Adults

For Seizure Disorders: Initially 0.5 mg three times daily, gradually increased by 0.5 mg to 1 mg every 3 days until seizures are controlled or side effects prevent further increase. Maintenance dose usually 8-10 mg/day, maximum 20 mg/day. For Panic Disorder: Initially 0.25 mg twice daily, increased to 1 mg/day after 3 days; may be increased up to 4 mg/day for some patients.

Elderly

Lower initial doses (e.g., 0.25 mg once or twice daily) are recommended, with careful titration due to increased sensitivity to benzodiazepines.

Renal_impairment

No specific dosage adjustment is usually required for mild to moderate renal impairment, but caution is advised in severe renal dysfunction due to potential accumulation of metabolites. Monitor patients for exaggerated effects.

Onset

Onset of action is typically within 20-60 minutes.

Excretion

Excreted primarily in the urine as metabolites, with less than 2% excreted unchanged.

Half life

Elimination half-life ranges from 18 to 50 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 to 7-amino-clonazepam, and also by N-acetylation and hydroxylation, followed by glucuronidation.

Opioids

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

CYP3A4 inducers (e.g., rifampin)

May decrease clonazepam plasma concentrations.

Alcohol and other CNS depressants

Potentiation of sedative effects, increased risk of respiratory depression.

Anticonvulsants (e.g., phenytoin, carbamazepine)

May alter clonazepam or co-administered drug levels.

CYP3A4 inhibitors (e.g., ketoconazole, fluconazole)

May increase clonazepam plasma concentrations.