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Teva brand clonazepam no longer an option. Help!


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39 minutes ago, CrazyRedhead said:

I am not a pdoc. but you are on a pretty low dose of clonazepam (less than 1mg/day)......

If this small dose is truly not effective for you, I would suggest talking to your doc and letting him know that.

In other words, don't just tell him you need a higher dose right off the bat--Just tell him that your current dose isn't effective, and see what he has to say first.

I have no doubt that he'll raise my dose to what I need. It's getting to him that's the issue since there's a degree of agoraphobia and decreased motivation that comes with these things. he clonazepam itself seems to affect the way I approach things as well. I just have to try to get to a functional state. 

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33 minutes ago, Schlep said:

I have no doubt that he'll raise my dose to what I need. It's getting to him that's the issue since there's a degree of agoraphobia and decreased motivation that comes with these things. he clonazepam itself seems to affect the way I approach things as well. I just have to try to get to a functional state. 

Again, I'm not a doc, but IMO, a good first step might be increasing to at least 1mg/day of clonazepam  (.5 in morning, and .5 at night, maybe?)........I'm happy to hear he'll work with you, and increase it to what you need to be functional.

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As someone who has been on klonopin for a long time, .5mg 2x a day seems to be the optimal dose.  When I was on 1mg 2x a day I was really flat and it probably contributed to my depression being worse.  If vraylar works to help control my anxiety as well as gabapentin I think I'm going to ask my pdoc to try and get off of the klonopin.  Hopefully I can do without it.  I really don't like being on a med that is physically and psychologically addictive.  I don't exhibit any drug seeking behavior, but 10 years+ on the drug is probably long enough. 

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Going to try 3 doses today for the first time (took 1/4 of .5 pill, 1/2 a pill in a little while, and 1/2 at bedtime.) Reluctant to try a whole .5 pill because I can't imagine how bad the Actavis exclusive side effects would be like (though I seem to be over them for these smaller doses.) I had a random boost from 1/2 a pill a few nights ago and, while pleasant, could have been too much if multiplied. I've never done well with the Teva side effects either, but at least I still felt like myself on them. 

Two big hits a day rather than 3 smaller hits probably should be more effective, considered I always started on clonazepam with at least a whole pill. I guess it all depends on exactly how the drug works. It should also be noted that all non-Teva clonazapem lacks an ingredient called povidone, which apparently affects the delivery of the drug by extending the time over which the clonazepam is dispersed. 

Anyway, so I guess my present debate is between .25 mg three times a day or .5 mg twice a day. I'm just sad that I couldn't just resume my normal dosage from the Teva.

Also, anyone know the advantages and disadvantages of sublingual application. I "sublingualed" an Actavis for the first time today and sort of felt something. In the past I usually just got by by swallowing.  

Edited by Schlep
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1 hour ago, Schlep said:

   Also, anyone know the advantages and disadvantages of sublingual application. I "sublingualed" an Actavis for the first time today and sort of felt something. In the past I usually just got by by swallowing.  

Taking a dose sublingually (dissolving it under tongue), gets the dose directly into your bloodstream faster, via the mucous membranes under the tongue.

If you swallow a dose, it takes longer to get into the bloodstream, because it has to pass through the digestive tract, and be metabolized by the liver.......When a drug is metabolized through the liver, there is a small reduction in the amount of the drug that actually gets to the bloodstream.

So,as to disadvantages and advantages of both methods:

Sublingual.......Slightly more of the drug gets into your system faster, but then (theoretically), the effects don't last as long.

Swallowing.....Slightly less of the drug gets into your system more slowly, but (again theoretically), the effects of the drug last longer.

There are some extended release versions of certain drugs that have a special coating, which allows a slow release of the drug  as it passes through your system, and these types can't be taken sublingually......But that doesn't really apply to clonazepam, anyway.....I think Xanax has an extended release version (Xanax XR)

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1 hour ago, CrazyRedhead said:

Taking a dose sublingually (dissolving it under tongue), gets the dose directly into your bloodstream faster, via the mucous membranes under the tongue.

If you swallow a dose, it takes longer to get into the bloodstream, because it has to pass through the digestive tract, and be metabolized by the liver.......When a drug is metabolized through the liver, there is a small reduction in the amount of the drug that actually gets to the bloodstream.

So,as to disadvantages and advantages of both methods:

Sublingual.......Slightly more of the drug gets into your system faster, but then (theoretically), the effects don't last as long.

Swallowing.....Slightly less of the drug gets into your system more slowly, but (again theoretically), the effects of the drug last longer.

There are some extended release versions of certain drugs that have a special coating, which allows a slow release of the drug  as it passes through your system, and these types can't be taken sublingually......But that doesn't really apply to clonazepam, anyway.....I think Xanax has an extended release version (Xanax XR)

Yes, that was my understanding of it. I had a bad reaction to doxycycline last year that resulted in some kind of diluted yet extended panic attack that felt more like a serious physical illness. With nothing else to really do I took half a clonazepam pill sublingually and was amazingly back to normal in about an hour (though I guess it's debatable whether taking them that way made a difference). I was holding steady at 1/4 of a pill twice a day until now. It could be the case that with just a single heavy offense I could get back to normal, but this brand is somewhat unpredictable. Actavis has really pushed me towards the depressive end of the spectrum since I started it, and I desperately don't want to reach a point of no return in terms of dosage amount if I would be better off taking less of it. 

And I wonder what happens to the inactive ingredients when you take a med sublingually. Do they break down and become "more inactive"? Maybe just get absorbed into the saliva?

Edited by Schlep
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11 hours ago, Schlep said:

 Actavis has really pushed me towards the depressive end of the spectrum since I started it, and I desperately don't want to reach a point of no return in terms of dosage amount if I would be better off taking less of it. 

And I wonder what happens to the inactive ingredients when you take a med sublingually. Do they break down and become "more inactive"? Maybe just get absorbed into the saliva?

Have you told your doc how the Actavis is effecting you?.....If it's making you more depressed, maybe you should talk to doc about trying another brand of generic clonazepam......

I really don't know how the inactive ingredients of a drug would be affected by taking sublingually.....I would think they just get absorbed along with the active ingredient, but again, I'm not really sure.

Edited by CrazyRedhead
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3 hours ago, CrazyRedhead said:

Have you told your doc how the Actavis is effecting you?.....If it's making you more depressed, maybe you should talk to doc about trying another brand of generic clonazepam......

I really don't know how the inactive ingredients of a drug would be affected by taking sublingually.....I would think they just get absorbed along with the active ingredient, but again, I'm not really sure.

Right now I don't feel the Actavis doing much of anything (though much of the anxiety seems suppressed. From what I've heard, the only other remaining brands of regular clonazepam are Accord and the non-generic, with no real guarantees they'll be the answer. I don't see my doc being receptive to any of these concerns, and he's just not enjoyable to talk to. Not to mention that he just rushes through each visit as quickly as possible. Is it normal for a doctor to do that?

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2 hours ago, CrazyRedhead said:

Some docs are like that these days......I've had docs that do this.......Sad, but true.

Did I mention that my doctor once threatened to have me committed because I was looking things up on the internet?

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Well I have something that could be thought of as good news: I called the pharmacy to see if by chance they had anything left by Teva in stock, of course they didn't. (something about it being "backordered"). But they did say they were getting a lot of complaints over the Actavis clonazepam, so at least I know I'm not just the only one.

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The accord and the actavis brand have both been fine with me, I really haven't noticed a difference at all. It honestly might be placebo... Since people who are on Klonopin are naturally very anxious and overthink things. I was hesitant but I had no choice, and both worked out fine.
 

Schlep, it sounds like you need to find a new doctor asap. That isn't normal how your psych treats you. You pay HIM for his services, he is there to HELP you. I have never heard of a psych that thought anxiety wasn't "real"?? That sounds very alarming.... Find a new doctor asap.

 

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6 hours ago, icygrave said:

The accord and the actavis brand have both been fine with me, I really haven't noticed a difference at all. It honestly might be placebo... Since people who are on Klonopin are naturally very anxious and overthink things. I was hesitant but I had no choice, and both worked out fine.
 

Schlep, it sounds like you need to find a new doctor asap. That isn't normal how your psych treats you. You pay HIM for his services, he is there to HELP you. I have never heard of a psych that thought anxiety wasn't "real"?? That sounds very alarming.... Find a new doctor asap.

 

In his defense, he's only my medical doctor. 

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My old pdoc's clinic moved to a somewhat distant location two years ago, I was stable so it made sense to just go to my MD for meds.

I think I may have slightly adjusted to the Actavis clonazepam, as my anxiety has been greatly reduced over the last few days. I still don't feel where I was on Teva, and the fatigue from Actavis (-/+ .75 mg over the day) is somewhat extreme compared to the same dose on Teva. It was practically crippling upon waking up today.

I finally saw my MD today and he was surprisingly more receptive than I thought he'd be. If there's a single word that describes him, it's "brusque". I somehow made it out with an RX for 30 0.125 mg Teva oral disintegrating tablets that are supposed to last for two weeks. (forgot about my nortriptyline rx during the session, so I notified the receptionist, then I notified him, then I called him from the pharmacy... never received it; oh well...) How 30 0.125 mg pills ("as needed") are going to last two weeks when I'm currently taking approx .62 mg presently I can't really figure out. I'm thinking of maybe tapering down the Actavis pills for a few days (and I am a little apprehensive of what the Teva pills might do.)

Anyway, this is the back of the blister pack. I have no idea why there's a German cross there, but I guess it could have been worse...

20181025_184215.jpg

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