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Re: klonopin 0.5

Posted by Cam W. on December 13, 2001, at 22:06:45

In reply to Re: klonopin 0.5 » Cam W., posted by Elizabeth on December 13, 2001, at 20:34:31

> > You will notice a quicker effect by doing this, but the effect may not last as long.
> Because the AUC remains fixed, right?

• Yes, the AUC for the individual.
> > This may just be a matter of symantics though, since the half-life of Klonopin is fairly long anyway (18h to 80h, depending on how your body pharmacokinetically handles the drug - ie. rate of absorption, distribution, metabolism and excretion).
> My understanding is that the duration of action doesn't depend only on the half-life, but also on other factors such as volume of distribution. Still, clonazepam is a long-acting benzo (possibly the longest -- what do you think?) and even if you increase the rate of absorption, it's liable to be long-acting still.
• Diazepam (Valium™), BTW whose main metabolite is oxazepam (Serax™ t1/2 = 5-15h), as well as the first benzodiazepine developed, chlordiazepoxide (Librium™), chlorazepate (Tranxene™), and flurazepam (Dalmane™) all have longer half-lives than clonazepam. Their half-lives are all on the order of 100h (including active metabolites).

• For the record, although it's not used much anymore (due to hangover effect), flurazepam is still one of the best hypnotics for those who have trouble staying asleep. Chlorazepate is wonderful for those with schizophrenia who have daytime anxiety problems, when nothing else works. Both are powerful benzos, though and can cause dependence problems with long term use. Chlordiazepoxide is still used during alcohol withdrawl (to help prevent DTs, I believe), as well being used to help a person to adjust to a life without booze (although there are some addiction concerns that I think are sometimes overstated, especially in those who are motivated to stop drinking). And Valium is Valium is Valium; it still is good, in a Prozac sense, to help wean those off of the shorter acting benzos.

> > I know of people who are taking a quarter of a 0.5mg tablet daily for anxiety related to bipolar disorder, and this is enough for them.
> 0.125 mg? That's too weird. 1 mg is at typical daytime dose for me, 2 mg at bedtime; but for panic attacks, I need 2 mg of *Xanax* (and this is on an empty stomach) to get full relief. I knew that 0.5 wasn't that unusual, but when I hear of people taking 0.125 that just falls short of shocking.
• The person I am referring to is being treated only with lithium for bipolar I (600mg Duralith qhs - sustained release); otherwise, perfectly functional. This person has tried a couple times to stop the clonazepam, but the anxiety always came back. The doc and I had shook our heads over this a few times. But hey, if it works, it works (I think that some of the anxiety may be psychological, but this person is holding a respectable, high paying job, and is good at it). You would never guess that mania almost destroyed this person's life.

- Cam




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