Question:
I was on xanax (regular type) for anxiety briefly before switching to
Klonopin 1mg daily about four years ago. A few months ago I started
to have breakthrough anxiety which I treated, as needed, with small
doses of xanax (.25mg) - all under a pdoc's supervision, of course.
Seven months ago, at my med check, she gave me a brochure on Xanax XR
and told me a switch might be in order. At my med check last month,
we agreed that I would try Xanax XR at 2mg daily.
I have always been the type who is asleep immediately upon "head
hitting pillow", but since I have been on the Xanax XR, I have
experienced pretty severe insomnia. After about three nights of very
poor restless sleep, I decided to go back to "regular" Xanax for a day
to see of there was a change. The night after taking the "regular"
xanax throughout the day (.5 early am, .5 around noon, .5 around 5pm
and .25 at bedtime) I had a good night's sleep. Went back on XR next
day and insomnia reappeared.
Except for the insomnia, I have been very pleased with the XR. It has
controlled my anxiety very well and feel it has helped with my
depression, which I am not taking medication for.
Have a three of questions for the group.
1. Has anyone else experienced insomnia after starting XR? If so, did
it go away and how long did it take? I have read all the literature I
can find, including the manufacturer's detailed description, and
insomnia is not listed as a side effect, but as one would expect,
hypersomnia is. The only place I found any reference to insomnia
being a possible side effect is in the statistics in the
manufacturer's premarketing report where they state insomnia did occur
in a low percentage of patients.
2. Is switching from 1mg klonopin to 2 mg xanax xr a reasonable dosage
switch? Older equivalency charts used to invariably indicate xanax
2mg was equivalent to klonopin 1mg, but recently I have seen charts
which seem to imply that 1mg klonopin is equivalent to 1 mg xanax. My
pdoc suggested the 2:1 equivalency. Since I admittedly am scared
s__tless of taking drugs, I don't want to take more than is necessary.
3. When switching from one benzo to another benzo, does the tolerance
factor "carryover" to the new benzo or is the tolerance built up for
the original benzo fully or partially erased, negated, done away with
or whatever term is appropriate? IOW, assuming my anxiety has not
worsened, when switching should I be able to switch to a dose of the
new benzo equivalent to the original dose of the original benzo?
Answer:
yes-but everyone metabolizes drugs differently and time released drugs become
even more problematic because their pharmacokinetics are quirky-so you may need
higher doses of the xr or a supplement of regular xanax at bedtime
yes-all things being equal which they may not be.
it sounds like a mild discontinuation syndrome-so increasing the xanax may be a
good idea-ask your doc
I don't have insomnia on Xanax XR and never heard of it either...
Equivalency charts are not to be taken too seriously because our
reactions to meds are so individual. As a rule, however, a mf of K. = 2
mg. of X, so it's a good starting point.
Yes. Benzos are cross tolerant and work immediately (Klonopin is the
only one that gets to work better after a while but it is also
beneficial from the outset) so you can switch all you want overnight.
Sorry to interrupt here, but does this Xanax XR come in a generic form
like alprazolam is for the regular xanax?
Nope. It's Pharmacia/Upjohn's brand product and it will take years for
it to become available in generic form which of course is part of the
reason why the altruistic manufacturers invented it in the first place.
And I gather that it's very expensive in the US (I am from Holland and
my insurance pays for it).
