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Took Klonopin last night, woke up bad anxiety
by mary m, Jul 31, 2007 09:01AM
Ryan, I took 1/4 of a 0.5 Clonazepam ast night along with my half of a Flexeril,(5.0) and woke up with really big bang anxiety. So I this morning I had to go back and take a .05 Ativan and I also took half a 0.5 Clonazepam. Should I take both for a while? For how long? Or jus increase the Clonazepam and stop the Ativan. I get such pains in my back and shoulders and neck. I think it's from no Ativan. What should I do?
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What dosage of Ativan were you taking, and how many times/day were you taking it? How long have you been taking Ativan?
Once I have the answers to these questions, I'll be able to help you.
You should not combine Klonopin and Ativan.
Ryan
The easiest way to transfer from Ativan to Klonopin would be to take the Klonopin three times daily, 0.25 mg, (morning), 0.25 mg (afternoon), and 0.5 mg (night). The larger night time dose will help with any insomnia, and promote sleep. Ideally, the doses should be separated by eight hours each/
To accomplish this, you will need a prescrption for Klonopin 0.5 mg, 60 tablets.
The two 0.25 mg doses are 1/2 of a 0.5 mg tablet, and the nightly dose is an entire 0.5 mg tablet.
The transition from Ativan to Klonopin is not instantaneous...Klonopin reaches 1/2 of steady-state in three days, and full steady-state in two weeks. Therefore, since Klonopin does not work immediately to replace Ativan directly, there will be a window of between 3-14 days where you will be "vulnerable" to rebound or withdrawal phenomena. It is important to understand that this is common, and that it will pass. The first three days is usually the worst of it. See Gina's post about her experience switching from Xanax to Klonopin (which is more difficult).
Once you are stabilized on 0.25 mg, 0.25 mg, 0.5 mg (after one month), you can begin to taper each dose by 0.125 mg, starting with the afternoon/evening dose. Every four weeks, 0.125 mg is removed, starting with the evening dose. Beginning on the 8th week, 0.125 mg is tapered from the morning dose. Beginning on the 12th week, 0.125 mg is tapered from the night dose. This process repeats every four weeks (removing 0.125 mg from each dose, revolving from the evening, morning, and night doses) until the drug is discontinued.
Once you make the decision to transfer from Ativan to Klonopin, do NOT take another dose of Ativan for any reason. Taking Ativan concomitantly with Klonopin increases the risk of tolerance, and may render the Klonopin less effective. I do not suggest taking Flexeril concomitantly with Klonopin, as it has an additive effect on the CNS, and increases the risk of oversedation/apnea/respiratory depression. Drugs such as Flexeril and Soma should not be taken in combination with Benzodiazepines.
If you do not have the proper prescrption of Klonopin (0.5 mg, 60 tablets/month), see your doctor and obtain them. Any drug taper regimen should be under the supervision of a medical doctor.
Questions?
Ryan
I'm going to be straight-forward with you:
You are in a bad situation, however, you can get yourself out of it if you really want to. Your ill-informed doctor prescribed Ativan, a drug that is not indicated for long-term use. Prolonged use of Ativan leads to tolerance and loss of efficacy. At this point, you are merely taking Ativan to prevent withdrawal. None of this was your fault, but never-the-less, you must now deal with it, and it is helpful to understand how it can be dealt with.
Ativan is a Benzodiazepine, and targets the neurotransmitter GABA. Remeron, Seroquel, and the SSRI's do NOT target GABA receptor sites in the brain. There is no plan B or C, only plan A. There is only one solution, despite what the doctor may tell you. Unfortunately, the drugs you list simply will not help you at this point, and no amount of wishful thinking will change that fact.
PLAN A (Transition from Ativan to Klonopin):
Like Ativan, Klonopin is a Benzodiazepine. Unlike Ativan, Klonopin is indicated for long term use. Therefore, switching from Ativan to Klonopin is key - to prevent further Benzodiazepine tolerance. The sooner this is done, the better you will fare over the long term.
The first thing to do is to express to the doctor your desire to switch from Ativan to Klonopin, so that he may provide the proper prescription. If you already have a Klonopin prescription, you can begin immediately. You will require (60) 0.5 mg tablets/month.
Starting tomorrow (or when you obtain the Klonopin prescription, and your doctor is aware of your desire to switch drugs), follow this regimen (or another where the doses are spaced 8 hours apart):
6:00 AM - take 0.25 mg (1/2 of a 0.5 mg tablet) of Klonopin.
2:00 PM - take 0.25 mg (1/2 of a 0.5 mg tablet) of Klonopin.
10:00 PM - take a full 0.5 mg tablet of Klonopin
The morning and afternoon doses of Klonopin are equal to the Ativan doses that you were previously taking. The night dose is double, and is comparable to 1 mg of Ativan. This dosing schedule will replace the Ativan that you were taking, and re-establish efficacy so that your symptoms will dissipate.
As stated above, the transition from Ativan to Klonopin is not instantaneous; it will require some patience on your part. There is a window of vulnerability ranging from 3-14 days after making the transition. During this time frame, you will go through Ativan withdrawal, and will experience severe anxiety. Unfortunately, this cannot be avoided. Keep in mind, however, that two weeks of hell is better than a lifetime of hell. If you do not replace the Ativan now, your condition will continue to worsen. If you take more Ativan, it too will lose its effectiveness, and you'll be back to square one. Eventually, you will have to face this situation, and there is no better time than now to do it.
Plan A, as outlined above, is your only option at this point. There are no other options.
Once you start the transition, do not back out, and do not take any Ativan once you begin.
Ryan
I think you'll be amazed at how you will feel two weeks from now. Each day you take the Klonopin (Clonazepam), it will accumulate towards steady-state. While the first several days will be "rocky" in terms of heightened anxiety, this will dissipate quickly. Once it dissipates, and the Klonopin reaches steady-state, your symptoms will be under good control (and will remain under good control).
To help accomplish this, you should take the Klonopin exactly as described above (0.25 mg, 0.25 mg, and 0.5 mg at night).
Ativan has a half-life of between 8-12 hours. It will take a few days for the Ativan to be fully eliminated from your system. As the plasma level of Ativan declines, withdrawal phenomenon will begin (severe anxiety). The Klonopin will eventually take the place of the Ativan, but not instantaneously, therefore, there will be some withdrawal symptoms until it does. The important thing is to stick with the Klonopin, and not to take any Ativan during the transition period.
Follow this schedule:
7:00 AM - Take 0.25 mg (1/2 of a 0.5 mg tablet) of Klonopin
3:00 PM - Take 0.25 mg (1/2 of a 0.5 mg tablet) of Klonopin
11:00 PM - Take an entire 0.5 mg tablet of Klonopin
Within the next two weeks, the Klonopin will replace the Ativan that you were previously taking, and the effects will be MAINTAINED (unlike the Ativan).
To answer your question about why you are still feeling anxiety:
Both Ativan and Klonopin are Benzodiazepines, and both target GABA exclusively. Ativan carries a short half-life (8-12 hours as described above). Ativan has a rapid onset of action. Klonopin carries a long half-life (50 hours), and works on the principal of steady-state and accumulation. Unlike Ativan, Klonopin does not work instantly. Klonopin works once steady-state is reached (two weeks). This is why Klonopin will not offer immediate benefits. However, once it reaches steady-state, the risk of tolerance is extremely low (unlike Ativan), thus the drug will maintain its effectiveness over the long term. This is the difference between Ativan and Klonopin. Ativan has a rapid onset of action, and Klonopin has a much slower onset of action.
Ryan
Ryan, Since I did ok last night on .25, should I do .50 or .25 tonight? Will the .50 help me to be more stable after I wake up? Thanks, Mary
If you did well on 0.25 mg of Klonopin last night, you could continue to take this dose. My feeling was that if you took the entire 0.5 mg tablet at night, it would offer greater relief, and help to re-establish efficacy as you have developed a tolerance to Ativan.
If you feel that you need the full 0.5 mg dose, take it. If not, 0.25 mg will suffice.
0.25 mg of Klonopin three times daily is the equivalent of the dose of Ativan that you were previously taking. Once the Ativan plasma level begins to decline (and it already has), you may or may not require the full 0.5 mg dose at night.
Good luck to you!
Ryan
wmac
Ryan
Here is another strange thing. I was getting such spasms all over my back. My hypothesis is that is was the Ativan wearing off. And I felt, especially at night, that I could never get comfortable and just sit down and relax. I was so geared up, I would just try and go for a walk, didn't help because I had to come home and face things again. I was always adjusting my body. I was always uncomfortable. Did I just build up a tolerance?
It's 3:00 and I just took my .25 afternoon dosage. I have slight palpitations and I'm a little jittery, but I think I'll be ok. I wasn't saying that yesterday. I am guardedily optimistic that I am going to make it with your support and everyone that's writtento me. I hope my chronicle helps others.
I an supposed to see the psychiatrist on Tuesday. I'm half tempted to just call him and tell him how I'm doing and have him call in a script. Is the generic better than the brand name? Do you think I should go see him?
Ryan,, I know I am not out of the woods yet. Do or anyone else know of any good cognitive strategies to help?I know one that I try to say to myself is that we all have thoughts that pass incessantly through our minds, it's what we give significance to that causes the panic, and as you told me last night about the deep breathing, easier said than done. Do GABA levels return to normal after people taper and finish tapering? Thanks again for everything. I'll keep everyone posted.
Good to hear that the shortness of breath was short lived, and that increasing the nightly dose to 1/2 mg proved to be beneficial. The benefits of the night dose should be apparent for roughly 12 hours.
I agree with your hypothesis that the spasms were a direct result of Ativan withdrawal/tolerance.
Should you notify your psychiatrist of your progress? Absolutely. The generic is comparable to name brand Klonopin. However, if you can get the name brand, I would recommend using it during the transition period for the sole purpose of maintaining consistency. The generic may vary by +/- 20% in potency.
Once you are stabilized on Klonopin, I would speak with the psychiatrist about twice daily dosing, 0.5 mg, twice daily. Dosed in this manner, a consistent steady-state level of 15 ng/mL would be maintained, and would provide full 24-hr coverage of your symptoms.
GABA(a) will return to normal provided that the Klonopin is tapered very gradually. Klonopin agonizes GABA(a). Gradual taper is key. However, the fact that you were prescribed the Ativan primarily for Hyperventilation would suggest that you may need long term treatment. If that is the case, Klonopin would be the best long-term option, as it would maintain its efficacy. Hyperventilation Syndrome is a variant of Panic Disorder, and Klonopin is the front-line treatment for Panic Disorder.
The palpitations, jitteriness, and other manifestations of Ativan withdrawal will subside once Klonopin reaches steady-state. Having an optimistic outlook will certainly help you. Things will begin to look up for you very shortly.
Ryan
I know Klonipin is keeping the anxiety and things that go through my mind that used to trigger it and set it off because I forgot to mention that I had my 6 month dental cleaning today and usually, I'd be a wreck about it, ruminating, filled with anxiety, and it seems the Klonopin kept the dread from taking off. I went. Dental anxiety is a whole other story I'll share when I'm more stable. But I went, the dental hygenist said things looked good, the dentist said things looked good, and the Klonopin is helping me to not start the "What if..." Why is it so hard for us type to accept what the reputable doctor tell us? I think it's giving my brain the ability to not go there.
I even pushed myself to go out when I got back with my husband. He offered to take me to buy a Homedics Infrared Back Massager for those damn spasms that come and go.
Ryan, I even feel less depressed. Do you have any knowledge of how that can occur? And why are mornings the hardest? I am definitely taking the .50 tonight that you recommended.
Ryan, when do people start moving from 3 time a day doing to 2 time a day, just wonering. Thank you again. I'll keep you all posted tomorrow.
I'm glad to read that you're doing much better! You will continue to get better as well.
Nope, no mania with the Klonopin! If you have depression secondary to anxiety, Klonopin will elevate your mood by reducing the anxiety. Treating the primary component (in your case, anxiety), will also treat the secondary component (depression). This is why you are feeling better and less depressed.
Definitely take the entire 0.5 mg tablet at night. Not only will it help you sleep, it will also reduce anxiety in the morning (typically, anxiety is worse in the mornings). Mornings are worse due to an increase in the level of Cortisol, the hormone that gives us the energy to rise. Cortisol peaks in the early morning hours, and declines during the day, dropping sharply at night.
Twice daily dosing can be implemented in two weeks (with authorization from your physician). 0.5 mg in the morning, and 0.5 mg at night. The doses should be spaced by exactly 12 hours. When switching from t.i.d to b.i.d dosing, there is a three day "window of vulnerability" where anxiety may increase in the afternoon/evening hours. The drug will reach a new "steady-state" within three days, and all symptoms will pass.
Best to you,
Ryan
I took .50 last night and the anxiety was diminshed this morning. I took my .25 this morning. I can now feel it kicking in abut 1 1/2 hours later, but I am really wiped out this morning, sleepy. I want to go back to bed, but I don't want to. When I was on the Ativan and I would overdo the dosage a little too much in the morning and fall back asleep, I woke up with anxiety again. Should I reduce my morning dose a little bit? Thanks Mary
No, I wouldn't reduce the morning dose. Mild sedation is an initial side effect of Klonopin, it will pass.The morning dose is already very low, and there isn't anything to reduce it down to that would be effective.
The break-through anxiety is to be expected during the first two weeks. This is normal. As your plasma Ativan level declines, you will go through Ativan withdrawal until the Klonopin reaches steady-state. This is variable, and lasts anywhere between 3-14 days. Everyone has a unique response initially, but everyone responds after 14 days.
Klonopin can cause respiratory depression at higher dosages, but would be uncommon at the dosages that you are taking, unless you are predisposed to chronic respiratory disorders (sleep apnea, COPD, or other forms of obstructive airway disease). Snoring is non-specific.
Ryan
I was so active until this summer. I noticed needing more in February. I used to take .25 of Ativan when I was driving home from school some days and even be able to run 2 miles and lift weights. Then I started needing more this summer and I know, like Ryan said, I was only taking it to feed the withdrawal symptoms. I guess I should be grateful I've only got the muscle aches in my back. take all sorts of vitamins, don't eat red meat, don't drink soda, and only eat nonprocessed foods. I am going to see the psychiatrist and internist on Tuesday.
I would avoid combining Vicodin and Klonopin, as when the two are used concomitantly, they have an additive effect on the central nervous system.
I doubt that the muscle spasms alone are from anxiety, and would suggest seeing a doctor in regard to them. Anxiety, or Ativan withdrawal may make the spasms worse, but anxiety is unlikely to fully explain them. The other symptoms would be from Ativan withdrawal. Of course, those will pass within the two week period.
Yes, the "need for more Ativan" is defined as *tolerance*. This is the problem with Ativan, Serax, and Xanax. Tolerance is not an issue with Klonopin, as it was designed for long term use.
You will start to feel better in the next two weeks. Once you do, speak with the psychiatrist about implementing twice daily dosing (0.5 mg, b.i.d). This will increase the steady-state plasma level to 15 ng/mL, which is the standard maintanence dosage for panic disorder. This dosage can be implemented after the two week period. You should be well maintained on this dosage.
Ryan
You should start to experience a noticable improvement very shortly. However, if the mornings are still rough, you can take the Klonopin twice daily (0.5 mg in the morning, and 0.5 mg at night), rather than dividing the morning and evening doses into 0.25 mg increments. What this will do is increase the plasma level slightly, and the attainment of steady-state will be reached more quickly, and evenly (particularly when the doses are all equal in strength).
The Klonopin itself wouldn't trigger anything, but you are experiencing Ativan withdrawal. At this point, the Ativan is almost eliminated from your system. As the Klonopin accumulates towards steady-state, it will directly take the place of Ativan. If you had a positive past experience with Ativan, you will also have a positive experience with Klonopin. The difference is that Klonopin will maintain its effects once it has reached steady-state.
Since you had a negative experience with Seroquel and Risperdal, bipolar disorder would seem unlikely. Remeron is best reserved for depression.
Well, today will be day #6, and the Klonopin will have accumulated past 1/2 of steady-state. You are almost there. Just hang in there a little while longer. This will pass. If your mornings do not improve, take the Klonopin twice daily, 0.5 mg in the morning, and 0.5 mg at night. A single dose provides benefits for at least 12 hours (typically longer).
Hopefully, the Rheumatologist will be able to help with the muscle pains/spasms. While they are unlikely primarily due to anxiety, the Ativan withdrawal tends to magnify symptoms by a factor of 10. While the hypersensitivity may be increased, it won't be for very much longer. Things will begin to look up, for sure.
Ryan
Tomorrow, start taking the Klonopin twice daily, 0.5 mg in the morning, and 0.5 mg at night. This should give you a little more help.
I'm sorry to hear that you had a bad morning. Shaking and jitteriness are both signs of Ativan withdrawal. I know that it's hell, but you must remain optimistic that things WILL get better.
I'm not feeling so great myself, as I did something stupid. I missed my dose of Klonopin last night, and went 14 hours without it. I take 0.5 mg twice daily. I woke up "on edge" this afternoon, and I'm still "on edge", slightly jittery. It is noticable, but not unbearable.
Ryan
Had a stupid panic attack about something stupid around 2 PM. Thank goodness it was close time to my .25. I MADE myself go work out around 4:00. This IS HARD!!! It had gotten so bad that I was even scared to go work out because I'd do something to my body and that would set off obsessing about what is wrong with me now!!!
Ryan, the back aches or spasms that come and go that I've been dealing with are much diminished today. I pray, I mean pray that they will continue to fade. I think it was the Ativan withdrawal. I read somewhere they can last for up to a week. I had a long talk with my neighbor down street who happens to be a psychologist, very intelligent- into holisitc, integrative approaches as well. She said the same thing you've been repeating for me to get it in my mental tape recorder - that there's an adjustment window, and that the receptors from the Ativan are saying,"Heck, you've been doing all the work for me!" and that the back, neck pains are where a lot of the switch. She could not believe that the psychiatrist told me that I could not get addicted on the amount I was taking.
I read one of your old posts about driving - Before summer, you should have seen me driving toschool. I don't know what it is about the fastness. You have been great. Thank you agian. Mary
No, actually I didn't. Benzodiazepines are GABA(a) agonists, all of them.
An example of a GABA(a) ANTAGONIST would be Flumazenil, which is the drug of choice for reversing the effects of Benzodiazepines.
Ryan
No, Klonopin is a GABA(a) agonist only. It increases GABA activity, which in turn provides a variable degree of CNS depression and anti-anxiety effects.
It doesn't sound like manic-depressive disorder, although I'm not qualified to make any diagnosis. It is can almost certainly be attributed to Ativan withdrawal.
IT IS HARD...there is no doubt about that, but it WILL get better. The entire problem from the get-go was the Ativan itself. The drug simply is not effective over the long term.
On a positive note, the spasms have dissipated. And I'm also glad to hear that the Psychologist has reinforced what I have stated. This should give you some optimism that things WILL get better, very shortly.
The 0.5 mg twice daily dosing should help you out a little more. The drug won't reach steady-state faster, but it will increase the steady-state plasma level to the optimal 15 ng/mL figure.
I hope day #7 proves to be better for you.
Ryan
Ryan,
I saw my psychiarist today. He was very glad that I switched to the Klonopin he had given me in Feb. Just like you said, he said stay with .25 morning AM, .25 afternoon, and try and not do night dosing if I feel I can handle it. He said don't worry if I need it at night. He was very glad I did what I did. I don't know about that idea of skipping night yet. It's a little early. I'm still vulnerable.
Plus, today, I'm off schedule with going down to the univeristy/hospital and all that. I took .50 this morning and really didn't notice much of a difference from .25. And I didn't get to my .25 dosing until I realizied it was 3:30 while driving home. I'm going to take .25 tonight and see how I do.
I think I'll need it because (I forgot to tell you but back in June I pulled a hamstring). When I went back to exercise yesterday, I walked (warm up) on the threadmill and thought I'd give it a five minute run. Running was such a good stress reliever for me. Well, my hammie is bothering me.
When I say my interist today, he said I still sounded like a hamstring strain strain, like the sports med. doc. said. I told him about all my back spasms and told my psychiatrist. They are better. My internist ran all sorts of blood work - plus the same stuff that the rheumatologist would have run and said, "Don't you think I would send you to someone if I thought you needed it?" I do trust him as I have been going to him for over twenty years. Plus, he would't have send me to the one I was going to see anyway.
I'm anxious about the hamstring situation. Here I thought I was on the road back both mentally as well as physically. He gave me the name of another sports ortho HE likes that really spends time with you, so I'll call him tomorrow. Part of my anxiety is that I seek reassurance about things that go wrong with me. If I could come up with some good Cognitive Sayings, I know it would help.
I'm just glad I now have enough Klonopin, actually, I have the generic, which I had all along, and things will get better. Don't you think that the fact that it was 3:30 and I hadn't taken my afternoon dose and hadn't had my dose since 7:00 shows I'm getting better? I don't think that would have happened with the Lorzepam. I'll report it tomorrow, Ryan.
Take Care and Good Night,
Mary
"I saw my psychiarist today. He was very glad that I switched to the Klonopin he had given me in Feb. Just like you said, he said stay with .25 morning AM, .25 afternoon, and try and not do night dosing if I feel I can handle it. He said don't worry if I need it at night. He was very glad I did what I did. I don't know about that idea of skipping night yet. It's a little early. I'm still vulnerable."
--end quote--
Hi Mary,
Unfortunately, the Psychiatrist has made a gross error in his prescribing of the Klonopin. If you continue to take 1/4 mg in the morning, and 1/4 mg in the afternoon, your plasma level will bottom out, and you will relapse, SEVERELY. The minimum effective plasma level is 15 ng/mL, and with your current dosage, the plasma level is barely reaching 5-8 ng/mL. If Klonopin is to be taken twice daily, the doses MUST be spaced 12 hours apart. Otherwise, the drug will not be effective, as it will not accumulate properly. 24-hr coverage of your symptoms will not be acheived, and your illness will not be maintained.
All of the effort that you have put into the past week will be wasted if a change is not made immediately in your dosing schedule. Therefore, I would call the doctor first thing tomorrow morning. I would ask for his approval to reinstate the Klonopin in three divided doses of 0.25 mg, 0.25 mg, and 0.5 mg for a period of two weeks. After a period of two weeks, I would request that he prescribe the drug twice daily (0.5 mg in the morning, and 0.5 mg at night). Once twice daily dosing is initiated, the drug will accumulate to a plasma level of roughly 15 ng/mL, which is the target threapeutic dosage for panic disorder.
If you have authorization from the doctor, take a full 0.5 mg tablet tonight. From what you wrote above, it appears as though you do have permission. If you don't get the plasma level back up, you are going to relapse back into Benzodiazepine withdrawal.
You were making good progress, until your dosage was inappropriately altered. DON'T give up. Call the doctor first thing tomorrow morning. Explain to him that 0.25 mg in the morning and afternoon is not sufficient. Tell him that you would like to reinstate the Klonopin in three divided doses of 0.25 mg in the morning, 0.25 mg in the afternoon, and 0.5 mg at night. Once you stablize in the next several days (likely the next three days), ask for twice daily dosing. 0.5 mg in the morning, and 0.5 mg at night. Do not switch to twice daily dosing until you are feeling well again.
DO NOT TAKE ANY ATIVAN! If you take Ativan, you will destroy everything that you've worked for. Do not give up, not now. You don't realize just how close you are.
Ryan
Called the doc around 4:30, he called me back in less than a minute. I told him what was going on, "He said I thought you better. I tried to be positive and stiff-upper-lipish yesterday. He said, "You're in Ativan withdrawal. He said to take .50 right now and and other .50 going to bed and do that tomorrow and then on the third day take .50 and see if I can taper. He said he'll get me "out of the woods and that I'll be ok." I feel calmer. New withdrawal symptom for all you reading out there, stomach pains. Ugh! I was hoping not to get that one. I just keep repeating to myself what he said to me, "We'll get you out of the woods and you'll be allright." This has been the worst day yet, BUT I called him and I'll get out of the woods. Mary
This doctor is ill-informed, severely ill-informed.
You do not treat a two-year Ativan dependency by switching to Klonopin and taper off of it after three days. Here is where physicians' screw up, and this is why Benzodiazepines have a bad reputation.
Klonopin reaches steady-state only when dosed two or three times daily, and the period of time before the drug even accumulates to steady-state is two weeks. After one month, the drug accumulates from 1.5 - 3 times that of steady-state.
For Klonopin to be effective, it must first reach steady-state, and ultimately, accumulate. You must be *stabilized* on Klonopin before you can attempt to taper from it. By *stabilized", I mean two things; (1) Your symptoms are under good control, and (2) The drug has accumulated beyond steady-state. The typical stabilization period is one month. Therefore, you can not successfully taper from Klonopin for a period of a least one month. If you do, the plasma level will decline abruptly, and you will experience withdrawal symptoms.
You need to discuss in detail with this physician that "you are not better" (as he falsely assumed), and that you will require a stabilization period of at least one month on Klonopin, at the target dosage of 1 mg daily. Ativan and Klonopin are not directly interchangable, they are *indirectly* interchangable due to the differences in their half-lives. Klonopin has a much slower onset of action, and requires more time for the full benefits to be obtained.
Ryan
My doc gets it now. It's my fault, I went to see him and was so positive about how the Klonopin was a prayer from heaven, he thought I was better; he gets it now. What is your suggestion for the rest of today? I don't want to take too much and I don't want to suffer like that yesterday. It was terrible.
Mary
I have his permission. .50 2 o 3 times: morning, noon, bed. But I don't want to overdo it and end up like I was on the Ativan.
At this point, I would take 0.5 mg in the morning, and 0.5 mg at night. No afternoon dose will be required once the Klonopin reaches steady-state.
Once you are stabilized on this dosage, simply notify the Psychiatrist of your progress. He will keep you maintained at this dosage.
You can expect to see a rather dramatic improvement in the next three days. Keep in mind that you may require a slight adjustment to the new twice daily dosing, and that any symptoms (ie: heightened anxiety) will quickly pass.
Good luck, and I'm glad to hear that you were able to work the dosing out with the physician.
Ryan
I see that everybody loves you!! lol Are a doctor or just a fellow sufferer? I've only tried zoloft for a few months a few years ago but it didnt do much for me. I've never taken anything else. Too scared to. But it seems that this Klonopin is the new craze. What's so great about it. Mr. Ryan oh ye god to anxiety sufferers, lol. :)
It seems engaging the mind helps, but the Catch 22 is getting out of the "anxiety focus" mind channel. By the way Ryan, my doc said no more Flexeril either. I forget to mention that.
Ryan, does the Klonopin help dissipate worrying and obsessing? I know the front line drugs for obsessing are the SSRI's but I could write a book about them. For some people, their effficacy can't be denied, but for me, I couldn't take them. Mary
You're making progress. Within the next two days or so, you'll be much more stable. The twice daily dosing routine will stabilize you, and you won't have to worry about the afternoon's any longer.
I absolutely agree with the doctor..no more Flexeril. It has an additive effect on the Klonopin. Flexeril and Soma are similar to Meprobamate (Miltown), which was an old school anti-anxiety drug. The "mother's little helper" of the mid 1950's....
Does Klonopin help with worry and obsessions? Only if they are secondary to the anxiety. Only time will tell. I can't give you a straight-forward answer, as the answer is unknown. But I think the fact that the SSRI's made you worse suggests that the primary component IS anxiety.
What are your obsessions about? Your health?
Ryan
Bad day so far. I can't figure out why I can't get better control of the mornings. Took my .50 at 6:00 AM, and it's almost one and I haven't felt any relief. I am just trying to push myself to function. I walked the do at 7:00 and went to work out around 10:00, thinking that would calm me down. But now I even get panic about working out. A panic attack on an elliptical is no fun. Ryan, I am trying so hard, so hard, so hard. I work out at a health club affiliated with their a cardiac rehab center, because it's close to home an cheaper than a health club. My pulse was 97. By the way, the doc said no Propranalol either. I hate this feeling of inward restlessness, jitteryness, wishing someone could rock you, or you could crawl in a warm slightly tight cocoon. I have a Klonopin sitting on the kitchen counter with my trusty pill splitter. I'm trying not to take one this early. But when your are jumping inside. This hot weather doesn't help either, cabin fever, it's like "meta-anxiety."
What do I obsess about? My health. I'll get a pain that I can't explain away and it'll just take off in my mind, the uncertainty. My first attack was over 20 years ago. I experienced shortess of breath in the '80; doc in the ER gave my Xanax. It had just come out I think. Thank goodness I never got on it.
I could go on an on about bodily sensations that have almost ruined me. Once there was the brain tumor, lump in throat, many times where I couldn't get control of the shortness of breath. People laugh.
I know you said two more days, two more days. Mary
I think the thing that really dragged you down more than anything was the constant change in the dosage. Initially, you started out good on 0.25, 0.25, and 0.5 mg, but then the dosage was switched to 0.25, 0.25 mg.
Then, you switched to twice daily dosing, 0.5 mg and 0.5 mg.
The issue with Klonopin is its gradual onset of action. Making any changes to the dosage (particularly when you are trying to stabilize on it) can result in major issues. Anytime you alter the dosage, you alter the steady-state level, which ultimately governs how the drug will act and effect you.
Therefore, I would continue with the 0.5 mg and 0.5 mg regimen. I would not make any further change, and I would not increase the dosage. I wouldn't even take a half, as ultimately, it is going to screw up your regimen. At this point in time, you must allow yourself to stabilize on 0.5 mg, b.i.d.
Things WILL get better, but only if you take the drug properly, and at the scheduled times.
Ryan
Yes, Mary, every 12 hours. Twice daily, 0.5 mg in the morning, and again at night. Klonopin's efficacy is greatest when dosed every 12 hours for twice daily dosing, or every 8 hours for three times daily dosing.
I'd imagine that you would be a ball of tension! It'll improve, soon (at least the anxiety component will). You'd definitely want to stick it out now, as resorting back to Ativan would only cause severe tolerance issues in the future.
Ryan
Then today I had to take my 85 year old mother to the ER, and I don't know if I mentined, but my dad has esophageal cancer. Usually, when they get sick I am in worse shape, maybe the Klonopin is helping?
I do feel a little better today considering I made it in one piece. As I take the dosage, I'm not gettting wiped out, sleepy like I used to. Is my body adjusting? Maybe it's just going to take me longer. I have to have faith, faith, tht I will see my way out of the woods, but that creeping anxiety is making me think that these syptoms (symptoms) are the Klonopin and not withdrawal and maybe Ativan was the drug that matched me, but I am not going to give up yet. I have to go and try and get myself in a state of relaxation. I didn't want you to think I fell off the face of the earth. This is a tough road thrugh the woods. Mary
I'm glad to hear that you called the doctor, and that he gave you the authorization to take the Klonopin in three divided doses of 0.5 mg each. Take it every 8 hours. This will certainly help you out a little bit more. The doctor is correct, you are still undergoing Ativan withdrawal. Keep in mind that it may take up to 14 days for the full benefits of Klonopin to become apparent. This is particularly true in your case, as you are switching from a shorter-acting agent (Ativan). 14 days can seem like an eternity, and indeed it can be a tough road through the woods.
If Ativan worked well for you, there is no reason why Klonopin shouldn't. You just have to get past the "transition period", and past the "window of vulnerability". You are still slightly "vulnerable", but it will pass (it always does).
Yes, the somnolence (sedative quality) wears off pretty quickly, usually within two weeks. This is normal, and desirable.
Don't worry, you WILL make it out of the woods in one piece! Just try to hang in there, just a little while longer. You'll really be glad you did.
Ryan
Week One - Take 0.375 mg of Ativan nightly (3/4 of a tablet).
Week Two - Take 0.25 mg of Ativan nightly (1/2 of a tablet).
Week Three - Take 0.125 mg of Ativan nightly (1/4 of a tablet).
Week Four - Take 0.125 mg of Ativan every other night.
Weeks Five - Take 0.125 mg of Ativan every third night.
Week Six - The Ativan is discontinued. Should you experience rebound insomnia, take 50 milligrams of Diphenhydramine Hydrochloride (Benadryl) nightly as-needed, for not longer than two weeks.This is available over-the-counter. Should the insomnia persist, inquire about 10-20 milligrams of Doxepin Hydrochloride (Sinequan) nightly. The Doxepin will not only relieve insomnia, but anxiety as well. It is a sedating Tricyclic Antidepressant (non habit-forming). Avoid Ativan, Klonopin, Serax, Valium and Xanax unless they are absolutely necessary. These are Benzodiazepines (habit-forming), and may be exceptionally difficult to discontinue, as the above posts reveal.
--Ryan