Clonazepam = Rivotril

(Klonopin)

INDICATIONS AND USE: For the treatment of petit mal, Lennox-Gastaut, infantile spasms,
and akinetic and myoclonic

seizures, either as a single agent or as adjunctive therapy.

ACTIONS: Depresses all levels of the central nervous system (CNS) including the limbic and
reticular formation

by binding to the benzodiazepine site on the γ-aminobutyric acid (GABA) receptor complex;
suppresses the

spike-and-wave discharge in absence seizures by depressing nerve transmission in the motor

cortex.

DOSAGE: PO.

Seizure disorders

•Infants and children <10 years or 30 kg.

•Initial daily dose: 0.01–0.03 mg/kg/day PO (maximum 0.05 mg/kg/day) given in 2–3 divided
doses;

increase by no more than 0.5 mg every third day until seizures are controlled or adverse
effects occur.

•Maintenance: 0.1–0.2 mg/kg/day PO divided into 3 doses; do not exceed 0.2 mg/kg/day.

ADVERSE EFFECTS: Hypotension, drowsiness, hypotonia, thrombocytopenia, anemia,

leukopenia, eosinophilia,

tremor, choreiform movements, bronchial hypersecretion, respiratory depression.

PHARMACOLOGY: Cytochrome P450 isoenzyme CYP3A3/4 substrate. CNS depressants

increase sedation; phenytoin,

carbamazepine, rifampin, and barbiturates increase clonazepam clearance; drugs that inhibit
cytochrome

P450 isoenzyme CYP3A3/4 may increase levels and effects of clonazepam (monitor for
altered benzodiazepine

response); concurrent use with valproic acid may result in absence status.

COMMENTS: Caution in patients with chronic respiratory disease, hepatic disease, or

impaired renal function.

Abrupt discontinuation of clonazepam may precipitate withdrawal symptoms, status

epilepticus, or seizures.

(Withdraw gradually when discontinuing therapy in children. Safely reduce by ≤0.04

mg/kg/week and discontinue
when the daily dose is ≤0.04 mg/kg/day.) Worsening of seizures may occur when
clonazepam is added

to patients with multiple seizure types.