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 1 mg tablet | ৳ 9.00 | ৳ 90.00 |
Description
Overview of the medicine
Clonatril 1 mg Tablet contains Clonazepam, a benzodiazepine. It is primarily used to treat various types of seizure disorders (epilepsy) and panic disorder. It works by calming the brain and nerves, helping to reduce abnormal electrical activity and anxiety.
Uses & Indications
Dosage
Adults
For seizure disorders, initially 0.5 mg three times daily, increased by 0.5-1 mg every 3 days until control is achieved; maximum dose 20 mg/day. For panic disorder, initially 0.25 mg twice daily, increased to 1 mg/day after 3 days; maximum dose 4 mg/day.
Elderly
Start with lower doses (e.g., 0.25 mg daily or BID) and titrate slowly due to increased sensitivity and potential for adverse effects.
Renal_impairment
No specific dose adjustment is generally required, but use with caution and monitor for adverse effects.
How to Take
Administer orally with or without food. Swallow the tablet whole with water. Do not crush, chew, or break it.
Mechanism of Action
Clonazepam enhances the effect of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the central nervous system. It binds to specific benzodiazepine receptors on the GABA-A receptor complex, increasing the frequency of chloride channel opening, leading to hyperpolarization and decreased neuronal excitability.
Pharmacokinetics
Onset
Anticonvulsant effect within 20-60 minutes; anti-panic effect within 1 hour.
Excretion
Primarily excreted in the urine as metabolites, with less than 2% as unchanged drug. A small amount is excreted in feces.
Half life
Plasma elimination half-life ranges from 18 to 50 hours.
Absorption
Rapidly and completely absorbed orally, with peak plasma concentrations occurring within 1-4 hours. Bioavailability is approximately 90%.
Metabolism
Extensively metabolized in the liver, primarily via nitroreduction by CYP3A4, followed by N-acetylation.
Side Effects
Contraindications
- Hypersensitivity to benzodiazepines or any component of the formulation.
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency.
- Severe hepatic insufficiency.
- Myasthenia gravis.
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampin, phenobarbital, phenytoin)
May decrease clonazepam plasma concentrations.
Anticonvulsants (e.g., phenytoin, carbamazepine, phenobarbital)
May alter clonazepam plasma levels or increase adverse effects.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin)
May increase clonazepam plasma concentrations.
Other CNS depressants (e.g., alcohol, sedatives, hypnotics, antipsychotics, antidepressants)
Additive CNS depressant effects.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include drowsiness, confusion, ataxia, diminished reflexes, hypotension, respiratory depression, and coma. Management involves supportive care, maintaining a patent airway, and close monitoring of vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used with caution, as it can precipitate seizures in dependent patients.
Pregnancy & Lactation
Pregnancy: Category D. There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk. Neonatal withdrawal syndrome can occur. Lactation: Clonazepam is excreted in breast milk. Not recommended for breastfeeding mothers due to potential for sedation and feeding difficulties in infants.
Side Effects
Contraindications
- Hypersensitivity to benzodiazepines or any component of the formulation.
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency.
- Severe hepatic insufficiency.
- Myasthenia gravis.
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampin, phenobarbital, phenytoin)
May decrease clonazepam plasma concentrations.
Anticonvulsants (e.g., phenytoin, carbamazepine, phenobarbital)
May alter clonazepam plasma levels or increase adverse effects.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin)
May increase clonazepam plasma concentrations.
Other CNS depressants (e.g., alcohol, sedatives, hypnotics, antipsychotics, antidepressants)
Additive CNS depressant effects.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include drowsiness, confusion, ataxia, diminished reflexes, hypotension, respiratory depression, and coma. Management involves supportive care, maintaining a patent airway, and close monitoring of vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used with caution, as it can precipitate seizures in dependent patients.
Pregnancy & Lactation
Pregnancy: Category D. There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk. Neonatal withdrawal syndrome can occur. Lactation: Clonazepam is 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
24-36 months from manufacturing date
Availability
Pharmacies, Hospitals
Approval Status
Approved by regulatory authorities (e.g., FDA, DGDA)
Patent Status
Generic available (Patent expired for active ingredient)
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of clonazepam in the treatment of various seizure disorders and panic disorder, leading to its widespread approval and use.
Lab Monitoring
- Periodically monitor liver function tests (LFTs) during prolonged therapy.
- Complete blood counts (CBC) may also be monitored.
- Renal function may be assessed in patients with kidney impairment.
Doctor Notes
- Counsel patients thoroughly regarding the risks of dependence, abuse, and withdrawal symptoms, emphasizing the importance of not discontinuing abruptly.
- Strictly warn against co-administration with opioids due to the heightened risk of respiratory depression and sedation.
- Initiate therapy with the lowest effective dose and titrate slowly, particularly in elderly or debilitated patients, to minimize adverse effects.
- Monitor patients for signs of respiratory depression, especially during initiation of therapy or after dose increases.
Patient Guidelines
- Do not stop taking Clonatril abruptly without consulting your doctor, as it can lead to severe withdrawal symptoms.
- Avoid alcohol and other central nervous system depressants while taking this medicine.
- Inform your doctor about any unusual side effects or worsening of symptoms.
- Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next scheduled dose. Do not double your dose to make up for a missed one.
Driving Precautions
Clonatril can cause drowsiness, dizziness, and impaired coordination, which may affect your ability to drive or operate machinery. Patients should be warned not to engage in such activities until they determine how the drug affects them.
Lifestyle Advice
- Avoid driving or operating heavy machinery until you know how Clonatril affects you, as it can cause drowsiness and dizziness.
- Maintain a regular sleep schedule to support overall well-being.
- Consider stress-reduction techniques such as meditation or yoga.
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