here's a fact often overlooked or ignored by both the patient and the practitioner. it's in the prescribing literature so you can check for yourself any time.
clonazepam is a mighty drug. [that's not in the literature, that's my opinion]. it is a very potent antiepileptic, and you will see that it's index spans far and wide, with 24mg as a daily dose listed as one that should not be exceeded. [for the sake of less bickering in response to the 24QD MAX, you can go through the lit and see that from the early days , when it was not approved for anxiety disorders (and fun fact; called Clonopin) but only for control of epilepsy and maint. therapy, the number fluctuated by a few mgs every couple of years, so there. ok]
back to the topic. clonazepam is typically not sedating. for the benzodiazepine-naive patient, a single dose of 20 will usually cause some mild 'inebriation' which is not noticed by the patient but more often noticed by those observing him [that is, you don't feel much from it in terms of what is usually deemed euphoria or sedation or comatose crap, drooling , falling over, etc...but those witnessing you post a 30mg ingestion will see that you're 'not quite yourself', meaning you will act like a moron and usually fall asleep intermittently only waking up to forget that you fell asleep, do you understand?].
once having misread/misinterpreted the lit, i ingested those 24mg at once, 'felt quite fine', was very very angry at the roach corporation for their placebo pill, outraged in fact....three days later my mother explained to me that
1. three days passed since my last megadose [i thought less than 8 hours at most passed]
2. my psychiatrist, upon finding out about my decision to change dosing regimen from 4mg a day [a mighty dose also] to the absolute and dangerous maximum, made a house-call, since i apparently called him and left a message, an angry one with much cursing...and then about five more since i would keep forgetting what i did a few hours ago [one message was in swedish, which i barely speak, for instance], but i was so sweetly caught up in a comatose slumber when he rang the bell, that he could not get to me to stick me with some flumazenil [benzo killer drug for when you do silly-willy things with potentially fatal drugs and dose adjustments], i did not open the door as i was transitioning between universes, so to speak. But I woke up fine, saw the bottle, saw it was not quite full but almost depleted, recalled my actions, called him to give him a dose of my fury, wrote a letter to the roach corp which looks like a poltergeist wrote it......etc etc etc.
ANXIOLYTIC effect from benzos does NOT go away with time. Sedating benzos lose sedating properties with time, if you take them like a good little boy, same time every day for a month...others will stop working in a few weeks, others in a few months...for some people this does not even apply - it's all based on your individual chemical psyche, so to speak. Yet, triazolam will usually, almost always and inevitably, stop working as a sleepy-med if taken nightly rather soon, compared to others. There's seldom an exception in the case of triazolam.
PROBLEM - clonazepam is not really effective [wait, don't hate yet] for Generalized Anxiety Disorder. But it's used for said illness as often as diazepam and alprazolam and clorazepate and chlordiazepoxide and the others, depending on which land you reside in.
- clonazepam is not indicated and never was indicated [correct me if im wrong, i often am] BY THE FDA to be used as maintenance therapy for GAD.
- 'off label' use of clonazepam for GAD is all the rage because it is popular to treat it like alprazolam in terms of dosing [that is, max 4mg a day...but typically you will very rarely find any practitioner in their right mind exceeding this dose to reach 10 as with alprazolam MAX dose suggestion, in the treatment of GAD in off-label mode]
- 'all the rage' has historically proven to reverberate and strike back with a vengeance in some unpleasant way or other, and here, we see a very common dilemma; a person asking 'how much do i need (to feel something)'.
PROBLEM 2 - Clonazepam is one of those odd little tigers that, as we will find in the Holy Reference, is more effective for its indicated use in maintenance therapy for PANIC DISORDER in the dose of 0.5mg a day MAX. But not as a single dose [for that we must wait for KLONOPIN XR to surface somehow]...as an AM dose and second dose to be taken at bedtime [0.25mg q 12h]. Many require more, many benefit from 0.25 bid, many frustrated people simply exit on valium or 'the drugs you can feel' because in anxiety disorders, that is 50% or more of the therapeutic manifestation in terms of effectiveness.
SOLUTION - Believe. If you have Panic Disorder, try the 0.25 bid regimen. If you also have GAD, talk very politely and firmly with your doctor about addressing the GAD with a medication approved for GAD. 0.25mg in the morning of KL-NOPIN would not send many doctors reeling into a tirade [as i do now] if you request or suggest or hint at another benzodiazepine approved for GAD, as the second dose of KL-NOPIN is taken at bedtime and theres no danger of stumbling and falling into a pit to your death as a result of combining benzos, as many practitioners without experience believe [that is, when you sleep there's less of a chance of falling down upon not doing anything].
DEMI-ANSWER - you would need, most likely a dose that i cannot mention without a minyan present, to feel a delicious and grandiose buzz of euphoria and euthymia and jello-like-myorelaxation. Yet, it IS a 'street drug' and many people exist who use it for fun/pleasure, and since they're paying a pretty penny for it, evidently it is a euphoriant to some, I would even say many. Is it placebo euphoria? Most likely, but placebo euphoria is euphoria, so it doesn't matter in this case.
TRIVIA - [i might be wrong but...] the 0.5 mg tablet does not come in a fomulation that is scored. Implications; i imply nothing. But it's odd.
The KLONOPIN WAFER, comes in 0.25mg form. Discuss.
WARNING – a potent drug used in management of certain epileptic episodes, you put yourself in great danger when you ingest a dose higher than the one you are prescribed, be it for Panic Disorder, GAD, PTSD, anything in the anxiety d/o spectra, as well as for maintenance of and control of symptoms in seizure disorders [same holds for abrupt cessation or abatement of dose, including down-titration in a rushed manner. Clonazepam is a SLOW drug, with slow onset, and long duration of action, a pretty long t ½ elimination – In essence, if you don’t FEEL it in you and it don’t make you happy, remember it IS in you, and it’s working very effectively most of the time at very low doses. 4mg a day is a common dose, but there is no explanation for why this practice is popular. Neurologists will gladly lecture you on the matter. Dosing is tricky with this one, but BE VERY CAREFUL. Suddenly wanting to be chillin and illin on 40mg when you take 1mg every now and then is akin to Belorussian Roulette. Note that please, and spread the info to your teenybopper loved ones who don’t understand this concept, nor should they, just scare them for now so as to deter them from the idiotic tendency.
[sorry for the length, i have issues with graphomania when it comes to medicine. a sophomoric quality i cannot control]
- isqander
