Prozac, also known by the generic name fluoxetine, is an antidepressant in the SSRI class (Selective Serotonin Reuptake Inhibitor). Prozac being labelled as an antidepressant is a misnomer, as in addition to depression, Prozac treats anxiety disorders, such as panic disorder.
Prozac can be initiated at 10mg once daily, then increased by 10mg every 1 to 2 weeks until there is clinical effect. The therapeutic dose is between 20mg to 40mg daily. If starting with 10mg daily produces significant side effects, then decrease the dose to 5mg once daily, increasing by 5mg every 1 to 2 weeks until clinical effect.
The problem with just starting Prozac on its own for panic disorder is that it can take 4 to 6 weeks for the Prozac to be effective. In addition to waiting for weeks until clinical effect, Prozac can have side effects in the first few weeks, which include increased anxiety, agitation, and restlessness. So to counteract the possible side effects with the initiation of Prozac, and to cover the period of time when waiting for the Prozac to work, a benzodiazepine can be started on a short-term basis. Prescribing a benzodiazepine short term also reduces the risk for addiction, as benzodiazepines have addictive potential. When choosing a benzodiazepine to start concurrently with Prozac, you want a benzodiazepine that has a longer duration of action, such as Klonopin, also known by its generic name clonazepam.
Start Klonopin at 0.5mg twice daily, along with your starting dose of Prozac. If needed, the Klonopin can be increased to 1mg twice daily. Once the Prozac is effective for the anxiety symptoms weeks later, then the Klonopin can be reduced and eventually discontinued.