klonopin

[wmac]

Ok I tried Klonopin.Yikes!! Im such a light weight its scarey. The doc prescribed me 0.5mg so I took half yesterday at 11:20 AM and it did help with anxiety and I really felt fine. Then at about 10;30 last night I started to feel sick and it felt like a lead brick in my gut. But at 12:15 last night or am I took another 0.25mg when I finally went to sleep I slept really good, I think I may have died. lol.. but when I woke up this morning I felt hungover, sick, lead brick in my gut felt like I was ran over by a semi truck. I felt sickish all day really tired, and just not real well. So I will not take that again. I will switch back to ativan. I take 0.5mg in am and at pm but I will add another dose in the middle of the day. The doc wants me to do 1mg twice daily but I think that may be too much that is why he switched me because klonopin is longer lasting. I talked to the pharmacist and she asked if I had changed any thing else yesterday and I said no. She agreed it was the klonopin. So my vote is no for klonopin. I was kinda anxious to try it thinking it would be my answer to relieve my anxiety on a daily basis but I guess not. Its a pretty potent drug.
wmac

[RCA7591]

The sedation and tiredness is common initially when starting Klonopin therapy. Unlike Ativan, Klonopin accumulates (which is why the development of tolerance is rare).

One day really isn't a fair trial, and the sedative quality is very short lived. Klonopin reaches steady-state in two weeks, and the sedative effect will progressively dissapear. After a month, the drug accumulates from 1.5 to 3 times that of steady-state, and the sedative quality will vanish, leaving the anxiolytic/anti-panic effect.

I would give it another try, starting with 0.25 mg, bid for the first three days. After three days, increase the dose to 0.5 mg, bid. The incidence of sedation actually decreases when the dosage is increased towards the target range of 1 mg daily.

It is best to make the transition from Ativan to Klonopin now, rather than increase the Ativan to 0.5 mg, tid. When Ativan is dosed three times daily, steady-state is reached, but only temporarily. The plasma level declines rapidly, and the effects will ultimately wear off with prolonged use. Tolerance to Ativan occurrs rapidly. Ativan should only be used for short periods of time, or as needed only.

Technically, 0.5 mg of Ativan is equal to 0.25 mg of Klonopin. However, the effects are not equal subjectively, as the two drugs possess different properties. Ativan is a rather non-specific anxiolytic, while Klonopin possess very strong anticonvulsant/anti-panic properties. Klonopin is both potent and long lasting, and is indicated for long term use.

The doctor's suggestion to use 1 mg of Ativan, bid is actually poor practice. Used in this manner, there will be an eight hour gap between the two doses, and you will not have full 24 hr coverage. Tolerance will still develop, just not as fast as if it were dosed three times daily. Used three times daily, tolerance can develop in as little as four months.

Alternatives would be Librium 10-25 mg, tid, or Valium 5-10 mg, tid. These two are also indicated for the long term, but they are less desirable than Klonopin (Klonopin is very specific towards panic).


-Ryan

[heartfluttersflyawayplz]

wow i hate that you didnt like the klonpin, i also took ativan when needed, but i this point and time in my life i need something everyday until i can get back on my feet, and klonopin is the best because it levels off and keeps you calm and your body does not want more and more . where as with the ativan it will. you can stay on klonpin for life if need to but not ativan.when i first started taking it i was very tired and yes sick at stomack but the stomack was from all the weeks of anxiety i had gone through and it messing up my stomack. now i have gone back on the klonopin have been on it 4 days today and i feel much better and my stomack is feeling lots better am getting where i can eat better , yes am tired but i can deal with that. am still taking just the half of a .05 in the am and pm it seems to work for me so not sure if i will go up to .05 at anytime. am going to stay on it a few weeks and than start coming off of it to see if my stress has gone away to where i can handle it .

[heartfluttersflyawayplz]

wow i hate that you didnt like the klonpin, i also took ativan when needed, but i this point and time in my life i need something everyday until i can get back on my feet, and klonopin is the best because it levels off and keeps you calm and your body does not want more and more . where as with the ativan it will. you can stay on klonpin for life if need to but not ativan.when i first started taking it i was very tired and yes sick at stomack but the stomack was from all the weeks of anxiety i had gone through and it messing up my stomack. now i have gone back on the klonopin have been on it 4 days today and i feel much better and my stomack is feeling lots better am getting where i can eat better , yes am tired but i can deal with that. am still taking just the half of a .05 in the am and pm it seems to work for me so not sure if i will go up to .05 at anytime. am going to stay on it a few weeks and than start coming off of it to see if my stress has gone away to where i can handle it .

[heartfluttersflyawayplz]

as you can see i didnt get ti finish what i was saying above, but was just checking to see you did say i could just stay on the .25 right it seems to do the job i really dont want to go up to .05 a pill, and in a week or so am going to try and see if my anxiety is gone after i start eating better and stomack does not wake up sick and all the tingling is gone i will try and go off of it , anxiety has never been a life thing for me so i hoping i can get off of the pill but if i had to i would stay on klonpin its been a great med for me , thank you telling me about it .

ryan did you go back to hospital this week and if so how did it work out for you this time, you have been in my thoughts and i was happy to see you back on here . let us know how your doing. your in my prayers . Barbara

[Darius5691]

Ryan,
I switched to Klonopin a few weeks ago (1/2 of a .5mg tab bid), from Xanax .5 mg (dosing varied - anywhere from 3/4 to 1-3/4 tabs per day). I think because I was tinkering with my sleep med at the same time (from Restoril to Rozerem - which didn't work), I experienced heightened anxiety. At the time, I attributed the increased anxiety to Klonopin, I think erroneously. I have a psych appt next week and plan to speak with him about trying the Klonopin again, since I've heard it's not as addictive as Xanax. Do people who switch from Xanax to Klonopin typically have any problems? Side effects? Etc.? Is Xanax XR any better than regular Xanax? Is it similar in nature to Klonopin?

If you don't mind ... I also have a question about Xanax. I've been on .5 mg for 5 weeks now - at first PRN q4-6 hrs. (I took anywhere from 1/2 tab/day to 1-1/2). Then I started on Restoril as a sleep aid, and my Xanax dose went down to 1/2 or 1/4 tablet in the a.m. and another 1/4 to 1/2 in early afternoon. Now I've switched to Trazodone for sleep (50mg), because I wasn't comfortable being on two benzos at one time, and my Xanax dosing has gradually increased - instead of just two doses/day, I'm up to 4: 1/4 or 1/2 tablet in the a.m., 1/4 tab at noon, 1/4 at 4 p.m., and 1/2 tab at night with the Trazodone, per my psych's recommendation. The combo has been hit or miss, sometimes I can sleep 5-6 hours, sometimes not. It's always interrupted sleep, though. yuk. I tried once not taking the Xanax with the Trazodone, and it wasn't a successful evening.

If I am successful in switching to Klonopin, would I still be able to take the Trazodone as a sleep aid? I mean, I'm really hoping that once I can myself evened out, I won't even need sleep medicine. But, until that happens, I'm wondering if I'll need to switch sleep med again. I hate switching meds, because it seems that my body doesn't always react very pleasantly to it.

Thanks for whatever insights you can give.
Anne

[RCA7591]

Hi Barbara,

You can take 0.25 mg of Klonopin twice daily, and it will still reach "steady-state". Try to eat balanced meals throughout the day as well. 0.25 mg of Klonopin b.i.d is a sufficient dose for some folks (all drugs need to be individualized for the person).

In regard to the events that transpired on 2 July 07 (the allergic reaction to CT contrast dye):

I've obtained my medical records from that hospital. Once I had them in hand, I cancelled the MRI that they offered to me free of charge (as per the advice of my attorney AND good friend). The MRI has been scheduled at another hospital about 20 miles away, Tuesday at 2:00PM.

The records clearly show an oxygen saturation of 100% on room air, BP of 110/72, respirations 18/min, and a pulse of 56 bpm. EKG shows normal sinus rhythm with IRBBB, and was a normal EKG for me. Thus, there was no "code blue", and no reason for the CCU doctor to order intubation.

After intubation, oxygen saturation decreased to 94%, BP decreased to 90/45, respirations increased to 25/min, and pulse increased to 120 bpm. Rhythm strip (lead II of EKG) reveals chronically ischemic, inverted T-waves.

Review and comparison of the pre-intubation and post-intubation vitals reveals that intubation actually compromised my health (and that the ventilator setting was incorrect). Drugs given were Benadryl 50 mg IV, Succinylcholine Chloride 100 mg IV plus maintanence drip, Atropine Sulfate 0.01 mg IV, and Valium 5 mg IV. I remained in this compromised state for roughly five hours, paralyzed and hyperventilating. And I couldn't do a damn thing about it. The sick thing is, the nurse knew that I was conscious the entire time.

Therefore, I'm filing a malpractice suit against the hospital, the attending doctor who ordered the treatment, and the nurse practitioner who implemented the treatment, all without prior written or verbal consent. Ultimately, I would like for both the doctor and CRNP to have their licenses revoked permanently.

The hospital did try to "make good" by offering to cover the expenses of the botched CT and CCU treatment (and even offering to cover an MRI), as well as apologizing. Clearly, they fessed up to making a mistake by offering such incentives, however, only a fool would actually accept them.

-Ryan

[RCA7591]

Anne,

I would concur that altering the dosage(s) of the insomnia drugs is what led to the heightened anxiety, and not the Klonopin.

If you have been on Xanax long-term, making the transition from Xanax to Klonopin may or may not produce heightened anxiety. Xanax works immediately, has a short half-life, and it does not accumulate. Klonopin on the other hand has a slow onset of action, accumulates slowly to steady-state, and is long acting (unlike Xanax).

Klonopin reaches 1/2 of steady-state in three days. Therefore, if you have been using Xanax long-term, you may require a transistion period of about three days to notice the benefits of Klonopin. The full benefits are reached in two weeks (once the drug reaches steady-state). After one month, Klonopin accumulates from 1.5 to 3 times that of steady-state, and will provide long-term management for your anxiety symptoms.

Xanax-XR is no better than traditional Xanax, it is merely an extended release version. Both are indicated for short-term or PRN use only.

q 4-6 hours is not PRN use, it is excessive use, and will lead to rapid tolerance within four months. Tolerance means that you will require more drug to produce the same effect. Restoril is also indicated for short-term use only (< 7 days), or as-needed on an infrequent basis.

I would recommend making the transistion from Xanax to Klonopin in the near future, as to avoid forming a tolerance to Xanax. Both Xanax and Klonopin cause *dependency*, but Klonopin rarely leads to *tolerance*, as it carries both a long half-life and accumulation. *Dependency* is a non-issue for the long-term treatment of anxiety disorders, and Klonopin is indicated for long-term use.

There is a distinct difference between the terms addiction, tolerance, and dependency.

As for the Trazodone, you can use it in conjunction with Klonopin, but you will likely find that this isn't necessary. Klonopin is more effective in monotherapy if only an anxiety component is present.

-Ryan

[Darius5691]

Ryan,
Thanks so much for your response. I truly appreciate your suggestions. I definitely plan to speak with my psych this coming week about switching to Klonopin, unless he has some other recommendation that will allow me to come off Xanax. Do people experience tolerance after being on Xanax for 5 weeks? I am glad you thought to explain the difference between dependency and tolerance, as I wasn't aware of it. I'm afraid I've already built up a tolerance, but am not sure. How does one know?
Anne

[RCA7591]

"Do people experience tolerance after being on Xanax for 5 weeks?"

It is possible, and depends on how much of it you took over the five week period.

"How does one know?"

You would begin to experience anxiety again at your current dosage, and would require more of the drug to null the anxiety. The anxiety would be classified as withdrawal phenomenon from the acquired tolerance to the drug.

Tolerance is common with Xanax, but uncommon with Klonopin.

-Ryan

[Darius5691]

Ryan,
Thanks again. And before I even go into any discussion about Xanax and tolerance, etc. ... I am sooo sorry to hear about what happened to you at the hospital. Unbelievable. How are you feeling now? I didn't read your response to Barbara until after I'd sent my questions to you. Now I feel badly. You're not feeling well, just getting over such a terrible time, and I'm bothering you with Q's. Sorry.

If you feel like even answering another question ... !! ... do you happen to know if lowering my dose of Xanax (i.e., total tabs per day) would make my blood pressure go up? Over the past few days, I've been getting more sleep and so my anxiety level has gotten lower during the day. I've switched from taking upwards of 1-3/4 to 2 tabs of .5 mg Xanax down to 1-1/4. Would making that change cause me to feel spacey in the head, with higher blood pressure? Normally I'm at 100/60 or 110/70. Now my readings are more like 125/77. Not all the time, but I definitely feel like something's different blood pressure-wise. It's harder for me to take a deep breath, for instance. Just wondering if I'm causing this to happen by lowering my already fairly low dosing.

Hope you're feeling better.
Anne

[RCA7591]

Anne,

I'm doing just fine now. Thanks for asking!

The blood pressure fluctuations are trivial, and are well within the "normal" range. Any effects you are feeling subjectively are unrelated to the blood pressure. Stress and anxiety have a trivial effect on BP, but the BP itself is not causing your symptoms. You can only "feel" high blood pressure when it hits extremes (ie: > 200 systolic and > 110 diastolic), and the most common feature is headache.

Xanax is predictable, as the half-life is about 4 hours. It doesn't accumulate, and it is rapidly eliminated from the body. Increasing or decreasing the dose, even by 0.125 mg increments, can give a "rollercoaster" type effect. Decreasing the dose could indeed make you feel "spacey".

Subjectively, it feels harder to "take a deep breath" because you are hyperventilating (overbreathing), also a withdrawal symptom.

Xanax-XR prevents the rollercoaster effect, but it does not decrease the risk of tolerance (it increases it). Every four months or so, you'd need to double the dose. Therefore, I would recommend switching to Klonopin before tolerance can occur. When making the transistion from Xanax to Klonopin, there is a three day window that makes you vulnerable to rebound anxiety and temporary withdrawal. This effect will pass after three days. To minimize this, start at 0.5 mg, bid.

Tolerance: By definition, the need for more drug to produce the same results as the original starting dose.

Dependency: As it applies to Xanax and Klonopin, the normal adaption of the drugs agonizing influence on GABA(a) receptor sites in the brain. Any drug-induced alteration of brain chemistry over time requires that the drug be used consistently to maintain normal brain chemistry. If the drug is abruptly withdrawn, brain chemistry is altered, and withdrawal symptoms develop. Dependency is not addiction, and is a normal response.

Addiction: Drug abuse and misuse, cravings for more and more drug for the sole purpose of abuse or euphoria, often in combination with other drugs.

Addiction is a non-issue in treating anxiety disorders, unless there is a past history of drug abuse. Dependency is also a non-issue, as the drug may be tapered gradually. Tolerance is the main concern with Benzodiazepines, and should be prevented by choosing the appropriate drug for the indication.

Therefore, there are two classes of Benzodiazepines; short-acting and long-acting. The former are indicated only for the short term or for PRN use only on an infrequent basis (Ativan, Serax, Tranxene, and Xanax). The latter are indicated for the long term management of anxiety disorders (Klonopin, Librium, Valium). The main difference between the two classes is their half-life, which governs their onset of action, duration of effects, and tolerance risk.

-Ryan

[wmac]

I absoulety respect or opinon as does everyone else. However when you said it was poor practice on my doctors part to prescribe 0.5mg times three per day I disagree with you. You seem to be pushing klonopin on everyone here and Its not for everyone and that includes myself. I do well with ativan so im sticking to it. I have no reactions and I know what to expect. the only thing I think it has done to me is lower my white blood count which it can rarely do but maybe i just run low anyway and its not alraming low anyway. I get so many anxieties due to my heart arrthymias and I need something. I did however feel that klonopin did help with anxiety it just seemed to make me feel level but I dont like the hung over feeling or being tired and the gut ache and nauesa. Ativan has never done that to me.who know maybe I should switch to valium maybe that would be better but I suggested it to my doc and he said no for some reason. maybe I should up my dose of ativan to 1mg times two instead of the 0.5mg times three. thats what he wanted me to do to begin with. I just want something that will help the anxiety go away. Alot of the antidepressants have cardio side effects and im not sure i want that . My doc suggested zoloft he said it would just help me not be so obsessive about it and I could be normal again ..lol But yes dont take it personal what I said we all really appreciate you and you your knowledge maybe you can help me come up with some answers to my problem as well but not with klonopin. lol
wmac

[RCA7591]

I didn't state that it was poor practice to prescribe Ativan 0.5 mg, tid. I stated that it was poor practice to prescribe 1 mg, bid, as there would be an eight hour gap in coverage.

If it were to be prescribed 0.5 mg, tid, it should not be taken for greater than four months (and that is the absolute maximum time frame). The issue is tolerance. Ativan's active metabolite Lorazepam does not accumulate, and because Lorazepam does not accumulate, prolonged use leads to tolerance. Tolerance is bad, and limits future options.

In my opinion (and only in my opinion, as I'm certainly not living in your shoes), you didn't give the Klonopin a fair trial. The transition period from Ativan from Klonopin may require three or more days (this gives the Klonopin a chance to accumulate towards steady-state). Ativan works rather quickly, while Klonopin doesn't.

It is also possible that the remaining Ativan that was in your system had an *additive* effect on the Klonopin, contributing to the "hung over" feeling. One day is not a fair trial, IMHO.

While you'd probably be reluctant to try it, I would suggest reinstating the Klonopin at a dosage of 0.25 mg, bid, increasing the dosage to 0.5 mg, bid after three days. The sedative side effect will vanish progressively, even more so once the target dose of 1 mg daily is reached.

I don't "push" Klonopin on everyone. I have suggested various other drugs in the past depending on the circumstances involved. I tend to suggest Klonopin as a long-term option only, largely because it is the best long-term option available in Benzodiazepine form. It has relatively few contraindications and side effects, and is an attractive medicine for the management of anxiety disorders.

When choosing a Benzodiazepine, three factors should be taken into consideration:

(1) The type of anxiety disorder requiring treatment (GAD, Panic Disorder, Panic Disorder with phobia, Somatiform Disorder, Neurosis)

(2) The particulars of the disorder (ie: is it recurring or intermittent?) Daily anxiety or panic attacks? Agoraphobia? Anxiety or panic induced by phobia (ie: driving over a bridge).

(3) The persons age

#1 is irrelevant, as all genuine anxiety disorders respond to Benzodiazepines in general.

#2 is most important. If the disorder is intermittent, a short-acting drug is sufficient to control infrequent or sporadic attacks, or attacks brought on by phobia. Both Xanax and Ativan are indicated here. If the disorder is recurring, a long-acting drug is indicated to prevent tolerance (Klonopin, Librium, Valium).

#3 is also important. The older the person is, the greater the likihood of excessive accumulation with the long-acting drugs. This leads to "problem sedation". Problem sedation is more common with Librium and Valium, as these have a half-life of 200 hours. It is most common with Librium. These two drugs may accumulate between 5-10 times that of steady-state (depending on metabolism). Klonopin is a possible exception, as the accumulation is only between 1.5 to 3 times that of steady-state. Provided that no liver or kidney disease is present, Klonopin can be assumed to be a safe choice for all age ranges, 18 years of age and up. Klonopin has one active metabolite only, and accumulates just enough to prevent or minimize the risk of tolerance. The other two (Librium and Valium) have two or more active metabolites, and those metabolites may accumulate excessively depending on the health and age of the individual.

These are the three factors that I look at when making a recommendation. Perhaps this will shed some light on why I recommend Klonopin more frequently than the other Benzo's.

Zoloft and other SSRI's generally worsen cardiac manifestations of anxiety. They are good for depression and OCD, but they are largely ineffective for true anxiety disorders.
Some of them may cause cardiac conduction disturbances, and Zoloft has been reported to induce hyperlipidemia.

-Ryan

[wmac]

What is hyperlipidemia??? Ok my problem is im a bit ocd anyway with anxiety attacks. When I have my nonsustained ventricular tachycardia it really throws me into a anxiety attack and sometimes panic. Now the anxiety does not cause the heart arrthymia vise versa. I worry all day everyday about having another episode all the time, im fearfull in going places getting to far from help. All the cardio docs have said my nsvt is not life threating I have had to eps and they could not induce the arrthymia. But Im scared everyday even when I get single pvcs or pacs and I just want to not worry about this. I took beta blocker toprol xl for three days and had the worse episode ever it got recorded so that is not  a good option either. I just want to help the anxiety of all of this so I can be a bit normal is all.

[RCA7591]

Hyperlipidemia is an increased lipid count (including Cholesterol), and is a potential adverse effect of Zoloft.

The is a distinct difference between OCD, anxiety, and panic. The latter two are treated in a similar fashion. From your description, it appears that you have panic disorder with phobia. Chronic worry about future episodes, avoidance or apprehension towards places that are not easily escapble, and a phobia with regard to your heart function (cardiac neurosis) would strongly confirm the diagnosis.

NSVT, PVC's and PAC's in a structurally normal heart carry no clinical significance, they are benign (and you know that). The fact that the NSVT could not be replicated in the EP lab makes the condition even more benign. Even though you were assured that they are not life-threatening, you continue to seek reassurance despite the fact of having an essentially negative work-up. This is an anxiety reaction, a neurosis that ultimately progressed to panic disorder. Most anxiety disorders are progressive, and the sooner they are treated, the better off you will be over the long term.

Therefore, in my opinion, you don't have OCD, but rather "panic disorder with phobia", with the phobia focused primarily on your heart function.

Beta-Blockers can go one of two ways, and not all beta-blockers will prevent or worsen arrhythmia's:

(1) Arrhythmia is reduced due to decreased sympathetic activity, decreased heart rate, and by blocking the effects of adrenaline on the myocardium.....

(2) Arrhythmia is aggrevated due to loss of sympathetic activity on the myocardium, or by reduction of the pulse rate...

Metoprolol is a relatively cardio-selective beta-blocker, and just because you had a negative effect to it does not mean that other beta-blockers will not help you. Since the negative effect occurred with Metoprolol, I would avoid cardio-selectivity. Other options are Propranolol, Timolol, and Corgard, all of which are non-selective. Inderal (Propranolol) has an excellent track record for treating arrhythmia's of many types.

"Normal" isn't possible at this point, but "close to normal" is, and that is the best that you can hope for. With the right combination of drugs and a positive outlook, significant improvement can be made. It may take some trial and error to find the ideal combination, therefore, a cooperative doctor who is willing to work with you is essential. There is no "end all" cure, but the proper combination of drugs can minimize most of the symptoms.

My take:

(1) Treat the underlying anxiety disorder (panic disorder with phobia). Don't give up on the Klonopin just yet, as it is the front line treatment for panic disorder. I would not continue to take Ativan, as to avoid building up a tolerance to it. Tolerance may limit future treatment options.

(2) Reducing the anxiety/panic will likely reduce the frequency of the NSVT and PVC's as well, but they will recur. To prevent or minimize them from recurring, the addition of a non-selective beta-blocker should be considered. Inderal would be my first choice (considering your response to Toprol). The dosage should be started out very slowly, 10 mg, bid. If this dosage does not increase or decrease the NSVT, the dose should then be raised to 20 mg, bid. If this is well tolerated, the dose should ultimately be raised to 40 mg, bid. This will serve as your maintanence dose.

(3) The Klonopin and Inderal (or what ever combination of drugs you and your doctor find to be effective BUT NOT ATIVAN) will work in concert to treat both the anxiety and cardiac components of your illness.

(4) Patience and trial/error will be required on your part if you truly wish to get better. Furthermore, you can't take a drug one time and say "it's not for me", unless there is some genuine untoward reaction to it.

(5) Do not anticipate the worst when beginning a new drug regimen. Anxiety can closely mimick the side effects of certain drugs, and anxiety can set off an NSVT attack (whether you "feel" anxious or not). It is difficult to differentiate if the anxiety or the drugs are contributing to the arrhythmia. Therefore, do not anticipate the worst, give the medicine a chance to help you. Finding the right combination can be frustrating as hell, but you must remain patient. It is worth the reward.

I also suffer from NSVT and PVC's, but unlike you I actually have heart disease. The drugs as outlined above worked beautifully for me at reducing the frequency of the events to almost zero. The NSVT and PVC's were NOT due to the heart disease, they were largely due to an anxiety/panic reaction, which goes to show just how significant anxiety can be. It took me roughly three years to find the correct combination of medicine, mostly because I would not accept an anxiety diagnosis. I can't honestly say that every single day has been "stellar", but the good days far outnumber the bad ones.

So, don't give up on the Klonopin, and speak with your doctor about adding a beta-blocker to help minimize the NSVT attacks. Start out slowly on the beta-blocker. Inderal gives you greater control over the dosing, and has a great track record for treating all forms of arrhythmia's.

-Ryan

[wmac]

Thanks for the post. Ok first of all I started to take the toprol xl the dosage they gave me was 12.5mg but beings that im so senitvie to meds the first day I took 1/4 of it and the second day I also took a 1/4 of and the thrid day I took half and six hours on the dot booooommmmmm... In the begining the cardio saids med could make it worse so for two yrs I fought not taking it. then I did and it was worse. The cardio suggested flecinaide and im like no way. I have seen ep after ep for this. The ep in utah at the university suggested nadolol. didnt want it Now my main cardio says nadolol and then another in utah heart clinic says cardizem. Well nadolol is non selective and im afraid of that because I smoke. yes I said it i smoke. The only times I have my episodes are when at rest watching tv or on computer so my heart does the nsvt at slower beats and like one of the docs said on the heart forum if it happens to you at slower beats then a beta is not for you but if it happens at higher rates then it is for you. The 26 beat run was eternity and I thought I was going to die. dont want to go there again. As for the ocd yes I am that even the counsler said I have it. I have rituals I do at night checking everything as it seems at least 100 times (not that much really) making sure things are unplugged washing my hands all the time. I like a song I listen to it over and over and over again. I make myself crazy. I am thinking strongly about the klonopin again but I dont know if I can up the dose the third day to .5mg because .5mg is like 1mg of ativan and I havent even ever done that. New meds throw me into a panic inself.  Inerderal is non selective right? The problem with cardizem lowers your bp and im already 92/62normally.The same with betas. Im just at such a lost here. How long has your nsvt been. the ep at the utah heart clinic said if I really wanted he would take me back into the ep lab. and not sedate me this time only to put the caths in unlike the two other times I was pretty well sedated with versede. so may thats what I should do I just dont know anymore.
Thanks Ryan

[RCA7591]

Toprol-XL is an extended release medicine. It is available in 25 mg, 50 mg, 100 mg, and 200 mg versions.

The 25 mg tablet is scored, and may be cut in 1/2 to form 12.5 mg. However, if you CUT the 12.5 mg in half or in quarters, you defeated the time release feature. In short, you released more of the Toprol than you intended to. 12.5 mg is the lowest dose that is obtainable in the XL form. Perhaps this is where the problem occurred. If cut, all of the medicine would be released at once. You should never cut a time-released pill.

Flecinaide is an anti-arrhythmic drug, used to treat severe cardiac arrhythmia's. It can also cause lethal arrhythmia's, so the benefits do not outweight the risks in your case (your condition is benign). Cardizem is a calcium channel blocker, and it too can increase the severity of arrhythmia's.

With your low BP of 92/62, I wouldn't take anything other than the Klonopin. Cardizem may cause you to faint, and BB's (except for low doses) would also lower the pressure excessively.

I would also look into Hypothyroidism and Addison's. The BP is unusually low for a smoker. Have your GP order TSH/T3/T4 for thyroid, and 24-hr urinary Cortisol for Addison's. Both of these conditions can cause cardiac arrhythmia's and anxiety.

I wouldn't do another EP study. Too much risk and unlikely to produce results.

My NSVT also occurred at lower rates (60-65 bpm), but my blood pressure is 160/100. Beta-blockers work for me.




-Ryan

[wmac]

Ya they have checked my thyroid. But what is addison's? never heard of it. So your thinking what im thinking just treat the anxiety and not the heart arrthymia right? I also dont drink enough water and I know dehydration can cause low bp also I do have kidney stones which are calcuim oxalate which are caused from dehydratioin.

[wmac]

Ya they have checked my thyroid. But what is addison's? never heard of it. So your thinking what im thinking just treat the anxiety and not the heart arrthymia right? I also dont drink enough water and I know dehydration can cause low bp also I do have kidney stones which are calcuim oxalate which are caused from dehydratioin.

[RCA7591]

http://www.medhelp.org/www/nadf3.htm

-Ryan

[Darius5691]

Ryan,
Do you happen to know what is the equivalent dose of Klonopin to Xanax .5 mg? Thanks very much for your incredible wealth of knowledge! Are you a doctor, by chance? Just wondering where you get all of this from, or is just personal experience dealing with anxiety? Amazing. You are a huge help to us here on this forum. :-)
Anne

[wmac]

Well I just pulled all my recent blood test that I have copies of and my potasium is on the lower side not the higher side and my sodium is within normal limits. I also just had surgery and they say something traumatic or surgery makes it worse. Although my bp went down to 80/44 after the surgery but spinals do that too. And the two espion (something) nuero(something) within the white blood cells are normal which they say for addisons they are higher. So I dont think thats the problem. They have also checked my thryoid as recent as March of this yr or Feb cant remember. It was normal I was wishing that was the problem. Im just a lucky one to have nsvt thats all.My doc was not worried about the lower bp after surgery. So who knows why I have what I have no one does they call it idiopathic nsvt. Just my luck.