klonopin vs xanax

[HypoDi]

Please can someone tell me which is better?
I am on Tareg for blood pressure, from specialist....then my GP put me on Wellbutrin and klonopin .... which my specialist took me off and said take Xanax only with the Tareg.
Any comments much appreciated.

[bettie1976]

xanax is a stronger, faster acting benzo. klonipin is a longer acting benzo and in my opinion not as strong. but then nothings working for me right now cept valium and even then i need large doses (like 40mgs at least) but my anxiety is from withdrawing from opiates and alcohol so i might not be the best person to answer this one. I do know that xanax is one of the strongest benzos...

[Raine9]

Xanax is very strong and addictive because it is, as bettie said, faster acting and the effects are short lived.  You should ask your specialist why he/she would have you take Xanax instead of Klonopin.  Does Klonopin and the Wellbutrin have some sort of negative reaction when taken with Tareg?  

[Raine9]

I read your profile and wow, you are so candid.  Good for you though.  You seem like a very positive person and a proactive one in terms of making yourself better!

Best wishes!

[RCA7591]

Tareg is the foreign name for Diovan (Valsartan), an angiotensin II receptor blocker. I take 320 mg daily.

Wellbutrin raises blood pressure in hypertensive or anxious patients, and therefore, should not be used comcomitantly with Tareg.

Klonopin is the agent of choice when cardiac manifestations of anxiety are present. Xanax is not approved for the long term management of anxiety disorders, and will lead to rapid tolerance and loss of efficacy due to its short half-life. This will cause severe problems in the near future.

Xanax is NOT stronger than Klonopin, they are equal in potency. Xanax's onset of action is immediate, while Klonopin's is delayed. This may give the impression that Xanax is stronger, but it is not. Whenever an anxiety disorder requires treatment over the long-term, Klonopin or Valium are the drugs of choice.

Klonopin works on the principal of steady-state, where by a constant plasma level of the drug is maintained, provided it is taken at least twice daily. The maintanence of steady-state has two beneficial effects: (1) It largely prevents tolerance, and (2) It provides round the clock coverage against the symptoms of anxiety and panic. Klonopin reaches steady-state in two weeks.

In contrast, the plasma level of Xanax peaks rapidly, producing beneficial effects for only 4-6 hours. The rapid peak and trough in the plasma level leads to severe tolerance issues. It also causes a sort of "rollercoaster" effect, with severe rebound of anxiety symptoms. Therefore, Xanax is indicated only for as-needed use, or intermittent use only. If it is used daily, the drug will lose its efficacy.

Valsartan (Tareg) may produce a heightended sense of anxiety. This is one side effect. A better choice would be Atenolol or Metoprolol, which are cardio-selective beta-blockers. Beta-blockers antagonize the effects of catecholamines (adrenaline) on the heart. Hypertension that is caused secondary to an anxiety state would benefit from beta-blockade. Valsartan modifies the renin-angiotensin system, which is responsible for the hormone Aldosterone. While it may lower your static blood pressure, it may be largely ineffective during a state of high anxiety.

Therefore, I'd recommend 50 mg, qd of Atenolol, and 1/2 mg, b.i.d. Klonopin. The two work in concert to reduce autonomic hyperactivity and anxiety induced hypertension.

Wellbutrin is absolutely contraindicated.

Ryan

[HypoDi]

Thank you Bettie for your input here, I appreciate it and I wish you all the best...you can do it ;-)
Thank you Raine, I have jsut had my sons memorial and his birthday woulod ahve been enxt week, so maybe sub consciously all this is takign it's toll. If you'd like to read  bit how I got to where I am slowly....  www.cranalysis.co.ls
Thank you for your kind words. I have had it rough in life, but am a survivor and strong iron will that I never ask " Why me? "  I always say " try me" :-) You gotta stay positive, but it's sooooooooooo hard.

Thank you Ryan for your info here, I really appreciate it. I became very sinus congested and mucousy on Rivotril " klonopin. I have stopped the Wellbutrin, as my specialist said, exactly what you say here, it caused Blood Pressure to raise. I woke up 2am this morning straight into a panic attack...they wake me up. He has changed to Zanor " Zanax" to try, if this fails, I will ask for valium maybe. I am not depressed at all, just get hit with no warning with panic feeling. I have always been such a strong person, but as you will read on my sons website, I had a very abusive husband, divorced him weeks after my son died..but it all catches up with you, and with me because as a child I was never allowed to express myself, I keep things inside, and put on a smiley face and sub consciously it wacks me ( smile)
Your knowledge is very very impressive Ryan. I have seen how much you have helped others on this site. You are an absolute Angel for helping so much.

Thanks for reading this.

Take care everyone :-)

Elaine

[bettie1976]

"Klonopin is the agent of choice when cardiac manifestations of anxiety are present. Xanax is not approved for the long term management of anxiety disorders, and will lead to rapid tolerance and loss of efficacy due to its short half-life. This will cause severe problems in the near future."

I was told by the last doctor I saw that valium and xanax were the strongest of the benzos. At least for me xanax is certainly stronger because back when I was abusing I could take 4 mgs and pass out. If I take Klonipin it does nothing for me. I also wanted to add that all the benzos Ive tried (valium aside) recently, ativan, klonipin, librium, have worked for a few days and then done nothing to help at all. Im very aware of how addictive xanax is and its definitely not for long term use. Just wanted to clear that up.

[Jade59]

bettie1976/ryan   So Valium and Klonipin are similar?

[RCA7591]

"I was told by the last doctor I saw that valium and xanax were the strongest of the benzos."

quote^

Klonopin and Xanax are both twenty-times stronger than Valium. However, what you perceive subjectively will vary with these three agents. Valium produces stonger sedation/hypnosis, and it may *subjectively* appear to be more potent than Klonopin, even though it really isn't. Some folks attribute sedation to potency.

Librium was the first Benzodiazepine, the model drug. 25 mg of Librium is equal to:

-10 mg of Valium (Diazepam)
-1 mg of Ativan (Lorazepam)
-1/2 mg of Klonopin (Clonazepam
-1/2 mg of Xanax (Alprazolam)
-15 mg of Serax (Oxazepam)

If Valium helps you, there is nothing wrong with that. Valium is a good drug. Like Klonopin, tolerance to the effects of Valium is rare. The starting dose (for a person who never took it) is 5-10 mg, three times daily. For those who were on the ultra potent drugs (Klonopin, Xanax), 10-20 mg three times daily may be required.

Unlike Ativan/Klonopin/Xanax, Valium has several active metabolites. The beneficial one is Oxazepam, which lasts roughly 8 hours. This is why Valium is dosed three times daily. The other (Desmethyldiazepam), has a half-life of 200 hours, and accumulates between 5 -10 times that of steady-state. This accumulation prevents tolerance.

Librium is very similar, but much weaker than Valium. Typical dose is 25 mg, three times daily. Librium is the safest Benzo.

Ativan/Klonopin/Xanax possess strong anti-panic properties, and are good for panic disorder. Valium and Librium are good for generalized anxiety, acute alcohol withdrawal, and various other things.

At any rate, when treating something long-term, Klonopin, Librium, and Valium are three good choices. Tranxene is another, but it isn't used much anymore.

Ryan

[Jade59]

Thank you so much for this excellent info.  I have to write it down free-hand, the computer cuts off the r-side when I print.  I am going to talk to my doc re: Valium.    

[uniqueflower]

Wow.  RCA7591 posted some scary dosages.  To readers:  if you're the type to self-medicate, please consult a Pharmacist rather than RCA7591's post; I guarantee you that a PharmD will say 10-20mg of xanax or klonopin 3 times daily is very dangerous...especially for a starting dose--you'll fall into the deepest sleep you've ever been in within 15-30 minutes of taking 20mg of xanax or klonopin your first time; if klonopin, you won't wake up for quite a while.  Ask a PharmD to calculate the maximum safe dosage for your weight, and RCA7591 obviously doesn't understand that dosages are directly proportional to weight.  If you ever take that much, call 911 and/or a friend to drive you to the ER and have your stomach pumped and/or ingest large amounts of activated charcoal.  He must have gotten all of his information from wikipedia or the like, or really mixed up his research.
YOU'VE BEEN WARNED!

[xanweaner]

A quick FYI to you re: Ryan....he is probably our most knowledgeable of posters here in this forum. As you are a newer member here, you've missed out on a wealth of information that he's provided to many people in need and desperate for help and assistance. When he posts, you can be quite confident that you'll definitely learn something. So, be sure to really take the time to read carefully before attempting to discredit him.

[barfer]

I couldn't have said it better myself!  You showed great control.

[xanweaner]

Thanks...there's no reason to "shoot the messenger" especially when our messenger has the expertise and knowledge that Ryan has....

[lynn57]

You misunderstood Ryan's post.  He said for people who have never taken valium a starting dose may be 5-10 mgs three times a day.  If you had previously taken ultra potent drugs like Xanax or Klonopin you may need 10 to 20 mgs of valium t.i.d.  He did NOT tell anyone that 10-20mgs of Klonopin or Xanax t.i.d. would be a proper dose.  Please read his post carefully.  Obviously if 25 mgs of librium is equal to 1/2 mg of Klonopin this would not make sense.   Ryan's stats are amazing and I always look forward to his advice. I have been on Klonopin.  It is very potent.  After 5 years I was still on 1 1/2 mgs a day. It's not the fastest acting but keeps you steady.  Since it is such a "steady state" drug it doesn't cause a quick change in emotions leaving it harder to abuse.  Drug seeking behavior usually leans more towards the fast acting benzos.

[xanweaner]

Many people need a faster-acting benzo for particular situations in their medical conditions. Xanax does have its place, as does Klonopin, Valium, Ativan, etc.

The problem that comes into play is when the short-acting benzos are used over a long period of time, and also, when it's time to get off of them. But, that can also be said about many psychiatric meds. I don't think that people who are suffering and turn to a benzo to "quiet the beast" are drug seeking...they are just trying to get a sense of calm to hopefully get their lives back on track.


I

[lynn57]

I did not mean to discredit faster acting benzos. Everyone that uses them is certainly not drug seeking. I personally took Ativan for a short time and it helped tremendously.  When you need that quick response during a panic attack they are wonderful.  I was merely saying that does not make them stronger.  Klonopin may not act as quickly, but if you need something a little longer to get to a steady state, it's great. And it definitely is stronger. Also I was a bit upset that Ryan's post was misunderstood. When uniqueflower thought he said to take 10 to 20 mg's of Klonopin or Xanax T.i.d., that was scary.  Everyone has to slow down and really read his stats.  They make sense.

[jikram]

I am a chronic patient of panic attacks, palpitation and anxiety and tried each of the above-mentioned medications, such as Librium, Valium, Ativan and Xanax. I found Ativan and Xanax more effetive and suitable.
My physician has advised to add up Buspar, 5 MG combined with Xanax 0.5 MG
Does somone at the Forum has some experioence and information about Buspar?
Jikram

[xanweaner]

Ryan has posted some great info. about Buspar - you might try doing a search on it here in the forum, and when you see posts by his name - pay particular attention to those. He's provided some great info. on Buspar.

I would caution about relying upon Xanax as your long-term management of your panic attacks. It's best to be used for only short-term periods, or taking it as an "as needed basis".

It would be interesting to know more about how your Dr. prescribed the different drugs - what dosages, how many times/day, etc. Perhaps they weren't dosed properly for you to receive the full therapeutic benefit. As I'm learning here, that's the key component for success in using the longer-acting benzos, like Librium, Valium, and Klonopin.

Good luck....and I hope you receive the info. that you're looking for.

[RCA7591]

Panic with autonomic manifestations (palpitation, hyperventilation, sweating, etc) would be classified as panic-anxiety. If they recur, or if you worry about having future attacks, the diagnosis is upgraded to "panic disorder".

There are two very good class of therapeutics to address this situation:

(1) A panic-specific Benzodiazepine (Klonopin). It should be borne in mind that the therapeutic dosage ranges from 1.5 - 4 milligrams, and that this dosage must be tailored for your specific needs. It should be taken at least twice daily, or ideally, three times daily in more severe cases. Maximum effectiveness is seen after two weeks of use. Would recommend 0.5 mg, t.i.d. initially.

Librium, Tranxene, and Valium are no good here, as they have no affinity for panic states. Responses to these would be incomplete or ineffective.

(2) Non-selective beta-blocker. By far, the best choices are those that possess no intrinsic sympathomimetic activity, and those that are not beta(1) selective. Inderal 20-80 mg, twice daily is exceptionally effective when combined with Klonopin. Inderal blocks the physical symptoms of panic.

BuSpar has no affinity for panic. It doesn't have affinity for much of anything to be quite honest. It's a mild antipsychotic, a Dopamine antagnoist. It also possesses weak affinity for 5-HT1 (Serotonin). Such an agent would be of no value to you (unless you had nausea). BuSpar = expensive placebo with side effects. The sugarcoated prescribing information is very misleading for this drug.

As Xanweaner (soon to be "Xanfree"!) explained, Xanax is not to be used over the long-term. While it is certainly effective for transient attacks, it must never be used for prolonged periods. The long-term (greater than 4 months) use of Xanax will result in complete loss of effectiveness and render the drug useless. This is to be avoided, as your original symptoms will rebound (they will be worse than when you started Xanax), and the tolerance developed will compromise future treatment options with other Benzodiazepines.

Would strongly recommend visiting a psychiatrist, and inquiring about Klonopin and Inderal.

Ryan

[jikram]

Thank you for such a useful information. Your analysis is very logical and helped me psychologically to gain confidence.
Right now I am sticking to Buspar 0.5 mg and xanax 0.5 mg, when needed.
I will talk to my physician about Klonospin at the next visit.
Jikram

[illogirl]

Hi Ryan,

thank you for all of the great info:) I just spoke with my psych today and he said he was switching me to klonopin (I have been on xanax for
a very long time). My diagnosis started as anxiety with depression and then became "mildly" bi-polar, but I keep trying to tell the docs anxiety is my BIG problem--I've lived with being moody my whole like, but panic attacks out of the blue leave me weak and very upset.

When I have a panic episode my heart pounds like a drum, my breathing is all off and I shake alot. The episodes can leave me tired for days. Anyhoo I just tried lithium and just felt flat and even more depressed.

Thanks for reading this--does klonopin sound like it will do the trick?
(oh I also take ambien for sleep problems--I wake up all the time).

thanks again!
illogirl

[Northcoast]

Very informative post.  Question: Is Klonopin just for people with panic attacks?  I have what I would describe as generalized anxiety.  Just feel stressed a lot of the time with muscle tension and a lot of anticipatory anxiety.  Never had a panic attack in my life.  My doctor put me on xanax for a while but now he's moved me to Klonopin.  I just saw him and asked him to increase the dosage, so now I'm on .5 mg twice a day (had been on .25 mg twice a day).  My concern is that a lot of people mention panic attacks when they discuss Klonopin and since I've never had those I'm wondering if this is the correct medication for me.  Also, I asked my doctor if I would be on this for the rest of my life and he said that I could take it as needed.  I asked him if he meant I could not take it if I was feeling well and then start taking it when a stressful time came up and he said yes.  Does that sound right?  I'd appreciate any advice people have for me.  

[RCA7591]

Clonazepam (Klonopin, Rivotril) is more specific at addressing agoraphobia, panic attacks, and panic disorder. Klonopin is more selective than Ativan, Librium, Serax, Tranxene and Valium. Klonopin binds to central GABA receptors with high affinity, Xanax binds to both peripheral and central GABA receptors with high affinity, and the remaining ones outlined above bind to peripheral GABA receptors with high affinity.

Those that bind to peripheral GABA receptors are the ones indicated for GAD ot tension-anxiety. They target the hypothalamus and limbic systems, are non-selective, and reduce generalized anxiety and tension. Klonopin has mild to no affinity for peripheral GABA receptors compared to the others, which makes it somewhat unique. It may or may not be effective for GAD. It is not approved to treat GAD, but it is often very effective never-the-less.


Generalized Anxiety and Tension:

-Ativan 1.0 mg - 2.0 mg, three times daily (short-term use only) - 6 mg max.
-Librium 10 mg - 25 mg, four times daily (maintenance) - 100 mg max.
-Serax 15 mg - 30 mg, four times daily (short-term use only) - 60 mg max.
-Tranxene 7.5 mg - 30 mg, twice daily (maintenance) - 60 mg max.
-Valium 5 mg - 10 mg, three to four times daily (maintenance) 40 mg max.
-Xanax 0.5 mg - 1 mg, three to four times daily (short-term use only) - 4 mg max.

Panic Attacks and Panic Disorder:

-Klonopin 0.5 mg - 1 mg, two to four times daily (maintenance) - 4 mg max.
-Xanax 0.5 mg - 1 mg, three to four times daily (short-term use only) - 4 mg max.

Klonopin 0.25 mg, b.i.d. is a sub-therapeutic dosage. The target dosage is 0.5 mg, b.i.d. If you do not obtain results from this dosage after one month (give it a month), inquire about Valium (5 mg, q.i.d.). The only downside to Valium is that the duration of action is short (six to eight hours), and it must generally be dosed three to four times daily to prevent interdose when used regularly.

It should also be borne in mind that if you were taking the Xanax long-term, the Klonopin will not instantaneously replace it. Klonopin requires an accumulation period of two weeks before the full therapeutic benefit is obtained. For Klonopin to accumulate properly, it must be dosed at least twice daily.

Klonopin is a poor "as-needed" choice, as the onset of action ranges from 45 minutes - 1 hour. The drug works more effectively when taken on a daily basis, as this holds the blood plasma level steady. If you take the Klonopin daily for a length of time, it must never be discontinued abruptly. When used "as-needed", it should never be used more than 2-3 times per week - dosed one time during each occurrence. This will prevent it from accumulating. It should be taken 1/2 to 1 hour prior to an event where an anticipatory reaction will be present. Ditto for Valium.

Klonopin, Librium, Tranxene and Valium may be used indefinitely within their specified therapeutic range without the development of tolerance to the anxiolytic or anti-panic effect. The hypnotic/sedative effect will partially or completely vanish over time (usually rapidly). This is of no significance.

Ryan

[xanweaner]

YAY - you're baaaaaaaack...........
We've missed you............

♫xan

[illogirl]

Last night I picked up my script for Klonopin I took half a pill (of a .05 dose)
and suddenly started to feel super sleepy. Has anyone else had this happen to them?
I thought the stuff took 2 weeks to build up in your bloodstream. About 2 hours earlier
I took a Xanax (.25 dose) since I am supposed to overlap the 2 meds. Xanax never left me sleepy and out of it---I liked the med cos it just reduced my anxiety levels, but the feeling from Klonopin was weird and tired, Will this pass?

thanks for any input--I'm getting anxious just thinking about taking Klonopin:)
illogirl

[Sadiecal]

My doctor just prescribed me Xanax for anxiety. She believes my anxiety is due to my Grave's Disease which makes affects your heart rate. I don't think this is so. I feel nervous and anxious most of the time. Especially in social situations. I've never had a panic attack in my life, but get VERY nervous when put in situations where I have to speak to a large group of people or again in social settings. I don't know if Xanax is good for this or not. I just want to feel normal in these situations, not nervous. I was on Klonopin for a while and I think it was helping. I am just wondering if this will as well. She told me to take one before going to bed. Since it has such a short life, how would this help me the next day? I'm confused. Plus I took one today and couldn't stay awake!

[RCA7591]

"Since it has such a short life, how would this help me the next day?"

^quote

The short answer is...it wouldn't. The onset of action for Xanax is typically twenty minutes, and the duration of action is typically less than six hours. Exceptions would be in the case of the elderly, or those with compromised liver function.

Xanax is rapidly excreted from the body, and as such, it never accumulates. For Xanax to be effective, it would need to be dosed four times daily. Such dosing is appropriate only for a short-term course of therapy (2-4 weeks). With repeated dosing, Xanax will lose part or all of its efficacy within four to six months. Xanax was designed to be taken only as-needed (as-needed being very infrequently).

Since Xanax has a fast onset of action with a very short duration of action, it is best reserved for emergencies only (a "rescue" med if you will). It is not a viable long-term treatment option for a number of reasons.

(1) Interdose anxiety/panic (due to the short duration of action, significant anxiety/panic may manifest in between doses)

(2) Short half-life. Xanax never accumulates. The rapid peaks and troughs in the blood plasma level not only give rise to interdose, but to the development of tolerance as well. Thus over an "X" amount of time (and "X" is highly variable), the drug will lose its efficacy.

Klonopin, by comparison, carries a 50-hour half-life (mean 38 hours). The onset of action is far slower (45 minutes - 1 hour), and the duration of action is a minimum of 12 hours. When dosed at least twice daily, Klonopin accumulates to steady-state, and ultimately accumulates to 1.5 times that of the steady-state plasma level. Thus, if you were taking 1 milligram daily, you'd have the plasma equivalent of an additional 0.5 mg dose reserved in your system. This accumulation prevents interdose symptoms, and since the plasma level is held steady (rather than peaking and troughing), the risk of tolerance or loss of efficacy is virtually zero - at dosages less than 4 milligrams daily.

Klonopin is for maintenance (long-term daily use), and Xanax is for emergency use. That is the difference between the two.

Another maintenance option is Valium. Like Klonopin, Valium carries a long hafl-life. Unlike Klonopin, Valium's half-life is biphasic. The onset of action is slightly over one hour, and the duration of action is 6-8 hours. Like Xanax, Valium may induce interdose symptoms due to the short duration of action (although this is rare after one month of t.i.d. or q.i.d. dosing). Unlike Xanax, Valium will not lose its efficacy over the long-term. Unlike Klonopin or Xanax, Valium has no affinity towards panic, or the autonomic symptoms of anxiety (palpitations, tachycardia, hyperventilation, etc).

If your nervousness occurs only in social settings, using Xanax as-needed prior to the event would likely be sufficient. If you feel as though you need a long-term option, I would inquire about a longer-acting agent. Amoung them are Klonopin, Librium, Tranxene and Valium.

HYPERthyroidism and Grave's are two underlying endocrine/autoimmune etiologies that could explain your anxiety-like symptoms. Treating the underlying disorder should improve the symptoms. Symptomatic treatment could consist of a combination of a beta-blocker and a long-acting Benzodiazepine (i.e.: Inderal and Klonopin). Inderal blocks the effects of adrenaline on the heart as well as receptor sites in the nervous system, and Klonopin prevents or minimizes the physical manifestations of anxiety before the autonomic nervous system is triggered. The two work in concert by increasing the threshold of the homeostatic mechanism (fight or flight response). Less triggering = less symptoms. Grave's absolutely predisposes you to anxiety/panic.

~Ryan

[ettebette]

I have been taking Xanax XR for many years, and will be starting Klonipin shortly for my generalized anxiety disorder.  In all of your posts, you've talked about Xanax, but not Xanax XR.  Xanax XR is the slow release form of the drug, and differs for regular Xanax.  The reason I'm switching to Klonipin is that I feel that Xanax XR is not working well anymore for me.  I take Effexor XR for depression and anxiety, and I also take Lyrica for headaches and anxiety as well.  So, you can see, I'm a mess as far as anxiety issues go!  Can you shed some light on Xanax XR vs plain old Xanax?  Thanks so much!

Ellen

[RCA7591]

Hi Ellen,

Xanax-XR is no better than immediate-release Xanax. Alprazolam is Alprazolam, and there is nothing that can be done to alter its pharmacokinetic profile. By creating an extended-release version, the manufacturer has merely timed the drug to be released roughly every six hours. This is just enough to prevent interdose/rebound anxiety. This would be comparable to you taking the drug four times daily - only you wouldn't have to "watch the clock".

The half-life of the drug remains fixed at around 11 hours. If used over an extended period of time, Xanax-XR will lose its efficacy, just as the conventional, immediate-release Xanax would. Therefore, it is recommended that Xanax (in any form) be reserved for short-term treatment only. In my opinion, Xanax-XR is one of the worst preparations ever devised, as it gives folks a false sense of security, only later to leave them in a state of rebound.

Since you've perceived a loss of effectiveness from the Xanax, the Klonopin dosage should ideally be slighly higher than the current Xanax dosage. For instance, if you are taking a single 1 mg tablet of Xanax-XR, the ideal Klonopin dosage would be 1 mg, twice daily. This will help to reestablish efficacy. The Benzodiazepines are cross-tolerant, and when effectiveness is lost, effectiveness will be lost to all of them.

A word of caution: You do NOT want to switch directly over to Klonopin, especially if you've been taking the Xanax for an extended period. You see, Klonopin must accumulate before it will replace the Xanax entirely. Klonopin carries a 50 hour half-life, and accumulates to "steady-state" within two weeks. During those two weeks, you would have no Xanax remaining in your system, and there would be nothing to replace it. Therefore, there would be a two week "window of vulnerability" where you would undergo Xanax withdrawal until the Klonopin accumulated to steady-state.

The best way to prevent this is to switch to IR Xanax. For instance, if you were taking a 1 mg Xanax-XR tablet daily, you'd switch to 0.25 mg of IR Xanax four times daily. Each week, one dose would be "stepped out", while 0.5 mg of Klonopin is "stepped in" to replace it. Once stabilized on 0.5 mg of Klonopin four times daily for one month, the Klonopin dosage may be taken twice daily (1 mg/dose - every twelve hours). However, Klonopin may be taken three-to-four times daily if necessary. Whatever works the best for you is all that counts. The twice daily dosing is not etched in stone, and each of us is individualized.

My only other concern with Klonopin would be a worsening of your depression. You state that you're depressed and are taking Effexor for that. Should Klonopin worsen your depression, it may be substituted for Valium at that time (10 mg, four times daily).

Speak with the doctor about these recommendations. Hopefully, you've gained more insight into this matter.

Best regards,

Ryan

[illogirl]

Hi Ryan,

Why did you write to Ellen that Klonopin could worsen her depression?
I have been on Klonopin for about a month and a half and I have noticed an increase in depression (I am NOT on any anti depressants).
Overall I just roll with it and try and stay positive and I started to get acupuncture along with talk therapy. This week I will see my p-doc and I'm sure all of this will come up in my visit.
Do you think Klonopin causes weight gain as well?

thanks,
illogirl

[cappo65]

Hi Ryan,
            I have a degenerating spinal injury, I have many disc prolapses and I also have grandmal epilepsy.  I was bruitally attacked and my spine was damaged in the 3 different sections of the spine.  I got grave's disease when I gave birth to my son and live on a concoction of meds.

I am wondering, eventhough I have studied most of my injuries and know heaps about my medication, I was wondering if there was anything stronger than xanax that you know of as I'm going to see my pain management specialist and my psychiatrist, yes I have depression, mainly because of the attack and what I live with every day.

I am on 150mg's of Kapanol twice a day,  Oxy Contin 80mg twice a day, Oxy Norm 20mg every 4 hours and Pan Forte, Paxam, Xanax 2mg 3 a day, Baclofen, Oxazapam 30mg and Valium.

I am starting to have pain before I'm ready for my next dose and am about to be put up to the next level which they tell me may be ampules, I have no idea, I'm thinking of the Facet Joint Denervation, but they tell me that each time you have it, your body gets used to it and works less and less each time and I'm paying a fortune in private health care for this op and there are 3 procedures every time and I've no idea if I can have them all at once or if I have to travel to Melbourne each time I have to have it, which is over  a 3 hour drive.  I know that by upping my meds it lessens my life, i know that.  But I have permanent sciatica and chronic pain 24 hours a day and depression and wow, anxiety is a bad word, I have nightmares about the attack.

I'm just wondering if there is anything else I can ask about when I already have valium, oxazepam and xanax and I do take more than I am meant to, but my doctors know that because of the amount of other meds I have and they also said if anyone else tried to take the amount of meds I have to take it could kill them, but I live like this every day.

Some days I feel like giving up, but that's only letting my attackers win and I will not let that happen. I have lost 85% feeling in my left leg and 25% in my right and use a walker to get around and have a full time carer too.  It's not a great life, but it's my life and I do the best I can, and I fight like hell. I just want some time with no pain and something to stop the panic attacks without being a zombie and am afraid that just won't happen.

No pressure Ryan, it just seems you know a lot and I was just hoping you might be able to help me, but if you can't I honestly understand, it's a lot to ask someone and I have studied a lot of this already, but I don't know that much about benzodiazapines, and was hoping you could help.

Thanks
Cappo

[Bob641]

Hi Ryan, I will like to have your advice. I had been using Xanax 2mg 4 or 5 times daily for more than a year almost two if I'm correct. I also take Wellbutrin for my depression, Vicodin 5/500 twice a day for about a year and Tramadol 50mg for about two years. I want to get rid of the Xanax, the Vicodin and the Tramadol, so far I managed to take 3 Xanax daily( at night before going to bed and when I wake up in the middle of the night, two times almost always, no taking none during the day but I'm experiencing anxiety, shaking in my hands, sweating hands and feet, pain in my shoulders and upper back and fast heartbeat. It's very hard for me to fight it. I should mention too that I have not taken Vicodin in two days, and the Tramadol has been moved from two pills a day to one a day. Am I going too fast or should I do something different?

[Bob641]

Sorry Ryan, I forgot to mention that I suffer from bad migraines and I take Imitrex 100mg, is good but my insurance only cover 9 pills a month. I'm also diabetic type II, I take Fortamet 500mg for that and is under control and also suffer from cardiac arritmia (did I spelled right?)
Your advice will be greatly appreciated .
Thanks, Bob

[Tinks343747]

Hi Ryan,

Wondered if you could help, my wife is currently taking 1Mg of Xanax 4 times daily.  How would you recomend that she makes the switch to Klonopin, so that it does not produce the Xanax withdrawal.

Thanks in advance for your help and advice,

Martin.

[AnastasiaG]

I have the same question as Tinks343747.  I go to the Dr. next week and am considering the switch.  I have been on1 mg. 4x daily of xanax and am thinking it is not working anymore.  My attacks have been getting more and more frequent even with it. Sometimes I have to take 5 - never more because it scares me.  I have been doing this for five years now.  I have full blown "I am having a heart attack" panic.  Sweating, chest pain, shaking, thinking for sure this is my last day on earth.  It's horrible.  I should also mention though that I have an out of whack thyroid so I know this contributes to my condition.  But, I would still like to try the klono but I can't handle xanax withdrawal effects if that is what is going to happen.  Can you take klonopin and take xanax "as  needed" for quick relief?  Meds scare me and I wish I could be off all of them and have tried so many times but I always end up right back where I started.
Thanks for any answers you can give me.

[YankeesNyy132]

I have been on 6 mg. of Alprazolam (Xanax) Then went straight to 3 mg. of Klonopin and I didn't have no severe withdrawl at all, The Klonopin helps that out alot! I've taken Valium, Klonopin, Xanax, Buspar, and Ativan I like Klonopin the best Like Ryan said longe lasting less addicting, Buspar don't really help if you have severe anxiety!!

[jodell59]

Ive been on xanax 1mg for over 20 years since I was 27.  Even when I was young I knew something was wrong with me, Id hyperventilate until my hands and feet were crooked.  I threw up at stress and anxiety.  I could not be still, I  threw up and couldnt stop thought Id rather die. One day while at work I had an anxiety attack where I thought I was loosing my mind and I got to the dr and THat is where it started I got xanax.
  I take as needed usually a half of a tablet if that dose not work a whole tablet as needed.  Latley Ive taken it about three to four times a week 1/2 tablet.  I had my new doctor, I recently moved say she wanted to take me off of xanax it was not her drug of choice I freaked out.  Ive been on it so long and it has worked for me so well I cant see having a normal life without it.  I have been on paxil for 8 years also 20 mg daily sometimes it was 30mg.  I have anxiety and depression and post tramatic stress.  Do you think that it is wrong to want to be able to live and work and need the xanax to feel kind of normal. I dont feel as though Im addicted I just need it to live a normal life.  Ive accepted the fact im anxiety ridden and both meds work for me.  do you think something else would work. I told my doctor I didnt want to switch. I usually get a perscreption for xanax two times a year 1mg pill and 60 pills each perscription so I feel as though Im not trying to abuse it I need it.  please help me.  Im scared to not be able to get it any more from my new doctor? JO

[abby10]

See site benzo.org.uk
abby

[AnastasiaG]

Hey

First of all, I haven't been on here for awhile.  I've been trying to figure out what's going on with me.  In my previous post above I was freaking out because my panic attacks were increasing and everything seemed to be going haywire.  Well I recently found out that although I have Hashimotos disease - the endo said my GP should not have put me on the meds I was on because I kept getting worse and worse.  My TSH was 0.01 and instead of feeling better like I should've been - it was getting worse.  So NOW I am completely off thyroid medicines.  Someday I may need them -may not. I do have thyroid damage but not bad enough yet for the meds they had given me.

So, about the Xanax -I have been on xanax for over five years now - I was thinking of switching because of my increased panic attacks which were not even due to the inefficiency of the medicine but because my thyroid was going bonkers.  I talked to my doctor about the X and asked questions about dependency, side effects, blah, blah.....This is what she told me:  Who cares if you are addicted if it helps you?  People with high blood pressure are 'addicted' to their meds too but are we going to take their meds away - NO!  There is no shame in responsibly taking a medicine that helps you and from the sounds of it - the quantity you are taking is minimal in comparison with what a lot of people take.  I hardly call what you are taking unreasonable.  If it makes you feel better and your doctor is going to take it away and not replace it with something that makes you feel just as good - GET ANOTHER DOCTOR.  I will probably never be off Xanax - I, like you, have had these attacks since I was a child and even with the meds still get them occasionally - out of the blue for no particular earth shattering reason.  But, when they come on, I will take my X and sit quietly until it passes and the world will continue to turn and I will have not hurt myself or anyone else.  You should never ever let anyone make you feel bad about taking a medication that makes you feel better.  My dad is 'addicted' to painkillers too because he has cancer - should we take them away?  I think not.  Sorry if others don't like this post but it's my opinion and, as the saying goes............well you know it.

[MichaelC66]

I am a 42 year old man, I have had anxiety for years but to be honest I never really understood what it was or what it was doing to me. I had gastric bypass surgery and since then I have been having what I thought were heart attacks but after going to the emergency room my heart was fine and we kinda of fiqured out that they were panick attacks.  I have never taken any type of drugs at all I do not even drink but I was seen by a psychiatrist and was given a script for 1mg xanax, I started off with half and then went to one whole pill like the bottle said but to be honest I barely felt anything, it helped with my hand tremors and may have helped with the severity of the panic attacks I have two or three big ones (panick attacks) and a few little ones weekly but what is the best approach to asking for a stronger dose without appearing to be a drug person obtaining narcotics. It is honestly becoming difficult for me to function with these attacks, I am getting to the point that I do not want to leave my house. Any help would be great thanks, Michael

[Cupcake306]

Klonopin is the devils poison.  Once you get on it, you'll never get off of it without a horrible withdrawal that will send you straight to hell screaming to get out.  It will ruin your life and your family's life.  You may think that it is good the first couple of years, but then you will reach a tolerance and you will be forced into withdrawal.  It will happen to anyone taking it, NO EXCEPTIONS!!!  

[abby10]

Watch what you say about klonopin...you'll start being called a "benzo basher"!!! You see a drug that eventually makes your original symptoms WORSE is a relly great drug, according to some people.

abby

[shannonhoon]

I've been on klonopin for 5 years, found it easy to lower the dose.  I'm taking more now because I'm withdrawing from oxycontin but know that I will manage to lower the dose again.  I used to take 2 ..5mg a day now take 4.  I think it's the best for anxiety, it does lower your mood but sometimes you have to make some hard choices.  Good luck!

[Eric203]

Serax is stronger and faster-acting then Librium..When Serax hits you,it calm you down much fiercer then Librium does..It doesn't last as long as Librium, which I prefer...Librium has a very long half-life, like Valium and Klonopin and Doral and Tranxene..that is why alot of patients and Dr.'s prefer Serax.It has less potential for interactions with other type drugs -because it leaves your system faster, but the intitial calming effect is very pleasing  and you feel much less anxious then on Librium..I take Serax 30 mg and have compared it to Libriums 25 mg capsules.In the long run, Serax is the best anxiolytic on the market-since 1965-by Wyeth..It was the next one after Valium..And it is less harsh on the liver then most other benzo's..It is similar in many ways to Restoril..They are the most popular benzo's in Australia..the highest in sales per year.

[Eric203]

I will ay the same thing about Serax 30 mg. for GAD...The most similar benzo anxiolytic to Serax ,for me is Xanax...I one time, ran out a couple days early before I could refill my Serax..So my Mother has been taking Xanxax for GAD,also a recent divorce and diagnosis of CLL-a form of Leukemia..She had the o.5 mg Xanax..Now I took 2 of thos to match the Serax 30 mg, adn that was lie taking the same drug..I really couldn't feel anything different especially  in terms of any more or less anxiousness..The only difference I felt is that i honestly think the Serax's half-life is shorter then Xanax, so therefore I didn't need to take another Xanax for little longer.But I also felt less drowsy on teh Serax.That's one of the big plus' for me..I think it's the perfect benzo for GAD..That's why I was prescribed it many yrs ago. And only really tried Librium and Xanax and Ativan for it...Ativan, being my least favorite.I always went back to the Serax 30 mg.Now I am a muscular 5'11 205 lb man.Ativan gave me a weird taste in my mouth-also made me feel much woozier then all teh others..Couldn't wait to call my Dr. and ask for my Serax back..The reason why I was trying others,was the price of generic Serax.It's fairly expensive if you don't have coverage..I now do and #90 Serax 30 mg.capsules are on;y $15/mnth..

[Pino10]

Dear Ryan, please forgive this intrusion into your conversation. I was reading Elaine's remarks when I saw your post knowledgable post My therapist (a psychiatrist) has kept me on xanax for many years and I believe the med is no longer effective. I have asked to be passed over to Klonopin in the hope that this benzo might help me prevent palpitations that occur during sleep but have been refused. Most admit the xanax was very effective at first but since last November I have been experiencing palpitations after the first hour or two of sleep and that's only hours after I've taken one mg of xanax. At present I'm using 3mgs a day, one in the morning, one in the afternoon and the last one to sleep. But I'm going through very difficult period. Palpitations only occur during sleep and the xanax simply doesn't work.  I do not require the other two mgs, during the day, but I use them to keep and even amount of the med in my blood. My cardiologist has indicated that I can switch to Klonopin and use very low dose (my heart rate is very low--48-52) of beta blocker Metoprolol and this might work. He has added that it would not hurt me to use sleeping pill along with this if necessary. He is willing to experiment in trying to help me. My therapist is not. I would greatly appreciate any info you can supply that you feel might help me. Often I go for days on end without any good sleep and it's beginning to seriously depress me. R.  

[RCA759I]

Xanax, if used on a continual basis, will eventually lead to partial or complete loss of efficacy. The time frame in which it does is highly individualized, and could range from as little as four months to several years. Once Xanax loses its efficacy, your anxiety/panic symptoms will return to those of baseline (pre-treatment state). Continual use of Xanax beyond this point is associated with tolerance withdrawal - meaning that despite taking the drug as prescribed, you undergo Xanax withdrawal in the form of rebound anxiety/panic- rebound referring to anxiety/panic that is worse when compared to baseline. The long-term use of Xanax actually increases both the frequency and severity of recurring panic attacks. Ideally, the drug should be used on an as-needed basis only, or over a short span of time during the initial (acute) phase of panic disorder.

3 milligrams of Xanax is a moderate dosage. Xanax and Klonopin are roughly equivalent in potency. The Xanax should be replaced with a Klonopin dosage of 3 milligrams, 1 mg, t.i.d. This must be done slowly, stepping out the Xanax and stepping in the Klonopin. Since the half-life of Klonopin is much longer than that of Xanax, the Klonopin must accumulate to a steady-state level before it will fully replace the Xanax. Klonopin reaches steady-state over a span of two weeks. To prevent withdrawal symptoms during the conversion, the Xanax should be stepped out in 1/2 mg increments, while stepping in Klonopin in 1/2 mg increments.

Example:

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

Days 3-6: Morning (Xanax 0.5 mg, Klonopin 0.5 mg), Afternoon (Xanax 0.5 mg, Klonopin 0.5 mg), Night (Xanax 1 mg)

Days 6-9: Morning (Xanax 0.5 mg, Klonopin 0.5 mg), Afternoon (Xanax 0.5 mg, Klonopin 0.5 mg), Night (Xanax 0.5 mg, Klonopin 0.5 mg)

Days 9-12: Morning (Xanax 0.5 mg, Klonopin 0.5 mg), Afternoon (Klonopin 1 mg), Night (Xanax 0.5 mg, Klonopin 0.5 mg)

Days 12-15: Morning (Klonopin 1 mg), Afternoon (Klonopin 1 mg), Night (Xanax 0.5 mg, Klonopin 0.5 mg)

Day 15: Klonopin, 1 mg, t.i.d.

There will be NO withdrawal if done in this manner. What you do not want to do is replace the entire 3 milligrams of Xanax with 3 milligrams of Klonopin. This will induce a temporary withdrawal syndrome, and may provoke seizure considering the high dosage involved. It is best to not only err on the side of caution, but to eliminate distress while making the conversion.

For sympathetic manifestations of panic, a combination of Klonopin with a *non-selective* beta-blocker is ideal. Given your low heart rate, I would not recommend Atenolol or Metoprolol. Both are very potent (even at lower dosages), and may induce severe bradycardia or first-degree AV blockade. Provided you do NOT have asthma, I would recommend a very low starting dosage of Propranolol (Inderal) - 5-10 mg, b.i.d. or Timolol (Blocadren) - 2.5- 5 mg, b.i.d. Inderal is the weakest (safer option), and given the non-selectivity, will block not only cardiac manifestations of panic, but all sympathetic manifestations of panic. Atenolol and Metoprolol are cardio-selective, and chiefly block the effects of catecholamines (adrenaline, noradrenaline) on the heart. The Inderal, in my view, is a better option. It is also far weaker, is easily titrated, and is the least likely to severely decrease your already low heart rate.

I will note that the use of a beta-blocker at any dosage in your case is a relative contraindication. If you experience skipped beats (PAC's/PVC's), a beta-blocker may provoke them, as such rhythm disturbances occur chiefly at lower heart rates. However, since a beta-blocker reduces cardiac stroke and output, you'd be less likely to physically feel them due to decreased contractility.

Avoid the hypnotic "Z" class of drugs for insomnia (ie: Ambien), as tolerance to the hypnotic effect develops rapidly. When discontinued, they cause rebound insomnia. Generally, I suggest either Doxepin or Trazodone in this situation, but these are likely to worsen your palpitations and increase your pulse. I will recommend Hydroxyzine (Atarax), 25-50 milligrams instead. Rarely, this one can cause cardiac effects, but it isn't very likely.

Good luck,

Ryan

[pgcc313]

I like ur posts, very informative. But I don't agree with your theory that you cannot switch from xanax right to kolonopin without risking withdrawal. I understand the science and it makes sense, the problem is that I have done the exact thing you described and had absolutely no withdrawal. I actually feel so much better then on the xanax. I have realized my doc is a bit crazy; he had me on 2mgs of xanax 4X a day for a long time. And I took it 4X or more, towards the end, every day. Truthfully, I was addicted and need to stop so I went to a new doc and was switched to kolonopin 2mgs 3X a day which is still a lot but the transition was smooth. Next month he is going to drop me to 1mg and then maybe .5 depending on my panic symptoms and my depression. I also take zoloft. Can anyone recommend another anti-depressant; the zoloft keeps me awake I think. Anyway everyone here is right when they say xanax is not for long term use. I got to the point of taking 8-12mgs a day with little to no effect. I have a terrible tolerance and people need to not just trust their docs blindly. I have learned that lesson; you are responsible for your own well being. The kolonopin is a god send. I used to wake up with an ache in my belly until I took a xanax but with the kolonopin I wake up fine. It’s been a week now and all is good. Maybe I am an unusual case but considering the amount of xanax I was taking if your theory was correct the switch to kolonopin should have caused withdrawal? Any explanation?

[pgcc313]

I really think tolerance to xanax can happen much faster. I have found lessening effects in as little as a week. Again kolonopin seems the drug of choice for long term treatment.

[scout4568]

Hi Ryan, I have read with interest your posts, re: Xanax/Klonopin.  After developing numbness in my face, I was tested for just about everything (Lyme's, brain tumor, multiple sclerosis, etc.).  Ultimately, it was determined to be a viral infection in the 5th cranial nerve.   As I'm a professional orchestral musician and was unable to play my instrument for many months, this led directly to the anxiety, as I did not know if I would ever play again.   I am happy to say I have been playing again, with no adverse effects.  But the anxiety has stayed.   I have recently changed from Xanax to Klonopin, however the doctor did recommend that I only take it on an as-needed basis after the inital 2 week regimen.  But after reading your well-researched posts, I am going to ask her if this is the appropriate prescription.  Thanks so much for taking the time to write, you've helped me prepare for my doctor check-up next week.  :)

[RCA759I]

Hello,

If you were formerly on a standing dose (daily dose) of Xanax, this may be substituted with Klonopin. However, the Klonopin cannot be abruptly discontinued following a two-week period following the substitution, with the intention of taking it as-needed. If a standing dose of Xanax was formerly used, and Klonopin was substituted in its place, the Klonopin would need to be gradually withdrawn. If it is not, severe withdrawal phenomena will follow shortly after.

If you were taking the Xanax as-needed, or sporadically (up to three times/week), you should have little problem discontinuing it with Klonopin (or with nothing at all).

As-needed use of Klonopin following exposure to Xanax is unlikely to net much of a result, given that Klonopin has a very slow onset of action, followed by a prolonged duration of action. If the goal is to use something on an as-needed basis (up to three times/week), Ativan, Serax and Xanax are the top choices. These are fast-acting agents with a short duration of action.

Additionally, in your case, if you feel that you require a standing dose of an anxiolytic, my recommendation would be Valium. Klonopin tends to induce varying states of depression over the long-term, and would not be my first recommendation for a musician. "Lack of creativity" and "loss of motivation" are commonly reported with long-term Klonopin use. Valium, 5 milligrams, three-to-four times daily would be a better option in my view.

-Ryan

[scout4568]

Hi Ryan - thanks again for the info.  Just for the record, I was taking Xanax on an as-needed basis, only a few times a month for over a year, until a stressful situation occurred and I began taking it daily for nearly a month.  It was due to this, the Doctor said I may be developing an immunity to it and it was not meant to be taken daily.  So, I was prescribed the Klonopin.  I will ask my Neurologist about the efficacy next week and our options.  She had also wanted to put me on Lexapro, but after reading about it, I decided I'd try good old-fashioned exercise and doing what I could to limit stress, which has helped far more than any medication.  Lexapro just looked a tad scary to one who has rarely taken medication before.   BTW:  I read that you were an engineer, but your medical knowledge is extremely impressive!  Thank you again.

[glendola]

I was on an aplrazolam, diazepam, and clonazepam. The only one I found effective was clonazepam.  It helped for the longest period of time, with out even really knowing it was working, (as far as getting high).  It also worked the most effectively for the longest period of time, ulike alprazolam, which it seemed like I was always wating to take the next dose.  There was a feeling that would come over me as though I have to have another dose.  The clonazepam kept me in control for a good five four hours without having any problems, and I was at the lowest dosage (.5mg). I would highly recommend trying that before any other benzo.  Good luck.

[felixdesouza]

Im currently on Klonopin (.5mg 3x for 8 years) and flexeril (10mg 3x for 2 months) to treat my anxiety and muscle spams. The last month my anxiety has been at an alerting new level of bad, and my back spams havent gotten much better. My pcp told me to speak to my psychiatrist about switching to Valium 10 mg 3x to help with both instead ok taking the other two. Is this a good idea?

[FlybyeNite]

Hi Ryan and everyone. I was on xanax for 1.5 years and it became more of a drug than a medicine for me. Not on purpose, but it drops of so quick it leaves you wanting the next. I have just been put on klonopin but am a smoker. I am told this makes it less effective. So, once I quit smoking, will I feel the full effect of this medication? Or am I screwed because I started taking it as a smoker. Also am on wellbutrin but can't seem to take advantage of the "quitting smoking" side effect. Oh, and my klonopin dose is .5mg x2

Thanks!

Fly bye Nite

[Adder2009]

I have been using Xanax for almost 20 years to manage my panic attacks. I am one of the lucky ones that responds well to only 0.5mg on an as needed basis. I can tell you from LONG experience with the drug that after making my way out of the initial onslaught of attacks the first year or so (taking up to 3 x 0.5mg /day for a week or two at a time), the drug still is quite effective for me now on a as needed basis (taken individually maybe 2-3 times a month).

I really have found all the posts here quite informative and my heart goes out to all of you who are struggling to gain some balance in your lives. I know the pathology of my panic attacks were likely more psychological than physiological, so in that respect I've learned to manage them over time.  

[cannot_get_meds]

Hi Ryan,

    I suffer from extreme anxiety, which stops me from sleeping/living normally, and extreme
PTSD. My mind does not stop racing, my muscles and jaw are always tight, I worry and think
of the most extreme negative things that can happen in any situation. I am hypervigalant also, and
I'll explain why.

In 2001, I lost my firstborn son and I was in the delivery room the entire time. The nurses made me hold
him after he passed. I went to state run mental health clinic and got the typical cattle call of SSRI's.
Wellbutrin, Paxil, Lexapro, Trazadone Seroquil (not all at same time) and none of them worked. I rather live like
i am now, than live with more rage/ anger than I have now, nausea, restless legs and diahrrea. In 2007
I went to the Dr. that lost my firstborn son, and she prescribed 0.25 Xanax, once a day. It worked wonders
for a few hours a day. On my 2nd visit, I told her it was only working a few hours a day and she told me
I was abusing it and 'seeking'. Needless to say, she didn't remember losing my son, because she loses
many patients and has lost her license a few times due to that and giving meds too easy
at patients request.

Last year, an hour after midnight on Halloween (true story) I was driving home on a 70mph interstate. A
guy and girl (boyfriend and were arguing on the side of the interstate,  with no hazard lights,
dark car. I saw nothing til the impact, the guy pushed the girl and I hit her. Then he shot at me 3 times
after. Of course my anxiety and ptsd got extremely worse, even thought I was not charged and he is
being charged with murder. I can't sleep, can't stop my mind from racing/ worrying, I have nightmares
when I do sleep and during the day it's constantly replaying in my mind. Both events.

Getting to my point and question - I went to a dr. today but only a nurse saw me, and she prescribed
Lexapro and Trazadone. I told her that does not help, so she referred me to their in house psych. because
only he can prescribe benzo's. Recently while researching online, I have learned that Xanax is short term,
short acting and addictive. I don't want to get addicted of course. I also learned of Klonopin for the first time.
The psych. wants to see me again this coming week (i'm bringing my firstborn son's pray card from funeral
and newspaper with police write up of my accident as proof, so he does not think i'm a 'seeker') The psych.
told me today he will fight the biggest fire first, whatever that means.

Anyway, based on what I said, what would you prescribe?  I'm just wanting other professional opinions.
Sorry I'm scatter brained with this post, but it is my first and I have not slept in about 32 hours now.

Thanks in advance

[cannot_get_meds]

Sorry my post was so scattered. I had to write it in Word notepad and copy and paste it because my laptop has viruses and pages backspace by themselves.

[jhemnes]

Hi I have had anxiety and panic attacks since my mid twenties....they almost went away during my mid thirties...and last year they came back with a "vengeance" as the psychologist at the hospital put it. Im 47 now. I had always been treated with everything from ativan to xanax to antidepressants you name it.
This last Doc which was the hospitals on staff psychologist put me on Clonazepam (Klonipin) twice a day. To put it in a nut shell I have my life back. I had to stay with someone constantly before and now I dont need a babysitter...yea!
I hope this helps you.

Janet

[cannot_get_meds]

Thanks for writing. I hate when people say 'it's gods will'. Also, a psych I saw a few years ago told me to 'be a man and get over it'!  Can you believe a professional would say that? Needless to say, the cops were called because I went ballistic! I'm 36 years old and I know what works and what does not work on me. Clonazepam works in a multi purpose way, I can sleep, my mind stops racing, I'm not on edge and
snapping at people I love, I just feel normal. What pisses me off, is that I know people personally and have read people's posts on here that have GAD, with NO traumatic experiences and THEY live on anxiety meds. But since 2001, I can't get a dr. or psych to give me anything expect SSRI's.

Also, I'm very hypervigilant, because even thought everyone in this town knew that girls boyfriend pushed her, i still had threats on my life. I am ready at all times to defend myself to the death. If someone I don't know gets too close to me physically, I am READY to kill with my barehands in a second. I'll stare them down, eye to
eye after and let them know I'm not to be played with. Anyway, I have a good feeling about this new psych.

From what he said, he knows my problems are real and INTENSE. He said he will fight the biggest fire first. Whatever that means. I hate the people that lie to get benzos for their addiction  or to sell on the streets, it only makes it harder for people who really need them to get them. You have to wait while your
psych. screens you on a couple of visits til he realizes you are real.

[DrHook58]

Is it safe to switch form Librium75 mgs to ativan 3 mgs? I had taken 3 mgs daily for years and also Dr switched me to Ativan once and it took a while to get through the switch. This was a couple years ago. Moved to a new city where my new doctor put me on Librium 75 mg and it's horrible. Of all Med's I've taken for anxiety, Ativan seem to have the least side effects. My new doctor siad that Librium would be more steady and I find that it's side effect profile for me, sedation, amnesia, sleep disturbances are horrible. I've been on it almost 3 months now. He says the side effects will go away, but it's been long enough for me to know they are not. All answers appreciated.

[DrHook58]

I meant to say 3 mgs xanax for years, then switched to ativan once a couple years ago.

[RCA759I]

Benzodiazepine Equivalency for 25 milligrams of Librium:

-Ativan 1 mg
-Klonopin 0.5 mg
-Serax 15 mg
-Tranxene 7.5 mg
-Valium 5 mg
-Xanax - 0.5 mg

Each 25 mg Librium dose may be interchanged with it's equivalent (ie: 1 mg of Ativan). If you took 25 milligrams of Librium three times daily, the correct Ativan dosage would be 1 milligram, three times daily.

Librium (given the long elimination half-life) often accumulates excessively (7-10 times that of the steady-state value or greater). The active metabolite is that of Valium (Desmethyldiazepam). Such accumulation can seriously impact cognition over the long-term. The half-life elimination is about 8 days, and the drug is cleared in about 5 half-lives, or 40 days.

The attractive thing about Librium is the long duration of action, and resultant reduced risk of developing any significant tolerance. No "roller coaster" effect like you'd get with Ativan. Often, lowering the Librium dose slightly will resolve the side effects. The change would not be apparent for several weeks, given the accumulation.

Neither Ativan or Xanax are attractive for long-term use, as both are short-acting and tolerance tends to develop rapidly. You may want to try Klonopin first, and see how it works for you. If Klonopin isn't effective or produces untoward effects, Ativan is the lesser of the two evils in the short-acting class.

The agents approved for long-term use are...Klonopin, Librium, Tranxene and Valium. The former is good for panic, while the latter three are good for generalized anxiety.

Ryan

[Chrissy1972]

To Ryan

I tried switching from Xanax to Klonopin and i was weaning while starting the klonopin. But I did not have a good reaction to the Klonopin it made me feel more anxious, nausciious, zombie like & had a constant faint headache. My Dr told me to just go back to my .5mg of xanax and BID. She also stated that since its such a low dose that she isnt concerned with addiction at this point especially if it is making me comfortable. Accordign to her both drugs are benzo's and equally addictive. Now since everyone claims you to be the benzo addict is what she saying correct in your opinion?  I need that added benzo right now my paxil alone isnt cutting it.

Thanks

Chrissy