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Dr. Andrew Rynne

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Can Lexapro and Klonopin be taken together for treatment of OCD?

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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 2653 Questions

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Posted on Thu, 21 Aug 2014 in Eating Disorders
Question: I have some symptoms of OCD back. My psychiatrist wants to rise lexapro 2,5 mg to something more, but i am poor metabolizer cyp2c19 and mild cyp 2d6. How far can i go if i want to rise lexapro with my psychiatrist?
I fear interactions between lexapro and klonopin by cyp3a4.
So, i feel insecure...
Thanks beforehand XXXXXXX
doctor
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
It can be increased safely upto 10mg per day

Detailed Answer:
Dear XXXXXXX
Thanks for posting a wonderful query at healthcaremagic.

I understand your concern at level of Cyp450 3A4 between Klonopin and Lexapro.

As you are aware that the maximum dose of Lexapro is 20 mg per day can be used safely in majority of individuals. It is metabolized by CYP2D6, 2C19, and 3A4. Because escitalopram is metabolized by multiple enzyme systems, inhibition of a single enzyme may not appreciably decrease escitalopram clearance.

Secondly even in patients with drug interactions there are no major problem reported because the Lexapro have high therapeutic index (indication of safety in high doses).

Having said this you can allow your psychiatrist to increase the dose of Lexapro to 5mg at first and then observe effects and side effects over a period of time. They show some improvement in period of two weeks and if you and your psychiatrist have some observation that you are improving than you can continue at 5 mg for long period.
In case 5mg dose does not yield results than it can be increase to 10mg provided there are no intolerable side effects.

'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. Yogesh D
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Follow up: Dr. Ashok Kumar 32 minutes later
Dr. XXXXXXX
Thank you very much. I have just a last question: lexapro can be increased at the same time than klonopin? In this case, my psychiatrist would like to have klonopin to avoid during some time the symptoms of a higher dose of lexapro (nervousness maybe).
Thanks beforehand, XXXXXXX
doctor
Answered by Dr. Ashok Kumar 9 minutes later
Brief Answer:
Yes it can be but to be avoided

Detailed Answer:
Dear XXXXXXX
Welcome back and thanks for following me.

This can be increased at the same time but I usually avoid because of the following reasons.
1. After concomitant increase of two doses I am not sure which drug caused the effect. In such scenario it is difficult on later part of treatment to decrease the dose of one or another medicine when you feel that you need to reduce the dose of one or another medicine.

2. The second reason is side effects. Many of medicine have similar side effects. In case one develops excessive sedation with increase of Klonopin and lexapro, I can not determine which is the culprit drug and that complicates the management of he patient.

If I would have been your doctor I liked to increase the dose of one medication at a time. His decision to increase Klonopin at first is right as your nervousness seems more bothering to him.


"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. Bhagyalaxmi Nalaparaju
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