Epnil
Generic Name
Clonazepam
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| epnil 05 mg tablet | ৳ 8.00 | ৳ 80.00 |
Description
Overview of the medicine
Clonazepam is a benzodiazepine medication used to treat certain seizure disorders (including absence seizures or Lennox-Gastaut syndrome) and panic disorder. It works by enhancing the activity of GABA, a neurotransmitter that inhibits brain activity, thereby producing a calming effect on the brain and nerves.
Uses & Indications
Dosage
Adults
For panic disorder, initially 0.25 mg twice daily; may be increased to 1 mg/day after 3 days. Max 4 mg/day. For seizure disorders, initially 0.5 mg three times daily; gradually increase by 0.5-1 mg every 3 days. Max 20 mg/day.
Elderly
Start with lower doses (e.g., 0.25 mg once or twice daily) and titrate slowly due to increased sensitivity and slower metabolism.
Renal_impairment
No specific dosage adjustment recommended for mild-to-moderate renal impairment, but caution is advised. Not recommended in severe impairment.
How to Take
Take orally, with or without food. Swallow the tablet whole with water. Do not crush, chew, or break the tablet.
Mechanism of Action
Clonazepam enhances the activity of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the brain, by binding to benzodiazepine receptors on the GABA-A receptor complex. This leads to increased chloride ion influx, hyperpolarization of the neuron, and decreased neuronal excitability.
Pharmacokinetics
Onset
20-60 minutes
Excretion
Excreted predominantly in the urine as metabolites, with a small amount in feces.
Half life
18-50 hours (average 30-40 hours)
Absorption
Rapid and complete absorption after oral administration. Peak plasma concentrations usually reached within 1-4 hours.
Metabolism
Extensively metabolized in the liver, primarily by nitroreduction by hepatic cytochrome P450 enzymes (mainly CYP3A4) to 7-aminoclonazepam.
Side Effects
Contraindications
- Known hypersensitivity to clonazepam or other benzodiazepines
- Acute narrow-angle glaucoma
- Severe respiratory insufficiency
- Severe hepatic impairment
- Myasthenia gravis
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
Strong CYP3A4 inducers (rifampin)
May decrease clonazepam plasma levels.
Anticonvulsants (phenytoin, carbamazepine)
Altered plasma levels of either drug.
Strong CYP3A4 inhibitors (ketoconazole, ritonavir)
May increase clonazepam plasma levels.
CNS Depressants (alcohol, sedatives, hypnotics, antidepressants)
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, diminished reflexes, and coma. Management is primarily supportive; maintain a patent airway, monitor vital signs, and provide symptomatic treatment. Flumazenil, a benzodiazepine receptor antagonist, may be considered in severe cases but should be used with caution, especially in patients with a history of seizure disorders, as it can precipitate withdrawal seizures.
Pregnancy & Lactation
Clonazepam is categorized as Pregnancy Category D. It can cause fetal harm and withdrawal symptoms in newborns if used during pregnancy. It is excreted in breast milk and may cause sedation and feeding difficulties in breastfed infants; therefore, it is generally not recommended during lactation.
Side Effects
Contraindications
- Known hypersensitivity to clonazepam or other benzodiazepines
- Acute narrow-angle glaucoma
- Severe respiratory insufficiency
- Severe hepatic impairment
- Myasthenia gravis
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
Strong CYP3A4 inducers (rifampin)
May decrease clonazepam plasma levels.
Anticonvulsants (phenytoin, carbamazepine)
Altered plasma levels of either drug.
Strong CYP3A4 inhibitors (ketoconazole, ritonavir)
May increase clonazepam plasma levels.
CNS Depressants (alcohol, sedatives, hypnotics, antidepressants)
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, diminished reflexes, and coma. Management is primarily supportive; maintain a patent airway, monitor vital signs, and provide symptomatic treatment. Flumazenil, a benzodiazepine receptor antagonist, may be considered in severe cases but should be used with caution, especially in patients with a history of seizure disorders, as it can precipitate withdrawal seizures.
Pregnancy & Lactation
Clonazepam is categorized as Pregnancy Category D. It can cause fetal harm and withdrawal symptoms in newborns if used during pregnancy. It is excreted in breast milk and may cause sedation and feeding difficulties in breastfed infants; therefore, it is generally not recommended during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months from manufacturing date
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Expired
WHO Essential Medicine
YesClinical Trials
Clonazepam has undergone numerous clinical trials demonstrating its efficacy and safety in the management of various seizure disorders, including absence and myoclonic seizures, as well as in the treatment of panic disorder. Ongoing research also explores its potential in other neurological and psychiatric conditions.
Lab Monitoring
- Periodic monitoring of liver function tests and complete blood count (CBC) may be considered during prolonged therapy, especially if clinically indicated.
- Monitor respiratory function, especially in patients with chronic obstructive pulmonary disease (COPD) or when co-administered with other CNS depressants.
Doctor Notes
- Monitor patients for respiratory depression, especially with concomitant use of opioids. Caution advised in patients with pre-existing respiratory disease, hepatic impairment, or a history of drug/alcohol abuse.
- Warn patients about the risk of dependence and emphasize the importance of gradual tapering when discontinuing therapy to minimize withdrawal symptoms. Advise against abrupt discontinuation.
Patient Guidelines
- Do not stop taking this medicine abruptly, as it can cause withdrawal symptoms. Always consult your doctor before discontinuing.
- Avoid alcohol and other CNS depressants as they can increase sedative effects.
- This medication may cause drowsiness or dizziness, so be cautious when driving or operating machinery.
- Report any unusual mood or behavior changes, including thoughts of self-harm, to your doctor immediately.
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 take your next dose at the regular time. Do not double the dose to catch up.
Driving Precautions
This medicine can cause drowsiness, dizziness, and impaired coordination. Do not drive or operate heavy machinery until you know how it affects you.
Lifestyle Advice
- Maintain a regular sleep schedule and practice good sleep hygiene.
- Limit or avoid caffeine and other stimulants.
- Engage in stress-reducing activities like meditation or yoga.
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