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How Long Does A Change In Klonopin Dose Take To Be Effective?

Posted on Thu, 23 Jun 2016

Question: Was fine on klonopin, but I tried weaning off 1.5 mg klonopin, got down to 1mg after a month. then started having bad anxiety. Immediately re-upped my dose to 1.5mg. How long will it take for the upped dose to get me normal again?

Answered by Dr. Chintan Solanki (55 minutes later)

Brief Answer:
within 3-4 days you should be normal,taper more slowly

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern.

You will be normal within 3-4 days with upped dose otherwise increase the dose up to 2 mg with permission of your treating doctor.

For you information: You have reduced 0.5 mg (33% of total dose) and you suffered from withdrawal symptoms. In that case I recommend slower tapering. You should reduce 0.25 mg dose every 15 days. This will cause no or very less and tolerable withdrawal. In any case if you still get problem with this , you have to ask for 0.25 mg tablets to your doctor and you can reduce 0.125 mg(half of 0.25) every 10 days.

Hope I have answered your query, I will be happy to help further.

Regards,

Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (1 hour later)

would taking 1 or 2 mg of Ativan help cover the anxiety until I reach normalcy? what do you think of my chances for not having to up my Klonopin dose, since I have only been on it a few months. I was fine at 1.5mg. My treating pdoc refused to help me because she did not want me to taper. she just says go to the ER, so I doubt I could get more if I needed it. I have always relied on my Cymbalta to control my anxiety and 40mg has worked for 15 years, until this year. Now on 60mg Cymbalta and was prescribed klonopin to cover my new anxiety, that is why I thought I did not need the klonopin anymore. Thank you so much for your help.

Answered by Dr. Chintan Solanki (4 hours later)

Brief Answer:
ativan can help but I recommend klonopin

Detailed Answer:
Hi,

Thanks for follow up. Ativan can help to control your anxiety if you do not want to increase the dose of klonopin. However ativan and klonopin are more or less same as both belong to benzodiazepine group. Action and effects are same except klonopin has longer half life and you need less frequent dosing. That is why I recommend increasing dose of klonopin if needed rather than adding another drug from same group. Hope you are clear now.

Hope you will be better with cymbalta 60 mg as soon as drug becomes completely effective.

Feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (5 hours later)

have been on the 60mg Cymbalta since January. this will be my third day back at 1.5mg of klonopin, but I feel worse today. are you pretty sure I should feel better soon? I asked about taking the Ativan now to see if you think it will stop some of my anxiety until the klonopin kicks in.

Answered by Dr. Chintan Solanki (11 hours later)

Brief Answer:
take ativan

Detailed Answer:
Hi,

I am sorry for delayed response. You can take ativan 1 mg or 0.5 mg klonopin more to control anxiety for a while. You can repeat the same dose after 6 hours if needed.

Also use deep breathing technique. Inhale for 3 seconds, keep breath in for 3 seconds and exhale for 3 seconds. Do it for 0-5 minutes. You will feel relax.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (11 hours later)

good morning doctor, well its day four and no improvement yet. still just taking the original dose of 1.5mg klonopin, and enduring the anxiety as best I can. are you sure I will stabilize on this dose soon? felt so good on it until I tried weaning off.

Answered by Dr. Chintan Solanki (1 hour later)

Brief Answer:
please take extra klonopin or ativan

Detailed Answer:
Good morning (in fact late evening here).

I have already told that if 3 days have passed please add 0.5 mg klonopin or 1 mg ativan for a while to control your anxiety. You can taper this increased dose after you become stable for 3-4 days. You can stabilize on 1.5 mg dose then onward that is for sure.
You are welcome to clear your doubts if any.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (3 hours later)

so just to be clear, .5mg klonopin three times a day, and 1mg Ativan once a day when needed? or .5mg klonopin four times a day until stable (any idea how long that might take)? you also say after I am stable for three or four days that I can taper back to 1.5mg....using your formula? is there any chance if I wait long enough at 1.5mg that I will stabilize? this is all very confusing.

Answered by Dr. Chintan Solanki (6 hours later)

Brief Answer:
wait for more 2 days on 1.5 mg if you can tolerate

Detailed Answer:
Hello,

Sorry for inconvenience. First of all continue your 0.5 mg klonopin 3 times a day. You have waited for 3 days on this dose. There is very less chance that now you can stabilize on this dose soon. Still you can wait for 2 more days if you can tolerate your current anxiety.

In any case even after 2 days problem persists, take below step or you can move with below step right now if you want to stabilize faster.

Add 0.5 mg klonopin or ativan 1 mg more in daytime dose to current 1.5 mg dose of klonopin. You should be stable in 2 days with this approach. If you are not, add another 0.5 mg klonopin or 1 mg ativan after 2 days. With that dose you must be stable. You should continue the dose for 5 days on which you will become stable. After 5 days you can reduce 0.25% dose of either klonopin or ativan (which you have taken apart from your 1.5 mg klonopin) every 5th day until you reach only remaining dose of 1.5 mg klonopin.

Hope you are clear now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (19 hours later)

what do you think my odds are of stabilizing at just the 1.5mg if I wait it out? do you think that is likely and how long might it take? today is five days with no improvement except for a few hours last night. but today was bad again. I would prefer not to up my klonopin because it is obviously a very addictive drug, and I would run out of pills anyway before I got to my psychiatrist. thanks.

Answered by Dr. Chintan Solanki (10 hours later)

Brief Answer:
klonopin is not addictive as you think

Detailed Answer:
Hello,

You are on 5th day without much progress. You want to wait without increasing the dose. There is no harm in waiting. Only thing is you should be able to tolerate your symptoms. According to pharmacokinetic of klonopin its steady state in body reaches around 7th day. You can wait for 10 days (now for 5 days)maximum otherwise there is no option except increasing the dose.

I want to clarify that klonopin is not so addictive that you think. It is almost has the least dependence potential among benzodiazepine and due to long half life one can stop it safely when it is tapered gradually. If I were your treating doctor I would like to increase the dose for a while as I mentioned.

However your preference, less availability of pills and some improvement last night are favoring that you can wait for more 5 days to see the response.

Please do not think actively about anxiety and medicines, continue meditation, relaxation and deep breathing and keep yourself occupy with some stuff if feasible.

Wish you good health and early stability.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Chintan Solanki (8 hours later)

I am in sixth day with very little or no progress. I tried 1mg Ativan last two days with no help. how would you recommend spacing the extra .5mg dose of klonopin. one every six hours, or two every twelve hours, or some other method? I will stop the Ativan. thank you for your help so far.

Answered by Dr. Chintan Solanki (9 hours later)

Brief Answer:
two every 12 hours

Detailed Answer:
Hi,

I am sorry that you are not much improved yet. It is good that you are ready to increase the dose of klonopin. You can take 1 mg every 12 hours. First dose in morning after waking up. In between if you feel anxiety you can take half (0.25 mg) tablet more.

take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (37 hours later)

I am in the eighth day now, don't get to see my psychiatrist until this coming Friday. I let the anxiety get the best of me yesterday so I took 1mg Ativan with my afternoon dose of .5mg klonopin. I used guided meditation, fell asleep and felt pretty good the rest of the day (no anxiety). slept that night for six hours then toss and turn with minor anxiety, can't fall back asleep. Anxiety creeping back in as day wears on. I am unsure to up-dose, what if it does not work then I am really screwed. I don't know what to do, so many others (benzo-bloggers) saying I should ride it out. I guess I really don't have a question for you unless you have a last bit of wisdom for me. Thank you for all your help and support, you are a good man. I am not sure why Ativan worked yesterday but not the other two days I tried it. Just want this all to go away.

Follow up: Dr. Chintan Solanki (4 minutes later)

if I ride this out wouldn't I stabilize sometime? won't my brain heal itself at 1.5mg eventually?

Answered by Dr. Chintan Solanki (3 hours later)

Brief Answer:
you will stabilize at 1.5 mg but when is difficult to say

Detailed Answer:
Hi,

Thanks for updating me your status. It is good sign that Ativan has given some relief to you. Reason for improvement on 3rd day is likely due to steady level of the drug in the body as well as meditation. Keep continue meditation with Ativan or more 0.5 mg klonopin.
If you ride it out , you will definitely stabilize at 1.5 mg but exactly when is difficult to say. It may take 1 week to 1 month.

As an expert I recommend increasing the dose of benzo for improvement because ultimately you can surely reduce the benzo gradually. As a patient you have right to decide to increase dose or not. If you can tolerate and wait, then there is no harm in not increasing the dose.

Do not think much about medicines. Take decision about final dose and continue meditation. I hope you will feel better before you can consult your psychiatrist.

Wish you early recovery and take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (25 hours later)

Day nine here and sleeping better but soon as I get out of bed anxiety returns. I endure this and later in the day I exercise then take my middle dose of .5mg klonopin and add 1mg Ativan at 3:00pm. I then use meditation and feel pretty good until I go to bed. do you think my anxiety is rebound from my body wanting Ativan, or just anxiety from my messing up my brain with a to rapid weaning from the klonopin? Still holding at 1.5mg klonopin. I am somewhat scared to keep using the Ativan because my psychiatrist put me on the klonopin to get me over Ativan withdrawls I developed from taking it while my Cymbalta dose was upped from 30 to 60mg. I seem to be very sensitive to all of these medications. I don't think I can up my klonopin dose without my doctors approval, and I don't see her until Friday. If she does not agree with you then I would run out of pills and be really screwed.

Answered by Dr. Chintan Solanki (4 hours later)

Brief Answer:
continue ativan till then

Detailed Answer:
Hi,

I can understand your situation. I already told that taking 0.5 mg klonopin or 1 mg ativan more or less same. Your anxiety is likely due to rapid weaning of klonopin and ativan is treating it. Only positive aspect about klonopin is longer half life and that is why it is used in ativan withdrawal in your case. I hope your doctor will also understand your situation and will prescribe what you need. Until you see your doctor, you can continue ativan to control your anxiety.

Take care dear.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Chintan Solanki (19 hours later)

If I use the 1mg Ativan won't it interfere with me stabilizing at just the 1.5mg of klonopin? Like you said it is the same as .5mg klonopin, so essentially I am upping my dosage aren't I? What if my psychiatrist does not allow me to up my klonopin dosage and says to ride it out. Won't I then be in a bad place because I do not have any refills of Ativan. I would love to take the Ativan and stop my anxiety. what do you think would happen if I took it until Friday and then had to stop?

Answered by Dr. Chintan Solanki (5 hours later)

Brief Answer:
no major problem will be there, inform your doctor truth

Detailed Answer:
Hi,

I can understand your apprehension. You have added ativan to control your excess anxiety which is not controlled with current klonopin dose. Inform your doctor about the same. You also should mention that you would like to reduce/stop it as soon as you improve. Considering this aspect your doctor surely will allow refill of ativan or increment in klonopin dose. You should also ask about tapering. This will give a message that you have taken medicines for your problem and you are not abusing it. Your doctor will surely help you positive manner.

In any case if your refill of ativan is not done (and it is rare possibility I guess) and your doctor continue with 1.5 mg klonopin dose there will be some anxiety but it will be not serious and it will go away in 2-3 days. You can take help of ER anytime if you are feeling more problem if this happens.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (38 hours later)

12 days since re-upping my dose, and I decided to tough it out without the Ativan. Still at 1.5mg klonopin. I am feeling about 80% normal in the evenings as long as I meditate and rest in the late afternoon for an hour or more. The first half of the day is more difficult, but I do see very small gains. Do you still think I will get back to normal as you stated earlier at 1.5mg? You said it could take a up to a month, but not sure I want to wait that long. In your opinion do you think I actually need the klonopin in the long run to control my anxiety considering I have never needed benzos long term before. My Cymbalta had performed well for 15 years at just a 30mg dose. Now I am at 60mg Cymbalta. One would think that is all I should need. Klonopin makes my vision blurrier in my right eye, so I would love to be off it, just not sure if I really need it. You have been excellent and I will give you a great review. thanks.

Answered by Dr. Chintan Solanki (12 hours later)

Brief Answer:
no need of klonopin lifelong

Detailed Answer:
Hi,

Thanks again for follow up.

You are improving very slowly. Considering these 12 days progress I still hope that there is chance that you will be completely stable in 1 month.
There is no history of long term use of benzo in past. This favors that you will not need klonopin lifelong. There is no harm in taking it for few weeks/months. You just be careful that do not stop it cold turkey.

Blur vision in one eye can be due to some eye problem rather than side effect of a drug. If at all it is a side effect of a drug it should be bilateral and is seen with cymbalta rather than klonopin. Please discuss this aspect more with your treating doctor.

Please continue non medicinal approaches to control anxiety and try to think actively that you will be stable soon.

Also ask your doctor about CBT- cognitive behavior therapy for anxiety disorder.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (46 hours later)

14 days in and I am feeling better every day. still some very minor anxiety in the mornings. I saw my psychiatrist today who kept me at all the same dosages and said I need the klonopin to control my anxiety and that my anxiety was not caused from a to fast taper. she talked about accepting that I will need the klonopin for a long time which scares me, but that I should accept it. you seem to think otherwise. from our long discussions, what is your long term prognosis for me and the usage of the klonopin? for now I will follow her instructions and try to get back to 100 percent and stay there until maybe I could get a second opinion. thank you so much for all of your help and input.

Answered by Dr. Chintan Solanki (56 minutes later)

Brief Answer:
your long term prognosis seems good

Detailed Answer:
Hi,

This is really good news that you have improved like most of my patients do. I totally agree with your psychiatrist that you need klonopin for long time. It does not mean that for lifetime. In my patients I usually start tapering the drugs after 6 months of 100% improvement and luckily more than 50% can stop gradually in first attempt. By observing the way you have accepted the fact that you need klonopin as well as your concern about long term use I can say your prognosis is good. Just continue meditation, healthy lifestyle and psychotherapy and you can stop the klonopin approximately in 6 to 12 months. Reducing 10-20% dose every time will help to prevent withdrawal and you can stop.

For any further query you are welcome through follow up or you can close the discussion with rating.

In future you can contact me directly with following link:

http://bit.ly/drchintansolanki

by clicking on 'Ask me a question' on same page with three follow up questions. This link will post your query directly to me and I being aware about your history can help you better.

Wish you good health.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Chintan Solanki (2 days later)

day 17 since re-upping klonopin. I forgot to tell you my psychiatrist upped my buspar from 20mg to 30mg a day. well I took the upped dose last night and now I have anxiety back and its all day long today. would upping the buspar cause this? is it normal and how long will it last? or should I stay at 20mg? I feel awful and have bad anxiety. I just don't understand this and I don't know what to do.

Answered by Dr. Chintan Solanki (5 hours later)

Brief Answer:
buspar does not cause this

Detailed Answer:
Hi,

Thanks for follow up.

You are already on buspirone and increasing the dose of that should not cause anxiety.In any case if it is due to that it will go away on its own.

Other possibility is your anxiety problem itself has increased and buspirone will control it soon.

I recommend continuing 30 mg. If at all problem persists for more than 3 days, you should reduce dose to 20 mg.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (21 hours later)

I thought buspirone takes like three weeks to become effective, how could it help me within three days? Or are you saying the anxiety if caused from the buspirone should be gone in that time. I just don't understand how I could have been feeling so much better (but still not 100%) on Friday, and suddenly wake up with bad anxiety on Monday morning, (after taking the extra 10mg of buspirone Sunday night). Tuesday was barely better than Monday.

Answered by Dr. Chintan Solanki (40 minutes later)

Brief Answer:
if it is caused by buspirone

Detailed Answer:
Hi,

Yes you got it right. If it due to buspirone , it will go away in 3 days. If it is not due to buspar, it will take time to control completely with new dose of buspar approximately 2-3 weeks.

Do not think much about drugs, continue relaxation and you will be fine as on Friday.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (23 hours later)

it has been three days and my sleep is worse and anxiety is still bad, I barely can work and all I want all day is to get home and do meditation which helps. You said previously to reduce the buspirone if I was not better in three days back to 20mg. Is this still true? I contacted my psychiatrist and she won't do anything without seeing me, which is 6 weeks. She said I should check myself into a day outpatient mental hospital to get evaluated and stabilize.

Answered by Dr. Chintan Solanki (14 hours later)

Brief Answer:
reduce buspirone

Detailed Answer:
Hi,

I am really sorry for delayed response.

In my opinion you should reduce bupspirone to 20 mg again. If no improvement after that then we can confirm that your basic anxiety problem has been increased and we should add another medicine or add more klonopin for a while. You can inform your doctor about this.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (2 days later)

well it has been 3 days since I reduced the buspirone back to 20mg and I do feel better, the major anxiety is gone (thank goodness) but I am still not well. my sleep is slightly better but I still wake up and toss and turn and have minor anxiety that wears on me. what do you think my chances are of retuning to normal eventually at my present medications after this latest setback? I am not sure I want to miss probably a week of work by going to outpatient mental day classes to get evaluated, but I don't want to wait 5 weeks to see my psychiatrist who won't do anything without seeing me either.

Answered by Dr. Chintan Solanki (11 hours later)

Brief Answer:
increase the dose of klonopin for a while

Detailed Answer:
Hi,

it is good that you have improved of recent problem. Considering your overall history in my opinion there is need of increasing the dose of klonopin for a while. You will of course return to normal without increasing the doe of klonopin but when it is difficult to say. Increasing the dose of klonopin will surely lead to improvement in 4-5 days.

Take care.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar