Clonazepam

Anti-epileptic · Benzodiazepine

Indications

All forms of epilepsy.

Dosage

Adults: Initial: Up to 0.5 mg three times daily. Titrate: Increase by 0.5-1 mg every 3 day. Max: 20 mg/day. Children: All forms of epilepsy: 1 mth-1 yr, initially 250 mcg at night for 4 nights, increased over 2-4 wk to usual maintenance dose of 0.5-1 mg at night (may be given in 3 divided doses if necessary); 1-5 yr, initially 250 mcg at night for 4 nights, increased over 2-4 wk to usual maintenance of 1-3 mg at night (may be given in 3 divided doses if necessary); 5-12 yr, initially 500 mcg at night for 4 nights, increased over 2-4 wk to usual maintenance dose of 3-6 mg at night (may be given in 3 divided doses if necessary); 12-18 yr, initially 1 mg at night for 4 nights, increased over 2-4 wk to usual maintenance dose of 4-8 mg at night (may be given in 3-4 divided doses if necessary).

Administration

Administered by slow IV injection. For bolus administration, the content of the diluent ampule is added to the drug immediately before administration. The injection is administered at a rate not exceeding 0.25-0.5 mg/min into a large vein of the antecubital fossa. Clonazepam is also administered as a slow IV infusion, up to 3 mg of clonazepam is added to 250 mL of compatible diluent. Compatibility: Dextrose 5%, NaCl 0.9%. Stability: After dilution, the infusion should be completed within 24 hours.

Adverse Effects

Fatigue, muscle weakness, dizziness, ataxia, light headedness, somnolence, confusion, depression, anterograde amnesia. Rarely urticaria, pruritus, GI upset, headache, urinary incontinence, loss of libido, impotence, respiratory depression, blood dyscrasias, raised liver enzymes, restlessness, poor concentration, disorientation, nystagmus. Dependence, paradoxical reactions.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Contraindicated or not recommended. Contraindications: Acute pulmonary insufficiency, respiratory depression, sleep apnoea, myasthenia gravis. Severe hepatic impairment. Active drug or alcohol abuse. Precautions: Chronic pulmonary insufficiency, mild to moderate hepatic impairment, renal impairment, spinal or cerebellar ataxia, history of depression and/or suicide attempts, elderly. Withdraw gradually. Risk of respiratory hypersecretion in children.

Interactions

Alcohol, CNS depressants, other anticonvulsants, CYP3A4 inhibitors or inducers, St John's wort, theophylline, antihistamines, baclofen, lofexidine, tizanidine, nabilone, antihypertensives, disulfiram, levodopa.

Advice to Patient

Take oral form with or without meals. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is change in mental status, confusion, depression, increased sleepiness, agitation, headache, lack of sleep, nightmares, increased drowsiness or dizziness, fatigue, change in memory, difficulty in breathing, change in urinary pattern, change in sexual activity, muscle cramps, weakness, tremors, change in vision, ringing in ears, increased sweating, abdominal cramps, vomiting, constipation, loss of appetite. Avoid alcohol during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Carry identification card that you take an antiepileptic medication.

Pharmacokinetics

Onset of action: Approx. 20-40 mins. Duration: Infants and young children: 6-8 hrs; Adults: =12 hrs. Absorption: Rapidly and completely absorbed. Metabolism: Extensively hepatic. Bioavailability: Approx. 90%. Half-life elimination: Children: 22-33 hrs; Adults: 17-60 hrs. Time to peak, serum: 1-4 hrs. Excretion: Urine (>2% as unchanged drug).

Brands with this active ingredient

Compiled by Healify Pharmacy from published drug references. How we compile it →

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