Clonatril
Generic Name
Clonazepam
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| clonatril 05 mg tablet | ৳ 7.00 | ৳ 70.00 |
Description
Overview of the medicine
Clonazepam is a benzodiazepine derivative. It has anxiolytic, anticonvulsant, muscle relaxant, and sedative properties. It's primarily used to treat various seizure disorders and panic disorder.
Uses & Indications
Dosage
Adults
Seizure disorders: Initially 0.5 mg three times daily; may increase by 0.5-1 mg every 3 days until seizure control or side effects preclude further increase. Max: 20 mg/day. Panic disorder: Initially 0.25 mg twice daily; may increase to 1 mg/day after 3 days. Max: 4 mg/day.
Elderly
Lower initial doses (e.g., 0.25 mg once daily or twice daily) and slower titration due to increased sensitivity and risk of adverse effects.
Renal_impairment
No specific dose adjustment generally needed, but use with caution. Hepatic impairment: Use with caution. Lower doses may be required, especially in severe impairment.
How to Take
Administer orally, with or without food. For seizure disorders, divide total daily dose into 2 or 3 doses. For panic disorder, give twice daily. Do not suddenly discontinue; gradually taper to avoid withdrawal symptoms.
Mechanism of Action
Clonazepam enhances the activity of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the central nervous system. It binds to specific benzodiazepine receptors on GABA-A receptor complexes, leading to increased chloride ion influx and hyperpolarization of neurons, thereby reducing neuronal excitability.
Pharmacokinetics
Onset
20-60 minutes (oral)
Excretion
Primarily renal (urine) as metabolites; a small amount excreted in feces.
Half life
18-50 hours
Absorption
Rapidly and completely absorbed after oral administration. Peak plasma concentrations are reached within 1-4 hours. Bioavailability is about 90%.
Metabolism
Primarily hepatic, via cytochrome P450 3A4 to inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to clonazepam or other benzodiazepines
- Acute narrow-angle glaucoma
- Severe respiratory insufficiency
- Severe hepatic insufficiency
Drug Interactions
Opioids
Increased risk of respiratory depression, sedation, coma.
CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin)
May decrease clonazepam levels.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, fluvoxamine)
May increase clonazepam levels.
CNS depressants (alcohol, other benzodiazepines, barbiturates, antidepressants, antihistamines)
Additive sedative effects.
Storage
Store below 30°C, in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include somnolence, confusion, diminished reflexes, coma, and impaired coordination. Treatment is primarily supportive. Flumazenil may be used in severe cases, but caution is advised due to risk of seizures in benzodiazepine-dependent patients.
Pregnancy & Lactation
Pregnancy: Category D. May cause fetal harm including congenital malformations and withdrawal symptoms in neonates. Use only if potential benefit justifies the risk. Lactation: Excreted in breast milk. Not recommended for breastfeeding mothers due to potential for sedation and feeding difficulties in infants.
Side Effects
Contraindications
- Hypersensitivity to clonazepam or other benzodiazepines
- Acute narrow-angle glaucoma
- Severe respiratory insufficiency
- Severe hepatic insufficiency
Drug Interactions
Opioids
Increased risk of respiratory depression, sedation, coma.
CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin)
May decrease clonazepam levels.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, fluvoxamine)
May increase clonazepam levels.
CNS depressants (alcohol, other benzodiazepines, barbiturates, antidepressants, antihistamines)
Additive sedative effects.
Storage
Store below 30°C, in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include somnolence, confusion, diminished reflexes, coma, and impaired coordination. Treatment is primarily supportive. Flumazenil may be used in severe cases, but caution is advised due to risk of seizures in benzodiazepine-dependent patients.
Pregnancy & Lactation
Pregnancy: Category D. May cause fetal harm including congenital malformations and withdrawal symptoms in neonates. Use only if potential benefit justifies the risk. Lactation: Excreted in breast milk. Not recommended for breastfeeding mothers due to potential for sedation and feeding difficulties in infants.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months
Availability
Pharmacies nationwide
Approval Status
Approved
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Ongoing studies for various indications, including refractory epilepsy and certain anxiety disorders, to further understand efficacy and safety profiles.
Lab Monitoring
- Liver function tests (baseline and periodically, especially with long-term use)
- Blood counts (periodically with long-term use)
Doctor Notes
- Inform patients about the risk of dependence and withdrawal, emphasizing gradual tapering over several weeks or months.
- Monitor for signs of respiratory depression, especially with concomitant use of opioids or other CNS depressants.
- Assess for history of substance abuse or psychiatric disorders prior to initiation.
- Regularly evaluate the need for continued treatment and consider non-pharmacological interventions.
Patient Guidelines
- Take exactly as prescribed. Do not increase or decrease dose without consulting your doctor.
- Do not stop taking the medicine suddenly, as this can cause withdrawal symptoms.
- Avoid alcohol and other CNS depressants due to additive sedative effects.
- Be aware of potential drowsiness or dizziness, which can impair ability to drive or operate machinery.
Missed Dose Advice
If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to catch up. Contact your doctor if unsure.
Driving Precautions
May cause drowsiness, dizziness, and impaired coordination. Patients should avoid driving or operating heavy machinery until they know how the drug affects them.
Lifestyle Advice
- Maintain a healthy sleep hygiene.
- Practice stress-reduction techniques (e.g., meditation, deep breathing).
- Regular exercise can help manage anxiety and improve overall well-being.
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