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Suggest Alternative Medication To Replace Clonazepam For Anxiety
Question: My psychiatrist is withdrawing me from Clonazepam. It was tried twice before not successfully. Is there some medication not addictive that could take its place. I have high anxiety.
Brief Answer:
librium/ oxazepam with escitalopram or sertraline
Detailed Answer:
Hello,
Its good that your psychiatrist is trying to stop clonazepam as it is harmful for anyone when used on long term basis and espically someone of your age. It is liver toxic in long term.
You have not specified the dosage of clonazepam you were taking and also the reason for using geodon . Geodon is an anti psychotic and is not recommended for withdrawing clonazepam. So , im not sure of the role of geodon in your case.
There are some drugs which can be used for tapeing clonazepam in general clinical practice.
I have used librium (chlordiazepoaxide) quite successfully in many similar cases. This is also a benzo but with long half life amd so dosent have significant addiction potential.
We can also use zolpidem (provided you are using clonazepam for sleep).
Many times laorazepam is also recommended for tapering clomazepam as it is also a long half life benzo.
Some non sedative molecules like- oxazepam is also used-- this will take care of anxiety and can be safely given in someone with liver dysfunction. You have to see if this is available in your area. It is a commonly used drug for deaddiction.
So, depending on the availability you can go for any of the above choices.
I would recommend - librium or oxazepam as initial choices.
Along with meds- please add an anti anxiety drug for sometime for better relief and early withdrawal from benzos. Molecules like: escitalopram or sertraline have good anti anxiety action and are safe choice at any age group.
Good luck and have a speedy recovery..
Please ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychaitry
librium/ oxazepam with escitalopram or sertraline
Detailed Answer:
Hello,
Its good that your psychiatrist is trying to stop clonazepam as it is harmful for anyone when used on long term basis and espically someone of your age. It is liver toxic in long term.
You have not specified the dosage of clonazepam you were taking and also the reason for using geodon . Geodon is an anti psychotic and is not recommended for withdrawing clonazepam. So , im not sure of the role of geodon in your case.
There are some drugs which can be used for tapeing clonazepam in general clinical practice.
I have used librium (chlordiazepoaxide) quite successfully in many similar cases. This is also a benzo but with long half life amd so dosent have significant addiction potential.
We can also use zolpidem (provided you are using clonazepam for sleep).
Many times laorazepam is also recommended for tapering clomazepam as it is also a long half life benzo.
Some non sedative molecules like- oxazepam is also used-- this will take care of anxiety and can be safely given in someone with liver dysfunction. You have to see if this is available in your area. It is a commonly used drug for deaddiction.
So, depending on the availability you can go for any of the above choices.
I would recommend - librium or oxazepam as initial choices.
Along with meds- please add an anti anxiety drug for sometime for better relief and early withdrawal from benzos. Molecules like: escitalopram or sertraline have good anti anxiety action and are safe choice at any age group.
Good luck and have a speedy recovery..
Please ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychaitry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am on 1mg. clonazepan for anxiety not sleep. I take it in the morning. I was on 2mg. and have gone done to 1mg. The withdrawal from clonazepam has been attempted two times in a hospital setting. They brought me down to .5 mg. I went home on this amount. A few days later I had hallucinations & had to go back into the hospital. I ended up with 1 mg. clonazepam. I can't seem to go to .5mg. My doctor wants me off entirely because of the France/quebec study associate Clonazepan use with Altzheimers. I do have to function however. She is doing this detox with me at home. I am very leery of further detox. because of my experience. The hallucinations were horrible.
My psychiatrist use risperdone which cause tremendous weight gain. I told her I do not want a weight gain. That is why she wants to use Geodon. It does not cause weight gain. I am bipolar. I take Venlafaxine 75 mg. 3X a day. As I said I am taking 1mg. of cloneazepam. I am doing very well. No doctor has seen me manic including my present doctor. I believe I was misdiagnosed. I definitely have depression. I do not see manic either. i hope this information helps you. Thank you, XXXX
My psychiatrist use risperdone which cause tremendous weight gain. I told her I do not want a weight gain. That is why she wants to use Geodon. It does not cause weight gain. I am bipolar. I take Venlafaxine 75 mg. 3X a day. As I said I am taking 1mg. of cloneazepam. I am doing very well. No doctor has seen me manic including my present doctor. I believe I was misdiagnosed. I definitely have depression. I do not see manic either. i hope this information helps you. Thank you, XXXX
Brief Answer:
can take quetiapine or resperidone..
Detailed Answer:
Hello,
One miligram of clonazepam is quite a low dose but I think your system is very sensitive to develop its withdrawal effects.
Also, now I know - you were put on geodon to handle those halllucinations which you developed during reduction of dosage.
If geodon was not effective- I would recommend using resperidone or quetiapine. Quetiapine is very effective in managing anxiety component along with hallucinations which might come up. It is safe for females and also good in old age. This will be a better choice compared to geodon. You can discuss with your doctor about the above drugs.
You were using clonazepam in morning- and not for sleep. This makes things easier.
You should try to take lots of water and eat more veggies and salads/ sprouts during withdrawal. Fruits and juices also help.
I even teach deep breathing and muscular relaxation before hand to my patients to handle the possible anxiety they might develop later in withdrawal.
Hope the reply is useful. Do feel free to ask more questions for clarifications.
Dr. Manisha Gopal
MD Neuropsychiatry
can take quetiapine or resperidone..
Detailed Answer:
Hello,
One miligram of clonazepam is quite a low dose but I think your system is very sensitive to develop its withdrawal effects.
Also, now I know - you were put on geodon to handle those halllucinations which you developed during reduction of dosage.
If geodon was not effective- I would recommend using resperidone or quetiapine. Quetiapine is very effective in managing anxiety component along with hallucinations which might come up. It is safe for females and also good in old age. This will be a better choice compared to geodon. You can discuss with your doctor about the above drugs.
You were using clonazepam in morning- and not for sleep. This makes things easier.
You should try to take lots of water and eat more veggies and salads/ sprouts during withdrawal. Fruits and juices also help.
I even teach deep breathing and muscular relaxation before hand to my patients to handle the possible anxiety they might develop later in withdrawal.
Hope the reply is useful. Do feel free to ask more questions for clarifications.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had the halucinations years ago. The psychiatrist handling the case upped the clonazepan to 1mg.
My current psychiatrist likes to use antipsychotic medication. Why I don't know. I have not have good results with antipsychotic medication. She is now putting me on Geodon because I will not have weight gain which I had with Risperdahl. This psychiatrist feels the Geodon will treat anxiety. She is not a psychopharmacologist. I tried to change doctors but the doctor who is a psychopharmacologist doe not take Medicare nor Emblem my seconday insurance. I live on LI NY.
Bottom line I don't have confidence in this doctor. I feel based on one study (France/Quebec study) is not enough to take me off 1 mg clonazepam. Have you heard of this study which links benzo use to Altzheimer. I have asked 2 doctors who I know. One is my endocrinologist who said there is definitely not enough research and my internist who did not know the study but said I have to be able to function. With anxiety, which is social anxiety, I am not able to function Do you know this study? What are your thoughts?
Please Dr. XXXXXXX my clarified response to you. I was diagnosed as bipolar however no doctor has seen me manic. I have not seen me manic not have my friends I have depression. My current doctor has not seen me manic. I tale 3 tabs of Venlafaxine 75mg. a day to handle depression My psychiatrist likes to prescribe antipsychotic to prevent hospitalization. I do not react well to them. I hope this clarifies all the issues. I realize it is complex.
Thank you. XXXX
My current psychiatrist likes to use antipsychotic medication. Why I don't know. I have not have good results with antipsychotic medication. She is now putting me on Geodon because I will not have weight gain which I had with Risperdahl. This psychiatrist feels the Geodon will treat anxiety. She is not a psychopharmacologist. I tried to change doctors but the doctor who is a psychopharmacologist doe not take Medicare nor Emblem my seconday insurance. I live on LI NY.
Bottom line I don't have confidence in this doctor. I feel based on one study (France/Quebec study) is not enough to take me off 1 mg clonazepam. Have you heard of this study which links benzo use to Altzheimer. I have asked 2 doctors who I know. One is my endocrinologist who said there is definitely not enough research and my internist who did not know the study but said I have to be able to function. With anxiety, which is social anxiety, I am not able to function Do you know this study? What are your thoughts?
Please Dr. XXXXXXX my clarified response to you. I was diagnosed as bipolar however no doctor has seen me manic. I have not seen me manic not have my friends I have depression. My current doctor has not seen me manic. I tale 3 tabs of Venlafaxine 75mg. a day to handle depression My psychiatrist likes to prescribe antipsychotic to prevent hospitalization. I do not react well to them. I hope this clarifies all the issues. I realize it is complex.
Thank you. XXXX
Brief Answer:
buspirone & quetiapine will be helpful
Detailed Answer:
Hello,
So, there are several things going on simultaneously in your case which were not clear in initial query...now things make more relevance.
1. Regarding bipolar -- anyone to be diagnosed of bipolar disorder must have atleast one manic episode. If not, then he can never have bipolar disorder. I dont know why they disgnosed you this but anyhow you were never treated with mood stabilizers, so we need not panic .
2. Yes, the french study and many others are there which say that benzo have an anxiety relieving role in alzhimers but I could not find any meta analysis to conclude. Even buspirone is highly recommended for the same purpose.
3. I can see that you had issues with resperidal in past, but the weight gain and other issues crop up at high dosage strength...however, as I said- quetiapine will be a better choice as it is a milder antipsychotic and also has antianxiety action. Please discuss this with your doctor once. Its good and we can use it in you. There is hardly any side effect...and weight gain is seen at high dosage.
4. You take venalafaxine 75mg thrice a day. It suggests that you probably not only have social anxiety but generalised anxiety disorder as well. Quetiapine can be used nicely along with venalafaxine without any harm.
5. I understand your fears with anti psychotic use but let me tell you that these drugs are very good and even life saving in many cases...having bad experience with one dosent mean that all others are also harmful...atleast give it a try..it may help you! Also, you are on high dose of venalafaxine and it should not be raised further, so we need another drug in any case..
I have tried to answer your queries. Please feel free to ask for more clarifications.
wish you good luck.
Dr. Manisha Gopal
MD Neuropsychiatry
P.S. - please get TSH and Vit. B12 levels done.
buspirone & quetiapine will be helpful
Detailed Answer:
Hello,
So, there are several things going on simultaneously in your case which were not clear in initial query...now things make more relevance.
1. Regarding bipolar -- anyone to be diagnosed of bipolar disorder must have atleast one manic episode. If not, then he can never have bipolar disorder. I dont know why they disgnosed you this but anyhow you were never treated with mood stabilizers, so we need not panic .
2. Yes, the french study and many others are there which say that benzo have an anxiety relieving role in alzhimers but I could not find any meta analysis to conclude. Even buspirone is highly recommended for the same purpose.
3. I can see that you had issues with resperidal in past, but the weight gain and other issues crop up at high dosage strength...however, as I said- quetiapine will be a better choice as it is a milder antipsychotic and also has antianxiety action. Please discuss this with your doctor once. Its good and we can use it in you. There is hardly any side effect...and weight gain is seen at high dosage.
4. You take venalafaxine 75mg thrice a day. It suggests that you probably not only have social anxiety but generalised anxiety disorder as well. Quetiapine can be used nicely along with venalafaxine without any harm.
5. I understand your fears with anti psychotic use but let me tell you that these drugs are very good and even life saving in many cases...having bad experience with one dosent mean that all others are also harmful...atleast give it a try..it may help you! Also, you are on high dose of venalafaxine and it should not be raised further, so we need another drug in any case..
I have tried to answer your queries. Please feel free to ask for more clarifications.
wish you good luck.
Dr. Manisha Gopal
MD Neuropsychiatry
P.S. - please get TSH and Vit. B12 levels done.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Serequel is known to cause weight gain in the stomach area & you cannot lose it. It seems to handle anxiety. I don't think this is the answer.
I was put on Buspar years ago & it did not work. My anxiety is debilitating.
I didn't understand your comment on the France/Quebec study. Do you feel based on this one study I should go off 1 mg. clonazepam right now or do you think more study is needed?
Thank you so much for your replies & patience. Since you are a pyschomarmacologist, I value your opinions. Waiting to hear from you, XXXX.
I was put on Buspar years ago & it did not work. My anxiety is debilitating.
I didn't understand your comment on the France/Quebec study. Do you feel based on this one study I should go off 1 mg. clonazepam right now or do you think more study is needed?
Thank you so much for your replies & patience. Since you are a pyschomarmacologist, I value your opinions. Waiting to hear from you, XXXX.
Brief Answer:
yes, quetiapine is not ideal but suitable for you
Detailed Answer:
Hello,
Nice to hear from you and I can see that you read and then believe and just dont follow what anyone tells you to do.
Now the answers:
1. I have also explained the fact that quetiapien leads to weight gain but another fact is that it would do so at a high dose and not 25-75mg...In your case I hope that a low dose would suffice for both hallucinations and anxiety. I know that it is not the ideal option in antipsychotics but according to me it is one of the good we have around- safe for you and suitable for the cause .
In any case -when we decide the drug to be given we compare the risk and benefit and then prescribe. Whenever the benefit out weighs the risk and drug is necessary -we start it.
So, I would still recomemend that you atleast discuss this option with your treating team.
2. And yes, I feel that only on the basis of one study nothing can be decided. We need proper cross sectional studies or best meta analysis to recah to a conclusion. If this sounds technical- then in simple terms: only one study dosent carry much weight.
Hope the reply helps you.
Please ask more queries if there are any doubts.
Dr. Manisha Gopal
MD Neuropsychiatry
yes, quetiapine is not ideal but suitable for you
Detailed Answer:
Hello,
Nice to hear from you and I can see that you read and then believe and just dont follow what anyone tells you to do.
Now the answers:
1. I have also explained the fact that quetiapien leads to weight gain but another fact is that it would do so at a high dose and not 25-75mg...In your case I hope that a low dose would suffice for both hallucinations and anxiety. I know that it is not the ideal option in antipsychotics but according to me it is one of the good we have around- safe for you and suitable for the cause .
In any case -when we decide the drug to be given we compare the risk and benefit and then prescribe. Whenever the benefit out weighs the risk and drug is necessary -we start it.
So, I would still recomemend that you atleast discuss this option with your treating team.
2. And yes, I feel that only on the basis of one study nothing can be decided. We need proper cross sectional studies or best meta analysis to recah to a conclusion. If this sounds technical- then in simple terms: only one study dosent carry much weight.
Hope the reply helps you.
Please ask more queries if there are any doubts.
Dr. Manisha Gopal
MD Neuropsychiatry
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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