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How to learn when to take your benzo?


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I'm so confused.

So, pdoc's instructions were basically - take half a pill (half of a .5mg clonazepam) or up to a whole pill, up to twice a day to deal with anxiety. So in theory up to 1mg per day. She even wrote a refill on the Rx, and is seeing me next week.

Pharmacist stressed the addictive potential, and warned me verbally, and with a note in the paperwork, to take "only during times of severe anxiety".

So what do I do?

Tuesday, the first day, I took half a pill (.25mg) around noon, then the other half around bedtime. Tuesday was a fairly good day.

Yesterday, I took half a pill around 1pm and that was it. Sleep was rough.

Today, I was feeling worried about taking the benzo (anxious about taking an anti-anxiety med - just great!) so I didn't take any. Today I raised my voice to my oldest (not flat out screaming, but enough to really get his attention). I still haven't taken any, because I just don't know what to do.

Part of me is thinking "she wrote the Rx, take the damn meds!"

Part of me is thinking "I don't want to become addicted! I'm scared of this class of meds! Besides, I've lived with these feelings, this level of anxiety, for most of my life, I should be able to just use therapy skills and COPE dammit!"

AHhhhh!!!

I'm not sure what exactly I'm looking for in responses here, sorry.

Yes, I'm experiencing what I would consider an increase in anxiety, even right this moment. But it isn't "severe", imo. I've felt worse.

Ok, so the meds are to help me not feel even this "increased" level of anxiety, right?

I guess that's what I need to hear.

Can you tell me that it's ok to take a benzo, that it's here to help me?

Can you tell me when/how you figured out your benzo routine?

Aw, crap, now I'm crying. What is so scary about all of this??

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I wish I could help....I have my Ativan prescribed PRN and I never know what to consider bad enough to take it.

I would go with what your p-doc told you to do though. They have the best knowledge of you and your needs. You can always talk to her about your concerns next week.

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When I took Klonopin, my doc told me to do what your doc told you to do. My family has a long line of addiction issues, and I never had a problem with benzos.

Listen to your doc. Take the pills as the doc prescribed. Don't let the pharmacist scare you.

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1mg a day isnt a large dose. Ideally, with time, you will only need to take it PRN, but for now, do as your dr suggests and go easy on yourself. There is plenty of time to get your anxiety levels down; sounds like for now you need the klonopin.

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I took 1 mg three times a day of Klonopin for over 3 years. I never had a problem with it, and I never became addicted. When I felt that I no longer needed it, I just stopped taking it without any withdrawal problems.

I think that it was wrong for your pharmacist to interject his/her opinion on the matter. He/She is not a doctor. It is not as addictive as it is made out to be. Certaintly no where near as addictive as alcohol or nicotine.

Follow your doctor's orders, and forget what the pharmacist said.

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Xanax is actually very addictive. It is useful for treating panic attacks on a PRN basis, or during the introduction of other treatment such as SSRI'S.

I was hooked on 3 x 1mg/day of xanax, and eventually had to go through withdrawal, which i can assure you is not pleasant. I had a seizure and a series of classic migraines (which I am not prone to). I also had additional physical withdrawal symptoms such as cold sweats, awful headaches and intense anxiety and panic.

The problem with xanax is that it has such a short half life that with repeated dosing (especially several times per day) you end up on a rollercoaster ride of anxiety and withdrawal, which mimic each other.

http://www.benzoliberty.com/information/xanaxwd.php

Having said all of this, the longer acting benzos such as clonozepam and diazepam are much safer for daily use due to their longer half life. You will find that Klonopin that you take today will stilll have a mild effect the next day. Also as the entire process is stretched out, you are less likely to experience withdrawal.

You are not on a high dose either, so I advise you to take it as prescribed by your dr.

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Thanks so much. I need to remember she wouldn't have written the Rx if she didn't think it was in my best interest.

I will definitely take my 2 (half) doses today.

Di, yes, I am in therapy. In fact, years ago, I refused benzos and just did CBT. However situational stuff has pushed me over the edge, and for now, pdoc thinks I need a benzo.

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Xanax is actually very addictive. It is useful for treating panic attacks on a PRN basis, or during the introduction of other treatment such as SSRI'S.

I was hooked on 3 x 1mg/day of xanax, and eventually had to go through withdrawal, which i can assure you is not pleasant. I had a seizure and a series of classic migraines (which I am not prone to). I also had additional physical withdrawal symptoms such as cold sweats, awful headaches and intense anxiety and panic.

The problem with xanax is that it has such a short half life that with repeated dosing (especially several times per day) you end up on a rollercoaster ride of anxiety and withdrawal, which mimic each other.

http://www.benzolibe...ion/xanaxwd.php

Having said all of this, the longer acting benzos such as clonozepam and diazepam are much safer for daily use due to their longer half life. You will find that Klonopin that you take today will stilll have a mild effect the next day. Also as the entire process is stretched out, you are less likely to experience withdrawal.

You are not on a high dose either, so I advise you to take it as prescribed by your dr.

There is a big difference between addiction and dependance and they are not the same thing. You are talking about dependance. Addiction is a psychological state of increasing doses and drug seeking behavior. The majority of the people who say they are addicted are really dependent. Addiction is often used as a scare word, used for its sensationalistic effects.

nf

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Didn't I pin a topic in this very forum about the difference between addiction and dependence?

EDIT: Also, I generally don't think it wise to take a pharmacist's instructions over a doctor's instructions. Pharmacists can tell when two drugs may interact, and IIRC they're supposed to contact the prescribing doctor (or instruct the patient to contact him) when they encounter such an interaction to make sure he didn't miss it. However, I would not trust a pharmacist's medical opinion over a doctor's.

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Yeah, and I even read (and reread) the post on addiction/dependence.

I just discovered, through a very nasty episode, that my dad is (most likely - can you hear the denial?) an alcoholic. So addiction is on my mind.

I'm also a bit concerned about the dependence issue, and weaning off, but when the pharmacist said "potential for ADDICTION" that was all I heard.

I'm trying taking .125 (quarter of the .5 pill) during the day the past 2 days because I had to drive and wasn't sure how I'd do on more, but I certainly felt better taking .25. So I'm taking .25 at night for now. I have to drive every day this week, but I also see pdoc on Tues, so maybe she can tell me I'm a fool for not taking more, for not seeking symptom relief (which I'm not really getting at .125).

I need to get over it.

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So a little update -

Saw pdoc on Tuesday and she did tell me I was a stupid fool (not her words, but the gist) and then wrote me a NEW Rx for .5mg twice a day, and lectured me that people take up to 2mg a day and are just fine, and the pharmacist was just doing a cya thing.

So Tuesday night I took a full .5mg pill. Wednesday morning I took just half (so .25). The difference from the lower dose? AMAZING. Thoughts were rational and calm. No stupid shaking of hands.

I have been in some pretty big crowds (my good old trigger) this week, and on .125 - not so good. I could use my therapy skills to keep me in my seat, but I had to hyper focus on the speaker, and the fact that I had my oldest kid with me, and resist the urge to go running into the hall screaming.

Then Thursday came along. Kid didn't want to come with me. BUT I had taking .25mg K. I was OK!! I was able to sit, and listen, and just be chill.

OMG, is THAT how these things work? Seriously?

If that is what I can expect going forward, I think tdoc and I can make much better progress now. Hard to stay in the moment when you want to run screaming down the hall and your hands are shaking faster than a stripper with a debt to pay off, and your heart is keeping time with a mariachi band, all while you just can't get your lungs to remember how to inflate. Much easier when all you're doing is noticing "huh, my mind just wandered, back to active listening".

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EDIT: Also, I generally don't think it wise to take a pharmacist's instructions over a doctor's instructions. Pharmacists can tell when two drugs may interact, and IIRC they're supposed to contact the prescribing doctor (or instruct the patient to contact him) when they encounter such an interaction to make sure he didn't miss it. However, I would not trust a pharmacist's medical opinion over a doctor's.

Pharmacists are supposed to know more about meds than doctors. It's their specialty. But, the addictiveness of benzos is something on which reasonable people can disagree. Pharmacists are more attuned to the risks of meds, and doctors are more attuned to the benefits.

Personally, I took Klonopin for a couple years. My dose varied from 0.25/day up to about 1.5mg/day. At times, I was psychologically dependent on it. But, I never got intense cravings for it like you might get for cocaine or opiates. If you get to a high daily dose, you will need to taper in order to avoid possible seizures.* In the end, I stopped taking it because it clouded my mind. It was not difficult to stop once I had a mind to.

* That is, if you want to quit.

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Actually, the thing that worries me about benzos is not addiction, it's the disinhibition. You can find yourself doing things that you would not normally do, as if you had had a few drinks. It's more insidious than alcohol, though, because you don't feel drunk. It's just something to be aware of. If you start doing something unusual, you should think, "Do I really want to do this, or is it the Klonopin?"

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EDIT: Also, I generally don't think it wise to take a pharmacist's instructions over a doctor's instructions. Pharmacists can tell when two drugs may interact, and IIRC they're supposed to contact the prescribing doctor (or instruct the patient to contact him) when they encounter such an interaction to make sure he didn't miss it. However, I would not trust a pharmacist's medical opinion over a doctor's.

Pharmacists are supposed to know more about meds than doctors. It's their specialty. But, the addictiveness of benzos is something on which reasonable people can disagree. Pharmacists are more attuned to the risks of meds, and doctors are more attuned to the benefits.

A pharmacist's specialty is safely and accurately dispensing medications. All types of medications. Blood pressure meds, anti-cancer meds, cold meds, diabetes meds, painkillers, antiretrovirals, anything you can think of. There's thousands upon thousands of different medications a pharmacist could handle. Further, pharmacists don't regularly consult with patients in the same way that doctors do. Their primary job is to fill orders given to them by doctors in the form of prescriptions. Thus, a pharmacist cannot possibly know as much about a particular type of medication as a doctor who uses those medications to treat patients does.

In this instance, the pharmacist is not working directly with the patients who take benzos. All he sees is the warning on the label that they can be habit-forming. Does he know what that means in real terms? Maybe not, but the prescribing doctor does.

What the pharmacist does know is what medications a particular patient is taking, and how those medications might interact. Doctor A might have written a prescription for some drug, unaware that the patient is currently taking another drug prescribed by doctor B. If the two drugs are known to interact, the pharmacist should call doctor A and make sure it's okay to proceed.

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A pharmacist's specialty is safely and accurately dispensing medications. All types of medications. Blood pressure meds, anti-cancer meds, cold meds, diabetes meds, painkillers, antiretrovirals, anything you can think of. There's thousands upon thousands of different medications a pharmacist could handle. Further, pharmacists don't regularly consult with patients in the same way that doctors do. Their primary job is to fill orders given to them by doctors in the form of prescriptions. Thus, a pharmacist cannot possibly know as much about a particular type of medication as a doctor who uses those medications to treat patients does.

Pharmacists are supposed to be the experts on the meds they dispense. That doesn't mean that in practice they know more than a particular doctor about a particular med. Doctors are supposed to call pharmacists for advice when they are unfamiliar with a med. For all of the reasons you mentioned, a patient's doctor is often better positioned to advise that patient than a pharmacist. I happen to think that most pharmacists have a pretty chill job. They go to school for four years, and yet when I ask one a question, they always seem to look it up on a computer or in a book. I could read the book myself, and I am only trained as a nurse. They don't have to make many decisions, and when something goes wrong, they rarely take the blame. With such minimal responsibility for patient care, they probably start to forget what they learned in those four years in school. Whereas, say, a doctor or a nurse gains in experience with the meds they work with daily. But, none of this changes the fact that they are supposed to be the experts on all types of meds.

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Not to say that these pill can't be helpful. But use them cautiously. I still need to take Klonopin regularly because I'm slowly tapering down, (to avoid a second benzo-induced grand mal seizure) and PRN use for panic attacks is probably the best way to take these kinds of meds (in my unprofessional opinion). A benzo addiction/dependence is the LAST thing you want or need. I found my dose slowly increasing over time, and ironically, my anxiety seemed to increase along with it. I got inter-dose withdrawal symptoms, and I would find myself counting the time until I could take my next dose, attributing all of my anxiety to withdrawing from Klonopin (psychological dependence).

All drugs cause psychological dependence, but the thing is, benzodiazepines, along with alcohol, are clinically physically the most dangerous drugs to withdraw from. After my grand mal, I thought I needed even more Ativan, and feeling it wear off between doses would make me terrified of getting another seizure. I became even more dependent/addicted (I think it's some of both).

Barbiturates and some other tranquilizers have the same risks, but they are hardly ever used anymore.

Klonopin is longer-acting than Ativan, so it should be less likely to cause problems with bottoming out.

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