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basuraeuropea

Long-Term High-Dose Benzodiazepine Use

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Hi Fellow Panic/Anxiety Sufferers!

 

So, I am currently taking 900mg of Lyrica per day, 3mg of Klonopin per day, and 60mg of Cymbalta daily for very treatment-refractory panic disorder and generalized anxiety disorder. I had decreased Klonopin from 4mg/day to 2mg/day a few months ago and sort of fell unstable, so I recently increased to 3mg/day, although I still don't feel solid and considering, with my doctor's blessing, increasing back to my original dosage of 4mg/day. I had taken 3mg/day for about 12 years and was stable on more medication -- my previous doctor added an atypical which was disastrous and so I tapered off and increased Klonopin to 4mg/day in lieu of for about six months. I wanted to reduce my overall medication intake and so I reduced back to 3mg/day, although I fell quasi-unstable which is where I stand today. 

 

I have read that tolerance to the anxiolytic effects of benzodiazepines grows very slowly or not at all, while tolerance to the other effects of the class of the drug can grow quite rapidly. For those who are taking a benzodiazepine daily and have been doing so for a long period of time, have you noticed a decrease in effectiveness in the drug? If you were in my shoes, would you increase back to 4mg/day of Klonopin as suggested by my doctor? I'm conflicted as to what to do! Help! I need to feel solidly stable!

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Sorry, I can't give any advice. But now I feel stupid for flipping a brick because my doc wanted to increase Lyrica to 150. Good luck.

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46 minutes ago, basuraeuropea said:

I have read that tolerance to the anxiolytic effects of benzodiazepines grows very slowly or not at all, while tolerance to the other effects of the class of the drug can grow quite rapidly. For those who are taking a benzodiazepine daily and have been doing so for a long period of time, have you noticed a decrease in effectiveness in the drug? If you were in my shoes, would you increase back to 4mg/day of Klonopin as suggested by my doctor? I'm conflicted as to what to do! Help! I need to feel solidly stable!

I have been taking 3mg Klonopin daily for about 6 years or so..........I take it for anxiety and sleep......I have so far not needed an increase in dose, and my doctor has not suggested any increase.

However, if you are not stable, and your doc has recommended an increase, if I were you, I would at least give it a try, and see how you do with 4mg..........Just my 2 cents.

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1 hour ago, CrazyRedhead said:

I have been taking 3mg Klonopin daily for about 6 years or so..........I take it for anxiety and sleep......I have so far not needed an increase in dose, and my doctor has not suggested any increase.

However, if you are not stable, and your doc has recommended an increase, if I were you, I would at least give it a try, and see how you do with 4mg..........Just my 2 cents.

Thanks, CrazyRedhead! I appreciate your input. I will definitely try it out and see how it goes!

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Posted (edited)

I have been on as much as 3 mg, went to 5 during a life threatening illness. 20 years and now I am on 1 mg. I get tolerant to the sedation but not the antianxiety effects. I find lowering the dose easy, provided I don't really need the higher dose.

Edited by notloki
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14 hours ago, CrazyRedhead said:

I have been taking 3mg Klonopin daily for about 6 years or so..........I take it for anxiety and sleep......I have so far not needed an increase in dose, and my doctor has not suggested any increase.

However, if you are not stable, and your doc has recommended an increase, if I were you, I would at least give it a try, and see how you do with 4mg..........Just my 2 cents.

Agree, while I wouldn’t advocate that in normal circumstances, it sounds like your Panic is a bitch, and you should do what you gotta do to feel healthy as long as your pdoc is on board 

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7 hours ago, Iceberg said:

Agree, while I wouldn’t advocate that in normal circumstances, it sounds like your Panic is a bitch, and you should do what you gotta do to feel healthy as long as your pdoc is on board 

yeah, i mean, i feel hesitant increasing to the maximum recommended by the fda for the treatment of panic disorder, but you're absolutely right, my panic is a total bitch, so i think i'm going to try it out. 

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So, I took 2mg of Klonopin last night and 2mg this morning for a total of 4mg/day per my doctor's orders. I can't say that I feel a great difference between 3mg/day and 4mg/day. I actually feel a bit more stimulated, although this could be due to the slight reduction in anxiety which is liberating. I know that Lyrica and the benzodiazepines when taken in conjunction with one another are quite potentiating, so perhaps I should give it a few days even though benzodiazepines tend to work very, very quickly in reducing symptoms of panic and anxiety. 

Any thoughts/words of advice? Thank you!

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Posted (edited)
8 minutes ago, basuraeuropea said:

 Any thoughts/words of advice? Thank you!

I would suggest give a little more time, a few days, a week maybe?....

If things don't improve after a week, I would say call pdoc.

Edited by CrazyRedhead

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36 minutes ago, CrazyRedhead said:

I would suggest give a little more time, a few days, a week maybe?....

If things don't improve after a week, I would say call pdoc.

Thanks for the advice! 

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2 hours ago, basuraeuropea said:

So, I took 2mg of Klonopin last night and 2mg this morning for a total of 4mg/day per my doctor's orders. I can't say that I feel a great difference between 3mg/day and 4mg/day. I actually feel a bit more stimulated, although this could be due to the slight reduction in anxiety which is liberating. I know that Lyrica and the benzodiazepines when taken in conjunction with one another are quite potentiating, so perhaps I should give it a few days even though benzodiazepines tend to work very, very quickly in reducing symptoms of panic and anxiety. 

Any thoughts/words of advice? Thank you!

Agreed with CRH again. While most people feel benzos quickly, they are often feeling the sedative/hypnotic effects too. You have a strong tolerance against them, which might be blocking the initial relax feeling for a bit until the med level settles 

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So, while 4mg/day works better than 3mg/day, I have decided to drop down back to 3mg/day as I feel stable in most circumstances at this dosage and will take 3.5-4mg/day on an as-needed basis when I know I may have a panic attack, or my basal anxiety levels are higher than usual. 

This may change in the future, however I hope it doesn't!

Thanks to all who helped/contributed!

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1 hour ago, basuraeuropea said:

So, while 4mg/day works better than 3mg/day, I have decided to drop down back to 3mg/day as I feel stable in most circumstances at this dosage and will take 3.5-4mg/day on an as-needed basis when I know I may have a panic attack, or my basal anxiety levels are higher than usual. 

This may change in the future, however I hope it doesn't!

Thanks to all who helped/contributed!

I think that’s a really good idea. I think it would be a little scary going so high, in the case you ever have to come off of it for whatever reason. It’d be one less mg of agony. Just my take. 

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Posted (edited)
21 minutes ago, DammitJanet said:

I think that’s a really good idea. I think it would be a little scary going so high, in the case you ever have to come off of it for whatever reason. It’d be one less mg of agony. Just my take. 

oh, i don't ever plan on coming off of klonopin. it is one of my core medications along with the other two listed in my signature. i've been taking klonopin for about 13 years now, the vast majority of which at 3mg/day, and i will absolutely find a psychiatrist who is willing to prescribe the medication to me as it is imperative in keeping me a stable and functional member of society. thankfully, i live in southern california where the use of benzodiazepines for treatment-refractory panic disorder is both warranted and respected by many leading psychiatrists. my current psychiatrist, who i've had for about five or six years now, is very benzodiazepine friendly. 

i've actually taken 4mg of klonopin daily for a few months about a year ago but dropped down back to 3mg/day and then to 2mg/day and nearly relapsed. so here i am again, taking 3mg/day. 

Edited by basuraeuropea
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1 minute ago, basuraeuropea said:

oh, i don't ever plan on coming off of klonopin. it is one of my core medications along with the other two listed in my signature. i've been taking klonopin for about 13 years now, the vast majority of which at 3mg/day, and i will absolutely find a psychiatrist who is willing to prescribe the medication to me as it is imperative in keeping me a stable and functional member of society. thankfully, i live in southern california where the use of benzodiazepines for treatment-refractory panic disorder is both warranted and respected by many leading psychiatrists. my current psychiatrist, who i've had for about five or six years now, is very benzodiazepine friendly. 

i've actually taken 4mg of klonopin daily for a few months about a year ago but dropped down back to 3mg/day and then to 2mg/day and nearly relapsed. so here i am again, taking 3mg/day. 

Ok. 

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So, I've been faced by a problem that has been plaguing me for quite a while now. I take 3mg/day of Klonopin divided into equal doses of 1.5mg taken 12 hours apart and the doses are always combined with my twice-daily dosing schedule of Lyrica (450mg BID) as the two drugs have amazing synergy/potentiation together. Anyhow, I find that neither Lyrica nor Klonopin lasts the full 12 hours before I need to re-dose and I experience increasing anxiety as I near the time I need to take my next dose of both medications. I can't split up either medication into TID dosing because then the amount taken at each interval isn't enough to get me through the majority of the day comfortably. 

I am prescribed 4mg of Klonopin to take per day, but I reserve taking 4mg total per day of the drug on occasions when I know I'm going to be in a situation during which I will panic without the increased amount or when my basal level of anxiety is super high. Also, taking 4mg total per day makes me anorgasmic and that sucks. So, while I could take a booster dose using my leftover milligram on a daily basis, I don't due to the aforementioned. 

Any tips on what I could possibly bring up to my psychiatrist or does anyone have any ideas on how to get around this? I do not want to increase Cymbalta because it induces apathy, sexual dysfunction, anhedonia, emotional blunting, etc., at higher dosages. 

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1 hour ago, basuraeuropea said:

  Any tips on what I could possibly bring up to my psychiatrist or does anyone have any ideas on how to get around this? I do not want to increase Cymbalta because it induces apathy, sexual dysfunction, anhedonia, emotional blunting, etc., at higher dosages. 

Well, since your doc has already prescribed you 4mg per day, the only compromise I can think of right now, would be to try increasing your two doses of Klonopin to 1.75mg, in other words 1.75 mg twice a day.......That would be a daily total of 3.5 mg, though.....You could try that and just see how it affects you.

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2 minutes ago, CrazyRedhead said:

Well, since your doc has already prescribed you 4mg per day, the only compromise I can think of right now, would be to try increasing your two doses of Klonopin to 1.75mg, in other words 1.75 mg twice a day.......That would be a daily total of 3.5 mg, though.....You could try that and just see how it affects you.

Thanks for the suggestion, CrazyRedhead. I think that I may try that out here and there whenever I wake up very anxious. There are actually some days during which 1.5mg BID works well enough and others when it doesn't work well at all with the doses not lasting nearly long enough before needing to re-dose. I might just put up with the transient anxiety, though, as the medications are already screwing up my sexual functioning to a certain degree. There is also the possibility that should I increase to 2mg BID that I will become tolerant to the negative side effects associated with the medication. I don't know if that's likely, though. I mean, the only negative side effects associated with Klonopin and Lyrica are mild/moderate sexual dysfunction. Everything works, just not as well (or as frequently) as I want it to. I think increasing would only worsen this. 

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@CrazyRedhead, do you think that switching to another potent benzodiazepine, e.g., Xanax XR (probably taken twice daily), would remedy these issues?  I know that Klonopin has serotonergic activity which is unique within the benzodiazepine class and this may be causing sexual problems. Conversely, the serotonergic activity may be quite helpful when it comes to anxiolysis. 

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Just now, basuraeuropea said:

@CrazyRedhead, do you think that switching to another potent benzodiazepine, e.g., Xanax XR (probably taken twice daily), would remedy these issues?  I know that Klonopin has serotonergic activity which is unique within the benzodiazepine class and this may be causing sexual problems. Conversely, the serotonergic activity may be quite helpful when it comes to anxiolysis. 

I'm not sure if switching to Xanax XR would help......To be fair, though, I've never tried it.......My best advice would be talk to your doc and see what he/she thinks.......No harm in at least trying it if your doc gives the green light, IMO.

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