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Author Topic: Ativan to Klonopin?  (Read 312 times)

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Offline Sunlover

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Ativan to Klonopin?
« on: February 21, 2014, 05:54:21 PM »
I am posting this for my daughter who is 26.   She had been taking Ativan for maybe a year or more and felt she was becoming addicted to it because if she cut back or cut down she'd get REALLY nervous.  So she went to a psychiatrist to see what can be done about it, she really doesn't want to take ANY medications now.  So the psychiatrist gave her Klonopin in order to ween her off the Ativan.   She is afraid to take the Klonopin because she "KNOWS" that it isn't going to help and she'll keep waking up in a nervous panic.   My question is this - do you think it WILL work and she'll be able to relax and sleep? I don't know anything about medications like that (I generally use Xanax as needed, so that's the only one I'm familiar with, but Xanax doesn't work for her at all)
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Offline 2sungo

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Re: Ativan to Klonopin?
« Reply #1 on: February 21, 2014, 06:21:24 PM »
Klonopin is longer acting than Ativan, so it would likely be easier to wean off of, though I see many advocate using valium which has a really long half life to wean off of a shorter acting benzo or even klonopin if that is difficult. I have weaned off klonopin at least twice in the past once I had an effective antidepressant covering me and I did so slowly, really slowly, without issue.  I always carried some just in case but rarely had to use them.   I am on klonopin now for over a year because the antidepressant (Lexapro) has not worked as well as before, and am in the process of trying a switch to pristiq, if it works out I will one day try going off the klonopin again. Some people stay on klonopin for years or decades even, I have a cousin who takes the same dose 1.5 mg for at least 25 years.
 However you might want to ask the doc what might happen, as if she has a biological (genetic) anxiety disorder as opposed to something that is exclusively situational then going off the benzo without a new plan is probably not a wise idea, it will likely come back.  So she might go on an antidepressant first, it really depends on the nature and severity of her anxiety, so you really need to discuss that with her and a psychiatrist. 
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Offline Sunlover

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Re: Ativan to Klonopin?
« Reply #2 on: February 21, 2014, 06:35:47 PM »
Thanks for the reply....  she IS genetically disposed to this anxiety stuff (me AND my husband have given her those "nice" little genes...) she tried some antidepressants and had all kinds of side effects.
Your cousin has stayed on the same does of Klonopin for 25 years and it still works?   That's really good to know!
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Offline insights

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Re: Ativan to Klonopin?
« Reply #3 on: February 21, 2014, 11:38:26 PM »
She had been taking Ativan for maybe a year or more and felt she was becoming addicted to it because if she cut back or cut down she'd get REALLY nervous.

Your daughter isn't addicted, but she probably developed a dependence to Ativan after a month or two which means she will need to wean of the drug rather than quitting 'cold turkey.' This would also be the case with antidepressants and most other psychotropic drugs.

BTW-this study will illustrate the difference between addiction and dependence: (Hirschowitz BI, 1998). Very few of those taking benzodiazepines (BZDs) would behave as the study patients if BZDs produced similar consequences. 

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So the psychiatrist gave her Klonopin in order to ween her off the Ativan.

The first thing that MUST be considered is how she is going to control her anxiety when she is no longer taking BZDs. There is little point in weaning off without having an alternative in place first as the process will likely fail. Both antidepressants and the cognitive and/or behavioural and/or mindfulness therapies have been proven to be effective anxiety treatments.

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She is afraid to take the Klonopin because she "KNOWS" that it isn't going to help and she'll keep waking up in a nervous panic

Klonopin is as effective as Ativan, and in some respects more potent. It works in exactly the same way. The main difference is that it is longer lasting having a half-life of 30-40 hours compared to 12-15 hours for Ativan.

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My question is this - do you think it WILL work and she'll be able to relax and sleep?

Up to a point, yes, however, diazepam (Valium) would be better. It has an ever longer half-life, up to 200 hours which tends to smooth out plasma level highs and lows, especially at low doses which makes life much easier. It is also a low potency drug requiring much higher doses (1mg Klonopin = 20mg diazepam), but comes in relatively small dose tablets of considerable size which makes cutting back by small steps much easier than is the case with Ativan and Klonopin.

What was her Ativan dose, and how much Klonopin has she been prescribed?

Ian

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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Sunlover

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Re: Ativan to Klonopin?
« Reply #4 on: February 22, 2014, 11:11:04 AM »
insights, my daughter's Ativan dose was 1mg, the Klonopin is .5
She said she was extremely nervous last night because she took the Klonopin and didn't take Ativan.  I think it's in her head, she is convinced that she NEEDS the Ativan.  She is OK during the day it's only at night.
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Offline insights

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Re: Ativan to Klonopin?
« Reply #5 on: February 22, 2014, 04:27:21 PM »
insights, my daughter's Ativan dose was 1mg, the Klonopin is .5

The equivalence is about correct (it is impossible to be precise because there are individual variations in response to the different BZDs).

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I think it's in her head, she is convinced that she NEEDS the Ativan.  She is OK during the day it's only at night.

You are almost certainly right. There is nothing magic about Ativan that renders it more powerful than the other BZDs, however, confidence is very important. Hopefully, her's will build over the next few days. If not, it might be another reason to switch to diazepam. Ativan (lorazepam) is a metabolite of diazepam, so in effect she would still be taking it, just via the parent compound.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

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