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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by qbsbrown on December 4, 2007, at 11:59:16
I'm switching from klonopin to ativan. klonopin gives me the wet blanket feeling, and i believe is a part of my depression.
I was going to just swap them out, but seems that in doing so, is causing me depersonalization.
Perhaps mix for a few days, the all ativan?
Regards,
Brian
Posted by Phillipa on December 4, 2007, at 13:03:04
In reply to Changing Benzos: switch out,or wean and introduce?, posted by qbsbrown on December 4, 2007, at 11:59:16
Try valium but I've taken more than one benzo at a time. I have taken xanax and klonopin and valium with chloral hydrate at same time in the hospital. A med switch. Phillipa
Posted by sonic_gb on December 4, 2007, at 15:17:24
In reply to Changing Benzos: switch out,or wean and introduce?, posted by qbsbrown on December 4, 2007, at 11:59:16
Since Clonazepam has such a long half life, you should just be able to switch over. What dosages of each med are we talking about. I agree with you about the clonazepam, I think it has worsened my depression, and I'm on a fast (too fast in my opinion) taper off of it completely.
Sonic
Posted by qbsbrown on December 4, 2007, at 18:17:24
In reply to Re: Changing Benzos: switch out,or wean and introduce? » qbsbrown, posted by sonic_gb on December 4, 2007, at 15:17:24
> What dosages of each med are we talking about.
I usually take 1.5-3mgs of klono per day. so that would be 3-6 of ativan,,riht?
what is your current wean schedule
Posted by sonic_gb on December 4, 2007, at 23:14:28
In reply to Re: Changing Benzos: switch out,or wean and introduce?, posted by qbsbrown on December 4, 2007, at 18:17:24
> > What dosages of each med are we talking about.
>
> I usually take 1.5-3mgs of klono per day. so that would be 3-6 of ativan,,riht?
>
> what is your current wean scheduleqbsbrown,
I think you have the conversion right. My taper is 2mg/ day to 0mg per day over 7 days. Not exactly what I had hoped for. I also take 30mg of oxazepam for sleep which will be tapered next week, also over 7 days.
Anyways, back to your situation. I always found Ativan to be more overtly sedating than Klonopin, but with a much shorter duration of action, so there were always peaks and valleys in my anxiety. On the other hand, Klonopin seems to worsen my depression. I think you could try cross-tapering over a week or so, and that should minimize any untoward effects. So each day, replace .5 of Klonopin with 1mg of Ativan until you are only on the Ativan. That seems to be the smoothest way of doing it. Let me know how things are going, and good luck!
Sonic
Posted by yxibow on December 6, 2007, at 2:13:02
In reply to Re: Changing Benzos: switch out,or wean and introd » qbsbrown, posted by sonic_gb on December 4, 2007, at 23:14:28
Crosstapers are better to determine the appropriate amount of the final medication. That being said, Ativan is a shorter acting benzodiazepine, and has a more immediate effect. If your doctor recommends this, well maybe they have a reason, but I would personally taper to Valium or a benzodiazepine with a longer half life. At any rate, Dr. Bob's culled list of equivalency #1 is about on track. #2 is rather off in places.
Posted by qbsbrown on December 6, 2007, at 14:11:02
In reply to Re: Changing Benzos: switch out,or wean and introd » sonic_gb, posted by yxibow on December 6, 2007, at 2:13:02
Coming from 2mgs of klonopin, what would be a good way to taper over to Ativan??
I tried going just directly over, but caused really bad depression.
Regards,
Brian
Posted by sonic_gb on December 6, 2007, at 14:47:37
In reply to What's a good crosstaper schedule??, posted by qbsbrown on December 6, 2007, at 14:11:02
> Coming from 2mgs of klonopin, what would be a good way to taper over to Ativan??
>
> I tried going just directly over, but caused really bad depression.
>
> Regards,
>
> Brian
Let's assume you take 2mg of Klonopin and want to switch to 4mg of Ativan If I were to do it, it would go like this:Day 1: 2.0mg Klonopin, 0mg Ativan
Day 2: 1.5mg Klonopin, 1mg Ativan
Day 3: 1.0mg Klonopin, 2mg Ativan
Day 4: 0.5mg Klonopin, 3mg Ativan
Day 5: 0.0mg Klonopin, 4mg AtivanYou could do this twice as slowly by dividing the increments in half, and making it a 10-day cross-taper. This might be a little smoother, and advisable if the quick switch caused depression, but it gets hard to divide tablets at a certain point. I find that clonazepam just makes my depression worse, period. It's the only benzo I've tried that does this to me. The literature says it should do the opposite since it is slightly sertotonergic.
Also, the benzo equivalence charts aren't exact science. You might actually need slightly more or less Ativan to equate to 2mg of Klonopin. Keep this in mind.
This is slightly complicated because you're cross-tapering from a very long acting benzo to a short acting benzo, so for a while, you will have substantial Klonopin in your system, AND be taking a decent dose of Ativan. I wouldn't be surprised if you noticed an increase in sedation during the cross-taper, and then a decrease 2 or 3 days after the taper is complete.
Let me know if this makes sense, or if I've made any errors in logic or pharmacology here. I'm not a doctor, just someone interested in psychopharmacology...
Sonic
Posted by qbsbrown on December 6, 2007, at 19:31:28
In reply to Re: What's a good crosstaper schedule??, posted by sonic_gb on December 6, 2007, at 14:47:37
from 2 mgs of klonopin. i've noticed that klonopin makes me depressed, but coming off too quickly causes depression as well.
Earlier in the summer I went cold turkey from Trileptal, and this same type of occurred.
This is the end of the thread.
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