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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by man_oh_man1977 on May 1, 2004, at 20:45:12
Hey Gang:
As the title says, I have two questions:
A) I only take Klonoping as needed, and usually just 1-2mgs. Not for every stressful ocassion, as I am trying to desentitve (sp?) to the point where I can function w/o to much panic in certain stiuations.
B) Trazadone - usually only take it if I have the feeling I am going to have a restless night, or am wired from caffeine. The rest of my cocktail for bp2 I take always - don't think I've missed a day except when we tried to add lithium for suicidal ideation and was sick for a week (yuk!!!).
So, what are your thoughts on taking the klonopin and/or trazadone as needed. For some reason I have never asked my pdoc about this... although I think he is of the opinion that the Klonoplin doesn't have to be "all, or nothing".
Hope everyone (at least in the Northeast) is enjoying this nice weather. Looking forward to hearing from y'all soon!
Thanks,
Man-oh-man
Posted by chemist on May 1, 2004, at 22:28:00
In reply to Two Questions about drugs (as needed), posted by man_oh_man1977 on May 1, 2004, at 20:45:12
> Hey Gang:
>
> As the title says, I have two questions:
>
> A) I only take Klonoping as needed, and usually just 1-2mgs. Not for every stressful ocassion, as I am trying to desentitve (sp?) to the point where I can function w/o to much panic in certain stiuations.
>
> B) Trazadone - usually only take it if I have the feeling I am going to have a restless night, or am wired from caffeine. The rest of my cocktail for bp2 I take always - don't think I've missed a day except when we tried to add lithium for suicidal ideation and was sick for a week (yuk!!!).
>
> So, what are your thoughts on taking the klonopin and/or trazadone as needed. For some reason I have never asked my pdoc about this... although I think he is of the opinion that the Klonoplin doesn't have to be "all, or nothing".
>
> Hope everyone (at least in the Northeast) is enjoying this nice weather. Looking forward to hearing from y'all soon!
>
> Thanks,
> Man-oh-manhi there, chemist here.....for prn (as needed) dosing, the trazadone is more of a kick in terms of sedation than klonopin. in *my* experience, klonopin is NOT given for as-needed anxiety, but in chronic dosing for low-level side-effects and little to no dose escalation. trazadone is a big histamine hitter (among others), and is being used in your case for difficulties falling/staying asleep. as for the klonopin: in prn dosing, valium is quicker acting than ativan, and both are preferable to xanax in terms of withdrawl (note bene: this comes from a poster - me - who has been up to 4 mg xanax qd). not to say any withdrawl is pleasant, but prn dosing of klonopin seems rather misdirected, in my opinion and experience. advice: for breakthrough anxiety or panic, valium or ativan. again, prn dosing with either will result in valium being the quickest acting, and ativan less so, but not much. chronic dosing of valium can be troubling, and if need to go to a daily benzo, try klonopin at the 1 mg or less range and see how you make out...all the best, chemist
Posted by Kon on May 2, 2004, at 16:02:51
In reply to Two Questions about drugs (as needed), posted by man_oh_man1977 on May 1, 2004, at 20:45:12
> A) I only take Klonoping as needed, and usually just 1-2mgs. Not for every stressful ocassion, as I am trying to desentitve (sp?) to the point where I can function w/o to much panic in certain stiuations.
My doc initially put me on daily klonopin for anxiety. I was a bit of a chicken about potential long-term side-effects so I chose to use it as needed instead and have been taking it that way for almost 2 years. Have tried ativan but I seem to respond slightly better to klonopin. Have thought about xanax instead of klonopin since this would decrease the sedation period (plus faster onset) but I'm more worried about tolerance developing to xanax. There seems to be more anecdotal reports of anti-anxiety tolerance developing to xanax than klonopin. Not sure if actual studies exist to verify this, although most of the material I've read also suggests an increase tolerance risk with shorter-acting benzos like xanax. Also despite having a shorter half-life I feel more sedated on ativan than klonopin when using equivalent anxiolytic doses. Klonopin seems smoother when coming down. Less rebound. If xanax has the same up and down feeling, that's another reason why klonopin prn may not be such a bad idea? Maybe I'm just trying to justify it to myself...especially since my doc would be hesitant to prescribe xanax.
Posted by Keith Talent on May 3, 2004, at 6:27:10
In reply to Re: Two Questions about drugs (as needed) » man_oh_man1977, posted by Kon on May 2, 2004, at 16:02:51
I can only agree with chemist and Kon - take clonazepam chronically or not at all. Trazodone is a dirty drug - it hits histamine-1 and serotonin-2 receptors and weakly block serotonin reuptake. I would avoid it and if you need to, use Ambien or Halcion for sleep. Chemist, you implied re tolerance to Xanax that 4 mg per day was a high dose, but wouldn't you eventually hit a tolerance "ceiling"? If so, doesn't that render the whole debate about Xanax dose escalation moot?
Posted by chemist on May 3, 2004, at 13:24:41
In reply to Re: Two Questions about drugs (as needed), posted by Keith Talent on May 3, 2004, at 6:27:10
> I can only agree with chemist and Kon - take clonazepam chronically or not at all. Trazodone is a dirty drug - it hits histamine-1 and serotonin-2 receptors and weakly block serotonin reuptake. I would avoid it and if you need to, use Ambien or Halcion for sleep. Chemist, you implied re tolerance to Xanax that 4 mg per day was a high dose, but wouldn't you eventually hit a tolerance "ceiling"? If so, doesn't that render the whole debate about Xanax dose escalation moot?
>
kind of, in my opinion and experience. the thing about xanax is that you need to keep dosing at pretty regular intervals if you are doing it chronically (this is why the new extended-release version is such a hit, from what i have heard). xanax also has some antidepressant qualities, and is associated with a bit of a ``high'' when one takes it, so i think that dose escalation is a real possibility......don't know if this is the answer....all the best, chemist
Posted by man_oh_man1977 on May 3, 2004, at 15:26:43
In reply to Re: Two Questions about drugs (as needed) » Keith Talent, posted by chemist on May 3, 2004, at 13:24:41
Hey guys,
Forgot to sign up for further notifications on this thread, so sorry for being remiss in not following up. Chemist, what about a combo of klonoplin (1 mg daily as you suggested) and xanax for sudden panic attacks. I also found it useful in the past for feeling "bummed", i.e. not my Major Depression issues, just "blah". As for trazadone being a dirty drug, Keith, I have tried ambien - did nothing; never tried halcion and consider that since I only take traz. for those "restless" nights, the negative effects probably aren't too pronounced.
Thanks a lot guys; see my pdoc on Thurs. - he is always very open to suggestions.
I'll keep y'all posted,
Man-oh-man
Posted by chemist on May 3, 2004, at 16:07:03
In reply to Re: Two Questions about drugs (as needed), posted by man_oh_man1977 on May 3, 2004, at 15:26:43
> Hey guys,
>
> Forgot to sign up for further notifications on this thread, so sorry for being remiss in not following up. Chemist, what about a combo of klonoplin (1 mg daily as you suggested) and xanax for sudden panic attacks. I also found it useful in the past for feeling "bummed", i.e. not my Major Depression issues, just "blah". As for trazadone being a dirty drug, Keith, I have tried ambien - did nothing; never tried halcion and consider that since I only take traz. for those "restless" nights, the negative effects probably aren't too pronounced.
>
> Thanks a lot guys; see my pdoc on Thurs. - he is always very open to suggestions.
>
> I'll keep y'all posted,
> Man-oh-manhi there, chemist here...i think your proposal sounds excellent. i have used that recipe personally in the past, and found it to be quite rewarding.....please let us know how it works out, and all the best, chemist
Posted by Keith Talent on May 3, 2004, at 22:39:18
In reply to Re: Two Questions about drugs (as needed) » man_oh_man1977, posted by chemist on May 3, 2004, at 16:07:03
Thanks again for your insight, chemist.
This is the end of the thread.
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