Instead of 48 hours, I took Clonazepam 22 hours after the last pill. Will it damage my brain?

Question

Hi doctor,

I am worried after taking Clonazepam 0.5 mg for five days.

Does it cause any adverse effects in my life?
Can I have memory loss or cognitive impairment?
Will it cause any damage to my brain?
It has not improved my anxiety. Can I have any impact due to it?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for getting in touch with us.

As far as I understand, you took Clonazepam for five days. The dose was 0.5 mg per tablet. I can guarantee you that this has absolutely no long-term effects on your brain, on your body, or anything else. You are suffering from an anxiety disorder. Therefore, treatment makes sense. However, as long as you do not have a REM (rapid eye movement) sleep disorder, or a difficult case of obsessive-compulsive disorder, or above all, epileptic seizures, Clonazepam is not the drug of the first choice.

I suggest you go back to your doctor and ask him or her to prescribe you another anxiolytic that is not habit-forming and has no potential to make you addicted to it. But I can assure you that after five days, there is no addiction and no long-term effect.

I suggest that you take Atarax with a substance called Hydroxyzine. So you can tell your doctor that I suggested Atarax, and then you can see if he will prescribe it. Of course, Atarax has side effects too, but rest assured and trust me, it will not harm you as long as you do not have a severe heart condition. So, please accept my explanation and stop worrying about today, try to enjoy the weekend, and try to get a new anti-anxiety medication from your local doctor.

Revert in case of further queries.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

After more than 25 years as a physician, I am very familiar with these commonly prescribed substances. So I am impressed by how much you know about medicine and how careful you are. However, the topical use of Erythromycin and its oral use are like two different drugs.

The reason: Erythromycin is excellent against acne, but it is not useful in permeating through the skin layers and tissues below the skin into your “system.” Orally taken, Erythromycin and Clonazepam both use the same enzyme in the liver, leading to more severe side effects. But this does not apply to topical use or Erythromycin. So you can continue to use it, and you do not need a liver enzyme or cholestatic liver test because of topical Erythromycin. Believe it or not, even I use topical Erythromycin when I have a small inflammation due to an ingrown hair, and I would never take a harmful medication, nor would I prescribe it. Why do I use Erythromycin and no other topical antibiotic? Because it is safe.

Nevertheless, 4 % is quite strong (fine but strong) and might irritate your skin. Have you ever tried it with 2 %? My patients do very well with 2 % Erythromycin topical for acne. However, if your skin has no problem with it, continue with 4 %, even long-term. As to your constant worries, I would see you get optimal treatment. Do you have a chance to discuss Atarax with your local physician?

Atarax is safe as long as no major heart condition is known. As long as you do not take any other oral, intramuscular, intravenous, or rectal medication that uses the liver enzyme CYP-2D6 (Cytochrome P450 2D6), being careful is good; being in a state of constant worry is not healthy.

Revert in case of queries.

Thanks.

Answer 3

Hello,

Welcome back to icliniq.com.

Please forget that you took the Clonazepam. Yes, it has a long half-life, but there is no reason to even think of an interaction between Clonazepam and Cephalexin.

However, Cephalexin and Erythromycin are not a very clever combination, even when the latter is used topically only. When you take Cephalexin orally (positive outcome in acne at around 70 % of patients), you want to permeate it into the skin to fix your issues there. Once the oral Cephalexin has reached all skin layers, it will meet the topical Erythromycin there. And then something happens that nobody knows why, but as they "meet, they reduce each other's function. So you should take either the topical Erythromycin or the systemic Cephalexin if it is only for acne. Not both at the same time for acne.

If it is all about acne, you may send me a photo. Have you ever tried Aspirin, Gaviscon (Aluminium hydroxide and Magnesium Carbonate) liquid, Diphenhydramine, topical Erythromycin, and a daily pore cleaning with R-foam instead of an oral antibiotic? In mild to moderate acne, I see good results with this approach. It would help if you did not underestimate the effect on your general health, and long-term oral antibiotic treatment will affect the equilibrium in this RGD (Arginylglycylaspartic acid).

Revert in case of further queries.

Regards.

Answer 4

Hi,

Welcome back to icliniq.com.

Excuse me for having to wait for a little while. It is a busy day, and I want to give you a detailed answer since you are very informed and careful.

For some patients, too many details are confusing, but I understand that you know a lot about medicine. So rest assured that I will always answer in an easily understandable but detailed way.

First of all, there is zero evidence that antibiotics could make you more susceptible to SARS-CoV-2. What is more, in case you should test positive for SARS-CoV-2, we have an exceptionally effective treatment plan that is evidence-based, of course. So do not panic.

As to the course of antibiotics, you are now on. May it be right or wrong, please finish the course because you seem to tolerate the substance, and we do not want more resistant bugs in you and out there; one of the main reasons for new resistant bacteria in patients who do not finish their antibiotics.

However, I would like to know what this blister is all about. Like a blister, we usually define a bump of the skin's upper layer(s) filled with a watery liquid. That is usually no reason for an oral antibiotic. So, could it be you mean a boil or a furnace?

But even then, I favor cutting them open and cleaning them carefully, followed by post-treatment with a topical antibiotic like Tetracycline. This can and must be done by a physician only, since manipulating a boil or furnace is very dangerous when done by laypeople, especially in the head region. It could easily lead to sepsis when the remote procedure is done incorrectly or by a careless health care provider. So I would appreciate understanding better what is happening on your skin because I am, as you already know, not happy with the recurrent use of oral antibiotics if not necessary.

Natural yogurt is helpful for gut bacteria. However, I strongly suggest probiotics from the pharmacy. It does not matter which brand as long as it is from the pharmacy, of high quality, and licensed to be used to improve the bacteria's status in your intestines.

Revert in case of queries.

Thank you.

Answer 5

Hello,

Welcome back to icliniq.com.

I understand your concern.

It is very nice to hear from you again. As always, I read your description of your symptoms very carefully.

I will tell you without a doubt that this is not a “textbook carpal tunnel issue”. You have no idea how easy it is to get an “irritated nerve”. And that is exactly what makes sense and explains your symptoms. Since your nerves are way more resilient than you fear, I suggest a careful wait-and-watch strategy.

I do not know if you do sports regularly, but you must keep your body in action as much as possible. So go for a walk every day, do some gymnastics or yoga, and physiotherapy might also help. A search for the “right” nerve(s) and the exact location where the irritation happens is a highly complex endeavor. Until then, this issue will most likely have resolved itself before you get the right diagnosis.

So as long as it doesn't get much worse, keep your body in motion and let nature do its job. Should it get worse or should it persist longer than 3 to 4 weeks, please see a neurologist then, not now (now, only if it should escalate). I know it's irrelevant to you, but I myself had the same problem at least six or seven times until now. By accident, I found out the cause of the problem, and it vanished completely when I started to use the computer mouse with my left hand instead of with my right hand. Believe me, there is no study about something like that. But maybe it will give your mind some peace when you know that the doctor you're asking for his opinion has gone through the same symptoms as well. Stay strong and healthy.

Follow up when needed.

Thank you.

Answer 6

Hello,

Welcome back to icliniq.com.

I understand your concern.

Good to hear from you. Let’s tackle the questions systematically: As to your eye condition, have you ever tried a long-term therapy with cromoglicic acid eye drops?

Cromoglicic acid is a wonderful mast cell stabilizer. Even better would be to take it combined with a cromoglicic acid nasal spray. In many countries, eye drops and nasal sprays are sold in one pack without a prescription. Cromoglicic acid is a safe and very effective medication; it takes two weeks to see its full effect. So that would be my suggestion. If this should not be enough, you can add Clemastine tablets. Clemastine is a great old antihistamine with significant mast cell stabilizing properties. The only real side-effect it makes (other than those ultra-rare ones mentioned in the textbooks) is that it might make you a bit drowsy. So if you drive a car, you can only take it before going to bed, more often.

Of course, I had a sharp look at your eyes (attachments removed to protect the patient's identity), and I am sure that this level of medication will be more than sufficient. I saw nothing worse than you described, nothing worrisome, no reason for fears, just an irritation which is consistent with a common dry eye or light allergy. Now, you should avoid eye drops containing hyaluronic acid. They have become very popular around the globe (because they are cheap to manufacture, not because they’re good). They are quite often the cause of irritations in many of my patients.

Instead, I suggest lipid-based eye drops like Systane Balance (propylene glycol 0.6 %). Use this at least once every two hours for the first week. As to the pimple near your eye, yes, you can try that medication as long as it does not get into your eye. And, as you most likely already know, please don’t put any pressure on that pimple. With everything around us, we have to be extra careful.

I hope I answered all your questions.

But you know, I am here when you need me.

Thank you.

Answer 7

Hi,

Welcome back to icliniq.com.

I understand your concern.

I had a day off, but just saw your question and decided to answer it now right away since I am aware of your concern regarding your health and taking it seriously. Honestly, I’m not too happy with the Azelastine HCL (hydrochloride) since that’s a topical antihistamine, which is again just an on or off therapy.

I wanted you to take a mast cell stabilizer, Cromoglicic acid, for a longer period of time. Nasal spray plus eye drops. Regarding the eye pressure, normal values are defined as 10 to 20 mmHg, but 7 to 17 mmHg is more realistic for your young age. Corticosteroids can indeed cause higher eye pressure values. However, normally, only in long-term users (14 days plus), and the pressure returns to normal once the medication is out of your system.

A side-effect that is more serious in the long run for long-term steroid users is early-onset cataract, which is permanent. As to your heightened level of alert in general (hyper-vigilance) and somehow like a “mirror” in your immune system (allergy, and/or irritation-like symptoms): I still believe Clemastin 1 mg, three times a day, would be a good help to avoid many symptoms and potentially harmful over-therapy due to colleagues who are easy to frighten.

Sometimes less is more. Regarding the probiotics, natural yoghurt can be enough. Just observe your bowel movements and your stools. If everything is normal, you don’t need extra probiotics, but they would also cause no harm.

I hope this information will help.

Thank you.

Answer 8

Hi,

Welcome back to icliniq.com.

I understand your concern.

As to the Azelastin. Yes, I truly believe you should rather take a mast cell stabilizer rather than an antihistamine nasal spray or eye drops on and off. From what I know about you, I get more and more the impression that you’re dealing with an overactive immune system rather than with normal allergies.

As to your nose, you can take that topical antibiotic, but since you have acne often, less is more. It is clearly visible that you have congested pores on your nose. These are like breeding stations for bacteria. I suggest you seriously apply shaving foam on your nose ten minutes before taking a shower. After a warm shower, rub your nose gently with a fresh towel. If this is not enough to keep your pores open, you should see a cosmetic salon to get them cleaned regularly.

You will have way less trouble with infections afterwards. I fully understand that you have a lot of medical knowledge, but in daily practice, good doctors quickly learn that over-treating a patient might be as dangerous as under-treating him or her. Many doctors prescribe something every time because the patients expect action, although a wait-and-see approach is often the best course of therapy.

I hope this helps.

Thank you.

Answer 9

Hi,

Welcome back to icliniq.com.

I understand your concern.

The redness of your eye is a symptom, not a cause. As mentioned before, it is very well possible that the different symptoms you have are being caused by the same reason, an overactive innate immune system.

Just have a look at the medications you got for several issues: antibiotics, steroids, a benzodiazepine, etc. That's quite a lot for a healthy young man. So, I stick with my suggestion of a mast cell stabilizer and Clemastin. If the eye situation worries you, you might want to see an ophthalmologist.

But on the photos you provided the last time (attachments removed to protect the patient's identity), it didn’t look like a dramatic condition. It would be wise to define a treatment goal for you: to be less dependent on treatments with strong medication for one reason after another, but to calm down your irritated innate immune system.

I truly hope you understand that I suggested that because I’m truly worried.

Revert in case of queries.

Thank you.

Answer 10

Hi,

Welcome back to icliniq.com.

I understand your concern.

You may take the Optilast (Azelastine hydrochloride), it’s not bad. Nevertheless, I still believe that a mast cell stabilizer would be a better choice. As to the immune system, that’s rocket science and easily confusing. So, I see signs of an overactive immune system (there are dozens of variants). Regarding the cyst or furuncle, the medication should do it.

Of course, any doctor could remove it with a small incision. Then it would be done and gone. You also asked about the acne scars. Honestly, the best results we see are in treatments offered in beauty-focused dermatology clinics. Self-treatment is always a “try-and-error approach” since every skin reacts differently.

I hope this answers your query.

Thank you.

Kind regards.

Answer 11

Hi,

Welcome back to icliniq.com.

First of all, no, such symptoms are normally not connected to blood clots. But of course, I would like to see them. However, for reasons I don’t know, the photos you mentioned were not attached.

Thank you.

Answer 12

Hello,

Welcome back to icliniq.com.

I understand your concern.

First of all, no worries, your toes (attachments removed to protect the patient's identity) look fine. The photo arrived this time. As to the toenail, to me, it seems to still be a case that can be solved in a medical foot care studio, not a beauty salon (terrible hygiene in these shops), but in a medical foot care practice. They are normally trained to even treat diabetic patients, which is a really sensitive, dangerous, and tough job. I would try that one before involving a surgeon.

Hope this resolves your doubts.

Thank you.

Answer 13

Hi,

Welcome back to icliniq.com.

I understand your concern.

There is a phrase, sometimes less is more. Regarding post-inflammatory hyperpigmentation, it’s the exact right approach. Let it fade away. It might take a while, maybe even two or three years, but to wait is the best therapy in this case. Sophisticated ignorance is also my approach to my own post-inflammatory hyperpigmentation. All treatments that are advertised only stimulate the cells anew; that’s the reason why doing nothing is the solution in this case.

You will have much less trouble with your skin in general when you make sure that your pores are always deeply cleaned. Washing your face is not enough to reach that goal. You can use shaving foam on your nose for ten minutes, before a warm shower, and rub your face with a fresh towel after the shower. Or you use a cheap peeling gel from a drugstore or supermarket. After the peeling, please disinfect the skin. But you should really take more care of your pores. That will prevent inflammation and irritation.

I hope this addresses your concern.

Thank you.

Answer 14

Hi,

Welcome back to icliniq.com.

For Cortisone in and on the eyes, there is a golden rule: not longer than 14 days. For up to 14 days, you should be safe. After that, monthly controls of the eye pressure and the status of the lens have to be done. Near the eyes, the risk is much lower. As for vaccination, normally, I am extremely pro-vaccination.

However, I have an issue with the mRNA vaccines. Technically speaking, it’s not a vaccine but a gene therapy. The mRNA (also the AstraZeneca vaccine, which is a DNA vaccine) uses your own cells to produce viral spike proteins against which the immune system reacts. Basically, that’s a purposely induced autoimmune reaction, not a vaccination of the type we have known for decades. Overall, the safety profile (short-term) seems to be good. However, we have no long-term or even just detailed data. Therefore, the United Kingdom National Health Service (NHS) banned the Pfizer-BioNTech vaccine for people with severe allergies in their medical history, a correct and appropriate step. At 19 years of age, you are in a very low-risk group.

On the other hand, there are also severe cases occasionally in your age group. Maybe the prophylaxis and therapy guidelines of the FLCCC (Front Line COVID-19 Critical Care Alliance) would be an alternative that will give you some more time to think it through until it’s your time to get vaccinated.

I personally am not allowed to get the Pfizer-BioNtech vaccine since I have a history of anaphylactic reactions and an autoimmune disease. So I am waiting for Moderna, which seems (not sure) to have a slightly better safety profile. The AstraZeneca vaccine is no option for me personally since it interacts with the cell’s DNA, a technique I consider something between crazy and brainless. So, my suggestion is you take the Moderna and, in the meantime, follow the suggestions of the FLCCC.

With my most kind regards.

Thank you.