Zanax weaning using kolonopin

[Fletch906]

A friend age 81who has been very active and who has been using .5mg. zanax tid for 20 years began to feel that the dosage needed to be increased as it wasn't holding her like it had in the past. She was inititially placed on this drug due to panic attacks. Her internist decided to try to wean her off of zanax by first using kolonopin .25 alternating with the .5 zanax. After a few days it became apparent that the dosage of kolonopin wasn't effective so the dosage was increased to .5mg. At 8am she takes .5mg of zanax, at noon she takes .5 mg. of kolonopin, at 6pm .5mg of zanax and at 10pm .5mg. of kolonopin. The problem is that since the onset of kolonopin she has the recurring sensation that the .5mg of zanax does not hold her for the 4 hours that it used to. Her body seems to want more zanax before her next dosage is due. At 9:30 pm she feels nauseaus and faint and has early stages of panic until she takes her kolonopin at 10pm. The effectiveness of this dosage only lasts approximately 5 hours which results in sleep deprevation. She obviously is very tired most of the day and very dependent on her next dosage. She has been on this regimen for 13 days and feels very discouraged as her internist has given no indication how long he expects this regimen to last. Any suggestions would be most appreciated as her quality of life is being hampered.

[greenlydia]

I think it's really great that you're helping your friend. I commend you on that! And she does sound like she needs more help than her pcp is giving her. After 20 years on Xanax, I find it difficult to believe it's even working for her anymore, but I don't want to get into a big discussion on the pros and cons of one benzo over another in THIS post.
If possible, I would suggest you take your friend to a Psychiatric Medication Manager. Almost every psychiatrists office has one. And that is all they do (well, probably not ALL, but it is what they are trained to do) They will be able to look at the whole picture of where your friend is with her medication and determine what she needs to maintain and possibly even improve her quality of life. If the MM decides that a switch to Klonopin would be the best choice, he will discuss that with her and TOGETHER they will devise a taper plan off the Xanax onto Klonopin and he/she will do it that without leaving "holes" in your friends med cycle where she must "suffer" until her next dose. This cross-over technique is not always easy and will take quite a bit of time to fully accomplish, but I think your friend will be much happier with the Klonopin. (Which is just MY opinion)
I recommend these PMM's because they fully understand the usage of psychotropic drugs far better than your average internist and especially their use in the elderly.
I wish your friend the best.
Peace
Greenlydia

[Merbromin]

"A friend age 81who has been very active and who has been using .5mg. zanax tid for 20 years began to feel that the dosage needed to be increased as it wasn't holding her like it had in the past"

^quote

For the elderly, Xanax is generally a good choice, given that it has a short half-life and does not accumulate excessively. It doesn't accumulate at all. The elimination half-life of Xanax is often prolonged in the elderly, but it would ultimately depend on the person and their metabolism. When the elimination half-life is not prolonged, the elimination follows the same course as it would in a younger person, and tolerance eventually develops to the anxiolytic effect of the drug. Twenty years is a considerable length of time for Xanax to maintain its efficacy.

When Xanax ultimately does lose its efficacy, it is best not to increase the dosage, as such increase will only lead to a very transient amelioration of the symptoms before tolerance sets in again. It would be best to switch to another Benzodiazepine entirely.

There are three types of Benzodiazepines - those that are short-acting (Ativan, Serax, Xanax), those that are intermediate-acting (Klonopin), and those that are long-acting (Librium, Tranxene, Valium). The latter three should be avoided, as they tend to accumulate excessively in the elderly when taken for prolonged periods of time, or for maintenance of an anxiety disorder.

The two preferred drugs are Ativan and Serax, however, given her interdose rebound (reemergence of symptoms between dosing), it would be better to administer the intermediate-acting Benzodiazepine Klonopin. Klonopin is very similar in effect to Xanax, is of the same potency as Xanax, and carries a fairly prolonged half-life of 36 hours. The duration of action (once steady-state plasma levels have been achieved) is 8-12 hours. Unlike Xanax, significant tolerance does not typically develop to the effects of Klonopin, and the "roller coaster" effect is eliminated. She won't have to "watch the clock".

Given that Klonopin carries a prolonged half-life compared to Xanax, the Xanax must be withdrawn gradually while simultaneously stepping in the Klonopin. As the Klonopin accumulates, it will replace the Xanax entirely - without withdrawal phenomena.

The former Xanax dosage was 1.5 mg daily. The equivalent Klonopin dosage is 1.5 mg daily - in three divided doses.

Transition - 1.5 mg Xanax to 1.5 mg Klonopin

Days 1-3: Morning (Xanax 0.5 mg), Afternoon (Xanax 0.25 mg, Klonopin 0.25 mg), Night (Xanax 0.5 mg)

Days 3-6: Morning (Xanax 0.25 mg, Klonopin 0.25 mg), Afternoon (Xanax 0.25 mg, Klonopin 0.25 mg), Night (Xanax 0.5 mg)

Days 6-9: Morning (Xanax 0.25 mg, Klonopin 0.25 mg), Afternoon (Xanax 0.25 mg, Klonopin 0.25 mg), Night (Xanax 0.25 mg, Klonopin 0.25 mg)

Days 9-12: Morning (Xanax 0.25 mg, Klonopin 0.25 mg). Afternoon (Klonopin 0.5 mg), Night (Xanax 0.25 mg, Klonopin 0.25 mg)

Days 12-15: Morning (Klonopin 0.5 mg), Afternoon (Klonopin 0.5 mg), Night (Xanax 0.25 mg, Klonopin 0.25 mg)

Day 15: Klonopin, 0.5 mg, t.i.d.

Given that she may have developed a significant tolerance to the clinical effect of Xanax, it may be advantageous to increase her Klonopin dosage to 2 mg (dosed 0.5, 0.5, 1 mg) to compensate for probable tolerance. This would reestablish efficacy.

Should the Klonopin lead to ataxia, over-sedation, staggering or other signs of excessive accumulation, it may be dosed 1 mg, b.i.d. , or it may be replaced with the dosage equivalent of Ativan.

Speak with the physician about the recommendations outlined above.