Yet another Klonopin Question

[debaser23]

As I said in a different post, a few weeks ago I switched from Caraco generic clonazepam to Teva.  I did not notice anything immediately but I have felt an increase in my anxiety level since switching and also have experienced a couple of panic attacks recently.

Obviously I can't study myself.  I do not know whether the switch has anything to do with the way I'm feeling.  It could be any number of other factors.

Thing is, I'm about to go to the doctor for a refill.  Right now I'm in between insurance and am not covered, so I'm having to pay for the office visit out of pocket.  Even though my old doctor is a couple hundred miles away, I'm going all the way back there to see him for this because he's familiar with my case.  Anyway, the appointment will be very brief as he's going to "cut me a deal" and I need to be very succinct with my questions.  So....

Ryan and I had discussed that I could be metabolizing the Klonopin quickly, and that an increase in dosage may be warranted to compensate.  I do not fully understand the principles behind this, apparently.  I thought that I had a slow metabolism.  That is, if I eat bad things I get fatter than most other people.  I have to watch it.  But does this have anything to do with the way I metabolize drugs?  Another thing, if I have a headache and take an Advil, it takes a couple hours to work.  Others I know say that it works much more quickly for them.  Does this suggest that I metabolize slowly or does it mean anything at all?  

I've always been hesitant to up my dose.  Currently I'm on .5 mg bid.  On two different occasions I took an extra .25 mg under the tongue to help out.  That's two times in something like four or five months.  Obviously, I'm very cautious about this.

If I'm to ask for an increase in my dose, should I ask about taking an extra .25 or .5 mg tablet as needed?  Or should I just go to tid and let that build to a steady state?

I'm also wondering if I should switch back to the Caraco if I can find a pharmacy around here that sells it.  

Anyway, I'm going to be taking off work to drive 200 miles and pay 80 bucks to see this guy for five minutes, so I want to be able to ask concise questions and make the most of it.

Thanks in advance,
D

[RCA7591]

For most drugs, it is assumed that a +/- 20% tolerance shouldn't have any impact on efficacy, however, that doesn't hold true for many drugs. Anticonvulsants (Dilantin, Tegretol), Thyroid replacement drugs (Synthroid), anticoagulants (Coumadin), and others have what is known as a "narrow therapeutic index", a very narrow range in which the drug provides efficacy. If the drug falls short in potency or bioavailability, efficacy is compromised.

I believe that what you are currently experiencing is a loss of efficacy from the TEVA brand Clonazepam. The therapeutic window for Clonazepam varies between 15 - 80 ng/mL (the plasma level). The minimum effective Clonazepam plasma level for panic disorder is 15 ng/mL, which is produced with 1/2 mg, b.i.d dosing. If the plasma level falls short of 15 ng/mL, problems can result (loss of efficacy).

You stated that the change was not immediate, which would be very common with a modest dosage reduction. Keep in mind that with Clonazepam's long half-life, effects may not be obvious for up to two weeks. If the potency or bioavailability of TEVA is less than that of Caraco, loss of efficacy would be the result. The therapeutic window is extremely narrow for Clonazepam and other anticonvulsants. It is suggested that once you start on one brand (name or generic), that you continue using that brand in the future.

Case in point, my brother suffers from Grand Mal seizures, and takes Tegretol 1200 mg daily. He has not experienced a seizure until recently, when his health insurance company suggested that he switch to generic Carbamazapine.
Three days after switching from brand to generic, he suffered from a massive, 20-minute seizure. His neurologist now indicates "brand necessary". My brother has lost his driver's license for six months due to this event. Like Carbamazapine, Clonazepam has a "narrow therapeutic index". The slightest change in dosage may result in compromised efficacy. Technically, both drugs are classified as anticonvulsants.

In your case, pursuing the Caraco brand generic may be the best option. I know that Walgreens stocks this particular brand. Clearly, the TEVA is resulting is loss of efficacy.

Clonazepam is metabolized primarily by the liver. Depending on your hepatic metabolism, and the way that it metabolizes Clonazepam, you may require more Clonazepam. The half-life is said to be 50 hours, however the actual range is variable between 18-50 hours. The wide range in half-life can be attributed to hepatic metabolism. No two people respond alike, and therefore, the drug must be individualized to suit your particular needs. The reference ranges given in the clinical trials are those only; a general reference. If you require 0.5 mg, t.i.d, there is not a problem with this. Problems do not result until the daily dose exceeds 2 mg.

P.R.N use is another option to discuss with the doctor. If your symptoms are under reasonably good control, an extra p.r.n dose of 0.25 - 0.5 mg taken every third day is a logical alternative to increasing the daily dosage. Taken every third day, or twice a week, the steady-state level is not grossly altered.

I know that one of your biggest fears is developing a *tolerance* to Clonazepam. However, rest assured that adding an additional 0.5 mg daily or as-needed will not increase your risk of tolerance. 1.5 mg is a typical dosage (a very typical dosage indeed). The extra 0.5 mg will simply increase the plasma level to a new steady-state (20 ng/mL). When dosed three times daily, it will ultimately accumulate to 3 times that of steady state within one month.

Hopefully, this gives you a basis to form questions on. I would do two things: (1) Locate a supplier of Caraco, and (2) Ask for t.i.d dosing.

Best to you,

Ryan

[debaser23]

Thanks, man.

So when a skinny guy is said to have a "fast metabolism" that doesn't necessarily have anything to do with drugs?  That's just how quickly he burns off calories and is another issue entirely, I would guess?

I'll ask my doctor about going to tid or possibly a third dose as needed, as well as switch back to the Caraco if I can find it.  There are Walgreens up here; I just don't know where.  I do know that some of them carry purepac, too, which is widely known to be ****.

But if it were you, you'd ask about going to 1.5 mg's everyday as opposed to as-needed?  My doctor already said I could take extra if I needed it, but without insurance I've had to "conserve".  I forgot he'd said that, haha, because running out early hasn't been an option for me.  I have less than a week's supply left bid right now and can't get to the doctor until next week.  It's gonna be close!

[Raine9]

Mr. debaser:

This post is gonna cost you $25.  Oh, since it was directed towards Ryan, you have to pay a premium.  You owe $40, plus applicable taxes.  

Cash only please.  Your checks are no good here son.

Thank you for your patronage.  Come back real soon, ya hear!

[numbercruncher]

I switched to teva also.  I am having the same problems you are.  I have tried increasing and decreasing.  I take 0.5 at night. Nothing works....I am tired all the time and want to sleep more. I see my doctor in a week.  I talked to my pharmacist about this and he told me that the teva actually caused anxiety.....What???  Looking forward to your next post. NC

[pvcqueen]

This is sooooo unethical.I really cannot beilieve this........and it hurts me.  what has become of this world?

[debaser23]

This is a patient-to-patient forum and I think we all know that Ryan isn't a doctor and that we should discuss any advice he may give with our physicians.  Is that what you're talking about?

And Raine, shut up.  I know where you live.

[often]

I find it highly unethical also.  Suggesting asking a doc about one drug or another because "gee...it works for me and I have studied up on it" and actually giving out dosing info are two very different things.  Apparently Med Help doesn't give a rat's a-s.  Probably getting a kick back from the K peeps.

[RCA7591]

"I talked to my pharmacist about this and he told me that the teva actually caused anxiety.....What???"

--end quote--

That is really interesting. About a month ago, I too switched to TEVA (I had been taking Roche Klonopin eight months prior to switching). My new insurance would not cover brand name if there was a generic equivalent.

I had always assumed that TEVA was pretty close to genuine Klonopin, and initiallly, my experience reflected this. However, now I have doubts, as I too am experiencing some minor issues with this make of Clonazepam. I tend to look at things objectively, but there has been no significant stress in my life since making the switch. So I could only assume that the bioavailability of TEVA is less than that of Roche Klonopin. I will attempt to back this with fact if possible.

I'll be digging through the files tonight, and I will try to locate TEVA's FDA approval for Clonazepam. I have Mylan, and a few of the others, but will need to look for TEVA. If I find the documents, I will post them.

As far as TEVA actually causing anxiety....NO! The increased anxiety would be attributed to switching from one generic to another, or from Roche Klonopin to a generic that has less bioavailability or potency. The increased anxiety is withdrawal phenomena. Less bioavailability or potency = decreased plasma level. The minimum effective level is 15 ng/mL with 1/2 mg, b.i.d dosing for panic disorder.

-numbercruncher-, what brand of Clonazepam were you using prior to making the switch? Was it Caraco?

-pvcqueen-, there is indeed a difference between generics with an NTI. The experiences of the other two folks who posted just confirmed it. While those may be subjective observations, they are very significant in my opinion.

-debaser- "fast metabolism" has nothing to do with drug metabolism. In the case of Clonazepam, hepatic metabolism ultimately governs how the drug is metabolized. So if it were me, I'd ask for 1.5 mg daily (and I have myself). I use it p.r.n, however. 90 tablets/month is my prescription. I was well maintained on b.i.d dosing until making the "switch" to TEVA. I'm not having severe issues, but they are absolutely noticable at this point. I'm not going to "wait and see" if they get worse, I'm going back on Roche Klonopin tomorrow.

Ryan

[Raine9]

debaser:

Since you know where I live, you can hand deliver the cash.  I'm only open during normal business hours.  A money order will work too.  Ryan gets 10%.

Ryan:

I take TEVA and it seems to work fine for me.  Of course, I have nothing to compare it to, I don't take it regularly and my anxiety is not as severe.  Anyway, maybe it just affects everyone differently.

[RCA7591]

"I find it highly unethical also.  Suggesting asking a doc about one drug or another because "gee...it works for me and I have studied up on it" and actually giving out dosing info are two very different things.  Apparently Med Help doesn't give a rat's a-s.  Probably getting a kick back from the K peeps. "

--end quote--

Having frequented this board for the past eight months, I have seen many things that I would personally consider "unethical":

(1) Improper prescribing of short acting agents for the long term management of anxiety disorders (Ativan, Serax, Xanax). By far, this is the biggest concern of many who post here, or who have posted here. These drugs are not approved for long term use for a very good reason. Said drugs loose their efficacy, leaving the user both dependent and tolerant to the effects, resulting in a severe worsening of the presenting illness. This is unethical prescribing  in my opinion.

(2) The use of Atypical Antipsychotics for the treatment of anxiety states. Not only are such drugs not approved to treat anxiety disorders, they carry a plethora of adverse side effects, many of them potentially very serious. This is by far, the most unethical prescribing of a drug in my opinion.

(3) Doctors that prescribe short acting agents, and continually increase the dosage to re-establish efficacy. Again, another common complaint of folks who have posted to this board. Ultimately, the drug loses all of its efficacy, leaving the user screwed. Doctors who inappropriately prescribe these drugs do not understand their pharmacology, and are not versed with discontinuation schedules. It is the patient that ultimately suffers from the ill-informed doctor's decision. Again, unethical prescribing in my opinion.

(4) More recently, the issue of bioavailability tolerance between name brand and generic drugs, particularly drugs with a narrow therapeutic index. The generic is allowed a range of 80-125% tolerance in bioavailiability compared to that of the model (name brand) drug. Patients are often told that there is no difference between brand and generic, and that is unethical in my opinion considering the fact that there is for many of them. My brother lost his drivers license for six months due to switching from brand to generic Tegretol/Carbamazepine (an anticonvulsant).

As far as "gee Klonopin works for me", that isn't the issue. Yes, it works for me, but that is not why I recommend it. Vasotec, Atenolol, Diovan, and Lasix also work for me, but you won't see me recommending any of those. The only reason why I suggest Klonopin over Ativan and Xanax is due to its long half-life and retainment of long-term efficacy. Tolerance is rarely, if ever an issue with Klonopin/Clonazepam. The drug is an anticonvulsant, approved for long term use. It is also the front-line treatment for panic disorder, and it is approved for this very use.

As far as the actual dosing is concerned, it is fairly standardized. The drug has a narrow therapeutic index for panic disorder (1 mg - 4 mg daily). Anything above or below this range is less effective, or largely ineffective. The initial starting dose is 0.25 mg, b.i.d, and increased to the "target" dosage of 0.5 mg, b.i.d after three days. This is what the manufacturer recommends. Further efficacy has been demonstrated with dosages up to a maximum of 4 mg daily for panic disorder.

My postings are not unethical in my opinion, they offer objective information, information that is often withheld or undisclosed by medical doctors. The fact that Ativan and Xanax are not indicated for long term use is an objective fact. The folks who have posted here requesting help have demonstrated this fact time and time again. I believe that I've helped quite a few people. If not, than I am mistaken.

I am NOT a *medical* doctor. I am an electrical and electronics engineer, with a background in analytical chemistry. I had intended to become a medical doctor, however, that ambition was altered 4 years ago due to a serious medical condition, which has ultimately progressed in severity over the past four years.

Cordially,

Ryan

[ccamrine]

I happen to think Ryan is quite knowledgable on the subject of klonopin.  I was already taking it, just started actually, when I started reading this forum.  He really taught me alot more about it than my own Dr. did.  My Dr. told me to take it twice a day, and in my thinking, I thought it was like xanax and I tried to take it only once a day.  Two  weeks later my Dr. was very upset when he found out I wasn't taking it twice a day.  He never explained why I needed to take it twice a day.  But I learned, from Ryan on this forum why and how it works.  I'm very thankful that he's here to answer questions about it.  No, he's not a Dr., big deal, but he's very informed on it.  And from what I remember he always says to talk to your Dr. about it.  Just my opinion.

[often]

cc...you state...

"...My Dr. told me to take it twice a day, and in my thinking, I thought it was like xanax and I tried to take it only once a day.  Two  weeks later my Dr. was very upset when he found out I wasn't taking it twice a day.  He never explained why I needed to take it twice a day..."

All I can say is shame on you.  Your doc writes you a scrip and you decide HE must be mistaken (yeh   that is basically what you did when YOU decided to  only take one).  Did it occur to you to ask your doc why twice?  Did it occur to you to ask your doc what it would do, how it would act, what you would feel?  At the time, did you even care?  Probably not.  How many of your meds have you done that with.  You know...only taken every other day, instead of daily.  Taken 2 when you are only supposed to take one. One thing we all should know that you are supposed to take scrips as written.  Taking less is just as abusive as taking more than prescribed.

I am amazed everyday here.  It seems that everyone complains about the docs out there not taking time, not explaining, keep on writing scrips.  When are people going to take responsibility for their own lives. When are they going to stop searching for that great panacea and start paying attention to what they are really doing.   I will hand that one to Ryan...he has done his research and he knows his meds...certainly this particular class and he has taken responsibility.  I just don't believe he should be going as far as he is.  My opinion.  Obviously a minority opinion.  And maybe if he was my saviour I would be defending him to the death.  

I question my docs on every med they give me.  Why this one?  What are the sides on that one? Can I get by without this.  Can I cut this dosage now I am feeling better.  I have had a few that wouldn't give me answers....I FIRED them!  

I take an anti-depressant.  I became clinically depressed after some major health issues.  I recognized it and went to my primary.  WE discussed my situation..WE discussed the med choices... then I made the decision.  I know when I can back off the dosage.  I know if I need to up it.  But I do nothing until I talk to my doc and WE discuss it.  

Ergo, I don't need a Ryan in my life.  I guess I am happy you all have someone to hold your hands, but had you been a little more agressive, you wouldn't need the Ryan's of the world.

[debaser23]

That should've read "I really wish you'd STOP mucking up my thread", obviously.

Again, this is a patient to patient forum and Ryan is an informed patient.  I'm an informed patient seeking advice from other informed patients so that when I have my five minute visit to the doctor I can make the most of it.  Period.  

Nobody here is altering their dosages based on anyone else's advice.  You're missing the whole point.

[debaser23]

Well, I really wish you'd start mucking up my thread.  This is a PATIENT TO PATIENT FORUM.  I am here asking advice so I'll have some things to go on WHEN I SPEAK TO MY PHYSICIAN.  

If you want to complain about Ryan, do it somewhere else.  I was trying to address some issues here that are of significance to me personally, so I'm personally asking you to not post in this thread anymore.

[ccamrine]

Why shame on me?  I had been told by my psychiatrist for along time that I could take my xanax as needed every six hours, but try not to take it that much.  Which I never did,knowing that it could cause tolerance and addiction.  Knowing that klonopin is a benzo like xanax, I tried not to take it that often.  

If you're so self sufficient and informed what are you doing on this forum?  Sounds like you already know how to take care of yourself.

[numbercruncher]

http://medicine.wustl.edu/~wumpa/outlook/winter2000/panic.html#start

This may sound dumb, but I never noticed what the generic was before the switch. I looked recently because of the problems I was having. The link above may be interesting to some.  When I read it, I felt so much better about my "whatever."..........I am really glad I found this forum.  I visited one last week for the first time, and could not have a good discussion because they were all dedicated to the Claire Weekes books.....Which I have read. Oh well.....NC

[numbercruncher]

I started on the Roche klonopin yesterday and yes there is a major difference in the way I feel. I am having to pay for it myself, but it is worth the price. My doctor told me that some of the pharmacies shop around for the cheapest generic. I was using CVS.  I took my new subscription to them for the real klonopin and guess what???? They did not carry the Roache klonopin.  I had to go to Walgreens.  They carry the real klonopin and also their generic is Carroco. (sic)   When I am sure I am alright with my benzo again, I will try their generic Carroco.  NC

[debaser23]

I actually went back on Caraco today.  Can't feel a difference, yet, of course...it'll take a few days.  The Target pharmacy in my area sells Roche Klonopin qty 60 .5 mg tabs for only $86.  That's MUCH less expensive than Walgreens was charging for the same thing.  When I'm on my new insurance, though, I'll have to use the hospital mail-order pharmacy.  I expect that it'll be in that range and maybe cheaper then as they're non-profit.

[RCA7591]

"I started on the Roche klonopin yesterday and yes there is a major difference in the way I feel. I am having to pay for it myself, but it is worth the price."

There is a major difference, and indeed it is worth the price for the relief alone. I took Roche Klonopin for approximately eight months before switching to TEVA. Initially, I didn't notice a difference. The difference between the two didn't mainfest until nearly a month later. I've since switched back to Roche Klonopin, and full efficacy has been re-established. In three days, you'll really notice the change.

My Pharmacy doesn't stock it, as insurance doesn't usually pay for it, and very few people buy it. They do have plenty of TEVA, and claim it to be a "best seller". So they order it for me special. Price for (90) tablets is $120, and the insurance reimburses at the generic rate ($30), bringing the grand total to about $90. I don't actually take all (90) tablets, just (60) of them, so I'm going to have the script changed to (60) tablets/month. Price for (60) 1/2 mg Klonopin tablets is $80, and the generic rate is $19.99. So I'd pay $60 for a one month supply of (60) tablets.

In my opinion, insurance should cover brand Klonopin. It's an anticonvulsant. Insurance usually covers NTI drugs such as anticonvulsants, thyroid replacement, and others when "brand necessary" is required. If the indication were epilepsy, they probably would, but not for "panic disorder".

I've had no issue with other TEVA products (and I take plenty of them).

Ryan

[Shannon Wyatt]

Ryan, does your pharmacy not carry Clonazepam -- the generic version of Klonopin?  Aren't the two basically the same?  Or am I reading here that the Roche Klonopin is much better than the generic version (Clonazepam)?  Thanks!

[HockeyShark]

Unethical?....

Next time you walk into your doctors office look around. Paxil Clocks, Lexapro Pens, Xanax note pads, and he is probably wearing Zoloft underwear to match his gold Prozac watch. That is of course if you can get in to see him as he will be at all expense paid "Conference" at Lake Tahoe for GSK.

[whineyhiney]

it is called  "marketing".....I have even partcipated....but never in my life have I witnessed such a co-dependency................lol.

[mia193]

all i can say is "WOW"  I really thought that people came here to help one another and take a little of this and a little of that in their lives and try to get through life!  Life is hard enough without all of this-
i value every bit of ADVICE everyone has to offer- if it works for me, then great, if not,  then I will find some other advice i am sure from someone out here.  I truly think that all of the NEGATIVE people need to leave and let us learn from one another that we are not as alone out there as we might think we are.  I believe EVERYONE, has anxiety in their life- some deal w/it better than others.  If anyone should be ashamed of themselves or feel that anything is unethical, then don't participate- you are adults - so act like one!!
I just want to thank all of you who are genuine and sincere and help all of us no matter what you have after your name-
have a GREAT night-
m-

[numbercruncher]

I forgot to mention that my bp was 178/76 when I visited my doc. Not only did he give me the real Klonopin, but he put me on a beta blocker med.  Just a thought.........has anyone else experienced high bp taking TEVA?  I am not on a witch hunt, nor am I tying to make something out of nothing.  Just a thought.  nc

[Gingin515]

[Gingin515]

Is TEVA the .5 yellow pills?  That is what I take and once I got my prescription filled at Walgreens instead of CVS and got Pink pills.  Within a week I was a total basketcase.  I called my Dr. and he called my script in to CVS and I started back on the yellow pills.  It took me several days to realize what had happened.  I couldn't figure out what was going on and then it was like a lightbulb went off, my pills are pink now instead of yellow...DUHHHHHHHHHH.  Anyway, I stick to the yellow ones now.  I am actually weaning off very slowly using a water titration method.  It is no fun coming off these little pills!!!

Also, where did you get your info that you do not become tolerant to klonopin like other benzos.  Just curious because I have had 3 different Dr's tell tell me you can become tolerant to ALL benzos.  

Thanks for your advice and help.

[RCA7591]

TEVA 0.5 mg tablets are scored, yellow in color, and bear the code:

93
832

I'm not sure what the pink tablets are, but if you can provide the code off of the tablet, I can find out in about two minutes.

Issues can arrise when switching from one generic brand of Clonazepam to another, or from name brand Roche Klonopin to a generic. The drug has a narrow therapeutic index, and any small change may manifest in symptoms. The generics are allowed (by the FDA), a 80% - 125% tolerance with respect to bioavailability. It is suggested that once you start on one generic brand of Clonazepam, or brand name Roche Klonopin, that you remain on that brand only (due to the fluctuations in tolerance).

For instance, let's assume that you were previously taking Roche Klonopin, and the bioavailability was 100%. Then, you switched to the generic PurePac, and it had a bioavailability of 80%. The steady-state plasma level would decline to that of the new generic (PurePac), and withdrawal phenomena may result (within 3-14 days).

As far as the water titration method, I do not believe in it. Benzodiazepines are not water soluble, which is why the injectable forms of Clonazepam, Chlordiazepoxide, Diazepam, Lorazepam, and Midazolam are suspended in a vehicle of Propylene Glycol and Benzyl Alcohol to facilitate absorption. Otherwise, they would not be absorbed.

The best way to taper Klonopin is by 0.125 mg increments every four weeks, under medical supervision.

The issue with all Benzodiazepines is *dependency*. All of them create some degree of physiological and psychological dependency, which manifests when the drug is abruptly withdrawn, or when the drug is abruptly tapered.

The other issue is *tolerance* (the need for more drug to produce the same results), and this is to be avoided. Tolerance is largely a non-issue with Klonopin, as the drug was intended for use as an anticonvulsant. Since epilepsy is a long term illness, the efficacy of the drug(s) used to treat it must remain intact over extended use. Klonopin, Librium, and Valium are all agents that are approved for long term use. Since Klonopin is both more potent and more specific towards "panic", it is often the agent of choice for treating anxiety disorders.

Keep in mind that the average dosage of Klonopin used in seizure states is 10 mg daily. Dosages under 4 mg (and ideally, under 2 mg) are far less likely to produce tolerance. The retainment of steady-state prevents tolerance issues.

In other words, Klonopin is approved for the long term treatment of anxiety disorders, and it maintains its efficacy unlike the shorter acting agents (Ativan, Niravam, Serax, and Xanax). It would not be unusual for the starting dose to remain effective for decades, if not indefinitely.

Ryan

[RCA7591]

No, you're not on a witch hunt at all. What you experienced reflects my experience as well, and I tend to look at things very objectively. I have switched back to Roche Klonopin due to *mild* issues, issues that I did not experience with the brand name that I had taken eight months prior to switching.

By BP is volatile, the average is 160/100 (but that's another story, for another place and time).

Beta-blockers are great medicines, especially if you suffer from cardiac manifestations of anxiety. They antagonize beta-adrenergic receptor sites in the heart, blocking the effects of Catecholamines (Adrenaline), such as those produced in high anxiety states. You can expect to see a modest decline in your blood pressure, and in your pulse rate. The only caveat is if you a very physically active, as beta-blockade may reduce your exercise tolerance to some degree depending on the dosage.

Ryan

[Shannon Wyatt]

Hey Ryan -- my BP hovers around 150/90 -- which, I believe is "high."  My doctor says the increase is due to my anxiety.  When I ask him about this, he says "time will tell" -- and that he does not want to place me on a BP medication at this time.  My question is -- how do you think our bodies will react over to time to this increased BP?  Thanks!

[RCA7591]

My question is -- how do you think our bodies will react over to time to this increased BP?

--end quote--

It would depend whether or not the hypertension was fixed or labile (intermittent). Labile hypertension is the type that is attributed to anxiety attacks, or high anxiety states. The amount of Adrenaline produced during an anxiety attack is comparable to walking up a standard flight of stairs. BP fluctuates, constantly, and it may also fluctuate during an anxiety attack. Normal fluctuation of blood pressure is not a cause for concern, and no treatment is warranted.

FIXED Hypertension (defined as a pressure greater than 140/90 after 15 minutes of rest) warrants treatment. For accurate readings, the measurements should be taken in a stress free environment (your home). Readings that are consistently greater than 140/90 would be defined as Hypertension, and ideally, you would want to treat it with lifestyle changes or drug(s).

Some folks are anxious about going to the doctors, and this mild increase in anxiety may produce "white coat hypertension" (falsely elevated readings). This is an extremely common phenomenon. Therefore, it is suggested that you take serial measurements in an environment free of stress, record the measurements, and present them to your doctor. If the average is consistently greater than 140/90, drug treatment is warranted if lifestyle changes do not lower the pressure (ie: reduced sodium intake, weight loss if warranted, and exercise).

Ryan

[Shannon Wyatt]

Thanks Ryan!  My BP is only checked at the doctor's office -- so I'm sure it is this "white coat hypertension" that you mention.  I remember once when I first got to the doctor's office, my BP was checked at 150/90 -- and when I brought this to my doctor -- he retook my BP and it had dropped down to 130/90.  I had no idea that BP could change so rapidly.  I'm a fairly healthy 42yo male -- 5'11"/180lbs -- exercise regularly; doesn't smoke; etc.  So, thanks in telling me this fluctuation in my BP is not a cause of concern -- it is probably just my anxiety.  I suppose I should get a BP machine and check it from time-to-time.  Do you have any recommendations on such a machine?  Also, from your thread above, you mention your BP averages 160/100.  Is this a fluctuation too for yourself?

[RCA7591]

It sure sounds like labile hypertension, or "white coat". Most medical assistants will take the blood pressure immediately after you are called back, which is less than ideal. Ideally, it should be taken after 15 minutes of sitting quietly, and with the cuff level with the heart. It isn't unusual to see falsely elevated pressure at the doctor's office.

But yes, normal fluctuation in BP is no cause for concern, as it's not a reference measurement. BP fluctuates wildly throughout the day, depending on your level of activity, stress, and anxiety.

If you want to measure your own BP, I would suggest purchasing a traditional
Sphygmomanometer (the type that the doctor would use). If you are unfamiliar with using a Sphygmomanometer, an automatic model, such as those made by Omron would also be a good choice. The automatic models are less accurate however, and are prone to user error. It is important to follow the instructions that come with the machine to obtain accurate readings.

If you purchase a BP machine, don't take the readings obsessively, as that will only fuel your anxiety. Transient spikes to 150/90 wouldn't concern me in the least.

Ryan

[numbercruncher]

I have been on the "real" Klonopin for over a week. Such a difference from the TEVA. I feel great and I am not having any problems.  I still take 0.5 at bedtime.  I need to fly to Seattle Sept. 23......Scared to death....My doc told me to take an extra 0.5 the morning of my flight, but to test it by going on a dry run......I did and I still didn't want to get on that airplane.  Wonder what will happen when I board?????.  Has anyone on this forum flown using Klonopin... and if so....what can I expect?  Makes me nervous to even type this question. (grin)  Numbercruncher

[Shannon Wyatt]

Ahh yes, the dreaded airplane flight.  I used to never be afraid of flying until I had my first anxiety/panic attack.  It is not so much the fear of crashing as being trapped in an enclosed space -- with nowhere to go, right?  The best thing I've learned to do is to face your fear and do it anyway.  But here is how I help myself with the situation.  Usually I take a .5 Ativan the morning of the flight to take the "edge of."  Then I try to take a portable DVD player and/or my ipod, with some magazines.  The distraction of these items seems to help me.  Also, I've learned that talking with the person right next to you helps alot too.  Not about the anxiety, but just mundane items.  Also, deep breathing from your stomach -- "try" to engage yourself in some in-flight meditation.  I usually close my eyes and concentrate on my breathing and think of open spaces.  This helps alot too.  Lastly, internally talk to yourself that "everything will be fine."  "Even if I do have a panic attack, I can let it flow right through me."  Try to counter your negative "what if's" with a positive rational response.  Hope this helps.  Good luck!

[numbercruncher]

This is something John Hopkins Health Letter had in it today.  I found it very interesting....Maybe All will also. The epileptic seizure drug was of interest to me.  Wonder if Klonopin is one.

Thanks to all for the comments on flying.  I guess I will just do it. (EEEK)

Health insurance companies love generic drugs, because they cost less money than branded versions – but are generic drugs right for you?

Are generic drugs safe? The short answer is yes, because in the United States, manufacturers must prove to the FDA that the generic version of a drug has the same active ingredient as the original, branded version and that it is absorbed into the body approximately as well (with no more than a 20% difference in absorption).

In short, a generic drug should be interchangeable with the brand-name version, if used in the same way for the same medical conditions. According to an FDA website, studies show no difference in the rate of side effects between generic drugs and brand-name drugs.

Health insurers love generic drugs, because they cost less money than branded versions -- on average, 30% less. But there are some instances when your doctor may not think it’s a good idea to switch to a generic drug. This is often the case for medications that have a narrow therapeutic range (NTR).

When you take an NTR drug, the most effective dose with the fewest side effects lies in a narrow range between too little and too much. These are medications in which small changes in the dose and/or blood concentration could result in clinically important changes in drug efficacy or safety. Usually, these drugs require frequent adjustments in the dosage and the user needs to be monitored carefully, regardless of whether the drug is a brand-name or generic drug product.

One such drug in common use is Coumadin. If you have taken brand-name warfarin for a long time, your doctor may not want to switch you to a generic because slight differences in the generic version could alter the concentration of the drug in your blood. This could thin your blood too much, causing bleeding, or too little, raising the risk that a clot could form. Other common NTR medications include digoxin (a cardiac treatment) and certain drugs used to control epileptic seizures.

For more Alerts and Special Reports, please visit the Prescription Drugs Topic page.






Johns Hopkins Bestsellers:
Prescription Drugs