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Re: Is it ok to add Ativan to Klonopin for panic disor

Posted by SLS on July 13, 2005, at 10:19:27

In reply to Re: Is it ok to add Ativan to Klonopin for panic disor, posted by SLS on July 13, 2005, at 9:56:31

Here's a paper that helps establish both alprazolam (Xanax) and clonazepam (Klonopin) as being effective for panic disorder. It recommends clonazepam for its longer half-life. If your doctor is curious about this, he can read the full article and contact the authors. This paper was submitted by the group at Harvard Medical School that works out of Mass. General. I'm sure the article provides reviews of previous work done by others in the field.

I wish I could come up with something that recommended Xanax as an add-on PRN to clonazepam. I really didn't look that hard, though. I think the Xanax PRN strategy makes perfect sense as long as it is not taken chronically.

- Scott


J Clin Psychiatry. 2004;65 Suppl 5:3-6. Related Articles, Links

The development of clonazepam as a psychotropic: the massachusetts general hospital experience.

Rosenbaum JF.

Department of Psychiatry, Massachusetts General Hospital, Boston, USA.

The pathophysiology of anxiety disorders is not clearly understood; therefore, clinical observation, case reports, and case reviews continue to enhance physicians' understanding of disease and treatment mechanisms. At Massachusetts General Hospital (MGH), physicians and researchers are guided by the recognition that available approved treatments are a small subset of what is sensible to try in anxiety disorders and have thus chosen to remain open minded and prepared to challenge assumptions about therapeutic agents and to explore new uses, including early work with high-potency benzodiazepines. Clinical trials established alprazolam as efficacious for panic disorder, and the agent was widely prescribed for patients at MGH after its approval. Soon, however, clinical observation suggested a short duration of benefit for a given dose in some patients. In some cases, patients who missed a dose reported rebound worsening. In response to the apparent problematic pharmacokinetics of alprazolam, members of the MGH psychiatry department pursued investigation that ultimately established the antipanic efficacy of clonazepam as well as examined its effectiveness in the treatment of other disorders, such as bipolar disorder and social phobia. The process of exploring new uses of older agents remains a worthy effort while we await newer agents with innovative mechanisms of action.

Publication Types:

PMID: 15078111 [PubMed - indexed for MEDLINE]




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