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Avatar universal

Doctor switching from 1mg Xanax XR and 2 .5 regulars to 2 .5 klonopin a day - should I be worried?

So I've been on Xanax for years... I think the first time it was prescribed to me was in 2004 and I started taking it full-time after having a collapsed lung last year.

I'm currently on 1mg of Xanax XR in the morning... then two .5mg doses as needed... Lately, my anxiety has gotten out of control. I've been on this regimen for roughly 2 months and it was working... but now... I've missed almost the entire work week (Monday and Tuesday entirely, 3 hours on Wednesday, 4 hours Thursday) because I've started having nasty panic attacks.

I had one the other night that was so severe, I took two .5mg tablets and dissolved them under my tongue and still had tachycardia for another hour or so before I finally passed out for 10 hours.

I saw my doctor today and we discussed options. I suggested moving to klonopin or valium as I've read that they're both much better at controlling anxiety in the long term and don't develop tolerance as fast, not to mention that they work longer.

This is what he did. He prescribed me 60 .5mg Klonopins and 60 .5mg Xanax.

I am aware of the delayed onset of Klonopin and its a bit concerning... I've noticed that with Xanax, I get a lot of tachycardia for about 15-20 minutes after I take it when its starting to settle in before everything calms down. Reading online, it seems like Klonopin is not known for causing tachycardia as a common side effect, while Xanax, Ativan, and Valium are.

What has me concerned though is that I'm going from 2mg of Xanax straight to 1mg of Klonopin. The things I've read online seem to differ in opinion as to whether Klonopin is stronger than Xanax, the same, or weaker.

My doc is a family doctor and he doesn't have a lot of experience with Klonopin but he says that if I need to, adding Xanax to my Klonopin shouldn't be a problem if I need the extra boost.

I'm wondering if it would be smart for me to take a regular .5mg Xanax tomorrow morning and half of a klonopin once that has kicked in to try and slowly get my body adjusted to it? I've had some rather nasty reactions to medications in the past. To give you all a history:

Paxil - blacked out and had extreme panic attacks third day of dosing
Lexapro - felt like a tweaker for the week that I took it and had a racing heart, chills, felt like I was high, and always felt on the verge of a panic attack
Lyrica - was FANTASTIC for the first few days then I had a panic attack so bad that I was stuck in the bathroom at work for over 45 minutes just wishing I would die.
5-HTP - lots of anxiety, mild visual distortions (gel-like colored patterns all over the place), shaking, extreme nausea
Vicodin - triggers panic attacks as soon as it hits, which have to be countered with Xanax.

As you can see, I don't have the best track record with meds. My body absolutely hates them. Xanax is the only med that has never triggered something nasty in me. I won't even take antibiotics because of how horribly poisoned they make me feel.

I have read that Klonopin is better-tolerated than Xanax and has fewer side effects. Is this true?

I seriously wanted to kill myself the other night... I just wanted to kill myself and have the panic stop. And I'm not a suicidal person - it just was THAT bad.

If I don't get this under control, I could lose my job... and if I lose my job, that's pretty much the end of my rope.

So what do you all suggest? I need some encouragement and some answers here. I have a feeling my body isn't just going to be like "oh hello Klonopin, come on in!" - I think I'm going to have to mix the two until I can slowly taper off the Xanax and move over to Klonopin.

To be honest, I think the problems all started when I took the XR. The XR doesn't really seem to do what they say it should. At the most, I got effects from it for 6 hours... Even taking two of them, I still didn't feel anywhere near as calm and collected as a .5mg Xanax made me feel. It feels like all it did was increase my tolerance to Xanax - after the first few weeks, I had to take the 1mg with a .5mg Xanax about 2 hours later in order to avoid hitting full on panic mode.

To top it all off, I'm an insomniac... I take a .5mg Xanax at 3AM... but can't fall asleep til 6... so it starts wearing off before I even fall asleep and has triggered some really nasty episodes there too.

Please someone give me good news. I really need some support right now because I am so scared of trying something new - especially at half the dose that I was taking with my Xanax!!
17 Responses
Avatar universal
Here's how to switch from Xanax to Klonopin :

Ideally, you shouldn't be on the full dose of Xanax while simultaneously implementing Klonopin as a substitute. Likewise, the Klonopin should NEVER be directly substituted for Xanax, as this induces a temporary withdrawal syndrome that may last for up to two weeks.

In order for Klonopin to replace Xanax, it must accumulate. Klonopin accumulates to steady-state within two weeks, at which point it will fully replace the Xanax from a potency standpoint. Xanax doesn't accumulate, therefore, simultaneously replacing it with Klonopin would lead to withdrawal phenomena. The Xanax plasma level would trough sharply, and there would be nothing to replace it.

Therefore, it would be advisable to "step" the Klonopin in, while simultaneously stepping out the Xanax. This is best done in 0.25 mg increments.

*Example* - You were formerly taking 0.5 mg of Xanax three times daily, and the goal is to transition to Klonopin, 0.5 mg, t.i.d....

Days 1-3: Take 0.5 mg of Xanax in the morning and afternoon. Take 0.25 mg of Xanax and 0.25 mg of Klonopin nightly.

Days 3-6: Take 0.5 mg of Xanax in the morning, and 0.25 mg of Xanax and 0.25 mg of Klonopin in the afternoon and nightly.

Days 6-9: Take 0.25 mg of Xanax and 0.25 mg of Klonopin in the morning, afternoon, and nightly.

Days 9-12: Take 0.25 mg of Xanax and 0.25 mg of Klonopin in the morning and afternoon. Take 0.5 mg of Klonopin nightly.

Days 12-15: Take 0.25 mg of Xanax and 0.25 mg of Klonopin in the morning. Take 0.5 mg of Klonopin in the afternoon and nightly.

Day 18: Take 0.5 mg of Klonopin, t.i.d. The Xanax is discontinued.

This is the accelerated method of transitioning from Xanax to Klonopin. The three day intervals may be extended to one or two weeks if necessary. This is rarely necessary.

You can discuss a similar schedule with your doctor. It is absolutely crucial that the Klonopin be taken at least twice daily. It depends on how many times/day you take Xanax. If you take it three or four times daily, the Klonopin should also be taken three or four times daily initially.
Avatar universal
The above is just an example of switching. Nothing got to do with your own dose. But you should be able to get some idea from it.
Avatar universal
Thanks for the advice... I'm confused as to how to do this in my situation though.

I had a panic attack first thing this morning, which required a Xanax. I ended up taking my Klonopin with the Xanax and I am definitely inclined to believe that Klonopin is about twice as strong as Xanax unless they really potentiate each other *THAT* much...

I got knocked on my you-know-what when the Klonopin hit about 45 minutes after the Xanax peaked and remain there, 3 hours later.

But my problem is that I was on 1mg of XR and then two doses at .5 a day... How would I taper with that? I don't even know what the equivalent dose of Klonopin would be compared to the XR.

Also, what is t.i.d? I see it all over but have never seen that term before this website.

Thanks :)
370181 tn?1428180348
First of all I am going to tell you that you absolutely MUST NOT do ANY stopping, starting, tapering, switching, mixing or WHATEVER with these meds ON YOUR OWN! EVER!
The taper plan that MrGreen presented IS very valid, but you must take it for what it is..........an EXAMPLE of what a taper schedule would look like. You and a qualified doctor must devise a taper/cross-over designed specifically for YOU. There is no such thing as a "one size fits all" taper.
I don't think your doctor has enough knowledge with benzos to help you in this situation. Most family doctors know only what the drug reps have told them about these types of meds, which is why they get handed out like candy at Halloween. I would ask my doctor immediately for a referral to a colleague with vastly more experience dealing with benzos! If he refuses, my advice would be to run away. Call the physcian hot line for a referral to a doctor who IS competant to help you. I don't mean to diss your doctor, but I don't think he's the man for this job.
Some medical jargon for you:
qd=daily
b.i.d.=twice a day
t.i.d=three times a day
q.i.d.=four times a day
prn=as needed
DX=diagnosis
That is your lesson for today.
My advice for the day...........keep taking whatever your doctor has prescribed for you exactly how he has prescribed it and make an appointment with him as soon as possible to discuss all of this. And I repeat myself, only becuase it is so important, please do not alter your meds, in any way, until you've talked with him.
I wish you the best and PLEASE let us know how you're doing, OK?
Peace
Greenlydia    
Avatar universal
Thanks for the response...

Well I can tell you that I think the dose of the klonopin is simply too low. I just had a panic attack but its definitely doing SOMETHING because usually when I have a panic attack, I dissolve a xanax under my tongue to get rid of the fear but the tachycardia continues at about 120-140 BPM for a few hours... This time, the panic attack AND the heart rate were back to normal in about a minute.

He gave me a script for 60 k, 60 x, and I still have about 15 XRs... but I really don't like the XRs.

The psychs that he recommends are not approved by my insurance and the ones that are... well, lets just say they suck.

I'm not terribly worried about making the switch, I just think he should have given me .5mg three times a day instead of .5mg twice a day...
370181 tn?1428180348
Not sure what you're saying here........I mean, I understand what you did with your recent panic attack, but what you plan to do in the long run is a bit of mystery. I gave you what I thought was some fairly sound advice regarding messing around with your medications, but we can't control what folks do here, so I do wish you the very best in your search for relief and hope you find the anwers you need.
Please be careful.
Peace
Greenlydia
Avatar universal
What I was saying is that I can't find a good pdoc around here. The ones I CAN find are booked for 2-3 months and I have to do something in the mean time.

Do you really think that moving from Xanax to Klonopin would be so dangerous? I've been told by my doctor and the pharmacist that it should be relatively smooth and have less side effects than the Xanax did when it starts working... And that its pretty safe to just transfer from one to the other.

I'm curious if I should take two in the morning (like 3-5 hours apart) then 1 in the evening, 1 before bed since that would equal 2mg.
Avatar universal
Well just updating my post. Today has been great. Started the day with .5mg xanax, a few hours later .25 xanax and .25 klonopin, a few hours later, .25mg xanax, and just now about 4 hours later, .25 klonopin.

A huge relief is that it seems that klonopin has the same effect as xanax when dissolved under the tongue - instant relief of anxiety and panic - only it doesn't cause the tachycardia!

I'm now at 1.5mg for the day between the two - and that's about 4 1/2 hours later than when I'd usually be there.
Avatar universal
Neither is stronger than the other. They are of equal strength. But I seriously think you have a choice to make. One or the other. Both may lose there effectiveness if taken together. The xanax will for sure. Not today or tomorrow. But a little bit down the line. Your doctor should just get you off the xanax once and for all. Be that by giving you twice the dose in Klonopin, with some valium in the middle of the day. Once the Dr knows the Xanax is out of your system he / she can lower the klonopin dosage to the required amount. It's a far better tablet that can be used for years. Xanax is fast acting but short lived.
Avatar universal
Yeah, I think I've made the choice to keep the Klonopin. For one, I'm sleeping again. We're talking, I'm out cold. Two, it doesn't make my heart race like Xanax does, and three, my libido is already improving. Xanax has been hampering that for awhile now.

What I did this morning was I had some early morning anxiety (I call it the Xanax hangover) so I took a Klonopin and half a Xanax. The Xanax killed the anxiety - the Klonopin knocked me out. But I feel fine now. I'm feeling really good about this switch and wish my doctor would have listened to me 6 months ago when I told him to move me to Klonopin!
Avatar universal
Just updating everyone.

After unsuccessfully trying to taper myself off of the Xanax, I've gone another route.

I bought some Valerian extract and fish oil and starting today, I took two klonopins in the morning, spaced about two hours apart (to simulate the release of my Xanax XR) and started having withdrawals from the Xanax about 2 hours ago. Popped a Valerian and within minutes, the withdrawals were completely gone. Just took another dose about 20 minutes ago.

Its working EXCEEDINGLY well and I wish I knew about Valerian's anxiolytic properties long before I started on the benzo train. Seems like all I ever needed was maybe a St John's Wort and Valerian combo.

Anyway, I thought I'd update this since its been a few days. My body's klonopin levels are building up and I'm already noticing a bit more calmness than usual -- I didn't wake up in a panic first thing this morning for one -- which I have done every single day for at least the last 6 months (early morning Xanax withdrawals are totally NOT a great way to start your day) and the Xanax withdrawals didn't start until about 5 hours after waking. I've never made it more than 3 hours without Xanax before.
Avatar universal
Excellent, safe, sound, correct information -- as always.  Thank you!
Avatar universal
who is your doctor I am in seattle, just relocated and can not find a doctor to precribe benzos
Avatar universal
Just thought you'd like to know that neither Xanax nor Klonopin causes tachycardia (your heart to race).  Xanax is processed through the liver and is metabolized by the body very quickly.  The longer you take Xanax, the faster your body processes it, and your body becomes dependent on it.  Your heart begins to race as a result of the withdrawal symptoms your body begins to feel when it has processed the last dose of Xanax and craves another dose.  You may also notice twitching of your arms, hands, legs, or feet during the night or when Xit is time for another dose.  Klonopin is routinely given to people who have detoxed from Xanax to keep them from having seizures during Xanax withdrawal.  It is also a very good drug for anxiety, and is a better drug than Xanax because it stays in the bloodstream much longer than Xanax.

Hope this information is helpful to you.  My doctor advised me of this when I discontinued Xanax and was given Klonopin as a substitute, not only for anxiety, but to combat bad withdrawal symptoms from long term prescribed Xanax.
Avatar universal
Does Anyone know a doctor in seattle that prescribes these meds? I am literally going crazy with anxiety and no one will help. I've tried every class of antidepressants and nothing works. I just feel like I want to die ...
Avatar universal
1 month ago i took 3 .25mg xanax 3 times a day im down to 1 .25mg at bedtime :/ its been difficult im tempted to go to 2x a day again :/  i would feel better if i could sleep better i was thinking if i could take my xanax dose at 11pm before bed , if i take 2 valerian pills around 8am so i can rest  a few more hours ? i CANT sleep more than 5 hrs at night :(
480448 tn?1426952138
You have posted to a very old thread.  You might have better luck if you start your own thread.
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370181 tn?1428180348
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