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Clonazepam

Clonazepam

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Published by: api-3797941 on Oct 17, 2008
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clonazepam
(kloen a' ze pam)
Apo-Clonazepam (CAN), Clonapam (CAN), Gen-Clonazepam (CAN),
Klonopin, Klonopin Wafers, Rivotril (CAN)
Pregnancy Category D
Controlled Substance C-IV
Drug classes
Benzodiazepine
Antiepileptic
Therapeutic actions
Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an
inhibitory neurotransmitter.
Indications
\u2022

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)

\u2022

Unlabeled uses: Treatment of panic attacks, periodic leg movements during sleep,
hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, adjunct
treatment of schizophrenia, neuralgias

Contraindications and cautions
\u2022

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).

\u2022
Use cautiously with impaired liver or kidney function, debilitation.
Available forms
Tablets\u20140.5, 1, 2 mg; orally disintegrating tablets\u20140.125, 0.25, 0.5, 1, 2 mg
Dosages
Individualize dosage; increase dosage gradually to avoid adverse effects; drug is available
only in oral dosage forms.
ADULTS

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.

PEDIATRIC PATIENTS > 10 YR OR 30 KG
Initially, 0.01\u20130.03 mg/kg/day PO; do not exceed 0.05 mg/kg/day PO, given in two or
three doses. Increase dosage by not more than 0.25\u20130.5 mg every third day until a daily

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.

Pharmacokinetics
Route
Onset
Peak
Duration
Oral
Varies
1\u20132 hr
Weeks

Metabolism: Hepatic; T1/2: 18\u201350 hr
Distribution: Crosses placenta; enters breast milk
Excretion:Urin e

Adverse effects
\u2022
CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy,
fatigue, light-headedness, disorientation, anger, hostility, episodes of mania and

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

treatment
\u2022
CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension,
palpitations, edema
\u2022
Dermatologic: Urticaria, pruritus, rash, dermatitis
\u2022
EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing,
nasal congestion
\u2022
GI: Constipation, diarrhea, dry mouth,salivation, nausea, anorexia, vomiting,
difficulty in swallowing, gastric disorders, hepatic dysfunction, encoporesis
\u2022
GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
\u2022
Hematologic: Elevations of blood enzymes\u2014LDH, alkaline phosphatase, AST,
ALT; blood dyscrasias: agranulocytosis, leukopenia
\u2022
Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances,

gynecomastia. Drug dependence with withdrawal syndrome when drug is
discontinued; more common with abrupt discontinuation of higher dosage used
for longer than 4 mo.

Interactions
Drug-drug
\u2022
Increased CNS depression with alcohol
\u2022
Increased effect with cimetidine, disulfiram, omeprazole, hormonal contraceptives
\u2022
Decreased effect with theophylline
\u2022
Risk of increased digoxin levels and toxicity; monitor patient carefully
Nursing considerations
CLINICAL ALERT!
Name confusion has been reported between Klonopin (clonazepam) and
clonidine; use caution.

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