(kloe na' ze pam)
P : Caution when used during pregnancy
L : Caution when used during lactation
|| See TERMINOLOGY & ABBREVIATIONS ||
|Indication(s) & Dosage||Oral
Adult: Initially, 1 mg given at night for 4 nights, gradually increased over 2-4 wk. Maintenance: 4-8 mg daily. Max: 20 mg/day
Child: 1-5 yr: 250 mcg daily; 5-12 yr: 500 mcg daily. Maintenance (given in 2-4 divided doses): Infants: 0.5-1 mg daily; 1-5 yr: 1-3 mg daily; 5-12 yr: 3-6 mg daily. Max: 200 mcg/kg/day
Elderly: Initially, 500 mcg at night for 4 nights, may gradually increase over 2-4 wk.
Hepatic impairment: Dose reduction may be needed.
Adult: Initially, 250 mcg bid, increased after 3 days up to 1 mg daily. Max: 4 mg daily.
Hepatic impairment: Dose reduction may be needed.
Emergency management of status epilepticus
Adult: 1 mg as inj or infusion given over at least 2 min, repeated if necessary.
Child: and infants: 500 mcg as inj or infusion given over at least 2 min, repeated if necessary.
Hepatic impairment: Dose reduction may be needed.
|Administration||May be taken with or without food.
|Overdosage||Somnolence, confusion, ataxia, diminished reflexes or coma. Treatment is symptomatic and supportive. Flumazenil, a benzodiazepine antagonist, may be used in the management of benzodiazepine overdosage after weighing the benefits and risks. Emesis or gastric lavage may be performed followed by activated charcoal and saline cathartic to remove any remaining drug. Monitor patient's heart rate, blood pressure, and respiration. Dialysis is of no known value in clonazepam overdosage.|
|Contraindications||Hypersensitivity to benzodiazepines, acute pulmonary insufficiency, acute narrow angle glaucoma.|
|Special Precautions||Neonates, chronic pulmonary insufficiency, hepatic/renal dysfunction, porphyria, elderly; pregnancy and lactation.|
|Adverse Drug Reaction(s)||Drowsiness, fatigue, muscular hypotonia, coordination disturbances, dizziness, vertigo, anorexia, visual disturbances, libido changes.
Potentially Fatal: Salivary or bronchial hypersecretion leading to respiratory problems (children). May produce diminished reflexes or coma. Rarely, blood dyscrasias.
|Drug Interactions||Carbamazepine, phenobarbitone or phenytoin may accelerate clonazepam metabolism.
Potentially Fatal: Increased sedative effect with alcohol, general anaesthetics and TCAs. Please consult detailed drug interactions before prescribing.
|Pregnancy Category (FDA)||Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).|
|Storage||Intravenous: Store at 25Â°C. Oral: Store at 25Â°C.|
|Pharmacology||Clonazepam is an effective anticonvulsant. It raises the threshold for propagation of seizure activity and prevents generalisation of focal or local activity. Clinically, it improves focal epilepsy and generalised seizures. It is also believed to enhance the activity of GABA, and acts as anxiolytic.
Absorption: Well absorbed from the GI tract (oral); peak plasma concentrations after 4 hr.
Distribution: Crosses the placenta; enters breast milk. Protein-binding: 86%.
Metabolism: Extensively hepatic; converted to 7-aminoclonazepam.
Excretion: Urine (as free or conjugated metabolites); 20-40 hr (elimination half-life).
|ATC Classification||N03AE01 - clonazepam; Belongs to the class of benzodiazepine derivatives antiepileptic. Used in the management of epilepsy.|
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|AROTRIL||Aristopharma Ltd.||Clonazepam 0.5mg & 1mg & 2mg||Tablet||0.5mg x100's, 1mg x50's, 2mg x30's: 300.00 & 200.00 & 150.00 MRP|
|CLOMA||Biopharma Laboratories Ltd||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x50's, 2mg x30's: 100.50 & 120.60 MRP|
|CLON||Globe Pharmaceuticals Ltd||Clonazepam 0.5mg||Tablet||100's: 200.00 MRP|
|CLONAPIN||Popular Pharmaceuticals Ltd.||Clonazepam 0.5mg & 2mg||Tablet||30's each: 60.29 & 120.62 MRP|
|CLONATRIL 0.5||Healthcare Pharmacuticals Ltd.||Clonazepam USP 0.5mg||Tablet||50's MRP 250 Tk|
|CLONATRIL 2||Healthcare Pharmacuticals Ltd.||Clonazepam USP 2mg||Tablet||30's MRP 210 Tk|
|CLONIUM||ACI Ltd.||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x100's, 2mg x50's: 300.00 & 250.00 MRP|
|CLORON||Eskayef Bangladesh Ltd||Clonazepam USP 0.5mg & 2mg||Tablet||0.5mg x100's & 2mg x50's MRP: 300.00 & 250.00|
|CLORON Drop||Eskayef Bangladesh Ltd||Clonazepam USP 2.5mg/ml||Drop||10ml MRP: 80.00|
|DENIXIL||Renata Limited||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x50's, 2mg x30's: 150.00 MRP|
|DEPANIL||Rangs Pharmaceuticals Ltd.||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x50's, 2mg x30's: 100.00 & 120.00 MRP|
|Disopan 0.5||Incepta Pharmaceuticals Limited||Clonazepam 0.5mg Tablet||Tablet||10x10's:MRP 300 Tk|
|Disopan 2||Incepta Pharmaceuticals Limited||Clonazepam 2mg Tablet||Tablet||10x5's:MRP 250 Tk|
|EPICLON||General Pharmaceuticals Ltd||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x50's, 2mg x30's: 100.50 & 120.60 MRP|
|EPITRA 0.5||Square Pharmaceuticals Ltd.||Clonazepam 0.5mg||Tablet||5x20's: 402.00 MRP|
|EPITRA 1||Square Pharmaceuticals Ltd.||Clonazepam 1mg||Tablet||3x20's: 301.20 MRP|
|EPITRA 2||Square Pharmaceuticals Ltd.||Clonazepam 2mg||Tablet||3x20's: 361.20 MRP|
|EPITRA O-DROP||Square Pharmaceuticals Ltd.||Clonazepam 2.5mg/ml||Oral Drops||10 ml: 80.55 MRP|
|EPNIL||Sandoz/Novartis||Clonazepam 0.5mg & 2mg||Tablet||0.5mgx50's: MRP 275.00 & 2mgx30's: 240.00|
|ESYPAN||Silva Pharmaceuticals Limited||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x100's, 2mg x50's: 100.38 & 200.75 MRP|
|ESYPAN Drop||Silva Pharmaceuticals Limited||Clonazepam 1.25mg/ml||Drop||10ml: 80.00 MRP|
|LEPTIC||The Acme Laboratories Ltd.||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x100's, 2mg x50's: 201.00 & 200.50 MRP|
|LONAPAM||Delta Pharma Limited||Clonazepam 0.5mg & 2mg||Tablet||30's each: 60.00 & 120.00 MRP|
|LONAZEP||Sun Pharmaceutical (Bangladesh) Ltd.||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x50's, 2mg x30's: 125.00, 135.00 IP|
|PASE||Opsonin Pharma Limited||Clonazepam 0.5mg & 2mg||Tablet||0.5mg x50's, 2mg x30's: 150.00 MRP|
|PASE Drop||Opsonin Pharma Limited||Clonazepam 1.25mg/ml||Drop||10ml: 80.00 MRP|
|RIVOTRIL||Roche Bangladesh Limited||Clonazepam 0.5mg & 2mg||Tablet||50's each: 300.00 & 550.00 MRP|
|XETRIL 0.5||Beximco Pharmaceuticals Ltd||Clonazepam USP 0.5mg||Tablet||100's: 300.00 MRP|
|XETRIL 2||Beximco Pharmaceuticals Ltd||Clonazepam USP 2mg||Tablet||50's: 250.00 MRP|
Why is Clonazepam prescribed?
Clonazepam is used alone or in combination with other medications to control certain types of seizures. It is also used to relieve panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Clonazepam is in a class of medications called benzodiazepines. It works by decreasing abnormal electrical activity in the brain.
How should Clonazepam be used?
Clonazepam comes as a tablet and an orally disintegrating tablet (tablet that dissolves quickly in the mouth) to take by mouth. It usually is taken one to three times a day with or without food. Take clonazepam at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
Do not try to push the orally disintegrating tablet through the foil. Instead, use dry hands to peel back the foil packaging. Immediately take out the tablet and place it in your mouth. The tablet will quickly dissolve and can be swallowed with or without liquid.
Your doctor will probably start you on a low dose of clonazepam and gradually increase your dose, not more often than once every 3 days.
Clonazepam can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time or in a different way than prescribed by your doctor. Take clonazepam exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Clonazepam may help control your condition, but will not cure it. It may take a few weeks or longer before you feel the full benefit of clonazepam. Continue to take clonazepam even if you feel well. Do not stop taking clonazepam without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood, If you suddenly stop taking clonazepam, you may experience withdrawal symptoms such as new or worsening seizures, hallucinating (seeing things or hearing voices that do not exist), changes in behavior, sweating, uncontrollable shaking of a part of your body, stomach or muscle cramps, anxiety, or difficulty falling asleep or staying asleep. Your doctor will probably decrease your dose gradually.
Other uses for Clonazepam
Clonazepam is also used to treat symptoms of akathisia (restlessness and a need for constant movement) that may occur as a side effect of treatment with antipsychotic medications (medications for mental illness) and to treat acute catatonic reactions (state in which a person does not move or speak at all or moves or speaks abnormally). Talk to your doctor about the possible risks of using Clonazepam for your condition.
Clonazepam is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions to follow?
Before taking clonazepam,
- inform your doctor if you are allergic to clonazepam, other benzodiazepines such as alprazolam, chlordiazepoxide, clorazepate, diazepam, estazolam, flurazepam, lorazepam, midazolam, oxazepam, temazepam, triazolam, or any other medications.
- inform your doctor what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone; certain antibiotics such as clarithromycin, erythromycin, and troleandomycin ; antidepressants; certain antifungal medications such as itraconazole and ketoconazole; antihistamines; certain calcium channel blockers such as diltiazem and verapamil; cimetidine; HIV protease inhibitors including indinavir, nelfinavir, and ritonavir; medications for anxiety, colds or allergies, mental illness, or pain; other medications for seizures such as carbamazepine, phenobarbital, phenytoin, or valproic acid; muscle relaxants; nefazodone; rifampin; sedatives; certain selective serotonin reuptake inhibitors such as fluvoxamine; other sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- inform your doctor what herbal products you are taking, especially St. John's wort.
- inform your doctor if you have or have ever had glaucoma (increased pressure in the eye that may cause vision loss) or liver disease. Your doctor may inform you not to take clonazepam.
- inform your doctor if you drink or have ever drunk large amounts of alcohol, use or have ever used street drugs or have overused prescription medications. Also inform your doctor if you have or have ever had lung or kidney disease.
- inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. Clonazepam may harm the fetus. If you become pregnant while taking clonazepam, call your doctor.
talk to your doctor about the risks and benefits of taking Clonazepam if you are 65 years of age or older. Older adults should receive low doses of clonazepam because higher doses may not work better and may cause serious side effects.
- if you are having surgery, including dental surgery, inform the doctor or dentist that you are taking clonazepam.
- you should know that Clonazepam may make you drowsy. Do not drive a car or operate machinery until you know how Clonazepam affects you.
- talk to your doctor about the safe use of alcohol during your treatment with clonazepam.
- you should know that your mental health may change in unexpected ways, and you may become suicidal ( thinking about harming or killing yourself or planning or trying to do so) while you are taking clonazepam for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took anticonvulsants such as clonazepam to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as clonazepam, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood), talking or thinking about wanting to hurt yourself or end your life, withdrawing from friends and family; preoccupation with death and dying, giving away prized possessions, or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.
What special dietary instructions to follow?
Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking Clonazepam.
What to do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can Clonazepam cause?
Clonazepam may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
problems with coordination
difficulty thinking or remembering
muscle or joint pain
- changes in sex drive or ability
Some side effects can be serious. If you experience any of these symptoms call your doctor immediately:
swelling of the eyes, face, lips, tongue, or throat
difficulty breathing or swallowing
- difficulty breathing
What to know about storage and disposal of Clonazepam?
Keep Clonazepam in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, consult your doctor. If the victim has collapsed or is not breathing, consult local medical emergency services.
Symptoms of overdose may include:
coma (loss of consciousness for a period of time)
What other information to know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to Clonazepam.
Do not let anyone else use your medication. If you still have symptoms and need further treatment, consult your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Ref: U.S. National Library of Medicine.
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.