Zolium
Generic Name
Clonazepam
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| zolium 025 mg tablet | ৳ 2.00 | ৳ 20.00 |
Description
Overview of the medicine
Clonazepam is a benzodiazepine used to treat various seizure disorders, panic disorder, and anxiety disorders. It works by enhancing the effect of a certain natural chemical (GABA) in the brain, which helps to calm nerve activity.
Uses & Indications
Dosage
Adults
For panic disorder: Initially 0.25 mg twice daily, may increase to 1 mg/day after 3 days. Max 4 mg/day. For seizure disorders: Initially 0.5 mg 3 times daily, gradually increased by 0.5-1 mg every 3 days until seizures are controlled. Max 20 mg/day.
Elderly
Lower initial dose (e.g., 0.125 mg twice daily for panic disorder), slowly titrate due to increased sensitivity to benzodiazepines.
Renal_impairment
Use with caution. Dosage adjustments may be needed based on patient response and kidney function. No specific guidelines, but careful monitoring is advised.
How to Take
Take orally, with or without food. Swallow the tablet whole; do not crush, chew, or split it unless specifically instructed by your doctor.
Mechanism of Action
Clonazepam binds to specific benzodiazepine receptors on GABA-A channels in the central nervous system, enhancing the inhibitory effects of GABA. This leads to increased chloride ion influx, hyperpolarization of neurons, and resulting in CNS depression.
Pharmacokinetics
Onset
20-60 minutes (oral)
Excretion
Excreted predominantly in the urine as metabolites, with less than 2% unchanged drug.
Half life
18-50 hours
Absorption
Rapidly absorbed orally. Peak plasma concentrations are reached in 1-4 hours. Bioavailability is approximately 90%.
Metabolism
Extensively metabolized in the liver, primarily via nitroreduction to 7-aminoclonazepam and N-acetylation, mainly by CYP3A4.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Severe liver disease
- Hypersensitivity to clonazepam or other benzodiazepines
- Significant respiratory depression
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin)
May decrease clonazepam plasma concentrations.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin)
May increase clonazepam plasma concentrations.
Alcohol and other CNS depressants (e.g., barbiturates, antidepressants, antipsychotics)
Potentiates CNS depressant effects, leading to increased sedation and drowsiness.
Storage
Store below 30°C (86°F) in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves general supportive measures, monitoring vital signs, and maintaining an adequate airway. Flumazenil, a benzodiazepine receptor antagonist, may be used but with caution due to the risk of precipitating withdrawal symptoms or seizures.
Pregnancy & Lactation
Pregnancy Category D. Clonazepam can cause fetal harm when administered to a pregnant woman. Avoid during pregnancy, especially in the first trimester. Excreted in breast milk and may cause sedation or feeding difficulties in infants; avoid during breastfeeding.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Severe liver disease
- Hypersensitivity to clonazepam or other benzodiazepines
- Significant respiratory depression
Drug Interactions
Opioids
Increased risk of profound sedation, respiratory depression, coma, and death.
CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin)
May decrease clonazepam plasma concentrations.
CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin)
May increase clonazepam plasma concentrations.
Alcohol and other CNS depressants (e.g., barbiturates, antidepressants, antipsychotics)
Potentiates CNS depressant effects, leading to increased sedation and drowsiness.
Storage
Store below 30°C (86°F) in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves general supportive measures, monitoring vital signs, and maintaining an adequate airway. Flumazenil, a benzodiazepine receptor antagonist, may be used but with caution due to the risk of precipitating withdrawal symptoms or seizures.
Pregnancy & Lactation
Pregnancy Category D. Clonazepam can cause fetal harm when administered to a pregnant woman. Avoid during pregnancy, especially in the first trimester. Excreted in breast milk and may cause sedation or feeding difficulties in infants; avoid during breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 3 years from the date of manufacture, specific expiry date mentioned on the packaging.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of clonazepam in the treatment of seizure disorders and panic disorder. Ongoing research explores its role in other neurological and psychiatric conditions.
Lab Monitoring
- Liver function tests (baseline and periodically, especially with long-term use)
- Complete blood count (periodically for long-term therapy)
- Renal function tests (as clinically indicated)
Doctor Notes
- Counsel patients thoroughly on the risks of dependence and withdrawal, emphasizing the importance of gradual dose reduction when discontinuing.
- Assess for co-morbid substance use disorders, as benzodiazepines carry a high risk of abuse.
- Monitor for signs of respiratory depression, especially when co-administered with opioids or in patients with pre-existing respiratory conditions.
Patient Guidelines
- Do not stop taking this medicine abruptly without consulting your doctor, as it can lead to severe withdrawal symptoms.
- Avoid alcohol and other CNS depressants.
- Report any unusual mood changes, thoughts of self-harm, or severe allergic reactions immediately.
- Take exactly as prescribed by your doctor and do not exceed the recommended dose.
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
Zolium can cause drowsiness, dizziness, and decreased alertness. Do not drive or operate heavy machinery until you know how this medicine affects you.
Lifestyle Advice
- Avoid tasks requiring mental alertness, such as driving or operating heavy machinery, until you know how this medicine affects you.
- Maintain a regular sleep schedule and practice good sleep hygiene.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
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