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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Nic on December 4, 2000, at 10:54:59
I have been on Serzone for about 5 months now and seems to be working fairly well. Had also been taking Ativan also to help with my anxiety and panicv attacks.
Currently my Pdoc has me on 600mg of Serzone and 2mg of Klonopin a day.
I asked him to take me off the Ativan, because it was affecting my memory. I'm hoping the Klonopin won't have the same effect. The Serzone seems to be making me a little lethargic, and when I first get up in the morning, my vision is really weird. He insist that to get the full benefit of Serzone I need to be on 600 mg.
Was wanting some advice for those who have been on this combo (doses, etc.). Or if other combos work better for them for bipolar and severe panic and anxiety attacks.
Thank You so very much in advance.
Nic
Posted by Sunnely on December 6, 2000, at 18:39:21
In reply to ????---Serzone + Klonopin, posted by Nic on December 4, 2000, at 10:54:59
> I have been on Serzone for about 5 months now and seems to be working fairly well. Had also been taking Ativan also to help with my anxiety and panicv attacks.
>
> Currently my Pdoc has me on 600mg of Serzone and 2mg of Klonopin a day.
>
> I asked him to take me off the Ativan, because it was affecting my memory. I'm hoping the Klonopin won't have the same effect. The Serzone seems to be making me a little lethargic, and when I first get up in the morning, my vision is really weird. He insist that to get the full benefit of Serzone I need to be on 600 mg.
>
> Was wanting some advice for those who have been on this combo (doses, etc.). Or if other combos work better for them for bipolar and severe panic and anxiety attacks.
>
> Thank You so very much in advance.
>
> Nic+++++++++++++++++++++++
Hi Nic,
A drug-drug interaction may be involved between Serzone (nefazodone) and Klonopin (clonazepam). I believe Klonopin is metabolized by a liver enzyme (called CYP3A4), while Serzone markedly inhibits this liver enzyme. This can cause an increase in the blood level of Klonopin. In effect, you may be getting the effect of as much as 50% more than your current dose of Klonopin. Since Serzone is already a sedating antidepressant, there is an additive sedating effect provided by Klonopin. If you are also taking Ativan on a prn (as needed) basis, this will add further to the sedation.
I am not sure what you meant by your "vision being weird." One visual disturbance commonly reported with Serzone is called "palinopsia" (seeing again), better known as "ghost trails" or "ghost shadows." This is a dose-related phenomenon, i.e., the higher the dose the more it tends to occur. Incidentally, this phenomenon has also been reported with the use of Desyrel (trazodone), a drug with some structural similarity to Serzone.
Posted by Nic on December 7, 2000, at 9:51:59
In reply to ????---Serzone + Klonopin, posted by Nic on December 4, 2000, at 10:54:59
> I have been on Serzone for about 5 months now and seems to be working fairly well. Had also been taking Ativan also to help with my anxiety and panicv attacks.
>
> Currently my Pdoc has me on 600mg of Serzone and 2mg of Klonopin a day.
>
> I asked him to take me off the Ativan, because it was affecting my memory. I'm hoping the Klonopin won't have the same effect. The Serzone seems to be making me a little lethargic, and when I first get up in the morning, my vision is really weird. He insist that to get the full benefit of Serzone I need to be on 600 mg.
>
> Was wanting some advice for those who have been on this combo (doses, etc.). Or if other combos work better for them for bipolar and severe panic and anxiety attacks.
>
> Thank You so very much in advance.
>
> Nic
CURRENTLY I AM 600MG OF SERZONE AND 2MG OF KLONOPIN. MY VISON PROBLEM I GUESS IS MORE LIKE GHOST SHADOWS.
I HAVE TRIED TAKING THE SERZONE DOSAGE ALL AT ONCE BEFORE BEDTIME.
THE KLONOPIN I TAKE ONE THE MORNING AND ONE LATER IN THE AFTERNOON.
Posted by dove on December 8, 2000, at 15:04:43
In reply to Re: ????---Serzone + Klonopin, posted by Nic on December 7, 2000, at 9:51:59
I take Serzone (400 mgs) with Klonopin (1.5 mgs) and am seemingly doing alright, functioning on a day-to-day level. I do experience lethargy, and sleepiness when I take the two meds too close to each other. I've been tinkering with the idea of taking the full 400 mgs of Serzone at bedtime with my Amitriptyline, and utilizing the Klonopin during the day, maybe that would help as well as simplify things, for me at least.
I wish I had some wisdom to add to your concerns, but I really don't. I take a number of sedating meds, that really don't sedate me that much until the clock hits midnight. Panic attacks have lessened with the addition of Klonopin, and for me, that's worth the extra fatigue.
Just some thoughts...
dove
Posted by Nic on December 8, 2000, at 22:03:48
In reply to Re: ????---Serzone + Klonopin, posted by dove on December 8, 2000, at 15:04:43
> I take Serzone (400 mgs) with Klonopin (1.5 mgs) and am seemingly doing alright, functioning on a day-to-day level. I do experience lethargy, and sleepiness when I take the two meds too close to each other. I've been tinkering with the idea of taking the full 400 mgs of Serzone at bedtime with my Amitriptyline, and utilizing the Klonopin during the day, maybe that would help as well as simplify things, for me at least.
>
> I wish I had some wisdom to add to your concerns, but I really don't. I take a number of sedating meds, that really don't sedate me that much until the clock hits midnight. Panic attacks have lessened with the addition of Klonopin, and for me, that's worth the extra fatigue.
>
> Just some thoughts...
>
> doveIs that only 1.5mg of Klonopin a day?
I was thinking about increasing the Klonopin to 3mg/day and decreasing the Serzone to 400mg. taking the Sezone at before bed and the klonopin (one in the morning, one in the afternoon and one early evening. But is that risking to much klonopin????Nic
Posted by dove on December 13, 2000, at 15:11:14
In reply to Re: ????---Serzone + Klonopin, posted by Nic on December 8, 2000, at 22:03:48
>
> Is that only 1.5mg of Klonopin a day?
> I was thinking about increasing the Klonopin to 3mg/day and decreasing the Serzone to 400mg. taking the Sezone at before bed and the klonopin (one in the morning, one in the afternoon and one early evening. But is that risking to much klonopin????
>
> NicYes, that's 1.5 mgs of Klonopin per day, taken morning, noonish, and evening. But you need to realize that I'm also taking sedating meds like Serzone, Amitriptyline, Neurontin, and Ativan (as needed); in conjunction with Adderall and Prozac. So, I have a number of possible drug-to-drug interactions working here, sometimes beneficially, and other times not.
I definitely don't think that decreasing the Serzone could hurt, other than some nausea or wooziness from the missed dosages. Upping the Klonopin doesn't seem all that serious to me, other than the concept of trying to withdraw from the med itself sometime in the future.
I am still taking the Serzone (400mgs) throughout the day, and I don't agree with the concept that one can take the full 24 hour dosage amount in one gulp at bedtime. Weird vision in morning, no kidding. Try spacing the Serzone out, especially on any day you don't have to do something like go to work. Keep everyone updated.
Wishing you the best!
dove
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