Posted by ed_uk2010 on January 23, 2015, at 12:29:20
In reply to Re: klonopin-frequent dosing, posted by ed_uk2010 on January 23, 2015, at 11:15:29
Low or high?
...I would (personally) tend to categorise clonazepam doses as follows. This is not set in stone by any means. It's an approximate guide.
TOTAL dose per 24 hours shown below (the total dose is normally given once daily or divided into 2, 3 or 4 smaller doses as appropriate):
0.125mg to 0.25mg per day. Very low dose treatment.
May be particularly suitable in the elderly. Also used while tapering off the medication gradually.
0.25 to 0.5mg per day. Low dose treatment.
Those who are sensitive to benzos may respond well to low doses. Anxiety can be reduced with fewer side effects. Can be useful in conditions which respond well to benzos, especially when used for less than a month. Low doses are normally ineffective for conditions poorly responsive to benzos eg. mania.
0.5mg to 2mg per day. Standard/average dose for severe anxiety and panic disorder.
Useful for exacerbations of anxiety and while waiting for antidepressants to take effect in severe anxiety disorders. Sometimes continued long term for resistant anxiety, especially where several antidepressants have not been effective. Klonopin is not suitable for mild temporary anxiety at any dose. Similarly, benzos are not appropriate for mild insomnia.
3mg to 4mg per day. High dose treatment.
Sometimes used in acute mania, for severe agitation and for the short-term relief of severe anxiety states. High doses are best used for the shortest possible duration. Mania is more effectively treated with other drugs beyond the first few days, occasionally weeks. Large doses of benzos are normally a short term measure where rapid sedation is necessary. Benzos are not usually very effective for mania except at doses which produce substantial sedation - antipsychotics are considerably more effective but may be inadequate alone for severe agitation, hence the use of benzos as an add on.
5mg to 8mg per day. Very high dose treatment.
Not much used in outpatients. Mainly used in inpatients for the same reasons as high dose treatment.
>8mg to 20mg per day. Unusual dosing!
Possible; but almost never appropriate for any indication, either psychiatric or epilepsy. The idea that ultra high doses of clonazepam are appropriate in epilepsy is misleading. Very few pts are rxed such doses. Side effects are likely to be severe and efficacy beyond the first few weeks is poor due to the development of tolerance. Most seizure disorders are best treated chronically with other meds. Benzos are useful short term at standard doses, sometimes being used to 'cover' exacerbations and while switching other meds. Injectable benzos are very useful for prolonged seizures. Lorazepam is popular for this purpose.
poster:ed_uk2010
thread:1075365
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