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How Long Does Klonopin Take To Show Effect In A Person With Moderate Metabolism?
Question: Hi,
I would like to clarify this subject, because i received here contradictory explanations. I am on Lexapro 5 mg, Klonopin 3 mg (i take 1 mg more since four days), Keppra 1000mg and Solian (amisulpride) 100mg.
I asked what happens with Klonopin because i am intermediate metabolizer for cyp2c19. If i am an intermediate metabolizer, It means, as far as i know, that the med works more slowly (with a reduced activity) in my liver and that there are some more side effects. This is because i am in a middle place btween normal (extensive) metabolizer and POOR metabolizer. My question is: ¿i have to wait a little bit more to reach steady plasma concentrations and the therapeutic good effects of Klonopin?
I've been told that Klonopin works on me faster, something strange because my metabolism in the liver works more slowly (? maybe there is something i am not understanding), and i've been told that i don't have to worry because everything is "normal" by the same person who told me that being an intermediate metabolizer (i have to remember that i lack of an allele, which is non-functional), it's necessary to take care of dosages. As far as i know, therapeutic window is not always easy to find for an intermediate metabolizer. But i really cannot understand how a liver which works a little bit like a funnel can work in a "normal" o "quick" way (?).
Please, if possible, let me know if the steady plasma concentration state some days after the rise of the dosage is reached more slowly -or if it's more "variable"- because of my condition and if it's true that i can have for the while some more side effects. Klonopin seems to be working fine but i still have some downsides with this med.
Thanks beforehand, XXXXXXX
I would like to clarify this subject, because i received here contradictory explanations. I am on Lexapro 5 mg, Klonopin 3 mg (i take 1 mg more since four days), Keppra 1000mg and Solian (amisulpride) 100mg.
I asked what happens with Klonopin because i am intermediate metabolizer for cyp2c19. If i am an intermediate metabolizer, It means, as far as i know, that the med works more slowly (with a reduced activity) in my liver and that there are some more side effects. This is because i am in a middle place btween normal (extensive) metabolizer and POOR metabolizer. My question is: ¿i have to wait a little bit more to reach steady plasma concentrations and the therapeutic good effects of Klonopin?
I've been told that Klonopin works on me faster, something strange because my metabolism in the liver works more slowly (? maybe there is something i am not understanding), and i've been told that i don't have to worry because everything is "normal" by the same person who told me that being an intermediate metabolizer (i have to remember that i lack of an allele, which is non-functional), it's necessary to take care of dosages. As far as i know, therapeutic window is not always easy to find for an intermediate metabolizer. But i really cannot understand how a liver which works a little bit like a funnel can work in a "normal" o "quick" way (?).
Please, if possible, let me know if the steady plasma concentration state some days after the rise of the dosage is reached more slowly -or if it's more "variable"- because of my condition and if it's true that i can have for the while some more side effects. Klonopin seems to be working fine but i still have some downsides with this med.
Thanks beforehand, XXXXXXX
Brief Answer:
Dose should be reduced ideally
Detailed Answer:
Hello XXXXXXX Thanks for asking from HCM
We have discussed this with earlier also. You are an intermediate metaboliser for CYP2C19. CYP2C19 is a cytochrome enzyme system that takes part in metabolism of a number of drugs. If we consider the types then they are Ultra Rapid Metabolisers, Rapid Metabolisers, Intermediate Metabolisers and Poor Metabolisers.
If we consider by research studies then about 20-25% of population in USA is Intermediate Metaboliser (IM) in CYP2C19 enzyme. But in normally used doses the status doesn't alter the doses of the drug, onset of action and full effects. As you are an IM so ideally the doses of the drug used should be used in less doses as compared to normal individuals. This means that theoretically the effects would be relatively rapid as compared to normal persons.
IM status means that liver will metabolise the drug relatively slower as compared to normal individuals and dose of Clonazepam should be reduced ideally instead of increasing. So no need to worry.
I hope this helps you. If you are not clear on this thing then please ask again.
Thanks.
Dose should be reduced ideally
Detailed Answer:
Hello XXXXXXX Thanks for asking from HCM
We have discussed this with earlier also. You are an intermediate metaboliser for CYP2C19. CYP2C19 is a cytochrome enzyme system that takes part in metabolism of a number of drugs. If we consider the types then they are Ultra Rapid Metabolisers, Rapid Metabolisers, Intermediate Metabolisers and Poor Metabolisers.
If we consider by research studies then about 20-25% of population in USA is Intermediate Metaboliser (IM) in CYP2C19 enzyme. But in normally used doses the status doesn't alter the doses of the drug, onset of action and full effects. As you are an IM so ideally the doses of the drug used should be used in less doses as compared to normal individuals. This means that theoretically the effects would be relatively rapid as compared to normal persons.
IM status means that liver will metabolise the drug relatively slower as compared to normal individuals and dose of Clonazepam should be reduced ideally instead of increasing. So no need to worry.
I hope this helps you. If you are not clear on this thing then please ask again.
Thanks.
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Dr. Bishnoi,
I understand better now, thanks for you answer. If i will metabolize the drug slower, i guess the SAME dose of Klonopin -not a reduced one, but a higher one since my psychiatrist decided to give me one mg more (1mg)- can take more time to reach the steady plasma concentration state (i mean this 1 mg), since liver is acting like a funnel (so, slower, it's what a funnel means): slower therapeutic effects, and at the beginning more side effects (of course more RAPID because of the funnel in the liver). If the dose was lower, it could be different (more rapid therapeutic effects, less side effects), but i am asking in this case about a HIGHER dosage, because it seems i need it.
What i mean is that i want to know the effect of a higher dose, since is this what I am receiving and it seems i can need it because of equilibrium between my meds. If liver will metabolise the drug slower, i would like to know if it means (without any change in the dose, so 3 mg, that's to say 2 mg plus 1 mg MORE since five days now) that i'll need some more time to reach the steady plasma concentrations, because -again- a higher dosage means that the drug is acting slower? I mean: at a HIGHER dosage the drug acts slower because i am IM metabolizer?
I am sorry but i think there is still some misunderstanding: i ask for the effect of a higher dosage in steady plasma concentration (when can i reach it) and taking into account the "funnel effect" because metabolism is slower (i guess in this case therapeutic effects are slower too, especially is dose is higher!).
Thanks for you patience and i'll be waiting for your answer,
Best regards, XXXXXXX
I understand better now, thanks for you answer. If i will metabolize the drug slower, i guess the SAME dose of Klonopin -not a reduced one, but a higher one since my psychiatrist decided to give me one mg more (1mg)- can take more time to reach the steady plasma concentration state (i mean this 1 mg), since liver is acting like a funnel (so, slower, it's what a funnel means): slower therapeutic effects, and at the beginning more side effects (of course more RAPID because of the funnel in the liver). If the dose was lower, it could be different (more rapid therapeutic effects, less side effects), but i am asking in this case about a HIGHER dosage, because it seems i need it.
What i mean is that i want to know the effect of a higher dose, since is this what I am receiving and it seems i can need it because of equilibrium between my meds. If liver will metabolise the drug slower, i would like to know if it means (without any change in the dose, so 3 mg, that's to say 2 mg plus 1 mg MORE since five days now) that i'll need some more time to reach the steady plasma concentrations, because -again- a higher dosage means that the drug is acting slower? I mean: at a HIGHER dosage the drug acts slower because i am IM metabolizer?
I am sorry but i think there is still some misunderstanding: i ask for the effect of a higher dosage in steady plasma concentration (when can i reach it) and taking into account the "funnel effect" because metabolism is slower (i guess in this case therapeutic effects are slower too, especially is dose is higher!).
Thanks for you patience and i'll be waiting for your answer,
Best regards, XXXXXXX
Brief Answer:
Higher doses wouldn't delay the action
Detailed Answer:
Hello again XXXXXXX thanks for a follow up question
Klonopin is a benzodiazepine drug and the drug is a short acting drug. The drug doesn't need a ceiling effect. Higher doses result in higher effects. The drug acts rapidly and then result in immediate effects. The drug doesn't need to cause changes at molecular levels to show its effects.
So in my opinion higher dose will not result in delayed effects. Your Cyp2c19 IM status wouldn't cause much effects on its actions if we consider high doses.
As you are metabolising the drug relatively slower so either normal or slightly reduced doses would work. The dose has been increased in your case for quick effects as higher doses result in more effects.
So "higher doses doesn't mean that the drug is acting slower".
For benzodiazepines steady state concentration have not much roles in total action of the drug.
Thanks, still have some uncleared things please ask again.
Take care
Higher doses wouldn't delay the action
Detailed Answer:
Hello again XXXXXXX thanks for a follow up question
Klonopin is a benzodiazepine drug and the drug is a short acting drug. The drug doesn't need a ceiling effect. Higher doses result in higher effects. The drug acts rapidly and then result in immediate effects. The drug doesn't need to cause changes at molecular levels to show its effects.
So in my opinion higher dose will not result in delayed effects. Your Cyp2c19 IM status wouldn't cause much effects on its actions if we consider high doses.
As you are metabolising the drug relatively slower so either normal or slightly reduced doses would work. The dose has been increased in your case for quick effects as higher doses result in more effects.
So "higher doses doesn't mean that the drug is acting slower".
For benzodiazepines steady state concentration have not much roles in total action of the drug.
Thanks, still have some uncleared things please ask again.
Take care
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Above answer was peer-reviewed by :
Dr. Yogesh D
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