Anti-anxiety: clonazepam, Klonopin, Leponex, Rivotril
Generic Name: clonazepam
Brand Name(s): Klonopin, Leponex, Rivotril
Common Use: Antianxiety agent
Clonazepam's pharmacological profile is similar to other
anxiolytic/sedative benzodiazepines. Its basic anticonvulsive properties
are also similar to those of other diazepines.
Alone or as an adjunct in the management of myoclonic and
akinetic seizures and petit mal variant (Lennox-Gastaut syndrome). May also
be of some value in patients with absence spells (petit mal) who have failed
to respond to succinimides.
Significant liver disease, narrow angle glaucoma, sensitivity
Although simultaneous administration of several anticonvulsants
may be considered with clonazepam, such combined therapy may result in an
increase of central depressant adverse effects. In addition, the dosage
of each drug may be required to be adjusted to obtain the optimum effect.
Abrupt withdrawal of clonazepam particularly in those patients on long-term,
high dose therapy, may precipitate status epilepticus. Therefore, as with
any other anticonvulsants, gradual withdrawal is essential when discontinuing
clonazepam. While clonazepam is being gradually withdrawn, the simultaneous
substitution of incremental doses of another anticonvulsant may be indicated.
Caution patients receiving clonazepam against engaging in
hazardous occupations requiring complete mental alertness, such as operating
machinery or driving a motor vehicle.
They also should be warned against the concomitant use of
alcohol and other CNS depressant drugs. The CNS depressant action of benzodiazepines
may be potentiated by other drugs such as alcohol, narcotics, barbiturates,
nonbarbiturate hypnotics, anxiolytics, phenothiazines, thioxanthene and
butyrophenone antipsychotic agents, MAO inhibitors and tricyclic antidepressants.Benzodiazepines
have produced habituation, dependence and withdrawal symptoms similar to
those noted with barbiturates and alcohol. Therefore, patients who may be
prone to increasing the dose of drugs on their own initiative should be
under careful monitoring when receiving clonazepam. Periodic liver function
tests and blood counts are recommended during long-term clonazepam therapy.
Adverse Side Effects
The most frequently occurring adverse reactions to clonazepam
are referable to CNS depression. Drowsiness occurs in approximately 50%
of patients and ataxia in approximately 30%. In some cases, these may diminish
with time. Behaviour problems have been noted in approximately 25% of patients
and increased salivation in 7%.
Alterations in behaviour, which have been variously reported as aggressiveness,
argumentative behaviour, hyperactivity, agitation, depression, euphoria,
irritability, forgetfulness and confusion. These behavioural reactions are
particularly likely to occur in patients with a prior history of psychiatric
disturbances and are known to occur in patients with chronic seizure disorders.
Other adverse reactions involving the CNS have included nystagmus,
unsteady gait, slurred speech, dysarthria, vertigo, insomnia, and diplopia.
Isolated reports of akinesia, hemiparesis, tremor, hypotonia, headache and
choreiform movements have been received. Minor changes in EEG patterns specifically
low-voltage fast activity.Increased salivation, nausea, vomiting, anorexia,
constipation, diarrhea, encopresis, dry mouth, increased appetite, abdominal
pain, hepatomegaly.Rare instances of dysuria, nocturia, incontinence, urinary
retention, enuresis. Nonspecific erythematous, papular and maculopapular
rashes, swelling of the face and eyelids, urticaria, pruritus. Hirsutism
and hair loss have also been reported, but drug relationship has not been
established. Muscle weakness, low back pain. Hypersecretion in the upper
respiratory passages, rhinorrhea, dyspnea, respiratory depression.Anemia,
leukopenia (WBC below 4000/mm(3)), thrombocytopenia, eosinophilia. Slight,
transient elevations of transaminase and alkaline phosphatase. Palpitations,
coated tongue, dehydration, fever, lymphadenopathy, weight gain or loss,
changes in libido, gynecomastia, hallucinations, dysdiadochokinesis, coma,
The cardinal manifestations of overdosage are drowsiness
and confusion, reduced reflexes and coma. There are minimal effects on respiration,
pulse and blood pressure, unless the overdosage is extreme. When the effects
of the drug overdosage begin to wear off, the patient exhibits some jitteriness
and over stimulation.
Gastric lavage may be beneficial if performed soon after
ingestion of clonazepam.
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