Clonatril
Generic Name
Clonazepam
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| clonatril 2 mg tablet | ৳ 11.00 | ৳ 110.00 |
Description
Overview of the medicine
Clonatril 2 mg Tablet contains Clonazepam, a benzodiazepine primarily used as an anticonvulsant and an anxiolytic. It is prescribed for the treatment of various seizure disorders, panic disorder, and sometimes for restless legs syndrome and anxiety.
Uses & Indications
Dosage
Adults
For epilepsy: Initially 0.5 mg three times daily, gradually increased by 0.5-1 mg every 3 days until seizure control or side effects intervene, typically 2-4 mg/day (max 20 mg/day). For panic disorder: Initially 0.25 mg twice daily, increase to 1 mg/day after 3 days; maximum 4 mg/day.
Elderly
Lower initial doses (e.g., 0.25 mg once daily for panic disorder) and slower titration; monitor closely for sedation and ataxia.
Renal_impairment
Use with caution; dose adjustment may be necessary in severe impairment. Start with low doses and titrate gradually.
How to Take
Clonatril tablets should be taken orally, usually with water. It can be taken with or without food. To avoid withdrawal symptoms, do not stop taking this medication suddenly.
Mechanism of Action
Clonazepam enhances the effect of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the brain, by binding to specific benzodiazepine receptors on the GABA-A receptor complex. This leads to increased chloride ion influx, hyperpolarization, and decreased neuronal excitability.
Pharmacokinetics
Onset
Oral: 20-60 minutes.
Excretion
Excreted mainly in the urine as free and conjugated metabolites.
Half life
18-50 hours.
Absorption
Well absorbed from the gastrointestinal tract; peak plasma concentrations reached in 1-4 hours.
Metabolism
Extensively metabolized in the liver, primarily by nitroreduction via CYP3A4, to inactive metabolites.
Side Effects
Contraindications
- Known hypersensitivity to clonazepam or other benzodiazepines.
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency.
- Severe hepatic insufficiency.
Drug Interactions
CYP3A4 inducers (e.g., rifampin)
May decrease clonazepam plasma concentrations.
Anticonvulsants (e.g., phenytoin, carbamazepine)
May alter clonazepam levels or vice versa; monitor for altered efficacy or increased side effects.
CYP3A4 inhibitors (e.g., ketoconazole, fluconazole, grapefruit juice)
May increase clonazepam plasma concentrations.
CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, hypnotics, antipsychotics)
Increased risk of sedation, respiratory depression, hypotension, and profound CNS depression.
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 somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management is primarily supportive; maintain airway, monitor vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used as an antidote, but its use carries risks, especially in patients with long-term benzodiazepine use or seizures.
Pregnancy & Lactation
Pregnancy Category D: Clonazepam may cause fetal harm when administered to a pregnant woman. It can increase the risk of congenital malformations. Use only if the potential benefit justifies the potential risk to the fetus. Lactation: Clonazepam passes into breast milk. Breastfeeding is generally not recommended while taking this medication due to the potential for adverse effects on the infant (e.g., sedation, poor feeding).
Side Effects
Contraindications
- Known hypersensitivity to clonazepam or other benzodiazepines.
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency.
- Severe hepatic insufficiency.
Drug Interactions
CYP3A4 inducers (e.g., rifampin)
May decrease clonazepam plasma concentrations.
Anticonvulsants (e.g., phenytoin, carbamazepine)
May alter clonazepam levels or vice versa; monitor for altered efficacy or increased side effects.
CYP3A4 inhibitors (e.g., ketoconazole, fluconazole, grapefruit juice)
May increase clonazepam plasma concentrations.
CNS Depressants (e.g., alcohol, opioids, other benzodiazepines, hypnotics, antipsychotics)
Increased risk of sedation, respiratory depression, hypotension, and profound CNS depression.
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 somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management is primarily supportive; maintain airway, monitor vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used as an antidote, but its use carries risks, especially in patients with long-term benzodiazepine use or seizures.
Pregnancy & Lactation
Pregnancy Category D: Clonazepam may cause fetal harm when administered to a pregnant woman. It can increase the risk of congenital malformations. Use only if the potential benefit justifies the potential risk to the fetus. Lactation: Clonazepam passes into breast milk. Breastfeeding is generally not recommended while taking this medication due to the potential for adverse effects on the infant (e.g., sedation, poor feeding).
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2-3 years from the date of manufacture, specific to lot.
Availability
Pharmacies, Hospitals
Approval Status
Approved (DGDA, FDA for generic)
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Clonazepam has been extensively studied in numerous clinical trials for its efficacy in treating epilepsy, panic disorder, and various anxiety disorders. Ongoing research continues to explore its role in other neurological and psychiatric conditions.
Lab Monitoring
- Routine liver function tests (LFTs) with prolonged use.
- Complete blood count (CBC) with prolonged use, especially if any signs of blood dyscrasias are observed.
- Monitor renal function in patients with renal impairment.
Doctor Notes
- Emphasize the risk of dependence and withdrawal; educate patients on gradual tapering.
- Monitor for signs of respiratory depression, especially with concomitant opioid use.
- Assess for suicidal ideation, particularly in patients with pre-existing depression or psychiatric conditions.
- Regularly re-evaluate the need for continued treatment, especially for long-term use.
Patient Guidelines
- Do not stop Clonatril suddenly without consulting your doctor, as this can lead to severe withdrawal symptoms.
- Avoid alcohol and other CNS depressants while taking this medication.
- Report any unusual mood changes, worsening depression, or suicidal thoughts to your doctor immediately.
- Do not drive or operate heavy machinery until you know how this medication affects you.
- Take the medication exactly as prescribed by your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not double dose to catch up.
Driving Precautions
Clonatril can cause drowsiness, dizziness, and impaired coordination, which can significantly affect your ability to drive or operate machinery safely. Patients should be advised to avoid such activities until they are certain that Clonatril does not adversely affect their ability to perform them.
Lifestyle Advice
- Establish a regular sleep schedule to help manage any sleep disturbances.
- Consider stress-reduction techniques like meditation or yoga to complement your treatment.
- Avoid caffeine and other stimulants, especially in the evening, as they can interfere with the sedative effects of clonazepam.
- Discuss any concerns about dependence or withdrawal with your healthcare provider.
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