Psycho-Babble Medication Thread 526138

Shown: posts 1 to 9 of 9. This is the beginning of the thread.

 

Is it ok to add Ativan to Klonopin for panic disor

Posted by rjlockhart98 on July 11, 2005, at 10:58:48

usally i have read that Xanax is usally used in conjenjunent with Clonazepam in some severe cases.

I dont want to do that method. Lorazepam didnt stop panic, but did ease tension, some "relaxation" NOT tranquility.

What makes me mad is people talk about Xanax i read, Katie Holmes, i got just a little nervous before a interview i had to have A XANAX!

On the internet "is the most widely prescribed medication for panic disorder" B*LLSHIT! according to my pdoc is the least used. The pharm. companies...... are full of crap

A low Dose lorazepam .5mg - 1mg X 2-3 daily. At one time i was on 6 mg of Lorazepam by itself which did NOTHING for panic phobic symbtoms. I would just sit back and have a panic.

 

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

Posted by woolav on July 12, 2005, at 9:15:36

In reply to Is it ok to add Ativan to Klonopin for panic disor, posted by rjlockhart98 on July 11, 2005, at 10:58:48

Ok, so your taking klonopin right now? and want to add ativan?
I took xanax for years for SP, and your right, it did not do much at all. And finally when my tolerance got too high, I was switched to klonopin. It works better than anything else I have tried for social anxiety. I take 1 mg 2 times a day and if i really have trouble sleeping, i take 1 at bedtime too. How many mg do u take??
S

 

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

Posted by rjlockhart98 on July 12, 2005, at 10:28:02

In reply to Re: Is it ok to add Ativan to Klonopin for panic disor, posted by woolav on July 12, 2005, at 9:15:36

Current

Symbyax (6 mg Zyprexa/ Prozac 25 mg)

Clonazepam 4mg -daily

Restoril 30mg - may be discontinued.


Discontinued: (5 weeks ago)

Lorazepam (Ativan) 6mg (2mg X 3) daily - this was not a panic med, rather general tension. Did not stop panic attacks, or phobic symmtoms.

WITH Restoril.

 

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

Posted by med_empowered on July 13, 2005, at 2:55:27

In reply to Re: Is it ok to add Ativan to Klonopin for panic disor, posted by rjlockhart98 on July 12, 2005, at 10:28:02

hey! The thing about benzos is this: generally speaeking, they're more alike than they are different, so using more than one is overkill..and expensive. Restoril and Halcion are kind of exceptions, since they are used exclusively as sleep aids; however, many docs dont even use them, and instead use xanax, ativan, or an extra 1mg or so of Klonopin or Tranxene for sleep. The general rule seems to be that if you're on a benzo long-term for anxiety AND you have or develop insomnia, then that same benzo (say, Valium, for instance) is adjusted to help you sleep. So...if you're taking 20mgs valium and you cant sleep for days on end, you could go up to 30, with the add-on dosage near bedtime to help you sleep. Depending on your situation, the extra med could be phased out, kept, or the extra could be taken in the daytime to prevent anxiety (since anxiety causes insomnnia). The only times I've ever taken more than one benzo is when I took Restoril along with Tranxene, and that was just b/c I'm resistant to Ambien and my doctor loves writing multiple scripts. Good luck!

 

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

Posted by SLS on July 13, 2005, at 9:56:31

In reply to Is it ok to add Ativan to Klonopin for panic disor, posted by rjlockhart98 on July 11, 2005, at 10:58:48

It seems that clonazepam is the only thing that works for some people who suffer from panic disorder. It might be interesting to use a combination of clonazepam + either Neurontin or Lyrica. The latter two drugs might keep at bay the more diffuse anxiety that remains in the background. I think you need to pursue clonazepam. Get some stuff in black-and-white to show your pdoc.


- Scott

 

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:
Review

PMID: 15078111 [PubMed - indexed for MEDLINE]

 

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

Posted by TerraJo on July 13, 2005, at 21:23:31

In reply to Re: Is it ok to add Ativan to Klonopin for panic d, posted by med_empowered on July 13, 2005, at 2:55:27

> hey! The thing about benzos is this: generally speaeking, they're more alike than they are different, so using more than one is overkill..and expensive. Restoril and Halcion are kind of exceptions, since they are used exclusively as sleep aids; however, many docs dont even use them, and instead use xanax, ativan, or an extra 1mg or so of Klonopin or Tranxene for sleep. The general rule seems to be that if you're on a benzo long-term for anxiety AND you have or develop insomnia, then that same benzo (say, Valium, for instance) is adjusted to help you sleep. So...if you're taking 20mgs valium and you cant sleep for days on end, you could go up to 30, with the add-on dosage near bedtime to help you sleep. Depending on your situation, the extra med could be phased out, kept, or the extra could be taken in the daytime to prevent anxiety (since anxiety causes insomnnia). The only times I've ever taken more than one benzo is when I took Restoril along with Tranxene, and that was just b/c I'm resistant to Ambien and my doctor loves writing multiple scripts. Good luck!

you might try tricking your body. ambien one night, restoril another, xanax the next. i become resistent to ambien after about three days. so i have scripts for ambien, restoril, klonopin and xanax. i don't abuse any of it. but it seems to work to trick your body by switching them around in order to get sleep. i've read others have done the same.

 

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

Posted by TerraJo on July 13, 2005, at 21:25:47

In reply to Re: Is it ok to add Ativan to Klonopin for panic disor, posted by SLS on July 13, 2005, at 10:19:27

> 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


Scott, if you find something regarding Xanax PRN i'd love to know about it. That's what I'm doing now- klonopin with xanax as needed. I'm lucky that i don't have a pdoc who's afraid of benzos and trusts me. but it really does work. it'd be great to be able to back it up with some literature.

t.

 

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

Posted by rjlockhart98 on July 14, 2005, at 10:23:05

In reply to Re: Is it ok to add Ativan to Klonopin for panic disor, posted by TerraJo on July 13, 2005, at 21:25:47

Xanax does have alot of literature to it.

I dont realy know really much about Ativan.

I was on it, its really is just a general tension med. There's not really any speacial charaisteristics about it. It's just "Ativan"

There are NUMEROUS articles on clonazepam.

Anyways, i just thought i would drop my input.


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