Clonazepam

Indications
Oral
Epilepsy
Adult: Initially, 1 mg given at night for 4 nights, gradually increased over 2-4 wk. Maintenance: 4-8 mg daily. Max: 20 mg/day
Child: 1-5 yr: 250 mcg daily; 5-12 yr: 500 mcg daily. Maintenance (given in 2-4 divided doses): Infants: 0.5-1 mg daily; 1-5 yr: 1-3 mg daily; 5-12 yr: 3-6 mg daily. Max: 200 mcg/kg/day
Elderly: Initially, 500 mcg at night for 4 nights, may gradually increase over 2-4 wk.
Hepatic impairment: Dose reduction may be needed.
Oral
Panic disorder
Adult: Initially, 250 mcg bid, increased after 3 days up to 1 mg daily. Max: 4 mg daily.
Hepatic impairment: Dose reduction may be needed.
Intravenous
Emergency management of status epilepticus
Adult: 1 mg as inj or infusion given over at least 2 min, repeated if necessary.
Child: and infants: 500 mcg as inj or infusion given over at least 2 min, repeated if necessary.
Hepatic impairment: Dose reduction may be needed.
Contraindications
Hypersensitivity to benzodiazepines, acute pulmonary insufficiency, acute narrow angle glaucoma.
Warnings / Precautions
Neonates, chronic pulmonary insufficiency, hepatic/renal dysfunction, porphyria, elderly; pregnancy and lactation.
Adverse Reactions
Drowsiness, fatigue, muscular hypotonia, coordination disturbances, dizziness, vertigo, anorexia, visual disturbances, libido changes.
Potentially Fatal: Salivary or bronchial hypersecretion leading to respiratory problems (children). May produce diminished reflexes or coma. Rarely, blood dyscrasias.
Overdose Reactions
Somnolence, confusion, ataxia, diminished reflexes or coma. Treatment is symptomatic and supportive. Flumazenil, a benzodiazepine antagonist, may be used in the management of benzodiazepine overdosage after weighing the benefits and risks. Emesis or gastric lavage may be performed followed by activated charcoal and saline cathartic to remove any remaining drug. Monitor patient's heart rate, blood pressure, and respiration. Dialysis is of no known value in clonazepam overdosage.
Drug Interactions
Carbamazepine, phenobarbitone or phenytoin may accelerate clonazepam metabolism.
Potentially Fatal: Increased sedative effect with alcohol, general anaesthetics and TCAs.
See Below for More clonazepam Drug Interactions
Mechanism of Actions
Clonazepam is an effective anticonvulsant. It raises the threshold for propagation of seizure activity and prevents generalisation of focal or local activity. Clinically, it improves focal epilepsy and generalised seizures. It is also believed to enhance the activity of GABA, and acts as anxiolytic.
Absorption: Well absorbed from the GI tract (oral); peak plasma concentrations after 4 hr.
Distribution: Crosses the placenta; enters breast milk. Protein-binding: 86%.
Metabolism: Extensively hepatic; converted to 7-aminoclonazepam.
Excretion: Urine (as free or conjugated metabolites); 20-40 hr (elimination half-life).
Administration
May be taken with or without food.
Storage Conditions
Intravenous: Store at 25°C. Oral: Store at 25°C.
ATC Classification
N03AE01 - clonazepam ; Belongs to the class of benzodiazepine derivatives antiepileptic.
Storage
Intravenous: Store at 25°C. Oral: Store at 25°C.
Available As
  • Clonazepam 0.25 mg
  • Clonazepam 0.5 mg
  • Clonazepam BP 0.5 mg
  • Clonazepam 0.50 mg
  • Clonazepam 1 mg
  • Clonazepam 2 mg
  • Clonazepam 2.5 mg
  • Clonazepam 5 mg
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