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Xanax or Klonopan? Need your advice
by Northcoast, Jun 01, 2007 12:00AM
I suffer from generalized anxiety. Just seem to be stressed and tense most of the time. No panic or anything, just tense muscles in shoulders, neck and jaw. My doctor gave me a xanax prescription and it helps. I take one at night before bed and one in the morning if I feel I need it. At my last visit to my doctor, he prescribed Klonopan instead of the xanax. He said he thought it would get me thru the night better. I've had weird symptoms of not being able to open my eyes for five or so seconds when I get up to pee in the middle of the night. Like my eyes are clamped shut. This may be stress related but not sure. Anyway, does anyone have any advice on moving to Klonopan from the xanax. The pros and cons of each? I'd like to get onto a regimin and take a low dose every day to see if it helps me de-stress and actually enjoy my life. Any feedback would be appreciated. Thanks!
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Klonopin has a 50 hour half-life (Xanax has a 4 hour half-life). The anxiolytic effects of Klonopin are longer lasting when compared to Xanax. Klonopin, when taken at a dosage of 1/2 mg BID (twice daily) reaches "steady-state". This gives you full, 24-hr coverage, where as Xanax does not.
Initially, Klonopin may sedate you excessively, which is why the starting dose is 0.25 mg BID. After three days, the dose is increased to 1/2 mg BID. The sedative quality is short lived, lasting about two weeks for the typical person. Since everyone is different, the drug should be individulaized to suit your needs. The target dose is 1/2 mg BID, as the clinical trials showed maximum efficacy at this dosage level.
Give the Klonopin a week or two, and the sedative effect will likely wear off. The anxiolytic (anti-anxiety) effect will be maintained, however.
Pro's and Con's:
XANAX:
Pro's:
-May be used "as needed"
-Rapid onset of action
-Does not accumulate
Con's:
-Not intended for the long-term
-Short half-life, effects wear off quickly (interdose anxiety)
-Tolerance is common (more drug is needed after a relatively short period of time)
-Dependency is high
-Withdrawal phenomena is severe if taken daily or in excessive doses
KLONOPIN:
Pro's:
-Indicated for the long-term management of anxiety/panic
-Intermediate half-life of 50 hours, effects are long lasting
-May be taken everyday as a maintanence anxiolytic
-Fairly easy to discontinue if done properly
-BID dosing maintains a steady-state level for 24-hr coverage
-No "interdose" anxiety
*Con's:
-Not a good "as needed" drug
-Slow onset of action (30 minutes to 2 hours)
-Accumulates
* Only Con's for short-term anxiety disorders. Does not apply to the long-term management of anxiety disorders.
-Ryan
Thank you and have a great day!
Hi Barbara,
Depending on the individual (and his/her metabolism), Ativan's half-life varies between 6-12 hours (median 8 hours).
Ativan is a good "as needed" drug, and it lasts somewhat longer than Xanax. It is also fast acting (even more so in the sublingual form). But it should only be taken "as needed" infrequently (no more than one tablet every other day).
Blocadren (Timolol) is a non-selective beta-blocker. It is a good drug for PAC's/PVC's and to control rapid heart rate (tachycardia). It's an older drug, but it works rather well. Blocadren is usually dosed BID (twice daily), and lasts about 12 hours per dose. Atenolol 50 mg is another choice that offers full, 24-hr coverage with a single daily dose. Atenolol should also have less side effects, as it is cardio-selective (acts only on cardio beta receptors).
I would not recommend Lexapro to anyone with cardiac manifestations of any form, as Lexapro and other SSRI's tend to worsen such manifestations. I personally would not take any SSRI/SNRI drug, for any reason.
If your anxiety condition worsens (recurs more often than it once did), I would recommend Klonopin 1/2 mg BID in place of the PRN Ativan. I would also recommend switching to Atenolol or Toprol-XL 50 mg, which would likely offer better control over the premature beats. I would choose Atenolol over Toprol, mostly because it is more affordable.
-Ryan
A single dose at night is not sufficient to reach "steady-state". While the effects will carry over through part of the next day, the drug will eventually wear off.
Also, the sedative quality will take longer to wear off when dosed qd (once daily).
I'd ask for 1/2 mg BID.
-Ryan
Barbara,
I'm not a *medical* doctor. I'm an electronics engineer, but have done extensive research on pharmaceuticals as well.
A blood pressure of 93/51 isn't very ideal, and it is rare for Atenolol to have such a profound effect on BP (beta-blockers in general are very poor choices for the control of hypertension). They are better suited for *rate* control.
Both Atenolol and Toprol are cardio-selective, while Blocadren (Timolol) isn't. If the Blocadren works most of the time, I'd stick with it. If it doesn't, you can try Inderal 20-40 mg BID instead (also non-selective like Blocadren). Inderal is a bit stronger, and may supress the PAC's to a more tolerable level. You could also ask the doctor to increase the dose of Blocadren/Timolol slightly.
You DO develop a *dependency* to beta-blockers, but not a tolerance to the *efficacy* (ability of the drug to limit the PAC's). The *dependency* is most notable when the drug is discontinued, and manifests primarily as tachycardia and rebound hypertension. You can take an extra dose as-needed with your doctors blessing. I frequently take an extra dose of Atenolol "as-needed". One doesn't develop a tolerance to the effects of beta-blockers.
The frequency of PAC's may also be increased by stress and anxiety. Controlling the anxiety may decrease the frequency of PAC's.
-Ryan
Northcoast,
No, you can make a direct transition from Xanax to Klonopin.
Since you only took Xanax twice daily, it never reached steady-state.
Klonopin reaches 1/2 of steady-state in three days when dosed BID, and the other 1/2 within six day to two weeks (depending on the person). Once the Klonopin reaches 1/2 of steady-state, it will directly replace the Xanax that you were previously taking.
Therefore, there is no need to taper down on the Xanax. In fact, during the first three days of the transisiton period, you can take a Xanax as-needed until the Klonopin reaches 1/2 of steady-state (use it sparingly in 0.25 mg form only). You shouldn't need to use it, but you can if you need to.
Tomorrow morning, start taking Klonopin 0.5 mg BID in place of the Xanax. After three days, you will no longer require Xanax. Klonopin's onset of action is roughly 30 minutes - 2 hours (typically 1 hour).
-Ryan
Northcoast,
Yes, Klonopin is indicated for the long-term management of panic disorder. It is not officially approved for GAD, but will work just fine. The risk of *tolerance* is lower with Klonopin, but the risk of *dependency* is great with ALL Benzodiazepines.
In short, *tolerance* is your body's need for more drug to produce the same results. With Xanax, the possibility of tolerance is extremely high due to the short half-life. It is far lower with Klonopin and similar drugs with longer half-lives.
*Dependency* may be physiological or pyschological, and merely means that your body becomes dependent on the drug and its effects over a period of time, and dependency is readily apparent if the drug is removed abruptly. Provided the Klonopin is tapered properly, dependency is rarely a problem.
In my opinion, the Klonopin is a better choice than the antidepressants for the treatment of anxiety disorders. The antidepressants are largely ineffective, and they too will cause *dependency* to some degree.
BID = 0.5 mg in the morning, and 0.5 mg at night, or every 12 hours depending on your routine.
-Ryan
I have suffered from "anxiety" as a young child which led to SAD only when a bathroom is not available right away. I believe my past experiences in early childhood has created the trigger and onset of the bathroom being needed or available at all times. If a restroom is not available I feel unsafe and this will lead to a panic attack.. ( going insane feeling). This has been interfering with daily life..traveling with friends, etc.
I really do not want medication due to side effects and dependency ( for I was addicted 10 years ago to drugs, marijuana, for years.
I do not any longer , Praise God, with drugs but am leary to have that introduced. I am however desperate and need something to help me cope as I continue my Christian counseling. I really am hesitant to be put on an antidepressant as well due to me not struggling with depression.
I have read up on the knoloplin and beta blockers..
I am wondering if this is the way to go?
As long as I do not become a slave to them..
Am I able to take the beta blockers as needed?
Thank you so much.. I've seen you have given great advice.
I like to take only one if able... is effexor or knoloplin more mild and effective?
And the question behind the beta blocker is that I desire to sing for my church and cannot due to physical symptoms. Can I take one as needed to help me get on the platform?
Also... are you aware of any natural remedy for SAD which is triggered only by "no availability to restroom"? I am ashamed, embarrassed and afraid of rejection and judgment. I cannot get out of this vicious cycle right now and it is increasing.
Thank you
I have suffered from "anxiety" as a young child which led to SAD only when a bathroom is not available right away. I believe my past experiences in early childhood has created the trigger and onset of the bathroom being needed or available at all times. If a restroom is not available I feel unsafe and this will lead to a panic attack.. ( going insane feeling). This has been interfering with daily life..traveling with friends, etc."
^quoted text
Hello,
Are you able to shed any insight into WHY you chose the bathroom as your "comfort zone" from an early age? Do you go there to "catch your breath", so to speak? To get away from it all? When you get anxious, do you feel the urge to urinate frequently? Is this why there must always be a bathroom present?
Essentially, what I'm looking for is insight from you as to why you believe you have selected the bathroom as your "comfort zone". The first step is to reason this out. What if a bathroom is not available? Clearly, your anxiety level is greatly raised, but why is that the case? What is the worst that could happen from your point of view if no bathroom is available? Visualize yourself in a restaurant. You are sitting in a booth (the inner part), and your friend sitting next to you is blocking your escape route. You grow increasingly nervous and feel "trapped". You glare over at the bathroom, and there is a mile long waiting line. List whatever pops into your mind, both thoughts and physical sensations. Furthermore, what would you do in such a situation? How would you cope?
You indicate that this does NOT interfere with your daily routine, your relationships and so forth. What you have is more akin to a *specific phobia* and not a true social phobia. The phobia is a fear of a bathroom not being available or present.
What you need to do is rationalize why the bathroom holds such a symbolic meaning to you, to understand it. What relief does the bathroom bring to you? What, excluding the bathroom, could offer similar relief or substitute for it?
Medication is out of the question for this scenerio. Taking medication for this would essentially be self-medicating, and would be no better than alcohol. Medicine would act as a temporary solution, and would not confront the problem. In fact, the use of medicine would hinder your progress, as you'd be inclined to attribute relief to the medication rather than your own initiative, which is not good. This is also transient...you are not always placed into this situation, which would make a daily medication regimen unnecessary and expose you to unwanted effects such as the risk of physical and psychological dependence.
The only thing that I would suggest medication wise (and as a last resort) is Xanax, 1 milligram, to be taken ONLY when needed. One to two times per week - never to be exceeded. Yes, the drug works. The problem is that it works too well. And when something works too well and offers an intense amount of relief, we are inclined to rely on it. Again, not a good situation.
My recommendation is to forget about prescription medications, and to use a combination of talk therapy and exposure therapy. Once you gain the insight and understanding into why, precisely, the bathroom is symbolic to you, you can use such wisdom to confront your fears head-on. This is the cure for specific phobia. There is no magic cure in the form of a tablet, and such tablets often do more harm than good in your particular situation.
If I suspected social phobia (and I do not based on the info given), I would have recommended Tofranil, which is a Tricyclic Antidepressant. Social phobia/social anxiety is almost always induced by a strong component of depression. Tofranil inhibits the reuptake of Norepinephrine (Adrenaline) at the synaptic cleft, and hence increases its availability. While not directly stimulating, the brain is stimulated and depression (and concurrent anxiety) is lifted.
So far, you've named two specific phobias...fear of restroom availability and fear of performing in public. The latter is very common. Inderal, 20 mg, taken 1/2 hour before the performance will relieve the autonomic (physical) sensations of anxiety/panic. Inderal may be taken as-needed for performance phobia. It will not alter your perceptions, it will block the physical symptoms. If the performance anxiety is severe, the Inderal should be taken with 1 milligram of Xanax prior to performing. This combination will relieve both the anxiety and the physical sensations that accompany it. Again, a temporary solution, and one that should NOT be relied on greater than twice a week. Confronting your fears via repeated exposure is the best treatment. It may not feel great, but continued attempts will net results if you are motivated.
Please do not take Benzodiazepines (Ativan, Klonopin, Valium, Xanax) more often than twice a week. You shouldn't take them at all in my opinion. You have overcome drug abuse, and I would hate to see you fall back into the trap. Out of all of the prescription drugs available, this particular class (Benzodiazepines) are the absolute worst to discontinue in the majority of folks who take them. They can be an invaluable tool when used properly, but such is rarely the case. They should be reserved only for severe anxiety disorders that do not respond to conventional modalities.
Wishing you the best,
Ryan
Are you able to shed any insight into WHY you chose the bathroom as your "comfort zone" from an early age? Do you go there to "catch your breath", so to speak? To get away from it all? When you get anxious, do you feel the urge to urinate frequently? Is this why there must always be a bathroom present?
Separation anxiety occurred when I was 5 years old leaving a twin brother I was extremely close to by going into my big girl bedroom. Shortly, after I feared going to bed and mentally I felt I needed to urinate frequently. I was not physically ill and would often pray that I could just hold my urine for a minute before going again. I had a hard time falling to sleep because of this need to go. I felt awful about myself and it did lead up into the daytime as well. I never really needed to urinate much when I went but it was all in my head and I felt pressure physically. I was made fun of and called hypochondriac. Nightly my brother would put me to sleep in the middle of the night out of my own fear and his nightly bed tucks stopped suddenly around 4th grade time which lead to nervous stomach. I would yell at night to him "You don't love me... please..I'm scared." I would have pain and direhea often which interfered with slumber parties or even friends moms picking me up to go to a movie. The "waiting" created so much anxiety and I often could not go. I was teased often for going frequently, number 2, and always had pain in the stomach. I feared going to school and waiting for the bus stop as well due to my nervous stomach. Often now as a grown adult it is a 50/50 deal where I need to go now or I can find myself getting through the car ride and never had to go. My problem more is not the frequent urination but the need to go number 2 and gas pains. This DOES interfere with my life greatly and with many relationships! I cannot do many things with my child and husband. I cannot go for hikes or long walks with my friends because of this condition. I cannot sing at my church which I greatly desire to do. I cannot car pool with others for events and such. I am saddened due to the loss of opportunities.
I do know that anxiety, fear, alcoholism and OCD run in my immediate family.
I often drive myself alone to not be an inconvenience to others if I need to stop. If others are with me I often cannot finish what I need to "do" in the bathroom due to pressure and being an inconvenience which leads to panic. But then panic more as soon as I leave the restroom because I have pain to go.
I often put myself at the end of isles of tables and always ask if there are restrooms available. When I see there is only one restroom available with a long line or knowing people are waiting while I am in the restroom I panic. My stomachs gets painful with gas, my throat tightens up, heartbeat rises, I get flushed and often cannot focus on other peoples conversations. I often cry and feel like I am going crazy. I am shameful, embarrassed and fear judgement and rejection. I would cope and tell myself that there is a another store right next store and if a terrible emergency arose I could quickly go there.
I do know when I am around people that I feel are "unsafe" which is almost everyone besides a few dear friends and husband my anxiety increases. I have a need for unconditional love and acceptance and fear not meeting needs and thus getting rejected. I have been rejected by the most dear people to me as a young child and the bathroom all revolves around this pain.
I have worked on this issue for years and have not yet been able to move through this but I am not giving up. This started when I was 5 and I am now 30 years old. I have never been to a Dr to get diagnosed but was thinking about doing so in the next week.
I have just bought a natural pill called Tension Release to take daily which is used in India as a prescription for anti anxiety and thought I could still take my .5 mg Klonopin as needed for big events.
I am seeking out another counselor that aids with anxiety and prayerfully she can offer some CBT and actual clinical settings.
I cannot vision anything being a substitute for my need of the bathroom besides a diaper..which I will not go there.
I feel my daily life is exposure to my problem and it does not get better. I have forced myself to go on stage and it is literally torture for the whole week ahead and I am so relieved when it is over. I often panic on stage and cry or feel awful when over.
I hope I made sense...
Thank you for your insight.. and more to come if you understand more of my history.
I also as a young child until 20 years old wrote everything I had to do and if done out of order I felt like something bad would happen in my day.
Now I no longer do this or feel this way...
Thank you Ryan.. I know it is complicated..ughhhh
Do you know much about this?
I need something to help me cope as I pursue more therapy..
I was diagnosed at 19 with IC..interstitial cystitis and wonder if I have dealt with most of my life IBS. I also experience tension headaches almost daily, teeth grinding at night and often feel unrefreshed in the morning from a full night sleep...along with mid back pain since the age of 15. I just came to the knowledge that alot of these are interlinked with one another and also came to the awareness that children can experience IC that comes and goes.
Dr.s and studies show that this can be a nerve relation.
Any ideas?
Thanks!
I'd like to stay with natural remedies if possible..