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

Hello,

Welcome to icliniq.com.

Thank you for getting in touch with us.

As far as I do understand, you took the Clonazepam for five days. The dose was 0.5 mg per tablet. I can guarantee you that this has absolutely and in no way any 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) 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 recommend 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 recommend that you take Atarax with a substance called Hydroxyzine. So you can tell your doctor that I recommended 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.

Thank you.

Hi,

Welcome back to icliniq.com.

After 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 ERY 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 ERY 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% ERY 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?

Maybe the pharmacies in your place also accept a digital prescription. So I will write it down for you in the respective field. Perhaps you want to try if they accept this digital prescription. 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 worries is not healthy.

I am here when you need me.

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 is not a very clever combination, even when the Ery is used topically only. When you take the Cephalexin orally (positive outcome in acne at round about 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 Ery 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 your bacteria's effect on your general health, and long-term oral antibiotic treatment will affect the equilibrium in this RGD (Arginylglycylaspartic acid).

Hi,

Welcome back to icliniq.com.

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

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 (0) evidence that antibiotics could make you more susceptible to Sars-CoV-2. What is more, in case (God forbid) that you should be tested positive for Sars-CoV-2, we have an exceptionally effective treatment plan in the clinic where I work as deputy head physician. Evidence or study 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 furuncle?

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 furuncle is very dangerous when laypeople do, especially in the head region. It could easily lead to sepsis when the remote procedure is done wrongly 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 use of recurrent use of oral antibiotics if not necessary.

Natural yogurt is a help for the gut bacteria. However, I strongly recommend pro-biotics 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.

I am here when you need me.

My dear Very nice to read you again. As always I read your description of your symptoms very carefully. You know I’m a straightforward guy. So 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’s exactly what makes sense and explains your symptoms. Since your nerves are way more resilient than you fear, I recommend a careful wait and watch strategy. I don't know if you do sports regularly, but it's important that you keep your body in action as much as possible. So go for a walk every day, do some gymnastics or yoga, 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 persists longer then 3 to 4 weeks please see a neurologist then, not now. (Now only if it should escalate). I know it's irrelevant for you, but I myself had exactly 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 the left hand instead of with the 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!

Dear Good to read you. Ok, 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 is combined with a cromoglicic acid nasal spray. In many countries the eye drops and the nasal spray are sold in one pack without prescription. Cromoglicic acid is a safe and very effective medication, however it needs you to two weeks to see it’s full effect. So that would be my recommendation. If this should not be enough you can add clemastine tablets (details below). Clemastine is a great old antihistamine with significant mast cell stabilizing properties. The only real side-effect it makes (other than those ultra rare one 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, otherwise more often (again, details below). Of course I had a sharp look at your eyes and I am sure that this level of medication will 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 recommend lipid-based eye drops like “Systane Balance”. It’s available in Israel, I just checked it. Use this at least once every 2 hours for the first weeks. You can also contact a very interesting colleague who is a terrific medical doctor who is (not only) specialized in herbal remedies. I know that he is very good in treating “dry eyes”, among many other things that he treats extremely well. His name is Dr. Dr. Ari Barsfeld. Maybe you want to consult him, too. You will find him most easy when you google the full name and “DocCheck”. He doesn’t accept new patients, but if you mention that I referred you that should open the door for you. 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 the eye we have to be extra careful. I hope I answered all your questions. But you know, I am here when you need me. Have a good night!

Dear I apologize that you had to wait longer than usual, 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 them serious. Honestly I’m not too happy with the Azelastine HCL since that’s a topical antihistamine which is again just an on/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, but 7 to 17 is more realistic at 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 on the long run in 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 1mg, 3 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... Rgd. the probiotics: natural yoghurt can be enough. Just observe your bowel movements and your stools. If there everything is normal you don’t need extra probiotics, but they would also cause no harm. I hope I could answer all you questions and wish you well. I’m here if you need me.

Dear You are always most welcome! As to the Azelastin. Yes, I truly believe you should rather take a mast cell stabilizer rather than antihistamine nasal spray/eye drops on/off. From what I know about you, I get more and more the impression that you’re dealing with an over-active inert 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 recommend (seriously) to apply shaving foam on your nose 10 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/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. This just between you (as a very well informed patient) and me as your physician who wants you to stay as healthy as possible.

Dear 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 over-active innate immune system. Just have a look at the medications you got for several issues: antibiotics, steroids, a benzodiazepine etc. That’a quite a lot for a healthy young man. So, I stick with my recommendation 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 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 you irritated innate immune system. I truly hope you understand that I recommend that because I’m truly worried. Thanks!

Dear You may take the Optilast, 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 over-active immune system (there are dozens of variants). Rgd. the cyst/furuncle: The medication should do it. If 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 in treatments offered in beauty-focussed dermatology clinics. Self-treatment is always a “try and error approach” since every skin reacts differently. Kind regards!

Dear Always a pleasure to read you. 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.

Dear First of all, no worries: your toes 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 a sensitive, dangerous and tough job. I would try that one before involving a surgeon. Have a great day!

Dear, Nice to read you. There is a phrase, “sometimes less is more”. Regarding post-inflammatory hyperpigmentations it’s the exactly 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. I also have some of these spots. “Sophisticated ignorance” is also my approach for my own post-inflammatory hyperpigmentations. 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 (10minutes) before a warm shower and rubbing your face with a fresh towel after the shower. Or you use a cheap peeling gel from a drugstore or supermarket. After the peeling pls. disinfect the skin. But you should really take more care of your pores. That will prevent inflammations and irritations. Wish you well!

Dear Good to read you. Hope life is treating you well. For Cortisone in and on the eyes there is a “golden rule”: not longer than 14 days. Up to 14 days you should be safe. After that monthly controls of the eye-pressure and the status of the lens has to be done. Near the eyes the risk it much lower. As to the vaccination: normally I am extremely pro vaccination. However, I have an issue with the mRNA vaccines. Technically spoken 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 auto-immune 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 (NHS) banned the Pfizer-Biontech vaccine for people with severe allergies in their medical history, a correct and appropriate step. With 19 years of age you are at a very low risk group. On the other hand there are severe cases occasionally also in your age group. Maybe the prophylaxis and therapy guidelines of the FLCCC would be an alternative that will give you some more time to think it through until it’s your time to get vaccinated: https://covid19criticalcare.com/ I personally am not allowed to get the Pfizer-Biontech vaccine since I have a history of anaphylactic reactions and an auto-immune 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 recommendation: take the Moderna and in the meantime follow the recommendations of the FLCCC. With my most kind regards.