Panic disorder clonazepam

Panic disorder SSRIs Venlafaxine XR Alprazolam Clomipramine Clonazepam Imipramine Phenelzine... 

Benzodiazepines. The introduction of the benzodiazepines represented a significant advance in the treatment of panic disorder. In contrast to MAOIs and TCAs, the benzodiazepines begin to provide relief the very first day of treatment, and many patients experience a complete response by the end of the second week of therapy. All benzodiazepines should theoretically alleviate the symptoms of a panic attack at comparable doses, but the benzodiazepines of choice are alprazolam (Xanax, Xanax XR) and clonazepam (Klonopin). It likely is not coincidental that these two are among the highest potency benzodiazepines. However, they differ considerably from a pharmacokinetic standpoint. If clonazepam is the tortoise of benzodiazepines, then alprazolam is the hare. 

We do not use benzodiazepines as readily when treating GAD as we do when treating panic disorder. In comparison to those with panic disorder, most patients with GAD can more easily tolerate the delay in treatment response and even any transient exacerbation of anxiety associated with antidepressant therapy. Benzodiazepines are reserved for those who present with especially severe anxiety that necessitates more rapid relief than an antidepressant can afford and for those who do not achieve a satisfactory response to antidepressant or buspirone therapy. Due to the persistent nature of the anxiety experienced by patients with GAD, shortacting benzodiazepines such as alprazolam are not especially helpful unless dosed 3-4 times per day. Instead, we prefer long-acting agents such as clonazepam. When used to treat GAD, clonazepam should be started at a low dose (0.25-0.5 mg/day) and titrated to higher doses (1-4 mg/day) if clinically necessary. 

Panic disorder Treatment of panic disorder, with or without agoraphobia (alprazolam immediate-release, extended-release, and orally disintegrating clonazepam). 

Barnett SD, Kramer ML, Casat CD, Connor KM, Davidson JR (2002) Efficacy of olanzapine in social anxiety disorder a pilot study. J Psychopharmacol 16 365-368 Beauclair L, Fontaine R, Annable L, Holobow N, Chouinard G (1994) Clonazepam in the treatment of panic disorder a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol 14 111-118... 

Frank JB, Kosten TR, Giller EL Jr, Dan E (1988) A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder. Am J Psychiatry 145 1289-1291 Goddard AW, Brouette T, Almai A, Jetty P, Woods SW, Charney D (2001) Early coadministration of clonazepam with sertraline for panic disorder. Arch Gen Psychiatry 58 681-686 Goodnick PJ, Goldstein BJ (1998) SSRIs in affective disorders. I. Basic pharmacology. J Psychopharmacol 12(Suppl B) S5-S20... 

Kutcher, S. and Mackensie, S. (1988). Successful clonazepam treatment of adolescents with panic disorder. / Clin Psychopharmacol 18 299-301. 

A multitude of studies show that benzodiazepine is effective in the treatment of panic disorder, sometimes freeing patients from panic attacks after six to eight weeks of use. Benzodiazepines tend to work quickly, with a reduction in panic being observed as little as one week after the start of treatment. However, benzodiazepines have the risks of tolerance and dependency. Common benzodiazepines used to treat panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). 

For the treatment of panic disorder, the starting adult dose is 0.25 mg twice a day, which may be increased by one mg daily after three days. Clonazepam s safety and effectiveness has not been determined for individuals under the age of 18. Side effects in the treatment of panic disorders are similar to many of the benzodiazepines, and include allergic reaction, inflamed sinuses or nasal passages, flu, menstrual problems, respiratory infection, speech problems, and vaginal inflammation. 

Bodkin JA, White K Clonazepam in the treatment of obsessive compulsive disorder associated with panic disorder in one patient. J Chn Psychiatry 50 265-266, 1989... 

Herman JB, Rosenbaum JE, Brotman AW The alprazolam to clonazepam switch for the treatment of panic disorder. J Clin Psychophamacol 7 175-178, 1987 Herrmann N Valproic acid treatment of agitation in dementia. Can J Psychiatry 43 69-72, 1998... 

Benzodiazepines are highly effective anxiolytics and sedatives. They also have muscle relaxant, amnestic, and anticonvulsant properties. Benzodiazepines effectively treat both acute and chronic generalized anxiety and panic disorder. The high-potency benzodiazepines alprazolam and clonazepam have received more attention as antipanic agents, but double-blind studies also have confirmed the efficacy of diazepam and lorazepam in the treatment of panic disorder. Although only a few benzodiazepines are specifically approved by the... 

Klonopin 8 Clonazepam 1-6 Panic disorder, anticonvulsant, alcohol withdrawal, social phobia, acute mania... 

A larger set of placebo-controlled studies show conclusively that imipramine is also effective for the treatment of panic disorders. Other agents shown to be effective in panic disorders include the SSRIs paroxetine, sertraline, fluvoxamine, fluoxetine and citalopram. Generally, initial treatment of moderate to severe panic disorders may require the initiation of a short course of benzodiazepines e.g. clonazepam (0.5 1 mg twice daily), and an SSRI. The patient will obtain immediate relief from panic attacks with the benzodiazepine whereas the SSRI may take 1 6 weeks to become effective. Once a patient is relieved of initial panic attacks, clonazepam should be tapered and discontinued over several weeks and SSRI therapy continued thereafter. There are no pharmacological treatments available for specific phobias, however controlled trials have shown efficacy for several agents, e.g. phenelzine, moclobemide. clonazepam, alprazolam, fluvoxamine. sertraline and paroxetine in the treatment of social phobia (Roy-Byrne and Cowlev, 2002). 

Pollack MH, Tesar GE, Rosenbaum JF, et al. Clonazepam in the treatment of panic disorder and agoraphobia a one-year follow-up. J Clin Psychopharmacol 1986 47 475-476. 

Fontaine R. Clonazepam for panic disorders and agitation. Psychosomatics 1985 26[Suppl 12] 13-16. 

Beckett A, Fishman SM, Rosenbaum JF. Clonazepam blockade of spontaneous and COj inhalation-provoked panic in a patient with panic disorder. J Clin Psychiatry 1986 47 475-476. 

Tesar GE, Rosenbaum JE, Pollack MH, et al. Clonazepam versus alprazolam in the treatment of panic disorder interim analysis of data from a prospective, double-blind, placebo-controlled trial. J Clin Psychiatry 1987 48[Suppl] 16-19. 

Worthington JJ III, Pollack MH, Otto MW, et al. Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull 1998 34 199-205. 

Rosenbaum JF, Moroz G, Bowden CL. Clonazepam in the treatment of panic disorder with or without agoraphobia a dose-response study of efficacy, safety, and discontinuance. Clonazepam Panic Disorder Dose-Response Study Group. J Clin Psychopharmacol 1997 17 390-400. 

Moroz G, Rosenbaum JF. Efficacy, safety, and gradual discontinuation of clonazepam in panic disorder a placebo-controlled, multicenter study using optimized doses. J Clin Psychiatry 1999 60 604-612. 

Ontiveros A, Fontaine R. Sodium valproate and clonazepam for treatment-resistant panic disorder. J Psychiatr Neurosci 1992 17 78-80. 

There is only one small (n = 12) double-blind, placebo-controlled study showing clonazepam to be effective in pediatric panic disorder and none in posttraumatic stress disorder (156). 

High-potency benzodiazepines (alprazolam, clonazepam) generally are more effective in panic disorder than low-potency benzodiazepines (diazepam, lorazepam, etc.). Although less research has been done on the low-potency benzodiazepines, it is generally accepted that they frequently result in sedation prior to adequately relieving panic attacks. The reader is referred to the discussion of benzodiazepines in Chapter 8 for a detailed overview of mechanism of action. A critique of the issues of benzodiazepine dependence and appropriate use is given in Chapter 13-... 

Alprazolam has been researched more extensively than any other benzodiazepine in panic disorder, and is very effective. Because of its short duration of action, it generally must be administered in three to five daily doses. Clonazepam, which has a longer duration of action than alprazolam, has also been investigated in panic disorder. It can generally be administered twice a day. Clonazepam is reported to have less abuse potential than alprazolam and to be easier to taper during discontinuation owing to its longer half-life. 

Alprazolam causes pronounced sedation but is devoid of anticholinergic properties. Alprazolam and, to a certain extent, clonazepam are effective in the treatment of panic disorder. 

Patients with panic disorder have usually been treated with TCAs [93], monoamine oxidase inhibitors (MAOIs) [94], and high-potency BZDs (i.e., alprazolam, clonazepam) [95, 96], Although the MAOIs had demonstrated effectiveness for panic disorder in several studies, they left the sleep complaint relatively unaffected [97],... 

TesarGE, Rosenbaum JF, Pollack MH, Otto MW, Sachs GS, Herman JB, Cohen LS, Spier SA (1991) Double-blind, placebo-controlled comparison of clonazepam and alprazolam for panic disorder. J Clin Psychiatry 52 69-76... 

Klonopin Clonazepam 0.5, 1, 2 mg Tablet Panic disorder Lactose, magnesium stearate, MCC, corn starch Roche... 

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