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Can I Change From One Benzos[alprazolam] To Another[clonazepam] Within 3days

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Posted on Sat, 13 Jun 2020
Question: can I change from one benzos[alprazolam] to another[clonazepam] within 3days without any ill effect?
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
can I change from one benzos[alprazolam] to another[clonazepam] within 3days without any ill effect?
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (55 minutes later)
Brief Answer:
Can be done with equivalent dose

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

First of all I like to inform you that it can be done but not with zero effect. There will be always some discomfort on switching from one benzodiazepine to another. This is because every medication have different metabolism and half life. For example half life of Xanax is just 7-10 hours in compare to clonazepam which have half life of 20-30 hours. However practically speaking most patients transit from one to another benzodiazepine with little discomfort.

While changing from one BZD to another please make sure to use equivalent dose. For example there will be need for roughly double dose of clonazepam when you shift from alprazolam.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (0 minute later)
Brief Answer:
Can be done with equivalent dose

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

First of all I like to inform you that it can be done but not with zero effect. There will be always some discomfort on switching from one benzodiazepine to another. This is because every medication have different metabolism and half life. For example half life of Xanax is just 7-10 hours in compare to clonazepam which have half life of 20-30 hours. However practically speaking most patients transit from one to another benzodiazepine with little discomfort.

While changing from one BZD to another please make sure to use equivalent dose. For example there will be need for roughly double dose of clonazepam when you shift from alprazolam.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (3 hours later)
alprozalam was 0.5 2 times a day and clonazepam is 1mil 2 times a day and neither one is working as intended do not want to overdose by taking more than prescribed.My anxiety has reach its peak.I will be seeing a mental health dr.in 10 days.I just want to get some relief in the meantime. What do you suggest beside going to ER. As I mentioned on the previous question the I am also taking paxil and mirtazapine.Your input will greatly be appreciated.Do not want to badger my pcp any more he is not a mental health doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
alprozalam was 0.5 2 times a day and clonazepam is 1mil 2 times a day and neither one is working as intended do not want to overdose by taking more than prescribed.My anxiety has reach its peak.I will be seeing a mental health dr.in 10 days.I just want to get some relief in the meantime. What do you suggest beside going to ER. As I mentioned on the previous question the I am also taking paxil and mirtazapine.Your input will greatly be appreciated.Do not want to badger my pcp any more he is not a mental health doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (16 minutes later)
forgot to mentioned that I had Xanax withdrawl before for stopping it too soon.
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
forgot to mentioned that I had Xanax withdrawl before for stopping it too soon.
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (7 hours later)
Brief Answer:
Mirtazepine can be increased

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

Considering the fact that you have anxiety disorder and using two proper antidepressants and xanax underlies the fact that we need to be slightly more aggressive in treatment of crippling problem.

First of all I like to inform you that Benzodiazpines are just for temporary relief and we can not rely on them for long term management of anxiety disorder due to obvious risk of addiction, falls and fractures and cognitive limitations. Having said this it can be suggested to go with slightly higher dose in addition to prescribed dose on need basis.

Secondly in my opinion Paxil is good molecule for anxiety disorders but have limited response/side effects when it comes about geriatric population. I feel changing to some safer and more effective molecule such as TCAs/Pristiq should be considered.

For time being the dose of mirtazepine can be increased as the prescribed dose is too low to be effective. The effective dose for most individuals with anxiety disorder falls between 30-60 mg per day.

Regarding withdrawal symptoms with xanax it is expected that clonazepam will take care for most of them .

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (0 minute later)
Brief Answer:
Mirtazepine can be increased

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

Considering the fact that you have anxiety disorder and using two proper antidepressants and xanax underlies the fact that we need to be slightly more aggressive in treatment of crippling problem.

First of all I like to inform you that Benzodiazpines are just for temporary relief and we can not rely on them for long term management of anxiety disorder due to obvious risk of addiction, falls and fractures and cognitive limitations. Having said this it can be suggested to go with slightly higher dose in addition to prescribed dose on need basis.

Secondly in my opinion Paxil is good molecule for anxiety disorders but have limited response/side effects when it comes about geriatric population. I feel changing to some safer and more effective molecule such as TCAs/Pristiq should be considered.

For time being the dose of mirtazepine can be increased as the prescribed dose is too low to be effective. The effective dose for most individuals with anxiety disorder falls between 30-60 mg per day.

Regarding withdrawal symptoms with xanax it is expected that clonazepam will take care for most of them .

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (15 hours later)
can Benadryl be use together with a BZD for sleep?
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
can Benadryl be use together with a BZD for sleep?
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Follow up: Dr. Dr. Ashok Kumar Choudhary (3 hours later)
how is BZD removed from your system without tapering?
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
how is BZD removed from your system without tapering?
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Follow up: Dr. Dr. Ashok Kumar Choudhary (12 minutes later)
I asked before why my clonazepam is not working....you indicated to upper the dose.I upper the dose 1 mil to no avail.Is there any vitamin you have to take with this med. for it to work
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
I asked before why my clonazepam is not working....you indicated to upper the dose.I upper the dose 1 mil to no avail.Is there any vitamin you have to take with this med. for it to work
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (5 hours later)
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

Addition of benadryl for sleep with BZD increases high chance of side effects including fracture and falls and urinary retention so should be avoided as far as possible. Even if it becomes necessary for some reason should be under direct supervision of medical expert.

Removal of BZD without tapering can cause severe withdrawal symptoms if the duration of use was more than 4 weeks. In case duration was less than 4 weeks you can expect mild withdrawal symptoms. In case duration was less than two weeks than we can expect negligible withdrawal symptoms for majority of subjects.

There is no medicine which works for 100% of patients and same may be true for clonazepam in your case. There is no definite cause can be established but the likely causes include fast metabolism of drug, misdiagnosis, atypical anxiety, co morbid disorders among others.

|In my opinion you need to see your doctor again as unresponsiveness of medication indicates there is something more rather than the anxiety alone.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (0 minute later)
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

Addition of benadryl for sleep with BZD increases high chance of side effects including fracture and falls and urinary retention so should be avoided as far as possible. Even if it becomes necessary for some reason should be under direct supervision of medical expert.

Removal of BZD without tapering can cause severe withdrawal symptoms if the duration of use was more than 4 weeks. In case duration was less than 4 weeks you can expect mild withdrawal symptoms. In case duration was less than two weeks than we can expect negligible withdrawal symptoms for majority of subjects.

There is no medicine which works for 100% of patients and same may be true for clonazepam in your case. There is no definite cause can be established but the likely causes include fast metabolism of drug, misdiagnosis, atypical anxiety, co morbid disorders among others.

|In my opinion you need to see your doctor again as unresponsiveness of medication indicates there is something more rather than the anxiety alone.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (10 hours later)
had an anxiety relapse after 12 years.At the time I was treated with Lexapro and Xanax until the Lexapro would kick in.After the Lexapro kicked in I kept taking the Xanax on and off for insomnia and obviously I became dependent to it.That was the reason for my previous question.Should I keep taking the previous mentioned medication?
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
had an anxiety relapse after 12 years.At the time I was treated with Lexapro and Xanax until the Lexapro would kick in.After the Lexapro kicked in I kept taking the Xanax on and off for insomnia and obviously I became dependent to it.That was the reason for my previous question.Should I keep taking the previous mentioned medication?
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (5 minutes later)
Brief Answer:
Xanax is not safe for geriatric population

Detailed Answer:
Hello,
Thanks for follow up.

I am sorry to know that the xanax was used on and off for a longer duration than the recommended duration leading to probably tolerance and poor response with the previous dose.

In the current situation I feel there is definite need to discontinue the xanax as there is high possibility to cause dependence and withdrawal symptoms. However this should not attempted before control of anxiety with definitive treatment such as Lexapro. I mean to say that xanax can be used for time being but effort should be made to discontinue as soon as possible.

I hope this answers you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (0 minute later)
Brief Answer:
Xanax is not safe for geriatric population

Detailed Answer:
Hello,
Thanks for follow up.

I am sorry to know that the xanax was used on and off for a longer duration than the recommended duration leading to probably tolerance and poor response with the previous dose.

In the current situation I feel there is definite need to discontinue the xanax as there is high possibility to cause dependence and withdrawal symptoms. However this should not attempted before control of anxiety with definitive treatment such as Lexapro. I mean to say that xanax can be used for time being but effort should be made to discontinue as soon as possible.

I hope this answers you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (4 minutes later)
I will still consult with a mental health doctor on this matter.
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Follow up: Dr. Dr. Ashok Kumar Choudhary (0 minute later)
I will still consult with a mental health doctor on this matter.
Answered by
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Dr. Dr. Ashok Kumar Choudhary

Psychiatrist

Practicing since :2000

Answered : 3355 Questions

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Can I Change From One Benzos[alprazolam] To Another[clonazepam] Within 3days

can I change from one benzos[alprazolam] to another[clonazepam] within 3days without any ill effect?