![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by 3 Beer Effect on February 8, 2002, at 17:08:36
I have done some research & have unfortunately found out some dissapointing news:
Provigil (Modafinil, Alertec), it turns out induces metabolism of drugs such as Klonopin (clonazepam) that are metabolized through the Cytochrome-P450 CYP3A4 liver enzymes. According to the official Klonopin prescribing information inducers of this enzyme such as Provigil, Dilantin, Phenobarbital, & Tegretol result in faster Klonopin metabolism, & an approximately 30% decrease in plasma Klonopin levels (both of which reduce the effectiveness of Klonopin for social phobia).
See PRECAUTIONS (drug interactions) for Provigil at--
http://www.provigil.com/pi.htmAlso see PRECAUTIONS (Drug interactions) at the revised (1999) official Roche Laboratories Klonopin Presribing information--
http://www.rocheusa.com/products/klonopin/pi.html
Posted by Ritch on February 9, 2002, at 0:27:13
In reply to Provigil induces metabolism of Klonopin :(, posted by 3 Beer Effect on February 8, 2002, at 17:08:36
Posted by Jason911 on February 9, 2002, at 1:23:19
In reply to Thanks, I may be taking both of those soon.... (nm) » 3 Beer Effect, posted by Ritch on February 9, 2002, at 0:27:13
Posted by Rick on February 9, 2002, at 6:28:22
In reply to Provigil induces metabolism of Klonopin :(, posted by 3 Beer Effect on February 8, 2002, at 17:08:36
3-Beer, there's no need to be disappointed. Your headline ("Provigil induces metabolism of Klonopin :(") is most likely incorrect. And even if it were accurate, it wouldn't matter much in terms of using those two meds together. Without realizing it, you've used what might seem like reasonable logic on the surface, but in reality has some big-time jumping-to-conclusions. I probably would have done the same a few years ago.
Explanaton:
--Most importantly, even if your logic and conclusions were true (and they're not), so what? Even if Provigil really DID cause an effective 30% reduction in Klonopin dose, would you expect me to convince myself, "damn, I guess I'm not really doing as well as I feel"? If there were safety issues, or if I were taking Klonopin for potentially-serious physical-consequences conditions like epilepsy or even severe panic, I might be a little more concerned (if your conclusion were true, that is). But let's say I'm taking 2 mg Klonopin. If it's "really" only 1.5 mg now, but still works better for my Social Phobia than any other med, why would I make any change other than a possible compensating increase in dosage to 2.5 mg? The best therapy is whatever works for you and is safe and affordable. Period. (Periodic liver checks advisable with any combo.)
--Even if Provigil really did induce Klonopin metabolism, your method for arriving at the magnitude of the effect ("30%") is just plain wrong. For some reason you're assuming that all inducers of CYP3A4 are *equally potent* inducers. It doesn't work that way. The induction potency of the drugs mentioned in the monograph just happened to be about the same vs. Klonopin. But the only way to attach a specific number is to do an actual test of impact. You can't just take a number from tests done with other inducers and assume it will be the same for *any* CYP3A4 inducers.
--Notice that the section you pointed out in the Provigil monograph -- which again did not cite any tests with Klonopin -- was entitled 'Precautions", NOT "Cotraindications".
Even if there were an induction effect against Klonopin (which there most likey *isn't*), that doesn't necessarily translate to a *theraputically* significant finding. For example, look at the Serzone monograph and you'll see that Serzone significantly reduces Propranolol levels, but that tests show that this DOESN'T cause reduction in Propranol effectiveness.-- Along the same lines, there is significant inter-individual variability when a real interaction occurs, since some people are poorer metabolizers of any given enzyme than other people are.
-- The Provigil monograph states that Provigil can induce its own metabolism, to the tune of a 20% plasma reduction at 400 mg. Does this mean you shouldn't take Provigil with Provigil?
-- The induction studies cited in the Provigil monograph were done on a high 400 mg dose, and I believe they said the amount of induction of CYP3A4 was dose dependent. So even if Provigil really did cause 30% induction of Klonopin at 400 mg (and again, it doesn't), it would lkely be a significantly lower effect at the standard 200 mg dose and a much lower effect at my 100 mg. So it might be as if I'm taking .9 mg of Klonopin instead of 1.0. Big deal. And they *don't interact, anyway.
OK, now that I've explained some of the reasons why your conclusion had some flaws in logic, let me explain why there probably *isn't* any induction effect. (And even if it's later proven that there really IS, that wouldn't be of much import for me, for some of the reasons discussed above... especially the fact that the combo WORKS for me!).
I'm attaching links to two studies, the first study being a recent look some mechanisms behind Provigil CYP3A4 induction. The second looks at how Klonopin is metabolized.
The first study concludes that Provigil's CYP3A4 induction interactions affect CP3A4 substrates that have significant *gastrointestinal* first-pass metabolism. Then the second study notes that Klonopin's first-pass metabolism is primarily *hepatic* (via the liver), rather than gastrointestinal. Thus, Klonopin would not be susceptible to modafinal induction of CYP3A4.
Anyway, I didn't mean to pounce on this, but I was dismayed to see the "bad news" about this dynamite combo proclaimed to readers when there's really NOT any bad news. And for the 57th time (sorry), even if there WAS an interaction, that sure isn't sufficient reason to dismiss the combo as ineffective. Provigil's possible reduction of GABA in some areas of the brain is another thing that people read and then incorectly conclude, "hey this combo can't work, the Provigil's cancelling out Klonopin's pro-GABA effects!" It's just not that simple. And dammit, it's a helluva combo -- for me, at least. I went back to Klonopin alone when for awhile when my Blood Pressure was going up. And I was still doing MUCH, MUCH better SP-wise than pre-meds. Klonopin is still my mainstay. But when I added back the Provigil, the theraputic enhancement came roaring back. Klonopin's the meat, Provigil's the savory seasonings and condiments that add flavor and zing. (Pretty lame analogy, huh?)
Rick
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2057519&dopt=Abstract
-----------------> I have done some research & have unfortunately found out some dissapointing news:
>
> Provigil (Modafinil, Alertec), it turns out induces metabolism of drugs such as Klonopin (clonazepam) that are metabolized through the Cytochrome-P450 CYP3A4 liver enzymes. According to the official Klonopin prescribing information inducers of this enzyme such as Provigil, Dilantin, Phenobarbital, & Tegretol result in faster Klonopin metabolism, & an approximately 30% decrease in plasma Klonopin levels (both of which reduce the effectiveness of Klonopin for social phobia).
>
>
> See PRECAUTIONS (drug interactions) for Provigil at--
> http://www.provigil.com/pi.htm
>
> Also see PRECAUTIONS (Drug interactions) at the revised (1999) official Roche Laboratories Klonopin Presribing information--
> http://www.rocheusa.com/products/klonopin/pi.html
Posted by Ritch on February 9, 2002, at 10:25:30
In reply to Why would you take if both don't work well mixed?? (nm) » Ritch, posted by Jason911 on February 9, 2002, at 1:23:19
The fact that one med could reduce the levels of the other med isn't going to be a problem-it just might require a dosage adjustment. It is just nice to know those things. Bottom line-they both could work quite *well* together-I just might have to take say 33% more Klonopin to get the same effect because the Provigil increases the level of enzymes in the liver that break down Klon.-so it will be eliminated faster and the level of Klon will be a little lower than it would be ordinarily. This kind of stuff happens all of the time especially for people with epilepsy who are taking more than one drug for their seizures. It is purely a dosing thing.
Mitch
Posted by IsoM on February 9, 2002, at 12:46:54
In reply to Provig DOESN'T Induce Klon/And if Did, No Big Deal » 3 Beer Effect, posted by Rick on February 9, 2002, at 6:28:22
Thanks, Rick. I was hoping someone else would write what you just did. I was too tired last night to write out a logical rebuttal. It is easy sometimes to misread warnings & precautions.
Posted by Mr. Scott on February 9, 2002, at 13:21:07
In reply to Provigil induces metabolism of Klonopin :(, posted by 3 Beer Effect on February 8, 2002, at 17:08:36
Provigil induces metabolism of Clonazepam by liver enzyme P4503a induction.
Just raise the dose if you need to, but some people find these two to work so synergisticly together you rarely hear a need for it.
Scott
Posted by Rick on February 10, 2002, at 5:37:16
In reply to An Excellent Reply and Reasoning » Rick, posted by IsoM on February 9, 2002, at 12:46:54
Posted by Rick on February 10, 2002, at 5:39:43
In reply to Thanks (nm), posted by Rick on February 10, 2002, at 5:37:16
Posted by manowar on February 11, 2002, at 13:06:24
In reply to Provigil induces metabolism of Klonopin :(, posted by 3 Beer Effect on February 8, 2002, at 17:08:36
Well, I've found ironically, that I can increase the effect of Klonipin by having two or three beers.
It's going to be tough, though... :):):)
Posted by manowar on February 11, 2002, at 14:06:58
In reply to Provig DOESN'T Induce Klon/And if Did, No Big Deal » 3 Beer Effect, posted by Rick on February 9, 2002, at 6:28:22
Rick, you're cool.
Thanks for taking the time to reassure us Kloni-pin-heads that everything is all right.>"Klonopin is still my mainstay. But when I added back the Provigil, the theraputic enhancement came roaring back. Klonopin's the meat, Provigil's the savory seasonings and condiments that add flavor and zing. (Pretty lame analogy, huh?)"
Yes it is, but very funny and quite accurate for me also.:)
I have a Question, but 1st some background.
Here's my meds:
Wellbutrin IR 300 mg daily (2 X 150)
Modafinil 200 mg daily (morning dose)
Concerta 54 mg daily (one morning dose)
Klonipin 1.5 mg in the evening
Clonidine 2 mg in the eveningThe Klonipin for me is the cement that holds my psychological walls in place. (I know-extremely lame, but VERY TRUE:)
When I asked my pdoc to increase the amount of Klonipin I take daily, he balked and instead prescribed Clonidine to take at bedtime with my Klonipin. Would this make sense to you?
This was about a month ago, and this is what I’ve noticed:
a) Clonidine knocks me out.
b) It seems to work much the same way that Klonipin does. Seems to have a catechalomine inhibitory effect—true?
c) Initially, a bit of cognitive fuzziness in the morning; less now.Now, I don’t know much, and you seem to be well versed in psychopharmacology, so here are my questions:
1) You said this: “But when I added back the Provigil, the therapeutic enhancement came roaring back.”—Can you detail what the therapeutic enhancement is for you? Could you also let me know how much you’re taking and what your present medicinal cocktail is?
2) Have you ever tried Clonidine?
3) What is you’re opinion of Clonidine?
4) My impression of Clonidine is that it is used as an adjunct to other mood stabilizers, is this true?
5) Any opinions of my cocktail?
Your opinions, comments and humor are very appreciated by yours truly.Tim
Posted by Rick on February 12, 2002, at 19:20:16
In reply to Re: Provig DOESN'T Induce Klon/And if Did, No Big Deal » Rick, posted by manowar on February 11, 2002, at 14:06:58
Tim, thanks for the kind words. Always good to hear from another Klonipin-head.
I wish I could agree that I *am* "well-versed in psychopharmocology", but to the extent that's true it's limited to the aspects that I've informally researched and thought through -- or experienced.
I know what Clonidine is, but that's about it. But at least I can reply to a few points, and then hopefully someone else who has used your meds or has nore knowledge of them will have some thoughts. (Of the meds you take, I've only used Klonopin, Provigil, and a very short trial of Wellbutrin.)
> The Klonipin for me is the cement that holds my psychological walls in place. (I know-extremely lame, but VERY TRUE:)Not lame at all! A nice, succinct way to explain WHY Klonopin is what I called my "mainstay".
> 1) You said this: “But when I added back the Provigil, the therapeutic enhancement came roaring back.”—Can you detail what the therapeutic enhancement is for you? Could you also let me know how much you’re taking and what your present medicinal cocktail is?
Sure, but remember that this is all in the context of non-depressive social phobia:
-- Increased energy, concentration, motivation, assertiveness, sociability, and improved ability to handle stress (up to a point). To some extent some of these may result directly from the increased energy. Even before I took any meds, it was clear that my anxiety was worse when I felt fatigued, e.g. because I didn't get a good night's sleep. Of course, the energy provided by a med or other stimulus must not have negative side effects that outweight the energy benefits, e.g. by making me feel too wired.Current Cocktail: 1 mg Klonopin, 100 mg Provigil, and 300 mg Serzone. All taken first thing in the morning. I sometimes bump up the Provigil to 200 mg. I've been doing the bump-up more frequently lately, because I've been going through an absolutely nuts period at work, leaving the office at 3 a.m., etc. But I find that after more than a few days at 200 mg, I start to get a tad wired.
For the last two months, I experimented with the a Klonopin+Provigil only combo, same dosages. It was a great combo, maybe just a little less effective than the trio. Serzone, as a powerful inhibitor of CYP 3A4, was quite possibly intensifying the effects of the other two meds.
It was a dynamite combination for me, especially back when I was taking 450 mg Serzone, but memory lapses were happening more frequently. I had once been on Klonopin alone for over a year with minimal memory detriment, so I suspected the Serzone.
After a few months with only K+P I did see some attenuation of the memory lapses, but oddly, without Serzone, Provigil started making my blood pressure shoot up. Because of this, and because I was feeling (non-clinically) depressed (including first big bout with insomnia in quite awhile), I started the Serzone again recently. BP's back down, but, (sigh) memory seems worse again at a time I can least afford that. So I might drop the Serzone again, soon. It does concern me that the Provigil raises my BP, which I had never noticed before, since I never took it without Serzone until a few months ago. From all I've seen and heard, that's not a typical Provigil side effect as it can be for amphetamine-based meds. I think my BP has an unusually strong reaction to meds, whether up (Provigil) or down (Serzone).
I wish there were something that could help offset the med-induced memory deficit in what is otherwise an incredible three-med cocktail for my Social Phobia (but, again, Serzone's main benefits for me might be potentiating the K+P, while nullifying the Provigil BP-raising effect).
Ironic that I'd end up talking about Blood Pressure, since I do know that Clonidine's official indication is as a (centrally-acting) antihypertensive. I wonder if your initial morning mental fogginess might have been due to hypotension, given that BP is lower while sleeping, and you are taking a BP medication.
Sorry for rambling a bit at the end.
Rick
Posted by Lorraine on February 13, 2002, at 13:38:28
In reply to Re: Provig DOESN'T Induce Klon/And if Did, No Big Deal » manowar, posted by Rick on February 12, 2002, at 19:20:16
Rick: I have recently started Progivil. I felt the drug on day one. I was on 50 mg. My blood pressure went up and my pdoc told me to scale back to 25 mg, which I have, but I suspect my blood pressure is still high. (150/100). But the drug is good--better energy, more focus without being wired, no hard landings like with amphetamines (even the long lasting ones like Concerta), less depressed mood and more motivation. Pretty compelling reasons to stay on it for someone who has been through about 50 med trials. I am adding the Klonopin (I have used it for a short time before and it helped my anxiety a lot). I am hoping the blood pressure thing resolves itself over time. If not, I'm not sure what the next step should be. I think I would rather try to control the blood pressure than go off the med. Any thoughts would be appreciated.
Lorraine
> Tim, thanks for the kind words. Always good to hear from another Klonipin-head.
>
> I wish I could agree that I *am* "well-versed in psychopharmocology", but to the extent that's true it's limited to the aspects that I've informally researched and thought through -- or experienced.
>
> I know what Clonidine is, but that's about it. But at least I can reply to a few points, and then hopefully someone else who has used your meds or has nore knowledge of them will have some thoughts. (Of the meds you take, I've only used Klonopin, Provigil, and a very short trial of Wellbutrin.)
>
>
> > The Klonipin for me is the cement that holds my psychological walls in place. (I know-extremely lame, but VERY TRUE:)
>
> Not lame at all! A nice, succinct way to explain WHY Klonopin is what I called my "mainstay".
>
> > 1) You said this: “But when I added back the Provigil, the therapeutic enhancement came roaring back.”—Can you detail what the therapeutic enhancement is for you? Could you also let me know how much you’re taking and what your present medicinal cocktail is?
>
> Sure, but remember that this is all in the context of non-depressive social phobia:
> -- Increased energy, concentration, motivation, assertiveness, sociability, and improved ability to handle stress (up to a point). To some extent some of these may result directly from the increased energy. Even before I took any meds, it was clear that my anxiety was worse when I felt fatigued, e.g. because I didn't get a good night's sleep. Of course, the energy provided by a med or other stimulus must not have negative side effects that outweight the energy benefits, e.g. by making me feel too wired.
>
> Current Cocktail: 1 mg Klonopin, 100 mg Provigil, and 300 mg Serzone. All taken first thing in the morning. I sometimes bump up the Provigil to 200 mg. I've been doing the bump-up more frequently lately, because I've been going through an absolutely nuts period at work, leaving the office at 3 a.m., etc. But I find that after more than a few days at 200 mg, I start to get a tad wired.
>
> For the last two months, I experimented with the a Klonopin+Provigil only combo, same dosages. It was a great combo, maybe just a little less effective than the trio. Serzone, as a powerful inhibitor of CYP 3A4, was quite possibly intensifying the effects of the other two meds.
>
> It was a dynamite combination for me, especially back when I was taking 450 mg Serzone, but memory lapses were happening more frequently. I had once been on Klonopin alone for over a year with minimal memory detriment, so I suspected the Serzone.
>
> After a few months with only K+P I did see some attenuation of the memory lapses, but oddly, without Serzone, Provigil started making my blood pressure shoot up. Because of this, and because I was feeling (non-clinically) depressed (including first big bout with insomnia in quite awhile), I started the Serzone again recently. BP's back down, but, (sigh) memory seems worse again at a time I can least afford that. So I might drop the Serzone again, soon. It does concern me that the Provigil raises my BP, which I had never noticed before, since I never took it without Serzone until a few months ago. From all I've seen and heard, that's not a typical Provigil side effect as it can be for amphetamine-based meds. I think my BP has an unusually strong reaction to meds, whether up (Provigil) or down (Serzone).
>
> I wish there were something that could help offset the med-induced memory deficit in what is otherwise an incredible three-med cocktail for my Social Phobia (but, again, Serzone's main benefits for me might be potentiating the K+P, while nullifying the Provigil BP-raising effect).
>
> Ironic that I'd end up talking about Blood Pressure, since I do know that Clonidine's official indication is as a (centrally-acting) antihypertensive. I wonder if your initial morning mental fogginess might have been due to hypotension, given that BP is lower while sleeping, and you are taking a BP medication.
>
> Sorry for rambling a bit at the end.
>
> Rick
Posted by manowar on February 13, 2002, at 20:03:07
In reply to Re: Provig DOESN'T Induce Klon/And if Did, No Big Deal » manowar, posted by Rick on February 12, 2002, at 19:20:16
Hi Rick, and thanks for your response.
The pdoc and the pharmacist told me that the Clonidine shouldn’t affect my BP at all, since I don't have a problem with my BP. But who knows, it could have dropped a bit. Good part is, I don't seem to have any side effects from it now.
I tried Serzone a year ago, and it really screwed me up. I felt more depressed, and agitated. It seems that serotonin drugs don’t do well for me at all.
The Provigil does the same for me as it does for you, but I have to take more of it. I don't think I had any SP, but when I'm down, I certainly don't want to socialize. However, now that I'm taking the Provigil, even when I'm kinda blue, I excel in social settings. I love the Provigil. I just wish it wasn't so damn expensive!
Take care,
Tim> Tim, thanks for the kind words. Always good to hear from another Klonipin-head.
>
> I wish I could agree that I *am* "well-versed in psychopharmocology", but to the extent that's true it's limited to the aspects that I've informally researched and thought through -- or experienced.
>
> I know what Clonidine is, but that's about it. But at least I can reply to a few points, and then hopefully someone else who has used your meds or has nore knowledge of them will have some thoughts. (Of the meds you take, I've only used Klonopin, Provigil, and a very short trial of Wellbutrin.)
>
>
> > The Klonipin for me is the cement that holds my psychological walls in place. (I know-extremely lame, but VERY TRUE:)
>
> Not lame at all! A nice, succinct way to explain WHY Klonopin is what I called my "mainstay".
>
> > 1) You said this: “But when I added back the Provigil, the therapeutic enhancement came roaring back.”—Can you detail what the therapeutic enhancement is for you? Could you also let me know how much you’re taking and what your present medicinal cocktail is?
>
> Sure, but remember that this is all in the context of non-depressive social phobia:
> -- Increased energy, concentration, motivation, assertiveness, sociability, and improved ability to handle stress (up to a point). To some extent some of these may result directly from the increased energy. Even before I took any meds, it was clear that my anxiety was worse when I felt fatigued, e.g. because I didn't get a good night's sleep. Of course, the energy provided by a med or other stimulus must not have negative side effects that outweight the energy benefits, e.g. by making me feel too wired.
>
> Current Cocktail: 1 mg Klonopin, 100 mg Provigil, and 300 mg Serzone. All taken first thing in the morning. I sometimes bump up the Provigil to 200 mg. I've been doing the bump-up more frequently lately, because I've been going through an absolutely nuts period at work, leaving the office at 3 a.m., etc. But I find that after more than a few days at 200 mg, I start to get a tad wired.
>
> For the last two months, I experimented with the a Klonopin+Provigil only combo, same dosages. It was a great combo, maybe just a little less effective than the trio. Serzone, as a powerful inhibitor of CYP 3A4, was quite possibly intensifying the effects of the other two meds.
>
> It was a dynamite combination for me, especially back when I was taking 450 mg Serzone, but memory lapses were happening more frequently. I had once been on Klonopin alone for over a year with minimal memory detriment, so I suspected the Serzone.
>
> After a few months with only K+P I did see some attenuation of the memory lapses, but oddly, without Serzone, Provigil started making my blood pressure shoot up. Because of this, and because I was feeling (non-clinically) depressed (including first big bout with insomnia in quite awhile), I started the Serzone again recently. BP's back down, but, (sigh) memory seems worse again at a time I can least afford that. So I might drop the Serzone again, soon. It does concern me that the Provigil raises my BP, which I had never noticed before, since I never took it without Serzone until a few months ago. From all I've seen and heard, that's not a typical Provigil side effect as it can be for amphetamine-based meds. I think my BP has an unusually strong reaction to meds, whether up (Provigil) or down (Serzone).
>
> I wish there were something that could help offset the med-induced memory deficit in what is otherwise an incredible three-med cocktail for my Social Phobia (but, again, Serzone's main benefits for me might be potentiating the K+P, while nullifying the Provigil BP-raising effect).
>
> Ironic that I'd end up talking about Blood Pressure, since I do know that Clonidine's official indication is as a (centrally-acting) antihypertensive. I wonder if your initial morning mental fogginess might have been due to hypotension, given that BP is lower while sleeping, and you are taking a BP medication.
>
> Sorry for rambling a bit at the end.
>
> Rick
Posted by Rick on February 13, 2002, at 20:49:59
In reply to Re: Provig DOESN'T Induce Klon/And if Did, No Big Deal » Rick, posted by Lorraine on February 13, 2002, at 13:38:28
Lorraine -
Glad to see you're having a great reaction to the Provigil, other than the BP increase. (Maybe this side effect isn't as uncommon as I thought. BTW, I'm assuming you had BP readings in the not-too-distant past, pre-Provigil as a benchmark.)
I completely agree with your logic, especially if it works so well for you and you've tried 50 meds!
I hope the BP goes down on its own, but if it doesn't and Provigil is really helping you, you need to find some way to keep the BP down (150/100 shouldn't be too hard to get down to 120/80, although it varies by person.) The beta blocker Pindolol is good because it has serotonergic qualities and a calming effect. But avoid beta blockers if you are over 30 and overweight...especially if you have any family history of diabetes. While Pindolol doesn't increase insulin resistance as mich as other BB's it still does so to some degree.BP, like anxiety, is nothing to take lightly. This really should be discussed with your physician. I was going to do so myself, but stalled awhile by taking supplements which got me back to about 125-130/85 average. And at the moment I'll leave things alone because starting Serzone again brought my BP back down to normal. I *will* mention this issue to both my pdoc and my GP when next time I see them. (BTW, on the flip side, Provigil really seems to counterbalance many of the Serzone side effects such as sedation and dizziness.)
My concern was that, even with Serzone blunting Provigil's BP effect, I might be developing irreversible "baseline" hypertension that would need to be kept in check with another agent forever. But, to test the theory, I tried Klonopin alone for several days during the no-Serzone period, and my BP immediately dropped way back to low-normal. And this was after a full year-and-a-half of Provigil. So now I'm alot less concerned. Most importantly, if your BP doesn't go down on its own while on Provigil, be sure to take something to keep it down. And stop the Provigil once in awhile to make sure the BP drops.
Rick
> Rick: I have recently started Progivil. I felt the drug on day one. I was on 50 mg. My blood pressure went up and my pdoc told me to scale back to 25 mg, which I have, but I suspect my blood pressure is still high. (150/100). But the drug is good--better energy, more focus without being wired, no hard landings like with amphetamines (even the long lasting ones like Concerta), less depressed mood and more motivation. Pretty compelling reasons to stay on it for someone who has been through about 50 med trials. I am adding the Klonopin (I have used it for a short time before and it helped my anxiety a lot). I am hoping the blood pressure thing resolves itself over time. If not, I'm not sure what the next step should be. I think I would rather try to control the blood pressure than go off the med. Any thoughts would be appreciated.
>
> Lorraine
>
> > Tim, thanks for the kind words. Always good to hear from another Klonipin-head.
> >
> > I wish I could agree that I *am* "well-versed in psychopharmocology", but to the extent that's true it's limited to the aspects that I've informally researched and thought through -- or experienced.
> >
> > I know what Clonidine is, but that's about it. But at least I can reply to a few points, and then hopefully someone else who has used your meds or has nore knowledge of them will have some thoughts. (Of the meds you take, I've only used Klonopin, Provigil, and a very short trial of Wellbutrin.)
> >
> >
> > > The Klonipin for me is the cement that holds my psychological walls in place. (I know-extremely lame, but VERY TRUE:)
> >
> > Not lame at all! A nice, succinct way to explain WHY Klonopin is what I called my "mainstay".
> >
> > > 1) You said this: “But when I added back the Provigil, the therapeutic enhancement came roaring back.”—Can you detail what the therapeutic enhancement is for you? Could you also let me know how much you’re taking and what your present medicinal cocktail is?
> >
> > Sure, but remember that this is all in the context of non-depressive social phobia:
> > -- Increased energy, concentration, motivation, assertiveness, sociability, and improved ability to handle stress (up to a point). To some extent some of these may result directly from the increased energy. Even before I took any meds, it was clear that my anxiety was worse when I felt fatigued, e.g. because I didn't get a good night's sleep. Of course, the energy provided by a med or other stimulus must not have negative side effects that outweight the energy benefits, e.g. by making me feel too wired.
> >
> > Current Cocktail: 1 mg Klonopin, 100 mg Provigil, and 300 mg Serzone. All taken first thing in the morning. I sometimes bump up the Provigil to 200 mg. I've been doing the bump-up more frequently lately, because I've been going through an absolutely nuts period at work, leaving the office at 3 a.m., etc. But I find that after more than a few days at 200 mg, I start to get a tad wired.
> >
> > For the last two months, I experimented with the a Klonopin+Provigil only combo, same dosages. It was a great combo, maybe just a little less effective than the trio. Serzone, as a powerful inhibitor of CYP 3A4, was quite possibly intensifying the effects of the other two meds.
> >
> > It was a dynamite combination for me, especially back when I was taking 450 mg Serzone, but memory lapses were happening more frequently. I had once been on Klonopin alone for over a year with minimal memory detriment, so I suspected the Serzone.
> >
> > After a few months with only K+P I did see some attenuation of the memory lapses, but oddly, without Serzone, Provigil started making my blood pressure shoot up. Because of this, and because I was feeling (non-clinically) depressed (including first big bout with insomnia in quite awhile), I started the Serzone again recently. BP's back down, but, (sigh) memory seems worse again at a time I can least afford that. So I might drop the Serzone again, soon. It does concern me that the Provigil raises my BP, which I had never noticed before, since I never took it without Serzone until a few months ago. From all I've seen and heard, that's not a typical Provigil side effect as it can be for amphetamine-based meds. I think my BP has an unusually strong reaction to meds, whether up (Provigil) or down (Serzone).
> >
> > I wish there were something that could help offset the med-induced memory deficit in what is otherwise an incredible three-med cocktail for my Social Phobia (but, again, Serzone's main benefits for me might be potentiating the K+P, while nullifying the Provigil BP-raising effect).
> >
> > Ironic that I'd end up talking about Blood Pressure, since I do know that Clonidine's official indication is as a (centrally-acting) antihypertensive. I wonder if your initial morning mental fogginess might have been due to hypotension, given that BP is lower while sleeping, and you are taking a BP medication.
> >
> > Sorry for rambling a bit at the end.
> >
> > Rick
Posted by Lorraine on February 13, 2002, at 23:43:08
In reply to Re: Provig DOESN'T Induce Klon/And if Did, No Big Deal » Lorraine, posted by Rick on February 13, 2002, at 20:49:59
This is the end of the thread.
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