Used alone or as adjunct in treatment of Lennox-Gastaut syndrome (petit mal
variant), akinetic and myoclonic seizures; may be useful in patients with absence
(petit mal) seizures who have not responded to succinimides; up to 30% of
patients show loss of effectiveness of drug, often within 3 mo of therapy (may
respond to dosage adjustment)
Unlabeled uses: Treatment of panic attacks, periodic leg movements during sleep,
hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, adjunct
treatment of schizophrenia, neuralgias
Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute
narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with
depression of vital signs; pregnancy (risk of congenital malformations, neonatal
withdrawal syndrome), labor and delivery ("floppy infant" syndrome), lactation
(infants become lethargic and lose weight).
Initial dose should not exceed 1.5 mg/day PO divided into three doses; increase in
increments of 0.5\u20131 mg PO every 3 days until seizures are adequately controlled or until
side effects preclude further increases. Maximum recommended dosage is 20 mg/day.
maintenance dose of 0.1\u20130.2 mg/kg has been reached, unless seizures are controlled by lower dosage or side effects preclude increases. Whenever possible, divide daily dose into three equal doses, or give largest dose hs.
Metabolism: Hepatic; T1/2: 18\u201350 hr
Distribution: Crosses placenta; enters breast milk
hypomania, restlessness, confusion, crying, delirium,headache, slurred speech,
dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness,
difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal
symptoms; mild paradoxical excitatory reactions during first 2 weeks of
gynecomastia. Drug dependence with withdrawal syndrome when drug is
discontinued; more common with abrupt discontinuation of higher dosage used
for longer than 4 mo.
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