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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Lisa on August 13, 2000, at 2:22:45
I was just prescribed Klonopin (.5mg 2x daily) for severe anxiety and panic. I've been taking it for about two days and it does seem like I'm feeling somewhat calmer, though I haven't been in any situations where I'm likely to panic. I'm wondering how long it will take for me to feel the full effect, and is .5mg twice a day a normal dose, or are higher doses generally required? Also, I get extremely drowsy for several hours every time I take a dose, so much that it is nearly impossible for me to stay awake. This helps my insomnia nicely at bedtime, but it's a problem when I take my daytime dose and I'm passed out on the couch for three hours instead of doing whatever work I need to get done. I'm not having any other side effects so I'm hoping this sleepiness will go away after a while. I'd like to know if anyone else has had a similar experience.
Thanks,Lisa
Posted by S.D. on August 13, 2000, at 18:54:25
In reply to Klonopin questions, posted by Lisa on August 13, 2000, at 2:22:45
>I'm wondering how long it will take for me to
> feel the full effect, and is .5mg twice a day a
> normal dose, or are higher doses generally
> required? Also, I get extremely drowsy for
> several hours every time I take a dose, so much
> that it is nearly impossible for me to stay
> awake.The drowsiness will probably decrease considerably in two to four more days of taking it! But you might want to try dividing any daytime doses into two "half-doses" a few hours apart. Unless it is different for panic than for social anxiety I think you can expect it to be fully in effect after two weeks.
I take it for Social Anxiety and didn't know if the typical dosages for Panic Disorder are different - I did a medline search which indicated that clinical trials have used a range of 1 to 4mg/day, so starting at 1mg/day sounds smart to me.
I pasted part of the results of that search at the end of this message. It is an interesting study result because it was that 1mg was as effective as higher doses. If your doctor knows of this study, he is probably better than most!
--------
J Clin Psychopharmacol 1997 Oct;17(5):390-400Clonazepam in the treatment of panic disorder with or without agoraphobia: a
dose-response study of efficacy, safety, and discontinuance. Clonazepam Panic
Disorder Dose-Response Study Group.Rosenbaum JF, Moroz G, Bowden CL
In this multicenter, parallel-group, placebo-controlled, fixed-dose study, the
efficacy, safety, dosing characteristics, and discontinuation of clonazepam were
analyzed in patients with panic disorder. Four hundred thirteen patients were
randomly assigned to receive placebo or one of five fixed daily doses of
clonazepam (0.5 mg, 1.0 mg, 2.0 mg, 3.0 mg, and 4.0 mg). After 3 weeks of dose
escalation, the fixed dose was given for 6 weeks (the dose-maintenance phase)
and then was tapered during a 7-week discontinuance phase. The completion rates
for the dose-maintenance phase ranged from 59 to 85% for the clonazepam groups
(74% for the placebo group). Efficacy measurements at the end of the
dose-maintenance phase indicated clinical improvement in all treatment groups
but with a clear differentiation of the four higher doses of clonazepam from the
0.5-mg dose and placebo. The minimum effective dosage, as determined by the
Williams' test, was 1.0 mg daily. Dose-response analysis showed that daily
dosages of 1.0 mg and higher were equally efficacious in reducing the number of
panic attacks.
---8< ---[rest of article abstract snipped]---8< ---> Thanks,
>
> LisaI wish you peace and health, Lisa
S.D.
Posted by Lisa on August 15, 2000, at 2:55:48
In reply to Re: Klonopin questions, posted by S.D. on August 13, 2000, at 18:54:25
> >I'm wondering how long it will take for me to
> > feel the full effect, and is .5mg twice a day a
> > normal dose, or are higher doses generally
> > required? Also, I get extremely drowsy for
> > several hours every time I take a dose, so much
> > that it is nearly impossible for me to stay
> > awake.
>
> The drowsiness will probably decrease considerably in two to four more days of taking it! But you might want to try dividing any daytime doses into two "half-doses" a few hours apart. Unless it is different for panic than for social anxiety I think you can expect it to be fully in effect after two weeks.
> I take it for Social Anxiety and didn't know if the typical dosages for Panic Disorder are different - I did a medline search which indicated that clinical trials have used a range of 1 to 4mg/day, so starting at 1mg/day sounds smart to me.
> I pasted part of the results of that search at the end of this message. It is an interesting study result because it was that 1mg was as effective as higher doses. If your doctor knows of this study, he is probably better than most!
> --------S.D.,
Thanks for the info. I'll try to stick with it a while longer and see if the drowsiness goes away. I tried dividing the daytime dose into two smaller doses today and it helped a bit (got a few errands done), but I still fell asleep on the couch for two hours when I should have been making dinner. The Klonopin has had one interesting effect. I have problems with extremely high and hard to control blood pressure, and it went down to normal and has stayed there or below since I took the first dose of Klonopin. Weird! I hope it works that well on my anxiety and panic.
Can't say if my doctor knows of the study you mentioned. I think she just likes to be very cautious when starting me on new medicaions since I have had very bad reactions to a large number of previous medications.One more question. Do you take the name brand or generic Klonopin? My pharmacy gave me the generic, and I'm a bit worried that it own't work as well based on previous messages I've read on this board, and also that it could possible cause more side effects. What do you think?
Thanks for your help,
Lisa
Posted by Lin on August 15, 2000, at 13:05:00
In reply to Re: Klonopin questions » S.D., posted by Lisa on August 15, 2000, at 2:55:48
Lisa,
I take Klonopin every day for anxiety and panic attacks too, and I DEFINITELY swear by the brand name. I took the generic for awhile, and when I changed psychiatrists, my new doctor told me that quite a few of her patients reported that the brand name seemed more effective. I was skeptical, but now am firmly converted to the brand name drug. Fortunately, my insurance covers both and the copay is the same. Also, as for the side effects, they should subside soon. When I started the medication, I was having a hard time staying awake, too. I divided my doses and now I don't feel any sedation at all when I take the drug. The only time I feel sedated is at night, but that's because I take the Klonopin with other meds (lithium and zyprexa).
Posted by claudeah on August 18, 2000, at 0:11:50
In reply to Re: Klonopin questions, posted by Lin on August 15, 2000, at 13:05:00
> Lisa,
I took Klonopin (non-generic) for about 6 weeks and with me it seemed to accumulate in my system or something because the side effects got worse. I was on the phone at work and all of a sudden forgot what I was doing on the phone and when I did figure it out I couldn't even think about talking about what I was supposed to talk about. Ok, so that sentence was bad, but I should sum it up by saying it made me 'drunk'. I ended up walking out of work and riding around on the subway for a few hours. Of course work called my doc and he was freaking out because noone knew where I was.
Anyway......it took me 3 days to sleep it off. I will never, ever take that again because it made me feel so out of control.
I wish you luck. What is amazing though, is how drugs affect everyone so differently. Isn't brain chemistry wonderful?
Claudeab
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