Xanax and Klonopin together(Ryan)

[msanxiety]

My dr. is tapering me off 1 mg. of xanax 3 times a day and adding me on o.5 mg. klonopin 3 times a day at the same time..........he has cut me down to 2 mg of xanax and adding the klonopin..this is my 3rd day........i have posted other posts maybe u could read. Anyways im woried about withdrawals from the xanax even though im on the klonopin i stopped xaanx last year after being on it 17 years cold turkey and was hopsitalized.Worrying about all this is causing my anxiety to be worse and neither med seems to be working .I felt ok yesterday till some person told me im on to much meds'
anyways if you could read my oterh posts eveeryione here says you know alot......I was on klonopin before and did great on it.however i feel they may depress me some..My drs goal is to get me off all meds

[RCA7591]

"My dr. is tapering me off 1 mg. of xanax 3 times a day and adding me on o.5 mg. klonopin 3 times a day at the same time"

^quote

Your doctor's approach is bizarre, and it won't work. I'd strongly suggest that you find another physician to manage your case - as your current doctor doesn't have a clue, and if you continue to follow his/her advice, you're going to be seriously screwed up.

One does not taper directly off of three milligrams of Xanax after seventeen years of use. Three milligrams is a substantial dosage, and it must be gradually stepped out by replacing it with a long-acting agent (Klonopin), which you can then gradually taper off of. Rather than taking this approach, your current doctor chose to add a moderate daily dosage of Klonopin to be taken in conjunction with the Xanax - you are being over-medicated. Not only are you being over-medicated, your probability of developing a tolerance to the effects of Benzodiazepines is sharply elevated. The simultaneous use of two high potency Benzodiazepines is contraindicated for this reason.

Xanax is a short-acting agent with a half-life of six hours. It never accumulates in the plasma. Thus, tapering directly off of the drug after prolonged use (and at dosages in excess of 1 mg) poses a challenge. Since there is no blood plasma level to subtract from, the onset of withdrawal phenomenon are abrupt and acute.

Klonopin, by comparison, is a long-acting agent with a half-life of fifty hours. Klonopin accumulates to steady-state within two weeks, at which point the full benefit of the drug is obtained. Unlike Xanax, Klonopin does not work instantaneously. Klonopin must accumulate, where as Xanax never accumulates. Therefore, Klonopin cannot immediately replace Xanax. To fully replace the Xanax, the Klonopin must accumulate over a period of two weeks. Once steady-state is established, it will replace the anxiolytic quality of Xanax.

The two are equal in terms of potency. 1 mg of Xanax is equal to 1 mg of Klonopin. This can be deceiving, however, as the effects of Klonopin are not appreciated for up to two weeks.

The Xanax must never be abruptly discontinued - rather, it should be stepped out gradually and replaced with a dosage equivalent of Klonopin. Once the transition has been made from Xanax to Klonopin, the Klonopin may be tapered from directly. Before you can get to this point, you must replace and discontinue the Xanax entirely...

TRANSITIONING FROM XANAX TO KLONOPIN PROPERLY (to be performed only under the direct supervision of a medical doctor):

Weeks 1-2: Take 1 mg of Xanax in the morning, 1 mg of Xanax in the afternoon, and 0.75 mg of Xanax nightly in conjunction with 0.25 mg of Klonopin.

Weeks 2-4: Take 1 mg of Xanax in the morning, 0.75 mg of Xanax in combination with 0.25 mg of Klonopin in the afternoon, and take 0.75 mg of Xanax in conjunction with 0.25 mg of Klonopin nightly.

Weeks 4-6: Take 0.75 mg of Xanax in conjunction with 0.25 mg of Klonopin in the morning, 0.75 mg of Xanax in conjunction with 0.25 mg of Klonopin in the afternoon, and 0.75 mg of Xanax in conjunction with 0.25 mg of Klonopin nightly.

Weeks 6-8: Continue to take the morning and afternoon combination of 0.75 mg of Xanax and 0.25 mg of Klonopin. Nightly, take 0.5 mg of Xanax, and 0.5 mg of Klonopin.

Weeks 8-10: Continue to take the morning dose of 0.75 mg Xanax and 0.25 mg of Klonopin.
Take 0.5 mg of Xanax in conjunction with 0.5 mg of Klonopin in the afternoon. Continue to take 0.5 mg of Xanax and 0.5 mg of Klonopin nightly.

Weeks 10-12: Take 0.5 mg of Xanax and 0.5 mg of Klonopin in the morning, afternoon, and nighlty.

Weeks 12-14: Continue to take 0.5 mg of Xanax in conjunction with 0.5 mg of Klonopin in the morning and afternoon. Take 0.25 mg of Xanax and 0.75 mg of Klonopin nightly.

Weeks 14-16: Continue to take 0.5 mg of Xanax in conjunction with 0.5 mg of Klonopin in the morning. Take 0.25 mg of Xanax in conjunction with 0.75 mg of Klonopin in the afternoon and nightly.

Weeks 16-18: Take 0.25 mg of Xanax and 0.75 mg of Klonopin morning, afternoon, and nightly.

Weeks 18-20: Continue to take 0.25 mg of Xanax and 0.75 mg of Klonopin in the morning and afternoon. Take 1 mg of Klonopin nightly.

Weeks 20-22: Continue to take 0.25 mg of Xanax and 0.75 mg of Klonopin in the morning. Take 1 mg of Klonopin in the afternoon and nightly.

Week 22: Take 1 mg of Klonopin morning, afternoon, and nightly.

Week 24: The Klonopin reaches steady-state

Week 26: The Klonopin accumulates to 3 times that of steady-state. A taper schedule may now be devised for discontinuing the Klonopin. Or, if you are well maintained at this dosage, no further change needs to be made. Should the Klonopin depress you, 25-75 milligrams of Amitriptyline or Desipramine may be added in conjunction with the 3 milligrams of Klonopin. This will replicate the Tricyclic structure of Xanax.

~Ryan

[msanxiety]

im not tapering off the xanax aafter 17 years (that was last year) this time i have been on xanx only since feb o8 and dr is tapering me off by adding the klonopin ...0.5 mg 3 times aday............I think my other posts explain it better if you could read them.........and yes i am still on xanax along with the klonopin..the pharmist say lost of drs are doing it this way...........

[msanxiety]

You seem  to know alot............how did you get the knowledge for this are you a dr. or pshy? I dont mean anything rude by this..........just wondering how you know all this and why you doubt my dr, who is a highly respected Pshycolgist?Thanks

[xanweaner]

I was happy to see that you finally got an answer to your cries for help...but, I'm a bit puzzled by your post back to Ryan. You asked his opinion....he took the time to respond...and your post does not appear to appreciate the info. he presented.

It's great the you're so comfortable with your "highly respected psychologist"...were you just looking for confirmation of their treatment plan for you?

I hope that you begin to feel better soon...

[JSGeare]

We are potentially on thin ice, here. It is staggeringly clear, based on Ryan's plain talk explanation, that messing about with the Xanax and Klonopin poses challenges to say the least. And msanxiety, while very clearly nervous about the right thing to do and what the impact of her actions will be, has been less clear about what is actually going on with the meds right now. We're talking drugs here, folks, and EXACT detail is a good thing.

The mission is to get you, msanxiety, on to whatever program is correct for you, period. While we know what you report about the tapering, we really don't know what the doctor actually said, we don't have your medical records in front of us, and if we did, we're not professionally qualified to evaluate them anyway. There is a lot of "assuming" involved and it is your life and peace of mind in the balance. And we do know that you were motivated, at least in part, to post the current question because "some person told me im on to much meds' anyways " I don't know and don't need to know who that someone was, but it seems very likely to me that the warning was enough to give you serious doubts. In any case, the whole business of mixing and tapering medications is really risky when the primary sources of information and action are "someone," and the people you've never met on a web site forum.

So, what do you do?

What you do is print this out -your post and all the responses to it, every word of it- and walk it in to your doctor. If you have a low confidence level in your doctor, then you consult with some other doctor but in any case put the whole thing in the hands of someone professionally qualified to express an opinion and lay out a course of action for you.

Ladies and Gentlmen, don't get me wrong, here. If I'm a bit stiff about this, it is because I am scared stiff about bad outcomes. Msanxiety, I want you to get well -that's the bottom line. And I want nothing that I or anyone else does here to encourage you to do anything that might not contribute to that effort. THAT SAID, it is entirely possible that what we HAVE said may be right on the money and serve as a wake-up call to the doctor who is directly responsible and accountable for your care, which is why I say to show your doctor what you have writen to us, and the responses you have received.

And then, please tell us the result. What you are facing -and how it is ultimately resolved- is of great interest and importance to fellow travelers on this forum, so I hope you will share it.

OK?