Taking half a .5 tablet of klonopin(generic)

[KevinNewYork]

Hey guys i seen the doc on tuesday and she said instead of taking the .5 tablet (generic klonopin) twice a day i should start off with splitting the pill and taking half in the morning and half at night.  so, so far i have taken 2 pills and one half which brings me here to thursday night.

I was wondering

1.  has anyone started on this lower dosage and had any affect?
2. if yes do you have any idea how long it takes at this dosage for an affect to be felt?

thanks guys

[RCA7591]

The manufacturer recommends starting at 0.25 mg, b.i.d (the dose you are currently taking), and increasing the dosage to 0.5 mg, b.i.d after three days.

Minimum therapeutic plasma level is 15 ng/mL, acheived from twice daily dosing at 0.5 mg each (spaced 12 hours apart).

Maximum benefit is obtained in two weeks, once the drug reaches steady-state.

If after two weeks you do not notice any significant improvement, inquire about increasing the Klonopin to the target dosage of 0.5 mg, b.i.d.

Ryan

[KevinNewYork]

Thanks for replying. so basically theres no point in taking.125 twice a day for an extended period as its too little to have any affect?  

BTW i've done searches on this drug in this forum and found you're answers in alot of them very informative. good job man  =)

[Mark TX]

Klonopin can be very effective in relieving anxiety.  I've been relying on it for ten years now.  Unfortunately, for me at least, the effect is only temporary.  My anxiety is usually greatly diminished within 20 minutes of a dose.  But several hours later, the anxiety may return with a vengeance.  And the mornings are sometimes unbearable.  Like waking up with a hangover.  It never used to be this way.  I started taking klonopin for occasional panic attacks, not severe anxiety.

If I were just now being prescribed a benzodiazepine for the first time, I'd discuss the benefits and drawbacks very carefully with my doctor.  How long do you plan to take these pills?  Weeks?  Months?  Years?

What happens when the .5 daily does isn't doing the trick?  How much do you increase in the future?  2 pills a day?  4?  10?

I never asked these kind of questions.  I wish I had.

mark

[RCA7591]

No, there would be no point in taking 0.125 mg twice daily, as it wouldn't be effective.

Ideally, you'd want to start on 0.25 mg twice daily, and increase the dosage to 0.5 mg twice daily after three days.

Klonopin is very beneficial at the target dosage of 1 mg daily. When it is dosed twice daily, it maintains the disorder it is to help treat. In the case of panic disorder, it would largely prevent recurring panic attacks.

Keep in mind that when used at dosages up to 2 mg daily, tolerance is exceedingly rare. Dependency will occur, but this is not an issue when treating a long-term anxiety disorder. Dependency can be effectively managed. In short, do not worry about taking a drug that will substantially improve the quality of your life. Used appropriately, Klonopin is extremely safe, and essentially void of any adverse side effects.

Klonopin was originally developed as an anticonvulsant in 1976 by Roche. Since epilepsy is more often than not, a long-term disorder, long-term efficacy is crucial. Klonopin does just that (provides efficacy over the long-term). The others (Ativan and Xanax) do not.

Ryan

[Mark TX]

I'm interested in your comment about tolerance.  The sources I've found all suggest that tolerance is likely to occur...

I'm new on the board so don't know if it's kosher to link or quote other medical sites.  But I've got two right now that are saying just the opposite.  If you go to epilepsy.com they state that klonopin has a 'high-degree' of tolerance and the the dosage must be increased over time to maintain anti-convulsive effectiveness.  They also warn that side-effects may also increase over extended periods of use.  I've found nothing to indicate that tolerance is rare.

mark

[RCA7591]

Mark,

You've mentioned using between 1-2 mg of Klonopin/day, but you didn't make it clear as to how you spread this dosage out (if at all). This is very important.

For instance, if you took 1 mg daily, you'd ideally want to divide the 1 mg into two divided doses of 0.5 mg each, spaced 12 hours apart. If you took the entire 1 mg at once, the effects would last for roughly 12 hours. Then, the symptoms would rebound.

Klonopin isn't really intended for p.r.n. use, it is intended to be used as a maintanence drug. If it is dosed twice or three times daily, it reaches a steady-state plasma level, and ultimately, accumulates. For twice daily dosing, the doses should be spaced 12 hours apart (8 hours apart for three times daily dosing). In other words, for the maximum benefit to be acheived, it must be dosed more than once daily. Otherwise, it will not reach steady-state. It is the steady-state plasma level that maintains the disorder. Abrupt peaks and troughs in the plasma level lead to symptoms.

How exactly have you been taking the Klonopin? If you are on a regimen that provides stability, there would be no reason to increase and decrease the dosage. There is quite a large difference between 1 mg and 2 mg. Tolerance (the need to increase the dosage to provide the same desired effect) is exceedingly rare if Klonopin is properly implemented. Proper use is key.

Ryan

[RCA7591]

First of all, none of the information that I supply comes from the internet. The internet is largely filled with misinformation.

The average Klonopin dosage used to treat epilepsy is between 8-10 mg (which is substantial). The manufacturer suggests that loss of efficacy may occur in up to 30% of those treated for certain forms of seizure disorders, if the drug is used in monotherapy (by itself). Generally, two or more drugs are used in combination.

The dosages used for anxiety/panic disorder are far lower than those used to treat epilepsy (target dose is 1 mg daily). Tolerance is exceedingly rare at dosages up to 2 mg. Dosages in excess of 4 mg are more likely to produce tolerance in up to 15% of cases. Dosages in excess of 8 mg are more likely to produce tolerance in up to 30% of cases. The maximum dosage for epilepsy is 20 mg (which is rarely used), and 4 mg for panic disorder (also rarely used).

It is not at all uncommon for a person to start on a dosage of 0.5 mg twice daily, and to remain at the same dosage for decades. The drug has proven efficacy over the long-term, which is why it is the front-line treatment for panic disorder.

As far as side effects, the more common one would be memory loss in the case of epilepsy. For the treatment of panic disorder, side effects are rarely an issue (dosage is much lower). Personally, I've never experienced one side effect from Klonopin. Of course, the response is individualized, and may vary from one person to the next. The most common side effect for the treatment of panic disorder is somnolence, which rapidly dissipates with continued use.


Ryan

[Mark TX]

Good questions about dosing... I've always taken the klonopin 'as needed' and my doctors have been fully aware of this fact.  From what I've read online after your last post, it seems I now have another complaint to add to my list.    =)

But putting aside my personal use of the drug... I still find that the reliable online sites support the idea that klonopin tolerance is the exception, not the rule.  I've checked about five different sites... including consumer drug sites.  The only site I discovered that insists there is little tolerance is a blogger.

Do you have a source for the tolerance issue?  I'm not trying to be argumentative.  I simply don't understand why the discrepancy.

Thanks,
mark

[Mark TX]

that should read... tolerance is the rule, not the exception, sorry.

[Mark TX]

Good point about the Internet!

(Of course, the things I'm learning from you are coming 'from the Internet'.)  ;)

mark

[RCA7591]

Well, you've identified your issue with the drug. A single dose lasts roughly 12 hours. If a single dose were used daily (at any dosage), there would be rebound symptoms. While it carries "a long half-life of 50 hours", the benefits are only apparent for 12 hours, after which point the plasma level troughs sharply. Since the drug never reaches a steady plasma level, it is far less effective. Therefore, it is dosed at least twice daily.

Ocassional "as-needed" use is fine, but Klonopin should not be taken daily as a single dose, for obvious reasons.

You're not experiencing tolerance, you're experiencing rebound once the beneficial effects of the Klonopin wear off. You can prevent this by taking 0.5 mg twice daily, everyday (with the approval of a doctor). The drug takes two weeks to reach steady-state, at which point the optimal effects would be apparent. Klonopin is a maintanence medicine, designed to prevent anxiety or panic attacks before they recur. This effect is acheived through the retainment of steady-state. Nothing provides a 100% cure, but the Klonopin is of tremendous benefit.

You also have a bipolar component, and Klonopin isn't really a mood stabilizer (although if your case is mild, it could be used as one). In place of Lithium (which is an excellent mood stabilizer, btw) are modern atypical antipsychotics. Abilify, Geodon, Risperdal, Seroquel, and Zyprexa. I don't know if you tried any of those.

There simply aren't any reliable online sources. Most of them originate in the UK, and they are largely anti-benzo. You're not seeing the entire picture, just biased opinions. Fact of the matter is, most of those horror stories stem from the improper use of the drugs. Some folks were on abnormally large dosages, some of them likely tried to stop taking them abruptly, while others may have tapered too rapidly. I've never read any of them, as I simply don't have any reason to do so.

I'm not sure if you're speaking of Benzodiazepines in general, or just Klonopin. Certainly, the shorter-acting agents such as Ativan and Xanax lead to rapid tolerance. But then again, they are not approved for long-term use, due to their short half-lives. Klonopin, Librium, and Valium are approved for long-term use (as they carry a long half-life). Tolerance is indirectly proportional to the half-life. The shorter the half-life, the greater the risk of tolerance. The shorter-acting agents do not reach steady-state or accumulate. Rather than the plasma level being added to, it is subtracted from. This is what produces tolerance.

I have a source (a doctor's library), however we can't upload files on this forum.
You can take my word for it, or you can choose to believe whatever you wish. The information that I post is unbiased and objective. If I do come across something objective online, I will provide a link.

As far as tolerance being the rule and not the exception with Klonopin, no. Again, dosages under 2 mg are highly unlike to produce tolerance. The target dosage of 1 mg rarely, if ever, leads to tolerance.

Ryan

[Mark TX]

I'm impressed with your knowledge.  And I appreciate your explanation.  I try not to pay attention to the 'horror' stories, which is why I've avoided message board forums in general.  But I've found this one, so far, to be a refreshing exception.

I try to limit my resource material to reliable medical sites.  Of course, as a layman I'm always prone to misunderstanding or misinterpreting the information.  And while epilepsy.com discusses the tolerance of klonopin