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Suggest Klonopin dosage

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Posted on Mon, 28 Jul 2014
Question: If I take 4X 05 mg klonopin perday, will the level in blood reach 182 NG/ML? I was stopped for dui
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Answered by Dr. Ashok Kumar (31 minutes later)
Brief Answer:
No it will not reach

Detailed Answer:
Hi,
Thanks for using healthcare magic.

Before I answer your query I assume that you mean to say 4 x 0.5 mg as 5 mg tablet is not available anywhere in the world as per my knowledge. Correct me if I am wrong.

So if I calculate your daily dose it comes 2 mg per day which is a therapeutic dose used in many conditions where klonopin is indicated like seizure disorder, panic attacks and lot more.
With the therapeutic dose the level of Klonopin in serum ranges from 20-80 ng /ml and never crosses 100 ng/ml. Level above 100ng/ml is toxic and anyone with this dose need to visit emergency.

In your case as you are taking 2mg of Klonopin per day, with this dose I expect that your serum level of klonopin will be in the lower range or may be below therapeutic level. So the level of 182 ng/ml is not possible with the current dose. Only exception to this statement is possible when you are having any hepatic impairment which works to eliminate Klonopin from body or other drugs which interfere with its metabolism and elimination.

Having said this I like to point out that your last statement in query is still incomplete. If you need to know more feel free to write back to me. I will be happy to assist you.
Thanks and Regards
Dr Ashok
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Ashok Kumar (1 hour later)
I had 182ng/ml measured. I have been taking drug for 18 years. What about tolerance? Please explain hepatic impairment. Could I have this? What about Klonopin half life? Isn't this cumulative? I have very high tolerance now to klonopin. Could I have 182ng/ml and still experience no effects? What is margin of error in blood analysis? You say it cannot reach this level, but it did and I had no effect. What you are saying is impossible unless an error was made. How reliable are these tests? There must be a margin of error.

if you are saying that 182 ng/ml should have sent me to an ER, and I am saying that I had no effect at all from taking usual dose, then the test was in error. Would you agree?
doctor
Answered by Dr. Ashok Kumar (5 hours later)
Brief Answer:
Yes it may be a error

Detailed Answer:
Hello,
Thanks for reverting back to me.

I agree with you that you got 182ng/ml result from laboratory and I am not doubting about it. It can happen with any test result.
It is cumulative but because of chronic use it does not go upto this level if your liver is doing fine. As I said earlier it may go that level in case of hepatic impairment.
Tolerance is very different issue. It may or may not affect blood level. Tolerance means you need more dose with time to have the same effect that you had with lower doses.
Hepatic impairment means any abnormality in liver which is used to metabolize klonopin. Suppose your liver is not working it will be accumulated in body over time and may cause toxicity and high level. Hepatic impairment can be tested by simple liver function tests in laboratory which detects nine parameters of liver and the report of this test is highly reliable.

Klonopin blood tests are highly unreliable. It may give you both false positive and false negative tests. It is classically said that "even if your test results are different from the normal value, you may not have a problem. Plasma levels of clonazepam can vary as much as tenfold between different patients."

Having no symptoms at this level mean the laboratory report is not a true report. Even the result of test vary from one laboratory to another laboratory. If you are not convinced you can ask for test from different laboratory although it is not a requirement as you do not have any symptoms.

I agree with you that most probably it is a error result.

'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. Prasad
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Follow up: Dr. Ashok Kumar (8 days later)
I was taking antacids. I vaguely recall they have some effect on clonazepam, what might that be?

The clonazepam metabolite amino-clonazepam was measured at 372 ng/ml. Does this mean clonazepam was never or little absorbed by the CNS? How on earth can the metabolite be HIGHER than the measured level of clonazepam itself?

Quote from you: "With the therapeutic dose the level of Klonopin in serum ranges from 20-80 ng /ml"

Too correct myself, I was taking 4 X 1MG per day. This is high as 80 ng/ml, right?

Assuming a dosage "every other day" and the half-life of clonazepam would be 80+40+20+10+5+1.5 etc. This is almost 160ng/ml. If I take it DAILY it would be TWICE that, 316ng/ml. There is something VERY wrong here!

Can hepatic interference be a temporary condition? what prescription drugs, over-the counter vitamins, cold medications, etc. interfere with absorption? I guess there is little research to go by...
doctor
Answered by Dr. Ashok Kumar (8 hours later)
Brief Answer:
Error is most probable cause

Detailed Answer:
Hello,
Welcome back to healthcare magic.

I do not think antacid affect metabolism of clonazepam. They only affect the absorption of clonazepam which generally reduces the total amount reached the circulation resulting in decreased concentration.

It is possible to have more concentration of metabolite as it has longer half life in compare to parent molecule. So finding higher concentration is quite possible for this.

As per your new information of your dose your calculation is perfect and it is possible that this data may be found if we follow mathematics. But unfortunately or fortunately human body is not a mathematical system where 2+2 is never equal to 4.

Regarding your last statement volumes of book already written about hepatic preference and there is no dearth of research but I do not feel that it is possible to cover this topic in this question and answer. The temporary or permanent nature of hepatic impairment depends upon the underlying condition.

Hope I clarified you doubts and if you need to discuss more feel free to write back to me.
Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ashok Kumar

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Suggest Klonopin dosage

Brief Answer: No it will not reach Detailed Answer: Hi, Thanks for using healthcare magic. Before I answer your query I assume that you mean to say 4 x 0.5 mg as 5 mg tablet is not available anywhere in the world as per my knowledge. Correct me if I am wrong. So if I calculate your daily dose it comes 2 mg per day which is a therapeutic dose used in many conditions where klonopin is indicated like seizure disorder, panic attacks and lot more. With the therapeutic dose the level of Klonopin in serum ranges from 20-80 ng /ml and never crosses 100 ng/ml. Level above 100ng/ml is toxic and anyone with this dose need to visit emergency. In your case as you are taking 2mg of Klonopin per day, with this dose I expect that your serum level of klonopin will be in the lower range or may be below therapeutic level. So the level of 182 ng/ml is not possible with the current dose. Only exception to this statement is possible when you are having any hepatic impairment which works to eliminate Klonopin from body or other drugs which interfere with its metabolism and elimination. Having said this I like to point out that your last statement in query is still incomplete. If you need to know more feel free to write back to me. I will be happy to assist you. Thanks and Regards Dr Ashok