Clonazepam

Clonazepam is a prescription medicine used to treat epilepsy (seizures), panic and anxiety disorder. It helps to decrease the abnormal and excessive activity of the nerve cells and calms the brain. Clonazepam may be taken with or without food. However, take it at the same time each day as this helps to maintain a consistent level of medicine in the body. Take this medicine in the dose and duration as advised by your doctor as it has a high potential of habit-forming. If you have missed a dose, take it as soon as you remember it and finish the full course of treatment even if you feel better. You should not stop this medicine suddenly without talking to your doctor as it may increase the seizure frequency and can cause nausea, anxiety, flu-like symptoms, and muscle pain.

Clonazepam is a benzodiazepine. It works by increasing the action of a chemical messenger (GABA) which suppresses the abnormal and excessive activity of the nerve cells in the brain.

• Panic disorder (with or without agoraphobia)
• Lennox-Gastaut Syndrome (petit mal variant)
• Akinetic and myoclonic seizures
• Absence seizures (petit mal) - in patients who have failed to respond to succinimides

Clonazepam exhibits pharmacological properties which are common to benzodiazepines and include anticonvulsive, sedative, muscle relaxing and anxiolytic effects. The central actions of benzodiazepines are mediated through an enhancement of the GABAergic neurotransmission at inhibitory synapses. In the presence of benzodiazepines the affinity of the GABA receptor for the neurotransmitter is enhanced through positive allosteric modulation resulting in an increased action of released GABA on the postsynaptic transmembrane chloride ion flux.

Clonazepam reduces the nerve transmission in the motor cortex which suppresses the spike and wave discharge in absence seizures. Its mechanism is believed to be related to its ability to enhance the activity of GABA. Clinically, it improves focal epilepsy and generalised seizures.

Adult Dose (Oral - Epilepsy): Initial: 1 mg at night (4 days), gradually increased over 2-4 weeks; Maintenance: 4-8 mg/day; Max: 20 mg/day.

Adult Dose (Oral - Panic Disorder): Initial: 0.25 mg twice daily, increased after 3 days up to 1 mg/day; Max: 4 mg/day.

Pediatric Dose (Oral - Epilepsy): <10 years or <30 kg: 0.01-0.03 mg/kg/day (max 0.05 mg/kg/day) in 2-3 divided doses; increase by max 0.25-0.5 mg every 3rd day; Maintenance: 0.1-0.2 mg/kg/day (3 divided doses); Max: 0.2 mg/kg/day.

IV Dose (Status Epilepticus): Adult: 1 mg slow IV (over 2 min); Child: 500 mcg slow IV.

Elderly: Initial: 0.5 mg at night (4 days).

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Clonazepam may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Clonazepam, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common Side Effects (in seizure treatment): Drowsiness (approx 50%), Ataxia (approx 30%), Behavioral problems (approx 25%)

Other Side Effects: Depression, dizziness, fatigue, impaired coordination, abnormal eye movements, aphonia, coma, tremor, vertigo, confusion, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis, palpitations.

• [UNSAFE] Clonazepam may cause side effects which could affect your ability to drive.
• The addiction/habit-forming potential is very high; take only as per the dose and duration advised by your doctor.
• Avoid consuming alcohol as it may increase dizziness and drowsiness.
• Inform your doctor if you experience worsening anxiety, depression, anger, violent behavior, or mania.
• Do not stop taking suddenly without talking to your doctor as that may lead to nausea, anxiety, agitation, flu-like symptoms, sweating, tremor, and confusion.
• Caution during pregnancy and lactation.

• Hypersensitivity to benzodiazepines
• Acute pulmonary insufficiency
• Acute narrow angle glaucoma
• Severe liver disease

Additive depressant effect with TCAs, MAOIs, sedatives and hypnotics, barbiturates, anxiolytics, antipsychotics, opiate agonists. May increase serum phenytoin levels.

[UNSAFE] It is unsafe to consume alcohol with Clonazepam.

[CONSULT YOUR DOCTOR] Clonazepam is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. Pregnancy Category D. Administration of high doses in the last trimester may cause neonatal hypothermia, hypotonia, respiratory depression, and poor feeding.

[SAFE IF PRESCRIBED] Clonazepam is safe to use during breastfeeding. Human studies suggest that the drug does not pass into the breastmilk in a significant amount and is not harmful to the baby. However, clonazepam is excreted in breast milk in small amounts; breastfeeding should be discontinued if there is a compelling indication for use.

Pediatric dose: Seizures (<10 years or <30 kg): 0.01-0.03 mg/kg/day (max 0.05 mg/kg/day) in 2-3 divided doses; Maintenance 0.1-0.2 mg/kg/day; IV: 500 mcg.

Elderly patients are more susceptible to benzodiazepine pharmacologic effects.

[CAUTION] Use with caution in patients with kidney disease. Renal impairment does not affect the pharmacokinetics of clonazepam; no dose adjustment is required. May cause excessive sleepiness in end stage kidney disease.

[CAUTION] Use with caution in patients with liver disease. Clearance of clonazepam may be reduced in liver cirrhosis.

Overdose symptoms: Drowsiness, ataxia, dysarthria, nystagmus, areflexia, apnea, hypotension, cardiorespiratory depression, coma. Treatment: Symptomatic and supportive; flumazenil (benzodiazepine antagonist) may be used.

Keep in a dry place away from light and heat. Keep out of reach of children.

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