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 2 mg tablet | ৳ 13.00 | ৳ 130.00 |
Description
Overview of the medicine
Clonazepam is a benzodiazepine derivative that has anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties. It is primarily used to treat various seizure disorders and panic disorder.
Uses & Indications
Dosage
Adults
Epilepsy: Initial 0.5 mg three times daily, gradually increased by 0.5-1 mg every 3 days. Max 20 mg/day. Panic Disorder: Initial 0.25 mg twice daily, increase to 1 mg/day after 3 days. Max 4 mg/day.
Elderly
Lower initial doses are recommended due to increased sensitivity and potential for adverse effects.
Renal_impairment
No specific dose adjustment generally needed, but caution is advised. Hepatic impairment: Reduce dose, use with caution.
How to Take
Oral. Can be taken with or without food. To minimize sedation, administer in divided doses.
Mechanism of Action
Enhances the effect of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter, by binding to GABA-A receptors, leading to increased chloride ion influx and hyperpolarization of neurons. This reduces neuronal excitability.
Pharmacokinetics
Onset
20-60 minutes (oral)
Excretion
Primarily excreted in urine as metabolites, with a small amount in feces.
Half life
18-50 hours
Absorption
Rapidly and completely absorbed from the GI tract. Peak plasma concentrations are reached within 1-4 hours.
Metabolism
Extensively metabolized in the liver, primarily by nitroreduction, to inactive metabolites.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Significant liver disease
- Hypersensitivity to benzodiazepines
- Severe respiratory insufficiency
Drug Interactions
Opioids
Increased risk of respiratory depression and sedation.
Antifungals (e.g., ketoconazole)
May increase clonazepam levels.
Antiepileptics (e.g., phenytoin, carbamazepine)
May alter clonazepam levels or increase CNS depression.
Alcohol, CNS depressants (e.g., barbiturates, hypnotics)
Potentiates sedative effects.
Storage
Store below 30°C in a dry place, away from light and moisture.
Overdose
Symptoms include drowsiness, confusion, ataxia, diminished reflexes, and coma. Treatment is supportive; flumazenil may be used to reverse benzodiazepine effects, but caution is advised in patients on chronic benzodiazepine therapy or with seizure disorders.
Pregnancy & Lactation
Pregnancy Category D. May cause fetal harm. Avoid during pregnancy unless benefits outweigh risks. Excreted in breast milk; advise against breastfeeding.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Significant liver disease
- Hypersensitivity to benzodiazepines
- Severe respiratory insufficiency
Drug Interactions
Opioids
Increased risk of respiratory depression and sedation.
Antifungals (e.g., ketoconazole)
May increase clonazepam levels.
Antiepileptics (e.g., phenytoin, carbamazepine)
May alter clonazepam levels or increase CNS depression.
Alcohol, CNS depressants (e.g., barbiturates, hypnotics)
Potentiates sedative effects.
Storage
Store below 30°C in a dry place, away from light and moisture.
Overdose
Symptoms include drowsiness, confusion, ataxia, diminished reflexes, and coma. Treatment is supportive; flumazenil may be used to reverse benzodiazepine effects, but caution is advised in patients on chronic benzodiazepine therapy or with seizure disorders.
Pregnancy & Lactation
Pregnancy Category D. May cause fetal harm. Avoid during pregnancy unless benefits outweigh risks. Excreted in breast milk; advise against breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months
Availability
Pharmacies, Hospitals
Approval Status
Approved by major regulatory bodies
Patent Status
Generic available, original patent expired
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials support its efficacy in epilepsy and panic disorder. Ongoing research explores other indications and long-term safety.
Lab Monitoring
- Monitor liver function tests periodically with long-term use.
- Monitor complete blood count (CBC) with long-term use.
- Monitor for signs of dependence and withdrawal.
Doctor Notes
- Emphasize gradual tapering to avoid withdrawal.
- Assess for co-morbid substance abuse history.
- Counsel patients on potential for sedation and driving impairment.
Patient Guidelines
- Do not stop taking abruptly; withdrawal symptoms may occur.
- Avoid alcohol and other CNS depressants.
- Report any unusual mood changes or thoughts of self-harm.
- Do not drive or operate machinery until you know how this medicine affects you.
Missed Dose Advice
Take the missed dose as soon as you remember, unless it is almost time for your next dose. Do not double dose.
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.
- Practice stress-reduction techniques.
- Avoid excessive caffeine.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.
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