Adverse effects
• 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 weeks 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, hepatic dysfunction, 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
Interactions
Drug-drug
• 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
Nursing considerations
CLINICAL ALERT!
Name confusion has been reported between Klonopin (clonazepam) and clonidine; use caution.
Assessment
• History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication; pregnancy; lactation; impaired liver or kidney function, 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, liver and renal function tests.
Interventions
• 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.
• Arrange for patient to wear medical alert ID indicating the patient has epilepsy and is receiving drug therapy.
Teaching points
• Take drug exactly as prescribed; do not stop taking drug (long-term therapy) without consulting health care provider.
• Avoid alcohol, sleep-inducing, or OTC drugs.
• Avoid pregnancy; serious adverse effects can occur. Use of barrier contraceptives is advised while taking this drug.
• 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.