Get your Health question answered in 3 easy steps

153 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 18 years

I will be looking into your question and guiding you through the process. Please write your question below.

Can Klonopin and Keppra be taken together?

Answered by
Dr.
Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 2579 Questions

default
Posted on Thu, 21 Aug 2014 in Mental Health
Question: I am taking two antiepilectics, klonopin 1 mg for anxiety and Keppra as mood stabilizer (1000mg). I would like to know if is not too much, i mean, if there is no interference between these two meds, or some kind of interaction0. I was in the same situation some years ago with Klonopin and Lamictal, and sometimes i had something like bradypsiquia or like impaired judgment. The dosage of one of these drugs should maybe be lower?
doctor
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
It is within normal range

Detailed Answer:
Dear XXXXXXX
Welcome back to healthcaremagic.

I do not think there is anything too much with current doses of medication.

The dose of Keppra in your case is in lower side of anti epileptic dose. For an adult male the maximum dose of Keppra for seizure is 3000 mg per day. What you are receiving(1000mg) is the initial or starting dose for seizure activity in adults.

Same thing is applicable with the Klonopin dose. What you are receiving is less than minimum dose for seizure activity. The starting dose of Klonopin for seizures is 0.5 mg three times a day which is 1.5 mg per day much higher than your dose. The maximum dose for seizure in a normal individual is 20 mg per day which can be used safely.

Having said this I like to inform you that the Klonopin dose in your case is in anti anxiety range and at this dose there is no or minimal anti seizure activity. Other than this Klonopin is not used for long term control of seizures as there is development of tolerance to anti seizure activity of Klonopin on long term use.

As the metabolism of Klonopin (Liver enzyme Cyp 3A4) and Keppra is by different routs (hydrolysis and renal excretion) I do not think there is need to lower the dose because of high dose concern.

'Hope I have answered your query. If you have any further questions I will be happy to help".
Thanks


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Ashok Kumar 53 minutes later
Dr. XXXXXXX
You are very clear, so i would like to make some other questions.
Klonopin can be an adjunctive to treatment of OCD, right? Is there a recommended dosage? In any case, 2 mg is not too much, i guess?
My second question is this one. OCD can reappear because of a chemical imbalance in the meds i am taking? I would like to know if there can be an imbalance with amisulpride 100 mg, since at lower doses it seems that there is some dopaminergic (in prefrontal cortex) activity in Solian. I mean, maybe i have some dopaminergic activity but low serotonine levels? Is this possible?
Thanks beforehand, and again for you very clear answers, XXXXXXX
doctor
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
Klonopin is temporary measure in OCD

Detailed Answer:
Dear XXXXXXX
Thanks for compliment and showing interest in my answer.

First of all Klonopin is not a adjunctive to OCD treatment. As OCD is associated with anxiety when you want to resist for some or another compulsion, Klonopin is used as a short term measure till the Anti OCD medicine take their effect on OCD symptoms. As I said earlier what you are receiving is anti anxiety dose. The maximum dose depends on the response. Suppose you are not having anxiety symptoms at 1 mg that mean this is the dose you require. In some cases we may go upto 8mg for short period of time. So it can be said that 2mg is not too high if you require.

The primary medicine for OCD is SSRI (lexapro is one) and few TCAs like clomipramine. For the initial purpose Klonopin is used to control anxiety till these medicine show their effect. It is recommended to discontinue Klonopin once you get desired effect with these medicines.

It is hypothesized that OCD is due to deficiency of serotonin in certain areas of brain which is corrected with help of serotonergic drugs like SSRI and clomipramine.
Amisulpiride does not cause such chemical disbalance that causes OCD. I like to tell you that Solian is used for the treatment of refractory OCD which fails to respond to the first line drugs described above.

What you are asking is theoretically possible but practically does not happen. The reason is involvement of other chemicals in brain other than serotonin which are not known exactly till date.


"If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you good health".

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions
Drug/Medication ,   ,  
Medical Topics

Recent questions on Clomipramine

doctor1 MD

Can gabapentin show up as methadone on a drug test?

doctor1 MD

I have OCD , ADHD , anixiety, and a lot of the time I have no interest in anything and feel tired all day long what is this from

doctor1 MD

I m 32 years old. During sex my sperm release is within two minutes. Please advise what can i do.

doctor1 MD

Hello...I have been on Anafranil for years for racing and intrusive thoughts. It has really helped me with symptoms more than any other drug. But now, I would like to get pregnant. I know that I cannot stay on Anafranil but am worried about stopping it since I have had such success. What type drug could I take that would help the same symptoms, but be safe for baby?

doctor1 MD

I have been taking Clomipramine for OCD for years, as well as Xanax for anxiety and Triazolam for insomnia. In the last year, the obsessive rituals have gotten worse, as well as the internal dialogue, the near-agoraphobia. Recently, my -- highly respected -- psychiatrist added SAD, GAD and clinical depression to his OCD diagnosis. Rather than replace the Clomipramine, which he says is among the best, he prescribed Gabapentin as an add-on (I cannot afford new drugs like Abilify.) The vicious cycle of sleep deprivation worsening the anxiety which worsens the rituals and so on is truly becoming unbearable. My doctor approves of my research and understanding of my disorders and available treatments. If I were your patient, would you recommend different medications(s)? Please keep in mind that I am woefully underinsured, so old-school is more reasonable financially for me.

doctor1 MD

I'm having severe anxiety attacks. I get heart palpitations, I sweat, I even shake sometimes. Is there anything that I can take for this? I already see an MFT for therapy once a week, but I don't know what else to do. I also take clomipramine, which helps most of the time, but I still go nuts several times in a week and I am absolutely frightened about it.

doctor1 MD

I have severe obsessive compulsive disorder. I take daily quetiapine 1200mg, clomipramine 200mg, pregabalin 600mg.



I would prefer an increase in medication. Do you think that is feasible? If yes what medication would be viable. Your personal opinion would be fine here, and just a rough guide on possible suitable medication