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Generic Name
Clonazepam

Therapeutic Class: Adjunct anti-epileptic drugs, Benzodiazepine hypnotics

Indications:

Tablet:

• Anxiety disorders (Generalized, Phobic & Panic disorders)
• Insomnia and sleep disturbances
• Epilepsy
• Labile arterial hypertension
• Peri and Postmenopausal anxiety (Anxiety in middle-aged women)
• Burning Mouth Syndrome
• Peri and Postmenopausal anxiety (Anxiety in middle-aged women)
• Postoperative mental disorder 
• Post-traumatic stress disorder
• Anxiety in cancer patients (palliative treatment)
• headache 
• restless legs syndrome (RLS) 
• Nocturnal myoclonus
• Bipolar major affective disorder 
• Tourette's syndrome 
• Resistant depression
• tic douloureux 
• Drug-induced dyskinesia
• Choreiform movement
• Fulgurant pain

Injection:

• Epilepsy
• seizure
• epilepsy
• Myoclonic seizure
• Tonic-clonic seizure
• Partial seizure
• Typical and atypical absences 
• Infantile spasm
• Absence seizure

Pharmacology :

Clonazepam reduces the nerve transmission within the motor area which suppresses the spike and wave discharge in the absence of seizures. Its mechanism is believed to be associated with its ability to reinforce the activity of GABA. Clinically, it improves cortical epilepsy and generalized seizures.

Dosage & Administration:

Tablet:

Adults: The initial dose for adults with seizure disorders shouldn't exceed 1.5 mg/day divided into three doses. The dosage could also be increased in increments of 0.5 to 1 mg every 3 days until seizures are adequately controlled or until side effects preclude any longer increase. Maintenance individualized dosage for each patient depending upon response. The maximum recommended daily dose is 20 mg.

The initial dose for adults with an anxiety disorder is 0.25 mg given in two divided doses. An increase to the target dose for many patients of 1 mg/day could also be made after 3 days.

Pediatric Patients: so as to attenuate drowsiness, the initial dose for infants and children (up to 10 years aged or 30 kg of body weight) should be between 0.01 and 0.03 mg/kg/day but to not exceed 0.05 mg/kg/day given in two or three divided doses.

Injection:

Infants and children: half a vial (0.5 mg) by slow IV injection.

Adults: 1 vial (1 mg) by slow IV injection or by IV infusion. This does is often repeated as needed (1-4 mg are usually sufficient to reverse the status). In adults, the speed of injection must not exceed 0.25 - 0.5 mg per minute (0.5-1.0 ml of the prepared solution) and a complete dose of 10 mg should not be exceeded.

Interaction:

Clonazepam doesn't appear to change the pharmacokinetics of phenytoin, carbamazepine, or phenobarbital. Clonazepam's effect on the metabolism of other drugs has not been investigated.

Contraindications:

It shouldn't be utilized in patients with a history of hypersensitivity to benzodiazepines, nor in patients with clinical or biochemical evidence of serious disease. It may be utilized in patients with open-angle glaucoma who are receiving appropriate therapy but is contraindicated in acute narrow-angle glaucoma.

Side Effects:

Tablet:

The most frequently occurring side effects of clonazepam are referable to as CNS depression, drowsiness, fatigue, dizziness, muscle hypotonia, coordination disturbance, hypersalivation in infants, paradoxical aggression, irritability, and mental change.

Injection:

Some side effects, like fatigue, muscle weakness, dizziness, somnolence, light-headedness, ataxia, restlessness, hypersalivation in infants, paradoxical aggression, reduced coordination may occur with Clonazepam therapy but these effects are transient and usually disappears within the course of the treatment. Respiratory depression may occur in patients with pre-existing airway obstruction, or brain damage, or if other medications which depress respiration are given. As a rule, this effect is often avoided by careful adjustment of the dose to individual requirements.

Use in Pregnancy & Lactation:

Clonazepam use during pregnancy or lactation should be avoided. Clonazepam is excreted into breast milk and will therefore be avoided in breastfeeding mothers.

Precautions:

Tablet:

Patients in whom several different types of convulsions disorders coexist, clonazepam may increase the incidence or precipitate the onset of generalized tonic-clonic convulsions. this might require the addition of appropriate anticonvulsants or a rise in their dosages. The concomitant use of Depokene and clonazepam may produce absence status. Periodic blood counts and liver function tests are advisable during future therapy with clonazepam. The sudden withdrawal of clonazepam, particularly in those patients on long-term, high-dose therapy, may precipitate epilepsy. Therefore when discontinuing clonazepam, gradual withdrawal is important.

Clonazepam may produce a rise in salivation. this could be considered before giving the drug to patients who have difficulty handling secretions. due to this and therefore the possibility of respiratory depression, clonazepam should be used with caution in patients with chronic respiratory diseases.

Because of the likelihood that adverse effects on physical or mental development could become apparent only after a few years, a benefit-risk consideration of the long-term use of clonazepam is vital in pediatric patients.

Injection:

Clonazepam use with alcohol and CNS depressants should be avoided. Such concomitant use has the potential to extend the clinical effects of Clonazepam, such as severe sedation, respiratory and cardiac depression. In some cases, dose adjustment of other medications is important. Clonazepam may produce a rise in salivation. this could be considered before giving the drug to patients who have difficulty handling secretions. Clonazepam is used with caution in patients with chronic respiratory diseases. due to the likelihood that adverse effects on physical or mental development could become apparent only after a few years, a benefit-risk consideration of the long-term use of clonazepam is vital in pediatric patients.

Overdose:

Tablet:

clonazepam overdosage Symptoms, produced by other CNS depressants, include somnolence, confusion, coma, and diminished reflexes.

Injection:

Clonazepam overdosage Symptoms, produced by other CNS depressants, include somnolence, confusion, coma, and diminished reflexes.

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

Brand Names

Brand Name	Company	Strength
Arotril Tablet	Aristopharma Ltd.	2 mg, 1 mg, 0.5 mg
Xetril Tablet	Beximco Pharmaceuticals Ltd.	2 mg, 1 mg, 0.5 mg
Disopan Tablet	Incepta Pharmaceuticals Ltd.	2 mg, 1 mg, 0.5 mg
Rivotril Tablet	Radiant Pharmaceuticals Ltd.	2 mg, 1 mg, 0.5 mg
Pase Tablet	Opsonin Pharma Ltd.	2 mg, 1 mg, 0.5 mg