Can someone explain in laymans terms (not links to info.) what happens
to cause fatigue and muscle weakness when your system runs out of
Klonopin? What action takes place or quits taking place.

Hello maluca,

   Anxiety disorder, panic disorder, fibromyalgia, seizures,and
restless leg syndrome are some of the  disorders Klonopin is used to
treat, as you probably already know!

  
  In actuality, the precise way that Klonopin works and what happens
at withdrawal is not fully understood, and the sedatory effects and
withdrawal symptoms can vary patient to patient, especially if the
patient is taking other medications, illicit drugs, and/or alcohol.
The split-second firing of nerve cells in the brain may also be slower
or faster in different patients Some people get relief from Klonopin
withdrawal by taking a milder anti-depressant, Kava (an alternative
medication made from a plant root, not the de-acidifed coffee) and
melatonin.


  The half life of Klonopin (clonazepam) is 35 hours. What this means
in 35 hours after taking a dose, half of the drug is still circulating
in your system. In another 35 hours, half of that which was left at
the first 35 hours, is circulating. And so on and so on, until it is
gone, providing you are not taking anymore. If you are taking your
daily dosages, then you maintain a steady therapeutic dose; the
optimal dosage needed to alleviate disorder symptoms.


  Very simply put, Klonopin slows the brain down, through a form of
sedation similar to that from Valium, preventing the nerve cells of
the brain and spinal cord from ?overfiring?. GABA (gamma-aminobutyric
acid), a brain chemical, transmits messages from one brain cell
(neuron) to another. The message that GABA sends is to slow down: it
tells the brain cells to slow down or stop firing.

  In the illustration below, you can see a drawing of neurons in the
brain. Klonopin enhances, or helps the effect of GABA Remember GABA is
a natural brain chemical that keeps too many neurons from being
stimulated, or ?fired up?. Excess ?firings? cause anxiety in some,
mania or restless legs in others.

See an illustration of how Klonpin ( a benzodiazepine) interacts with
GABA on neurons.
http://www.benzo.org.uk/images/bzcha1.jpg

http://www.wellesley.edu/Chemistry/Chem101/mental/GABA_Receptor.GIF

Other illustrations of neurotransmitters:
http://www.psy.plym.ac.uk/year1/psy128depression/synapse.gif

http://www.patientcenters.com/autism/graphics/pdd0103.gif

http://www.stanford.edu/group/hopes/causes/neuro/f_d02nrtrnsmtr.jpg

GABA itself has a calming effect on the body, a natural sedative, so
to speak. When GABA does not work as it should, due to overwhelming
anxiety, depression, or a variety of other disorders, Klonopin helps
GABA work more effectively.

This Klonopin-GABA duo can also cause muscles to feel weak and limp at
times. This is why an overdosage can cause sleepiness, confusion,
shaking hands, and slowed breathing. However, in patients who have
taken Klonopin for an extended period, at large doses, stomach and leg
cramps may occur at sudden withdrawal. Seizures and excitability,
along with insomnia can occur to patients who have taken this drug at
lower dosages and for a shorter time. Fatigue is generally not a side
effect of Klonopin withdrawal. Are you taking any other drugs that may
affect you this way? Birth control pills, some asthma medications,
Tagamet, Dilantin, sleeping pills and alcohol can all have adverse
effects with Klonopin.

 The brain works hard  to maintain a balance within the body - of
hormones, glucose, minerals,salts,acid-base,  brain chemicals,
temperature, etc. This process is called homeostasis and it attempts
to produce hormones and other chemicals when we need them, and
decreases production when they are not needed. Since the Klonopin  has
been helping balance brain messages, not enough GABA is produced by
the brain. When Klonopin is stopped suddenly,  the balance,
homeostasis is upset, and the body must learn to start making it?s own
GABA, in sufficient quantities.

  Benzodiazepines, the family of drugs to which Klonopin belongs is a
very efficient muscle relaxant, and is given often to treat the muscle
spasms of tetanus.  When Klonopin is withheld, there is a rebound
effect, meaning the muscles get very tense, causing aching, and
hyperexcitability. All of this ?action? can be sensed as fatigue in
some patients. The hormones adrenalin (epinephrine) and noradrenalin
(norepinephrine) can go a little crazy and overproduce. This can cause
muscle fiber excitation, as these hormones affect tyrosine, which is
found in muscle.  GABA also affects muscle, by stimulating the
production of HGH (Human growth hormone), which works to build
muscle.This is why one should never abruptly stop taking Klonopin, but
decrease the dosage gradually. This lets the brain gradually resume
it?s intended function, instead of leaving the brain ?hungry? for
GABA. This what causes muscle weakness when Klonopin is stopped. Some
patients experience a psychological dependence as well as a physical
dependence on Klonopin, and suffer a psychological physical withdrawal
symptoms.

 Restless leg syndrome is now thought to be caused by an imbalance of
neurotransmitters, those chemicals in the brain. You are probably
getting the idea that the brain and its attempt at homeostasis,
keeping everything in balance, affects all parts of the body! The
brain IS the master of the body!

  Do not stop taking Klonopin suddenly - to do so can be dangerous. To
stop using this drug, you need to taper off, by gradually decreasing
the dosage. Your doctor can write out a tapering dosage schedule for
you based on your present dosage. Please don't do it on your own.


I hope this sufficiently explains the physical effects of Klonopin
withdrawal to you. If not, please request an Answer Clarification,
before rating. This will allow me to assist you further, if possible.

Regards,
Crabcakes


Search terms
klonopin withdrawal physiology
Klonapin pharmacokinetics 
Benzodiazepine physiology

---

Request for Answer Clarification by maluca-ga on 07 Feb 2005 22:13 PST

To answer your questions: I am taking nothing else but Omega 3 oils. I
would be considered a long term low dose user. 5 years a .5 to 1 mg. a
day

You stated in a paragraph "fatigue is generally not a side effect of
Klonopin withdrawl". Two paragraphs later you describe several
actions/reactions then state "this is what causes muscle weakness when
it is stopped." Also stated is Klonopin has a 35 hour half life.

My siuation is this. When I walk at night I can only go 1/3 mile
before I am so fatigued I must quit.I feel as though I will faint.  If
I lift weights (small amounts 30-50 pounds)for 15-10 minutes I am in
bed for a day from fatigue.Really. I called my pharmacy and they said
a 8 hour half life at that dose? They felt I was draining it out of my
system because if I take even a quarter dose the fatigue disappears in
15 minutes, not many hours!! Klonopin is supposed to relax but it
gives me my energy back!

Your answer is already excellent. If you would please truncate your
answer to only what I have described with any further explanation you
may now have and direct me only to the pages representing that answer
I will tip accordingly.

---

Clarification of Answer by crabcakes-ga on 08 Feb 2005 06:50 PST

Hi maluca,
  I'll finish this clarification in several hours, as I have some
other chores to attend to.
  I did find conflicting information about fatigue and non-fatigue,
which is why I tried to explain how people are affected differently.
(Strange, eh?)I will post supporting links in several hours regarding
the half life information.

  Thank you for the additional information on which to work!

   Sincerely, Crabcakes

---

Clarification of Answer by crabcakes-ga on 08 Feb 2005 13:39 PST

Hi again, maluca!

 Thanks for your patience -- I now have your clarification request finished.


Fatigue: Fatigue is not generally a symptom of withdrawal. However, if
you are taking your dose regularly, coupled with the long half life of
Klonopin, you are not in withdrawal. If you are ?perking up? after
taking your dose, you may be feeling a minor paradoxical effect, or
you may need to take a smaller dose 2-3 times a day, or you may need a
larger dosage.

The paradoxical effect is caused when a drug does the opposite of what
it is intended for! ?A drug can have the potential to both decrease
and increase aggressive behaviour depending on the underlying
characteristics of the person who consumes it. Amphetamines,
methylphenidate, benzodiazepines and alcohol are examples. In the
majority of recipients, benzodiazepines have a calming effect but in a
minority they can cause paradoxical reactions (also called
disinhibitory reactions) characterised by acute excitement and an
altered mental state: increased anxiety, vivid dreams, hyperactivity,
sexual disinhibition, hostility and rage.?
http://pb.rcpsych.org/cgi/content/full/26/12/460#SEC2

Half life: Half life has nothing to do with the dosage you take. Half
life refers to how long it takes for the body to clear half of the
amount ingested. If you took .5mg or 3mg., the half life would be the
same. There would be less of the drug present in your circulation at a
low dosage, but it still takes about  35 hours to clear half of the
amount. Klonopin half life is around 35 hours, with a PEAK level of
the drug at about two hours. Absorption can depend on diet and your
metabolism.

?The half-life of the parent compound varied from approximately 18 to 50 hours,?
http://www.druginfonet.com/index.php?pageID=klonopin.htm

?Clonazepam (Klonopin, Rivotril)  18-50 Hr. half life
http://web4health.info/en/answers/bio-benzo-overview.htm

?Side effects include drowsiness and medication dependency. It is
easier to taper a patient off Klonopin (clonazepam) because it has a
long elimination half-life.?
http://psychclerk.bsd.uchicago.edu/lect_pharmacology.html

?The apparent half-life after a single oral dose is 20-40 hours?
http://www.labcorp.com/datasets/labcorp/html/chapter/mono/td033400.htm


This page has a long list of other medications, both prescriptions and
over the counter, that should not be taken with Klonopin. You said you
were not taking anything else, but I?m posting this for your
information!
http://www.accessmednet.com/prescription-drug-information/klonopin-side-effects.html

?Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor
can determine if it is safe for you to continue taking Klonopin. More
common side effects in seizure disorders may include: Behavior
problems, drowsiness, lack of muscular coordination
·Less common or rare side effects in seizure disorders may include: 
Abnormal eye movements, anemia, bed wetting, chest congestion, coated
tongue, coma, confusion, constipation, dehydration, depression,
diarrhea, double vision, dry mouth, excess hair, fever, fluttery or
throbbing heartbeat, "glassy-eyed" appearance, hair loss,
hallucinations, headache, inability to fall or stay asleep, inability
to urinate, increased sex drive, involuntary rapid movement of the
eyeballs, loss of or increased appetite, loss of voice, memory loss,
muscle and bone pain, muscle weakness, nausea, nighttime urination,
painful or difficult urination, partial paralysis, runny nose,
shortness of breath, skin rash, slowed breathing, slurred speech, sore
gums, speech difficulties, stomach inflammation, swelling of ankles
and face, tremor, uncontrolled body movement or twitching, vertigo,
weight loss or gain
Klonopin can also cause aggressive behavior, agitation, anxiety,
excitability, hostility, irritability, nervousness, nightmares, sleep
disturbances, and vivid dreams.
·Side effects due to rapid decrease or abrupt withdrawal from Klonopin
may include:
Abdominal and muscle cramps, behavior disorders, convulsions,
depressed feeling, hallucinations, restlessness, sleeping
difficulties, tremors
·More common side effects in panic disorder may include: 
Allergic reaction, constipation, coordination problems, depression,
dizziness, fatigue, inflamed sinuses or nasal passages, flu, memory
problems, menstrual problems, nervousness, reduced thinking ability,
respiratory infection, sleepiness, speech problems
·Less common or rare side effects in panic disorder may include: 
Abdominal pain/discomfort, abnormal hunger, acne, aggressive reaction,
anxiety, apathy, asthma attack, bleeding from the skin, blood clots,
bronchitis, burning sensation, changes in appetite, changes in sex
drive, confusion, coughing, difficulty breathing, dizziness when
standing, ear problems, emotional changeability, excessive dreaming,
excitement, fever, flushing, fluttery or throbbing heartbeat, frequent
bowel movements, gas, general feeling of illness, gout, hair loss,
hemorrhoids, hoarseness, increased salivation, indigestion,
infections, inflamed stomach and intestines, lack of attention, lack
of sensation, leg cramps, loss of taste, male sexual problems,
migraine, motion sickness, muscle pain/cramps, nightmares, nosebleed,
overactivity, pain (anywhere in the body), paralysis, pneumonia,
shivering, skin problems, sleep problems, sneezing, sore throat,
swelling with fluid retention, swollen knees, thick tongue, thirst,
tingling/pins and needles, tooth problems, tremor, twitching, upset
stomach, urinary problems, vertigo, vision problems, weight gain or
loss, yawning?
http://www.gettingwell.com/drug_info/rxdrugprofiles/drugs/klo1214.shtml

More side effects:
http://www.healthsquare.com/newrx/KLO1214.HTM

How other patients react
http://www.healthboards.com/ubb/Forum87/HTML/000282.html
http://www.healthboards.com/ubb/Forum87/HTML/000331.html

Please let your prescribing physician know of this reaction you are
having to Klonopin.

Wishing you the best, Crabcakes

Thank you Crabcakes Exactly as I needed.

Thank you for the 5 stars and the generous tip. Both are appreciated!

:-)     Crabcakes

HI,

I HAVE COLD TURKY KLONOPIN FIVE WEEKS AGO. MAYBE NOT THE BEST THING TO
DO BUT LIKE I SAID IM FIVE WEEKS INTO IT.
ITS HARD SOMETIMES TO GET OUT OF BED IN THE AM
I FEEL LIKE I AM GOING INSANE AT TIMES OTHER SYMPTOMS ARE LIKE I AM
SEEING IN 3-D, SINKING IN THE EARTH, NIMB HEAD, DON'T DO WELL IN
CROWDS.
MY CONCERN IS MY MENTAL STATUS.

PLEASE ADVISE