Epizam
Generic Name
Clonazepam
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| epizam 2 mg tablet | ৳ 8.00 | ৳ 80.00 |
Description
Overview of the medicine
Epizam 2 mg Tablet contains Clonazepam, a benzodiazepine primarily used to treat various types of seizure disorders (epilepsy) and panic disorder. It works by calming the brain and nerves.
Uses & Indications
Dosage
Adults
Initial dose 0.25-0.5 mg twice daily, increasing gradually every 3 days by 0.25-0.5 mg until seizures are controlled or side effects prevent further increase. Maintenance dose typically 1-8 mg daily in divided doses. Maximum dose usually 20 mg/day.
Elderly
Lower initial doses (e.g., 0.25 mg once daily) should be used, with gradual titration, due to increased sensitivity and potential for adverse effects.
Renal_impairment
No specific dosage adjustment guidelines available, but caution is advised. Metabolites are excreted renally.
How to Take
Epizam tablets should be swallowed whole with water, with or without food. Do not chew or crush. For panic disorder, usually given twice daily. For seizures, doses are often divided and given 2-3 times daily.
Mechanism of Action
Clonazepam enhances the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. By binding to benzodiazepine receptors on GABA-A receptors, it increases the frequency of chloride channel opening, leading to hyperpolarization and reduced neuronal excitability.
Pharmacokinetics
Onset
20-60 minutes (oral)
Excretion
Primarily excreted in the urine as metabolites (approx. 70%), with a smaller amount in feces (approx. 10%). Less than 2% is excreted unchanged.
Half life
18-50 hours (average 30 hours)
Absorption
Rapidly and completely absorbed after oral administration. Peak plasma concentrations are reached within 1-4 hours.
Metabolism
Extensively metabolized in the liver, primarily by nitroreduction by CYP450 enzymes (mainly CYP3A4) to 7-aminoclonazepam.
Side Effects
Contraindications
- Acute narrow-angle glaucoma.
- Significant liver disease.
- Hypersensitivity to clonazepam or other benzodiazepines.
- Acute pulmonary insufficiency.
Drug Interactions
Opioids
Increased risk of severe sedation, respiratory depression, coma, and death. Avoid concomitant use if possible. If unavoidable, use lowest effective doses and monitor closely.
Alcohol & CNS Depressants
Potentiated CNS depressant effects leading to increased sedation, respiratory depression, and impaired psychomotor function. Avoid concomitant use.
CYP3A4 Inhibitors/Inducers
Inhibitors (e.g., ketoconazole, fluconazole) may increase clonazepam levels, while inducers (e.g., rifampin) may decrease levels.
Antiepileptics like Phenytoin, Carbamazepine
May alter clonazepam plasma levels or enhance CNS depression.
Storage
Store below 30°C in a dry place, away from light. Keep out of reach of children.
Overdose
Symptoms include somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, maintaining a patent airway, and monitoring vital signs. Flumazenil may be used as an antidote, but caution is advised in patients with epilepsy due to risk of precipitating seizures.
Pregnancy & Lactation
Pregnancy Category D. Clonazepam can cause fetal harm when administered to a pregnant woman. Avoid during pregnancy unless the potential benefits outweigh the risks. Excreted in breast milk; advise against breastfeeding.
Side Effects
Contraindications
- Acute narrow-angle glaucoma.
- Significant liver disease.
- Hypersensitivity to clonazepam or other benzodiazepines.
- Acute pulmonary insufficiency.
Drug Interactions
Opioids
Increased risk of severe sedation, respiratory depression, coma, and death. Avoid concomitant use if possible. If unavoidable, use lowest effective doses and monitor closely.
Alcohol & CNS Depressants
Potentiated CNS depressant effects leading to increased sedation, respiratory depression, and impaired psychomotor function. Avoid concomitant use.
CYP3A4 Inhibitors/Inducers
Inhibitors (e.g., ketoconazole, fluconazole) may increase clonazepam levels, while inducers (e.g., rifampin) may decrease levels.
Antiepileptics like Phenytoin, Carbamazepine
May alter clonazepam plasma levels or enhance CNS depression.
Storage
Store below 30°C in a dry place, away from light. Keep out of reach of children.
Overdose
Symptoms include somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, maintaining a patent airway, and monitoring vital signs. Flumazenil may be used as an antidote, but caution is advised in patients with epilepsy due to risk of precipitating seizures.
Pregnancy & Lactation
Pregnancy Category D. Clonazepam can cause fetal harm when administered to a pregnant woman. Avoid during pregnancy unless the potential benefits outweigh the risks. Excreted in breast milk; advise against breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture.
Availability
Pharmacies, hospitals
Approval Status
Approved by regulatory authorities (e.g., FDA, DGDA)
Patent Status
Generic available, original patent expired
WHO Essential Medicine
YesClinical Trials
Clonazepam has been extensively studied in clinical trials for its efficacy in treating epilepsy and panic disorder. Studies have shown its effectiveness in reducing seizure frequency and severity, and in managing panic attacks.
Lab Monitoring
- Liver function tests (baseline and periodically, especially with long-term use)
- Complete blood count (periodically, especially with long-term use)
Doctor Notes
- Counsel patients on the risks of physical dependence and withdrawal, especially with long-term use.
- Emphasize the importance of gradual dose tapering when discontinuing treatment to minimize withdrawal symptoms.
- Monitor for signs of respiratory depression, especially if co-administered with opioids or other CNS depressants.
Patient Guidelines
- Take exactly as prescribed by your doctor. Do not stop taking it suddenly, as this can cause withdrawal symptoms.
- Avoid alcohol and other CNS depressants while on this medication.
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
- Do not drive or operate heavy machinery until you know how this medicine affects you.
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 take a double dose to make up for a missed one.
Driving Precautions
May cause drowsiness, dizziness, and impaired coordination. Patients should be warned 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.
- Manage stress through relaxation techniques or mindfulness.
- Avoid activities requiring mental alertness initially.
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