What's the max therapeutic dose of Xanax for panic disorder?
I was up to 5mg per day for about four years (1995-99...panic started in 1995) and then I tapered down to about 1 mg/day for the past several years until I had a relapse recently. I'm currently taking 6 mg/day, but want to increase it to 7mg/day. Clearly I would want to taper way down again once I'm feeling better for awhile.
I've read that the max is 10mg, but my doctor seems to think 5-6 is the max.
Thoughts would be appreciated!
Dan
What kind of Barbituate did the doctor offer you? Just curious, because of the rarity of their use now days for anxiety/panic disorders.
relationship with my doctor, but since you asked, Seconal or phenobarbital were on the table, due to their sheer potency. You're right, their use is indeed quite rare these days because of their safety profile...
But when 10mg of Xanax a day is not cutting the mustard anymore, you're in BIG trouble. The first day of my transition to Klonopin, I was taking the full 10mg of Xanax in addition to 2mg Klonopin t.i.d. Then we dropped from there over about a week until I didn't need the Xanax at all.
By the way, if the OP's doc "thinks" 5-6 is the max, then 5-6 is the max. The "max" is whatever a particular doctor feels comfortable writing for.
When someone takes Xanax they build a tolerance to it very quickly, I surmise because of its short elimination half-life. 10mg Xanax per day is a heavy dose so I can understand why your doctor would consider a Barbituate. The Seconal would probably work better than the phenobarbital, because of its shorter half-life and speedier effect. I have taken Phenobarbital before and it lasts forever but it did not seem particularily ideal for a panic disorder or anxiety (I only took 25mg and only one time in my life). I can see why it would be better suited for epilepsy.
I think you made the right decision going with Klonopin as its longer half-life will allow you to avoid that "roller coaster ride" of Xanax.
Is the dose you're now on of Klonopin equivalent to 10 mg Xanax?
Just curious. I've considered switching to Klonopin, but I have a tendency toward depression (secondary to anxiety), and find the anti-depressant effects of Xanax to be very helpful.
I really think that if I were to up my dose to 7 mg/day I'd feel better and would not need to increase it. I was on 5 mg/day for four years and never needed to increase, and ultimately tapered down to 1/5th of that dose (over a few years.) I think I need more now because I'm at a much more stressful time in my life - young kids, mortgage, etc - whereas when I was first diagnosed with Panic Disorder I was 23 and living with my parents, with very little else to worry about. I agree that, if my pdoc thinks 5-6 mg is the max, then that's the max. But I do think my pdoc is flexible and may budge and up it to 7 mg. Now I'm on 6mg and take it 5 times daily- when I take those two 1.5 mg doses, I feel much better, and the rebound anxiety before the next dose is minimal. The other three doses are 1 mg.
I don't want to take 10 mg/day. I just want my doc to believe that that's the max so she won't be afraid of 7 mg/day.
All that said, I do feel a ???$* of a lot better than I did a couple months ago when this relapse began, so I could "rough it" with 6 mg/day.
Thanks for the feedback...
Dan
but it's the maximum recommended dose for panic disorder (4mg) as per Roche. However, Klonopin can be used in doses up to 20mg day to control seizures. Maximum Xanax daily dose is 10mg,and that is only when it's being used to control panic disorder. Not G.A.D. One cannot really compare the two drugs completely because off the difference in their therapeutic effects, and mostly, their half lives. I have a good friend who works in the psychiatry department at Mt. Sinai, and he deals with this stuff all the time...Klonopins half life sets it apart, and Xanax does have the added benefit of relieving anxiety associated with depression, which Klonopin lacks.
I can tell your doctor is reluctant to prescribe you this medicine in the first place. You might be barking up the wrong tree.
At the risk of souring your doctor- patient relationship, tell him to read his PDR. Seriously.
What's PDR?
My doctor isn't all that reluctant to prescribe Xanax. She deals some (but not exclusively) with anxiety disorders, and I know she prescribes it to others, though I think I'm her highest dosage. That said, I was already on 5mg/day when I started seeing her in 1999, so she didn't initiate my Xanax treatment. She did help a lot in convincing me to cut down, and allowed me to do it very slowly. So, when this April 2009 relapse occurred, she said she was comfortable increasing my dose back to 5 mg/day since I've shown in the past that I am willing and able to taper off once I'm feeling better.
But it is entirely possible I should be seeing a pdoc who specializes in anxiety disorders.
PDR = Physician's Desk Reference
Physician's Desk Reference. It's the "bible" of medications.
As long as you feel comfortable, and have tapered in the past without major troubles, go for what you know.
It's common knowledge amongst medical professionals that 10mg is the max. As I said, it's not often prescribed at that dose. Good luck buddy; let us know how it goes.
Oh, I got off the Xanax train before they came out with the XR formulation. That might solve alot of potential "problems." Good luck with this, hope all is well.
allgood- you beat me to it...I'll get you on the next post ;)
Thanks for the input Feliks and allgood. We'll see what happens. I see her next in early August.
I do feel comfortable with 7 mg/day until I get back to feeling normal, but would be very uncomfortable at 10 mg/day.
Active forum topics
- Hydrocodone tolerance
- An open??? for 3years+ CPs:Which do you like better, your medicated or unmedicated (with pain) self?
- Please Help light blue round pill scored N008
- percocet-refill
- Afrin..know it sounds silly but I could use some help
- Taking a new job..
- Be warned! New formulated Opana ER has terrible side effects..
Navigation
Who's online
Latest image
according to the manufacturer. It's RARELY prescribed at that dose however.
There is a point where the Xanax will stop working for you, and you will run out of options.
I was on 10 a day and hit the ceiling. My options were 1. Barbituates 2. Klonopin. I chose the Klonopin. There is a big debate about what works better for panic disorder, but Klonopin and Xanax are the only two benzos that are indicated at present time. Xanax works wonders- but it has the potential to take you on a roller coaster ride.
No doctor will write for anything in excess of 10mg day. With an increase to 7mg/ day, you're getting close to the limit, and considering the short half life, you'll be there before you know it.
Upon administration of Xanax throughout the day, say q.i.d., plasma levels of the drug look like this: /\/\/\/\ (thats one day. spikes in 30 min-one hour, then plumment within 3-4)
Do some reading on "interdose rebound anxiety" This is something that can be avoided with Klonopin. Klonopin blood levels are much more constant due to it's long half life. At the right dose, it will prevent panic attacks in the first place. Klonopin is the atom bomb when it comes to panic disorder.
This is my well founded opinion, however, I'm sure you'll get a whole slurry of answers on this one...