Worked The First Time . . . Why Not The Second?

“Confused” writes in with a question . . .

In the past I have been prescribed Klonopin 1mg 3x a day.   This worked well for me until I built a tolerance. Several years have passed, I never experienced addiction or withdralls. I have been prescibed this medicine again for panic attacks, anxiety & being social phobic. Klonopin work for 2 days at .5mg, my Dr. changed the medication to Xanax at .25mg same thing worked once then completely ineffective even when we kicked it up a notch. Is there any reason why these meds will no longer work for me? Or are there some better than others? I just do not understand this. Please advise?

While you are not completely clear about the dose of Klonopin that was most recently started (0.5 daily????   0.5 3x daily???) it seems likely from your language that it was a lower dose than what was needed years ago.  Sound like your doc is being conservative.  Likewise with the switch to Xanax.  The 0.25 mg dose is very low.  Even if you “kick it up a notch” it is still low.  Judging form the information at hand, I would guess two possible reasons for your lack of benefit:

1.     You need more.  If 3 mg daily was needed a few years ago, it is likely that 3 mg will be needed now.  Since you did not have issues with addiction or withdrawal before, I would suggest that you and your doctor be more aggressive.  Going up to 2 or 3 mg daily does not bother me.  Going above that is when I start to have red flags sproing up.  But, some people need more.  Sounds like you might be one of those people.  

2.      Generic woes . . . I know, I know . . . all generics are supposed to be the same and they are all supposed to be equivalent to brand name . . . la ti da . . . how many stories have YOU heard about this not being true???  If you really want to see if it works, try a brand name.  For some it is way too pricey . . . but what price would you pay for peace of mind?  Whenever I have a patient on generic medicines and I really need to make sure the medicine does not work, I will switch over to brand name for a month or two.  If it doesn’t work, then the medicine clearly will not work.

If you poke around on this site and others, you will certainly see that medicine like Klonopin is not the only kind of medicine for treating anxiety.  I would certainly suggest that you try one of the antidepressants (either in conjunction with or instead of the benzos).  Remember to talk to your doc about all the safety issues involved in use of both kinds of medicines.

—Dan Hartman, MD

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