Klonopin, Rivotril
Generic Name
Clonazepam
Manufacturer
Many generic manufacturers (e.g., Square, Beximco, ACI in Bangladesh)
Country
Global
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Description
Overview of the medicine
Clonazepam is a benzodiazepine used to treat various seizure disorders and panic disorder. It works by increasing the activity of a neurotransmitter called GABA in the brain.
Uses & Indications
Dosage
Adults
For seizure disorders: Initially 0.5 mg three times daily, increased by 0.5-1 mg every 3 days until seizures are controlled or side effects prevent further increase. Max daily dose usually 20 mg. For panic disorder: Initially 0.25 mg twice daily, increased to 1 mg/day after 3 days. Max daily dose 4 mg.
Elderly
Lower initial doses (e.g., 0.25 mg once daily) and slower titration due to increased sensitivity and potential for adverse effects.
Renal_impairment
No specific dose adjustment is generally required, but caution is advised in severe impairment.
How to Take
Take orally with or without food. Do not chew or crush extended-release tablets. Do not stop suddenly.
Mechanism of Action
Clonazepam enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, leading to reduced neuronal excitability and central nervous system depression.
Pharmacokinetics
Onset
20-60 minutes after oral administration.
Excretion
Mainly excreted in urine as metabolites.
Half life
18-50 hours.
Absorption
Rapidly and completely absorbed from the gastrointestinal tract.
Metabolism
Primarily hepatic via nitroreduction, N-acetylation, and hydroxylation by cytochrome P450 enzymes.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Severe liver disease
- Hypersensitivity to benzodiazepines or any component of the formulation
Drug Interactions
Opioids
Increased risk of respiratory depression, sedation, coma.
CYP3A4 inducers (e.g., rifampin)
May decrease clonazepam levels.
CYP3A4 inhibitors (e.g., ketoconazole)
May increase clonazepam levels.
Anticonvulsants (e.g., phenytoin, carbamazepine)
May alter serum concentrations of either drug.
Other CNS depressants (alcohol, barbiturates, antidepressants)
Additive CNS depressant effects.
Storage
Store below 30°C, protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include drowsiness, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, gastric lavage, and activated charcoal if appropriate. Flumazenil (benzodiazepine antagonist) may be used with caution.
Pregnancy & Lactation
Pregnancy Category D: Evidence of fetal risk, but potential benefits may warrant use in pregnant women despite risks. Excreted in breast milk, not recommended during breastfeeding.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Severe liver disease
- Hypersensitivity to benzodiazepines or any component of the formulation
Drug Interactions
Opioids
Increased risk of respiratory depression, sedation, coma.
CYP3A4 inducers (e.g., rifampin)
May decrease clonazepam levels.
CYP3A4 inhibitors (e.g., ketoconazole)
May increase clonazepam levels.
Anticonvulsants (e.g., phenytoin, carbamazepine)
May alter serum concentrations of either drug.
Other CNS depressants (alcohol, barbiturates, antidepressants)
Additive CNS depressant effects.
Storage
Store below 30°C, protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include drowsiness, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, gastric lavage, and activated charcoal if appropriate. Flumazenil (benzodiazepine antagonist) may be used with caution.
Pregnancy & Lactation
Pregnancy Category D: Evidence of fetal risk, but potential benefits may warrant use in pregnant women despite risks. Excreted in breast milk, not recommended during breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2-3 years, depending on manufacturer and storage conditions.
Availability
Available in pharmacies worldwide
Approval Status
FDA and DGDA approved
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Extensively studied in clinical trials for seizure disorders and panic disorder, demonstrating efficacy and safety.
Lab Monitoring
- Liver function tests (periodically with long-term therapy)
- Complete blood count (rarely, if blood dyscrasias are suspected)
Doctor Notes
- Emphasize the importance of gradual tapering to avoid severe withdrawal symptoms.
- Assess patients for a history of substance abuse before initiating therapy.
- Monitor for signs of respiratory depression, especially with concomitant opioid use.
Patient Guidelines
- Do not stop taking clonazepam suddenly due to the risk of withdrawal symptoms.
- Avoid alcohol and other CNS depressants.
- Report any unusual mood or behavior changes to your doctor.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at once.
Driving Precautions
Clonazepam can cause drowsiness and dizziness, impairing your ability to drive or operate machinery. Avoid such activities until you are certain how the medication affects you.
Lifestyle Advice
- Avoid driving or operating heavy machinery until you know how this medicine affects you.
- Use caution when engaging in activities requiring mental alertness.
- Do not self-medicate or share this medication with others.
Alternative Medicines in Bangladesh
Similar medicines available in the market
Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.