Medicine Information

Clonil

Name: Clonil
Brand: Clonil
Rating: 4.5 (117 reviews)

Tablet2 mgAntiepileptic, Anxiolytic, BenzodiazepineATC: N03AE01

Generic Name

Clonazepam

Manufacturer

Square Pharmaceuticals Ltd.

Country

Bangladesh

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
clonil 2 mg tablet	৳ 10.00	৳ 100.00

Description

Overview of the medicine

Clonazepam is a benzodiazepine used to treat seizure disorders and panic disorder. It works by calming the brain and nerves, and is also used for restless legs syndrome and some movement disorders.

Uses & Indications

Panic disorder with or without agoraphobia

Lennox-Gastaut syndrome (petit mal variant)

Akinetic and myoclonic seizures

Absence seizures (petit mal) refractory to succinimides

Restless Legs Syndrome (off-label)

Dosage

Adults

Panic Disorder: Initially 0.25 mg BID, titrated up to 1 mg/day (max 4 mg/day). Seizure Disorders: Initially 0.5 mg TID, increased by 0.5-1 mg every 3 days until control (max 20 mg/day).

Elderly

Start with lower doses (e.g., 0.25 mg daily) and titrate carefully due to increased sensitivity and risk of side effects like sedation and ataxia.

Renal_impairment

No specific dose adjustment is generally required, but use with caution due to potential for accumulation of metabolites, especially with severe impairment.

How to Take

Administer orally with water. Can be taken with or without food. Do not chew, crush, or break the tablet. Do not stop abruptly to avoid withdrawal symptoms; taper dose under medical supervision.

Mechanism of Action

Clonazepam enhances the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, by binding to specific benzodiazepine receptors on the GABAA receptor complex. This leads to increased chloride ion influx and hyperpolarization of the neuron, reducing neuronal excitability and producing anxiolytic, anticonvulsant, sedative, and muscle relaxant effects.

Pharmacokinetics

Onset

20-60 minutes (oral)

Excretion

Primarily excreted in the urine as metabolites (50-70%), with 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 approximately 90%.

Metabolism

Extensively metabolized in the liver, primarily via nitroreduction and N-acetylation, forming inactive metabolites. CYP3A4 is involved to a lesser extent.

Side Effects

Contraindications

Hypersensitivity to clonazepam or other benzodiazepines
Acute narrow-angle glaucoma
Severe liver disease
Acute pulmonary insufficiency

Drug Interactions

Opioids

Increased risk of profound sedation, respiratory depression, coma, and death.

Probenecid

May decrease clonazepam clearance.

Valproic Acid

May increase clonazepam plasma concentrations and enhance adverse effects.

CYP3A4 Inducers (carbamazepine, phenytoin, phenobarbital)

May decrease clonazepam plasma concentrations, potentially reducing efficacy.

CNS Depressants (alcohol, barbiturates, antidepressants, antihistamines)

Enhanced sedative effects and increased risk of CNS depression.

Storage

Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children. Do not freeze.

Overdose

Symptoms include somnolence, confusion, impaired coordination, diminished reflexes, slurred speech, coma, and respiratory depression. Treatment is supportive; maintain airway, breathing, and circulation. Flumazenil, a benzodiazepine receptor antagonist, may be used to reverse effects but should be administered cautiously due to the risk of precipitating withdrawal seizures in dependent patients.

Pregnancy & Lactation

Pregnancy Category D. Clonazepam may cause fetal harm, including congenital malformations and withdrawal symptoms in neonates. Use only if the potential benefit justifies the potential risk to the fetus. It passes into breast milk and may cause sedation and feeding difficulties in infants; therefore, avoid during lactation or discontinue breastfeeding.

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

10 tablets (1x10)30 tablets (3x10)50 tablets (5x10)

Shelf Life

36 months from the date of manufacture

Availability

Pharmacies, hospitals

Approval Status

Approved

Patent Status

Generic available

WHO Essential Medicine

Yes

Clinical Trials

Clonazepam has undergone extensive clinical trials establishing its efficacy and safety for the treatment of various seizure disorders and panic disorder. Ongoing post-market surveillance contributes to understanding its long-term effects.

Lab Monitoring

Monitor liver function tests periodically, especially with prolonged use or in patients with hepatic impairment.
Monitor complete blood count (CBC) with prolonged use to check for blood dyscrasias.
Renal function monitoring may be considered in patients with severe renal impairment.

Doctor Notes

Counsel patients thoroughly on the risks of dependence and the importance of gradual dose tapering when discontinuing Clonazepam.
Monitor for signs of respiratory depression, especially in elderly patients or those concomitantly using opioids.
Assess for comorbid psychiatric conditions, as benzodiazepines can sometimes exacerbate depression or paradoxical reactions.

Patient Guidelines

Take exactly as prescribed by your doctor and do not change the dose or stop the medicine without consulting them.
Be aware of the risk of dependence and withdrawal symptoms; avoid abrupt discontinuation.
Avoid alcohol and other CNS depressants, as they can enhance the sedative effects.
Do not drive or operate heavy machinery until you know how this medicine affects you.

Missed Dose Advice

If a dose is missed, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.

Driving Precautions

Clonazepam can cause drowsiness, dizziness, impaired coordination, and blurred vision, which may impair your ability to drive or operate machinery. Avoid such activities until you are certain the medication does not affect your alertness and motor skills.

Lifestyle Advice

Maintain a regular sleep schedule and practice good sleep hygiene.
Avoid stressful situations where possible and consider stress management techniques like meditation or yoga.
Inform your doctor about all other medications, supplements, and herbal products you are taking.