Clonazepam

Clonazepam (Klonopin) is a prescription drug that is used to as a treatment to prevent and control seizures. This medication is known as an anticonvulsant or antiepileptic drug, which is used in the treatment of epileptic seizures. This drug is also used as a treatment for panic attacks, insomnia, and symptoms related to chronic anxiety and anxiety disorders. Clonazepam works by calming your brain and nerves.

It belongs to a class of drugs called benzodiazepines.

Benzodiazepines, also called "benzos' or BZs" for short, are a class of medications that work by affecting neurotransmitters in the brain. Neurotransmitters are chemicals that nerves release in order to communicate with other nearby nerves. Common generic and brand names for benzodiazepines are:

• Versed (midazolam)
• Halcion (triazolam)
• Xanax (alprazolam)
• Ativan (lorazepam)
• Librium (chlordiazepoxide), and
• Valium (diazepam)

This medication is by prescription only.

Consumers of this drug should read the information leaflet that accompanies the prescription each and every time it is filled. There may be new or different health information.

Risk of abuse or misuse of this medication is very high. This drug poses dependence, withdrawal symptoms and other long-term effects.

Clonazepam is available under the following different brand names: Klonopin.

Dosages of Clonazepam:

Dosage Forms and Strengths

Tablet dispersible: Schedule IV

• 0.12 mg
• 0.25 mg
• 0.5 mg
• 1 mg
• 2 mg

Tablet: Schedule IV (Adult Only)

• 0.5 mg
• 1 mg
• 2 mg

Dosage Considerations – Should be Given as Follows:

Panic Disorder Treatment

• Dose 0.25 mg orally every 12 hours initially; may increase to 1 mg/day after 3 days (may increase up to 4 mg/day in some patients)

Treatment of Seizure Disorders

• Seizures in adults: 1.5 mg/day orally divided every 8 hours; increase by 0.5-1 mg every 3 days until the desired effect achieved; not to exceed 20 mg/day
• Maintenance for seizures in adults: 2-8 mg orally; not to exceed 20 mg/day
• Children younger than 6 years:
  • Potential toxic dose: 0.05 mg/kg
• Children younger than 10 years or less than 30 kg
  • Dose 0.01-0.03 mg/kg/day orally divided every 8 hours; increase by 0.25-0.5 mg/day every 3 days to maximum 0.1-0.2 mg/kg/day orally divided every 8 hours
  • Maintenance dose: 0.1-0.2 mg per kg per day orally divided every 8 hours; not to exceed 0.2 mg per kg per day
• Children younger than 10 years or more than 30 kg
  • 1.5 mg/day orally divided every 8 hours; increase by 0.5-1 mg every 3 days until the desired effect is achieved; not to exceed 20 mg/day
  • Maintenance: 2-8 mg orally; not to exceed 20 mg/day

Dosing Considerations

• Discontinuation of treatment (seizures in adults): Withdraw treatment gradually over time; decrease the dose once every 3 days by 0.125 mg orally every 12 hours until completely withdrawn
• Discontinuation of treatment (seizures in children)
  • Children younger than 10 years: Treatment should be withdrawn gradually over time, as necessary
  • Children older than 10 years: Withdraw treatment gradually over time; decrease the dose every 3 days by 0.125 mg orally every 12 hours until completely withdrawn

Dosing Modifications

• Renal impairment: Supplemental dose in hemodialysis not necessary

Side effects associated with the use of Clonazepam, include the following:

• Drowsiness
• Sedation
• Abnormal coordination
• Loss of control of bodily movements
• Depression or symptoms of depression
• Dizziness
• Fatigue
• Memory impairment
• Upper respiratory infection or symptoms
• Confusion
• Difficulty speaking

Other side effects associated with the use of this medication may include:

• Runny nose
• Coughing
• Urinary frequency
• Impotence
• Decreased libido
• Increased salivation
• Worsening tonic-clonic seizures

This document does not contain all possible common side effects and other side effects that may occur. Check with your physician for additional information about the side effects of this drug.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Severe interactions include:
  • sodium oxybate
• Serious Interactions include:
  • hydrocodone
  • idelalisib
  • ivacaftor
  • valerian
• This medication has moderate interactions with at least 210 different drugs.
• This medication has mild interactions with at least 39 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more health information about this medicine.

Warnings

• This medication contains clonazepam. Do not take Klonopin if you are allergic to clonazepam or any ingredients contained in this drug
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Significant hepatic impairment
• Documented hypersensitivity
• Acute narrow-angle glaucoma

Effects of Drug Abuse

Prolonged use may result in psychological and physical dependence.

Short-Term Effects

• See "What Are Side Effects Associated with Using Clonazepam (Klonopin)?"

Long-Term Effects

• Prolonged use may result in psychological and physical dependence
• Abrupt withdrawal, particularly in people on long-term, high-dose therapy, may precipitate status epilepticus (back to back seizures with no recovery time in between); when discontinuing clonazepam, gradual withdrawal is essential; while being gradually withdrawn, the simultaneous substitution of another seizure treatment may be indicated.
• See "What Are Side Effects Associated with Using Clonazepam?”

Cautions

• Withdraw gradually when used for panic disorder
• Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicidal ideation
• Not recommended in people with depressed neuroses, psychotic reactions, severe respiratory depression, myasthenia gravis (allowable in limited circumstances), acute alcohol intoxication
• Anterograde amnesia reported benzodiazepine use
• May cause CNS depression and impairs the ability to perform hazardous tasks
• Hyperactive or aggressive behavior reported with benzodiazepines in pediatrics/adolescents and psychiatric patients
• Increased risk of suicidal thoughts/behavior reported with antiepileptic agents taking benzodiazepines; monitor patient for suicidal behavior and notify healthcare provider immediately
• Use benzodiazepines with caution in people with a history of drug abuse or acute alcoholism; drug dependency possible; prolonged use may result in psychological and physical dependence
• Use benzodiazepines with caution in patients with compromised respiratory function
• Benzodiazepine may have morphogenic effect; use with caution in patients with porphyria
• Benzodiazepines are not for concomitant administration with alcohol or other drugs that depress the central nervous system (CNS-depressant medications)
• When used in patients in whom several different types of seizure disorders coexist, clonazepam may increase incidence or precipitate onset of generalized tonic-clonic seizures (grand mal); may require the addition of appropriate seizure prevention treatments (anticonvulsant) or increase in dosages; concomitant use of valproic acid and clonazepam may produce absence status
• Abrupt withdrawal, particularly in patients on long-term, high-dose therapy, may precipitate status epilepticus; when discontinuing clonazepam, gradual withdrawal is essential; while being gradually withdrawn, the simultaneous substitution of another seizure prevention treatment (anticonvulsant) may be indicated
• May produce an increase in salivation; consider before giving drugs to patients who have difficulty handling secretions

Pregnancy and Lactation

• Only use clonazepam during pregnancy in LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk
• Clonazepam is excreted in breast milk; it is not recommended for use while breastfeeding