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Dr. Andrew Rynne

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Exp 50 years

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Can Klonopin and Keppra be taken together?

Answered by
Dr. Ashok Kumar


Practicing since :2000

Answered : 2653 Questions

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?
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
It is within normal range

Detailed Answer:
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".

Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Ashok Kumar 53 minutes later
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
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
Klonopin is temporary measure in OCD

Detailed Answer:
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

The User accepted the expert's answer

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