Adults

Initial dose for seizures: 0.5 mg three times daily, gradually increased by 0.5-1 mg every 3 days until control is achieved (max 20 mg/day). For panic disorder: Initial 0.25 mg twice daily, increased to 1 mg/day after 3 days; max 4 mg/day.

Elderly

Lower initial doses (e.g., 0.25 mg once daily) are recommended due to increased sensitivity and potential for adverse effects.

Renal_impairment

No specific dosage adjustment guidance, but caution is advised due to potential accumulation of metabolites. Start with lower doses.

Onset

Onset of action for seizures is 20-60 minutes (oral); for panic disorder, effects may be gradual.

Excretion

Primarily excreted in the urine as metabolites, with only a small amount of unchanged drug.

Half life

Plasma elimination half-life is 18-50 hours.

Absorption

Well absorbed from the gastrointestinal tract, with peak plasma concentrations occurring within 1-4 hours.

Metabolism

Extensively metabolized in the liver, primarily by nitroreduction to 7-amino-clonazepam, and then acetylated.

Opioids

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

Alcohol and other CNS depressants

Additive CNS depressant effects.

SSRIs (e.g., Sertraline, Fluoxetine)

Possible additive CNS depressant effects, or no significant interaction.

Anticonvulsants (e.g., Phenytoin, Carbamazepine)

May alter plasma levels of clonazepam or other anticonvulsants.