Generic Name: clonazepam
Brand Name: Apo-Clonazepam (CAN), Clonapam (CAN), Gen-Clonazepam (CAN), Klonopin, Klonopin Wafers, Rivotril (CAN)
Pregnancy Category D
Controlled Substance C-IV
Drug classes
Benzodiazepine
Antiepileptic
Therapeutic actions
Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter.
Indications
• 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 kidney function, debilitation.
Available forms
Tablets—0.5, 1, 2 mg; orally disintegrating tablets—0.125, 0.25, 0.5, 1, 2 mg
Dosages
Individualize dosage; increase dosage gradually to avoid adverse effects; drug is available only in oral dosage forms.
ADULTS
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 hs.
Pharmacokinetics
|
Route |
Onset |
Peak |
Duration |
|
Oral |
Varies |
1–2 hr |
Weeks |
Metabolism: Hepatic; T1/2: 18–50 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
