they're using. Ask if TEVA is available. Even CVS switches their generic brands around, so I have to ask them to order in my TEVA brand before it's time to renew my drug rx.

Remember, it's not about drug equivalency, except if you're referring to how many mgs. a pill is.... it's about their BA/BE - bioavailability and bioequivalency and when the drug reaches its peak serum levels.

I know that Ryan will explain this much better than I have, but I thought with this bit of info., you might be able to get started in checking out which brand your sister uses.

Good luck...