klonopin with effexor xr

[joe504]

I've recently been prescribed to klonopin for panic disorder.  The doctor is letting me diciide if I want to take the klonopin with an SSRI or SSNRI or by itself at a higher dosage.  Does anyone have any insight or thoughts.  Thanks.

[RCA7591]

Klonopin in monotherapy (by itself) would be the most efficacious in the absence of depression. The target dosage is 0.5 mg, b.i.d.

When combined with an SSRI or SNRI, some of the benefits of Klonopin would be negated (cancelled out), as most of these drugs have stimulating properties.

If there is no component of depression, Klonopin is the way to go for panic disorder.

Ryan

[joe504]

Hi again.  I appreciate your persistence.  What's your take on the xanax (extended release) as a long term medication?

[RCA7591]

Xanax-XR is not a long-term viable option, as it will lose its efficacy within four months. Once it does, you would experience withdrawal phenomena (despite the fact that you'd continue to take the drug). This is known as tolerance. It's a short-term fix, and it isn't worth it.

Ativan, Niravam, Serax, and Xanax are no good for the long-term.

There are four drugs approved for the long-term - Klonopin, Librium, Tranxene, and Valium. Of the four, Klonopin is the most specific towards "panic".

Is the Klonopin not working well for you?

Ryan

[joe504]

No it is.  I'm just sort of exploring all the possibilities.  I've been taking 0.5 mg pills twice daily but i think I might need to take the 1 mg pills twice daily.  I go back to the doctor tomorrow.  Thanks for all your help.

[RCA7591]

A better option would be to increase the dosing schedule to three times daily. 0.5 mg, three times daily (taken every 8 hours). This is almost always more effective than increasing the dosage to 1 mg, b.i.d.

You can speak with the doctor about this option. If at all possible, try to stay under 2 mg daily.

Ryan

[joe504]

Should I be concerned about building a tolerance for the klonopin?R

[RCA7591]

Only if the daily dosage exceeds 2 mg.

Tolerance would be exceedingly rare under 2 mg (15%). At 2-4 mg, the risk is 30%. Greater than 4 mg, 45-60%.

If possible, keep the dosage below 2 mg. Dosages greater than 1.5 mg rarely have any additional effect.

Ryan

[joe504]

It seems that the medication works better in the afternoon than in the morning.  Could that just be that I'm not a morning person?  Also, I find it extremely difficult to wake up if I take a pill right before bed.  What are your thoughts?

[RCA7591]

The Klonopin will generally work better in the afternoon, as Cortisol (a stress hormone) is always highest in the morning. Cortisol peaks in the morning, and declines sharply during the day (being lowest at night). Cortisol is what gives us the energy to rise in the morning.

However, a change in the dosing schedule can be helpful....

If you go to bed at 11:00 PM, take the pill four hours prior at 7:00 PM. Take one pill at 7:00 PM, and the other at 7:00 AM. This should help you out a little more. Klonopin peaks within 2 hours, so by 9:00 AM in the morning when you begin your workday, it will have reached peak plasma level.

Ryan