Closid
Generic Name
Clonazepam
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| closid 05 mg tablet | ৳ 6.00 | ৳ 90.00 |
Description
Overview of the medicine
Closid 0.5 mg Tablet contains Clonazepam, a benzodiazepine derivative. It is primarily used to treat various types of seizure disorders (epilepsy), panic disorder, and certain movement disorders. It works by increasing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity, thereby producing a calming effect on the brain and nerves.
Uses & Indications
Dosage
Adults
Initial dose for epilepsy is 0.5 mg three times daily, gradually increased by 0.5-1 mg every 3 days until seizure control is achieved (maximum 20 mg/day). For panic disorder, initial dose is 0.25 mg twice daily, increased to 1 mg/day after 3 days.
Elderly
Lower initial doses (e.g., 0.25 mg once or twice daily) are recommended due to increased sensitivity and potential for adverse effects. Dose titration should be slow and cautious.
Renal_impairment
No specific dose adjustments are usually required for mild to moderate renal impairment, but caution is advised. For severe renal impairment, dose reduction may be considered.
How to Take
Take the tablet orally with or without food. Swallow the tablet whole with a glass of water. Do not crush, chew, or break the tablet.
Mechanism of Action
Clonazepam enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, leading to an increase in chloride ion influx and hyperpolarization of the neuron. This inhibitory action reduces neuronal excitability, resulting in anticonvulsant, anxiolytic, sedative, and muscle relaxant effects.
Pharmacokinetics
Onset
Anticonvulsant effects typically begin within 20-60 minutes after oral administration.
Excretion
Excreted primarily in the urine as metabolites (70%), with a small amount (10%) excreted in feces. Less than 2% is excreted unchanged in the urine.
Half life
Elimination half-life ranges from 18 to 50 hours, allowing for once or twice daily dosing.
Absorption
Rapidly and completely absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations are reached within 1-4 hours.
Metabolism
Extensively metabolized in the liver, primarily by nitroreduction to 7-amino-clonazepam, followed by N-acetylation and hydroxylation. CYP3A4 is involved.
Side Effects
Contraindications
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency.
- Severe hepatic insufficiency.
- Hypersensitivity to clonazepam or other benzodiazepines.
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampin)
May decrease clonazepam plasma levels.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole)
May increase clonazepam plasma levels.
Antiepileptic drugs (e.g., phenytoin, phenobarbital, carbamazepine)
May alter clonazepam or other drug levels; careful monitoring required.
Alcohol and other CNS depressants (e.g., barbiturates, antidepressants, antihistamines)
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 somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, gastric lavage if ingestion is recent, and monitoring of vital signs. Flumazenil, a benzodiazepine receptor antagonist, can be used for reversal, but it should be used with caution, especially in patients with epilepsy, as it may precipitate seizures.
Pregnancy & Lactation
Pregnancy Category D: Clonazepam can cause fetal harm when administered to a pregnant woman. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Lactation: Clonazepam is excreted in human breast milk and may cause sedation and feeding difficulties in breastfed infants. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Side Effects
Contraindications
- Acute narrow-angle glaucoma.
- Severe respiratory insufficiency.
- Severe hepatic insufficiency.
- Hypersensitivity to clonazepam or other benzodiazepines.
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampin)
May decrease clonazepam plasma levels.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole)
May increase clonazepam plasma levels.
Antiepileptic drugs (e.g., phenytoin, phenobarbital, carbamazepine)
May alter clonazepam or other drug levels; careful monitoring required.
Alcohol and other CNS depressants (e.g., barbiturates, antidepressants, antihistamines)
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 somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, gastric lavage if ingestion is recent, and monitoring of vital signs. Flumazenil, a benzodiazepine receptor antagonist, can be used for reversal, but it should be used with caution, especially in patients with epilepsy, as it may precipitate seizures.
Pregnancy & Lactation
Pregnancy Category D: Clonazepam can cause fetal harm when administered to a pregnant woman. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Lactation: Clonazepam is excreted in human breast milk and may cause sedation and feeding difficulties in breastfed infants. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 to 36 months from the date of manufacture, depending on storage conditions.
Availability
Pharmacies, Hospitals
Approval Status
Approved by FDA/DGDA
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Clonazepam has undergone extensive clinical trials for its efficacy in epilepsy, panic disorder, and various neurological conditions. Ongoing research explores its potential in other areas and its long-term safety profile.
Lab Monitoring
- No routine lab monitoring is generally required for clonazepam unless long-term therapy or specific patient risk factors warrant it. Periodic assessment of liver function tests and complete blood counts may be considered for prolonged use.
Doctor Notes
- Emphasize the importance of gradual tapering to prevent severe withdrawal symptoms, especially in patients on high doses or prolonged therapy.
- Screen for a history of substance abuse, as clonazepam has abuse potential.
- Counsel patients on the risks of concomitant use with opioids and alcohol, highlighting the potential for severe respiratory depression.
Patient Guidelines
- Do not stop taking Closid abruptly, as this can lead to withdrawal symptoms or rebound seizures. Your doctor will gradually reduce your dose.
- Avoid alcohol and other CNS depressants while taking this medicine.
- Report any unusual mood changes, aggression, or new or worsening symptoms to your doctor immediately.
- This medicine may cause drowsiness or dizziness; avoid driving or operating heavy machinery until you know how it affects you.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Closid can cause drowsiness, dizziness, and impaired coordination. Patients should be advised not to drive or operate hazardous machinery until they are reasonably certain that Clonazepam does not adversely affect their ability to engage in such activities.
Lifestyle Advice
- Maintain a regular sleep schedule to help manage seizure disorders and panic attacks. Avoid caffeine and excessive sugar intake. Engage in stress-reducing activities like meditation or light exercise.
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