switching from xanax to klonopin

[jaburton1234]

I have been diagnosed with bipolar one with agrophobia, panic disorder and PTSD.  I am currenty taking xanax 1mg 4 times a day.  My doctor wants me to switch to Klonopin 1mg 4 times a day and I am scared.  I tried to take 0.5mg of Klonipin once when prescribed by another doctor and had a terrible panic attack  when it wore off (though I was on 1mg of Xanax then too, and from what I have read I should have been on 1mg on Klonipin.  I am also worried about the level of sedation since I have a 5 month old and  3 year old to care for.  Has anyone else ever had this fear?  I am really scared of the panic attacks coming back, I also have read it is three days of hell switching.  Do I taper the Xanax or jst go straight to the Klonopin?  I am so scared, please help me.  

[RCA7591]

"I also have read it is three days of hell switching."

^quote

Try 3-14 days of hell (average 10 days). 4 mg of Xanax is the absolute maximum limit, and such a hefty dosage concerns me. I would NOT transition directly from Xanax to Klonopin, but would use a stepped-schedule instead. I will write one for you. Before I do, let me explain how Klonopin works, and how it differs from Xanax:

Klonopin ( a long-acting Benzodiazepine) works on the principals of steady-state and accumulation. Through these two properties, Klonopin maintains its efficacy over the long-term, with no risk of tolerance at dosages of 4 mg or less daily. Xanax does not accumulate in the plasma. There is no accumulation, and the drug is not held at steady-state. Instead, the plasma levels of Xanax peak and trough, which gives rise to a "rollercoaster" effect. Most importantly, Xanax leads to rapid tolerance and complete loss of efficacy over a very short time span. Thus, Xanax is not indicated for the long-term (this is why the doctor has switched you to Klonopin).

What the doctor neglected to inform you of is the difference between Xanax and Klonopin. Xanax works immediately, and does not accumulate. To remain effective, it must be dosed frequently (every 4-6 hours). Klonopin does not work immediately, and to replace Xanax completely, it will require a period of up to two weeks in duration. During this two week phase, you would undergo complete Xanax withdrawal. At a daily dosage of 4 mg, seizure is probable. The withdrawal would be severe, and perhaps, life-threatening at your current dosage. Thus, one cannot safely transition from Xanax to Klonopin when the daily dosage exceeds 2 mg. The doctor should've known this.

Here's the soultion to the problem. The first 3 days may be slightly difficult, but after that, everything will procede smoothly. The following schedule is to be performed under the supervision of a medical doctor:

Weeks 1-2: Take 1 mg of Xanax, t.i.d. (morning, afternoon, evening). Take 1 mg of Klonopin at night. Keep the dosages spaced 8 hours apart if practical.

Weeks 2-4: Take 1 mg of Xanax, b.i.d. (morning, afternoon), and 1 mg of Klonopin, b.i.d. (evening, night).

Weeks 4-8: Take 1 mg of Xanax in the morning, and 1 mg, t.i.d of Klonopin (afternoon, evening, night)

At the end of week eight, the Xanax is eliminated, and replaced fully with Klonopin, 1 mg, q.i.d. Keep the doses spaced 8 hours apart (or a close as possible).

The idea here is to allow for the Klonopin to accumulate before removing each Xanax dosage. The two are equal in potency, however Klonopin requires a two-week period to fully replace the Xanax, as Klonopin must accumulate. This is the safest way to discontinue Xanax, and any withdrawal phenomena will be eliminated after the first three days of making the transition.

If any of this isn't crystal-clear, let me know.

~Ryan

[Mustard_Seed]

Listen, This is a sort of long story but may be very detrimental to anyone who tries to switch from Xanax to Klonopin, "Cold Turkey".

5 years ago i sought help for several emotional and social problems I was having. including severe insomnia. I went to three GP's anf two different mental health centers. Everyone had a different opinion. One said I had OCD, another said severe depression, "even though i had no signs of depression" and another even believed that i was biploar. I tried an entire regement of different meds. Trazadone, Halcion, Helidol, paxil, geodon, depakote, seroqel. Nothing helped.

My mind would race constantly; night and day, with no relief. Sometimes I would go three days with no sleep of any kind. My brain scaned information sort of like the desktop of a windows PC filled with houndreds of folders. i would try to play out, repair, rethink, solve, and fix every issue of that day, the day before, and the day to come, all at the same time. This not only caused the severe insomnia, but when a major issue did pop up.... tight chest, cant breath, tingling in fingers, chest pain, tunnel vision, weakness in my left arm, and exaustion. Or in other words, "PANIC ATTACK"!

Finally I found Dr. P. He specialized in my disorder ADHD. (Antention defecit hyperactivity disorder.) He also doscovered that i suffered from severe generalized social anxiety disorder. A family history revieled tha both my mother and grandmother had nervous breakdowns in their thirties, most likely due to the same issues.

Dr. P. started me out on 20mg 2x a day of Adderall (adderrall) for the ADHD. It was a Miracle - instantly my mind slowed down and I was able to handle day to day tasks like normal people. The big problem was still the Anxiety disorder and Insomnia, which he felt went hand in hand.

He put me on 1mg Xanax 3x a day, plus a 2mg Xanax at bedtime for sleep. Again, a Miracle.. no moe panic attacks, no more fears of being around people, and no more nights of sleeplessness.

I followed this program for three years and had lived a very happy, fun filled normal life!

Total 5mg Xanax a day

This is when thing got hairy!

After moving to another state for work, I had to find another GP. I had all my records faxed from all my doctors to the new one immediatly so that he didn't have any fears that I was a "Seeker". Everything was fine for six months, then the Doc asked me to see a Psych. I agreed even after having multiple bad experiences with them.

The day after my visit to the Psych  my GP called me into his office and anounced thay "they" were taking me off Xannax and switching me to Klonopin. No stepping, or weaning,  just cold turkey.

He explained that the two medications where of the same family, "Benzo" and that their strengths where 1:1 mg wise, but that the klonopin lasted longer with an almost a double half life, and was much less addictive. "ADDICTIVE"? Come on. 1st) after three years it's not addiction, it's a dependency! Both physical and emotional, "especialy considering the fact that I lived daily with the expectation of an almost immdiate relief from my panic attacks on hand".

But hey, he's the one with the PHD., so I figured he new what he was doing. I went to the pharmacy and picked up my new script.

Klonopin 2mg 3x a day.

Day # 1 Fine but edgy (Wife noticed I was starting to be confrontational and aggressive in stature.)

Day # 2 Woke to a strange feeling of undescriable faint electrical currents firing within my brain. "Sort of like nurological short cuircuits". Started to feel more anxious than usual and restless. (Wife noticed me beiing very confrontational and aggresive (aggressive) verbaly with friends and family." Layed awake in bed most of the night.

Day # 3 Woke up and went to T.V. room. Sat on couch with wife. feeling very exhausted and disorientated. Kinda felt dreamy. My cell phone rang. I answered phone. It was an old friend I hadn't seen in years. he said, ' Whats up bro?" I replied, "Not much, how you been?" Wife interupted; What the heck are you talking about? . I then Realized that I Had no phone in my hand, and was not tlking to anyone. OMG! Full blown hallucination! I freaked out. This had never happened before. I emmidietly called Psych. Office admin said she would page him.

While waiting, I started doing research on internet. Found that with Xanax there is no switching to other Benzo's after long time use. The only way to tapper off the Xannax is with lower doses of Xanax over a long period of time!

Psych called me in for emergency consult. He explained that GP hadn't informed him of the length of time I was on Xannax. By then, I was having a severe panic attack, I was trembling, and had developed double vision with no ability to keep my balance. I then found myself stumbling around office, out to car, and into pharmacy. Almost like being drunk. (Note: Wife was driving) Pharmacist almost freaked when my wife told him what had happened and felt that I was suffering from extreme withdrawls from the lack of Xanax.

The Psych by now had familiarized himself with the whole story from reviewing my entire records from the past five years, and agreed that I needed back on Xanax immediatly! My records showed that both my mother and grandmother spent their entire lives on Roach 10 Volume and Xanax.

He ordered the Pharmacist to dispense me 150 pills of 1mg Xanax with instructions to take 1mg 3 x a day and (2) 1mg Xanax at betime for sleep. (a one month supply) The next day, everything was back to normal. No hallucinations, no aggresion (aggression), no confrontation, and no "electric" (in brain). I was back to feeling completly normal, sleeping well and fully functional!

The moral of this experience is to ask questions, do your own research, and dont trust your life to one persons opinion.

This is the link that helped to save my "Sanity", and possibly life. If I had went to the hospital I would of most likely been held for a 72 hour eveluation which may have majorly complicated things and greatly increased my detoxification illness before anyone figured out what was going on.

http://ask.rrockr.com/showq.php/9170-difference-between-xanax-valium-klonopin

Thanks RRockR.com I don't know what I would of done before i read your article.

[RCA759I]

"Listen, This is a sort of long story but may be very detrimental to anyone who tries to switch from Xanax to Klonopin, "Cold Turkey"."

^quote

I couldn't agree with you more, and I wish you would have posted. I could have helped you (still can if you have a problem).

The issue here pertains to half-life variations between Xanax and Klonopin. Xanax reaches peak plasma concentrations very rapidly, after which point this level troughs after a span ranging from 4-6 hours - hence the need to pop them every 4-6 hours. Given the short duration and half-life, the chronic peaking and troughing of the plasma level will eventually render Xanax less effective or ineffective. Xanax does not accumulate, and never reaches steady-state plasma levels. It was designed to working quickly, and with a short duration of action. It is best reserved for as-needed use only, as loss of efficacy over the long-term precludes its use over the long-term.

Klonopin, on the other hand, accumulates. This is a function of its low protein biding and long terminal half-life of 36 hours on average (range 18-50 hours). For Klonopin to fully replace Xanax, it must accumulate to steady-state plasma levels. This occurs after two weeks of b.i.d. or t.i.d. dosing. Hence, the Xanax should not be gradually discontinued and replaced with Klonopin, it should ideally be stepped out while simultaneously stepping in the Klonopin.

Xanax 5 milligrams to Klonopin 5 milligrams (dose equivalent)...

Days 1-3 : Morning (2 mg Xanax), Afternoon (1/2 mg Xanax, 1/2 mg Klonopin), Night (2 mg Xanax)

Days 3-6: Morning (1 mg Xanax, 1 mg Klonopin). Afternoon (1/2 mg Xanax, 1/2 mg Klonopin). Night (2 mg Xanax)

Days 6-9: Morning (1 mg Xanax, 1 mg Klonopin), Afternoon (1 mg Klonopin). Night (1 mg Klonopin, 1 mg Xanax)

Days 9-12: Morning (2 mg Klonopin), Afternoon (1 mg Klonopin). Night (1 mg Klonopin, 1 mg Xanax)

Days 12-15: Morning (2 mg Klonopin), Afternoon (1 mg Klonopin), Night (1.25 mg Klonopin, 0.75 mg Xanax)

Day 15: 2 mg of Klonopin in the morning, 1 mg of Klonopin in the afternoon, and 2 mg of Klonopin at night.

You can adjust this in anyway you see fit. There is no "one size fits all", but you get the basic idea - step out the Xanax, and step in the Klonopin. The idea is for the Klonopin to accumulate while it is replacing the Xanax.

Of particular note is your dosage - 5 milligrams. Seizure may result from making a direct transition, and should never be done. Too risky. At dosages lower than 1.5 milligrams, it is rarely an issue, but for the sake of comfort, I still advise using a "stepped schedule", as Klonopin will not instantaneously replace Xanax. There is a two week window which must be observed with great caution.

-Ryan

[glendola]

I see no reason in changing from xanaz to klonopin, so long as you do it immediately. Your doctor may want you to change a quarter of a dose of the klonopin to acclamate yourself, but I don't think they'll be any problem.  Try not to make a mountain out of a molehill.  BEST OF LUCK!!