Generic Name: clonazepam
Brand Name: Apo-Clonazepam (CAN), Gen-Clonazepam (CAN), Klonopin, Klonopin Wafers, Nu-Clonazepam (CAN), Rivotril (CAN)
Other Info: Pregnancy Category X, Controlled Substance C-IV
Drug classes: Benzodiazepine, Antiepileptic
Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter.
- Used alone or as adjunct in treatment of Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures; may be useful in patients with absence (petit mal) seizures who have not responded to succinimides; up to 30% of patients show loss of effectiveness of drug, often within 3 mo of therapy (may respond to dosage adjustment); treatment of panic disorder with or without agoraphobia
- Unlabeled uses: Periodic leg movements during sleep; hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, neuralgias
Contraindications and cautions
- Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs; pregnancy (risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (“floppy infant” syndrome), lactation (infants become lethargic and lose weight).
- Use cautiously with impaired liver or renal function, debilitation.
Available forms: Tablets—0.5, 1, 2 mg; orally disintegrating tablets—0.125, 0.25, 0.5, 1, 2 mg
Individualize dosage; increase dosage gradually to avoid adverse effects; drug is available only in oral dosage forms.
Seizure disorders: Initial dose should not exceed 1.5 mg/day PO divided into three doses; increase in increments of 0.5–1 mg PO every 3 days until seizures are adequately controlled or until side effects preclude further increases. Maximum recommended dosage is 20 mg/day.
Panic disorders: Initial dose 0.25 mg PO bid; gradually increase to a target dose of 1 mg/day.
PEDIATRIC PATIENTS > 10 YR OR 30 KG
Initially, 0.01–0.03 mg/kg/day PO; do not exceed 0.05 mg/kg/day PO, given in two or three doses. Increase dosage by not more than 0.25–0.5 mg every third day until a daily maintenance dose of 0.1–0.2 mg/kg has been reached, unless seizures are controlled by lower dosage or side effects preclude increases. Whenever possible, divide daily dose into three equal doses, or give largest dose at bedtime.
Metabolism: Hepatic; T1/2: 18–50 hr
Distribution: Crosses placenta; enters breast milk
- CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility,episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment
- CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema
- Dermatologic: Urticaria, pruritus, rash, dermatitis
- EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion
- GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, encoporesis
- GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
- Hematologic: Elevations of blood enzymes—LDH, alkaline phosphatase, AST, ALT; blood dyscrasias: agranulocytosis, leukopenia
- Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia. Drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for longer than 4 mo
- Increased CNS depression with alcohol
- Increased effect with cimetidine, disulfiram, omeprazole, hormonal contraceptives
- Decreased effect with theophylline
- Risk of increased digoxin levels and toxicity; monitor patient carefully
Name confusion has occurred between Klonopin (clonazepam) and clonidine; use caution.
- History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication; pregnancy; lactation; liver or renal impairment, debilitation.
- Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests.
- Monitor addiction-prone patients carefully because of their predisposition to habituation and drug dependence.
- Monitor liver function and blood counts periodically in patients on long-term therapy.
- WARNING: Taper dosage gradually after long-term therapy, especially in patients with epilepsy; substitute another antiepileptic.
- Monitor patient for therapeutic drug levels: 20–80 ng/mL.
- If the patient has epilepsy, arrange for patient to wear medical alert identification indicating patient has epilepsy and is receiving drug therapy.
- Take drug exactly as prescribed; do not stop taking drug (long-term therapy) without consulting health care provider.
- Avoid alcohol, sleep-inducing, or over-the-counter drugs.
- Avoid pregnancy; serious adverse effects can occur. Using barrier contraceptives is advised while taking this drug.
- It would be advisable to wear or carry a medical alert identification indicating your diagnosis and drug therapy.
- You may experience these side effects: Drowsiness, dizziness (may become less pronounced; avoid driving or engaging in other dangerous activities); GI upset (take drug with food); fatigue; dreams; crying; nervousness; depression, emotional changes; bed-wetting, urinary incontinence.
- Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.
rivotril drug study, clonazepam drug study, nursing diagnosis for leukopenia, nursing interventions for leukopenia, nursing diagnosis for alcohol intoxication, clonazepam rivotril drug study, potentiate clonazepam