Klonopin (Klonazepam) for panic disorders
Klonopin was patented in the 1960, FDA approved it for use in the United States in 1975 went Generic clonopin in 1997 and it still ranks among the top 50 prescription drugs in the United States with more than 18 million prescriptions in 2018! Klonopin anti panic medicine, it treats panic attacks, klonopin anti seizure medicine, it treats certain types of seizures, is used significantly off label, it is used as a recreational drug.
Klonopin name is confusing – the doctors say you are supposed to take Klonopin or Clonazepam but you get the Klonodin instead because it sounds kind of similar. Klozepam is an anti-hypertensive.
Klobazim – that happens to be another benzodiazepine but with a completely different dosage. Klonopin has hypnotic activity and sedative activity, medicine with anti-anxiety effect, Klonopin is a muscle relaxant, it tends to cause a certain degree of amnesia.
Panic disorder, having unexpected panic attacks and then being worried about the panic attacks, being worried that they are going to reoccur and then worried about the consequences of attacks and then they change your behavior, because, let’s say you had your first panic attack sitting at the dentist office – you won’t go back to the dentist. You had your first panic attack driving a car – you won’t drive a car, have it in an elevator – you are walking up the stairs.
Klonopin in seizure disorders
Klonopin in seizure disorders – it can be used alone or as an adjunct to other medicines, used in partial epilepsy, typically used in acetic seizures, or the myoclonic seizures, absence seizures, petit mal epilepsy.
Klonopin is not really a great drug and in a certain amount of people, Klonopin loses its effectiveness within a period of three months. It could be increased in the dose and thus may regain its activity but that is why it is typically used with another medicine, may be Valproate, that as a matter of fact that Klonopjn does not seem even as effective as Tagretol or Phenitoine.
It is used off label in lots and lots of instances, so lots and lots of reasons to use the drug off label according to some people. The Food and Drug Administration does not agree, so it is used for sociophobia or social anxiety disorder, generalized anxiety, or it is used for bipolar disorder or mania, or just for grinding your teeth – something called “bruxism”.
Chronic restlessness that seems to come on in people who are taking the drugs in the family of the antipsychotics like Abilify Paxil or Seroquel – used for the spasticity of ALS Lou Garrix disease, alcohol withdrawal.
People who have problems while they are asleep – walking in your sleep or talking in your sleep, maybe they wake up at night and eat – or the hyperreflexia – a condition typically in children where they have hyper exaggerated startle.
Klonopin is used for people with restless legs syndrome – or insomnia, used in people when they have something called ram sleep behavior disorder. In REM sleep, you have vivid dreams but you lay perfectly still, while in REM sleep disorder you muscles are not controlled, so you flay all about.
Klonopin can reduce that.
Klonopin is used for people with Tourette’s Syndrome, or burning mouth syndrome. Klonopin is used for withdrawal from short acting benzodiazepines (Klonopin is a long acting benzodiazepine) – used in people with fibromyalgia or a neuropathic pain or even used in people with who have the common faint on a repetitive basis.
Clonopin for panic attacks
Panic attacks are very common, it is estimated that 2 to 3 percent of the population suffers from them, unrecognized in about 50% of the people and interestingly the first drug approved in the United States for treatment of panic disorder, panic attacks was Paxil. That’s right – Paxil , the selective serotonin reuptake depressor – the anti-depressant. That was the first drug.
How to pretend that you have panic attack (this is a joke – you should never pretend to have panic attacks)
Panic attacks are unexpected, they are associated with a discreet period of an intense fear or discomfort, the onset and the maximum intensity are in the period of ten minutes and you have to have at least four other symptoms associated with it.
So it is not just fear – you have to have a pounding heart or racing heart – you perspire, you tremble, you have a sensation that you are choking and you can’t get your breath. You have to have pain or discomfort in your chest, you have nausea, abdominal distress, you feel dizzy, light headed, you feel like you might faint. Or derealization like you feel when you are not attached to reality or depersonalization where you don’t seem to be involved in the activities, or you feel like you are loosing control, you are going crazy.
You fear you are dying you, you are having paresthesia’s – you feel the tingling in your hands and feet, or you have some hot sensations, hot flashes, and after these one attack for at least one month you have to have persistent fear of worry about having additional attacks and the consequences of those additional attacks. That leads to a maladaptive behavior – you don’t have candy bar, you don’t go to the dentist, you don’t ride in the car, you won’t get in the elevator.
It can’t be secondary to another drug that you are taking, the side effect of the drug, it can’t be secondary to a psychiatric defect like obsessive-compulsive disorder or social anxiety disorder.
The studies in panic disorder are all relatively small; they show that if you take Klonopin – you might be free of your panic attacks in some of the two thirds of three quarters of the people.
With placebo, a third to a half of the people might be absolutely resolved of panic attacks. On the other hand – lack of complete remission occurs anywhere between 20 and 40% of the people in study and in the community, up to two thirds of the people don’t get the significant benefit that the clinical studies show. The relapse rate if you stop taking Klonopin can be as high in a period of six month as 50 to 60%. So the question is : “ how long do you have to take Klonopin” – the answer is – “ we just don’t know”.
how much Klonopin do you need to take
If we combine Klonopin with some cognitive behavior therapy and other types of therapies then may it is possible that you can get off Klonopin. Now studying how much Klonopin do you need to take, what is the optimal Klonopin dose – it seems like Klonopin 1mg might be the sweet spot.
But if you take the Klonopin 1mg it is only going to reduce the number of panic attacks that you have per week by about one, and if you start off by having two, three four or five panic attacks – hey , you still are going to have some issues. Well in a flexible dose, seems like even a higher dose might be better, people taking Klonopin 2mg, or even Klonopin2,5 mg. They still only have one fewer panic attack per week.
Clonopin prescription is USA
There is a tendency in the United States now for people to get off benzodiazepines, the government says benzodiazepines are bad. They try to take you on selective serotonin reuptake inhibitors instead, the SSRIs or SNRIs.
But the effectiveness of the two classes of drugs seems to be about the same, and it seems like the doctors are not buying it, because there is still a significant number of benzodiazepines prescription. Aso, now that more and more people are on the SSRIs and we have more experience with the SSRIs, we know that that is not a very safe category of drugs either, as a matter of fact over a period of 20 years most of the studies that involve benefits from treatment of panic have involved the benzodiazepines.
So, what you should better do is to start of a dose of about 0,5mg Klonopin or 0,25mg Klonopin taken twice a day. Some people take the total dose just at nighttime. You slowly can increase that dose up to 1mg Klonopin a day – that is an optimal dose for Klonopin.
If you take 2mg Klonopin, 3mg Klonopin or 4mg Klonopin – seems to be less effective, interestingly it seems to be less effective if you take the higher dose of Klonopin, and not only is it less effective – it might have a higher risk of Klonopin complications.
If you have seizures – it is a different story – you will need more of the medicine, so you take a dose of 0,5mg Klonopin two or three times a day, so the total starting dose for Klonopin will be 1,5mg Klonopin. You can slowly increase it, and people who take Klonopin for seizure disorder frequently take a dose between Klonopin2mg to 8mg a day, but it can be as high as 20mg! They keep increasing it until they either have toxicity or until they have Klonopin to stop seizures.
There are warnings with Klonopin, because it can interfere with your cognitive or your motor performances, so it can make driving or operating heavy machinery hazardous.
Especially if you combine it with alcohol or other central nervous system depressants, like an opioid (take Klonopin with Tramadol for example), or you take a sleeping pill.
Klonopin in depression
It can increase the thoughts of suicide or the idea that you might want to commit suicide, especially if you are depressed.
We know that if your mood seems to change there might be risks, the risks seem to double in people who are taking Klonopin vs people who are taking the placebo. But the riskis relatively small even though the risk increases by three and a half fold in people with seizure disorder and one and a half fold in people with panic disorder.
Even though the one and a half seems to be less that the incidents in seizures – it starts from a much higher threshold, so people are more likely to commit suicide if they had therapy with Klonopin for panic, than therapy with Klonopin for epilepsy.
We have to realize that there are different kinds of epileptic seizures that people may have and it is possible that Klonopin can precipitate the increase of the incidence of seizures or change from focal to grand mal seizures that require additional medicine or additional higher dose.
We find if we combine Klonopin with Valproate, which we frequently do, – that might lead to an increase in the risk of the absent state, and it can cause an increase in salivation, there is much more saliva that you produce, and some people might have difficulty handling the saliva.
So, people with respiratory distress, people that have COPD, and definitely it is not recommended to take Klonopin for schizophrenia, if you have schizophrenia – it seems like Klonopin can precipitate violent behavior. In 2016 a Food and Drug Administration put out a warning for all benzodiazepines. If you combine Klonopin with Tramadol you might increase the risk of overdose and death.
Side effects of Klonopin
Side effects of Klonopin are drowsiness and sleepiness, an unsteady gate, abnormal eye movements, double vision, having that glassy-eyed appearance, headaches or respiratory distress, blurred speech, or dizziness.
There is confusion or motor impairment, people can become depressed or develop amnesia, or hallucinations, psychosis, people lose their appetite, they become anorexic, can become anorexic – those unfortunately are terribly common.
One more side effect of taking Klonopin is – people lose their libido, and paradoxically, some people who take the drug become excitable, irritated, or agitated. They become hostile and they get sleep disturbances. Some of the central nervous system depressant activity can be potentiated if you happen to take Klonopin with narcotics or to take Klonopin wit Tramadol.
Also this happens if you take Klonopin with phenobarbital or other barbiturates.
You should not take Klonopin with anti-anxiety medicine, sleeping pill.
Clonopin in pregnant
Studies show that Klonopin in first trimester of pregnancy causes risks for the embryo, certain birth defects are possible. Klonopin in the third trimester can linger in the fetus and can remain in the organism of the newborn from a couple of days till three weeks after birth. Several months after birth the child can have hyperreflexia or difficulty breathing if Klonopin during pregnancy was taken.
Child might have acne expels, be irritable or restless or might suffer from tremors or jitteriness. For such children cyanosis, difficulty eating, sucking are characteristic, so probably if a person is pregnant she probably needs to take a similar medicine, probably Valium in pregnancy would be a much safer drug.
Clonopin in senior people
In the Geriatric population, for people older than 65 the problem may be with the lasting period of Klonopin, for the drug lasts for a long time.
It remains in the system for a long time in young people, and when you are older – your liver function is not so good, your kidneys function is not quite as good as it used to be, so it is recommended to begin with a lower dose of clonopin. Doctors usually try to limit the treatment to several weeks because of the liver and kidneys functioning state.
In older people Klonopin metabolizes more slowly so it tends to build up in the system for a longer period of time and that increases the risk of the motor vehicle accidents and other kinds of problems.
There is also an issue of physical and psychological dependence on Klonopin, so it is not very good for people who are addiction prone.
How long does it take to become addicted to Klonopin?
You can become dependent to the drug in four to five weeks. In about one third of the people that leads to withdrawal symptoms if they try to stop taking Klonopin.
Tolerance has to do with chemical changes that occur on the receptors, so it is not really a good medicine for a long time use in epilepsy. We have other medicines that are quite good.
How to stop taking Klonopin
If you have decided to stop taking Klonopin – you have to slowly discontinue Klonopin if you have been taking it for a while, because otherwise you might have a withdrawal reaction to Klonopin.
Withdrawal reaction to Klonopin will lead to an increase in anxiety and an increase in panic attacks, increase in the seizures. It might have to do with lack of sleep and insomnia and headaches and tremors and sweating. All the symptoms that are characteristic for anxiety attacks – tremor and headaches, nausea and muscle cramps, confusion and depression and even hallucinations and seizures in some cases.
Unfortunately you can take too much of Klonopin, you can overdose on Klonopin, then you will also become confused, with a difficulty sleeping, problem of time saying, the blood pressure can go down accompanied by nausea, people can go down even develop coma.
Interestingly, this drug can be cyclical in its effect, so when overdosed on Klonopin you can go from being fully awake to being comatose to being fully awake. There are medicines that are available to reverse the effect of Klonopin, but unfortunately since they reverse the effect it may lead to seizures, it may lead to status epilepticus.
Recreationally we know that sedatives and hypnotics are extremely frequently abused, as a matter of fact benzodiazepines, of which Klonopin is a member – are the second most frequent drug implicated in drug shopping.
How clonopin works
The way the drug works is that it binds to to GABA receptor in the brain causes an increase in the GABA. Gaba – amino benzoic acid is an inhibitor of the central nervous system, so it suppresses the activity, that is the way it works supposedly in seizures, that is the way it works supposedly in the panic disorder. It works on lots of other mechanisms as well.
Once you take Klonopin – it is rapidly and completely absorbed, so that 90% gets into the system and the maximum amount of Klonopin will be in the system for one to four hours, for some people it may be four to eight hours. The drug is bound to plasma proteins, it means that most of the drug in the system is not going to be effective, its only the free chemicals that are effective.
Some people will see the effects of Klonopin in one hour after taking it, but the half-life of the medicine can be anything between 30 and 40 hours, so it lasts a long time once you take one pill. The clinical effect of Klonopin is only noticed for about six to twelve hours in adults and six to eight hours in children.
How they test for Klonopin
The plasma level, if we were to draw it to try and see how much of the drug is in your system and send it to the laboratory – at the same dose of Klonopin the plasma levels of it can vary tenfold!
As a matter of fact, to measure how much Klonopin is in the system you have to preserve it in sodium chloride in the low temperature and you have to analyze it very quickly – the drug itself is going to be metabolized by an enzyme present in a liver. That also means that if you have liver impairment you have to be extra careful for you may not be able to metabolize the medicine. If you have kidney impairment – that is the way the medicine is going to be excreted, so that is another issue.
Klonopin does not seem to interact a lot with other medicines, but other medicines seem to interact with its metabolism. If you take Dilantin or Phenytoin, it you take Tegratol or Phenobarbital – all of those are going to induce that 3a4 enzyme that metabolizes them and the Klonopin, so they are going to increase the metabolism of Klonopin and decrease its amount in your system by about 30%. On the other hand, if you do something to stop that enzyme activity, like if you drink a glass of grapefruit juice or you takes some Clarithromycin or you take some Flagyl – then the level of the Klonopin in your system is going to go up.
How much does Klonopin cost?
If you decide that this is an appropriate medicine for you and the doctor wants you to take it – you can buy Klonopin for cash, a months supply of Klonopin for less than $45, and if you have a coupon a months supply of clonopin for less than $20!
If you want to buy brand Klonopin with a coupon it would cost about $190.
They do have an oral disintegrating Klonopin Tablet that you put in your mouth – that is going to cost more but it can be effective for individuals who have difficulty with the swallowing or for some other reason they can not take other than disintegrating clonopin pill, for example such is Klonopin for children with epilepsy.
Klonopin for panic disorder, Klonopin for seizure disorder is still very popular, especially if Klonopin combined with Valproate or some other kind of medicine. Also many patients buy clean Klonopin.
It is frequently used off label for an enormous array of conditions for which proof of effectiveness really is not there. Remember, it is a benzodiazepine, it is a controlled substance, and it is a medicine of the same family as Xanax and Alprazolam or Lorazepam or Valium, so if you do decide to take the medicine – please be careful.